| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Current Products and Practice |
Centre for Postgraduate Dental Education, University of Edinburgh, U.K.
Department of Orthodontics, University of Athens, Greece
Eastman Dental Institute for Oral Health Care Sciences, University College London, 256, Gray's Inn Road, London WC1X 8LD, U.K
Specialist Dental Practice, Erding, Germany
Department of Orthodontics, Faculty of Medicine, Medical University of Warsaw, Poland
Abstract
This paper reports on a survey of the duration, funding, and assessment of postgraduate specialist orthodontic training, the requirement for postgraduate training prior to entering specialist orthodontic training and registration of specialist orthodontists in Europe. A questionnaire and explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax, when necessary. Completed questionnaires which were subsequently validated, were returned by orthodontists from 23 countries. The results indicated that a period of postgraduate training, prior to entering specialist orthodontic training was required in 12 of the responding countries. Specialist orthodontic training was reported as lasting 2 years in three countries, 3 years in 17, and for 4 years in three. Part-time training was reported as a possibility in four countries. In 21 of the 23 countries specialist training was reported to take place in full or part within universities, with some training taking place in government clinics in four countries. In five countries some or all training was reported to take place in specialist practices. Training was said to be funded solely or partially by governments in 15 of the 23 countries, to be solely self-funded in five countries, and partly or solely funded by universities in six countries. A final examination at the end of specialist training was reported to be held in 21 of the 23 countries. The nature of this examination varied widely and there was no such examination in two countries. Twelve of the 23 countries reported that they had a specialist register for orthodontics; 11 that they had no register. In none of the countries surveyed was there a requirement for those on a register to undergo periodic reassessment of competence once they are on the register. It was concluded that there was wide diversity in all aspects of specialist orthodontic training and registration within the countries surveyed.
Key words: Education Europe, Orthodontic, Postgraduate, Specialist
Introduction
This paper is one of a series produced by the Professional Development Group of the EURO-QUAL BIOMED II Project (ter Heege, 1997
).
The quality of healthcare depends in part on the quality of the education and training received at the beginning and throughout the working life of those who provide it. The content and duration of specialist training in orthodontics and oral surgery within the member states of the European Union (EU) and European Economic Area (EEA) are prescribed by EC Training Directive (78/687/EEC), which came into effect some 20 years ago. This directive lists topics to be covered during training, but makes no attempt to suggest the level of competence that individuals should achieve before qualifying as a specialist orthodontist, or to how to maintain competence. These issues are left to the individual member states or authorities within each state to decide. Orthodontic societies and university departments have agreed the Erasmus syllabus (van der Linden, 1996) as a voluntary pan-European guideline for orthodontic training. However, there is little evidence of harmonization of standards in specialist orthodontic training within Europe (Kerr et al., 1993) with a number of countries and educational establishments declining or unable to become involved in any agreed pathway.
This lack of uniformity is particularly noticeable in relation to the assessment or examination at the end of formal specialist orthodontic training. At present, there appears to be wide variation ranging from externally audited tests of orthodontic ability, to a somewhat introverted discussion between the student and his/her own orthodontic trainer. Both of these polarised scenarios lead to specialist status within Europe and give the right of individual clinicians with EU nationality to practice their profession anywhere within the EEA.
The survey relating to postgraduate orthodontic education was undertaken against this background.
Aims
The study aimed to establish answers to the following questions for the countries concerned:
Methods
The methods used have been described in the introduction to this series. The questionnaire used in this study is shown in Figure 1.
|
It was possible to validate the responses from 23 out of the 28 countries.
The responses indicated that in 12 of the 23 responding countries no period of training was required after graduation from dental school before beginning specialist orthodontic training. Of the 11 countries which did require such training, two (Switzerland and Germany) required 1 years' further training, eight (Austria, Czech Republic, Denmark, Finland, Ireland, The Netherlands, Norway, Slovenia, Sweden, and the U.K.) a minimum of 2 years and one (Poland) a minimum of 3 years (Figure 2).
|
).
|
).
|
).
Respondents from 21 out of the 23 countries reported that there was a final examination. In 11 countries, the examination comprised of four parts (orals, written, clinicals, and case presentations), in five of three parts, in a further three of two parts, and in the final two countries of just one part. It was reported that two countries did not set a final examination (Austria and Spain; Figure 5).
|
).
It was reported that there is a specialist register in 12 of the 23 countries and no such register in the other 11. There is immediate access, on completion of training, to the specialist register for orthodontics, in nine of the 12 countries. However, in one of these nine countries (Switzerland) applicants are required to perform case presentations when they apply to go on the register. In two of the 12 countries (Czech Republic and Denmark) entry to the specialist register cannot take place until 1 year after the completion of specialist training and involves passing an examination. In the twelfth country (Sweden) access was reported to be by examination, three years after the completion of specialist training (Figure 6).
|
Discussion
One of the joys of living in Europe is the cultural diversity within a relatively small geographical area. It would appear that this diversity also manifests itself in the postgraduate training prior to specialist training in orthodontics, Postgraduate (specialist) orthodontic training, and assessment within Europe.
