Barriers and facilitators to establishing a clinical academic career in clinical education research in the UK: A focus group study.

In a rapidly changing healthcare environment, we need a robust evidence base to inform effective education and training. This study aimed to examine factors perceived to determine career progression in clinical education research in the UK. Six online focus groups were conducted, with 35 participants from a range of medical, dental, nursing, and allied health professions who identified as aspiring or early career clinical education researchers. Transcripts underwent thematic analysis. Two themes and associated subthemes were constructed to illustrate perceived factors impacting on career development: (1) A cultural challenge from clinical norms. Challenges included differences between the epistemological assumptions of biomedical and clinical research, and the underlying philosophy of education research, which is more closely aligned with the knowledge generation of the social sciences. This led to difficulty communicating the impact of education research to patient care. There were also blurred boundaries between education delivery and research, with the latter lacking a clearly defined group identity. (2) Structures, systems and relationships for career progression. Practical considerations included time and funding (or lack thereof), the opportunity to undertake formal training, networking and role models. This research highlights a number of systemic barriers and facilitators to careers in clinical education research and offers targets of intervention to enable a sustainable academic workforce in clinical education research.

Exploring the declared and the formal and informal taught curricula at a UK dental school through the lens of pulp management.

Introduction This paper explores the declared and formal and informal taught endodontic curriculum within an undergraduate dental programme in the UK as part of a wider study, which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.Method The declared curriculum was identified through existing course guides and seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.Results Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines and the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.Conclusion This study highlights disparities between current evidence-based guidelines and the declared and taught curriculum in relation to pulp management in a UK dental school. Recommendations are that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, plus engagement with clinical lecturers, to enable more standardised teaching.

Twelve tips for conducting medical education research via videoconference.

The demand for current practical advice in how to conduct research by videoconference is internationally recognised. Many researchers in medical education are transitioning to using online methods for the first time, through design or necessity. This paper aims to provide practical advice on utilising videoconference technology for research, from design to execution. The tips include how to manage important elements such as ethics approval, online etiquette, contingency planning, technology management, and data capture. Recommendations include how to promote participant engagement with online data collection methods, in some cases paralleling the literature around synchronous online learning. The tried and tested tips have been developed by the authors based on their research experience, a literature review and the results of a post-participation survey of medical students on their experiences engaging in research online via videoconference.

Effect of tobacco and nicotine in causing staining of dental hard tissues and dental materials: A systematic review and meta-analysis.

INTRODUCTION: Dental staining is a common concern for tobacco users. However, little is known about which components of tobacco are responsible for the staining and whether nicotine may be implicated. This is of increasing relevance with the popularity of novel products such as heated-tobacco products and electronic cigarettes (E-cigarettes). OBJECTIVES: This systematic review aimed to establish the evidence base for the effect if any, of the various tobacco and nicotine products in causing staining of dental hard tissues and materials. MATERIAL AND METHODS: This systematic review was performed in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. There were four structured population intervention comparison outcomesquestions. A search was conducted up to December 2021 in three databases: MEDLINE, EMBASE, and Web of Science, and manual searching of relevant sources was also completed. Two researchers individually reviewed the titles then abstracts and finally full articles. A reporting quality appraisal was conducted appropriately to the study methodology. RESULTS: Of the 815 records titles identified, 56 full-text articles were assessed for eligibility, of which 27 were included for analysis. The included studies were mainly laboratory studies of varying reporting quality. There was evidence from 18 studies that tobacco exposure caused staining of dental hard tissues (pooled results from three studies- enamel/dentine; mean difference [MD]: 16.22; 95% confidence interval[12.11, 20.32; I2 : 96%)and materials (pooled result from four studies-resin composite; MD: 11.90; 95% CI: 11.47, 12.34; I2 : 100%). There was limited evidence that E-cigarettes 99%) and heated tobacco products (HTPs; pooled results from three studies--1.07, 6.54; I2 : 99%) cause staining, but this was lower than with traditional tobacco/found 11 compounds, of which 8 were terpenoids, from tobacco products implicated in causing staining. Finally, there was some evidence that resin composites stained more than other materials. CONCLUSIONS: Tobacco smoking causes dental staining. There was limited evidence that E-cigarettes and HTPs did cause dental staining that was less intense than that caused by traditional tobacco products.

From inputs to outputs: an analysis of the changes to learning outcomes for dental undergraduate education in the UK.

