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ePaper created 2016-04-19, 09:49:27 | version 1.38.0
Common reasons for choosing den- tistry as a vocation in the UKinclude having a fulfilling career where, af- terfivehardyearsinvestedatdental school,onecouldberewardedwitha highprobabilityofemploymentand the opportunity to marry scientific knowledgewithpracticalhandskills toprovideforthepublic,eitheronan NHS or private basis or both.A-level students have high standards to achieveandmaintaintogainadmis- siontoundergraduateprogrammes. Towards the end of their training, youngdentistsmayfeelliketheyare about to enter a minefield on grad- uation. In the last year of dental school, those wishing to enter vocational training are pitted against each other, then ranked nationally and allocated a training position ac- cording to their performance in that selection process. Whatever happened to being interviewed by a future employer and performing at that more personal, mutual as- sessment level? It appears that the system is becoming increasingly mechanistic, a conveyor belt if you will,whereacollegestudententers, iseducatedinacost-effectiveman- ner, assessed and allocated around the country. The issues involved in under- graduatetraining,asopposedtoedu- cation,havebeentopicalrecently.1,2 Dentistryhasbotheducationaland training aspects. Undergraduates need to undergo appropriate vol- ume-based improvement of their diagnostic, planning and hand skills, linked to appropriate knowl- edge. Pure education will never be enough for a practical profession where one is more likely to be judged against a technical out- come yardstick than on purely theoretical knowledge. Are dental schools providing this requisite training or are these absorbent minds being failed by the environ- ment that they now have to learn the practical, technical aspects, as well as some helpful clinical tricks ofthetrade?Thefaultseemsnowto lie more in the lack of appropriate nurturing of these talented and capable individuals, as opposed to unfairly criticising their nature, abilitiesormotivations.Ithinkless of the“when I were a lad”and more of the realisation of the difficulties they face is required. NHS dentistry: A brave new world? Once they have attained a posi- tion in the system in which they then work, this should surely be conducive to providing the right treatment to the right patient at the right time, right? Wrong. Even if skills were attained at the under- graduate level, the current NHS system based on units of dental ac- tivity (UDA) does not reward those mosttechnicallydemanding,most rewarding procedures that can im- prove quality of life, such as saving a molar tooth with endodontics. These time-consuming delicate skills with expensive single-use in- strumentsarerewardedfinancially at the same level as an extraction. Thereinliestheparadox,andcon- sequently the problem. Dentistry does not appear to be valued to thesamelevelasotherprofessions. We tend to undersell and under- state ourselves compared with other professions. Doctors tend to be looked upon favourably—there when patients need help most. Lawyers are viewed in a different, more formal way, especially when disputesarise.Incontrasttoitsper- ceptioninmanyotherplacesinthe world,dentistryisportrayedaspain inducing and expensive in the UK. Somewhat ironically, NHS med- ical services are free at the point of deliveryandNHSdentaltreatment isnot.Cueeverypatientcomparing ustoourmedicalcolleagueswhere there is no bill for a hysterectomy orahipreplacement,buttheyhave to pay £200 for a spoon denture. As such, the perception by the public and the media may always bemorenegativethanpositive,and the government may play on this to squeeze the pips of goodwill out of dentists until nothing is left. PurSUEing a career The NHS system is not the only daunting aspect of this brave new world that young dentists are entering. Dental litigation in the UK is rife and ever increasing and, as expected, indemnity premiums are increasing. Young dentists may well be nervous and risk averse, if notoutrightdefensive,whentreat- ing patients for fear of litigation or a complaint to our regulatory body, however trivial that may be. Can we expect them to develop and hone skills in such an envi- ronment? This is highly unlikely where self-preservation becomes the understandable consideration. As such, “defensive dentistry” can override instinctive motivation to treat deserving and unfortunate patientsandtherebydischargeour wider duty to society. This increase in indemnity pre- miums is unlikely to have been instigated by a swathe of amal- gam carvings without secondary fissures by dental foundation trainees.Anincreaseinprocedures such as implants, short-term or- thodontics and elective cosmetic dentistry is more likely to have had an effect on premiums for all. As a growing number of settle- mentsbecomeincreasinglysizeable, those possibly avoidable mishaps by the more senior, supposedly experienced, among us make the environment more difficult for our junior colleagues. Thereissomuchovertdentaldis- ease and a great need for this to be treated using predictable methods, and it baffles me that despite this many young dentists see opportu- nities to supplement their income andskillsetwithhigh-end,high-risk procedures more likely to lead to litigation well before the basics of proper, proven dentistry have been learnt, attained and honed. Unfor- tunately, the skills they may feel or beledtofeeltheywanttoachieveare not routinely what they probably need most or possibly what poten- tialemployersreallywantandlikely what the public requires. Recently, a colleague in practice called me about the CV of a young graduate with only four years of experience. He had gained “qualifications” in facial aesthetics and cosmetic den- tistry, had completed a course in super-quick orthodontics and was studyingforanMScinmetalscrews. Myfriendcommented,“IfItakehim on, who’s going to do the dentistry, thetherapist?”. Again,theNHSUDAsystemmay be blamed for not rewarding the management of plaque-associated disease to the level it merits, and becauseofthatperceptionsuchin- dividuals may hunt for more sup- posedly rewarding opportunities. Furtherspecialisttrainingisseem- ingly London centric and expensive. It looks increasingly unlikely that a UKgraduatewithfiveyearsofdebtin tuition fees will be able to afford to train and develop comprehensively if he or she desires this without falling deeper into debt. As such, thesepostgraduatespecialistcourses are popular among overseas stu- dents,whoselargefeesarewelcomed by academic units. Unfortunately, the overall experience and skill set within these shores is likely to de- creaseasaresultofmuchofthispost- graduateeffortwithanetincreasefor countries abroad where they will thenbringthatexpertise. Positive aspects of globalised dental education include the im- Dental Tribune United Kingdom Edition | 4/201510 TRENDS&APPLICATIONS “It appears that the system is becomingincreasinglymechanistic...” Graduation: A minefield for the younger generation of dentists By Aws Alani,UK DTUK0415_10_12_Alani 10.09.15 15:17 Seite 1 DTUK0415_10_12_Alani 10.09.1515:17 Seite 1