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Department of Orthodontics, Charles Clifford Dental Hospital, Wellesley Road, Sheffield S10 2SZ, U.K.
Address for correspondence: Miss M. Stern, Department of Orthodontics, Charles Clifford Dental Hospital, Wellesley Road, Sheffield S10 2SZ, UK.
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Abstract |
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There will be a predetermined number of fixed term training appointments (FTTAs), available through competitive entry, which will provide 2 years of additional training and lead to eligibility to apply for a Consultant appointment. The end point of the Specialist Registrar (FTTA) will be marked by the Intercollegiate Specialty Examination (ISE).
The current 3-year Senior Registrar orthodontic training will be reduced to 2 years as the transition to the Specialist Registrar FTTA grade occurs. In the light of these changes, a survey of full time NHS Senior Registrar posts was carried out to examine current job profiles with particular reference to their suitability for assimilation into the Specialist Registrar (FTTA) grade and preparation for the ISE.
Key words: Specialist Orthodontic Training, Sp. R, FTTA
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Introduction |
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A number of fixed term training appointments (FTTAs) of 2 years duration will be available by
competitive entry (Department of Health, 1998
),
to provide additional
hospital training, leading to eligibility to apply for a hospital Consultant appointment. The
number
and location of FTTA posts will be determined by the SAC in Orthodontics and Paediatric
dentistry following manpower planning advice from the Specialist Workforce Advisory Group
(SWAG), and it may be necessary for a trainee to move from one region to another in order to
complete their training. The end point of the FTTA will be marked by the Intercollegiate
Specialty
Examination (ISE) with the award of the F.D.S. (Orth.) by one of the Royal Colleges to
successful candidates. This additional 2-year training aims to prepare the future Consultant in the
provision of:
). The Grade Commissioning Date for Specialist Registrars in Orthodontics and Paediatric dentistry was 1st July 1998, and the current minimum 3-year training for a Senior Registrar in orthodontics will reduce to 2 years as a FTTA. In the light of these proposed changes, a survey was carried out to examine the job profiles of all current full time Senior Registrars with particular reference to their suitability for assimilation into the SpR (FTTA) grade and preparation for the ISE.
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Methods |
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TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
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).
The questions were divided into the following categories:
Assurances were given that all replies would be treated in strict confidence.
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Results |
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Job Rotation and Distribution
Twenty-two posts (70 per cent) were split between two centres, eight (26 per cent) between three
centres, and one post between four centres. Twenty posts (64 per cent) involved at least 3 days in
a teaching hospital, but one post had no sessions allocated to a dental teaching hospital. Fourteen
respondents (46 per cent) had at least one split day between centres and 24 (74 per cent) spent
more than 5 hours travelling during the week.
Clinical Sessions
Twenty-seven SR respondents (87 per cent) had at least five personal treatment sessions each
week (range 45–7 sessions). All Senior Registrars were attending new patient or
review clinics with 19 respondents (63 per cent) at one new patient/review clinic each week, and
the remaining 11 respondents attending two new patient/review clinics. Twenty respondents (64
per cent) were seeing eight or more new patients at each clinic, although this ranged from 3 to 20
patients.
Caseload and Case Mix
Seven respondents (23 per cent), mainly in their first year as Senior Registrar, had a caseload of
150 or less. Five Senior Registrar respondents (17 per cent) had a caseload of 151–200,
nine respondents (30 per cent) had 201–250 patients and a further nine (30 per cent)
carried a total patient caseload greater than 251 (range 50–465; seeFigure 1). However, the caseload was not directly related to the time
spent in the post, as one
first-year Senior Registrar had a caseload of 200 and one third-year Senior Registrar had a
caseload of 150.
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The number of transfer cases ranged from 0–173, which, when expressed as a percentage of the total number of treatment cases, gave a range from 0 to 49 per cent.
The number of orthognathic cases ranged from 11 to 60, with seven respondents (24 per cent) treating up to 20 cases, nine (31 per cent) treating up to 30 cases, four (14 per cent) treating up to 40 cases, and nine (31 per cent) treating more than 40 orthognathic cases (see Figure 2).
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Supervision
The number of Consultants directly involved in training programmes ranged from 2 to 8, the
majority of 19 (61 per cent) having three or four involved. The Consultant was almost always
available to assist or advise in the clinics.
Multidisciplinary Clinic Attendance
Although all Senior Registrar respondents attended orthognathic clinics, two (7 per cent) did not
attend a CLAP clinic, seven (23 per cent) had no access to a joint restorative clinic, and only two
respondents (6 per cent) attended an orthodontic/paediatric dentistry clinic.
