Medicine grande 3 Dental theory

The definition of CPD that has been adopted in this report is that used in the CPD guidance issued by the GDC, namely
Strong evidence from at least one properly designed, randomised control trial of
appropriate size.
Grade
III Evidence from well-designed trials without randomisation, single group studied pre and
post intervention, cohort, time series of matched, case-control studies.
Grade
IV
Evidence from well-designed, non-experimental studies from more than one centre or
research group.
Grade
V
Opinions of respected authorities, based on clinical evidence, descriptive studies or
reports of expert committees.
3.2 Literature from other healthcare professions
Literature on CPD from non-dental publications was reviewed. This included systematic reviews
published in peer reviewed journals identified using a Medline search that adopted the terms:
“medicine”, “nurses”, “continuing professional development”. From citations in these systematic
reviews, other papers were identified.
Documents from grey literature suggested by the GDC and from Subject Matter Experts were also
analysed. Dental SMEs and from wider healthcare included those from academic organisations,
regulatory bodies, postgraduate educational institutions, professional organisations, arms’ length
bodies, and national and European senior advisors. Consultation with them enabled the
identification of grey literature for dentistry and other areas of healthcare. Information relevant to
the seven questions posed by the GDC was extracted and its location in the papers/reports was
logged.
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4. Overview of the aOverview of the aOverview of the a Overview of the a Overview of the a Overview of the a Overview of the aOverview of the a nalysisnalysis nalysisnalysis of the of the of the of the literature for literature for literature for literature for literature for literature for literature for literature for literature for literature for dental and dental and dental and dental and dental and dental and othothother healthcare professionalshealthcare professionalshealthcare professionals healthcare professionals healthcare professionalshealthcare professionals healthcare professionals healthcare professionalshealthcare professionalshealthcare professionalshealthcare professionalshealthcare professionalshealthcare professionals healthcare professionals healthcare professionalshealthcare professionals healthcare professionals
4.1 Dental literature
There were 94 relevant papers identified from within the dental literature for the purposes of this review. A summary of the search results for the literature review is presented in Appendix C. From the search, 3779 titles were found that seemed eligible for further review. However, as many were found several times using different strings, there were fewer than 3779 papers. After reviewing the resulting list of titles, a list of 140 abstracts, which appeared to address the seven questions, was developed. The exclusion criteria were then applied to the abstract list, and the full papers were retrieved. The same exclusion criteria were also applied when reviewing the full papers. A total of 94 papers on dental CPD are included in this review. Of these, 93 were identified by the search and one, that by Wright and Franklin (2007), after consultation with the SMEs. Appendix D summarises the SMEs contacted and the information they provided.
52 of the studies were performed in the UK, and 42 were undertaken elsewhere, including in Australia, Canada, and the United States of America.
The most commonly used research method to explore issues around performance was the self-completion questionnaire, used in 63 studies. Six studies used qualitative interviews, interview-based questionnaires or focus group techniques. Other less common methods included: literature reviews, multiple choice questions, recordings of treatment and diagnostic information, participation rates, computer aided learning packages, and an overview of published systematic reviews.
The degree of scientific rigour varied considerably. Only one paper was assessed as Grade 1 and although published in a dental journal it reported four systematic reviews of Medical CPD. Six papers were assessed as Grade 2 and 20 as Grade 3. Of the remaining studies, 25 were assessed as Grade 4 and 42 were Grade 5.
A general observation applicable to all research themes and seven questions, is that there was a lack of solid scientific evidence from which robust conclusions can be based. This was evident from the very low numbers of papers graded 1 or 2.
Finally, the papers were analysed to assess which research themes they addressed. Some papers covered more than one research area. A summary of the 94 papers by the four research areas is set out below (Table 2). Some papers are relevant to more than one research theme, hence the total in Table 2 is greater than 94.
Further details of the studies analysed by country, methodology, quality grade and research area are provided in Appendix C.
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Table 2: Summary of the 94 papers on Dental CPD by the four research areas
Research Area Total No. papers found Total No. Papers 1-3
Models of CPD
55
26
Regulatory purposes of CPD
2
0
CPD participation
54
9
CPD and performance
0
0
4.2 Literature for other healthcare professional groups
Of the 12 non-dental papers on CPD that were reviewed, one was a review of systematic reviews (Bloom 2005), two were systematic reviews (Marinopoulos et al. 2007, Forsetlund et al. 2009), six were literature reviews or reviews within reports (Grisci and Jacano 2006, Friedman and Woodhead 2008, Donyai et al. 2010, Pharmaceutical Society of Ireland (PSI) 2010, Schostak et al. 2010, Grant 2011) and three were reports or policy statements. They provided further insights over and above those found in the dental literature on CPD. However, all the systematic reviews and literature reviews, both dental and non-dental, highlight the lack of a robust scientific evidence base to inform policy for many of the seven questions on CPD posed by the GDC.
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5. Key findings from the literature revieKey findings from the literature revieKey findings from the literature revie Key findings from the literature revie Key findings from the literature revie Key findings from the literature revieKey findings from the literature revieKey findings from the literature revie Key findings from the literature revie Key findings from the literature revie Key findings from the literature revieKey findings from the literature revieKey findings from the literature revieKey findings from the literature revieKey findings from the literature revie Key findings from the literature revieKey findings from the literature revie Key findings from the literature revie Key findings from the literature review
This section presents the key findings from the literature review across the four research areas, in answer to the following seven questions.
5.1 Models of CPD What are the least and most effective modes of CPD for the healthcare professions, and in particular dentistry?
In considering the least and most effective modes of CPD in dentistry, no literature of high quality was identified to address certain aspects of CPD programmes, such as the effectiveness of CPD, in terms of quality of care delivered, performance, professional standards, competence, public satisfaction or safety, or their longer-term effects on knowledge retention and application.
