Can I be a student again? How medical graduates make the decision to return to dental school prior to a career in oral and maxillofacial surgery.

INTRODUCTION: Oral and maxillofacial surgery (OMFS) trainees in the UK have traditionally completed their dental undergraduate studies prior to returning to medical school. Recently, there have been increasing numbers of medical graduates who return to dental school before embarking on OMFS specialist training. There is limited research into the career motivation within this group and little guidance on how they may integrate the dental undergraduate course into their postgraduate training path. This study aims to evaluate these factors in more detail. METHODS: Questionnaires and focus groups were used to evaluate prior surgical experience of qualified medics who return to dental school with the intention of pursuing a career in OMFS, along with the factors that affect the timing of their return to dental school. RESULTS: The average age of medical graduates entering dental school decreased during the study period. The average number of months each cohort of students spent as a practicing doctor prior to starting dentistry also reduced. Postgraduate experience in OMFS was highly variable, but the numbers of students who received alternative exposure to OMFS, such as undergraduate special study modules, medical school elective or taster weeks, increased. The key barriers that were carefully considered by these trainees before returning to university included the perceived increase in the length of training, trainees' prior surgical experience, financial implications and the impact on quality of life. CONCLUSIONS: A trainee's decision to return to study dentistry is a multifactorial process. Understanding when trainees decide to return to sit their dental degree is vital not only to provide guidance for future trainees but also to assist future workforce planning, thus aiding training, education and development within OMFS.

Widening participation - a comparison of the characteristics of successful UK applicants to the five-year and four-year dental programmes in 2007 and 2008.

AIM: To compare the demographics (age, sex, ethnicity, social status, disability, country/region) and academic experience (school type) of accepted UK applicants to the five-year and four-year dental programmes in 2007 and 2008. METHODS: Retrospective descriptive analysis was carried out on the University and College Admissions Services (UCAS) data for accepted UK applicants to the five- and four-year dental programmes at UK dental schools in the years 2007 and 2008. Logistic regression was used to model the outcome of dental admission to programmes (four-year vs five-year), controlling for the other explanatory variables. Data were analysed using SPSS v19. RESULTS: In the years 2007 and 2008 over 2,000 UK applicants were accepted on to a dental course (n = 2,274) within the UK. Of these accepted applicants, 84% (n = 1,903) were accepted onto a five-year and 14% (n = 322) onto a four-year, programme. Over half were female for both the five- and four-year programmes (58% cf 59% respectively). One tenth of students accepted to the five-year programme were 'mature' (n = 173) and nearly all of the students to the four-year programme (n = 321). Similar proportions of accepted applicants to both programmes were from minority ethnic groups (46%), with the majority of students being of White or Asian background; however, the four-year programmes accepted a higher proportion of black (4% cf 1%) and 'other' minority ethnic students (8% cf 3%) when compared with the five-year programme. A higher proportion of accepted students to the four-year programmes came from the lowest 'higher/further education participation areas' (POLAR2 groups 1-3) than the five-year programmes (38% cf 28%). Proportionally more accepted applicants to the four-year programmes came from London than the five-year programmes (30%, cf 20%). In contrast, a greater proportion of accepted applicants to the five-year programmes came from Scotland (13% cf 6%), Northern Ireland (9% cf 0%) and Wales (4% cf 2%). When all other factors were controlled, the odds of being accepted to the four-year rather than the five-year programme were higher if the applicants were mature and from Greater London. CONCLUSION: There is little definitive evidence that graduate entry programmes widen access to dentistry when compared with the traditional five-year programme; however, the findings do highlight geographic disparities in access to graduate entry programmes, which are important for policy makers and schools to consider.

Threshold concepts in dental education.

The paper presents a conceptual framework to inform dental education. Drawing from a vast body of research into student learning, the simple model presented here has an explanatory value in describing what is currently observed to happen and a predictive value in guiding future teaching practices. We introduce to dental education the application of threshold concepts that have a transformative role in offering a new vision of the curriculum that helps to move away from the medieval transmission model of higher education towards a dual processing model that better reflects the way in which professionals operate within the discipline. Threshold concepts give a role for the student voice in offering a novice perspective which is paradoxically something that is out of reach of the subject expert. Finally, the application of threshold concepts highlights some of the weaknesses in the competency-based training model of clinical teaching.

