Mind the 'GAPP': a pre-graduation assessment of preparedness for practice amid a pandemic.

Introduction 'Preparedness for practice' refers to a multifaceted concept, encompassing not only clinical skills, but also broader, non-clinical skills, such as communication and professionalism. Previous graduates have reported feeling less prepared for complex procedures, such as molar endodontics and surgical extractions. Dental students typically utilise their final year to refine their clinical skills, however, the COVID-19 pandemic has meant that newly qualified dentists will have had around six months where they have not performed clinical dentistry before beginning dental foundation training (DFT).Aims This study aimed to explore final year students' self-reported preparedness for practice, identify areas of relative weakness that may influence future training needs and to highlight any perceived impact of the pandemic on final year experience and potential impact on DFT.Materials and methods The current Graduate Assessment of Preparedness for Practice (GAPP) questionnaire was adapted for our specific research aims and piloted and the PreGAPP questionnaire distributed via the social media channels of dental school student societies. Analysis was carried out using IBM Statistical Package for the Social Sciences software using descriptive statistics and the Mann-Whitney U test for two unrelated variables.Results Responses were received from final year students across all 16 UK dental schools. Students reported increased preparedness across domains in which they had the most experience; for example, providing preventative advice and administering local anaesthesia. Male students reported feeling significantly more prepared than female students, mature students significantly more than younger students, and students on four-year courses significantly more than traditional five-year courses. The COVID-19 pandemic was expected to have a major-to-severe impact on undergraduate experience and future DFT prospects.Conclusion Dental graduates in the COVID-19 era may have significantly different training needs to those before them. Complex clinical procedures remain the areas where students feel they are least prepared for practice. The importance of a clinical passport to highlight current experience level to trainers, alongside the creation of a personal development plan at the beginning of DFT, will ensure that targeted and personalised training can be implemented where required.

Dental foundation training in the COVID-19 era - the national recruitment lottery.

National recruitment has radically transformed the selection and allocation of dental graduates to dental foundation training (DFT) schemes across England, Wales and Northern Ireland, with recruitment in Scotland via a separate, independent process. It has been reported as a mostly positive change to the previous deanery-led model, in which nepotism allegedly featured too widely. A candidate's ranking is typically based on performance across two face-to-face assessments and a situational judgement test (SJT). The COVID-19 pandemic, however, has created a recruitment 'lottery' of sorts, in which ranking for 2021 is now solely based on the SJT. Subject matter experts assert that neither preparation nor revision for the SJT is required; yet, following the announcement of the adaptation to DFT recruitment for September 2021, a rapid rise of exorbitantly priced SJT question banks, mock papers, workshops and courses has ensued - a shameless monetisation of the collective angst and increased pressure faced by dental students. Preparation courses present a conceivable risk of SJT 'coaching' and 'faking'. Where medicine leads, dentistry usually follows and future selection to DFT needs to strongly consider the introduction of academic performance measures. SJTs remain one of the most well-accepted, reliable and cost-effective means of selection into healthcare roles, however, only when part of a wider selection process.

The Six-Year-Old 'Adult'.

Children are not miniature adults, yet when a child celebrates their sixth birthday, little do they know that, with the arrival of their first 'adult' tooth, they are about to gain their first real experience of being a 'grown-up'. The age of six is a key milestone in the mental, physical and emotional wellbeing of children, with most children in the UK having commenced primary school education by their fifth birthday. Six-year-olds are about to enter the most critical period in their dental development, the mixed-dentition phase, where their mouths are in a near continuous state of flux. This pivotal age in their dental development should not be undervalued; the dental decisions we make at this age means childhood lasts a lifetime. Caries is the most prevalent, preventable global disease, and with one in four children suffering from dental caries in the primary dentition by the time they start school, the foundations we lay down at the age of six translate into lifelong benefits for the permanent dentition. In this paper, the aim is to demonstrate that at the age of six we get a second chance to get things right. From caries risk factors and tailoring the five pillars of prevention by educating parents on the developing dentition, to reinforcing the importance of habit-breaking, developmental anomalies of enamel and early orthodontic intervention, this paper describes the importance of the age of six, never before so exclusively expressed in a dental sense.

Dental core training: the trainee perspective.

Dental core training (DCT) is a postgraduate training period, eligible following successful completion of foundation/vocational training, which has multiple entry points and endpoints with a varied duration from one to three years. The introduction of national recruitment in 2017, away from a previous individual deanery-led process, has introduced new variables such as a ranking system for choosing training posts, with the outcome dependent on combined performance at interview and a situational judgement test for which competition is nationally against other applicants. This unique, trainee-led study provides an appreciation and understanding of the motivations and experiences of trainees who pursue DCT, such as the rationale behind location and speciality choice, the perception of national recruitment and the situational judgement test, and the influence of salary variation, alongside trainee perceptions and experiences of the training programme from inside the trainee perspective. Undertaking DCT is not a 'forever decision' and will stand the trainee in good stead in pursuit of speciality training or a return to general practice, with a wide variety of opportunities that can lead to fulfilment and a rewarding career pathway for enthusiastic dentists.

Agreement Among Dental Students, Peer Assessors, and Tutor in Assessing Students' Competence in Preclinical Skills.

The aim of this study was to determine the level of agreement regarding assessments of competence among dental students, their student peers, and their clinical skills tutors in a preclinical skills program. In 2012-13 at the University of Edinburgh, second-year dental students learned to perform the following seven cavity preparations/restorations on primary and permanent Frasaco teeth: single-surface adhesive occlusal cavity; single-surface adhesive interproximal cavity; single-surface adhesive labial cavity; multi-surface adhesive cavity; multi-surface amalgam cavity; pre-formed metal crown preparation; and composite resin buildup of a fractured maxillary central incisor tooth. Each student, a randomly allocated student peer, and the clinical skills tutor used standardized descriptors to assign a competency grade to all the students' preparations/restorations. The grades were analyzed by chi-square analysis. Data were available for all 59 second-year students in the program. The results showed that both the students and their peers overestimated the students' competence compared to the tutor at the following levels: single-surface adhesive occlusal cavity (χ(2)=10.63, p=0.005); single-surface adhesive interproximal cavity (χ(2)=11.40, p=0.003); single-surface labial cavity (χ(2)=23.70, p=0.001); multi-surface adhesive cavity (χ(2)=12.56, p=0.002); multi-surface amalgam cavity (χ(2)=38.85, p=0.001); pre-formed metal crown preparation (χ(2)=40.41, p=0.001); and composite resin buildup (χ(2)=57.31, p=0.001). As expected, the lowest levels of agreement occurred on the most complicated procedures. These findings support the need for additional ways to help students better self-assess their work.

Obtaining an evidence-base for clinical dentistry through clinical trials.

Ideally, all clinical practice should be based on the best available evidence; however, in general dental practice even a very routine issue, such as the appropriate management of the carious primary dentition, is hampered by the lack of a sound evidence-base from high quality clinical trials run in general dental practices. Furthermore, the use of the evidence that is available may be confounded by inadequate reporting. This paper reviews the difficulties reported in successfully completing such clinical trials, and reports on the authors' own experiences. Suggestions are made for overcoming the challenge of patient recruitment in randomised controlled clinical trials in primary dental care. These include: regular contact with a principal investigator, who is viewed as a peer; ensuring the relevance of the research topic to the dentists' daily practice; appropriate remuneration; acknowledgement of the contribution made and recognition of the contribution of research activity to continuing professional development. Use of the CONSORT statement to improve planning and reporting of clinical trials is recommended.