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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The Dental Foundation Interview Guide: with Situational Judgement Tests offers an indispensable step-by-step guide to the dental foundation training application process.
- Explains the application and recruitment process and includes essential interview tips
- Offers a wealth of practice questions with detailed answers to ensure familiarity with the process
- Highlights the importance of professionalism, leadership and management within the dental practice
- Written by recent graduates who understand the pressures of the application process
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Veröffentlichungsjahr: 2016
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Table of Contents
Cover
Title Page
Copyright
Preface
Acknowledgements
Chapter 1: What is dental foundation training?
Chapter 2: The application process
DF1 recruitment process
How to apply
Key dates
DF1 schemes – where to work
DF1 interview – format
Scotland applications
Chapter 3: The SJT exam
What is an SJT?
Format of the exam
Marking format of the exam
Chapter 4: Definitions and legalities
Definitions
Legislation for the dental team
Clinical governance
Chapter 5: Important notes for revision
Standards for the dental team
Consent
Confidentiality
Complaints
Scope of practice
Continued professional development (CPD)
Raising concerns
Child protection and vulnerable adults
A checklist of sources to consult during revision
Chapter 6: Practice scenarios
Introduction
Professionalism, leadership and management scenarios
Patient communication scenarios
Chapter 7: Situational judgement test practice questions
Introduction
Ranking-based SJTs: Questions
Ranking-based SJTs: Answers
‘Best of three’ SJTs: Questions
‘Best-of-three’ SJTs: Answers
Chapter 8: How to write a dental CV
Introduction
Format
Some dos and don'ts
The meet and greet
Some useful questions to ask
Index
End User License Agreement
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Guide
Cover
Table of Contents
Preface
Begin Reading
List of Tables
Chapter 2: The application process
Table 2.1 data collected for the application years 2011/12 and 2012/13 from COPDEND
Table 2.2 Proposed recruitment timetable
Table 2.3 Selection centre interview venues
Chapter 3: The SJT exam
Table 3.1 Mark scheme for ranking-based SJTs
The Dental Foundation Interview Guide
with Situational Judgement Tests
Zahid Siddique
Shivana Anand
Helena Lewis-Greene
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Library of Congress Cataloging-in-Publication Data
Names: Siddique, Zahid, 1985- , author. | Anand, Shivana, 1990- , author. | Lewis-Greene, Helena, 1954- , author.
Title: Situational judgment tests for dentists : the DF1 guidebook / Dr. Zahid Siddique, Dr. Shivana Anand, Dr. Helena Lewis-Greene.
Description: Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons Inc., 2016. | Includes bibliographical references and index.
Identifiers: LCCN 2015043956 | ISBN 9781119109143 (pbk.)
Subjects: | MESH: Education, Dental, Graduate–Great Britain. | Dentists–psychology–Great Britain. | Educational Measurement–Great Britain. | Employment–Great Britain. | Judgment–Great Britain.
Classification: LCC RK76 | NLM WU 20 | DDC 617.60071/141–dc23 LC record available at http://lccn.loc.gov/2015043956
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: © Getty/Westend61
Preface
There are several books available on medical situational judgement tests (SJTs) but none for dentistry. Situational judgement test questions were introduced as part of the DFT application interview process in 2013. A relatively new concept in dentistry, SJTs have been widely used in industry as part of the selection criteria for professionals. We wanted to provide students with a selection of subject-specific SJT questions to help with their DFT preparations. Guidance for preparation has been put together by recently qualified dentists who understand the pressures that undergraduate study can impose. We hope that this book will be useful in helping all students gain experience with SJTs, leadership and management as well as clinical scenarios.
The DFT application process is highly competitive. Simply put, the higher the ranking the better the chance of getting your first choice placement. We hope that this book gives you all the information that you need in order to achieve this goal.
The SJTs in this book were verified and standardized by a group of dentists and are answered in accordance to their opinion and expertise.
