European Journal of Dental Education ISSN 1396-5883
A review of continuing professional development for dentists in Europe* E. Barnes1, A. D. Bullock2, S. E. R. Bailey1, J. G. Cowpe1 and T. Karaharju-Suvanto3 1 2
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School of Postgraduate Medical and Dental Education, Cardiff University, University Dental Hospital and School, Heath Park, Cardiff, UK, Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Science, Cardiff University, Glamorgan Building, Cardiff, UK, Institute of Dentistry, University of Helsinki, Helsinki, Finland
Keywords continuing professional development; continuing education; dentistry. Correspondence Jonathan G. Cowpe Dental Postgraduate Section, Wales Deanery - School of Postgraduate Medical and Dental Education Neuadd Meirionnydd Heath Park Cardiff CF14 4YS, UK Tel: +44 (0)29 2074 4317 Fax: +44 (0)29 2074 3960 e-mail:
[email protected]
Accepted: 5 January 2012 doi:10.1111/j.1600-0579.2012.00737.x
Abstract Aim: To summarise findings from a literature review of dentists’ engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. Method: The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. Results: One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. Conclusion: To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner’s readiness to engage with education and training and the influence of the workplace environment.
Introduction Key competences required of the new dental graduate and a European perspective on the quality assurance of undergraduate education have been established (1). In the context of changing patterns of oral health needs (2), an increasingly wide range of health issues (3) and higher patient expectations (4–6), practitioners need to develop a wider knowledge base than that which can be provided by undergraduate training alone (6–10). Continuing professional development (CPD) is the mechanism by which dental practitioners develop their skills and knowl*Article reproduced from Eur J Dent Educ 16 (2012) 166–178 ª 2013 John Wiley & Sons A/S Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17
edge and maintain up-to-date practice. Definitions of CPD (11–14) draw attention to the career-long importance of CPD and its value for patient care. Although rules about the required amount and content of CPD vary across the European Union (EU) (15–17), there is evidence of a worldwide trend towards mandatory CPD (5, 9, 18–21). The need to update clinical skills and integrate new developments into patient care is an accepted part of professional practice and increasingly related to continued registration (22, 23). However, differences in CPD requirements mean that patients are likely to be subject to different standards of oral health care depending on where they live, or travel to, within the EU (24). This paper presents a summary of the findings 5
Review of CPD for dentists
Barnes et al.
of a review of the literature undertaken as part of a wider study (‘DentCPD’ – part funded by the European Commission (#509961-LLP-1-2010-1-UK-ERASMUS-EMHE). The review aimed to report dentists’ engagement in CPD, focused on Europe, and its effects on the oral health care for patients. This involved reviewing: l the volume of CPD undertaken, factors associated with uptake and barriers to participation; l the range of CPD delivery methods; l CPD topic preferences and l what is known about CPD effectiveness and impact-onpractice.
Method As well as searching for papers in the scientific, medical and nursing databases (Web of Science; OVID Medline; EMBASE; CINAHL; SCOPUS Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities), others were included to capture educational (ERIC after 1996; British Education Index) or social sciences and psychology aspects (ISI Web of Knowledge; ASSIA after 1987; PsychInfo). Unless otherwise indicated, there was no date limit initially, although papers published prior to 1990 were later excluded. An academic literature search engine (Google Scholar) was also utilised. This search was conducted in the UK and complemented by one undertaken by colleagues in Finland who searched four databases (OVID Medline; EBM Reviews – ACP Journal Club 1991
to December 2010; EBM Reviews – Cochrane Database of Systematic Reviews 2005 to December 2010, EBM Reviews – Database of Abstracts of Reviews of Effects 1st Quarter 2011). All searches were conducted during February 2011. The UK team employed the following search terms: dent* AND CPD dent* AND CPD AND Europe dental AND education dental AND education AND continuing dental AND education AND Europe dental AND education AND continuing AND Europe The terms employed by the Finland team were: dent* AND continuing education education, dental, continuing/legislation & jurisprudence, standards Additional papers were identified by the DentCPD research team through reviewing the reference lists of retrieved articles and hand searching the European Journal of Dental Education and the British Dental Journal. Titles and abstracts, if available, of each reference were scanned for relevance or further investigation. Only papers focusing on CPD for general dentists were included. This excluded papers focusing on dental care professionals (DCPs), undergraduate education, vocational training or assessment rather than continuing education. Papers published before 1990 and those advertising courses or events were also excluded. Papers including empirical evidence, reviews, summaries or opinion articles were included. Papers were first categorised by EB (UK) and TKS (FI). Uncertain cases were cross-checked with AB (UK).
