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GENERAL DENTAL COUNCIL VISITATION OF UNDERGRADUATE DENTAL DEGREE

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GENERAL DENTAL COUNCIL VISITATION OF UNDERGRADUATE DENTAL DEGREE Powered By Docstoc
					GENERAL DENTAL COUNCIL VISITATION OF
UNDERGRADUATE DENTAL DEGREE PROGRAMMES
AND EXAMINATIONS



VISITATION OF THE BDS PROGRAMME OF THE DENTAL
SCHOOL


UNIVERSITY OF LIVERPOOL


25, 26 & 27 JANUARY 2005


REPORT OF THE VISITORS


PROFESSOR J J MURRAY CBE BCHD LDSRCS MCHD
PHD FDS MCCD RCS FDSRCS (CHAIRMAN)

MRS S FARRELL BDS MSC MGDSRCS FDSRCS

PROFESSOR A HARRISON TD BDS PHD FDSRCS
ENG FDSRCS EDIN

PROFESSOR D T HERBERT BA PHD DLITT

PROFESSOR E W ODELL BDS FDSRCS MSC PHD
FRCPATH



ACCOMPANIED BY:

MS K C GREGORY BA MA

MR A D SETH-SMITH BA MA
FOREWORD

Purpose

1    As part of its duty to protect patients and promote high standards, the General
     Dental Council (GDC) monitors the education of dental students in the UK‟s
     dental schools. The aim is to ensure that dental schools provide high-quality
     learning opportunities and experiences and that students who attain a dental
     degree are safe to practise.

GDC Process

2    In a six-yearly cycle the GDC appoints a team to visit each dental school.
     Each team includes dentists and lay people. The visitors report to the Council
     on whether the University's programme and examinations meet the
     recommendations in the GDC's The First Five Years: A Framework for
     Undergraduate Dental Education (2nd edition).

3    This report sets out the findings of the three-day visit to the BDS programme
     of the Liverpool Dental School using the main headings in The First Five
     Years as a structure. It draws attention to the many areas of good practice
     but also to areas where issues of improvement and development need to be
     addressed. The report is based on the findings of the visit and on a
     consideration of a self-evaluation report and other supporting documents
     prepared by the School.

4    Two visitors will return to the School later in the academic year to observe the
     final examination. After the second visit has taken place, the visitors will
     make a recommendation to the Council on whether the programme and
     examination are „sufficient‟ (the term used in the Dentists Act) for the
     protection of patients.

5    The University will be given the opportunity to correct any factual errors in this
     report and then submit its observations. The report and response will then be
     considered by the GDC.

6    After the reports of the BDS programme and final examination visits to
     Liverpool Dental School have received formal approval from the GDC they
     will be published on the GDC website and presented to the Privy Council.
     The visitors' recommendations will be followed up through a formal monitoring
     process. A General Report will also be published when all dental schools
     have been visited. This will outline general trends and make overall
     recommendations for good practice and improvement.

Acknowledgements

7    The visit to Liverpool Dental School took place on 25, 26 and 27 January
     2005. Two visitors spent additional time, on the 24 and 28 January, visiting
     outreach facilities in Morecambe, Lancaster, Blackburn and the Wirral. We
     were welcomed by Professor C M Pine, the Dean of the Dental School.
     During the visit we met the Vice-Chancellor and senior members of University
     staff, the host Trust (the Royal Liverpool and Broadgreen University Hospitals
     NHS Trust), recent graduates, current dental undergraduate students,


                                         1
      Vocational Practice trainers, and Vocational Dental Practitioners. (A full list of
      those we met is attached to this report as Annex 1 and details of the
      documents we received are attached as Annex 2.) We thank all concerned
      for their help, hospitality and courtesy during the visit.


THE EDUCATIONAL ENVIRONMENT

The University

8     The University of Liverpool has 34 departments and schools which are
      grouped into six faculties. The Dental School forms part of the Faculty of
      Medicine which also incorporates the School of Biomedical Sciences, the
      School of Clinical Laboratory Sciences, the School of Clinical Science, the
      School of Health Sciences, the School of Population, Community and
      Behavioural Sciences, the School of Reproductive and Developmental
      Medicine, and the School of Medical Education.