Acknowledgements
Thank you to Mr Raj Rattan for his continued support and mentorship throughout this process. Thank you to Professor Dunne our Professor in Primary Dental Care at King's College London Dental Institute for his support and guidance from the beginning.
A huge thank you to some of the panel members who include:
Dr Razaullah Ahmed BDS
Dr Keshvi Patel BDS MJDF RCS(Lon)
Dr Nirupy Shanmugathas BDS MJDF RCS(Lon)
Dr Simrun Chowdhary BDS MJDF RCS(Lon)
Chapter 1What is dental foundation training?
Dental foundation training is a year when dental graduates across the United Kingdom embark on a period of relevant employment general dental practitioners under a contract of service by approved educational supervisors to provide a wide range of dental care and treatment. The successful completion of the DF1 year is mandatory for those who want to work in the NHS as part of their future dental career. Dental foundation training (DF1) introduces new graduates to general practice and gives them a protected environment in which to work and enhance the basic dental skills achieved through their BDS degree under the supervision of a educational supervisor practitioner. The educational supervisor's role is to help and support the dental foundation trainee in all aspects of employment and provide continuous academic development through tutorials. The DF1 trainees also attend weekly study days outside of their general practice with the aim and objective of enhancing clinical and administrative competence and promoting high standards through relevant postgraduate training. The following competencies are included within the DFT curricula:
to enable the dental practitioner to practise and improve dental practitioner's skills;
to introduce the dental practitioner to all aspects of dental practice in primary care;
to identify the dental practitioner's personal strengths and weaknesses and balance them through a planned programme of training;
to promote oral health and the quality of dental care for patients;
to develop and implement peer- and self-review and promote awareness of the need for professional education, training and audit as a continuing process;
to demonstrate that the dental practitioner is working within the General Dental Council's (GDC's) standard guidelines.
Excerpts from the National Health Service (Performers Lists) (England) Regulations 2013, found at http://www.legislation.gov.uk/uksi/2013/335/pdfs/uksi_20130335_en.pdf (accessed 24 February 2016).
Chapter 2The application process
Chapter Menu
DF1 recruitment processHow to applyKey datesDF1 schemes – where to workDF1 interview – formatScotland applicationsDF1 recruitment process
All DF1 training vacancies are allocated through a centralized process for England, Northern Ireland and Wales. The online application process usually opens in the month of September for all UK-based year 5 dental students and EU graduates or overseas dentists.
The recruitment process is split in two stages:
First stage
– trainees are first allocated a particular DFT (dental foundation training) scheme. This is based on their DFT interview score ranking. The higher the candidates' ranking scores, the greater is the likelihood of them obtaining their first scheme preference and so forth.
Second stage
– trainees are allocated a particular practice in spring / summer of the following year. The individual practices are allocated through the DFT interview ranking scores, so those with the highest scores will receive their first preference practice and so forth. Some schemes carry out second-round interviews, where an algorithm is used to pair up trainee preferences with educational supervisor preferences.
It is important to understand that the DFT application process is competitive. The number of DFT training places is generally linked to the number of final-year students but places cannot be guaranteed for all UK graduates and it is therefore of utmost importance that all students give themselves the best opportunity to secure a place.
Over the past few years the number of candidates applying has exceeded the number of DF1 positions available with EU and oversees dental applicants also applying.
Table 2.1shows the data collected for the application years 2011/12 and 2012/13 from the Committee of Postgraduate Dental Deans and Directors (COPDEND).