Databases searched
Results 4310 papers retrieved 2546 duplicates removed 1764 titles/abstracts screened
118 papers relevant
1646 papers excluded
32 could not access
26 from other sources 103 full papers
9 abstracts
only
114 sources included
Fig. 1. Literature selection process.
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Comprising: 83 empirical papers 8 reports 7 literature reviews 4 opinion pieces 12 topic summaries
Initial database searches identified 1764 potentially relevant papers of which 119 were judged to be relevant. An additional 27 were included from reference lists and hand searches. Of these, 105 were read in full, abstracts were only available for nine, and 32 could not be accessed. Eighty-three of these were empirical, and 31 were summary papers, reports, literature reviews or opinion pieces (see Figure 1). A full list of papers included and excluded are available upon request.
Continuing professional development uptake A number of studies have reviewed the amount of CPD undertaken by dental practitioners. Table 1 provides a summary. Most typically, information on the amount of CPD undertaken has focused on course attendance and has been gathered by questionnaire survey. These studies show that uptake varies considerably and several report a small proportion of dentists not participating in any courses (4, 31, 33, 39). However, it is difficult to make comparisons because studies report a variety of modes of CPD delivery and even where courses alone are considered, the type (e.g. lecture, hands-on) and duration (e.g. half-day, full-day) differ or are not specified. Furthermore, although the majority of these studies looked at courses undertaken in the previous year (4, 25, 31, 33, 34, 39–41, 43), some looked over a 2-year period (28, 29, 35, 36) and one considered intentions (10). ª 2013 John Wiley & Sons A/S Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17
Country
UK
Ireland
Worldwide
UK
USA
UK
Ireland
UK
UK
USA
Saudi Arabia
Northern Ireland
Switzerland
Authors
Walmsley and Frame (25)
Buckley and Crowley (26)
Allen et al. (27)
ª 2013 John Wiley & Sons A/S
Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17
Johnson, Johnson et al. (28)
Kuthy, Bean et al. (29)
Baldwin et al. (31)
Buckley and Gloster (32)
Mercer, Long et al. (33)
Ireland et al. (34)
Kuthy et al. (35)
Al Fouzan (36)
McGimpsey et al. (37)
Wiskott, Borgis et al. (38)
Audit of records, questionnaire (unclear – 40-60% of 1300)
Questionnaire, no n given
Questionnaire 298 returns
Audit 507 returns
Questionnaire 514 returns
Questionnaire 307 returns
Questionnaire, 90 responses
Questionnaire 183 responses
Audit 507 returns
Questionnaire 200 returns
Questionnaire 24 returns
Audit, 146 dentists
Audit, 1700 GDPs
Main method, numbers
Geneva
GDPs in eight urban cities within Kingdom of Saudi Arabia Sample of Northern Ireland GDPs
Dentists on Ohio register
Dentists on Health Authority lists in two regions
2 cohorts – 1 qualified just before mandatory DVT and 1 qualifying just after its introduction from the Scottish Dental School in 1991 and 1994 Sample of dentists on the Irish Dental Council register in the South West region GDPs taking part in clinical audit in Yorkshire
Dentists on Ohio register
Practitioners attending day courses
Sample of dentists participating in CDE in the South and Mid-West regions of Ireland 26 selected national dental associations
Data collected from records held by West Midlands Regional Postgraduate Dental Education Committee on attendance at courses
Context, subjects
TABLE 1. Studies reporting amount of continuing professional development (CPD) undertaken by dental practitioners
10 countries reported hands-on courses were taken by
