Sir, your recent interesting case1 is not unique but, rightly, malingering and factitious disorders should always be borne in mind. However, I would respectfully point out that such teaching has been available certainly in the UK dental schools in Bristol, Edinburgh, Glasgow and London (now KCL, QMUL, UCL) where I have worked with undergraduates and postgraduates, and is available in standard texts.2 Additionally, globally most graduates do realise it is their responsibility to pursue continuing development/education.

However, it is not only patients that are subject to such behaviour. I recall one student who moved to a hospital elsewhere after graduation, who was taken to task over radiology malpractice but who denied any teaching in that subject. The student failed to bargain that we kept records not only of the display of radiology teaching boards in public areas for a year; but also teaching attendances in the topic and results of their mandatory final examination question on the topic. Of course many are now within the 'blame culture'.