What I wish I'd learned as an orthodontic trainee: an online survey of British Orthodontic Society members concerning postgraduate training experiences

Survey of National Health Service (NHS) orthodontic practitioners in Wales, UK. Part 2: job satisfaction perceptions of the workforce 2021-2022

OBJECTIVE

To ascertain the perceptions of the Welsh NHS orthodontic workforce regarding their job satisfaction and work life balance.

DESIGN

Descriptive cross-sectional survey.

PARTICIPANTS AND SETTING

Clinicians providing NHS orthodontic treatment in Wales.

METHODS

An anonymised, email-distributed, electronic, two-part survey (onlinesurveys.ac.uk) of the Welsh NHS orthodontic workforce working within Wales was undertaken. The survey consisted of three sections: (1) demographic information (part 1); (2) respondents' working pattern (part 1); and (3) perceptions of professional job satisfaction and work/life balance (part 2). The responses received were exported into an Excel spreadsheet for descriptive analysis. The free-text comments were collated for each question and subsequently underwent a content analysis to identify any common themes.

RESULTS

Part 2 of the survey yielded an overall response rate of 69.6% (n = 78). Over 96% (n = 75) of respondents felt that they had 'made the right career choice, including 100% of orthodontic trainees, orthodontic specialists and orthodontic consultants. Of the respondents, 88.5% (n = 69) said they 'enjoyed going to work', with the remaining being mostly neutral in their opinion. Of the respondents, 79.5% (n = 62) felt they were able to 'provide their patients the optimum care' and 64.1% (n = 50) felt that more demands were being placed upon them by patients and parents. Overall, 52.6% (n = 41) of survey respondents believed it was becoming increasingly difficult to achieve an effective work/life balance, and this was more prevalent among male respondents (61.5%, n = 16) than female respondents (48.1%, n = 25), although this difference was not statistically significant (P >0.05).

CONCLUSIONS

Over 96% of respondents felt they have chosen the right career and that flexibility and a good working environment are important to job satisfaction. Respondents felt that there are increasing demands being placed upon them by patients/parents, employers, the Regulators, the Government and Health Boards. This is leading to increased difficulty in achieving a satisfactory work/life balance, especially among male respondents.

Usage of temporary anchorage devices: A cross-cultural and cross-sectional survey of orthodontists in Australia and the UK

INTRODUCTION

Detailed insight regarding the use of temporary anchorage devices (TAD) in Australia and the United Kingdom (UK) is lacking. The primary aim of the present cross-sectional survey was to investigate TAD usage among UK-based and Australian-based orthodontists. The secondary objectives were to compare TAD-related preferences and protocols between orthodontists in the two countries.

METHODS

A pilot-tested electronic questionnaire was distributed to members of the British Orthodontic Society and the Australian Society of Orthodontists. Questions pertained to their demographic details, and current use of TADs including protocols, treatment objectives and factors influencing their use.

RESULTS

A total of 192 responses were recorded (Australia: 122; UK: 70). One hundred and forty-two respondents (74.0%) reported using TADs as part of their orthodontic treatment, 77.0% in Australia (n=94) and 68.6% in the UK (n=48). Molar protraction was the most common procedure for which TADs were reportedly used (Australia: n=118; 87.2%, UK: n=36; 75.0%). "Loosening" was the most prevalent reported complication overall (n=124; 90.1%). "Confidence", "insufficient postgraduate education" and "availability of equipment" were the factors that most influenced the decision not to provide TADs.

CONCLUSIONS

Most orthodontists in both countries provided TADs. TAD protocols of orthodontists in both countries were reported. Similarities and differences regarding TAD-related clinical practices and procedures, complications and factors influencing the use of TADs and reasons for not using TADs were explored. Information from the present study can provide baseline data for future related studies in each country and for comparison of TAD usage in other countries.

Clear aligner therapy practice among orthodontists in the United Kingdom and the Republic of Ireland: A cross-sectional survey of the British Orthodontic Society membership

OBJECTIVE

To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS).

DESIGN

A cross-sectional online survey.

METHODS

An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems.

RESULTS

Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy.

CONCLUSION

CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.

Satisfaction of orthodontic Post-CCST training: A survey of trainee perceptions

INTRODUCTION

This survey was undertaken as a second part to 'Barriers to Post-CCST training in orthodontics: A survey of trainee perceptions'. Recruitment of Post-CCST trainees in certain areas of the country has attracted concerns as it has become increasingly difficult. This survey was undertaken to assess trainee satisfaction with Post-CCST training and to look at possible ways to improve trainee satisfaction and make Post-CCST training more desirable.

METHODS

The Training Grades Group (TGG) committee of the British Orthodontic Society (BOS) produced an online survey that was sent to all TGG members and newly qualified consultants in May 2021. All Post-CCSTs who entered training between February 2017 and October 2020, were asked to complete the survey.

