Colleagues will have noted the forthcoming changes to the GDC's CPD requirements, which are discussed in more detail elsewhere in this edition of the DDU journal.
It would be easy to dismiss this initiative as onerous, adding further to the regulatory and administrative burdens of modern practice life. Arguably, however, when viewed from a more positive perspective this reflective model could, by dint of the inherent risk management and career development elements within it, be beneficial and contribute towards practitioners enjoying a fulfilling and rewarding career.
I recall one of my undergraduate teachers cautioning that when in practice, it is all too easy to focus upon the day-to-day tasks of practice management and the delivery of clinical care, while losing sight of the overall goals and direction of travel of both the individual's career and the organisation as a whole.
As I recall, the analogy used was that of spending one's time down in the engine room of the ship, stoking the boilers rather than being up on the bridge looking forwards and ensuring safe navigation to the intended destination.
It seems inevitable that enhanced CPD is a stepping stone towards the introduction of revalidation, in line with the system already in place at the GMC and NMC. Revalidation is defined by the GMC as 'the process by which licensed doctors are required to demonstrate on a regular basis that they are up to date and fit to practise.'
As long ago as 2008 the GDC began a process of research, piloting and consultation for revalidation with an intended date of introduction around 2014, but the project has been very much on the backburner of late as the GDC has had other well documented fish to fry, not least reforming its fitness to practise procedures.
Domains and deficits
When first mooted, the GDC set out the four domains of professionalism, communication, clinical and management leadership, which when combined and maintained would constitute a competent practitioner. Colleagues who have been involved in foundation training will recognise that these are the same four domains which underpin the current dental foundation training curriculum.
It's easy to see how a deficit in any one of these areas can readily lead to problems during a practitioner's career. For example, one may be a highly skilled operator who is able to deliver technical work to a very high standard. But if communication skills are lacking it may be difficult to routinely obtain valid consent and to help the patient understand the need for the treatment in the first place.
Many of the cases with which the DDU assists its members contain an element of miscommunication, whereas a lack of leadership and management ability may result in a chaotic practice environment where safety and service levels suffer. This in turn can make it difficult to deliver the clinical excellence to which the operator aspires and is technically capable of.
Meanwhile, professionalism is at the heart of all that we do for our patients, and if lacking, can readily lead to a breakdown of the trust which is so important in the dentist patient relationship.
It seems inevitable that enhanced CPD is a stepping stone towards the introduction of revalidation.
Enhanced CPD requires registrants to have in place a personal development plan (PDP), which acts as a framework for, and a record of, professional development planning activity (a guide and template can be found on the Health Education England website). It is based upon the reflective practice model, whereby learning needs are identified and set out, activities such as attending courses are planned, carried out and then, importantly, reflected upon.
While all stages are essential to this cyclical process, the reflection element is particularly important. This distils out the learning from the activity undertaken and allows time to consider how that may be applied to and embedded within one's practise to effect improvement. The reflection may also identify further learning needs which can then be fed back in to the process, beginning the cycle once more.
Those who have undergone foundation training or been involved in its delivery will recognise this model, and if continuing to use it will be ahead of the game, and the COPDEND website features a very useful and practical guide to reflective writing, particularly as regards the difference between genuine reflection and simple description, for anyone needing a refresher. Reflection has long been an important part of the remediation process for dentists whose conduct or performance has been called into question.
In the DDU's experience, a practitioner who previously had difficulties but has demonstrated insight into the effect of their actions, undergone appropriate reflective learning with an expressed commitment to improve, and who (ideally) has evidence of improved practice, is less likely to have action taken on their registration.
We have seen many colleagues who were previously in difficulty but who have embraced this concept, becoming 'born again' dentists who take pride and satisfaction from the fact that they can be confident of the currency of their practise. When caring for our patients, a preventive approach is now the norm; a concept which can readily be applied to risk management in dentistry.
To derive the maximum benefit from a PDP, a degree of courage and honesty with oneself is important. It is all too easy for us focus on areas of practice that interest us but where we are already competent; our comfort zone, rather than challenging ourselves to acknowledge and address any areas where we may be less strong. Participation in peer review and appraisal may help here, as others can help us to identify our 'blind spots' which might obscure our development needs.
In encouraging and indeed requiring colleagues to proactively identify and meet their own learning needs, the GDC is beginning to roll out its stated intention, as set out in its discussion document 'Shifting the balance'; that of moving its effort 'upstream' to prevent problems rather than responding to them after the event.
In summary, we ought to view these changes positively. Rather than seeing the new requirements as yet another chore, we could look upon them as 'me time'; an opportunity to take stock and focus on our own needs, and one which will inevitably also benefit patient care.
As Benjamin Franklin supposedly once said, 'If you fail to plan, you are planning to fail.'
Head of the DDU
John Makin BDS PgDL PgCDE FHEA is head of the DDU. He qualified in Manchester in 1983 and has worked as a general dental practitioner in Lancashire and Devon before joining the DDU as a dento-legal adviser. He was involved with foundation training for many years as both a trainer and VT adviser/training programme director with the Manchester and Exeter DFT schemes.
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