Involvement in Teaching
Eighteen Senior Registrars (60 per cent) supervised at least one postgraduate session per week,
usually with Consultant cover. Twelve (39 per cent) were involved in the supervision of
undergraduates, usually without Consultant cover. More than 50 per cent of respondents were
regularly involved in lecture and teaching programmes for postgraduates and GDPs, while
35–48 per cent of respondents reported regular involvement in lecture and teaching
programmes for undergraduates, orthodontic study groups, and nursing/technical
staff.
Research and audit
Sixteen respondents (52 per cent) reported two protected study/administration sessions per week.
Seventeen respondents (55 per cent) had submitted between one and three papers for refereed
publication, but nine (29 per cent) had no paper submissions. Facilities for research were
regarded
as good or excellent by 18 (60 per cent) of respondents, whilst 12 (40 per cent) regarded their
facilities as poor or adequate.
Twenty-five Senior Registrar respondents (81 per cent) attend regular audit meetings and in 40 per cent of cases, this occurs more than six times a year. Fifteen (50 per cent) of respondents were involved in audit within the hospital and 11 (35 per cent) involved in national audit.
Study Leave
Twenty-four respondents (83 per cent) were aware of their annual allowance for study leave. In
64 per cent of cases, this was under £750 and in 32 per cent of cases this was between
£750 and £1000 per year (range £450 and `unlimited').
Seven Senior Registrar respondents (24 per cent) reported difficulty in obtaining funded study
leave.
Management
Twenty-seven respondents (90 per cent) had attended or would be attending a management
course. Ten respondents (34 per cent) had received training in interview skills, four (14 per cent)
in equal opportunities awareness, nine (31 per cent) in teaching skills, and five (17 per cent) had
received training in counselling skills.
Fourteen respondents (48 per cent) were involved in committee work within their hospital, 13 (45 per cent) in regional committee work, and 15 (52 per cent) in national committee work.
Contract
Only 26 respondents (87 per cent) had signed a contract of employment. Thirteen (45 per cent)
were receiving ADHs with 13 (45 per cent) being on-call for cleft lip and palate
patients.
Facilities
Facilities, such as fully equipped surgeries, trained DSA support, secretarial support,
radiographic
facilities, photographic facilities, laboratory support, personal desk space, computer, and library
access were generally readily available.
Formal Feedback
Nineteen Senior Registrar respondents (68 per cent) had formal meetings, at least once a year,
with their trainer. Seventeen (61 per cent) described these meetings as useful or extremely
useful.
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Discussion |
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Unless the two training centres are situated close together, split days are undesirable for effective working practice and are not recommended by the SAC, yet 46 per cent of jobs surveyed had at least 1 day, where the trainee worked at two sites.
Clinical Sessions
The minimum SAC requirement for personal treatment sessions is 589 per cent of
Senior Registrar respondents had at least five personal treatment sessions each week (range
45–7). The remaining 11 per cent of trainees with 45 personal
treatment sessions, may not have sufficient clinical time or an adequate number of suitable cases,
to prepare for the ISE.
Caseload and Case Mix
The total number of cases under treatment, divided by the number of clinical sessions, for each
respondent gave a range from 77 to 78 cases per clinical session. The SAC guidelines
suggest 30 cases under treatment per clinical session. For trainees, who have been in post for
longer than 2 or 3 years, the number of cases per session may reflect a larger proportion of
completed cases kept under review. However, in posts where current trainees are treating more
than double the suggested number of cases per session, it would appear that their service
commitment is taking precedence over their training requirements. Consultants responsible for
these posts may find it necessary to be more selective in allocating treatment cases to their
trainees, and the SAC should monitor more closely the caseload of trainees.
The number of transfer cases taken on by an incoming Senior Registrar varied greatly in the posts examined, from 0 to 49 per cent of cases under treatment. In the future, as the 3-year Senior Registrar programme is contracted into a 2-year Specialist Registrar FTTA, the proportion of transfer cases is likely to increase and, in particular, those involving complex, multidisciplinary treatment deemed suitable for examination in the ISE will be treated by a succession of post-holders. As a new post-holder enters a FTTA with a large number of transfer cases, it will be difficult to start a significant number of new cases that would show sufficient progress in their treatment after 18 months in order to be presented in the clinical section of the ISE. This difficulty would be most evident in those posts with less than five clinical sessions per week available for treatment. The guidelines currently issued to candidates preparing for the ISE will require alteration to take these potential problems into consideration, if presentation of clinical cases is to remain part of the examination.
