Introduction

Vocational Training (VT) became mandatory in 1993 for all newly qualified graduates wishing to be entered on to a Health Authority list to practise dentistry as an associate or principal. Currently, the management of the VT procedure locally is through the NHS postgraduate deans and centrally by the DVTA in England and Wales, and similar organisations in Scotland and Northern Ireland, although new arrangements will be introduced.1

Vocational Dental Practitioners (VDPs) immerse themselves into practice life within approved training establishments during a one-year programme. The assistance of a trainer helps provide support through tutorials and with clinical advice and help when necessary. The more formal component of vocational training is the day release programme that includes a minimum of 30 postgraduate training days spent in the majority at regional postgraduate centres.

The aims of dental VT for the General Dental Service (GDS) are to enhance clinical and administrative competence and promote high standards through relevant postgraduate training to meet the needs of general dental practice.2 The basis for VT is to provide new undergraduates with a structured training programme that allows gradual progression to independence within a protected environment. Although the majority of VDPs will be entering VT within the GDS, some will also be completing the scheme in the Community Dental Services (CDS). The Armed Forces also run a scheme organised by the Dental Defence Agency. These both have complete equivalence with VT training in GDS.

For those graduates who wish to gain experience in either the Hospital Dental Services (HDS) or CDS whilst keeping future career options open, a number of General Professional Training (GPT) schemes operate. These offer various permutations ranging from an integrated two year training pathway to an additional 'bolt on' year after VT, or a hybrid of the two. A further option after graduation is to work as an assistant employed by a principal practitioner under whose NHS contract number they work. An NHS contract number can only be obtained if the assistant is able to demonstrate 'equivalence' to the skills acquired by a dentist undergoing VT. This would involve attending the specified number of postgraduate courses similar to those undertaken by VDPs, and also evidence of a degree of supervision within general practice. 'Equivalence' is at present awarded by the Dental Vocational Training Authority (DVTA) although, as Ladwa1has recently highlighted, with the demise of the DVTA, this arrangement ceases. Instead responsibility for ensuring appropriate standards will lie with the deanery.

Following the selection of Vocational Trainers, the local postgraduate deaneries release a list of approved training practices between March and April each year that are available directly from the deanery or on the internet. Candidates are invited to apply directly to the trainers and interviews are then conducted purportedly using a person specification and ensuring equal opportunities legislation is adhered to. Some regions hold open days or 'job shops' where potential trainers and trainees can meet in an informal environment. Schemes in Scotland operate a 'matching scheme' where an attempt is made to match the potential VDP's preferences for a trainer to the trainer's preference of candidate. The majority of graduates commence VT in July/August and the remainder in January/February. VT is normally completed over a period of one year full-time or, exceptionally, over two years part-time.

In order to benefit from the opportunities provided by vocational training, undergraduates require guidance as to what will make the best training environment, as well as how to approach the application process. This could include advice and support on writing a curriculum vitae and interview techniques. Additionally, as VT is not necessarily the only route followed by dental graduates, career advice and information on alternatives before deciding future career pathways would be highly beneficial.

It is widely accepted that VT is a highly successful scheme, satisfying its aims to enhance both clinical and administrative confidence of newly qualified dentists.3 However, anecdotal reports from students suggest much discontentment and confusion regarding specifically the VT interview process in the months before finals.4 Previous local studies have revealed how VDPs considered that the list of practices offering VT was not published at an optimum time, although no clear consensus was reached as to when the best time was. This issue needs to be countered by the problems for the incumbent VDP who would have to decide before Christmas, ie only a third of the way into the VT year, whether he or she would be staying on at the end of the VT year. A further area of concern was the time, effort and money invested in visiting large numbers of practices in the run up to final examinations.5 One of the key findings of a study into how vocational training arrangements in Scotland were working also revealed how the matching scheme was considered inefficient and was distrusted by candidates.6

Given the importance of VT on the career development of dental graduates, information on how prepared they were for this stage of their careers would be of benefit to those involved in undergraduate education. This would identify problems and help ensure that undergraduate education is appropriate for a seamless transition from undergraduate to postgraduate life. This study sets out to investigate the experiences and feelings of a cohort of undergraduates on their level of support received at UK dental schools for VT as well as their impressions of the overall selection process.