Table 2.1 data collected for the application years 2011/12 and 2012/13 from COPDEND
Numbers
2011/12 England and Wales
EEA
United Kingdom
ROW
2012/13 England and Wales
EEA
United Kingdom
ROW
Places Total
927
978
Applicants Total
1190
101
1044
45
1172
110
1031
31
Applicants eligible and short listed
1145
97
1042
6
1153
109
1027
17
Applicants interviewed
1110
86
1018
6
1138
104
1021
13
Applicants offered place
940
47
889
4
1040
77
953
10
Applicants accepted offer
928
42
882
4
978
58
914
6
Applicants not accepted offer
12
5
7
0
18
13
3
2
Applicants not offered a place
48
13
35
0
55
11
41
3
Notes: *EEA – European Economic Area; ROW – Rest of the World
How to apply
London application process
The London deanery and COPDEND change the application process on a yearly basis. It is always beneficial to look at the guidance notes released by COPDEND on the London deanery web site beforehand at http://www.lpmde.ac.uk/ (accessed 22 November 2015).
Scotland application process
See below.
Key dates
COPDEND has the right to change the recruitment process on a yearly basis. Table 2.2 is a proposed timeline for recruitment with guideline months.
Table 2.2 Proposed recruitment timetable
Applications open
25 August 2015
Applications close
22 September 2015
Interview window
16 – 20 November 2015
Preferencing of schemes opens
8 December 2015
Preferencing of schemes closes
15 December 2015
Initial offers out by
06 January 2016
2nd round offers
06 July 2016
Placements commence
March 2016 and September 2016
Table 2.3 gives the selection centre interview venues across the United Kingdom.
Table 2.3 Selection centre interview venues
Centre
Venue
Dental schools covered
London
London Recruitment Events Centre
King's College LondonQueen MaryUniversity of London
Bristol
Bristol Marriott Hotel, City Centre
Bristol UniversityCardiff UniversityPeninsula College of Dentistry
Manchester
Reebok Stadium, Bolton
University of Central LancasterUniversity of LiverpoolUniversity of Manchester
Birmingham
West Bromwich Albion
University of BirminghamUniversity of Sheffield
Belfast
Ramada Hotel, Shaw's Bridge, Belfast
Queen's University, Belfast
Newcastle
Newcastle United Football Club
Newcastle UniversityUniversity of Leeds
DF1 schemes – where to work
A component of the DF1 application process involves choosing DF1 scheme area preferences around the United Kingdom. In 2014, applicants were asked to rank their scheme preferences via the UK Offers System, which was done separately from the submission of their online application form for their original DF1 application. Candidates will be emailed with information regarding their interview date (which they must confirm within 48 hours) and full instructions on how to complete scheme preferences, including use of the UK offers system. This involves logging into the system approximately 3 weeks after the interview and submitting their scheme area preference. The submission for schemes is open for 7 days – after this period submissions cannot be made.
The London Deanery usually produces an information sheet about the available schemes for that year. It is of utmost importance that candidates take time to consider all the schemes and their locations. Due to the competitive nature of the application process it is imperative that the candidates give themselves the best possible opportunity to obtain a DF1 job offer. These opportunities can decrease if candidates limit the number of schemes they are willing to work in. If they do not rank one of the schemes they will automatically forfeit their place, even if a position is available. However, it should also be noted that there is no point in candidates ranking a scheme if they are absolutely certain that they are not willing to work in that region. The rationale for this is that if they do rank such a region and are offered a place within it, they will not be offered an alternative, or be given an opportunity to swap, if they decline the offer. We therefore advise candidates to try to be as flexible as possible when ranking schemes to give themselves the best opportunity to secure a DF1 job.
It is also important to note that, at this stage of the application process, candidates will only be given information regarding their scheme locations and not the locations of the actual training practices as they are not approved until spring / summer and can change on an annual basis. Some schemes cover a large geographical area and the distance between practices within a scheme can take over an hour to commute. The deanery will only provide detailed information about practices once they have all been approved; however, it might be possible to see the previous year's information regarding individual practices on its web site.
Once candidates have accepted their scheme in the beginning of January, they will have an option to ‘upgrade’ or ‘accept’ the offer. If they choose to accept, their deanery will be notified of their acceptance and their place for the DF1 year will be confirmed. If they choose to ‘upgrade’, then on the last day of January their scheme will either be upgraded to a higher choice or the candidate will stay in the same scheme.