The numbers of orthognathic and restorative cases treated by current Senior Registrars varied between units, but all trainees appear to have access to multidisciplinary cases. However, seven Senior Registrars had no access to a joint restorative clinic and only two Senior Registrars attended a joint orthodontic/paediatric dentistry clinic. It would be advantageous for future FTTA posts to include access to these types of clinic to give the trainee greater experience in the diagnosis, as well as the treatment of multidisciplinary cases.
The number of cleft lip and palate (CLAP) patients treated by current Senior Registrars ranged
from 2 to 41 and was not related to the year of training. Surprisingly, two post-holders had no
access to a CLAP clinic. The CSAG report on cleft lip and/or palate (Sandy et al., 1998), surveyed a group of recently
appointed Consultant
Orthodontists, of whom 60 per cent indicated that their training could have been improved and
included a greater opportunity for personal treatment of a wide range of cases, as one area for
improvement. In the future, the clinical training in CLAP care for FTTA post-holders may be
limited to centres with large cleft lip and palate teams, which would modify the curriculum for
many trainees.
Supervision
Most trainees have training input from three or four Consultants, and reported that their trainer
was nearly always available for assistance or advice. However, for those post-holders receiving
input from up to eight Consultants, the value of a diluted approach is questionable.
Teaching
Current Senior Registrars have a large teaching commitment with 60 per cent regularly
supervising postgraduate clinical sessions and 39 per cent supervising undergraduate clinical
sessions. This is in addition to regular lecture and teaching programmes for postgraduates,
general
dental practitioners, undergraduates, and other auxiliary staff (although only 31 per cent of
respondents had received formal training in teaching skills). For future FTTA post-holders where
3 years of Senior Registrar experience will have to be gained in 2 years, some reduction of Senior
Registrars workload will be necessary. Reduction of teaching commitment may be one area
where
the Senior Registrar workload can be reduced.
Research and audit
Only 52 per cent of Senior Registrar posts examined have the two protected study/research
session per week advised by the SAC. Future FTTA post-holders will be required to prepare and
submit research papers in addition to preparing for the ISE, within a 2-year period, rather than the
current 3 years and, hence, it will be mandatory that the SAC guidelines are observed for all
posts.
Opportunities and back-up for research may require improvement in the 12 posts, where Senior
Registrars described facilities as being poor or just adequate.
Study Leave
Seven current Senior Registrars (24 per cent) reported difficulty in obtaining funded study leave.
In the future, if FTTA post-holders wish to have the same opportunities to gain experience from
national and international meetings over a 2-year period, rather than 3 years, the allowance for
each trainee's funded study leave will need to be increased. Otherwise, future trainees will
either loose the opportunity to learn from these courses or conferences, or self-fund themselves
(currently, study expenses are deemed not tax deductible by the Inland Revenue).
Management
Twenty-seven post-holders had been on or would be going on a management course arranged
regionally. Attendance on a management course is regarded as essential in order to prepare for
the
ISE. However, such courses are generally directed at the medical and surgical specialties, and, for
future FTTA post-holders, there may be the opportunity to attend courses specifically directed at
dental specialties with particular reference to the needs of future Consultant Orthodontists.
Most Senior Registrars surveyed had the opportunity to be involved in committee work either at local hospital, regional, or national level.
Contract
Surprisingly, only 26 respondents (87 per cent) had signed a contract. Those posts currently
allocating ADH units for cleft lip and palate on-call duties may well be revised following the
regional re-organisation of cleft lip and palate centres, which is occurring as a consequence of the
CSAG report. In the future, FTTA post-holders will be on a lower salary increment as Specialist
Registrars compared to current Senior Registrars. This combined with the possible loss of ADHs
and greater contribution to study leave expenses will financially disadvantage future
trainees.
Feedback
Nineteen current Senior Registrars currently have regular, formal feedback sessions with their
trainer(s), which were felt to be useful. For future FTTA post-holders, such feedback should be
incorporated in the annual Record of In-training Assessment (RITA) and regular appraisal
meetings.
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Conclusions |
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TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
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This survey has shown variation in the training of current Senior Registrars and identifies potential problems for incoming Specialist Registrar FTTA post-holders.
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Acknowledgments |
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References |
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TopAbstractIntroductionMethodsResultsDiscussionConclusionsReferences |
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Department of Health (1998) A Guide to Specialist Registrar Training, HMSO.
JCSTD (1998) Guidelines for the UK Specialist Programmes with Two Years Additional Training for NHS Consultant and Academic Practice (version S), HMSO.
Sandy et al. (1998) The Clinical Standards Advisory Group (CSAG) Cleft Lip and Palate Study, British Journal of Orthodontics, 25,21 –30.[Abstract]
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