The search revealed only one Grade 1 paper (Sohn et al. 2004) that, although published in a dental journal, investigated the medical literature. It presented findings from published systematic reviews on the efficacy of educational interventions in the form of continuing medical education and dissemination of educational materials, academic outreach, reminders and local opinion leaders, on the adoption of new knowledge and practices by primary care providers. It concluded that there is a limited knowledge base on the efficacy of the selected CPD interventions (lectures, workshops, educational meetings, and group training) on oral health screening by primary care clinicians. However, effective interventions such as small group discussion, interactive workshops, educational outreach visits and reminders are available to increase knowledge and change behaviours of medical providers.
As will be demonstrated in the analysis that follows, of the 54 papers that dealt with models of CPD, the majority reported self assessed effectiveness of various modes of CPD e.g. short term knowledge gain, or impact upon practice management or clinical practice. With specific reference to the GDC’s research questions that seek to assess the impact of CPD upon performance, from a regulatory perspective, only two studies demonstrated medium term improvement in practice. In one, Brown et al. (2004), periodontal record keeping improved after a one year CPD programme. In the other, Chapko et al. (1984), there was more delegation of duties to DCPs and increased productivity two years after an educational intervention. However, there were no data from other dental studies demonstrating benefits in terms of quality of care delivered, performance, professional standards, public satisfaction or safety, or longer term effects on knowledge retention and application. This finding is demonstrated visually in Figure 2.
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Figure 2: Summary of dental research examining impact of CPD
KEY:
No relationship
Weak relationship
Strong relationship
Impact /
effectiveness
of CPD
Quality of care delivered
Performance
professional standards
Competence
public satisfaction or safety
Longer-term effects on
knowledge retention and
application
Knowledge gain or retention
Practice management
Clinical practice
Knowledge gain or retention
Practice management
Clinical practice
Quality of care delivered
Performance
professional standards
Competence
public satisfaction or safety
Longer-term effects on
knowledge retention and
application
Impact /
effectiveness
of CPD
Impact /
effectiveness
of CPD
Actual claimed
impact
Self perceived
impact
Actual claimed
impact
Self perceived
impact
Effectiveness of CPD has been described in the literature in a variety of ways, indeed Grant (2011)
listed 38 methods of following up CPD and showing its effectiveness. Methods included: appraisal,
audit, educational records log books and self-assessment. However, the majority of the studies in
the dental literature identified in this literature review used self-assessed data to measure these
variables. It should be borne in mind that self-assessment as a measure can be subject to individual
bias, reflecting perceptual changes as opposed to observed actual changes.
The findings from the dental literature, set out below, have been broken down according to the
following three sub-headings: studies claiming effective modes of CPD for dentists, where a robust
outcome measure has been utilised e.g. pre/post tests or recording of treatment and diagnostic
information (Tables 3 and 6); studies using self assessed information from dentists, where self
reported data has been utilised e.g. perceived improvement in knowledge, or change in clinical
practice (Tables 4 and 7); and studies of modes of CPD which demonstrated that a particular mode
of CPD was not effective (Table 5).
Because there appeared to be different circumstances, e.g. employment status or working
environments for dentists, dental hygienists, dental nurses and dental technicians, the information
in all tables are presented according to these professional groups. Those for dentists reflect themes
from studies rated as Grade 1-3. There were far fewer studies on CPD for the other dental
professions and of those for dental nurses and dental technicians none graded higher than 4.
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Table 3: Studies claiming effective modes of CPD for Dentists
Professional group Study type Title
Dentists
Claimed effective modes of CPD The effectiveness of a quality improvement intervention with a broad-based approach (involving completion of a self-assessment manual, receipt of relevant references and individual scores) (Best and Messer 2003) Grade 2 The impact of radiation protection courses in terms of comprehension, knowledge levels, and knowledge application. (Absi et al. 2009, Absi et al 2006) Grade 3 Evaluating the medium-term knowledge retention of dental personnel following attendance at a postgraduate course in radiation protection, both immediately after training and at 6 month follow up. (Absi et al. 2011) Grade 3 The impact of a year-long CPD intervention on diagnostic and preventative activities related to the provision of periodontal care (Brown et al. 2004) Grade 3 The impact of management training on dentists’ delegation to auxiliaries (Chapko et al. 1984) Grade 3 An analysis of the outcomes of an online CPD programme in terms of users’ knowledge of material (Francis et al. 2000) Grade 3 The impact of an e-learning cross-infection control CD-ROM on GDPs’ level of knowledge of cross-infection control (Gray et al. 2007) Grade 3
The effect of continuing education on the topic of fissure sealants on dental professionals’ knowledge, attitude and use of sealant restorations. (Farsi 1999) Grade 3
The papers in Table 3 describe the impact of a range of CPD programmes, including the utilisation of a self-assessment manual, courses in radiation protection, longer term continuing education programmes, online applications and CD ROM programmes. Topics included a range of clinical and administrative themes ranging from periodontology, health and safety, practice management, cross infection control and the use of fissure sealants.
In a randomised controlled trial, Best and Messer (2003) examined the effectiveness of two interventions that included completion of a self-assessment manual with relevant references provided, with or without an associated continuing education course. The self-assessment manual contained 21 sections addressing clinical issues, administrative and process issues for dental practice and served as a measuring instrument to allow comparisons of baseline and post-intervention data. The results demonstrated that an intervention involving self-assessment, followed by the receipt of scores and references for the manual, resulted in modest (not statistically significant) improvements in total scores for dentists after one year. This intervention resulted in significantly better scores in the study group, than the two control groups.