Here are some useful points to consider when choosing where to work:
Travelling to work
How far are you willing to travel to work?
Do you drive? Will it be feasible to drive to work – Congestion charge? Parking?
If you don't drive will you need to relocate close to a train / tube station? Will you need to relocate to make your commute to work easier?
Finance
How expensive will your living accommodation be in certain regions?
Will living at home be more suitable?
How expensive will your commute be?
Do you have any family commitments or are supporting any children? If so, consider childcare and school arrangements.
Social life
It is important that the location and environment you choose to work in provide a suitable social lifestyle outside of work, which caters for your individual needs.
It is only for one year
Always take into consideration all factors. However, this is your opportunity to shine, build your CV, gain extra experience and make mistakes from which you will learn.
Chose an environment in which you will feel comfortable to grow professionally and personally. Flexibility is key and it
is
only for one year.
Location
It is important to consider the region you want to work in.
Do you want to be living at home? Do you want to stay in the same city as your university? Do you need to support a family? Are you someone who enjoys living in rural versus coastal areas?
Speak to family and friends to aid and advise you.
Speak to older dental colleagues to give you further information about regions within the United Kingdom.
The list below gives the schemes that are available for DF1 applications. They may be subject to change in the forthcoming year. The HE region or deanery is displayed in bold and scheme names are displayed below them. A virtual map of DF1 schemes in the United Kingdom may be found at https://maps.google.co.uk/maps/ms?msid=209915530480942479969.0004c3c6972fd1afc3248&msa=0 (accessed 13 November 2015).
HE East Midlands
Chesterfield Scheme
Leicester Scheme
Lincoln Scheme
Loughborough Scheme
Northampton Scheme
Nottingham Scheme
HE East of England
Basildon Scheme
Bedford Scheme
Essex Coast Scheme
Ipswich Scheme
Norwich Scheme
Peterborough Scheme
Welwyn Garden City Scheme
HE Kent, Surrey and Sussex
Central Scheme
Coastal Scheme
East Scheme
South Scheme
West Scheme
HE North East
GPT Scheme
North 1 Scheme
North 2 Scheme
South 1 Scheme
South 2 Scheme
West Scheme
HE North West
Blackburn Scheme
Lancaster Scheme
North Manchester Scheme
Pennine Scheme
Wythenshawe Scheme
HE North West (Mersey)
Aintree Scheme
Chester Scheme
Clatterbridge Scheme
Speke Scheme
HE South West
Bath Scheme
Bristol Scheme
Exeter Scheme
Plymouth Scheme
Salisbury Scheme
Taunton Scheme
Truro Scheme
HE Thames Valley / HE Wessex
Berkshire Scheme
Buckinghamshire / Milton Keynes Scheme
Oxfordshire Scheme
Portsmouth Scheme
Winchester Scheme
HE West Midlands
City Scheme
Coventry Scheme
Russells Hall Scheme (March only)
Solihull Scheme
Stafford Scheme
Telford Scheme
Worcester Scheme
HE Yorkshire and the Humber
East Yorkshire / North Lincolnshire Scheme
GPT Scheme
Harrogate Scheme
Sheffield and Doncaster Scheme
Wakefield and Dewsbury Scheme
York Scheme
London Shared Services
Northwick Park (March only)
Northwick Park
QMUL – Bart's Scheme
South East London Scheme
South West London Scheme
UCL– Eastman Scheme
Northern Ireland Deanery
Northern Ireland Scheme (August only)
Wales Deanery
East Wales Scheme
Glamorgan Scheme
North Wales Scheme
South Wales Scheme
South West Wales Scheme
Port Talbot Scheme
DF1 interview – format
Assessments are scheduled to take place in late November in six centres across the United Kingdom.
The assessment process consists of:
Professional, leadership and management skills – objective structured clinical examination (OSCE) station. (10 minutes)
Clinical communication skills – OSCE station with real actors. (10 minutes)
Situational judgment test (SJT) – 56 SJT questions comprising both ranking-based SJTs and ‘best of three’ SJTs (105 minutes, discussed further in
Chapter 3
).
