Examining the impact COVID, and the deferral of dental school graduations, has had on students and the profession
More than 1,250 dental and dental hygiene/therapy graduates enter the workforce every year, from UK and Irish dental schools. But in February it was announced that graduation for students at Dundee and Glasgow Dental Schools had been deferred until summer 2022, with all current year groups repeating the 2020-21 academic year.
Graduation for students in final year at Aberdeen was deferred until Christmas 2021 and all other students will repeat the 2020-21 academic year. Confirming that students would continue to receive financial support for the additional year of study, Mairi Gougeon, the Public Health Minister, said: “This difficult but necessary decision by Scotland’s dental schools will be extremely disappointing news for dental students across the country.”
A week later, Universities Scotland said that the country’s dental schools would not be accepting new students this September. All applicants interviewed for places this year will still receive a final decision on their interview by 20 May, but any offers made this year will be for a deferred start date of September 2022. Dental schools in other parts of the UK plan to offer a student intake in 2021, according to the Dental Schools Council.
A council spokesperson said: “Dental schools are working with the regulatory and training bodies to ensure students meet the competencies required in order to graduate and begin foundation training. However, due to the impact and variation of disruption, the timeline for this will differ between different regions and countries.”
But what will be the impact in Scotland on those, formerly, final year students and, crucially, on the profession in the coming years? Professor Mark Hector, who stood down as Dean of Dundee Dental School in March, said that all theoretical teaching had been delivered during the academic year but practical work, including clinical, “has been severely curtailed.”
He added: “There has been a focus on final year BDS and BSc (OHS) to start clinics. They have done a little from November to December but in January NHS Tayside stopped all elective surgery, including dentistry. Clinics restarted in early March and we are now scheduling all clinical students through the clinics. However, capacity issues and social distancing means we are operating at less than 30 per cent of normal activity.”
Clinical work, especially aerosol generating procedures (AGPs), are being undertaken in full PPE and in custom made ‘pods’ which have their own filtered air supply and in excess of 12 air changes an hour. As reported in the last edition of Scottish Dental, these pods have been installed in Dundee – and are now in Glasgow. “They are a great success,” said Professor Hector, “in that they mitigate against the design of the dental hospitals where, traditionally, there is no active air management.”
He said: “Academic work continues online using a blended approach. All assessments are likewise online. This has been difficult as our students are not necessarily in Dundee but scattered across the globe. So teaching is a blend of synchronous and asynchronous events – and exams have to be open for 23 hours to allow students to have good access in daytime hours.”
Ultimately, continuity of training from entry to dental school to completing vocational training will be uninterrupted, he said, maintaining quality and patient safety requirements. Students will lose a year’s income, “but I believe this is a small price to pay.”
The impact on the profession going forward of any disruption to graduation and student intake this year will be minimal, said Professor Hector, but “much bigger effect will result from Brexit, with fewer EU dentists applying to work here and many EU dentists returning home.”
Professor Angus Walls, Director of the Dental Institute at the University of Edinburgh, said that while face-to-face didactic teaching remains suspended, clinical skills training resumed last September, alongside clinical activity for both undergraduates in hygiene and therapy and post-graduate students, but at a reduced level of activity. The move to online didactic teaching appeared not to be an issue for undergraduates, he said, who welcomed the ability to study outside traditional school hours. Likewise, overseas students could continue their studies.
But ‘hands-on’ activity – such as AGPs – “remain a challenge,” with the delivery of care modified according to the four nations guidance. In this setting, the intense supervision of students has allowed a “more focused educational experience,” he said, but results in a different style of education which will “complicate the attainment of competence as a ‘competent beginner’, as stipulated by the GDC (General Dental Council).”
Professor Walls said that the wider impact on the profession will not be just as a result of the disruption to graduation, but also from – as indicated by Professor Hector – the effect of Brexit.
“There will be a significant shortage of Associates as a consequence of both the lack of supply from people completing dental foundation training and from people moving into national dental core training from primary care practice in greater numbers than normal – and from a reduced number of dentists moving to the UK from Europe,” he said.
“This will have its greatest effect in the parts of Scotland that, historically, rely on EU dentists most heavily – so, places like Dumfries and Galloway, Borders, Highland and Grampian although increasingly Lothian as well. The pattern of disruption will last for a number of years with an impact that will be most dependent on patterns of EU dentist movement.”