“The Graduating European Dentist” specifically stresses the importance of Patient‐Centred Care.
This approach is becoming increasingly prominent within the literature and within policy documents and is defined by the Institute of Medicine (2011) as “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”
Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide.
The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. The degree to which a dentist can assess and discriminate patient emotion will undoubtedly affect the quality and accuracy of history taking. The ability to read and manage emotions is therefore considered to be an important skill for any healthcare professional (Birks & Watt 2007).
In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient‐centred care (Scambler 2016). This often results in patients being more satisfied and more likely to actively participate in their treatment (Cuevas et al. 2017, Brunett & Shingles 2016).
The Areas of Competence in this Domain are described below. They include the following:
- The Scientific Basis of Oral Health Care
- Clinical Information Gathering and Diagnosis
- Treatment Planning
- Establishing and Maintaining Oral Health
The scientific basis of Dentistry is vast, and within this Domain the recommendation is made that educators refer to specialist societies and the curricula/guidelines, that they have published.
it is recognised that integrating relevant science teaching into an outcome‐based curriculum can be challenging, and vertical integration is recommended in order to provide a coordinated appreciation of structure‐function‐disease relationships (Bennett et al. 2016, Moxham et al. 2017). Finally, ADEE recommends that specialist societies and organisations use these Domain documents as a basis from which to develop or formulate their own curricula.
Notwithstanding the 21 learning outcomes below, it is expected that curricula will cover:
- The scientific basis of oral and related biosciences, including the relevant biomedical sciences, the mechanisms of knowledge acquisition, scientific method and evaluation of evidence
- The biological processes in the body to a sufficient depth to be able to exploit new emerging biological technologies in clinical practice, especially in regenerative medicine
- Mechanisms of behaviour change in order to effectively lead clinical teams, implement tailored oral healthcare regimes for patients and manage patient behaviours which are potentially harmful to general and oral health
- The complex interactions between oral health, nutrition, general health, medications, ageing and disease
The aetiology, pathology, diagnosis and management of oral diseases and disorders including (but not exclusively): i) caries, ii) tooth surface loss, iii) gingival, periodontal and peri‐implant diseases, iv) apical periodontitis, v) temporomandibular joint dysfunction and occlusal disharmony, vi) mucosal conditions and salivary pathology, vii) odontogenic cysts and tumours, viii) craniofacial disorders, dental and maxillofacial trauma and orofacial pain.
Disease processes relating to acute and chronic orofacial conditions, and how inflammation, disorders of the immune system, degeneration, neoplasia, metabolic disturbances and genetic disorders can impact on these
It is common for educators to deliver the scientific knowledge base using a “disease” framework (pathophysiology, signs, symptoms and investigations). Often, however, students then become preoccupied with recording their findings and being efficient in making a diagnosis. Students should also appreciate the “illness” framework, as perceived by the patient (ideas, concerns, expectations and feelings). Information should be gathered and recorded comprehensively and contemporaneously, but at the same time appreciating that the patient requires information that they can understand, freedom of choice, respect and adequate time for discussion (Field 2015). Information gathering is about a dynamic exchange of information and should result in shared decision‐making between the dentist and their patient. In order to facilitate recording the patient's presenting condition and reaching a diagnosis, educators are encouraged to refer to indices and screening tools championed by specialist societies (Table 1 of the published document).
Nine learning outcomes have been identified by the GED.
i) caries, ii) tooth surface loss, iii) gingival, periodontal and peri‐implant diseases, iv) apical periodontitis, v) temporomandibular joint dysfunction and occlusal disharmony, vi) mucosal conditions and salivary pathology, vii) odontogenic cysts and tumours, viii) craniofacial disorders, dental and maxillofacial trauma and orofacial pain—and the individual risk factors for each presenting condition
After successfully diagnosing the patient's condition, a graduating Dentist should be capable of writing a logical and comprehensive treatment plan that systematically addresses the patient's oral healthcare needs. It is important to account for any relevant biological, psychosocial or temporal factors that may impact on the timely delivery of safe and effective patient‐centred care. Nine learning outcomes have been identified within the GED.
Use behaviour and lifestyle analysis, identifying individual risk factors for oral health to develop a comprehensive prevention programme to maintain good oral health
Participate in the prompt and proper referral and coordination of patients with life‐threatening conditions (such as oral cancer) and in situations where their own knowledge and skills are not appropriate enough to provide adequate treatment (eg in relation to orthodontics, oral medicine, implant therapy or in relation to general anaesthesia)
In order to establish the highest standard of oral health, graduating Dentists must be competent to operatively manage dental trauma and disease and to develop appropriate behaviour change with patients. This means communicating effectively with patients at all stages of their lives, including children, adolescents, adults and the ageing population. Current concepts of prevention, risk assessment and treatment should be implemented using materials and techniques that maintain pulp vitality and soft tissue health, and restore tooth form, function and appearance in a way that is acceptable to the patient. For discipline‐specific learning outcomes, educators are encouraged to make reference to existing agreed curricula, published by specialist societies (Table 1). In relation to prescribing, educators are directed to the European Centre for Disease Prevention and Control guidance (ECPDC 2017) and specifically the NICE (National Institute for Health & Care Excellence) guidelines, which has a number of useful associated e‐learning resources on antimicrobial stewardship. This is increasingly important to slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment option for infection (NICE 2017).
19 learning outcomes are identified within this GED competence.
Develop strategies to predict, prevent and correct deficiencies in a patient's oral hygiene regime, work with the patient supportively to optimise their oral hygiene regime and provide patients with strategies to control habits that impact negatively on their oral health
Perform periodontal therapy (including prophylaxis, stain removal, biofilm removal, supragingival and subgingival root surface debridement) using both powered and manual instrumentation
Develop a programme to monitor and maintain interventions, most notably in relation to periodontal health, direct restorations and the fitting of fixed and removable prostheses
The following links and references will provide supplementary information. If you are an association or relevant body who has developed a curriculum and would like to have it link to this page please get in contact.