Professionalism, management and leadership skills station
This station is more like a mini viva station with the candidate discussing the scenario with two assessors. The candidate will be given a mark by both assessors, who will then collate their marks to calculate an average score for the student. Candidates will have 5 minutes to prepare in advance and 10 minutes for the actual station. (See mark scheme template in Chapter 3.)
Clinical communication skills station
This station will consist of a typical patient-dentist role-play scenario where an actor will be posing as the patient with a clinical problem. There will also be an assessor in the room, although he will have no involvement in the role play. The candidate will be marked by both the assessor and the actor in the role play (see mark scheme template in Chapter 3). Candidates will have 5 minutes to prepare for the station by reading and familiarizing themselves with the scenario and then 10 minutes for the actual station.
Scotland applications
Scotland has its own application process for which all year-five students can apply. The application for Scotland closes in early January and is done by emailing [email protected].
There is an application form to complete and to send to dental recruitment for Scotland. Supporting documentation is needed, such as proof of identity – one copy of photographic ID and two copies of confirmation of address.
Chapter 3The SJT exam
Chapter Menu
What is an SJT?Format of the examMarking format of the examWhat is an SJT?
The situational judgement test exam is designed to assess nonacademic skills and ethical values rather than clinical skills. Situational judgement tests are a measurement method designed to assess an individual's judgement regarding situations in day-to-day working practice. These questions provide an effective method of assessing the key attributes required in dentistry:
professional qualities;
coping with pressure;
communicating effectively;
teamwork;
putting patients' interests first.
Format of the exam
The exam consists of 56 SJT questions comprising both ranking-based SJTs and ‘best of three’ SJTs. Six of the SJT questions will be used for evaluation purposes. The candidate will have 105 minutes for the exam, which is machine marked.
Ranking-based SJTs
Candidates will be given a question with five possible responses to specific situations. They will then need to rank the five options from the most to least appropriate usually from A to E.
‘Best of three’ SJTs
The candidate will be presented with a situation question in which there will be eight possible answers. The candidate will then need to choose the three most appropriate answers when all of the answers are considered together.
Marking format of the exam
Ranking-based SJTs
As explained above, the candidate is asked to rank five possible answers from the most appropriate to the least appropriate. The table below demonstrates how the candidate can score the maximum mark of 20 points for each question.
For example, if the answer to a question is ACBDE, with A being the most appropriate and E being the least appropriate, your score will be calculated according to a matrix which can look like the one in Table 3.1. Ranking the options correctly scores the candidate 20 marks.
Table 3.1 Mark scheme for ranking-based SJTs
Correct
If you ranked
If you ranked
If you ranked
If you ranked
If you ranked
ranking
it first
it second
it third
it fourth
it fifth
A
4
3
2
1
0
C
3
4
3
2
1
B
2
3
4
3
2
D
1
2
3
4
3
E
0
1
2
3
4
Best of three SJTs
In this format the candidate must choose the three most suitable options when all the options are considered together. Each option scores four marks and therefore a maximum of 12 marks can be scored for each question. For example, if the correct three options are BCD the candidate will score 12 marks for choosing BCD, eight marks for only choosing two correct options, for example BCA, and four marks if the candidate only chose one correct option, for example BAE.
Chapter 4Definitions and legalities
Chapter Menu
DefinitionsLegislation for the dental teamClinical governanceDefinitions
General Dental Council
The GDC is the primary regulator of dental professionals, with a principal role in ensuring patient safety. There are 12 members on the GDC; six are dentists and six are lay people. The functions of the GDC are to maintain the dental register, to ensure quality, to supervise dental education and to administer any disciplinary action required against its members where appropriate. Section 38 of the Dentists Act states that it is illegal to practise without being placed on the GDC register.
