UK Dental Core Training Curriculum Framework. 16th April 2015

Transcription

1 UK Dental Core Training Curriculum Framework 16th April

2 Dental Core Training Curriculum Executive Summary This framework is the first stage in the development of the UK wide Dental Core Training Curriculum. Further work is planned in 2015/16 to develop a full curriculum with wide engagement from stakeholders. Health Education West Midlands is taking the lead on this project. This Framework gives proposed headings for the outcome of training, but the full curriculum will include detailed outcomes under those headings. Comments welcome to: Harjinder Purewal Project Manager Sarah Brothwood - Admin support to the project DCTDevprogramme@wm.hee.nhs.uk 2

3 Section 1 Training with purpose 1. What is Dental Core Training? Dental Core Training (DCT) is that period of postgraduate development which extends from the end of Dental Foundation Training (DFT)/ Dental Vocational Training (VT) to the start of specialty training, specialist practice, generalist practice or many other possible career options. As such, it is a training period that has multiple endpoints and a varied duration of from one to three years. It should be noted that there is no statutory or contractual requirement for any dental graduate to undertake Dental Core Training. It is however, seen by many recent dental graduates as being an extremely valuable training and education experience that helps clarify their own professional career intentions This grade has been reorganised and renamed several times in the past five years- from Dental SHO to Dental Foundation Year 2, to Career Development post, to Dental Core Training. The current name splits this period of training to DCT1 and DCT2/3 according to stage of training. There are 710 DCT posts in the UK (418 DCT1 and 292 DCT 2/3 SOURCE: COPDEND survey of DCT posts 2013). This demonstrates that in any given year, approximately half of the UKs Dental Foundation/Vocational trainees would be able to access Dental Core Training year 1. It is expected that trainees spending this length of time in further training posts would be able to clearly demonstrate progress and professional development in multiple areas of their personal portfolio. The range and content of this development is wide and has not always been adequately evidenced by trainees or trainers. There has been a significant element of service delivery in DCT posts which has often reduced the training and development focus of posts. The lack of a meaningful curriculum and assessment framework for this training period has compounded the problem and in many cases trainees have not been able to make best use of potential training opportunities. Equally, the curriculum that has been used has not mapped well to the training opportunities available in the various environments of DCT and has been focussed on competence acquisition, rather than evidence of outcomes. As dental workforce development moves forward, distinct roles and levels of training are now more clear. This allows distinction between the DCT 1 year and subsequent years. DCT 1 is training aimed at development of the skilled generalist, whilst DCT2, 3 are more aimed at the development of (or readiness for) specialist skills. This may result in exit from DCT to a dentist with additional competencies (Currently termed Dentist with Enhanced Skills DES in England) or into specialty training (StR). It should be noted that Dental Core training occurs prior to entry to specialty training and does not lead to run through training in the specialties. It is most often a stand alone period of training with a number of exits into career choices. (See Figure 1) Curricula for StR training are in place for all the dental specialties, with well developed assessment frameworks and portfolio structures. The DES curricula are under development, but will also provide some clarity on the level and range of skills and attributes that are expected of DCTs at the end of their training. It is in this context that this new curriculum has been produced and will need to be delivered. It is designed to support trainees and trainers in the process of early postgraduate professional development by providing a competence framework of knowledge, skills and attitudes and appropriate tools for the assessment of their acquisition. 3

4 Currently the majority of posts across the UK are in Oral and Maxillofacial Surgery (OMFS) - Units in District General Hospitals, whilst the remainder are mostly in the Dental Hospitals, with a few in the Salaried/Public Dental Service and General Dental Practices with Specialist input. The knowledge and skills obtained by the trainees, will in part, be dependent upon the setting in which they work. However they will be exposed to many experiences that are either similar or identical. These will include: Experiencing work and training in a different setting compared to Dental Foundation Training. Dental Core Trainees work in a supportive environment where they are properly managed and supervised, enabling them to learn through service delivery whilst ensuring that patients are not put at risk. Dental Core Trainees practise within their own level of competence and are provided with adequate supervision and feedback to reach higher level of competence in existing skills and to acquire new skills. Learn from many different supervisors in different settings. Learn to manage patients referred from Primary Care o Patients with complex dental conditions. o Patients with complex medical conditions. o Patients with both complex medical and dental conditions Be part of a large multidisciplinary team Consolidate knowledge of clinical and organisational governance. Learn to communicate with a wide variety of different healthcare workers. Work with experts in their field. Have opportunity to study and take p/g exams. Give opportunity to present at local/regional meeting Publish case reports. Learn many new skills. Maintain a portfolio of learning development and formative assessment Develop ideas about their career choice. For many, one year or two working in this Grade is career defining. 1.1 The difference between the DCT1 year and DCT 2/3 DCT 1: Should be as generic as the setting allows. Build on the skills, knowledge and behaviours gained in DFT. When completed, the trainee should be more knowledgeable, skilful and confident. Prepare the trainee for either a return to general dental practice or advancement to DCT2. DCT 2/3: Should be attractive to those determined to pursue dental speciality training or become a dentist with enhanced skills. Dental / OMFS Speciality focused. Should also be available either for one year or for two years as a run-through grade 4

