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There is a growing recognition by healthcare professionals of the need to ensure that their skills are kept up to date. While mandatory continuing professional development (CPD) has enforced this within the dental profession to some extent, there has also been an encouraging increase in the number of practitioners opting to undertake further postgraduate training through the completion of credit-rated certificates, diplomas and masters degrees.

Features of postgraduate education and training

For general dental practitioners (GDPs) to embark on postgraduate training, there needs to be a degree of flexibility on offer, with training and assessment undertaken in the workplace wherever possible. Universities, in particular, offer credit-rated, modular courses that may suit the GDP who wishes to complete a taught programme. Many of these courses are structured to allow participants to step on or off the 'skills ladder' as time and finances permit, while retaining educational credits for future use.

The provision of education should also reflect the development of 'portfolio careers', with many practitioners going on to pursue interests in clinically related and non-clinical disciplines, such as research, education and training, and leadership and management. The assessments for the Fellowship of both the Royal College of General Practitioners (RCGP) and the Faculty of General Dental Practice (UK) (FGDP(UK)) allow candidates to select a combination of achievements as reflective of their career in general practice.

Portfolio of evidence

Postgraduate dental education has evolved with an increasing emphasis on the demonstration of competencies through workplace-based portfolios. Key Skills in Primary Dental Care is well established as a distance-learning package, as well as a summative and formative assessment process. Primary care dentists and the dental team are able to demonstrate individually their understanding and application of key skills in dentistry, such as clinical record-keeping and radiography, through the production of an evidence-based and reflective portfolio. This, in turn, informs the development of their working environment.

One of the features of the clinical diplomas offered by the FGDP(UK) is the use of reflective commentaries as part of a personal development portfolio. The purpose of a reflective commentary within a clinical case is to demonstrate that the candidate is able to critically analyse an incident or problem, identify the cause, introduce corrective measures and then, ideally, to demonstrate how this has changed their practice for the better. Ultimately, this enables the practitioner to improve their practice and implement the necessary changes to deliver a higher standard of patient care.

Looking ahead to plans for revalidation, the General Dental Council (GDC)1 states that fitness for registration is likely to include some form of assurance of competence, in addition to knowledge. Satisfactory completion of a portfolio of evidence is one means of fulfilling future continuing professional development requirements.

The emergence of the 'enhanced practitioner'

Traditionally, postgraduate training in dentistry has led to specialisation early on in a dentist's career, with few options available to the generalist for career development. With the introduction of Dentists with Special Interests (DwSIs) came an acknowledgement of the desire among many practitioners to develop enhanced skills, and to have these formally recognised through the acquisition of taught, credit-rated postgraduate programmes or equivalent experience in practice.

The concept of an 'enhanced practitioner' in primary care, with extended skills and training, is receiving increasing recognition...

The concept of an 'enhanced practitioner' in primary care, with extended skills and training, is receiving increasing recognition; both as an alternative to a career in specialist dentistry and for the opportunity it affords generalists to develop their primary dental careers, be it in a clinical or non-clinically related capacity.

Taking this one step further, it would be a logical progression for enhanced practitioners, should they wish, to go on and train as full specialists and/or consultants. In these circumstances, it is appropriate that recognition is given to any previous training and experience when a practitioner is working towards the completion of a full specialist training programme. The continuing development of a training programme for primary care dentists in orthodontics by the British Orthodontic Society and the FGDP(UK), as mapped against the M(Orth), may allow a GDP to progress beyond the diploma level towards specialisation in the future, taking into account training completed en route.

Career pathways for both GDPs and DCPs

The FGDP(UK) has long recognised the vital role of dental care professionals (DCPs) in the delivery of dental care and that dentistry cannot function as a profession without the skills and support of a dedicated team of professionals. In consultation with DCP bodies, the FGDP(UK) has been working to expand its educational initiatives for the wider dental team. As well as developing routes to registration with the GDC, the FGDP(UK) is keen to provide opportunities for advanced training after registration, along with a career development framework, similar to the Career Pathway currently in place for GDPs.

It is also likely that we may see the more frequent inclusion of the dental team into the structure of current training programmes for GDPs. For instance, the FGDP(UK)'s Diploma in Implant Dentistry now incorporates an additional unit where practitioners studying for the diploma are accompanied by members of their team. The two-day event emphasises the importance of the whole team in the effective provision of implants through seminars and practical workshops. This concept may be extended to all clinical diplomas offered by the FGDP(UK), leading to a verifiable and certificated level of training for DCPs relevant to their area of expertise.