9     The Faculty of Medicine is a single budget centre within the University.
      Higher Education Funding Council for England (HEFCE) funding is allocated
      to budget centres by the University and these funds are managed at a Faculty
      level. For 2003/4 the School received, through the Faculty, HEFCE income
      for teaching and research amounting to £1.960m (including overseas fees);
      its expenditure was £2.668m. The income allocated to the School included a
      deduction of 40% for central overheads. For 2003/4 the School had a £709k
      deficit.  This was managed through cross-subsidy within the Faculty.
      Although the Faculty of Medicine, and the University, are very supportive of
      dental education, we are concerned at the recurrent HEFCE funding deficit.

10    Dental students have use of the Harold Cohen Library, located close to the
      Dental School, for private study and research. It is open every day, 78 hours
      per week during term time and vacations. The library has adequate study
      areas and houses 301 computers which are available to students during
      opening hours. In addition to the IT facilities available in the library, dental
      students have access to a suite of 12 PCs in the Dental School, 31 PCs in the
      Duncan Building, and 55 in the Sherrington Buildings. The Harold Cohen
      Library, although of good size, has a rather tired appearance. Many of the
      dental textbooks we found on the shelves were not up to date. We believe
      that more investment may be required to ensure that sufficient current copies
      of the main dental textbooks are available to students.

11    We were pleased to note the excellent support from the University and
      Faculty to develop the BDS programme and recruit academic staff. Despite
      the cross-subsidy of HEFCE funding for dentistry within the Faculty of
      Medicine, the University is re-investing in posts due to be lost to retirement.
      The University pursues a “community strategy” (for example, supporting
      Diploma courses for Professions Complementary to Dentistry) as well as a
      “research strategy”.

12    Liverpool Dental Hospital is 128 years old and the Dental School became part
      of the University 105 years ago. This history endorses the current philosophy
      of going forward as a hospital and school together. The School is now in the
      fortunate position of having strong support from the Faculty of Medicine and
      the Royal Liverpool and Broadgreen NHS Trust.



                                          2
The Dental School1

13       The last GDC visit to the BDS programme took place in 1994. Since this date
         the GDC has engaged in two follow-up monitoring exercises, one in 1996 and
         another in 1999. The Final BDS examination was visited in 2000. In addition
         the GDC visited the Dental Therapy Diploma programme, also in 1999.

14       The Dean of the Dental School is a member of the Faculty of Medicine Board
         and reports formally to the Dean of the Faculty of Medicine. The Dental
         School is divided into two operational areas: the Division of Dentistry and the
         Division of Professionals Complementary to Dentistry. The Division of
         Dentistry is grouped into four academic units: Basic Dental Science; Oral
         Health; Oral and Maxillofacial Diseases; and Restorative Dentistry. All
         teaching staff are allocated to one of these units. The chief executive body of
         the School and main committee for dental education is the Dental
         Management Group, which works in association with the School‟s Curriculum
         Committee and the Undergraduate Education Group of the Faculty of
         Medicine. The Dental Management Group meets on a monthly basis.
         Membership consists of the Dean, the Heads of the Academic Divisions, the
         Unit Heads, the Clinical Director, the Director of Research and the
         Programme Directors for the BDS and MDentSci. We formed the view that
         an open management style was in place with good leadership, and that there
         is a sense of the School moving forward with a common purpose and shared
         goals.

15       There are currently 276 students on the BDS undergraduate dental
         programme and the School aims to accept 60 undergraduate students per
         year, including up to five overseas students. The School makes particular
         efforts to recruit from diverse educational backgrounds and accepts a
         significant number of Access students and graduates; on average these
         students make up 20% of each cohort.

16       Additionally each year the Dental School accepts approximately 15 first year
         postgraduates, onto both taught and research programmes, 24 first year
         trainees for the Diploma in Dental Hygiene and Therapy, nine first year
         trainees for the Diploma in Dental Therapy, and 16 first year trainees for the
         Diploma in Dental Hygiene. The School also recruits 12 student dental
         nurses annually for an NVQ Level 3 programme, and two student dental
         technicians.

