Lifelong learning

The five 'C's of lifelong learning: CPD, choices, collegiality, challenges and consequences

Continuing professional development (CPD) serves many purposes and when working optimally, its constituent elements can work synergistically in the interests of patients and dental health professionals alike. It can and should be central to professionalism but can just as easily undermine it. This paper explores the ways in which the best intentions of lifelong learning and the missed opportunities of enhanced CPD have failed to keep up with the scale and pace of change in postgraduate dental education and the training 'market', information and communications technology and with the accelerating generational dichotomy within both the profession and wider society. In particular, the paper questions the basis upon which CPD activity is marketed, chosen and measured, and how its outcome, value, effectiveness and ultimate worth is assessed.

Dental Continuing Professional Development - Part I: Background on Dental Continuing Professional Development in Europe

INTRODUCTION

Continuing Professional Development (CPD) is mandatory in most European countries and evidence shows a move towards mandatory CPD across all Member States in the near future. Malta is one of seven Member States where dental CPD is still voluntary.

DISCUSSION

Although dental CPD is a legal requirement for recertification in many countries, integral aspects of dental CPD remain under debate, like whether CPD is truly effective. This is because the methods with which CPD programmes are evaluated are not sufficiently robust to give concrete evidence to determine whether CPD will actually improve quality of care, treatment outcomes and safety for the public. Evaluating the effect of CPD programmes on the public is an extremely difficult task that would require an enormous amount of resources and logistics. The minimum requirements for the number of compulsory CPD hours imposed by regulatory bodies are not evidence-based but purely arbitrary, and the core topics selected for CPD programmes, although supported by research to some extent, may not reflect the public's and profession's needs. The Dental Association of Malta recognised need for further research on dental CPD and embarked on a 3-year Dental CPD Research Project. This project will be presented in a two-part series of articles. This first article is focused on the background of dental CPD in Europe. An understanding of the current issues with CPD and flaws in methods of evaluation formed the basis of the Malta CPD Pilot Project, which will be covered in the next paper.

Medical students' orientation toward lifelong learning in an outcome-based curriculum and the lessons learnt

BACKGROUND

Lifelong learning (LL) is an important outcome of medical training. The objective of this study is to measure the orientation of medical students toward LL and to determine the types of self-directed learning (SDL) activities that contribute toward LL skills.

METHODS

The Jefferson Scale of Physician Lifelong Learning for medical student (JeffSPLL-MS) questionnaire was used. Factor analysis was performed, Cronbach's alpha and effect size were calculated. The types of learning activities that contribute to LL skills were identified.

RESULTS

Three-factor structure emerged from the factor analysis and were identified as learning beliefs and motivation, skills in seeking information and attention to learning opportunities. A significant increase (p < .05; ES = 0.27) in orientation toward LL with academic progression was observed. Clinical students improved significantly in the domains of 'skills in seeking information' (p < .001; ES = 0.48) and 'attention to learning opportunities' (p < .001; ES = 0.55). Problem-based learning, flipped classroom, guided reading, projects and experiential learning activities are perceived to be effective for promoting LL.

CONCLUSIONS

Medical students' LL skills develop progressively from preclinical to clinical years. Self-directed learning activities are perceived to be effective in promoting LL skills.

Soft skills and dental education

Soft skills and hard skills are essential in the practice of dentistry. While hard skills deal with technical proficiency, soft skills relate to a personal values and interpersonal skills that determine a person's ability to fit in a particular situation. These skills contribute to the success of organisations that deal face-to-face with clients. Effective soft skills benefit the dental practice. However, the teaching of soft skills remains a challenge to dental schools. This paper discusses the different soft skills, how they are taught and assessed and the issues that need to be addressed in their teaching and assessment. The use of the module by the Faculty of Dentistry, University of Malaya for development of soft skills for institutions of higher learning introduced by the Ministry of Higher Education, Malaysia.

A review of continuing professional development for dentists in Europe(*)

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.

A review of continuing professional development for dentists in Europe

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.

Revalidation of general dental practitioners in Scotland: The results of a pilot study Part 1 – feasibility of operation

AIM

To devise and operate a pilot scheme of revalidation for general dental practitioners.

METHOD

A representative group of dental practitioners was convened to advise on an approach to piloting revalidation. Ten general dental practitioners volunteered and completed portfolios of evidence of fitness to practise. The portfolios were assessed by a panel of three calibrated experts, using a specially developed assessment tool. A single decision "evidence presented allowed revalidation to be recommended" was made. A timesheet was used to record the time spent producing the portfolio.

RESULTS

Eight portfolios were assessed as sufficient for revalidation purposes. Two dentists were required to make supplementary submissions of evidence before they were found to be acceptable. An average of eight hours of dentist time and six hours of delegated time was spent producing the portfolios.