Introduction/aims Preparing for practice (PfP) was thought to represent a significant shift in the expectations of dental undergraduates compared to its predecessor, The first five years (TFFY). This project aimed to explore requirement changes by comparing learning outcomes for undergraduate dentists in these two documents. Changes in curriculum requirements defining clinical, professional, or a blend of these skills were also investigated.Methods Curriculum mapping was used to compare learning outcomes in PfP to requirements in TFFY.Results The total number of learning outcomes increased from 101 to 149 in PfP compared to TFFY. There was a proportional reduction in outcomes describing clinical skills and an increase in the proportion of outcomes describing professional and blended skills. Three TFFY requirements did not appear in PfP and a further 23 learning outcomes in PfP were absent in TFFY.Conclusions In the transition from TFFY to PfP, there has been an overall increase in the number of outcomes graduates must attain before they can register with the General Dental Council. There are more outcomes defining professionalism which subsequently has resulted in proportional but not actual decrease in outcomes related to clinical skills. While there is uncertainty over how schools have managed curricula to incorporate these changes and thus whether the perception of graduate preparedness can be directly attributable to these changes, it is timely to consider any changes within dental learning outcomes in the context of preparedness concerns.

Undergraduate dental education: an education or training?

The impact of the COVID-19 pandemic on undergraduate dental education has led to new ways of working, different modes of delivery for elements of programmes and, in some cases, revised timelines for progression. These expedient changes, like the virus, may be with us for some time. However, as we come out of an intense period of critical reflection and change, it may also offer us an opportunity and impetus to revisit unresolved challenges around the focus and role of undergraduate dental education. We reflect upon the necessity for both clinical development and scholarship for our undergraduates, and the subtle differences of purpose between education and training. We consider whether it is time to look afresh at the relationship between the universities and other stakeholders and perhaps also to start with renewed understanding, giving deeper consideration to the value of each. One of the biggest obstacles to resolving these issues is to consider how best we align institutional requirements with the education and training of healthcare practitioners. With the hindsight of the past 12 months, we would argue that such a review is timely and more meaningful as we can reflect on the pandemic-enforced and expedient changes to our programmes and more clearly understand where our future priorities lie.

Understanding dental students' use of feedback.

INTRODUCTION: Feedback can enhance learning and is thought to be highly valued by students; however, it is not clear from the literature how dental students actually use feedback. AIM: This study aimed to explore how dental students use feedback in a variety of contexts. METHODS: Qualitative methods involving audio-recorded focus groups were used to explore the use of feedback by undergraduate dental students studying at three UK dental schools. A purposive sampling strategy was used to ensure diverse representation across the undergraduate dental programmes in each of the schools. RESULTS: Six focus groups, involving a total of 72 students, were undertaken. Thematic analysis identified five main themes relating to the use of feedback: value, future applicability, accessibility, variability and understanding. The inter-connectivity and interaction of the themes (along with their subthemes) were used to develop a model for optimising feedback with the aim of enhancing its potential use by students. CONCLUSION: The use of feedback by students would appear to be strongly influenced by several factors. Understanding these factors and how they interlink may be helpful to education providers who are seeking to optimise their feedback processes.

Professionalism in undergraduate dental education: a pause for thought.

Professionalism in dental education, as well as in the wider dental profession, is a regularly discussed and debated topic. It may seem obvious what is meant by 'professionalism' and in many situations it is clear what constitutes a professional approach or behaviour, but contention exists in how to articulate, measure and consider aspects of this complex and context dependent phenomenon. Getting 'it' right early on, with our students and new graduates, is a strategic priority, contributing to 'upstream' activities which have an intention of preventing future issues or harm. The aim of this article is to summarise the challenges faced by providers of undergraduate education (and the dental regulator) in the UK in defining and determining attainment of 'professionalism' before registration. It is timely to take an opportunity for pause, re-assess frameworks and consider future direction.

Delivering to 'that list': the challenges of working with learning outcomes.

