Introduction

Most UK dental and medical undergraduates progress into NHS posts involving further postgraduate training. Two key organisations, a higher education institution (university) and Health Education England (postgraduate dental deanery), interface at this transition. It has been suggested that collaboration between these two organisations at this key transition into dental foundation training (DFT) is imperative to facilitate tailored training supporting personal, professional and clinical development.1 This collaboration is now well established in dentistry at Newcastle University and Health Education England, working across north east and north Cumbria (HEE NE) under the umbrella of a dental foundation programme undergraduate liaison group (FPUG).

This article provides the historical context of the relationship between these two key stakeholders in dental education and the establishment of the current positive and productive collaboration. We wish to pass on what we have learned and encourage others in similar roles to initiate and establish this type of group to support learners at a fundamental transition in their clinical and professional development.

Historical context of the group

Prior to the establishment of FPUG, the School of Dental Sciences and what was then the Postgraduate Dental Deanery strove to establish a forum for communication across this interface. This took the format of a large-scale lecture theatre based meeting, involving stakeholders with an interest in the transition to vocational training (now known as dental foundation training). All vocational training trainers in the region were invited along with those members of clinical staff from the school and hospital that were appointed as educational supervisors to trainees undertaking the two-year longitudinal training programme (general professional training).

It is unclear whether formal terms of reference were ever established for this group, as no minutes were recorded. Anecdotally, the meeting became an opportunity for both parties to vocalise criticisms of one another, with discussions often straying beyond the intended context and spirit of the meeting. These interactions were seldom helpful to either party and on occasion generated animosity.

As a consequence, and despite the meetings being held within working hours, many of the trainers and educational supervisors distanced themselves from attending, perhaps demonstrating a lack of interest and further deterioration of the intended relationship. The meetings were perceived to be unhelpful to both parties and abandoned.

In September 2009 the initiative was taken to re-establish a forum using a smaller group of leaders of dental education from the Dental Deanery and University. The initial meeting in this FPUG format included the leaders of final year undergraduate studies, leaders of DFT, three trainers and one educational supervisor representative. The agenda was to discuss the concept of, and define clear terms of reference for membership of this re-established group. As a result of this initial meeting, FPUG made a decision to also invite a final year student and foundation dentist representative to subsequent meetings.

The terms of reference established by FPUG in 2009, and approved by the postgraduate dental dean, were to:

  • Provide a continuum of education

  • Increase awareness of DFT curriculum by the School of Dental Sciences

  • Increase awareness of undergraduate curriculum by trainers, especially with regard to clinical experience, so that trainers may target training

  • Facilitate two-way communication between educators working in undergraduate and DFT settings

  • Work together to support remediation of foundation dentists in difficulty.

Subsequent to this meeting, the purpose, terms of reference and membership have been iteratively redefined to take into consideration changes to the organisational structures of postgraduate clinical education.

Current position

Currently, the purpose of FPUG is described as maintaining a link between Newcastle University School of Dental Sciences and the Directorate of Multi-Disciplinary Dental Education within HEE NE, with the aim of sharing information to assist students and foundation dentists in the transition from undergraduate studies to postgraduate training.

Specifically the responsibilities of the group as described in its current terms of reference, are to:

  • Play an active role in stakeholder engagement

  • Work collaboratively in the development and delivery of initiatives

  • Demonstrate the values and behaviours of the NHS constitution as it conducts its business

  • Maintain clear lines of communication between the two organisations

  • Advise the Postgraduate Dental Dean on matters relating to the DFT undergraduate interface

  • Provide a unique forum for senior members of the staff of the School of Dental Science, DFT programme directors, DFT educational supervisor (ES, formerly known as trainer) representative, trainee representatives and undergraduate representative to share ideas and best practice, and develop proposals for new ways of working and innovation

  • Provide a means of communicating local and national information, procedures and policies relating to dental foundation training.

The membership of the group is shown in Table 1, consisting primarily of leaders of the final year of undergraduate study, leaders of DFT, and leaders of the two organisations which meet at this transition. It also continues to include representatives of ESs, foundation dentists and final year students.

