Part 4. A New Hope? Re Registration for Dental Professionals in New Zealand. A Whole Dental Health Perspective, Appraissal and Reflection.

“A competent Dental Hygienist understands current biological, physical, cultural, social, and psychological factors involved in dental and oral disease, and in attaining and maintaining oral health.” NZDC, Scope of Practice for Dental Hygienists

Dental Hygienists are called, under a set of professional guiding standards, by the New Zealand Dental Council (NZDC) in their daily clinical and professional practice approach. They include putting our patients interests first, ensuring safe practice, communicating effectively, providing good care and maintaining public trust and confidence in the dental profession.

The NZDC also provides a legal Scope of Practice (SOP) document for Dental Hygienists in New Zealand, that compliments the Standards by guiding the practitioner to the boundaries of clinical activities pertinent to their specific qualifications. This demonstrates what is determined as “Best Practice” by understanding current scientific knowledge and skills, attitudes, communication, judgement and demonstrate a commitment to real health promotion.

“Enable patients to maintain and enhance their individual well-being by increasing their awareness and understanding of “health matters”. NZDC Standards Framework Document section 22.

The Dental Hygienist has a legal commitment to follow the NZDC’s continuing professional development (CPD) 2 year recertification cycle presently by completely and being able to demonstrate compliance through a portfolio of evidence, if required. The Framework Document and Scope of Practice aligns the clinician with what is deemed necessary to do to achieve future recertification, as well as, of course, paying a practice certificate fee. The cost of that to a New Zealand Dental Hygienist is not unsubstantial, in fact far cheaper than that of a UK Hygienist, and very near to want a practising general Dentist has to pay. 1.

The recertification process has recently come under scrutiny by the NZDC when in February of this year a summary of the key features of a final design for their new recertification programme was published and disseminated to the registered body. It has been the subject of focus group attention for several weeks prior to the approval of its principles. We await the final draft details but in the meantime we can posset its incarnation and comparison with the same outcomes that Dental Professionals have adopted in the UK in 2018. I find it interesting that the NZDC derives their inspiration for such change from UK and Europe, once again. Interestingly though it appears they have done things a little differently and, it seems to me, slightly better. Perhaps this alludes to the historic and cultural differences between practice cultures in New Zealand  and the UK, as well as the size of the professional populations of both countries.

“Will attending the course change the way you think, or carry out your role in your practice?” Postgraduate Medical and Dental Education for Wales, UK

The key features of the new design include the creation of a Professional Dental Plan (PDP), Professional Dental Activities (PDA’s) replacing the present learning title of CPD , annual online self-declaration to the effect of completion or attendance, a Professional Peer Relationship (PPR) and written reflective practice. These are radical departures from what is presently the norm and the will come into effect, it is reported, from the 1st April 2021. All the above components are found at the General Dental Council (GDC) of the UK with minor nuanced changes from 2018. 2.

Screenshot 2020-04-10 08.04.09

The roots of changes in the UK stem from the need to identify and develop personal professional skills, in line with your present skill set and workplace environment. The PDP allows you to track and achieve those goals. A degree of flexibility and review of your learning journey is set into the PDP criteria and is further boosted by the critical and supportive input of a skilled and qualified mentor, in the UK case and, here in New Zealand a  Professional Peer (PP). The PP “must be able to provide knowledge and credible feedback relevant to the practitioners professional development”. The New Zealand method is more personal, it can be one on one, via teleconferences or by email. The responsibility of the clinician/professional peer relationship is further emphasised by official confirmation that “before a practitioner applies for an Annual Practising Certificate (APC) each year, the PP will need to provide confirmation online that the practitioner has interacted with them during the year, has a PDP, participated in PDA’s and has reflected in writing”. The PP can also assist in developing and reviewing PDP’s and assist in PDA developmental choices.

“Fail to plan and you plan to fail.” Benjamin Franklin

Primarily though, it allows the clinician learner the ability, responsibility and accountability of self-directing their own knowledge creation. There are a variety of sources to effect meaningful learning. Traditionally we as a professional body have leaned heavily upon the local professional study groups and associated learning events. The annual professional body seminars, Dental Trade Industry (DTI) sponsored events and roadshows are traditionally well trodden sources of knowledge. There is a cost element attached to belonging to associations and paying for events, mollified by the DTI to some extent, more so in the recent years. This brings into focus the issue of PDA’s being overtly linked to commercial interest, in part, where the industry is in direct contact and potentially influencing decision making of professionals. Historically the DTI has been on the fringes of conferences and meetings but now appear to be more directly involved in providing CPD. This is effectively brought to the attention of the discerning clinician by Gillis and McNally (2010) who state “University-industry relationships are becoming increasingly common in academe. While these relationships facilitate curriculum relevance, they also expose students to external market forces”. They continue, “Industry’s presence in academe is a concern. Dental educators (and dental health professionals from 2021 – author’s note), as stewards of the profession, must be nimble in brokering industry’s presence without compromising the integrity of both the educational program and the teaching industry as a whole”. It appears that the NZDC’s move to create a new recertification process has considered this as well. Allowing self-directed study, independent research and authentic learning negates this influence, in part. 3.

