As trainee representative on the SAC I have been fortunate to be a part of the working group for National Recruitment for Oral Surgery. I thought I’d use my blog to update everyone on the process that has commenced this year for our specialty.
National Recruitment was first introduced to postgraduate dental training in 2011 for Dental Foundation Training (DFT) posts, formerly known as vocational training (VT). Then in 2012, Orthodontics was the first speciality to pilot the scheme for the recruitment of Specialty Registrars (StRs). The process was deemed to be successful, with both applicants and interviewers reporting positively on the experience. Subsequently, a similar recruitment process was rolled out with equal success for both Paediatric Dentistry and Restorative Dentistry.
In line with COPDEND’s plan to enrol all specialities in the process, the Oral Surgery SAC agreed in 2015 that National Recruitment to our specialty would begin in 2017. A working group was established in 2016, led by James Spencer, Lead Dean for Oral Surgery. The group’s mission was to formulate and co-ordinate the multi-station interview (MSI), and in doing so, ensure the process was suitable for recruitment to a career in Oral Surgery. Self-assessment of applicants was also introduced to aid short-listing.
Following many meetings and much constructive debate amongst the working group, the Oral Surgery National Recruitment process commenced as planned on 1st March 2017, with online applications opening on the Yorkshire and Humber HEE website. The online application platform remained open for three weeks. There were seven training positions available nationally on this occasion.
Formal interviews were conducted on 18th May 2017 at Elland Road Football Stadium. It was planned that approximately 3 applicants per available post were interviewed. MSIs were designed to assess applicants’ personal development portfolios, skills in communication and management. The process culminated with an OSCE style assessment.
Following a long day for all, feedback on the process was gathered from both applicants and interviewers. Overall, applicants were pleased with the fairness of the process, although many felt that the critical appraisal assessment was demanding. This feedback will be invaluable in helping to mould and develop the process for the future. It is a new process and as expected, may have the odd crease to iron out. The plan henceforth is for National Recruitment to Oral Surgery to continue annually.
As a trainee, I believe the process is fair and robust. It allows candidates to shine and to demonstrate a wide range of skills and competencies. Behind the scenes, I have seen the incredible work completed by the working group (Tara Renton, Colette Balmer, Pippa Blacklock, Julian Yates and Christine Goodall), and the focus to develop and secure our future as a profession.
Sarah McKernon : BAOS Oral Surgery Trainees Rep
Professor Paul Coulthard
BAOS Council Member and
Editor-in-Chief of Oral Surgery
Dubai and Conscious Sedation
First weekend in May I was running a sedation workshop in Dubai. I have been travelling to various places in world but especially the Middle East to promote the use of conscious sedation for more than twenty-five years now. Dubai and Abu Dhabi are fascinating in that they have huge expatriate populations served by expatriate dentists trained in all parts of the world and with vastly different educational experience in respect of conscious sedation techniques and in particular a wider understanding of the implications of the patients general health. All the health professionals who seek to work in the United Arab Emirates (UAE) are required to satisfy increasingly stringent regulatory requirements as the Government is on a mission to increase the quality of care provided for the population. The UAE regulation is tight around many areas of practice of clinical dentistry and the CPD requirements are significantly greater than required in the UK.
When I first visited the UAE I felt as though my efforts were in vain as conscious sedation could not be practiced freely by dentists and my courses were attended by Department of Health officials questioning the safety of such techniques in the hands of dentists. Thankfully the skeptics were won over and those early days are now history! Interestingly there was never any questioning of ‘the need’ for conscious sedation in dentistry as this was obvious.
Similarly when I taught in Eastern Europe there was intense interest in the use of conscious sedation because dentists were aware of the stress experienced by anxious patients undergoing dental treatment. In the same countries every sort of oral surgery procedure had been carried out under local anaesthesia alone. When professional colleagues have questioned the need to offer conscious sedation and general anesthesia services for oral surgery in the UK because they are ‘not necessary’ elsewhere in the world, I have had a strong reply! Many other countries are desperate for these services to enable delivery of oral surgery treatment to be provided humanely and would love to have the sedation and general anaesthesia services that we have available in the UK. Unfortunately because of historic or economic reasons these means of managing pain and anxiety are not always available elsewhere.