Care Quality Commission (CQC)
The CQC has been checking that healthcare service providers are meeting national standards for safe, effective, compassionate and high-quality care since 1 April 2009. It encourages all healthcare employers to always make continual improvements. The CQC hold inspections with all practices that should be registered with the CQC.
Faculty of General Dental Practitioners (FGDP)
Formed in 1992 as the academic home for general dental practitioners (GDPs). The FGDP(UK) is based at the Royal College of Surgeons of England (RCSEng) and aims to improve the standard of care delivered to patients through standard setting, publications, postgraduate training and assessment, continuing professional development, education and research.
Clinical commissioning groups
These are overseen by NHS England and are grouped in geographical areas by commissioning healthcare services including general practitioners, hospitals, dental services, pharmacists and specialist services.
Local authority teams
Local authority teams deal with practical, operational and administrative matters in communities. They report back to the NHS commissioning board. They have replaced primary care trusts (PCTs) but work with a central policy and consistent guidelines.
Clinical governance
Clinical governance is a systematic approach to maintaining and improving the quality of patient care within a health system such as the NHS. NHS organizations have a duty to seek quality improvement, maintain quality healthcare and minimize risks. The practice framework is subdivided into 12 distinct areas.
Indemnity provider
This is an organization to support and provide impartial confidential advice to dental professionals. The majority of indemnity providers are nonprofit organizations. It is a legal requirement for dentists to have in place arrangements for compensation to be arranged if they cause harm. A sum is paid on behalf of the dentists for the loss experienced by patients.
National Institute for Health and Care Excellence (NICE)
The NICE publishes guidelines in:
health technology within the NHS;
clinical practice;
public health sector workers in healthcare.
Examples of clinical practice include:
Prescription of antibiotics. The guidelines changed in 2008, so no prophylaxis against infective endocarditis is given. Advise patients against cover and liaise with their cardiologist for further assistance if needed.
Extraction of wisdom teeth:
unrestorable caries;
no treatment of pulpal and PA pathology are available;
cellulitis;
abscess;
osteomyelitis;
internal and external resorption on wisdom teeth or the adjacent tooth;
fracture;
disease of follicle – cyst/tumour;
reconstructive surgery;
in field of tumour resection;
pericoronitis for more than 2 years, one severe.
Bisphosphonates – can cause bisphosphonate related osteonecrosis of the jaw (BRONJ). If a patient is on IV or oral bisphosphonates for more than 2 years, this may be a contraindication for extractions.
Legislation for the dental team
The law related to confidentiality
Data Protection Act 1998:
data should be processed lawfully and fairly;
data should be processed for specific purposes;
adequate, relevant but not excessive note keeping;
accurate, up-to-date records – for example, medical histories;
medical records not kept longer than necessary – 11 years or 25 years if the patient is under 18 years old;
data should be processed in line with subject rights;
security: passwords and locked, encrypted USB safe sticks;
data should not be transferred to countries outside EEA without adequate protection.
Freedom of Information Act 2000:
the patient has a right to access notes and records;
the dentist has to give copy within 40 days of receipt of request;
radiographs are the dentist's property;
patients have the right to correct factual errors in their medical notes;
dentists may charge a fee for radiographs: £50 for a hard copy, £10 for a digital copy.
Legislation relevant to raising concerns
Public Interest Disclosure Act (PIDA) 1998:
A healthcare professional can break confidentiality and raise a concern if it is in the interest of the public. Qualified disclosure can occur when the law has been broken.
Confidentiality can be broken when there is a miscarriage of justice, environmental harm, when a crime has been committed, or when there is a serious health and safety issue.
The breach in confidentiality must be raised in good faith and undertaken using the correct process.
