In the early 1990s, social anthropologist Jean Lave and educationalist Etienne Wenger developed a model of 'situated learning'. This approach proposed that learning involved engagement in a 'community of practice', as opposed to the more traditional presumption that learning is better when separated from our day-to day-activities, has a beginning and an end, and involves teaching.
In my view, many of the characteristics described within this concept, such as commitment, shared competence, joint activities, information sharing, assisting colleagues and shared resources, are evident within dental practice and our profession. For many years colleagues have learned together, both formally and informally, by sharing knowledge and through activities such as peer review and study groups.
Arguably, one of the jewels in the crown of our profession has been vocational, now foundation, training. Few would disagree that the mentor-mentee relationship within foundation dentistry has been of great benefit to both parties and ultimately, therefore, to patient care – our raison d'etre.
Historically, newly qualified colleagues would directly join practices and build upon their undergraduate knowledge through an informal 'university of life' mentorship provided by experienced and supportive colleagues. Foundation training took the key elements of this arrangement, which was often hugely helpful but patchy, and provided a more reliable and predictable structure. The current dental foundation training curriculum is based upon four domains; clinical, professionalism, leadership and management, and communication. When combined, these key ingredients give rise to a competent practitioner.
Maintaining and updating this combination of skills and abilities is essential throughout one's career, and as such may eventually form the basis of a system of revalidation if introduced by the GDC as a requirement for continued registration. CPD and personal development plans should be balanced along with clinical skills to include all of these elements, as well as the so-called 'soft' skills of communication, listening, integrity, self-awareness and so on, which, given that dentistry is a 'people business', are vital.
The changing face of practice over the years has led to an inexorable shift away from single-handed practice towards corporate groups, with the amount of primary care delivered by such groups almost doubling from 12% to 22% between 2010 and 20141. One might reasonably assume that this would have led to a reduction in practitioner isolation, which is often a factor that contributes to practitioners finding themselves in difficulty. However, as practice ownership has become more remote it is in fact more possible for colleagues to have a sense of isolation from their peers.
It is therefore important to avoid professional isolation and all its attendant risks to dental professionals themselves, and by extension to the patients for whom they care. Thankfully there are positive steps colleagues can take to achieve this; for example, having a balanced CPD portfolio that includes face-to face-courses and avoids an over-reliance upon on-line courses. This can be combined with greater engagement with the wider profession through activities such as LDC membership, collaborative peer review and audit and attendance at local study groups.
As the old saying goes, the family that plays together stays together. In the face of all of the challenges currently facing the profession, I consider it important that we remain cohesive and supportive of one another, learning and developing along the lines set out by Lave and Wenger.
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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