Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions.

INTRODUCTION: In order to be eligible for consultant appointments within the NHS, orthodontists can undertake higher specialty training after their Certificate of Completion of Specialist Training (CCST). These training posts are known as Post-CCST positions and orthodontists must be eligible for inclusion on the General Dental Council's (GDC) specialist list for orthodontics before applying. There has been a decline in the number of applicants and the number of filled Post-CCST positions in recent years, leading to concerns over a potential shortage of appropriately trained consultant orthodontists to provide a secondary care service in the near future. This survey was undertaken to identify barriers to applying for Post-CCST training and assess potential options for increasing trainee numbers. METHODS: An online survey was distributed, by email, to current orthodontic trainees and those that had recently completed training in the last six months via the British Orthodontic Society Training Grades Group. Reminder emails were sent at two and four weeks. A total of 201 trainees were invited to complete the survey. RESULTS: Eighty-nine trainees completed the survey (response rate of 44.3%). Regarding applying to Post-CCST training, 32.6% and 47.7% of respondents, respectively, either wanted to or were considering applying for Post-CCST training. The South East was the most preferred region for Post-CCST training (38.0%). Reasons for not wishing to complete Post-CCST training included salary (71.9%), lack of consultant posts in desired regions (64.1%) and inability/unwillingness to relocate (63.5%). Part-time training (91.0%) and a higher salary during training (86.0%) were most likely to incentivise application for Post-CCST training. CONCLUSION: Financial, family and geographical concerns appear to be the main reasons why trainees might not consider Post-CCST training. Part-time and run-through training options may encourage trainees to apply for Post-CCST training.

Factors influencing orthodontic treatment outcome in South East Wales and implications for service commissioning.

AIM: To determine factors that may influence the outcome of orthodontic treatment undertaken in General Dental Services/Personal Dental Services in South East Wales. DESIGN AND SETTING: A retrospective study of a requested 20 consecutively treated cases (for the year 2014-2015) provided by 26 performers in South East Wales. METHOD: Performer and patient information was obtained by use of a questionnaire and FP17OW forms, respectively. A calibrated investigator recorded the Index of Orthodontic Treatment Need (IOTN), Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) on start- and end-study models for each case. Descriptive and regression analyses were undertaken to identify any predictive factors of a good treatment outcome. RESULTS: Two respondents completed < 20 cases, so all of their cases were assessed. A total of 495 cases were assessed. The overall achieved mean end-PAR score of 5 is collectively a good occlusal outcome. Predictive factors of a good quality of occlusal outcome (end-PAR score being ⩽ 5) were: dual arch treatment; use of functional with fixed appliances; treatment undertaken in non-corporate practices; and treatment undertaken by registered specialists (P < 0.001). Predictive factors for occlusal improvement (change in PAR score) were: IOTN aesthetic component (AC); IOTN dental health component (DHC) (1-3 or 4-5); and number of arches treated and malocclusion type (P < 0.001). CONCLUSIONS: Dual arch fixed appliances undertaken by orthodontic specialists in non-corporate environments produced the highest quality orthodontic outcomes. Those who have the highest need for treatment according to IOTN DHC and AC benefit most in terms of improvement achieved in PAR score.