There has been disproportionate attention in the use of sedation in dentistry in the UK with a huge number of published reports over the years compared to those in other areas of dentistry. This may however have been a good thing as conscious sedation practice remains in the hands of the dental team and has an exemplary safety record. Unfortunately publication of the ‘Standards’ document had a detrimental effect on the delivery of conscious sedation services with dentist ceasing to practice these techniques for fear of not satisfying in particular the new training requirements. In fact the training requirements proposed were only for new dentists and not those already using sedation techniques but there was considerable misunderstanding and confusion.
The authority of the ‘Standards’ document has been questioned and all four UK Chief Dental Officers have commissioned the Scottish Dental Clinical Effectiveness Programme (SDCEP) to update their ‘Conscious Sedation in Dentistry - Dental Clinical Guidance’ to offer some clarity to clinicians. As a member of the Guidance Development Group I was hugely impressed by the rigorous methodology used by SDCEP in their endeavor to make explicit the level of evidence supporting recommendations. Hopefully this guidance will encourage a reversal in the decline in sedation services.
As a passionate advocate of conscious sedation services I have been pleased to recently Chair a group on behalf of NHS England to write ‘Commissioning Dental Services - Conscious Sedation in a Primary Care Setting’ for commissioners. This guide should be published online by NHS England soon. This is an important element in ensuring the framework for delivery of services is in place in the current NHS system in England. So hopefully conscious sedation is back on track for the UK!
1. Standards for Conscious Sedation in the Provision of Dental Care: Report of the Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD). 2015;
2. Scottish Dental Clinical Effectiveness Programme (SDCEP). Conscious Sedation in Dentistry - Dental Clinical Guidance. Third Edition. 2017
Publisher: Scottish Dental Clinical Effectiveness Programme (SDCEP), Dundee. URL: http://www.sdcep.org.uk/published-guidance/sedation/
3. Commissioning Dental Services - Conscious Sedation in a Primary Care Setting. NHS England. In Press 2017.
Professor Paul Coulthard
BAOS Council Member and Editor-in-Chief of Oral Surgery
BDS MFDS RCS MsurgDent(Eng)
I don’t know about you but I know I haven’t cracked this “work/life balance” thing. Like many of you I am busy at work, dealing with patients, staff and generally running the practice as well as keeping an eye on how many UDA’s have been completed as the end of year is looming. Home is equally as busy with normal day to day stuff; the after school clubs, book week and even St David’s Day celebrations last week!
So many of my friends and family thought I had completely lost the plot when I announced I was going to Greece for a weekend to provide emergency dental treatment in a refugee camp. I signed up five months ago with the dental charity Dentaid who work with Health Point Foundation to provide dental treatment for refugees. The process was relatively simple, a few emails & forms to fill in and a phone call with Dentaid to ensure you know what to expect and iron out any queries you have. All of that was done before Christmas so last week it was a bit of a shock to realise the date had actually come round!
And so it was I found myself in Gatwick departure lounge early on a Friday morning meeting two fellow dentists, Rob & Niyi, who had also signed up for the weekend. The three of us flew to Thessaloniki and, after picking up the hire car, made our way to the hotel.
That evening we met up with the coordinators working on the ground in Thessaloniki and two other dental volunteers. The seven of us came from different backgrounds professionally and from different countries & cultures but it is amazing how much we had in common. Hassan & Rayyan, the coordinators, both spoke Arabic and were also dentists. They worked tirelessly over the Saturday & Sunday setting up the clinics, organizing patients, assisting with treatments and were always on hand to help translate & communicate with the patients. Both had been working in the role for a few weeks and planned to stay on for another two months or so.
The two other dentists had volunteered via Health Point Foundation. Ibrahim was from Australia and had arranged his volunteering to coincide with a ceramic aesthetic course he had attended in Athens earlier in the month. Gavin was a semi-retired Oral Surgeon from the Manchester area. Get two oral surgeons together and it’s not long before you start comparing notes - we had an interesting conversation regarding Eagle-Beak forceps!