Method

This study used a self-completed questionnaire that was sent to every VDP working in the GDS in the academic year 2004. The questionnaires were sent to all course advisors in England, Wales, Scotland and Northern Ireland in November 2004 with a covering letter asking the individual to distribute the questionnaires to their group. The structure of the questionnaire was decided following structured interviews with 12 VDPs from a South London scheme. Once completed the trainee was asked to return the questionnaire in the stamped addressed envelope provided. Confidentiality of responses was assured. A follow-up questionnaire was sent to non-respondents in pre-paid envelopes in January 2005. The data were subsequently entered onto a computer and analysed using the statistical package SPSS.

Results

The results are presented in two sections. First, analyses of the perceived level of undergraduate preparation for vocational training are provided. This section covers issues such as whether advice was given on obtaining a VT number, curriculum vitae preparation, interview techniques and choosing a suitable practice. The second section covers the graduates' perceptions of the application process. A total of 434 questionnaires were returned, a response rate of 64%. Respondents qualified from all 14 dental schools in the United Kingdom; 17 (4%) were overseas graduates (Table 1).

Table 1 Distribution of respondents by school of qualification
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Preparation for vocational training

When asked whether the undergraduate school provided them with appropriate information prior to making a vocational training application, considerable shortfalls were found. Seventy-three per cent responded that they felt that they were given insufficient advice with regards to options in obtaining an NHS number and 38% on curriculum vitae preparation. Sixty-two per cent felt that they were given inadequate help with interview techniques and 60% on helping choose a suitable practice. There was considerable variation between the schools. In all categories, foreign graduates reported the lowest level of support in their preparation for obtaining a VT post. However, the level in home students was in some cases equally as poor. For example, over 80% of vocational trainees qualifying from the two London undergraduate schools felt the information they had been given was insufficient while only 55% of VTs from Newcastle felt this to be the case. Over 90% of graduates from Leeds felt that they had had adequate curriculum vitae technique preparation while only 21% from Liverpool felt this to be the case.

Over 70% of graduates from Manchester felt that they had appropriate help with interview techniques while only 10% of Liverpool qualified VTs felt this to be the case. Sixty-one per cent of graduates from Dundee and Leeds felt that they had had sufficient help with choosing a practice, while the lowest percentage was that reported by graduates from GKT (24%). A full breakdown of information by area is given in Table 2.

Table 2 Percentage of respondents who felt that the level the information they were provided with by the undergraduate school was sufficient by subject area
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When asked about the usefulness of the source of information regarding VT, peers were felt to be most useful (Fig. 1). Over 50% felt that their peers were either very useful or useful while 32% felt that university staff were not useful or useless. The scale used ranged from 1 (very useful) to 5 (useless). The mean and standard deviation scores for each source are shown in Table 3. For peers the mean score was 2.64, (s.d. 1.25), while for the dental association the mean score was 3.01 (s.d. 1.08), and for university staff, mean score 3.03 (s.d. 1.12). The differences between the peers and the other two sources were significantly different at the p = 0.05 level.

Figure 1
figure 1

Distribution of scores on the perceived usefulness of three sources of information regarding Vocational Training

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Table 3 Mean and standard deviation scores of usefulness of source for information on Vocational Training (lower score is better)
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Table 4 shows the preference of the respondents on the format that would prefer information on vocational training to be delivered to them. Sixty per cent would prefer a lecture; the least popular format for delivery was through web based source material.