RESULTS

There were 37 respondents, which gave a response rate of 62%. While 61% of respondents were satisfied with their Post-CCST training, 17% were 'neither satisfied or dissatisfied' and 6% were either 'dissatisfied' or 'very dissatisfied'. Of the 37 respondents, 25 (67%) would apply for Post-CCST training again, 6 (16%) would not and 6 (16%) did not answer this question. When asked for possible suggestions for improvements to Post-CCST training to encourage greater satisfaction, the responses could be grouped into the following themes: Part-time training; Teaching; Time commitment; Salary; and Experience.

CONCLUSION

In general, respondents were satisfied with Post-CCST training. There was a significant range of positive and negative responses to various aspects of training including multidisciplinary team clinic preparation, support, supervision and management experience. Suggestions for improvements echo the barriers to Post-CCST training survey.

Orthodontic clinicians' attitudes and knowledge of dentogingival aesthetics: A cross-sectional survey of BOS members

OBJECTIVE

To assess orthodontic clinicians' knowledge and attitudes towards dentogingival aesthetics and to explore characteristics that predict the knowledge of dentogingival aesthetics.

DESIGN

Cross-sectional questionnaire.

SETTING

On-line survey of members of the British Orthdontic Society.

MATERIALS AND METHODS

An 11-item online questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered respondent demographics and questions relating to both knowledge and attitudes towards dentogingival aesthetics (six parameters). Descriptive statistics were calculated for study characteristics and summary values for the survey items. Responses to the eight knowledge-based questions were converted to a binary outcome (correct and incorrect answer). The maximum score that could be achieved was eight. Multivariable modelling was used in order to examine associations between the study characteristics and the aggregate score.

RESULTS

A total of 252 responses were obtained resulting in a response rate of 17%. Within this cohort, the respondents were primarily women (52.8%) and aged 30-40 years (35.7%). The mean score for the eight knowledge-based questions was 3.8 ± 1.8 (range = 0-8). Knowledge of the ideal gingival margin position of the anterior teeth was high (92.4%). Knowledge of the other five dentogingival aesthetic parameters was variable. In the multivariable analysis, lower knowledge scores were predicated by respondents who did not have a special interest in dental aesthetics (-0.54; 95% confidence interval [CI] = -1.01 to -0.07; P = 0.02), who could not recall attending courses, lectures or seminars on dental aesthetics in the past five years (-0.80; 95% CI = -1.43 to -0.17; P = 0.01) and with increasing age (-0.43; 95% CI = -0.62 to -0.23; P < 0.001).

CONCLUSION

Knowledge of ideal dentogingival parameters is generally suboptimal among orthodontists in the UK. The reported lack of knowledge of the ideal dentogingival parameters may also influence respondents' attitudes towards the importance of dentogingival aesthetics. Further teaching or courses related to dentogingival aesthetics is desired by orthodontic clinicians.

Postgraduate orthodontic education: An international perspective on content and satisfaction levels

BACKGROUND

There is significant international variation in the postgraduate orthodontic training. The aim of this study was to obtain information relating to the design, content, and delivery of formal postgraduate orthodontic training internationally. Moreover, we aimed to evaluate the perception of orthodontists towards their training as well as identifying factors associated with an improved level of satisfaction.

METHODS

A 42-question survey was sent to orthodontists worldwide via SurveyMonkey. The survey was circulated on orthodontic Facebook groups and through other digital channels including Instagram.

RESULTS

A total of 168 respondents completed all sections of the questionnaire. The vast majority believed programme length was appropriate (n = 150; 89%). Most respondents were confident with their research skills and in their ability to diagnose and treatment plan. Social media was frequently accessed by the respondents for the purposes of orthodontic education (n = 83; 49%). A high proportion (n = 70; 42%) did not treat any clear aligner cases during postgraduate training with many having experience using InvisalignTM only. The majority of respondents across the regions had training in buccal miniscrew insertions. Exposure to three-dimensional printing during residency was limited.

CONCLUSIONS

The study offers an overview of the structure, content, and modes of delivery in orthodontic postgraduate training internationally. While satisfaction levels are good, there is a disparity in terms of exposure to certain techniques internationally. Further training in the modern diagnostic approaches and mechanics may improve satisfaction with postgraduate training.

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.

Illustrates the perceived effect of the COVID-19 pandemic on final year students' preparedness for practice and the impact it may have on dental foundation training through quantitative and qualitative methods.

Highlights and explores the differences in the perceptions of preparedness for practice of final year students across sex, age and course length.

Explores various aspects of clinical supervision and assessment and reinforces the importance of appropriate student-staff ratios to ensure clinical learning is effective.