The refugees we treated had been relocated out of the camps into a disused warehouse and a hotel. On arriving at the sites our first job was to move all of the kit from the van to the allocated room and set up the “surgery” with two folding massage tables as the dental chairs, a clean kit area and a container for dirty instruments.
The seven of us quickly became a team. Whilst we were getting everything ready Rayyan would make a waiting list of all the people who wanted to be seen and would start spreading the word amongst the refugees that we were there for the day to provide treatment and advice. Hassan made sure everything was set up correctly and Gavin (having already been working as a volunteer for five days) also knew how the system worked in terms of getting everything organised.
Rob, Niyi and I provided the treatment for patients, whilst Gavin moved between us providing instruments, materials, advise and then cleaning up after us – we couldn’t have asked for a better assistant! Ibrahim was worth his weight in gold in helping us communicate with the refugees. This went beyond merely translating what we were saying as he also chatted to the patients and their families and reassured them about what we were doing.
The two days flew by and I thoroughly enjoyed the work we did. It was a challenging work environment and undoubtedly took us all slightly out of our comfort zones, probably me more so than Rob & Niyi as I undertook some restorative work and that’s not normally part of my day-to-day practice! It was amazing how many of the patients really wanted to try and save as many teeth as possible and this didn’t seem to be driven by a fear of dental extractions but a genuine desire to hold on to their dentition – I wish the same could be said of some of my usual patients!
All too quickly we were on our way home and I was sad to leave. I made some new friends who I know I’ll stay in touch with and I’m glad that I made a small difference to the people I treated, all of whom were very grateful for our help.
Already I’m thinking about when I can volunteer again and despite everyday life being very busy I think I’ve come home with a clearer perspective on what is actually important and what’s not so urgent.
If you’re thinking about volunteering - please do, I know you’ll find it as worthwhile as I did. www.Dentaid.co.uk
Julie Burke, our new BAOS secretary, has organised a comprehensive two-day core CPD course for you to fulfil many of your CPD requirements. The course is being held at the Royal College of Surgeons in Edinburgh on Monday 8th and Tuesday 9th May.
The GDC 'highly recommend' several topics as part of your minimum verifiable CPD of 75 hours per five-year cycle. These topics are:
Medical Emergencies - at least 2 hours/year
Disinfection and Decontamination - at least 5 hours in every cycle
Radiography and Radiation protection - again at least 5 hours in every cycle
The GDC also recommend you cover some other topics which contribute to patient safety, although they don't specify how long you should spend on them. These include:
Legal and ethical issues
Oral cancer: early detection
Safeguarding children and young people
Safeguarding vulnerable adults
So for £265 (early bird fee) you can tick off 12 hours of your CPD for 2017, as well as enjoying time to network with your fellow oral surgery colleagues over the tea-breaks! Donald Thomson, Consultant Oral and Maxillofacial Radiologist at Dundee will cover radiation protection in detail (and cover half of your cycle requirement). Aubrey Craig is highly qualified to update you on legal and ethical issues and complaints handling as head of the dental division of MDDUS. Christine Whitworth, a general dental practitioner in Liverpool and infection control advisor to the FGDP is going to talk about disinfection and decontamination. Professor Jim McCaul , Consultant Maxillofacial surgeon will speak about the early detection of oral cancer and is the RCS/BAOMS lead for research in Maxillofacial surgery. There is also a session on safeguarding children and young people by Graeme Wright, Consultant in paediatric dentistry, and of course not forgetting an update on medical emergencies by our very own Julie Burke and Kate Taylor, who are both ALS and ATLS trained.
As a further bonus, there is an update in sedation (Simon Morrow), a dentist and sedation practice inspector for some of the health boards in Scotland, and also Nick Palmer, who many will recognise is the author of the FGDP guidelines on antimicrobial prescribing and will talk about the highly topical area of antimicrobial resistance.
Don't delay, the early bird fee ends on 28th February.....