Table 4 Percentage distribution of preferred source of information on Vocational Training
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The application process

The overwhelming majority of graduates (83%) felt that the regional lists of vocational training places should be published on the same day throughout the country. Twenty-nine per cent approached a potential trainer prior to the publication of the job lists. Forty-six per cent found that on contacting the potential trainer, the post had been filled and 7% accepted a position prior to the publication of the job list. Forty-one per cent of those who responded attended a job shop with 75% of those who did attend finding it beneficial. Several benefits were listed by respondents, the most common of which was meeting the trainer. All respondents who attended the job shop reported that their attendance resulted in a job interview.

When attending for an interview, 37% were able to speak to the previous VDP privately at the interview with over 86% of this group reporting this to be a useful exercise. Two thirds of respondents felt that some positions were already filled although the trainers continued to interview other candidates.

Fifty-five per cent of candidates accepted the first offer they received. Twenty-two per cent reported accepting the offer on the spot while 18% were informed within a day. Sixty-six per cent felt this was an acceptable time period. Fifty-eight per cent were told by the trainer who conducted the interview about the success or otherwise of their appointment. Only 16% were given any feedback although 90% felt that they would have benefited had it been given.

Discussion

In general, UK dental students perceived the level of preparation received at university for VT application to be poor. These results are worrying given that for many undergraduates, leaving the familiar surroundings of a dental school and entering into professional life is the most challenging transition since applying for university.

At such an early stage in their career, they should be guided into an educational environment they find challenging, stimulating and supportive with a trainer they can respect and trust. Such information is available from professional organisations, for example the British Dental Association, who provide a CD-ROM called Getting your first job. Similar publications exist from both Dental Protection and Dental Defence Union. Web based material, for example that found at http://www.instantcv.co.uk, can also be useful. However, students reported that the most preferred method of obtaining this information would be through a lecture, probably due to its convenience. This is hardly surprising considering the time limitations that exist in the run up to finals, a period already fraught with anxiety and stress, where a lecture can potentially conveniently deliver a large amount of up-to-date information.

The most important criterion that has been reported by trainers in the selection of a potential VDP for interview is the CV.5 Students would benefit from appropriate instruction in the production of such a key document, as it is often the only information available to the trainer on an applicant before assessment can be made on whom to select for interview. However, the undergraduate schools fare poorly on this aspect with nearly 80% of graduates from one school feeling that they were ill prepared. The downside of such a suggestion would be the potential move to standardisation making it difficult for applicants to 'stand out'.

Students also need guidance in choosing a practice they will be happy in both socially and professionally. This decision is generally heavily influenced by financial, geographical and cultural considerations; however, students may have preconceived ideas about what they understand to be an 'ideal' practice. At dental school they become accustomed to working with materials and equipment of a particular standard with fully trained support staff treating a particular group of patients. This environment may be in sharp contrast to the realities of general practice life although it should be acknowledged that trainees have a full time nurse and can practise four-handed dentistry. The VT interview is also an important area where educational input for the potential trainee should be taking place, yet the undergraduate schools appear to be failing to provide adequate preparation.

Application process

For most candidates, the VT lists are published at a time when their primary concern is revision for the impending final examinations. This then has to be balanced with applying for jobs and attending interviews, adding to the pressures of a particularly stressful period. This disruptive effect on both teaching and stress levels has been previously demonstrated.5

Concern was raised by the respondents on dealing with funding the substantial transport costs incurred when attending interviews. The interviews are held at a time when those in receipt of an LEA loan are not entitled to Jobseekers' Allowance before graduation. This is a particular worry given that the average student debt upon graduation is now reaching substantial sums.7,8

Although the majority of the VDPs involved in the study believed that the job list was not released at an ideal time, there was no clear agreement on a more convenient date. The most common suggestion was the January-March period. However, at such an early stage in the VT year, it is difficult for both trainer and trainee to make a decision about what will happen at the end of the year. The next most common time recommended for job list publication was after finals' results. However, in many dental schools, results are released at the end of June with VT then commencing in August, that allows only a limited time period to apply for jobs and attend interviews. Nevertheless, previous studies have demonstrated that VDPs are generally happy to apply for VT positions without a qualification, despite their concerns regarding the publication date.5 This may be counterproductive for the trainers given the potential expense of having an unfilled post.

