MEDEV

School of Medical Sciences Education Development

Introduction

The University of Sheffield's School of Clinical Dentistry is increasing its outreach placements in primary care settings for undergraduates and professions complementary to dentistry.

This has necessitated the development and deployment of a transferable training package to support dental staff hosting students on placement.

Students are supervised by local dentists during their six-week block placements. A three-year National Dental Development Unit funded project first placed a pilot group of twenty students in ten Community Dental Service and Dental Access Centres in areas of high need across northern England in 2003.

Students provided treatment for of a greater number and wider range of patients than they would normally encounter in the dental hospital.

Evaluation

Qualitative evaluation of this pilot involved all twenty students, thirty staff in the placements and some of the students' university tutors.

It identified the following key points:

• Students profited from the experience and improved in both confidence and competence.
• Besides their anticipated increase in clinical experience and wider range of patient types, students found unexpected benefits from teamwork and opportunities to consider the influence of the patients' backgrounds and communities on their treatment.
• Placement staff enjoyed the break from routine and opportunities to take on new roles.
• Students especially valued the support, guidance and feedback from their hosts but the supervisors were not confident this met the School's requirements.

Building confidence

This last point, supervisors' lack of confidence in their role, was a concern as a consistent approach to supervision across on-site and outreach placements should reduce the time needed for students to adapt to the new learning environment, increase School tutors' confidence in supervising dentists' assessments of students and reduce the stress on those supervisors.

Two principle resources were available to be harnessed in the development of a solution. First, the experience and expertise of existing staff at this other schools could be shared more fully with the trainers.

Secondly, disseminating the best practice identified during the pilot stage of the development would provide a foundation for further development. Training supervisors has been shown to develop their approach and increase their confidence in the role (Hobson, 2004).

Consequently, together with the dental service managers involved, programme manager, Professor Michael Lennon, proposed two training events for dental staff based on these resources. The events would also address the quality assurance of supervision through considering educational, clinical and future aspects of outreach supervision.

LTSN-01 support

An LTSN-01 miniproject supported development and delivery of a resulting training package delivered to all supervising dentists and many of the dental nurses involved.

It was timed for the spring of 2004; shortly before the next cohort of 35 students were ready to start their outreach placements.

The programme outline is shown in the boxed inset but also gave ample opportunities for placement staff from different centres to meet in groups so that they could discuss their experiences and raise queries for the panels of experts to round off each session.

The combined experiences of supervising dentists from the pilot and several staff from dental schools' outreach programmes in Manchester, Liverpool and Sheffield, provided a sufficient mass of experience to generate examples, pitfalls and best practice to keep the whole event grounded in practice.

Judging by the hum of discussion and occasional raucous outbursts there was plenty of participation. This judgement is supported by the formal evaluation by the thirty plus attending each of the two events. Around 70% rated the sessions very worthwhile.

As a follow up some staff are to visit the dental hospital in Sheffield to see students working and being assessed in their normal environment.

Success

The intended outcomes were improved quality assurance of learning experiences that are integrated and consistent across the school of dentistry and the host clinics and an increased confidence among both placement and school staff that their teaching is being reinforced elsewhere and, finally, that staff at the host clinics will be more confident that they are better prepared to supervise students.

As I write the first batch of students have recently returned from the 2004 round of outreach. They report that excellent working relationships with their supervisors were quickly established and supervision was sensitively provided.

They felt they made significant strides towards becoming effective members of dental teams. No doubt the LTSN-01 supported training had some part to play in ensuring that.

This time the undergraduate students have agreed on their return to participate in some research which compares their competence in treatment planning and confidence in practicing dentistry with similar students who have not attended an outreach placement. But that's another story for another time.

Training event programme

Educational aspects, chaired by Prof Michael Lennon

• Clinical assessment procedures within the School: Dr Phillip Benson
• Clinical supervision and feedback: Mr Phil Young, SDO, Liverpool PCT - Workshop followed by questions to panel
• Clinical aspects, chaired by Professor Trevor Walsh

Expected levels of clinical competence in:

• Paediatric Dentistry, Dr Helen Rodd
• Oral Surgery, Dr Alison Loescher
• Dental Therapy, Ms Judy Hinchliffe

Workshop followed by questions to panel

Future aspects Future Developments, Prof Peter G Robinson and Mr Peter Bateman, Director of Dental Services, Sheffield