17       The specific learning outcomes of the BDS programme are set out in the
         course outlines and the expressed aims and stated outcomes of the
         programme are consistent with those of The First Five Years. The main aim
         of the programme is: to produce a caring, knowledgeable, competent and
         skilful dentist who is able, on graduation to accept professional responsibility
         for the effective and safe care of patients, who appreciates the need for
         continuing professional development, who is able to utilise advances in
         relevant knowledge and techniques and who understands the role of patients
         in decision making.

18       Administratively, the BDS programme is divided into 32 component elements.
         Some of these areas are delivered by a single course in the timetable

1
  We appreciate that individual schools may have adopted different terms but the headings from TFFY are used here
for the sake of consistency



                                                        3
     whereas others are divided between courses, to facilitate integration and
     progression of knowledge across subjects.

19   Students receive much of their teaching in the first year in the Human
     Anatomy Resource Centre, the Sherrington Building (which was refurbished
     in 2002 and became the Medical Education Centre) and Cedar House, all of
     which are close to the Dental School and Hospital. Some Problem Based
     Learning (PBL) tutorials take place at Cedar House, which houses 41 newly
     refurbished rooms for this purpose, and PBL plenary sessions take place in a
     large, modern lecture in the Sherrington Building, which can accommodate
     the whole year. We were impressed by the Human Anatomy Resource
     Centre, which is an excellent facility.

20   During the first year, alongside PBL teaching in the basic medical sciences,
     students undertake the following courses: „Introduction to Oral Health‟, which
     is focused on preventive dentistry, includes elements of behavioural science
     and aims to familiarise students with the cause and prevention of caries and
     periodontal disease; „Special Dental Module‟, lasting four weeks which
     provides students with an introduction to clinical skills through a junior
     phantom head course and includes an introduction to oral anatomy and
     dental materials; and „Communication Skills‟, which is taken in conjunction
     with medical students and involves students working through a series of 11
     scenarios of patient encounters and includes role play. Students complete a
     manual dexterity assessment at the end of the Special Dental Module, the
     purpose of which is to ensure that they are able to progress to supervised
     dental treatment on patients.

21   Teaching in oral science and medicine (OSM) is delivered through PBL in the
     second and third year, following the same structure as the first year course
     and supported by plenary sessions. Students undertake further training in
     clinical skills in laboratories during the second year, undertaking the
     „Introduction to Clinical Practice‟, „Prosthetics‟ and „Introduction to Paediatric
     Dentistry‟ courses. These courses are supported by tutorials and lectures.
     Students start treating adult patients towards the end of the second year,
     spending one session per week on clinics. Alongside these modules,
     students undertake supervised visits to schools or residential homes and
     complete a group behaviour change project for the „Health Education and
     Community‟ course. Students present these projects to their year at the end
     of the course and are formatively assessed.

22   Students continue to study clinical aspects of dentistry throughout the third
     year, with the addition of Periodontology, Endodontics, Dental Materials, Oral
     Surgery and Orthodontics. A one-week block dressership in Oral Radiology
     is also delivered during the third year, which includes tutorials in the
     Radiology Department.        Students are scheduled to attend clinics in
     conservative dentistry, oral surgery (extractions), paediatric dentistry,
     periodontology and prosthetic dentistry.

23   In the fourth year, students attend clinical attachments in combined
     restorative dentistry, orthodontics, paediatric dentistry, oral surgery
     (extractions and minor oral surgery), general anaesthesia, and oral medicine
     and radiology. These clinical areas are supported by lectures. Teaching in
     oral disease is delivered through a course of lectures, seminars and
     histopathology sessions, and students also attend lectures and workshops
     covering law, ethics and jurisprudence. Students have a one-week block


                                         4
     attachment to the regional maxillofacial unit of Aintree University Hospital,
     during which they attend clinics and theatre sessions and are taught by
     consultants and specialist registrars. Students are also required to complete
     an elective project during the summer period. This is preceded by the
     „Undergraduate Research and Evaluation of Knowledge‟ course that provides
     undergraduates with the necessary knowledge and skills required to complete
     their elective project.