Table 1 Membership of FPUG
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The group normally meets twice a year with hosting alternating between the School and HEE NE. The Chair of the Group alternates between the Postgraduate Dental Dean and the BDS Stage 5 Director depending upon host venue. Between meetings, the members are frequently in communication with each other, including in person, and all members act to disseminate learning and collate feedback from those they represent.

Current key activities

Since its formation the group has had three main areas of activity relating to the terms of reference of FPUG: information sharing; stakeholder engagement; and initiative development.

Information sharing

Significant value has been derived from two-way sharing of information and concerns between the school and HEE NE, both at FPUG and between meetings. Changes in DFT national recruitment,2 satisfactory completion of DFT3 and dental core training4 have been shared with the school by HEE NE, allowing the students to be better prepared for their future career pathways. The results of the 2016 HEE NE Dental Workforce Survey5 stimulated discussion regarding the implications for undergraduate and postgraduate dental training, and workforce development, in the area.

The school has presented helpful information regarding the changing nature of dental student skills (both clinical and non-clinical) and experience upon graduation. This has enhanced the understanding of HEE NE and ESs in practice regarding the skill set of the 'safe beginner' when they commence DFT.6 Both parties have gained an increased awareness of dental educational research which is relevant to the transition to DFT, enhanced through FPUG discussions covering research related to ES expectations of dental graduates.1

Soon after FPUG was formed, arrangements were made for HEE NE to communicate directly with students through Blackboard, the School's online learning environment. However, this was found not to be effective, and alternative communication pathways were enabled via FPUG members and events organised for the students.

Stakeholder engagement

A number of the activities of FPUG have resulted in the two organisations developing a better understanding of each other by engagement in each other's activities. For example:

  • Academic members of FPUG are now involved as external panel members during HEE NE's ES recruitment for training practices, while the Postgraduate Dental Dean now attends the school's executive meetings

  • Where appropriate, practice ESs have been invited to attend the school's Educational Development Day, and dental school/hospital educational supervisors and final year tutors have visited training practices to better understand the foundation dentist training environment.

Attempts to encourage engagement have met with varying success. Practice ESs were invited to visit and observe student clinics, to promote opportunities to become associate clinical lecturers at the school and teach in student clinics. This approach was not successful, largely due to the issues surrounding obtaining observer status, although a similar strategy could be considered again.

Initiative development and impact

FPUG discussions have resulted in a variety of new initiatives which we feel have benefitted all stakeholders, principally in relation to DFT national recruitment, information sharing with the wider groups represented at FPUG, and changes to clinical training. A number of examples of the impact of these initiatives are highlighted here.

With the advent of DFT national recruitment, the school was anxious to assist students in their preparation, without excessively coaching.7 Following FPUG discussions and needs assessment, an annual Professional Development Day including 'mock assessment' opportunities for final year students was developed with input from HEE NE, who delivered a lecture as part of the day about the national recruitment process. Ongoing evaluation of the event through FPUG resulted in ESs who were not scheduled to participate in national recruitment, but who had a clear understanding of the process, delivering the 'mock assessment' to enhance realism. The process leading to these changes is expanded upon in Figure 1, demonstrating the work of FPUG and the two organisations at meetings and outside of them.

Figure 1
figure 1

Establishment of annual Professional Development Day through FPUG

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HEE NE arranged a highly popular final year student visit to their dedicated postgraduate training facility as a result of FPUG discussions which highlighted the lack of student understanding about the DFT year. This was promoted and advertised by the school staff, and facilitated the students gaining a greater appreciation of DFT in general and the local DFT schemes. Students evaluated the visit highly, and reported an increased likelihood of ranking a local scheme first preference in national recruitment after the visit.