It could be argued that trying to establish an optimum publication date is futile considering the large numbers of students who obtain the previous year's list to contact trainers and procure a VT place prematurely. This is time consuming and disruptive to both potential trainer and trainee but would not occur if both trainers and potential VDPs refused to allow the process to operate. It is thus important to consider whether those students and trainers who comply with the rules and regulations outlined by the DVTA are already disadvantaged within this already fiercely competitive job market.

The questionnaire also revealed that a large number of VDPs suspected that many trainers continue to interview after a job has been offered, which is consistent with previous findings.5 Students within the same year at university will commonly apply for the same posts, and thus such information about job offers and acceptances becomes widely known. There are also anecdotal reports of trainers giving the impression to potential trainees that they will be offered the job at their practice but then eventually offering it to another candidate instead.4 Conversely, it has been suggested that students have also been known to accept positions but then breach this contract by accepting other offers in order to keep their options open.

The results from this study have demonstrated how many students found that on contacting a trainer the advertised position had already been filled. This is either a result of the organisational material detailing VT appointments not being continuously updated, or a result of trainers accepting applicants prematurely. Furthermore, there have been reported incidents of trainers cancelling scheduled interviews because the position has been given to another applicant.

Recent modifications to this application process have included regional 'job shops'. Although this has been a largely successful addition, suggestions for improvement included using a larger venue for the fair with pre-allocated time slots for each meeting. This could however, be difficult to organise considering the large numbers of applicants visiting the fair. A variation to the usual application process is the 'matching scheme' that operates in Scotland. Similar to the findings of previous studies, students questioned the reliability and efficiency of such a scheme that they perceived to only benefit the trainers, as pre-arranging of appointments was considered a significant problem.6

Upon gaining an interview, further problems were encountered. The results revealed that the majority of candidates were not able to talk to the previous VDP at the time of interview, despite the potential considerable benefits. A conversation between potential and existing VDPs in an informal environment would be an ideal opportunity to discuss the realities of working within that particular practice from the perspective of a newly qualified dentist.

It has also been reported that trainers give students only a very short period of time to make a decision once an offer has been made. The majority of participants in the study were forced to decide within two days or on the spot. While this was considered to be appropriate by some candidates, a potential reason for this may be sheer relief of having secured a job, perhaps highlighted by the fact that 55% of candidates accepted the first offer they received. In the run up to finals, the major priority for most students is revision: financial considerations may persuade many to accept the first job offered. Placing further pressure on students to make such a crucial decision in such a short time period is perhaps misplaced given the importance of this, their first position.

Another concerning element to this application process is the lack of established protocol regarding communication following a VT interview. Students fully appreciate being made aware if unsuccessful, but there does appear to be a general lack of agreement between trainers and applicants as to whether this is actually being achieved or not. Furthermore, it also seems that students are given no explanation of why they were not given the post. This is disappointing to learn as the VT specifically promotes peer and self-review to develop the critical and self-appraisal skills necessary for good practice. In this way the application process should be considered a learning process where, according to Mullins,9 without effective feedback there can be no learning.

Conclusion

This paper aimed to summarise the views of young practitioners on their level of preparation for vocational training, which has historically been felt to be highly successful. A number of shortcomings exist which do not require any major investment in resources: a series of lectures and closer working relations between the undergraduate schools and the vocational training system would alleviate the shortcomings and improve this system.

Co-operation and collaboration between postgraduate deaneries, the undergraduate deans, trainers and trainees will be required. It is the responsibility of the postgraduate deaneries to ensure that the regulations of the application and selection process are appropriate, monitor problems regularly and taking remedial action where necessary. Trainers and trainees must also aim to adhere to the rules of the system and understand the consequences of their actions on the process.