We are also pleased to announce that the educational programme for the BAOS conference in Belfast will shortly be revealed so you can make more decisions about study leave and educational updates for the year ahead. It's straightforward to get to Belfast, both Belfast International airport and Belfast City airport (which is slightly closer to the centre) connect to 20 major UK airports. Many of these have their flights already open and were about £25 each way when I looked. Obviously the sooner you book the greater the cost saving, however it's still likely to be cheaper than a train-fare! There is a bus service from the airport into central Belfast and most connect to the Europa Bus centre which is just around the corner from the Europa hotel, and our venue for the conference.
The social nights have however been finalised for the conference. Wednesday night you will need your sea-legs for a trip on the "Nomadic". This is the vessel that used to ferry the passengers in Southampton onto the Titanic. It has been restored and sits in the harbour just beside the Titanic slipway and Titanic exhibition centre. It is walking distance from the Europa (although probably not in high heels..) The Thursday night formal dinner will take place in the historic Belfast City Hall. This is definitely walking distance from the Europa hotel. There are plenty of reasonably priced hotels in the centre of Belfast, but you are advised to book early as they fill up quickly with tourists.
Also coming up, there is a study day in Edinburgh organised by the Scottish BAOS regional reps on 31st March, with a hands-on soft tissue management and socket preservation masterclass available the following day. A Newcastle study day is planned for 7th April, and two further study days at the end of May in Canterbury and Birmingham are also being organised by our regional reps.
So it seems there's lots of great choices for CPD for the year ahead and just too little time...
Probing Stress in Dentistry
As the festive season is fast approaching most of us will take in our stride with a few sighs and groans. Unfortunately, some of us will find it a traumatic time mentally. With the rigours of modern life and pressures of working in the dental community, none of us are immune to mental health issues. It is essential we are able to recognise the symptoms of stress, personally, within others in our work environment and in our patients. Many of you already have experience of supporting colleagues in times of personal and professional difficulty.
So I thought it would be a good time to highlight mental issues and show you what is happening across the water in Northern Ireland so that you may contemplate and compare what is happening in your area.
Following on from some good foundations laid down by NIMDTA (Northern Ireland Medical and Dental training Agency) and the HSCB (Health and Social Care Board), a working group, Probing Stress in Dentistry, has been formed by the BDA (British Dental Association) and supported by the BDA Benevolent Fund, PHA (Public Health Authority), NIMDTA, HSCB and the Indemnity Organisations. Its remit is to continue the work of raising awareness of stress and mental issues in the dental workplace and to inform and coordinate the various courses and resources available to the dental community. The group have identified the following resources open to members of the dental team.
The “Probing Stress in Dentistry” group is currently investigating further courses and development of the process, including the essential on-going support for identified mental health first-aiders in the dental community. The matter of mental health is paramount and hopefully someone reading this may take up the mantle and co-ordinate and develop services in their area. Next year with the BAOS Conference in Belfast we hope to have nurses with training in mental health issues available to talk to delegates on a one to one bases.
Please don’t ignore such opportunities and become one of the people who say, “If only I had known, I would have done something”.
Martin W. Curran BDS FDS(RCPS) MFGDP
Council Member and President Elect BDA(NI)
Please note; this blog does not represent the views of BAOS or its Council, not intentionally anyway]
Ok so I am a little on the edge at the moment. But bear with me. Oh, the old ones are the best. Sing along with me; ‘Nelly the elephant packed her trunk and said goodbye to the circus, off she went with a trumpety trump. Trump. Trump? Trump!?’
The seemingly unbelievable has occurred. As many of us are still reeling from the outcome of the Brexit vote, it seems we have been trumped (verb; to outdo/ surpass) by the Americans this year in the shock-vote stakes.
We need to look at why this could happen…..is this the result of Hillary facing a trumped up (phrasal verb; to devise fraudulently) charges? Or is this genuinely what the US wanted? Have they played their trump (noun; a key resource to be used at an opportune moment) card to cut themselves off from the rest of the world in search of self-preservation after the global crises we have had to face in the last decade or so?
How could have this been prevented? More of the US population voting, possibly. Only about 50% of those with voting rights actually did. Now, on a slightly smaller scale, if needed, voting for new BAOS Council members will be happening soon….please use your vote to get the best candidates elected. If you are up for election, I hope you have got your nomination in and make sure you seek support. Don’t leave it to chance. Learn from the past. Please vote! As a member of Council, I highly recommend it to those interested in seeing Oral Surgery develop as a specialty and a service. You will get to know some lovely people and have a great time in the process.