An introduction to concept mapping in dental education: the case of partial denture design.

The aim of this paper is to present concept mapping as a tool for enhancing clinical dental education and develops the authors' argument for the use of concept mapping presented previously in the pages of this journal. Materials presented are based on data gathered from extensive observation of learning and teaching in a UK dental school, and upon a case study of student learning of removable partial denture design. Using examples developed with students and teachers, critical elements of the approach are illustrated which can be used to support dialogue between the two parties. This approach can be used to develop active teaching strategies and engaged learning approaches that support the development of clinical expertise.

Using concept mapping principles in PowerPoint.

The use of linear PowerPoint templates to support lectures may inadvertently encourage dental students to adopt a passive approach to learning and a narrow appreciation of the field of study. Such presentations may support short-term learning gains and validate assessment regimes that promote surface learning approaches at the expense of developing a wider appreciation of the field that is necessary for development of clinical expertise. Exploitation of concept mapping principles can provide a balance for the negative learning behaviour that is promoted by the unreflective use of PowerPoint. This increases the opportunities for students to access holistic knowledge structures that are indicators of expertise. We illustrate this using the example of partial denture design and show that undergraduates' grasp of learning and teaching issues is sufficiently sophisticated for them to appreciate the implications of varying the mode of presentation. Our findings indicate that students understand the strategic value of bullet-pointed presentations for short-term assessment goals and the benefits of deep learning mediated by concept mapping that may support longer term professional development. Students are aware of the tension between these competing agendas.

Dental vocational training: identifying and developing trainer expertise.

AIMS: The aims of the study were two fold: to determine the influence of trainer expertise on the Vocational Training (VT) experience, particularly in terms of providing Vocational Dental Practitioners (VDPs) with positive role models; and to ascertain if it is possible to identify attributes of expertise that can signpost a successful path for new/less expert trainers. PARTICIPANTS: Thirty-five VDPs and each of their Vocational Trainers participated in the study. All training took place in the South East of England. DESIGN: The participants were followed through the 12 months of their VT year. Semi-structured interviews were conducted with both trainers and VDPs on two occasions, during the year and once VT had been completed. It was also possible to observe practice sessions and VT Study Day teaching. The descriptive analysis of the training partnerships has been previously described. The original data were revisited through a constant comparative analysis of the interview transcripts and observation notes. RESULTS: The influence of training expertise is identified and discussed as is the VDP view of the trainer as a role model. Attributes of training expertise are highlighted and presented as a guiding path for new/inexpert trainers. CONCLUSION: The training expertise of a trainer has a significant influence on the VT experience for both trainer and VDP. Expertise has the potential to be harnessed and used to good effect in VT.

Dental vocational training: some aspects of the selection process in the South East of England.

AIM: To explore aspects of the dental vocational training (VT) selection process. PARTICIPANTS: Thirty-five vocational dental practitioners (VDPs) and each of their trainers. The descriptive analysis of the VT year as experienced by these subjects has been previously described. DESIGN: Using a semi-structured interview format, the participants were interviewed once the prospective VDPs had secured a VT position. The interview transcript data were subject to a constant comparative analysis and a model of the typical selection experience was developed. RESULTS: The selection experience of the partnership that best fits the model is presented and where appropriate this is compared to the other VT partnerships. VDPs favoured practices close to their homes. A degree of formality within a pleasant atmosphere would result in an offer being accepted. For the trainer, again a local applicant was favoured, but above all else the prospective VDP had to fit into the practice team. CONCLUSION: The VT selection experience is not an easy one for VDPs - neither is it for trainers. The more effort participants put into the selection process, the more they are likely to achieve what they want. This is true not only for prospective VDPs finding a practice of their choice, but also for trainers finding a VDP who will become a successful member of the team.

Aspects of the dental vocational training experience in the South East of England.

AIM: To determine aspects of the 'lived experience' of dental vocational training (VT) for vocational dental practitioners (VDPs) and their trainers. DESIGN: A qualitative study: semi-structured interviews were conducted with the participants halfway through VT and once the VT year had been completed. PARTICIPANTS: Two consecutive cohorts of 13 and 22 VDPs and their trainers. RESULTS: The experience of VT for the VDPs and their trainers is presented together with a model of VDP progression through the VT year. CONCLUSION: VT is a success for VDPs and their trainers. Not one VDP would have wanted to enter general practice without VT. With very few exceptions the trainers considered VDPs capable of independent practice, post VT. Trainers were considered as positive role models by their VDPs. VT facilitates the transition of novice dentists into competent practitioners.