Respondents from the 23 countries were evenly split when asked if a period of general postgraduate training was necessary before undertaking orthodontic specialist training (12 yes, 11 no). Nine of those countries who insisted on pre-specialist training stipulated 2 years, two asked for 1 year, and one for 3 years.
Once specialist training begins, in the majority of 23 countries, courses are 3 years full time. In one of the two countries with a full time 4-year course (The Netherlands) the trainee orthodontists are required to teach undergraduates during the 4 years. In view of the recommendations within the Erasmus syllabus (van der Linden, 1996) and the requirements of the EC Training Directive (78/687/EEC), it was somewhat surprising to learn that three European countries, two of whom are members of the EU, still appear to offer a specialist orthodontist training programme which lasts for only 2 years full time.
It is becoming increasingly obvious that part time courses fulfil the needs of a number of students. It was reported that one country, France, offers tuition solely on a part time basis over a 4-year period. A further three countries, Sweden, Switzerland and the U.K., were reported as offering the option of part time training. For those countries offering a full time 3-year course, at least one additional year must normally be spent when the programme is undertaken on a part-time basis and the total course hours must be no less than if the course had been full time EC Training Directive (78/687/EEC)
When the location of specialist orthodontic training and sources of funding were investigated, the diversification within Europe became more apparent. Although in the majority of countries, such training was reported as taking place in universities and university clinics, in some it may be in combination with training in government clinics or specialist practice. In two countries training was reported as occurring exclusively within the specialist practice (Bulgaria and Slovakia), a situation also found in some German Länder (regions) when there are insufficient places at university. The authors found this diversity somewhat surprising.
A recent survey (Widström and Eaton, 1999) has shown that there is a ‘north/south’ divide within the 18 countries of the European Economic Area, as far as the provision of public funding for oral health care is concerned. In all EEA countries there is some public and some private funding and a variety of systems. However, the proportion of public funding for oral health care is much lower in the majority of the countries in the south of the EEA that in those in the north. Although a direct comparison is difficult, as several eastern European countries were included in the current study, it was noticeable that with the exception of Norway, self-funding for orthodontic training was commoner in southern European countries and public funding in northern European countries.
The widest diversification was reported in the form of the final examination at the end of orthodontic specialist training. If such an examination is deemed to be a mechanism for assessing the quality of care which an orthodontist can provide, then it is difficult to see how standards can be harmonized within Europe until such time as all orthodontic specialists are assessed when they complete training. It is also reasonable to suggest that any assessment should be to the same standard in all countries, if orthodontic specialists are to continue to enjoy the freedom to establish practice in European countries other than their own. The results of the current survey indicate that at present Europe is far from achieving these goals. In two countries it was reported that there was no formal examination whatsoever at the end of specialist orthodontic training. In the other 21 countries, there were considerable variations in the mechanisms for assessing the abilities of the trainees at the end of their training.
The reported absence of a specialist register in 11 of the 23 countries was also surprising, as was the range of mechanisms for gaining access to the register in the 12 countries with a register. It would be interesting to elucidate why four European countries require specialist orthodontists to successfully pass further assessments, after those taken at the end of specialist training, before they can be admitted to the specialist register for orthodontics. However, once on a specialist register, the responses to the survey indicated that European orthodontists are not currently reassessed at regular intervals to confirm their continuing competence.
Conclusions
This survey has shown that at present there is:
Acknowledgments
The authors would like to thank members of the EURO-QUAL BIOMED II project and colleagues in the countries who took part in the survey for their help and advice, and to Kate McWilliams for her help in producing the figures.
References
European Council Directive Number 78/687/EEC.Official Journal of the European Communities 1978, 21, L233, ISSN 0378-6978.
Kerr, W. J. S., Greck, B. and Bacon, W. (1993) Specialist Postgraduate orthodontic training: a comparison of two European universities.European Journal of Orthodontics, 15, 403–410.
ter Heege, G. J. (1997)EURO-QUAL, Towards a Quality System for European Orthodontic Professionals, European Commission, Biomedical Health Research, Directorate General XII, Science, Research and Development. I.Q. Press, Amsterdam, The Netherlands, 1997 ISBN 90 5199 330 7. Ohmsha, Tokyo, Japan, 1997. ISBN 4 274 90152 1 C3047.
van der Linden, F. P. G. M. (1996) Three year postgraduate programme in orthodontics: the final report of the Erasmus ProjectAmerican Journal of Orthodontics, Dental Orthopaedics, 110, 346–352.
Widström, E. and Eaton, K. A. (1999)Systems for the Provision of Oral Health Care, Workforce and Costs in the EU and EEA A Council of European Chief Dental Officers' Survey,STAKES, Helsinki, Finland. ISBN 951-33-0772-7.
This article has been cited by other articles:
|
|
 |
|
  O. P. Kharbanda Global issues with orthodontic education: a personal viewpoint J. Orthod., December 1, 2006; 33(4): 237 - 240. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