Back to Trumpton (an imaginary place where all are happy and all is well; the residents of which have no idea about what is going on in the real world), I think basically this the US is guilty of delivering a huge, stinking trump (verb slang Brit; to expel intestinal gas through the anus) to the rest of the world and we are going to be subject to its unpleasant stench for some time to come.
Or perhaps President Elect Donald will turn up trumps and we will all end up smelling of roses!
I hope you have all recovered well after a superb conference-it is always a great experience and was absolutely fantastic this year with excellent speakers and great social events. I thought I would use my blog to bring everyone up to date with what is happening from the SACs perspective. We have been focussed on three main areas-national recruitment; further developments with Dentists with enhanced skills (DES); and the GDC curriculum review.
All the Dental Specialties have been asked to develop a strategy for national recruitment, and each was to go in turn, orthodontics was first; followed by restorative dentistry and paediatrics and now it is the turn of oral surgery. A small working group was established to initiate the process and our first meeting was in June when we went along to observe the orthodontic recruitment. We are going to follow a similar format with multiple stations and we have spent the last four months developing these to ensure the process is both fair and robust. The likely timeline will be that all posts advertised before 31st December will be local recruitment but any posts after this time will be included in the new process. The posts will be collated and then the advertisement will go out in March for applications, and the actual interviews will be held in a centre (likely Elland Road Leeds) in May. A national person specification has been produced and applications that do not meet this specification will be longlisted out. Applicants invited for interview will be scored on each of the stations and the scores collated to produce a “ranking”. Applicants will be asked to preference the available jobs and then the jobs will be offered on the basis of the ranking and the preferencing. Having observed the process with orthodontics we are all confident that it is very fair and robust and we are all happy to move forwards with it. Individuals who have been appointed to academic posts will also have to go through the same process to be “benchmarked” before being awarded an academic NTN ie. They will have to achieve an appropriate ranking in an identical manner to non-academic trainees.
The publication of the commissioning guides has resulted in commissioners requesting guidance as to the possible assessment of applicants who wish to provide a tier 2 (IMOS) service. The CDO has established a working group to produce this guidance and requested that the initial focus was on three dental specialties-oral surgery; endodontics and periodontology. The focus of this guidance is to establish a method (hopefully common to the three specialties) of verifying the applicant’s clinical competency to be awarded a contract. This work has been very time consuming but everyone has contributed a great deal to the process. Each lead established a small working group to produce the documentation including colleagues from primary and secondary care; specialists and current tier 2 providers to ensure that the process that was suggested was fair; equitable and actually “do able”! The initial suggestions have been submitted for discussion and the process in on going ie still a “work in progress” but it is definitely starting to take shape and hopefully will be completed by the end of the year. The one thing we have all insisted on is that the assessment must be for the individuals actually carrying out the treatment, not the contract holder-as we all know there have been instances where contracts have been awarded, but the actual treatment is carried out by a separate third party which we do not feel is acceptable. The likely format will be a submitted portfolio of evidence including training; experience; CPD; work place based assessments; patient feedback etc and this will be reviewed by a panel of specialists to ensure appropriate governance is in place. I have no doubt there will be many further discussions on final structure; funding and indemnity but it is progressing to become a robust process with patient safety and governance being paramount.
GDC curriculum review
The GDC is undertaking a review of all the dental specialty curricula which obviously oral surgery is part of. The initial focus was to establish a generic curriculum for all the specialties in the non-clinical aspects of training eg management skills; communication; patient safety; governance etc. This was completed last month and was available for consultation on the GDC website. It is very thorough and comprehensive and accurately reflects the non-clinical skills a specialist should be trained in within a modern NHS. The next stage is for each SAC to develop the clinical part of the curriculum for their specialty and present this to the GDC-this should be completed by the end of 2017. The oral surgery SAC are already starting to do this and we are currently looking at each aspect of the current curriculum in terms of its relevance and application within modern oral surgery practice. We have also reviewed the current trainee’s experiences and will be incorporating this into our review. It is a daunting task and involves a huge amount of work but we are very hopeful that the end result will be to produce excellent high quality training for the oral surgeons of the future.