The law relevant to putting the patient's best interest first
Ionising Radiation Regulations (IRR)
Ionising Radiation (Medical Exposure) Regulations (IRMER)
Health Technical Memorandum HTM01-05
Publications of the Health and Safety Executive (HSE)
Disposal of Hazardous Waste/COSHH
Human Rights Act 1998
The law relevant to consent
Fraser guidelines
Gillick competency and Fraser guidelines refer to the competence of a child under the age of 16 to consent to his or her own medical care. The Fraser guidelines require healthcare professionals to assume that everyone has the capacity to consent until proven otherwise. A child is someone under the age of 18 years old. Persons who usually consent for those under 18 years of age are their mother and father (as named on the child's birth certificate) if the time of birth was after 2003, or the father at time of birth if this occurred before 2003. Therefore healthcare professionals can deem people under 18 years Fraser competent until otherwise proven. ‘Capacity’ is assessed by giving patients information and ensuring they are able to understand, retain, weigh up the options and communicate back a decision.
Legislation relevant to consent
Mental Capacity Act 2005
This enables those who are over 16 and lack capacity to be protected and empowered to make their own decisions. People who may lack capacity include those who have dementia, strokes, mental health issues, or learning disabilities. Healthcare professionals must assume that all have capacity until proven otherwise. They should help individuals make informed decisions themselves, assess periods of capacity versus no capacity and, if someone lacks capacity, help a decision to be made in that person's best interest.
Decisions made should be least restrictive of the affected person's basic rights.
The Mental Capacity Act allows for an ‘independent advocate’ or person provided to support decision making especially if it may significantly restrict the affected person's wellbeing.
How should professionals assess capacity? Does the person have a severe impairment? Does the impairment cause significant issues in specific decision making?
Capacity must be rechecked each time as there may be periods of lack of capacity interspersed with periods of capacity.
How should professionals test for capacity? Understand the information relevant to the decision. Retain the information. Use and weigh up the information. Communicate that decision back.
Healthcare professionals must support decision making by thinking about the following:
Has all relevant information been given?
Could information be presented more easily?
Have all alternatives been considered?
Can others help with communication?
Can the decision be delayed?
Can decisions be made at better times during the day or in better environments?
Have other methods of communication been explored?
Those who can help with decision making include:
guardians;
those previous named by the patient;
those who take an interest in their welfare;
those granted lasting power of attorney;
those granted enduring power of attorney;
a deputy appointed by Court of Protection.
Those granted a lasting power of attorney or an enduring power of attorney must make sure that the Mental Capacity Act statutory principles are followed if the patient does not have the capacity to make decisions. Enduring power of attorneys are valid from before date when the Mental Capacity Act came into force (1 October 2007).
All members registered with the GDC must have training in the Mental Capacity Act.
Clinical governance
NHS organizations have a duty to seek quality improvements, maintain quality healthcare and minimize risks. Clinical governance has seven pillars:
Clinical effectiveness
Audit and peer review
Risk management
Education
Patient information and safety
Using information and IT
Staff training.
Risk factors may be minimized by:
Identifying the risk
Assessing the risk
Removing the risk factors
Reducing the risk factors
Weighing up the outcome
Sending adverse incident reports and significant event auditing to the National Patient Safety Agency (NPSA).
The clinical governance framework is subdivided into 12 distinct areas, which are listed below.
Infection control
Supporting document HTM 01-05 – Decontamination in Primary-Care Dental Practices:
this is an essential requirement for best practice;
it requires involvement of the whole dental team: adequate staff training needed for CPD;
every practice should have written infection control policy which should be followed;
procedures should be regularly monitored during clinical sessions and routinely audited;
all members of the dental team should understand and practise procedures: regular discussions at team meetings are recommended;
employers have responsibility to provide safe and hygienic environment for employees and patients.
Child protection and safeguarding
Supporting document: Children and Vulnerable Adults:
dentists have a wider responsibility for the welfare of patients, which is not just limited to clinical care;
all members of the dental team have a responsibility to protect patients from harm and should understand what actions need to be taken if they have any concerns;
they should be able to recognize signs of abuse or neglect and find out about local procedures and follow them – raising concerns appropriately;
induction and training may be needed;
all staff need enhanced criminal record bureau (CRB) or now known as disclosure and barring service (DBS) checks;
patient safety: all staff should be open and honest about any incidents, practice policy should be followed on what to do, there should be contemporaneous record keeping, investigations should be followed, action should be taken where appropriate, lessons should be learned and there should be reflection at a staff meetings.