Patients with cardiac disease: considerations for the dental practitioner.

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

A clinical teacher's experience with the Open University MA in Education.

In this article, I outline my experience of undertaking the Open University Master of Arts Degree in Education Management. A brief overview of the structure of this modular degree is presented. I then assess the benefits that I have gained during this course of study; I also consider the relevance of this primarily mainstream education higher qualification to those in dental education, in particular those who teach at undergraduate level and in general dental practice.

Are graduates as good as they used to be?

A theme runs through discussions on dental undergraduate education, that 'they are not as good as they used to be'. Based largely on anecdotal evidence, we question whether this is true. Dentistry is changing. Today's graduates are different, but not worse. Graduates must qualify with basic competencies--agreed between all those responsible for their education. We maintain that vocational trainers are teachers, just as we are, and as such they have similar responsibilities. Close liaison between training practices and dental schools is essential.

A study on the use of the dentatus AEB face bow and its modification as an ear bow.

This study investigated the siting of the earbow mounting pins on the Dentatus ARL articulator relative to the condylar axis. Further, it showed the repeatability of registrations using the Dentatus AEB face bow and its modification as an earbow. Three face bow and three earbow recordings were made of 35 subjects. Registrations were fitted onto the subject's cast mounted on the articulator to show differences in the recording of the condylar axis. The mean horizontal relationship between the earbow and face bow registrations approximated to the relationship of the earbow mounting pin to the opening axis of the articulator. The mean diameter of the spread of registrations was less for the earbow than the conventional face bow. The use of the earbow modification to the Dentatus face bow is supported.

Diabetic hypoglycaemia and the dental patient.

Hypoglycaemic attacks in patients with insulin-treated diabetes are unpleasant and inconvenient at best, but may constitute a medical emergency at their most severe. This article provides the dental practitioner with an insight into the physiological processes which occur during such attacks, with clues to the recognition of the signs of impending hypoglycaemia. Steps which may be taken to avoid hypoglycaemia with the various forms of treatment are then considered against a background of their suitability for use in dental practice.

Early warning signs of impending hypoglycaemia masked by post-extraction labial paraesthesia.

Temporary lingual and labial paraesthesia are not uncommon following the removal of mandibular third molar teeth. In patients with insulin-treated diabetes circum-oral paraesthesia is a common and important sign of impending hypoglycaemia. This report highlights the case of a 17-year-old girl with Type 1 (insulin-dependent) diabetes who, following the extraction of her four wisdom teeth, experienced minor circum-oral sensory disturbances. These effectively masked her early warning signs of impending hypoglycaemia which had hitherto allowed her to have very good glycaemic control. Trembling, sweating and loss of concentration became the new presenting symptom complex, which she found both disabling and worrying. Fortunately, within six months the paraesthesia had subsided and the patient was once again able to appreciate her usual warning symptom of impending hypoglycaemia.

Using articulators to enhance clinical practice.

This paper looks at how articulators can be of value in everyday NHS practice. A variation on the conventional classification of articulators is suggested with advice provided for the practitioner who wants to enhance his or her restorative work without immediately investing in high cost equipment. It is argued that rather than prolong chairside time, for specific types of treatment the use of an appropriate articulator and facebow can not only enhance the quality of the completed restoration, but also save on chairside time.

Variability in complete denture assessment.

This paper reports variation in complete denture assessment between three groups of examiners, viz. general dental practitioners (GDPs), teachers of prosthetic dentistry and undergraduate students. A panel of three patients was assembled; each member wore complete dentures with specific faults. A short questionnaire was prepared covering the basic parameters of complete denture design; comments were also invited on desirability of denture renewal. The panel was examined by 30 GDPs, 30 students and 10 teachers. For the parameters, jaw relationship and need for renewal, there was little inter- or intra-group variation. However, for freeway space 90 per cent of the teachers agreed on the estimation of this parameter for each panel member but only 26 per cent of GDPs and 46 per cent of the students had similar findings.