READING POINT! Patterson F, Ashworth V, Mehra S, et al. Could situational judgement tests be used for selection into dental foundation training? Br Dent J. 2012: 213: 23–6.
The scores of all applicants from the selection centres are centrally collated to produce a single national ranking. Successful allocation to a foundation scheme is dependent upon the ranking achieved as a result of selection centre performance with those who score the highest being offered a place on the scheme they most prefer. For 2013, the 968 highest ranked individuals were offered places with 48% of applicants securing their first choice of scheme and 86% one of their top 10 preferred schemes.17 Offers of a place detailing the Health Education England region and scheme are then made available to successful applicants and once an offer is accepted it cannot be changed to a training placement in another region or scheme. Once all offers have been accepted the list of successful applicants, with their ranking within each scheme, is sent to the region hosting that scheme. Once allocated to a specific scheme the next stage is managed regionally with your ranking potentially being used to inform the allocation process between your training post and a training practice. This is when you generally have the opportunity to meet your potential trainer (Educational Supervisor).
In Scotland, recruitment is administered by NHS Education Scotland and although it starts with an online application process, it involves interviews with trainers during the visitation period. Preferences are then returned to NHS Education Scotland, meaning that applicants rank practices according to preference and trainers rank applicants according to preference. Matching results then indicate the training practice that you are allocated to. A short clearing process may also take place if there are unmatched applicants and vacant training practice posts.
Undergraduate to postgraduate
Perhaps a significant change for the FD is in becoming a ‘professional’, in that you begin to earn a living from dentistry, as opposed to being an ‘amateur’ whereby you do not earn a living from dentistry. While working in general dental practice you will be providing dental care to patients in return for either them or the state paying money to the practice, which should in itself highlight the importance of the quality of the care and treatment that you provide. So, another distinction between professionals and amateurs is that the performance of a professional is deemed to be of a higher standard. The way that being a professional differs to being a ‘tradesman’ is that you are bound by an ethical obligation to act in a certain way in order to uphold the reputation of the profession and to not undermine public confidence in it. This means that you can no longer act as an undergraduate student at, or beyond, the point of GDC registration because you are then automatically considered to become a ‘dental professional’, meaning that you must act as an ambassador for the profession both inside and outside of the surgery.
The transition from undergraduate student to GDC registrant brings with it a whole host of responsibilities, as outlined in the GDC’s Standards for the Dental Team,18 of which you should take note of standard 1.3.2:
You must make sure you do not bring the profession into disrepute.
However your internal ethical compass is set, it should be pointed to align to the GDC’s expectations, thereby helping you to visualise the boundary lines that you should not cross as a dental professional. The expectation for you to observe and conform to the standards set out by the GDC is also reinforced in clause 17.7 of the Foundation Contract.
If it is not right, do not do it: If it is not true, do not do it.
—Marcus Aurelius Antoninus (121–180 AD)
Novice to advanced beginner
As a new registrant, at the starting point of your FT journey, you are deemed to be a safe beginner,19 with the Dreyfus model of skill acquisition20 asserting that this journey arguably ends at the advanced beginner stage. This model can be used to describe your progress throughout the year in the development of skills or competencies and defines an acceptable level for the assessment of competence or capability. Based on the work of Dreyfus and Dreyfus21 we can depict different skill levels as a ladder that you walk up throughout your career (see Table 1.1), with each rung representing a different level with discrete characteristics.
Table 1.1 Dental skill acquisition
| Ladder rung | Stage | Standard of work | Characteristics |
|---|---|---|---|
| 6 | Expert | Excellence achieved with relative ease | Deep tacit understanding across area of practice, able to take responsibility for going beyond existing standards and creating own interpretations |
| 5 | Proficient | Fully acceptable standard achieved routinely | Sees overall ‘picture’, decision-making more confident and deals with complex situations holistically |
| 4 | Competent | Fit for purpose, although may lack refinement | Copes with complex situations through deliberate analysis and is able to achieve most tasks using own judgement |
| 3 | Advanced beginner | Procedures more likely to be completed to an acceptable standard | Working knowledge of key aspects of practice; exit point of FT |
| 2 | Safe beginner | Procedures likely to be completed to an acceptable standard | Working knowledge of key aspects of practice but supervision required for execution; entry point of FT |
| 1 | Novice | Unlikely to be satisfactory unless closely supervised | ‘Textbook’ knowledge with limited application to practice; requires instruction |
So, FT helps you to climb from the safe beginner rung upwards to the advanced beginner rung, helping to guide your own journey up the remaining rungs throughout your professional career.
Contrary to popular belief, a 1990 study22 by Ericsson found that it is not always talent or innate genius that makes you an expert but rather the hours that you are willing to put in. In his book, Malcolm Gladwell23 references this study asserting that the key to truly mastering a skill is, to a large extent, a matter of deliberately practising that skill for a total of around 10 000 hours. This has been calculated on the basis of performing that skill 20 hours a week, for 50 weeks a year, for 10 years. Using a comparative calculation, if you were to deliberately practice over the same hours worked as in FT for the foreseeable future (taking the same amount of holidays), this would calculate to over 6 years before you could be considered an expert.
Deliberate practice
This is not just a matter of practising your skills on phantom heads for over 6 years. It involves:
- evaluating and assessing your success
- monitoring your performance through reflection, and
- improving aspects of your performance that you are not so good at.
Terminology for starters
Table 1.2 Foundation Training terminology
| Name | Previous or related name | General role |
|---|---|---|
| Foundation Training (FT) | DF1 or Vocational Training | A one year period of training following initial qualification that builds on the achievements of the dental undergraduate curriculum. It aims* ‘to produce a caring competent reflective practitioner able to develop their career’ |
| Local education and training board (LETB) hosted by Health Education England (HEE) | Postgraduate deanery | They bring education, training and development together locally, to improve the quality of care and treatment of patients through the development of skills and values for the workforce |
| COPDEND (UK Committee of Postgraduate Dental Deans and Directors) | – | Governs and leads UK FT |
| Director of Postgraduate Dental Education | Postgraduate dental dean | Commissions and manages the delivery of postgraduate dental education and training in a region |
| Associate director of Foundation Training | Associate dean for Foundation Training | Oversees and strategically manages the commissioning and delivery of FT in a region |
| FTPD (Foundation Training programme director) | Vocational Training Adviser | Commissions and manages the delivery of the competencies within the COPDEND Dental Foundation Training Curriculum to a cohort of Foundation Dentists (FDs) in a scheme. They also recruit and support Educational Supervisors and FDs |
| ES (educational supervisor) | Vocational (in practice†) Trainer | Responsible for overseeing the educational progress and day-to-day clinical supervision of the FD. The ES may also be the FD’s employer |
| FD (Foundation Dentist) | Vocational Dental Practitioner | New registrant who has successfully been allocated an ES. Their skills learned as an undergraduate are built upon during FT |
* COPDEND. A Curriculum for UK Dental Foundation Programme Training. Oxford: COPDEND; 2007. p. 8.
† COPDEND. Guidance notes on the Foundation Contract. Revised. Oxford: COPDEND; 2013.
So, your position is as an FD working under the supervision of an ES in a training practice, after being allocated to an FT scheme accountable to one or more LETBs on behalf of HEE.
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