CONCLUSIONS

The small number of dentists in this pilot were able to use the portfolio satisfactorily. The dentists were all volunteers and so may not necessarily be fully representative of the profession. The time spent completing the portfolio was not considered excessive. The assessors were adequately prepared and calibrated for their work.

British Dental Journal based Continuing Professional Development: A survey of participating dentists and their views

OBJECTIVE

There is little information available on journal based verifiable continuing professional development (CPD). The aim of this study was to survey those dentists who have undertaken this form of CPD and elicit their views.

DESIGN

A questionnaire survey.

METHOD

Four hundred dentists who had registered to undertake CPD with the British Dental Journal (BDJ) were randomly selected and sent a questionnaire.

RESULTS

Three hundred and twelve questionnaires were returned (78%) of these 181 (58%) were male and 131 (42%) were female. Of the 312, 307 had undertaken the BDJ CPD initiative. Two hundred and sixty eight respondents (87.3%) agreed/strongly agreed that the BDJ CPD satisfied their personal CPD needs. Two hundred and eighty three (92.2%) agreed/strongly agreed that their knowledge has been increased as a result of undertaking the BDJ CPD initiative. Two hundred and twenty agreed/strongly agreed (71.7%) that an element of their clinical practice had changed as a result of undertaking the BDJ CPD initiative.

CONCLUSION

Journal based learning appears to be an effective way of undertaking verifiable CPD.

Attendance at and self-perceived need for continuing education among Mongolian dentists

In May 2000, a questionnaire-based survey was targeted at all Mongolian dentists practising in the capital city of Mongolia in May 2000 with the aim of evaluating attendance at and the self-perceived need for continuing education (CE) in relation to their background characteristics and to their attitude towards CE. The response rate was 98% (n = 245), with 38% of the dentists reporting a CE learning opportunity in at least one of the clinical disciplines of dentistry during the 2 years prior to the survey. A need for CE in at least one of the disciplines was perceived by 58%. A dentist's field of practice and attitude towards CE were the significant factors for attendance, whereas length of working experience, field of practice, holding a postgraduate degree, and having attended CE courses were significant factors for perceiving a need for CE, when controlling for all other variables in the logistic regression analyses (P < 0.05). There seems to be a need for an increased attendance at CE courses among the dentists and a need for preparing them to have a positive attitude towards CE. On the other hand, creating an organized CE system which produces courses for dental practitioners, based on their need, will be at present a challenge for the Mongolian dental profession.

1.1 Student selection and the influence of their clinical and academic environment on learning

Student selection and recruitment play a vital role in the successful outcome of dental education. To identify key issues and practices in selection and recruitment, the group assessed current processes, philosophies and practices from a range of different educational systems, although it was not possible to gather data from all countries or continents within the timeframe provided. Furthermore, the group explored the effect of the educational learning environment on the successful outcome of teaching dental students. It is clear that a wide variety of practices and philosophies exist and are used in different parts of the world. Measuring the success of any given process used for student selection remains a challenge. In some parts of the world, certain practices have become an integral part of the tertiary educational system, and have been applied in a similar way by many or all of the dental schools in that country. In other countries, methods vary from one dental school to another, often reflecting differences in the structure and philosophy of the educational system. There was great variation in the combinations of selection criteria used and in student recruitment strategies. However, it was clear that there was much to be gained by learning from the experiences of other dental schools in student selection. Lessons learned, best practices and philosophies used and supporting value systems proved to be very helpful for benchmarking the processes used. In the discussion of student selection, a number of important questions were raised which deserve further thought and reflection both in the ongoing debate and as part of the ever-changing world of dental education. Important new matters that require more debate and research include: a) ethical issues, including the nature of funding from the student perspective, and the concern that in some regions dentistry may become a profession only for the elite or wealthy students. b) Health standards of students entering dental school. c) How realistic is the applicant's sense of dentistry as a profession? d) How accurate is the students' sense of their career opportunities and the employment market upon graduation? Finally, the over-arching question remains, how valid, reliable and predictable are existing selection practices? Will it be practical and meaningful to standardize methods used, or will exchanging ideas as part of this global debate assist the thought process of dental leaders to improve selection practices by learning from the experiences of other schools in different parts of the world? The processes of open debate, sharing ideas and opinions and identifying sound practices across the globe is a powerful catalyst for developing innovative answers to the complex problems posed by student selection and recruitment. A 'virtual' global process with wide input from as many dental schools as possible should improve the efficacy of student selection, and allow dental educators to identify the 'potential' of prospective students and predict more accurately dental student outcomes. The debate that we have started will certainly contribute to providing a knowledge base which dental educators will be able to draw on when reviewing selection processes in their own schools.