5 2. Scope and Purpose of the Curriculum The range of knowledge, skills and attitudes required across dentistry is huge and can not be delivered in the context of DCT alone. Equally, DCT is delivered in multiple settings across primary and secondary care and in different specialties. The purpose of this DCT curriculum is not to be prescriptive, but to provide a toolkit which can be accessed according to the development and training needs of the individual trainee and according to the available training opportunities of the training location. The concept underpinning the curriculum is one that recognises that the needs of Dental Core Trainees are different at each stage of training (DCT1 vs DCT2 vs DCT3) as well as individually within each stage (depending on individual styles, abilities and also placement related factors). It is with this in mind that the curriculum assumes three levels of content: 1 - Fundamental content: The knowledge, skills and attitudes that underpin dental core training at all stages and that are key to the development of the skilled generalist. 2 - Facilitative content: The knowledge, skills and attitudes that are in keeping with development towards a higher level of skills and competence in a more specialised field of dentistry, that may contribute towards readiness for specialty training or development as a Dentist with Enhanced Skills in practice. 3 - Focussed content: The knowledge skills and attitudes that are in keeping with readiness for the move in to specialty training in one of the dental specialties The curriculum logically follows the structure previously established for the Dental Foundation Training Curriculum. The domains feed in to the expectation of readiness for a variety of career outcomes including general dental practice, hospital practice, community dental practice and specialty training. In the higher level competences, the DCT curriculum maps across to elements of the dental specialty curricula. However, this curriculum also recognises the needs of a flexible workforce to move into training for other areas and so presents the competences in a modular fashion to allow tailoring to individual needs. It is therefore possible to access the material in a fashion which is clearly structured according to stage of training, location of training, individual development need. This approach is supported by the assessment toolkit which will be familiar to many, having been adopted from the Dental Foundation Curriculum. 5

6 3. What core trainees are expected to achieve: The curriculum lists competences into subsections. Each subsection is headed by outcome descriptors indicating the levels of performance that core trainees must achieve in Dental Core Training year 1 (DCT1) and how theyshould be developing their ability to work with increasing independence in DCT year 2 / 3. The outcomes are the standard against which their performance will be judged and are achievable without the need to demonstrate achievement of each individual competence. At the first session with the educational supervisor, the dental core trainee may wish to discuss aspects of the Curriculum, which might include: -how to build on strengths from undergraduate training and DFT -particular areas of interest to explore -any potential targets for development which may need to be addressed Targets / aims for a particular placement -how to record achievements in the e-portfolio. The trainee and educational supervisor should also agree a timeline for this undertaking and recording of achievements, and they should agree the time and dates for subsequent meetings. 3.1 The context of Dental Core Training All Dental Core Trainees must make patient safety paramount and must practise with professionalism. They must learn how to empathise with patients conditions and develop professional attributes In accordance with the the GDC Standards for the Dental Team, trainees must also demonstrate the following: Integrity Compassion Altruism Aspiration to excellence via continuous improvement Respect of cultural and ethnic diversity Regard to the principles of equity Ethical behaviour Probity Honesty Leadership. At all times Dental Core Trainees must promote patient safety by: practising within their competence practising in accordance with prevailing professional standards and requirements including those expected in their placement seeking advice from more experienced clinicians whenever appropriate in the workplace. 3.2 Learning Dental Core Trainees will learn from experience. Learning is enhanced by feedback 6