“Before you decide to attend a course, or an educational event you need to question the relevance to you of the subject being covered”. Postgraduate Medical and Dental Education for Wales, UK

Additionally, in what I feel is a further bold move, there will be “No mandatory requirement to meet a quota of PDA hours.” There will also be no requirement for PDA’s to be verifiable and will be linked to “Any activity relevant to maintaining and building a practitioners competence in their SOP. PDA activities need to be aligned with “Specific developmental outcomes”.  Think about your workplace, your roles within in it, clinically or non-clinically, the nature of the practice and its clients. For example, I work in a general and modern orthodontic practice, I treat both disciplines from a dental hygiene perspective, the parents of the younger orthodontic cases tend to be very involved with their children’s care, they are included too. I work collaboratively with orthodontic auxiliaries, dental assistants, dentists and reception and office staff and managers too, as a team. Planning meaningful and practical PDA may see learning in non-dental related subjects such as leadership, communication or team building.

Writing a PDP begins with a honest appraisal of where you are now professionally, your workspace, where you feel you need to go by identifying your specific career goals and learning needs to ultimately accomplish them. Consider your timeline, the NZDC are preparing a move from it being 2 to 3 years, whereas the GDC, UK have structured 5 into theirs. I’m not sure how I feel about this, the longer would be preferable as learning can be more open ended and reviewing your PDP might lead to more changes as a consequence, as well as workplace changes leading to modifying learning goals. A 3 year cycle might be justified initially as trialling the new regime but alterations to future timelines might require adjustment from feedback and experience. The templates for PDPs will be required too, created individually or by supportive professionally bodies or the DTI.

“You may wish to reflect after every activity, or at intervals during the year, reflect with your employer, or a peer or mentor”. Postgraduate Medical and Dental Education for Wales, UK

Reflection maybe the biggest educational challenge that Dental Professionals face as part of this educational development change process. I had the opportunity to be exposed to reflection during a degree programme at the University of Kent several years ago. Initially the process was very confusing, understanding the methodology, learning to write and express the sentiment of something you do mentally, every day in many clinical and ordinary experiences. Consider cooking a new recipe, you taste it and realise it may need seasoning or more of something and less of the other to enhance it, the next time you repeat it you alter your process again. This reflective critical self-appraisal doesn’t have to be a novel or a work of literal art but just an honest and revealing attempt to describe a situation in your professional environmental.  We need to demonstrate learning that as occurred, what we alluded from it, or not, what would we do differently as a consequence of it. Eventually it leads onto planning improved practise and what future developmental directions do you think you need to go.

Self-reflection is a humbling process. It’s essential to find out why you think, say, and do certain things – then better yourself.” Sonya Teclai

I can remember re registering with the NZDC in 2013, returning to New Zealand from the UK with a portfolio of evidence of learning, with a PDP, PDA log and reflections linked to learning. I was advised that at that time that there were gaps in my portfolio and I needed to catch up with CPD hours to comply. I was horrified to think that what I had learned from a UK university whilst doing a dental education degree wasn’t deemed enough. Ironically now, it seems that the NZDC is adopting those things I presented way back then. I will fall back on what I originally learned and prepare a PDP, construct PDA’s and continue to reflect upon my processes . I will find a PP and form a relationship which will help me evolve my practise further. Also, as part 2 of this piece I will delve further into self-directed learning methods that can help the independently minded critical thinker learner/researcher to move forward in this COVID19, post COVID19 clinical environment “Brave New World”.

  1. Annual renewal and fees, GDC, UK.

          https://www.gdc-uk.org/registration/annual-renewal-and-fees

  1. Enhanced CPD guidance, GDC, UK. https://www.gdc-uk.org/docs/default-source/enhanced-cpd-scheme-2018/enhanced-cpd-guidance-for-professionals.pdf?sfvrsn=edbe677f_4
  1. Gillis, MR & McNally ME (2010). The influence of industry on dental education. https://www.ncbi.nlm.nih.gov/pubmed/20930240

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