Both organisations wished to support students who failed to transition at the expected time, through failure to obtain a DFT place in national recruitment, or deferral, or resitting their final BDS examination. HEE NE provided timely support and reassurance and facilitated a programme of hands-on clinical sessions at their training facility. These sessions aimed to prevent deskilling before applying again to national recruitment. FPUG also considered how the organisations could work together to support remediation of foundation dentists with performance concerns.8 Options considered included direct input from the school, but it was agreed that HEE NE was best placed to support such dentists, through a process which has since informed national satisfactory completion protocols.3

The school took part in 'ES training' and provided summary data on the clinical experience data from their undergraduate portfolio – iDentity.9 This helped to manage ES expectations with respect to the typical volume and range of undergraduate clinical experience, addressing a recognised source of tension between those involved with undergraduate and postgraduate dental education which has caused some to question the competence and preparedness of new graduates.1,10 Graduating students are also encouraged to share their personal clinical experience records from iDentity with their ES.1

Immediately before completion of the undergraduate programme the school now supports final year students to extend their on-going personal development plan into their DFT year, to share relevant information with their ES and incorporate it into their DFT e-portfolio. The format of the student personal development plan has been modified based on HEE NE feedback at FPUG, to align more closely with the expectations of DFT, maximising its value for graduates.

Recently, at the behest of foundation dentists and student representatives on FPUG, HEE NE has produced a checklist of requirements post-graduation and before starting DFT, including items such as when to apply for performer list entry. Also at the request of the foundation dentists, the school has generated a list of specialist contacts from the school and hospital, with whom foundation dentists could make contact to discuss their individual career plans. HEE NE has made this list available to all foundation dentists in their schemes.

The undergraduate curriculum has been modified based on areas of emerging need which have been identified through FPUG. As the business of dentistry came to the forefront,11 with implications for the majority of students who plan to work in primary dental care during DFT and thereafter, this topic was introduced through business enterprise workshops for final year students. The workshops, delivered by experienced general dental practitioners including practice owners, explored topics such as the NHS regulations in primary dental care, practice finances, business planning, and developments in dentistry.

Changes to clinical training have arisen through FPUG discussions, in particular the introduction of clinical refresher sessions for new graduates over summer to address the risk of deskilling before commencing DFT in September. These have been delivered by both HEE NE training programme directors and school staff, including the authors.

FPUG identified that further minor oral surgery training was a common learning need for new graduates, a widely acknowledged finding.1,10,11 Staff within the school became involved with delivering hands on study days in DFT to address this need. A further significant development which arose was the piloting of a Level 2 training programme in oral surgery for local general dental practitioners.

The school recently established a dental education research group,12 and through FPUG several members of HEE NE have become involved with this group and commenced collaborative research.

Discussion

The work of FPUG has been instrumental in fostering ever increasing collaboration between the school and HEE NE. All stakeholders value the close relationship between the organisations which has developed through meeting regularly, sharing information, and working together. Initiatives which have originated in FPUG have been effective in helping to facilitate the transition from dental student to foundation dentist. Notable examples include the annual Professional Development Day to help prepare final year students for DFT national recruitment, and the student trip to the HEE NE facilities at Bourne House.

It is acknowledged that the geography in the North East of England is conducive to this close collaboration between the undergraduate school and DFT. Over 85% of foundation dentists in the HEE NE area have graduated from Newcastle University historically,1 and an ongoing high proportion still having done so despite national recruitment. The benefit of a local group such as FPUG we feel could still be applied in many other parts of the UK, working with multiple universities and HEE local teams if necessary in some regions.

There have been a few areas where FPUG has not achieved the planned outcome, such as not being able to communicate directly between HEE NE and the undergraduate students using Blackboard. However, on reflection this route was perhaps not necessary and we have found alternative ways to communicate more effectively at all levels of both organisations. The plan to encourage more ESs to become associate clinical lecturers in the school was not successful at the first attempt, but we feel this would be worthy of further consideration to strengthen direct links between undergraduate teaching and DFT.

Changes in DFT continue apace,2,3 providing plenty of material for discussion in future FPUG meetings, and in turn generating innovative ways in which the organisations can mutually develop. We recognise the need to review the results of recent collaborative research undertaken locally and nationally on the transition to DFT.7,10,11 This analysis will hopefully generate proposals from FPUG for further local developments in relation to the undergraduate programme or DFT to better facilitate the transition.

Conclusion

By establishing and maintaining this FPUG group, with a small investment in time, all stakeholders involved with undergraduate and postgraduate dental training have benefitted from the positive collaboration. The group has been highly effective at helping to facilitate dental students' transition into DFT in the North East of England and North Cumbria. Formation of a similar group merits consideration in other areas of the UK.