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Features Section |
Dean of the Dental Faculty, Royal College of Surgeons (Eng).
Since the establishment of the new arrangements for specialist training in the UK, questions have increasingly been asked about the implications for trainees from the European Economic Area (EEA) and overseas (non-EEA), and their eligibility for entry to UK specialist lists. There has also been some confusion about the status of specialist training undertaken outside the UK, both for UK and non-UK graduates. A report from the Joint Meeting of Dental Faculties (JMDF) published in December 1999 attempts to answer these questions. In the preparation of the report, the JMDF paid particular regard to the implications of European law, and particularly to potential claims of discrimination both from non-UK and UK trainees.
Specialist training within the UK, which leads to the award of a Certificate of Completion of Specialist Training (CCST) and entry to a specialist list, can only take place in Specialist Advisory Committee (SAC) approved training programmes. However, a number of institutions have traditionally accepted additional specialist trainees, usually from outside the UK and self-funded, into training programmes that do not have SAC approval. In some cases, there was a mistaken belief that once SAC approval was granted to an institution, this extended to unspecified numbers of trainees that the institution might choose to admit. This group of trainees has been a source of concern for two reasons. First, the training may not be of the same standard if it has not been externally validated by SAC inspection and approval, and this could render the institution liable to potential claims of discrimination and exploitation by non-UK trainees, particularly where self-funding is involved. Secondly, additional trainees may undermine the quality of training available to those on approved programmes by making impossible demands on the educational resources and clinical opportunities available. Ultimately, this could have implications for the award of the CCST for recognized trainees. The report recommends, therefore, that all specialist training programmes in the UK must be approved by the SAC. This does not interfere with the right of institutions to admit postgraduate students to courses that do not lead to the award of a CCST or entry to a specialist list, but the SAC must be reassured about the impact of such courses on approved training. However, it must be made clear to trainees that specialist training can only lead to the award of a UK CCST and subsequent entry to a specialist list. This only occurs if the dentist is fully registered with the GDC, the entry requirements to specialist training have been fulfilled, a Training Number is allocated by the Postgraduate Dental Dean, and an SAC approved training programme (Type I as defined in A Guide to Specialist Registrar Training) is successfully completed.
The GDC has agreed that the entry requirements to specialist training in UK is the MFDS Diploma (MFD or FDS are acceptable). Whilst the UK is entitled to adopt this position, the requirement cannot be applied literally to a person from another Member State in the EEA. In other words, there is an obligation to test the equivalence of professional attainment reached by the person who wishes to train as a specialist in UK. The process must be fair, reasonable, and equitable to avoid potential claims of discrimination from UK trainees. Guidance is currently being developed by the Joint Committee for Specialist Training in Dentistry. There is no legal requirement to apply the same assessment of equivalence to overseas dentists from outside the EEA, but to do so constitutes good practice and would minimize the risk of potential claims of unfair discrimination under domestic law.
The same principle of assessing equivalence applies to the entry requirements to specialty diploma examinations. Thus, if an individual has entered a SAC approved specialist training programme on the basis of having demonstrated a similar level of professional attainment to the MFDS, there would be no requirement to hold the MFDS diploma to enter the examination. The final decision to allow entry to a particular candidate rests with the examining College.
It should be noted that candidates who are admitted to a UK specialty membership examination on the basis of having completed equivalent specialist training outside the UK, are not eligible for entry to a UK specialist list simply on the basis of the UK specialist diploma. The effect of the diploma outside the UK is, of course, a matter for each individual country.
Any dentist registered with the GDC, who has specialist dental qualifications awarded outside the UK that are directly recognized under the regulations, or who satisfies the GDC that those qualifications are equivalent to a CCST in the specialty in question, is eligible for entry to the UK specialist list in accordance with the European Regulations and the GDC Regulations.
For UK graduates on Type I training programmes within the UK, some specialist training can take place outside the UK, as long as this is agreed prospectively by the SAC. In such cases, the trainee must return to the recognized programme so that training undertaken outside UK can be taken into account in assessing the time needed to complete training, and to enable a recommendation to be made for the award of a CCST. It is for the SAC to ensure that overseas training is of an appropriate standard.
In summary, the report recommends that all specialist training in the UK must be quality assured by the SAC and that due consideration must be given to the implications of European law for the entry of dentists from the EEA to UK specialist training and specialty examinations. Entry to a UK specialist list by those who have undertaken specialist training outside the UK is clearly prescribed by the regulations.
References
Training in the United Kingdom for Graduates from the European Economic Area (EEA) and from Overseas (non-EEA) in the Dental Specialties, Joint Meeting of Dental Faculties, December 1999.
European Primary and Specialist Dental Qualifications Regulations, 1998.
General Dental Council (Distinctive Branches of Dentistry) Regulations, 1998.
A Guide to Specialist Registrar Training, Department of Health, 1998.
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