24   Clinical sessions continue into the fifth year, when students are attached to
     consultant clinics in oral surgery, sedation, dental radiography, orthodontics
     and implantology. Students attend a lecture course in advanced orthodontics
     and practical sessions in oral disease and clinical pathology. They have a
     second one-week block attachment to the regional maxillofacial unit of Aintree
     University Hospital and attend accident and emergency clinics at the dental
     hospital and the Royal Liverpool and Broadgreen University Hospital.

25   Students are attached to a variety of outreach facilities in the fifth year; these
     attachments are preceded by the „Dental Public Health and Primary Dental
     Care‟ course. This course includes case-based learning sessions with tutors
     from General Dental Practice and the Community Dental Service. Four
     weeks are spent in distance outreach locations in Lancaster and Morecambe
     Bay or Blackburn and Burnley, one day per week for ten weeks in local
     Community Dental Service (CDS) and one day per week for ten weeks in a
     local Personal Dental Service (PDS) practice.

26   The Dental School and Hospital consists of two interlinked buildings, originally
     constructed in the late 1960s, situated on the main University campus. The
     building belongs to the Trust and running costs for the Dental School and
     Hospital are deducted from the Dental Service Increment for Teaching (SIFT)
     allocation. The School is also subject to a top-slice based on resource use
     from the University. The School is in discussion with the University with a
     view to having the percentage of HEFCE top-slicing reduced, due to the fact
     that a deduction is made from SIFT allocation as well.

27   The School houses two modern lecture theatres, one with 120-seat capacity
     and the second with 60-seat capacity both with up to date IT and video
     conferencing facilities. There are four well equipped tutorial rooms which are
     used for PBL teaching and a modern suite of 12 computers, exclusively for
     BDS undergraduate use. Changing rooms, a canteen and common room
     facilities are provided on the fourth floor of the building. On the third floor of
     the building there is a newly refurbished clinical skills laboratory. This facility
     has 33 stations each with a manikin head and torso. Each station has its own
     monitor and the room is wired to a side surgery so students can observe live
     demonstrations. This laboratory can accommodate half a year. Similarly, the
     prosthetics teaching laboratory can accommodate half of the year at once.
     The School also has oral pathology laboratories which were refurbished in
     2004 and can accommodate 30 students. This facility is used by fifth year
     students. The teaching facilities in the Dental School are well equipped.

28   We were impressed by the academic and clinical support staff in both the
     Dental School and Hospital who are supportive, committed and enthusiastic
     teachers, and accessible to students. The School has good access to funds
     for recruitment and has been successful in obtaining the resources to appoint
     six posts. However, we noted that there is limited staffing in some
     departments, with retirements imminent.


                                         5
29    Newly appointed staff members are required to sign up to the University‟s
      staff inductions for teaching and assessment. Staff who are appointed
      without a teaching qualification are required to study for the Certificate in
      Professional Studies. Staff are also encouraged, where appropriate, to take
      the Post-Graduate Certificate in Learning and Teaching in Higher Education.
      All full-time academic staff are required to update an annual portfolio of
      activity that outlines their yearly activity in research, teaching and
      administration. There is a University-wide review process to identify staff for
      promotion. All staff are appraised at least once every three years. Staff
      holding Honorary Consultant contracts undergo annual appraisal by the Trust
      and the University as a joint procedure.

30    NHS consultants, Community Dental Service staff and others holding
      honorary teaching contracts support the teaching and learning of
      undergraduates, as do NHS staff in regional hospitals whilst students are on
      attachments. General dental practitioners also contribute to the teaching of
      undergraduates.

31    Research is focused on four areas: Cariology and Tooth Wear; Dental Public
      Health; Head and Neck; and Oral Microbiology. The Dental School is
      committed to high quality research that will enhance both the clinical and
      academic aspects of dentistry. The School was awarded a grade 4 in the last
      HEFCE Research Assessment Exercise (2001).

