Summary of: Supporting newly qualified dental therapists into practice: a longitudinal evaluation of a foundation training scheme for dental therapists (TFT)

Key Points

• Provides an evaluation of a foundation training scheme for dental therapists and includes a longitudinal view of the work experiences of dental therapists.

• Highlights that dental therapists can feel unprepared for starting work and shows how they benefit from support.

• Voices concerns regarding the challenge of maintaining therapy skills when carrying out mostly hygiene work in practice.

Abstract

Objectives Focused on the dental therapists foundation training (TFT) scheme run by the Postgraduate Dental Deaneries of Oxford and Wessex (NHS Education South Central – NESC) the objectives were (1) to evaluate the TFT 2010/11 scheme, identifying strengths, areas for development and drawing comparisons with the 2009 evaluation; and (2) to follow-up previous cohorts, reporting current work and retrospective reflections on the scheme.

Methods Data were collected from 2010/11 ('current') trainees (n = 10) through group discussion, questionnaire and portfolio extracts. Eleven past-trainees from 2008/09 and 2009/10 took part in a structured telephone interview or responded to questions via e-mail.

Results Data from 2011 consolidated that collected earlier. The scheme was highly valued. Current participants thought the scheme should be mandatory and all past-participants would recommend it to others. Trainees attributed an increase in confidence and ability in their clinical skills to participation in TFT. Current trainees' concerns about finding therapy work were echoed in past-participants' post-scheme employment.

Conclusions At the point of qualification, trainees do not feel well-prepared for starting work as dental therapists. Opportunity to develop confidence and skills in a supportive environment is a key benefit of the scheme. Maintaining ability in the full range of duties requires continued use of skills and the opportunity to do this remains an ongoing challenge.

Main

A. D. Bullock British Dental Journal 2013; 214: E20

Editor's summary

Skill mix, skill mix, skill mix...there I've said it three more times to add to the exponential increase in the use of this term in dentistry of late. The new General Dental Service (GDS) contract and its inevitable emphasis on prevention will mean skill mix is likely to become even more important. I have heard GDPs involved in the contract pilots say that they envisage an increased requirement for dental hygienists and dental therapists as part of any new contract.

With all of this in mind, how do we support newly qualified dental therapists into practice? That is the topic of this paper which looks at the value of a dental therapists' foundation training (TFT) scheme which has been run by the Postgraduate Dental Deaneries of Oxford and Wessex since 2008. The authors have been able to collect data from 'current' trainees (those trained in the 2010/11 academic year), in addition to past trainees in previous academic periods. This allows us to really see the usefulness of the course from the point of view of those undertaking it 'currently' and also those using their skills in practice a number of years after they had completed the course.

This study consolidates the results from the previous cohorts of trainees and confirms that the TFT scheme develops the skills and confidence of dental therapists. Interestingly, the study reveals that dental therapists from past years were finding it difficult to find therapy work in practices. This is well known and previous reports have also identified this problem (for example, a paper by Csikar et al.¹ in this Journal in 2009). There are 2,085 dental therapists registered in the UK at the moment.² What percentage of these qualified therapists have the opportunity to use their therapy skills on a daily basis?

The authors of this study indicate that there is a role for further training of the dental team to ensure that there is a better understanding of the extended duties of therapists and the ubiquitous 'skill mix'. Perhaps in addition to support from schemes such as the TFT, dental therapists could also benefit from the training of GDPs on the work that therapists are qualified to carry out and how they can contribute to the dental team.

The full paper can be accessed from the BDJ website ( www.bdj.co.uk ), under 'Research' in the table of contents for Volume 214 issue 8.

Ruth Doherty

Managing Editor

Author questions and answers

1. Why did you undertake this research?

The promotion of skill mix in dentistry necessitates a workforce of trained, capable DCPs. Foundation training is an essential part of the training of general dental practitioners but is far from universally available for dental therapists. This study provided a follow-on to our initial evaluation of the Oxford and Wessex Deaneries Dental Therapists Foundation Training (TFT) Scheme in its first year of operation (Bullock et al. BDJ 2010; 209: 295-300). Following the first evaluation minor modifications were made to the programme. This study evaluated the amended and more established programme, drawing comparison between the 2010/11 and 2008/09 cohorts and providing a longitudinal review, reporting on previous cohorts' retrospective reflections on the value of the scheme.

2. What would you like to do next in this area to follow on from this work?

The skill-mix landscape is changing and the impending developments to the dental contract are likely to create opportunities for dental therapists. Thus, it is important to further investigate the value and impact of foundation programmes for this group. As more deaneries introduce foundation training for dental therapists, we would like to undertake a national comparison of provision and look at the longer term impact of such training over time. What is also worth exploring is the extent to which shared training across members of the dental team at the foundation stage is appropriate and might be used to support collaboration within the dental team.

Commentary

The benefits of the first year of dental foundation (DF1) (previously known as dental vocational training) for newly graduated dentists have long been accepted. It therefore seems logical to extend the concept to dental therapists (DTs). The Oxford and Wessex Deaneries are to be congratulated for pioneering a parallel scheme for DTs. The scheme started in 2008 and was evaluated in 2009. This paper reports a follow-up study that evaluated the cohort of DTs who completed foundation training (TFT) in 2010/2011 and compared their responses with those from earlier cohorts.

In general, the results of this study were very similar to those of the first evaluation. The DTs were very positive about TFT and suggested that it should become mandatory. They reported that they did not feel that their undergraduate training had prepared them for working as a therapist. It was not mentioned whether or not their undergraduate course had involved any outreach training as this might have helped to make them more confident before they graduated. It was interesting to see that on average the DTs completed a similar number of UDAs to the target for DF1s and that during their TFT they typically worked as DTs for three days per week and as dental hygienists on other working days. Four of the 11 DTs who had previously completed the Oxford and Wessex TFT reported that they were currently working solely as dental hygienists. The paper comments that finding work as a therapist is not helped by GDPs' relative lack of knowledge about the work that they can perform. However, the evidence for this statement comes from studies performed in the early 2000s. It may be that at present the problem is due more to a perception that within the GDS contract it is financially unprofitable to employ a DT. It is to be hoped that if the new system for the GDS, currently being piloted, is introduced, this perception will change and that all DTs have the possibility of using all their skills.