The COVID-19 experience of orthodontists in the UK

OBJECTIVE

To understand and compare the perceived impact and ongoing effects of the COVID-19 pandemic on orthodontic clinical services in the UK.

DESIGN

Descriptive cross-sectional survey.

SETTING

Online electronic questionnaire.

PARTICIPANTS

Members of the British Orthodontic Society (BOS).

METHODS

Electronic questionnaires were circulated between March and June 2021. The UK survey was distributed via emails from the BOS, Orthodontic Managed Clinical Networks and WhatsApp groups.

RESULTS

A total of 560 unique responses were received. There were more respondents who were aged over 50 years (52%) then respondents who were aged below 50 years (48%) with the median age range being 50-54 years (20%). The main causes of disruption to clinical practice were felt to be national restrictions (85%), increased cross-infection measures (84%), social distancing (80%) and professional guidance (80%). Respondents felt more negatively in their opinions regarding dentistry's preparedness for the pandemic (5%) and how dentistry coped in the crisis (35%), when compared to orthodontic services specifically (8% and 58%, respectively). The respondents were not confident about the potential beneficial effects of a vaccination programme on orthodontic clinical service provision (21%). Telephone consultations (84%) and video consultations (61%) were the main adaptations used by the respondents during the pandemic.

CONCLUSIONS

Respondents felt that COVID-19 will have long-term societal, clinical and professional implications. The majority of our respondents supported the vaccination and weekly testing of the orthodontic team. Respondents felt that during the pandemic there had been a deterioration in care provision and were not optimistic about a vaccination programme restoring services to pre-pandemic levels of activity. During the pandemic, patients in active orthodontic treatment have been prioritised but at the expense of new and review patients, and as services recover respondents were concerned about the difficulty of arranging dental extractions.

The perceptions of undertaking a higher degree alongside orthodontic speciality training: a cross-sectional survey of British Orthodontic Society members

Introduction In the UK, orthodontic speciality training takes place over three years full-time. In addition to the clinical training, there is an expectation that trainees undertake a higher degree. Currently, there is little evidence regarding the impact of undertaking a higher degree on specialist orthodontists.Aims Investigate UK orthodontists' perceptions of undertaking a higher degree alongside speciality training.Materials and methods A cross-sectional research study involving the distribution of an anonymous, descriptive, online, questionnaire-based survey between May and June 2021 via the British Orthodontic Society. Data were obtained in relation to the impact of undertaking a higher degree on the completion of speciality training, research skills, delivery of patient care and career opportunities.Results In total, 166 questionnaires were completed (approximately 13.3% response rate). Most respondents 'agreed' or 'strongly agreed' that undertaking a higher degree had improved their scientific (77.1%) and critical appraisal skills (80.7%), job prospects (60.2%) and career opportunities (63.9%). Most respondents felt the benefits of the higher degree outweighed the associated costs (65.1%) and was a worthwhile component of training (69.3%).Conclusions Specialist orthodontists place a high value on undertaking a higher degree. The results of this questionnaire should be of importance to stakeholders involved in the development of the orthodontic curriculum.

The Journal of Orthodontics: A cross-sectional survey of British Orthodontic Society members

Objective:

To survey the opinion of British Orthodontic Society members on the Journal of Orthodontics.

Design:

Data collection involved an anonymous cross-sectional online SurveyMonkey™ questionnaire.

Methods:

An email invitation to complete the survey was sent to the 1842 members of the British Orthodontic Society on 9 June 2020 with a follow-up reminder on 15 July 2020. The invitation contained a brief description and online link to the questionnaire, which was active between 9 June and 9 August 2020. The 15-item questionnaire covered frequency of reading, preferred format, likes and dislikes, and what changes might improve the Journal. Data were analysed for the membership as a whole using simple descriptive statistics.

Results:

In total, 310 individuals completed the questionnaire, representing a response rate of 17% with 74.2% (n = 230) reporting reading at least one article per issue. The most popular way of reading the Journal (77.4%, n = 240) was through the distributed print copy. Overall, 63.6% (n=197) rated the Journal as excellent and 35.2% (n = 109) as satisfactory, with only 1.3% (n = 4) responding that it was poor. The scientific and clinical articles were the most popular aspect of the Journal and 90.3% (n = 280) of respondents felt the Journal content was relevant to their current clinical practice. Respondents were also given the opportunity to make additional free-text comments; and themes that emerged included a wish for more clinical content, more online interaction with authors through webinars and continued professional development.

Conclusion:

The Journal of Orthodontics is perceived as being relevant to current clinical practice by members of the British Orthodontic Society and has high-level satisfaction. There is a desire for more online interaction with the membership as part of its role within the society. However, the overall response rate was low and therefore a high risk of potential bias associated with this survey.