32    Vocational Trainers feed into the BDS programme through cross-
      representation on various committees. The Postgraduate Dental Dean is a
      part-time member of the clinical staff.

The Dental Team

33    Students receive tuition on the roles and responsibilities of members of the
      dental team at various stages during the programme, notably during the
      Restorative Dentistry, Prosthodontics and Periodontology courses, and during
      placements at outreach facilities during the fifth year. Students learn how to
      refer to dental technicians as part of the Prosthodontics course and are taught
      by technical instructors during the dental technology elements of some
      courses, during which they gain practical experience in the design and
      manufacture of appliances. There is currently the facility for senior students
      to refer patients from Periodontology to the School of Hygiene. We formed
      the view that, despite the high numbers of PCDs in training at Liverpool, the
      opportunity for shared teaching with dental students is underused. We note
      that the School has plans to increase integration of the teaching of dental
      undergraduates and PCDs.

34    Students work with dedicated dental nurses in outreach placements during
      the fifth year. However, students receive insufficient support from dental
      nurses during clinical sessions in the Dental Hospital. The School recognises
      this issue and a strategy is being developed for achieving greater equity of
      dental nurse support between treatment clinics conducted by staff and those
      attended by students. Plans to increase the numbers of dental nurses are
      also being made. Depending on securing funding, it is planned to staff clinic
      dispensaries solely with auxiliary staff, which will release more dental nurses
      for clinical duties. Opportunities for expanding the dental nurse complement



                                         6
      in training are being explored with the Hospital, School and Strategic Health
      Authority (SHA).


THE CLINICAL ENVIRONMENT

NHS Trusts

35    The Dental Hospital falls under the Cheshire and Merseyside SHA, is within
      Central Liverpool PCT and is part of the Royal Liverpool and Broadgreen
      University Hospitals NHS Trust (RLBUHT). The Dental Hospital liaises with
      North Liverpool PCT, which has the commissioning lead for dentistry across
      the city. The Dental Hospital benefits from strong support from the senior
      officers of the Trusts. Good communication structures are in place between
      the Dental School and Hospital and relevant NHS agencies, from whom the
      School receives very positive support which facilitates the development of
      outreach teaching.

36    The RLBUHT has 23 directorates, with 26 Clinical Directors, which are
      divided into three divisions: surgical, medical, and services. The Dental
      Hospital is in the services division. The Dental Hospital Manager and Clinical
      Director report to the Divisional Manager. The School of Dentistry is
      represented on the Hospital Management Committee and the Safety
      Committee. The Clinical Director sits on the Dental Management Group and
      the Curriculum Committee.

37    SIFT funding is paid to the RLBUHT. The Trust deducts overheads from
      Dental SIFT to cover the costs of the building. The remaining funds are then
      merged with other income streams to the Trust for the Dental Hospital, which
      include NHS posts funded from Medical for Dental SIFT, MADEL funding, a
      notional allocation for clinical service, and funds from the SHA which support
      hygiene and therapy training: these merged funds form the Dental Hospital‟s
      operating budget. Approximately 60% of the merged operating budget is
      used to support undergraduate teaching. The merged budget is managed by
      the Clinical Director, Directorate Manager, the Directorate Management
      Group, Trust Divisional Manager and the finance department of the Trust.

38    The Dental School has 139 dental chairs, an operating theatre with two
      associated day wards, a sedation unit and an x-ray department. The Dental
      chairs are organised into four 20-chair combined discipline teaching clinics,
      each having one or two side surgeries. There is an additional teaching clinic
      with 16 chairs and three side surgeries, one of which is equipped with
      specialist endodontic treatment equipment and can be linked to the clinical
      skills laboratory for live demonstrations. Additional chairs are located in
      surgeries elsewhere in the Hospital. The clinical facilities are of a good
      standard. £400k is set aside annually from the Dental SIFT budget for
      refurbishment and re-equipment. This funds all capital developments.
      Recent expenditure has included refurbishment of a restorative dentistry clinic
      in 2002 at a cost of £405k, upgrading of the pathology laboratories in 2003/04
      at a cost of £100k, and equipping of a latex-screened clinic in 2003/04 at a
      cost of £100k. We were pleased to note that there is a regular re-equipment
      programme in the Dental Hospital. Approximately 75,700 patient attendances
      were registered for each of the last three years. Due to an increase in the
      number of Dental Access Centres in the Liverpool area, the number of walk-in
      patients attending the Dental Hospital has diminished at a rate of