7 and subsequent reflection. Supervised learning events should be used to encourage this process. Dental Core Trainees and their trainers are expected to seek out both scheduled and unscheduled opportunities in the workplace to observe and discuss practice, clinical skills and management 3.3 Outcomes Dental Core Trainees (DCT1) should emerge with professional qualities described by the GDC and described in the curriculum. DCT2 and DCT3 dentists should further develop these qualities and also emerge with the understanding, skills and attitudes needed to enter specialty or Dentist with Enhanced Skills posts. The curriculum is outcome based. For clarity, the outcome descriptors for Dental Core Trainees are presented at the start of each subsection and expanded below as competences. Throughout the curriculum the outcomes for DCT2/3 include those for DCT1, to indicate that Dental Core Trainees are building upon previous experience and practising at a more sophisticated and increasingly independent level. Dental Core Trainees do not have to demonstrate that they have achieved every competence but will be expected to discuss or demonstrate achievement in each of the outcomes. Evidence of Dental Core Trainees learning and developmental achievements will be recorded in the e-portfolio. Further information and declaration forms for probity, professional behaviour and personal health can be found in the e-portfolio. Assessment should be carried out against an appropriate benchmark and is guided by clear descriptors of the expected outcome at each stage of training and readiness to progress. The full curriculum document will include an assessment framework. 4. Key Milestones in Dental Core Training 4.1 Outcome of DCT1 As previously described, the outcomes from DCT 1 training are the fundamental skills, attitudes and knowledge that would be expected of a skilled generalist. At minimum this would be commensurate with performance at level 1 of the clinical pathways approach to the delivery of dental services in England. It would be hoped that the skill level would be slightly above this as this level is expected at the end of Foundaiton training. These focus on the enhancement of a broad range skills in relation to holistic professional practice, rather than procedure based competence acquisition. There will also be scope for procedure based competences to be accrued in keeping with the trainee s Personal Development Plan (PDP) and opportunities available in the placement. Trainees should be able to demonstrate evidence against the following areas / outcomes: Enhanced clinical skills relevant to primary dental care. Understanding of the impact of referral. Options to work partly in OMFS services, dental hospital services and partly in salaried/public dental services. 7

8 Out of hours work in some posts but not all. Increased team working and working in multidisciplinary teams. Development as a professional. Development of confidence as a professional Enhanced skills in self reflection and construction of effective PDP Improved self-awareness Academic achievement (MFDS/MJDF/MFD, Audits, Presentations, Prizes) Enhanced awareness of career options and intentions Improved competence in index procedures such as simple extractions Ability to cope with more challenging and complex patients 4.2 Outcome of DCT2/3 As trainees progress through DCT1,2,3 it would be expected that the balance of fundamental, facilitative and focussed skills and attributes will change in line with expected career progression and exit from DCT Enhanced clinical skills. Portfolio of some outcomes required for entry to DES services in England (when published). Portfolio of outcomes required for entry to specialist training. Less generic experience More specialty specific Enhanced academic achievement (e.g. publications, presentations, teaching, research) The syllabus of the DCT curriculum will be a resource to guide trainees. However, other resources such as the DES curricula, specialty training curricula may well be valuable for trainees in setting realistic, career focussed objectives for their training. 5. Pathways through Dental Core Training There are a number of pathways through Dental Core Training, in keeping with the flexible nature of the workforce and variation in career paths. It is not uncommon for trainees to spend one year in core training to enhance their skills and then move on to a long term post in their chosen career. Equally, trainees may well spend a significant period in primary care before returning to dental core training to acquire specific enhanced skills or as a prelude to specialty training. It is essential that the curriculum supports this flexible workforce model and is able to address the needs of individual trainees and the circumstances of their training. The material is presented in themed areas and domains and structured according to expected outcomes at each stage. This structure then allows utility in multiple career pathways. 8

9 6. Assessment during Dental Core Training Dental Core Training takes place in a variety of settings including Oral and Maxillofacial Surgery Units, Dental Hospitals, Salaried/Public Dental Services and sometimes in General Dental Practice. As a consequence of these varied settings, the scope of practice individual DCTs are exposed to is very variable and will differ between experience in year one and year two. Further, it must be emphasised that only a proportion of trainees (, about50% who complete the DCT1 year go on to undertake a DCT2 year and fewer still a DCT3 year. For these reasons, the syllabus in this curriculum is outcome based rather than competency based. Formal assessment of progress will be made every six months and at the end of the placement. The clinical and/or educational supervisor s interim and end of placement assessments will be based upon multiple sources of evidence including feedback from more senior clinicians who have observed practice in the workplace (Workplace-based assessments). Other important evidence will be provided through the e-portfolio including Multiple Source Feedback, patient feedback, log book of activity, engagement with didactic study sessions and reflective practice throughout the placement. Dental Core Trainees are expected to demonstrate that the learning outcomes, listed in the Curriculum and relevant to the placement have been achieved. Individuals develop at different rates and many Dental Core Trainees are expected to achieve well beyond the minimum level specified in the Curriculum. The vast majority of Dental Core Trainee will have no difficulty in achieving these outcomes. When problems are identified, the Trainee will be encouraged to work to find solutions with the support of their clinical and educational supervisors. At the end of DCT year 1 and the end of DCT year 2 or year 2/3 (run-through), trainees who can demonstrate they have achieved the minimum requirements of the curriculum as determined by a Review Panel, will be issued a Certificate of Satisfactory Completion of Dental Core 1,2 or 3 training. 7. Satisfactory completion of Dental Core Training Collect evidence to support readiness to progress to next stage via the DCT e- portfolio. Mandatory items will include: 1. Documented appraisal 2. WBA 3. PAQ 4. Attendance at Study days 5. Case studies 6. Reflection 7. Audit outcomes 9