Staff should:
listen and observe the child;
seek an explanation from both child and parent or carer;
retain contemporaneous records of everything seen or discussed;
consider whether they suspect maltreatment or not;
record all actions taken, including their professional conclusion;
discuss concerns with colleagues, senior staff members and safeguarding lead;
note that informal advice can be taken from local social services anonymously.
Radiography
Supporting documents: Ionising Radiation (Medical Exposure) Regulations 2000; Health and Safety at Work Act 1974:
dental radiographs are taken very frequently – although the dose is small each time, professionals should always consider the collective effect;
a radiation protection adviser and supervisor must be allocated to each practice;
training records should be kept for all staff;
staff should consider the justification for and authorization of radiography;
they should consider equipment: keep maintenance records;
quality assurance – there should be a radiography maintenance plan;
aim for 70% grade 1 and 20% not more than grade 2.
Staff, patient, public and environmental safety
Supporting documents: Health and Safety at Work Act 1974, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2005.
This section outlines all duties that employers have to their employees and the public, plus duties employees have to themselves and one another. Some of these include:
providing necessary instruction, training and supervision and implementing health and safety practice policy;
reporting injuries, diseases, dangerous occurrences;
analysing procedures and initiating changes as a result;
ensuring that all potentially harmful substances are handled and stored safely;
providing a safe work environment;
dealing appropriately with hazardous waste;
disposing of mercury and amalgam correctly;
dealing appropriately with asbestos;
handling anaesthetic gases;
ensuring electrical safety;
taking fire precautions;
handling infection control correctly;
taking appropriate precautions regarding radiation;
noting the dates of medicines and clinical products;
handling storage correctly;
keeping adequate records.
Evidence-based practice and research
Supporting documents: NICE guidelines, Faculty of Dental Surgeons guidance:
follow relevant NICE guidelines – for example, with regard to recall intervals and wisdom-tooth removal;
evidence-based practice should be reflected in treatment plans, delivering better oral health;
this should be evident in advice given regarding caries, toothbrush use, fluoride, healthy eating, periodontal matters, smoking cessation, alcohol misuse, tooth erosion, and crowns/cuspal coverage for endodontically treated molars;
there should be compliance with referral protocols, for example the Index of Orthodontic Treatment Need (IOTN);
continuing professional development (CPD) should be evidence based.
Prevention and public health
Supporting document: Delivering Better Oral Health (DBOH) 2014:
evidence-based prevention policy for all oral diseases and conditions;
delivering better oral health – smoking cessation, alcohol consumption, diet, fluoride, toothbrushing, caries, periodontal, erosion.
Clinical records, patient privacy and confidentiality
Supporting documents: Data Protection Act 1998, Caldicott Guidelines 1997, GDC Standards: Section 4.3.12:
clinical records should be securely stored: locked/password protected;
there should be compliance with relevant legislation;
confidentiality should be maintained in all practice settings by all practice staff;
clinical audit reports should be kept.
Staff involvement and development
Staff recruitment: relevant qualifications, experience, skills, abilities – scope of practice.
Pre-employment checks: immunization, Disclosure and Barring Service (DBS), registration, indemnity.
Discrimination policy: written procedure manual including employment policies, for example regarding bullying, harassment, sickness, absence.
Appropriate staff training: dealing with complaints, appointing someone as a main point of contact and for basic life support.
Maintenance and CPD: CPD is a mandatory requirement and employers should ensure that staff undergo this.
Clinical governance: quality assurance should be monitored via clinical audit and peer review. Meetings should be well attended by all staff and contributions should be made via staff feedback and surveys.