Dental education providers have raised concerns around the challenges experienced when trying to demonstrate student attainment of 'professionalism', as described in the General Dental Council (GDC) document 'Preparing for practice'. This manuscript describes a documentary analysis of each 'outcome' within the dentist professionalism domain section, with an assessment of whether it met the criteria of a functional learning outcome. In addition, outcomes were scrutinised in terms of application within undergraduate degree programmes. Key challenges identified were: the 'outcome list' included standards and objectives as well as outcomes; not all statements were specific and focused, some were broad and multi-faceted; determining attainment where there was no identifiable endpoints; and judging achievability within the supervised and confined environment of undergraduate programmes. We conclude that issues have been created through the way that these learning outcomes have been expressed. Also, it is evident that there are ideological and philosophical issues about accurately articulating the attainment of complex phenomena like professionalism. The findings from this study reflect the challenges associated with using learning outcomes to adequately capture professionalism, the values that underpin it and the behaviours that manifest its existence in clinical practice.

Obtaining patient feedback for quality assurance of undergraduate dental teaching.

Introduction In order to achieve the educational standards of the General Dental Council, providers of UK dental education programmes are required to demonstrate that feedback from patients is collected and used to inform programme development. Aims To determine areas of undergraduate dental training programmes that patients feel able to comment upon, allowing development of a patient feedback questionnaire. Methods Patients receiving treatment from undergraduate students were recruited to focus groups (n = 5, n = 6) where their experience of receiving student care was explored. Audio transcriptions were analysed for emergent themes. These themes informed the design of a questionnaire which was presented to a further patient focus group (n = 4) for content and face validity testing. Staff (n = 4) and student (n = 8) focus groups discussed its delivery. Results Patients were able to comment upon treatment quality, safety, the student-teacher interaction, and appointment times. An 18-question questionnaire was developed to include free text comments and answers on a visual analogue scale. It was modified following focus groups with patients, staff, and students. Conclusion Patients undergoing student treatment identified aspects of the clinical teaching programme that could be included in a feedback questionnaire. Following a pilot, the questionnaire will form part of the teaching quality assurance process.

Provision of information to patients on dental implant treatment: Clinicians' perspectives on the current approaches and future strategies.

OBJECTIVES: To explore 1) the approaches that are adopted by clinicians to give patients information in relation to dental implant treatment during clinical consultations; 2) clinicians' reflections on their current practices of implant information provision; and 3) clinicians' suggestions to improve future implant information provision. METHODS: A qualitative study employing face-to-face semi-structured interviews with eight clinicians working in UK secondary dental care. The data gathering and analysis followed the principles of qualitative thematic analysis. RESULTS: Clinicians reported that patients often hold misconceptions about dental implants, which are commonly acquired from generic information sources such as the media. This might be linked to high expectations regarding treatment outcomes and difficulties in communicating during clinical consultations. Clinicians were sometimes reluctant to voluntarily offer information about the longevity/ lifespan of implant supported restoration (ISR) and they had different opinions regarding the timing of information related to their long-term maintenance needs. Several strategies for improving the current practice of information giving in relation to dental implant treatment were suggested by clinicians. CONCLUSION: Providing accurate and timely information to patients could be challenging, although clinicians recognised the importance of doing so. As clinicians explained and debated their current approaches and reflected on their practices, they identified areas of potential improvement and ways to improve information provision related to dental implants. These were mainly focused on transforming patient care so that there is efficient co-operative alliance between patients and dental care providers. Considering upgrading information provision throughout the implant treatment pathway would transform this aspect of healthcare to make it more "patient-centred" than it is currently.

Provision of information on dental implant treatment: Patients' thoughts and experiences.

OBJECTIVES: To explore patients' thoughts and perceptions of information provision regarding dental implant treatment. METHODS: This generic qualitative study involved 38 semi-structured face-to-face and telephone interviews with 34 participants, who were at different stages of dental implant treatment. The interviews were transcribed verbatim. The data collection and coding process followed the principles of qualitative thematic analysis. RESULTS: Clinical sources of information were generally trusted by patients; however, patients clearly lacked information relative to their own specific situation, concerns and preferences, and this may lead to patients' reliance on other general sources of information. Crucial information on the long-term prosthesis needs was requested by patients at all treatment stages. Issues concerning the longevity and functional capability of the implant restoration and the long-term maintenance including optimisation of hygiene practice were questioned by patients and required greater explanation. CONCLUSION: With growing patient interest in implants for replacement of missing teeth, complete and accurate knowledge and understanding of implants should be established with patients. This should be undertaken with more reliance on reliable clinically based sources of implant information.

Patients' perceptions of implant placement surgery, the post-surgical healing and the transitional implant prostheses: a qualitative study.

