Association for Dental Education in Europe

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Safe and Effective Clinical Practice

Dentists are required to ensure that they are capable of providing appropriate care for their patients, whilst also effectively managing and leading the wider clinical team.

The patient‐centred care that is provided should align to a contemporaneous evidence base wherever possible, and the quality of care and the management systems that underpin it should be regularly audited and improved. Dental training is very hands on and in many cases involves irreversible procedures. 

Once access to the clinical environment has been granted, it is expected that the vast majority of student clinical experience will involve preventive and operative care provided to actual patients.

The Areas of Competence in this Domain are described below. They include the following:

  • Evidence‐based Practise
  • Management and Leadership
  • Teamworking and Communication
  • Audit and Risk Management
  • Professional Education and Training

Each of these elements forms part of a wider strategy to continuously improve the quality of clinical care and services that are provided to patients. This wider strategy is often referred to as “Clinical Governance” and should create an environment within which clinical excellence can flourish.

2.1. Evidence Based Practice

Whilst it is important for Dentists to be familiar with the scientific principles that underpin their practise, it is equally important to ensure that they are working to a robust and contemporaneous evidence base. This requires a motivated and interested professional who is willing to seek out new information, rationalise its source and credibility, and apply it suitably to the clinical environment.

The GED identifies 5 learning outcomes within this competence that a graduating european dentist must be able tio demonstrate.

2.1.1. The scientific basis of dentistry

Demonstrate successful engagement with the scientific basis of dentistry, including the relevant biomedical sciences, the mechanisms of knowledge acquisition, scientific method and evaluation of evidence

2.1.2. Apply contemporaneous knowledge

Apply contemporaneous knowledge of basic biological, medical and clinical sciences to all clinical situation

2.1.3. Evaluate validity of industry claims

Evaluate the validity of claims made by industry, primarily in relation to the risk, clinical benefit and cost of products and techniques

2.1.4. Evaluate published research

Evaluate published clinical, scientific and public health‐related research and integrate this information to improve the oral health of the patient

2.1.5 Oral Health Promotion Concepts

Emphasise current concepts of oral health promotion, behaviour change, risk assessment and treatment of oral disease

2.2. Management and Leadership

Effective clinical leadership is increasingly being shown to result in higher‐quality care. Leadership involves setting a vision for the team, and inspiring and setting organisational values and strategic goals. Effective management involves the direction of resources to effectively achieve those goals (Swanwick & McKimm 2010). As the leader of a wider‐healthcare team, the Dentist is responsible for implementing a systematic approach to the delivery of safe, high‐quality patient‐centred, clinical services. This necessarily involves managing people and resources with openness and integrity.

On a very basic level, this means ensuring that leaders/managers and the team are adhering to all local policies and procedures. However, upon qualification, it is expected that Dentists will also be able to deal with minor performance issues, effectively audit local performance and mediate necessary changes.

Five learning outcomes have been identified within this competence that a Graduating European Dentsits must demonstrate. 

2.2.1. The working environment

Establish, manage and maintain a safe working environment

2.2.2. Time and resource management

Effectively manage their own time and resources

2.2.3 Integrated risk management

Effectively integrate other members of the dental team with regard to risk management, for example:

  • working posture
  • visual perception
  • the use of equipment
  • dealing with stress and burn‐out
  • cross‐infection control
  • working with hazardous chemicals and ionising radiation

2.2.4 Raising concerns

Effectively raise concerns in an appropriate manner, at various levels, recognising that those who raise concerns are protected from discrimination

2.2.5 Adverse Events

Manage adverse events in the short and longer term

2.2.6 The practice environment

 

Consider implementing changes within the team and the wider practise environment that will significantly improve efficiency and sustainability of resources

2.3 Team working and communication

As an autonomous healthcare professional, a graduating Dentist is responsible for communicating effectively with their patients, the local healthcare team and allied professionals who are involved with patient‐centred care. Being able to communicate and integrate effectively within a team requires a degree of emotional competence (Flowers et al. 2014). It is expected that new graduates will be ready and able to manage their own patients within a primary care environment. This involves the integration of both verbal and written methods of communication, judgements relating to timekeeping and awareness of their own personal and professional boundaries. Some of the most commonly reported problems with new graduates relate to their inability to know when to seek help, and poor time management (Gilmour et al. 2014)—it is therefore important, on a longitudinal basis, to expose undergraduates to these important elements throughout the delivery of carefully planned and realistic clinical duties. The need to communicate effectively may also extend to wider regulatory and professional organisations, healthcare system providers and insurance companies.

20 learning outcomes have been identified in the the competence.

