Time to get real

14 October, 2019 / editorial

Students with super high grades will strive to be specialists in lucrative and ‘niche’ treatments at the cutting edge. What about run of the mill dentistry?

The world of academia has a huge effect on the profession and practice of dentistry. Of course, it does, I hear you say. We all went to university to allow us to become dentists. What’s new about that? Well, the way it’s producing young professionals and the skills they are being taught.

There is a widespread feeling that the students currently produced by dental schools are lacking in the skills required for working in general practice. I think this is true. They simply don’t get enough practice to be as effective in general dentistry when they graduate as those trained a couple of decades ago. There are not enough patients going through dental schools or outreach programmes to get them the experience. Is it as simple as that? I don’t think so. I think there are many more obstacles to the production of experienced and suitable professionals. There are wider considerations about the type of students being recruited; the philosophy of the teaching; the desires of the GDC; what patients need and expect and what government will allow and pay for.

Let’s start with government. No CDO, no cash, no control of dentistry and no real, clear idea of what they want to do in terms of dentistry. They keep saying they want NHS dentistry but don’t have money to fund it. They like to be able to quote the massive registration figures but ignore the fact that only 65 per cent of people go ‘regularly’ (they think ‘regularly’ is at least once every two years). They want to address health inequalities but don’t know how to adapt their structures to do this. That includes who and how many dentists they are recruiting or allowing the universities to recruit. Last year’s graduate class was significantly reduced and remains at that level. 

The GDC has stated that schools should review their curriculum every three to four years and should be producing life-long learners. What does this mean? I would argue every day is a school day. I still learn every day and reflect on my own performance. I attend courses and much prefer to do it in person rather than online. I suspect that is different from the newly qualified. The massive integration of technology into courses and the digital age of dentistry is upon us. However, are these things better for dentistry and more importantly the patients? Does the course curriculum make people interested in CPD? I think it’s a more personal thing. 

Potential dental students now need to be fantastically well qualified. The entrance requirements for dentistry are exceptionally high. It’s simply supply and demand. Few places for loads of applicants. The universities want to pick very bright students. They are easy to teach. However, they may not be the best dentist. Even if they are the best dentist, it’s very likely they are female. This is a problem for workforce planning in terms of the long-term whole-time equivalents. 

Moreover, are the educated elite what the profession really needs? Students with super high grades will want to reach the pinnacle of their profession. They will strive to be specialists in lucrative and ‘niche’ treatments at the cutting edge. What about run of the mill dentistry? Who will do that? Dentistry is still, and I think it always will be, a profession which demands exceptional communication skills and practical, hands-on ability. Yet these aren’t the kind of things which can be demonstrated by spectacular higher grades. Common sense and the skills to talk to the ‘average punter’ are not necessarily attributes seen in modern dental students. These are also hard to teach.

However, the universities are trying to change the curriculum to develop modern professionals with these abilities. They are trying to create a more integrated learning experience without lecturing. Based on more practical clinical techniques taught from the very start with more detailed knowledge layered on top as they move through the years. I have to say I struggle to see how this works when students don’t have a sound theoretical base. Maybe that’s just because I’m unable to see beyond my own experience. Educators want to motivate students to learn by themselves, researching topics as they might have to do when qualified and on their own. This can’t be a bad thing, but I do worry that self-directed learning tends to create a narrow focus on things you have to or want to learn rather than a broad spectrum of learning.

So, I think we have an issue with the level of practical experience the students have at the moment. There is a problem in the disconnect between what type of professionals are being produced, the expectations of those professionals and what can actually be achieved when working on real patients, NHS or private. There needs to be a philosophical change in the production process of academia. I really hope the rhetoric about a change in curriculum to enhance practical abilities and problem solving is not hollow. I hope that the talk of working like general practice is achieved but more importantly advised by people who work in practice; not academics or people who used to 20 years ago. 

Change is constant, patients’ demands are ever higher, and young professionals want to work far fewer hours but achieve higher levels of education and, one would assume, remuneration. The only way this can happen is to change their initial education and manage their expectations. Perhaps a lower bar for entry may allow for greater realism, practical ability and more realistic professional aims? Maybe that is a factor to be considered in conjunction with changes in teaching methodology?

Arthur Dent is a practising NHS dentist in Scotland. Got a comment or question for Arthur? Email arthurdent@sdmag.co.uk

Tags: academia / cutting edge / Specialists / Students

Categories: Magazine

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