10 Award a certificate of readiness through a process similar to ARCP. Those who do not demonstrate readiness to progress are not awarded certificate. DCT1 some remediation will take place within a year long programme with targeted training. Consideration should be given as to whether DCT2/3 should have the training period extended for remediation. Requirements are agreed in the educational agreement at the beginning of the period. 8. DCT Programme structure 6months, 1 year, 2 year programmes Rotations. Modular approach for Year 2/3 10

11 Average national number of trainees entering each training grade per Year (best available estimate based on 2013 data) 100 Average national number of trainees exiting training per Year * * Figure 2. Indicative Post numbers in Dental Careers 11 * Estimate as breakdown between DCT2 and DCT3 is not available

12 Outcome of Dental Core Training For each of the identified outcomes, the final curriculum will define the competencies required. Section 1. The Core Dental Trainee as a developing professional 1. Professionalism, Leadership and Management 1.1 The generic descriptors of outcomes for this domain: Behaviour in the workplace DCT 1, 2 and 3 outcomes: Acts with professionalism in the workplace and in interactions with patients (and where appropriate/necessary carers and relatives) and colleagues Acts as a role model and where appropriate a leader for dental / medical students and other junior dentists, and assists and educates other staff Time management DCT1 outcomes: Is punctual and organised. Delegates tasks and ensures that they are completed Continuity of Care DCT1 outcomes: Ensures continuity of patient care is established. This includes ensuring the patient s general dental / medical practitioner receives an accurate and timely discharge / continuing care letter. Ensuring the patient understands the next step in their care. Where patient care is being handed over to the next team, ensures information is accurate and appropriately prioritised. DCT2 /3 outcomes (in addition to DCT1): Organises handover, referral as indicated and task allocation, anticipating problems for the next clinical team Takes pre-emptive action where required. 12

13 1.1.4 Team-working DCT1 outcomes: Displays understanding of personal role within their team including supporting the team leader and listening to the views of other healthcare professionals. Organises and allocates work within their clinical team to optimise effectiveness Leadership DCT1 outcomes: Demonstrates a leadership role within the team in certain clinical situations, e.g. when supporting dental students on clinics. Demonstrates extended leadership role within the team by making decisions and dealing with complex situations across a greater range of clinical and non-clinical situations, e.g. supervising DCT1 trainees, instructing dental nurses, etc Confidentiality 1.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum Clinical Skills and Knowledge Critical Thinking, Appraisal and Decision Making Coping with Pressure Patient Centred Care Team Working 13

14 2. Relationship and communication with patients 2.1 The generic descriptors of outcomes for this domain: Treats the patient as the centre of care within a consultation or treatment episode DCT1 outcomes: Prioritises the needs of patients above personal convenience without compromising personal safety or safety of others Works in partnership with patients in an open and transparent manner, treats patients as individuals and respects their perspective/views on their own treatment. Works with patients and colleagues to develop sustainable individual care plans to manage patients maxillofacial, oral and dental treatment needs Communication with patients DCT1 outcomes: Communicates effectively and with understanding and empathy in straightforward consultations Demonstrates increasing ability and effectiveness in communicating more complicated information in increasingly challenging circumstances e.g. time limited consultations (outpatients clinics, dental practice setting) Deals increasingly independently with queries from patients and relatives Communication in difficult circumstances DCT1 outcomes: Breaks bad news to patients or carer/relative effectively and compassionately and provides support, where appropriate. Recognises where patient s capacity is impaired and takes appropriate action in less straightforward circumstances Complaints DCT1 and DCT2/32 outcomes: Recognises situations which might lead to complaint or dissatisfaction. Apologises for errors and takes steps to prevent/minimise impact Consent 14