I would like to wish everyone in advance “all the best for 2017”-there will be a lot happening in our specialty next year!
After Pippa’s excellent blog last month on ‘Reflection’, I felt it would be timely to reflect upon what the BAOS council does behind the scenes for you, the membership.
There are 18 members on Council supported by the admin team who provide us incredible support, led by Roger Manson. Sarah and Louise provide additional part time support to the ever increasing BAOS workload. Martin Curran leads a team developing performance indicators for the admin staff in recognition of their increased workload.
Honorary Secretary Rebecca Hierons, now President Elect, has been a formidable secretary and overseen an update of the T’s and C’s for BAOS, and with Pippa, clarification of Council job descriptions for officers and the admin staff. Other council officers include Mike Murphy who remains Honorary Treasurer (and Lead for MCN consultation), Paul Coulthard Editor of the JOS (Chair of Commissioning working groups) and Pippa Blacklock Past President who leads annual teaching study days as well as the ever popular Teaching and Learning course and herself has developed a Masters Programme in OS.
The council have allocated duties, Rhian Jones, Rebecca and Greg Gerrard comprise the Primary Care group resulting in the production of national tariff recommendations and trial of PREMS and PROMS which we hope will advise NHS commissioning. Anna Dargue is regional rep lead (supported by Hannah Nasse in organising regional and annual rep study days), Colette Balmer is SAC chair and as a result leads as Training Advisor (and conceptualised the February commissioning day), Rachel Evans Media PR lead (resulting in increased PR and conference sponsorship), Sami Stagnell and Claire Harwood are Trainee advisor and rep, Julie Burke is lead scientific organiser for the Conference and lead for annual CPD study days. Greg Gerrard is lead for Audits and BAOS publications. Pete Brotherton is Website lead, Neil Oastler is lead for OS dental services and Rob Bunyan is lead for secondary care group.
Now I want to provide some examples demonstrating BAOS council influence.
OS Careers Colette Balmer is leading the development of national recruitment for oral surgery which starts May 2017. The number of OS NTNs continues to increase in contrast to other specialties, however, progress remains slow due to delayed implementation of the commissioning guides, and establishment of functional MCNs and Local Dental (professional) Networks.
I have participated in the GDC consultation of Specialty Curricula, which in turn will lead to new curricula for all specialties, possibly 3 plus 2 or 4 year run through for all dental specialties. These will be established in 2017. This consultation has provided an excellent opportunity to directly discuss OS specialist list representation of the actual OS workforce and inequalities and the lack of opportunities for SAS grades and career development. The open access to Membership specialty examinations is gaining progress and will be facilitated by the GDC review of the Specialty Curricula. Level 2 dental services are continued to be discussed by GDC but as yet there is no quality assurance or recognised training pathway.
There have been issues with Deaneries not providing support for trainees to attend the BAOS Conference and Colette Balmer (Chair of OS SAC) has provided a clear overview of study leave entitlements for Trainees and study leave . BAOS support the inter-specialty trainees meeting annually.
BAOS council is now in a strong position with regular invitations to participate on National Level Consultations, ensuring that Oral Surgery has a voice at the most influential levels.
The highlight of the year is the BAOS Conference (link) for which we get fantastic feedback every year and is well worth the registration fee.
The BAOS audit for 2015 M3M audit will shortly be published in JOS The 2016 audit will be a trial of a clinical scenario testing knowledge for antimicrobial stewardship. This will be rolled out for all specialties once validated
So on reflection you can see that the BAOS council is incredibly active on behalf of the BAOS membership in all aspects of training, commissioning, service development and in raising the profile of Oral Surgery. Our membership continues to expand and remains the heart of our Association. I very much look forward to seeing you all at the 2016 Annual Conference in Edinburgh later this month which will be a fantastic way to gain high quality CPD, catch up with old friends and make new ones. Lastly, we are launching a new Conference App this year (thanks to Claire Harwood) which will truly bring our meeting into the 21st Century!
Best wishes to all
Prof Tara Renton
President of BAOS