2.3.1 Leading the team

Effectively lead all members of the dental team

2.3.2 Roles of team members

Describe the role of all members of the dental team, and how they can contribute to a patient‐centred approach to the delivery of safe and effective care

2.3.3 Sharing information

Request and share information and professional knowledge effectively, using verbal, written and electronic methods

2.3.4 Referrals

Initiate appropriate referrals to effectively manage care including concerns regarding abuse and neglect

2.3.5 Laboratory and diagnostics

Request and correctly report on clinical laboratory and other diagnostic procedures and tests

2.3.6 The wider medical team

Effectively engage with the wider medical team, as required, during routine and emergency care

2.3.7 Informed consent

Obtain informed consent by effectively explaining and discussing aspects of treatment planning to patients including risks, benefits and likely longevity of treatment interventions

2.3.8 Explaining dental materials

Effectively explain to patients the properties of commonly used dental materials, their risks and intended benefits

2.3.9 Educate patients

Educate patients at all stages in their life, emphasising current concepts of oral health, prevention, risk assessment and treatment of oral disease

2.3.10 Assess patients developmental characteristics

Assess and take account of the intellectual, socio‐emotional and language development of patients

2.3.11 Managing Patient Needs

Effectively manage patients whose needs, desires and requirements may influence the planning and delivery of routine dental care

2.3.12 Patients role in prevention

Increase the patient's awareness of their own role in the prevention of oral disease, creating personalised methods and approaches for each patient where possible

2.3.13 Referral to specialist

Explain and discuss the need for advanced procedures and know the appropriate and proper method of timely referral for specialist care

2.3.14 Patient monitoring and maintenance

Evaluate the results of treatment and establish an effective monitoring and maintenance programme for patients, in cooperation with the wider dental team where appropriate

2.3.15 Acute oral conditions

Manage acute oral conditions, including appropriate communication for patient referral and prescription of drugs

2.3.16 Counsel patients

Counsel patient's regarding the nature and severity of their diseases and disorders, providing the patient with realistic options, expectations of how these are managed, and likely prognoses

2.3.17 Communicate with laboratories

Communicate effectively with a laboratory technician to design and prescribe appropriate restorations and appliances

2.3.18 Quality control of prostheses

Conduct effective quality control of prostheses (fixed and removable) and appliances, including dental implants and their associated components

2.3.19 Train workers in oral health promotion

Train allied dental and medical healthcare workers in basic skills of oral health promotion

 

2.3.20 Professional approach

Display appropriate professional behaviour towards all members of the dental team and in their dealings with other allied healthcare workers

2.4 Audit and risk management

Risks to patient care can be minimised through effective risk management. This necessarily includes Dentists being able to identify when things are going wrong, why they have happened, and what to do in order to prevent adverse events from happening again. Clinical audit is a process of measuring and monitoring the quality of care that is provided against a set standard, or previous performance—and this is an essential first step in identifying systematic risks to safe and effective patient‐centred care.

A graduating Dentist must be able to demonstrate seven learning outcomes.

2.4.1 Patient records

Produce and maintain an accurate, contemporaneous and secure patient record, in accordance with any legal requirements

2.4.2 Radio-graphic and diagnostic images

Interpret, grade and audit radiographic and other diagnostic images

2.4.3 Manage clinical environment hazards

Effectively communicate and manage the hazards within the clinical environment including cross‐infection control, use of hazardous materials and working with ionising radiation

2.4.4 Quality control

Conduct quality control of customised appliances

2.4.5 Dental equipment maintenance

Check and implement maintenance of, dental equipment in a timely manner

2.4.6 Patient satisfaction

Evaluate the satisfaction/dissatisfaction of those directly involved with patient‐centred care, including relatives and carers

2.4.7 Audit and clinical governance

Interpret, implement and disseminate aspects of audit and clinical governance

2.5 Professional education and training

It is essential that graduating dentists are familiar with the process of continuing professional development (CPD), appraisal and professional development planning. Graduation is considered to be a “springboard” leading to a period of lifelong learning, underpinned by this professional and academic development, achieved through the acquisition of quality CPD (DentCPD 2013). Graduates should therefore be in the habit of continually assessing and updating their knowledge and skills to keep up to date with the latest developments and evidence‐based practise. It is also important that Dentists are motivated and interested to learn and develop new skills for themselves and to facilitate this process for the wider dental team.  Four learning outcomes have been identified.

2.5.1 Use of technologies

Use contemporary information technology for documentation, continuing education, communication, management of information and applications related to health care

2.5.2 Review knowledge and skills

Review the knowledge and skills base (their own, and that of the wider team) and seek additional information/training to correct any perceived limitations

2.5.3 Performance appraisal

Effectively appraise performance (their own, and that of the wider team) and seek additional training/support to correct any perceived deficiencies

2.5.4 Record of clinical achievement

Demonstrate a “record of clinical achievement,” ideally through the use of a contemporaneous portfolio of clinical activity and reflection; something to use with pride and to be of value as a learning tool that impacts positively on their future and continuing clinical and professional practise.

© ADEE 2019

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