15 DCT1 outcomes: Obtains consent as appropriate in accordance with employers requirements Increases the breadth of procedures for which consent is taken 2.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum Informed consent Legal issues 3. Clinical Governance 3.1 The generic descriptors of outcomes for this domain: Risks of fatigue, ill health and stress DCT1 outcomes: Recognises that fatigue and health problems in healthcare workers (including self) can compromise patient care and where appropriate, must be urgently addressed If applicable recognises fatigue/stress/illness in members of the clinical team and seeks senior guidance to reduce this Quality and safety improvement DCT1 outcomes: Delivers high quality care in accordance with local/national guidelines Manages, analyses and presents at least one quality improvement project and uses the results to improve patient care. Competences: General Quality Improvement Audit Cycle 15

16 3.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum Record Keeping Use of Information Technology Organisational framework for clinical governance and its application in practice Risk assessment and risk management Guidelines Patient Safety 4. Ethical, legal and probity 4.1 The generic descriptors of outcomes for this domain: Ethical principles and confidentiality DCT1 and DCT2/3 outcomes: Practises in accordance with GDC Standards for the dental team Legal framework of clinical practice DCT1 and DCT2/3 outcomes: Takes personal responsibility for and is able to justify decisions and actions Comprehension of relevance of outside bodies to professional life DCT1 and DCT2/3 outcomes: Recognises many organisations and bodies that are involved in dental education and the regulation of dentistry. 4.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum Equality and Diversity 16

17 4.2.2 Clinical Teams Complaints Personal health Stress Financial Regulation Understand the role of the dentists in safeguarding 5. Teaching and Learning 5.1 The generic descriptors of outcomes for this domain: DCT1 outcome: Delivers presentations and teaching sessions to students and peer group, which support learning. Participates in the assessment of healthcare professionals and provides constructive feedback. Reflects on feedback from learners and supervisors to improve own teaching and training skills. Delivers presentations at Regional/National/International meetings. Contributes to the teaching, in specific circumstances, of Dental Foundation/Vocational Trainees and General Dental Practitioners. Makes contributions to peer reviewed publications, including Case Reports. Opinion Articles and Research Lifelong learning DCT1 outcome: Maintains personal development e-portfolio by recording learning needs and personal reflection including career development and planning. Complies with GDC requirements for CPD Recognises personal learning needs, addresses these proactively and sets SMART* goals *Specific, Measurable, Achievable, Realistic, Time limited. 5.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum. 17

18 5.2.1 Structure of the NHS and the principles of management (in the context of the envisaged role of the trainee) Teaching Appraisal and assessment Section 2: The Dental Core Trainee as a safe and effective practitioner 6. Good clinical care 6.1 The generic descriptors of outcomes for this domain: Across all of the subsequent clinical domain areas, which are grouped by specialty themes, these values must underpin competence acquisition and professional development Makes patient safety a priority in clinical practice DCT1 outcome: Delivers high-quality reliable care in accordance with the evidence-base and senior clinicians prescription. Recognises and works within limits of competency requesting appropriate assistance/ senior guidance to ensure patient safety. Demonstrates an ability to practice independently whilst remaining within their limits of competency Recognises when patient safety is at risk and institutes changes to reduce risk. 6.2 The Knowledge, Skills and Attitudes of this domain The knowledge, skills and attitudes for each area will be defined for this domain in the full curriculum The general knowledge, skills and attitudes The specialty specific clinical competences Preventive care Maintenance of Oral Health Oral Medicine and Soft tissues Restorative Periodontics Endodontics 18

19 Prosthodontics Oral Surgery Paediatric Dentistry Orthodontics Oral and Maxillofacial Surgery Medicine and Surgery in relation to Dentistry Special Care Dentistry Behaviour management and Anxiolysis Dental and Maxillofacial Radiology Oral and Maxillofacial Pathology Epidemiology Dental Public Health Section 3: The Assessment of the Dental Core Trainee 7. The Assessment toolkit 7.1 The rationale 7.2 Workplace Based Assessments 7.3 The Time line for assessments Section 4: Supporting documents (to be developed in full curriculum) 8.1 How to use the curriculum 8.2 Algorithms for DCT 1 / DCT2 / DCT3 8.3 Case studies 8.4 Line management of DCT 8.5 Quality Assurance for DCT programmes 19