OBJECTIVES: This study aimed to explore patients' thoughts, feelings about, and experiences of, implant placement surgery (IPS), the post-surgical healing stage and the immediate post-surgical transitional implant prosthesis (TIP) (fixed and removable). METHODS: A qualitative study design was chosen and 38 semi-structured telephone and face-to-face interviews were conducted with 34 patients at different stages of implant treatment. The interviews were transcribed verbatim; the data collection and coding process followed the principles of thematic analysis, which was facilitated through the use of NVivo10. RESULTS: Patients anticipated that surgery would be painful and unpleasant but were prepared to accept this temporary discomfort for the expected benefits of implant treatment. However, a key finding was that patients felt they had overestimated the trauma of surgery but underestimated the discomfort and difficulties of the healing phase. A number of difficulties were also identified with the TIP phase following implant surgery. CONCLUSION: Existing research has tended to focus on the longer term benefits of dental implant treatment. This qualitative study has investigated in-depth patients' perceptions of dental implant surgery, including their experiences related to sedation, and of transitional implant restoration. While patients felt their concerns were overestimated in relation to the implant surgery, they experienced greater morbidity than they expected in the healing phase. Recommendations are made for relatively small changes in care provision which might improve the overall patient experience. Partial dentate patients treated with a fixed transitional prosthesis experienced advantages more quickly than patients with an overdenture.

Patient non-attendance: utilising clinical time.

BACKGROUND: In undergraduate dental or medical programmes clinical time with exposure to patients is limited. A priority for all those involved in the delivery of a clinical programme is to ensure that this time is used effectively and to maximum potential. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important. METHODS: We have developed a range of close-contact teaching and learning activities (CCTLs) for dental students to productively use patient non-attendance time. CCTLs are short, skills-based tasks that are directly observed and have structured assessment criteria. Used formatively, they are performed in the clinical environment utilising the materials, equipment and clinical staff usually available during the clinical session. FINDINGS: The CCTLs have proved particularly useful for early-stage clinical students, by developing understanding and skills, reinforcing protocols and promoting the role of the wider dental team in teaching. Students have welcomed these activities and engagement has been high. In addition to improving skills, they have proved helpful in familiarising students with direct observation, and have inspired peer collaboration and feedback. DISCUSSION: The CCTLs have promoted opportunities for students to receive direct feedback, which may be difficult to deliver if a patient were present. Empowering students to lead on their own learning requirements also promotes the ethos of lifelong learning that will be fundamental to future professional development. Investment of resources to develop these activities has proved worthwhile, as we have found that CCTLs can complement and maximise the potential of clinical attachments. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important.

Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment.

OBJECTIVES: The decision-making process within health care has been widely researched, with shared decision-making, where both patients and clinicians share technical and personal information, often being cited as the ideal model. To date, much of this research has focused on systems where patients receive their care and treatment free at the point of contact (either in government-funded schemes or in insurance-based schemes). Oral health care often involves patients making direct payments for their care and treatment, and less is known about how this payment affects the decision-making process. It is clear that patient characteristics influence decision-making, but previous evidence suggests that clinicians may assume characteristics rather than eliciting them directly. The aim was to explore the influences on how dentists' engaged in the decision-making process surrounding a high-cost item of health care, dental implant treatments (DITs). METHODS: A qualitative study using semi-structured interviews was undertaken using a purposive sample of primary care dentists (n = 25). Thematic analysis was undertaken to reveal emerging key themes. RESULTS: There were differences in how dentists discussed and offered implants. Dentists made decisions about whether to offer implants based on business factors, professional and legal obligations and whether they perceived the patient to be motivated to have treatment and their ability to pay. There was evidence that assessment of these characteristics was often based on assumptions derived from elements such as the appearance of the patient, the state of the patient's mouth and demographic details. The data suggest that there is a conflict between three elements of acting as a healthcare professional: minimizing provision of unneeded treatment, trying to fully involve patients in shared decisions and acting as a business person with the potential for financial gain. CONCLUSIONS: It might be expected that in the context of a high-cost healthcare intervention for which patients pay the bill themselves, that decision-making would be closer to an informed than a paternalistic model. Our research suggests that paternalistic decision-making is still practised and is influenced by assumptions about patient characteristics. Better tools and training may be required to support clinicians in this area of practice.

Reducing the risk of failure in complete denture patients.

UNLABELLED: This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations. CLINICAL RELEVANCE: Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.