                                         7
         approximately 15% each year. It is therefore sometimes difficult to achieve
         an appropriate case mix of patients suitable for treatment by undergraduates.

39       Preliminary discussions are now taking place at the highest level concerning
         the future development of the adjacent Royal Liverpool Hospital. Various
         options have been considered, including re-building the hospital on its present
         site or building a completely new hospital two or three miles away. Although
         it appears unlikely that the Dental School and Hospital will move from its
         present location, the educational needs of dental students must be borne in
         mind as part of the option appraisals being undertaken at the present time.

Provision for Human Disease Teaching

40       Medical for Dental SIFT is administered via the Cheshire and Merseyside
         SHA and is used to support the teaching of human diseases to dental
         students. The Trust received £0.9m Medical for Dental SIFT funding for
         2003/04. The School is involved in the allocation of these funds through the
         Dean‟s role as an adviser to the workforce finance director of the SHA. We
         believe there should be greater transparency in the allocation of this funding
         stream.

41       Teaching in human disease is contained in the Oral Sciences and Medicine
         (OSM) and Oral Diseases courses which run in the second, third, fourth and
         fifth years. The OSM course is delivered through PBL and the scenarios
         include aspects of human disease. The requirements of The First Five Years
         in this area have been mapped onto the OSM course, particularly in the third
         year. Students attend lectures and interactive sessions in oral medicine
         during the fourth year and attend oral medicine clinics for four sessions each
         in the fourth and fifth year. Lectures in oral surgery are delivered in the third
         and fourth years and students attend oral surgery clinics in the fifth year.
         Teaching in oral pathology is delivered thorough lectures and tutorials in the
         third and fourth years and laboratory attachments and clinicopathological
         seminars in the fourth and fifth years. Oral pathology teaching is well
         developed and integrated.

42       Students have two week-long block attachments to the regional maxillofacial
         unit of Aintree University Hospital in the fourth and fifth years. During the fifth
         year students attend accident and emergency clinics at the dental hospital for
         two week-long attachments, and spend four days at the accident and
         emergency department of the Royal Liverpool and Broadgreen University
         Hospital. Students are given feedback by supervising staff during these
         attachments and are required to record their experiences in their logbooks.

43       The OSM course is assessed at the end of the second and third years by
         written papers. The Oral Medicine and Oral Pathology courses are assessed
         as part of the Oral Diseases component of the Final Examination, and
         formatively during the fourth and fifth years. Oral surgery is assessed
         formatively through the use of logbooks, written papers and an OSCE in the
         third year, and within the Final Examination.

Safety

44       Students are issued with the Liverpool University Dental Hospital and School
         of Dentistry Infection Control Policy (2004) which sets out the procedures of
         infection control in the Hospital. Sterilisation of instruments used at the


                                             8
      Dental Hospital is carried out centrally at the Royal Liverpool and Broadgreen
      University Hospital. Students are taught infection control as part of the
      Introduction to Oral Health course in the first year and are tutored in the
      practical elements of infection control whilst they are on clinics. During
      outreach placements students are taught how to operate autoclaves.

The Extended Clinical Environment and Outreach Teaching

45    The School has a Community Dental Service (CDS) outreach programme
      which has been in place for 14 years. From September 2004 the School
      expanded its outreach programme to include a pilot Personal Dental Service
      (PDS) outreach programme and a pilot distance outreach programme.
      Funding for the first year of these pilot outreach programmes was obtained
      from the South Yorkshire Workforce Development Confederation (SYWDC)
      totaling £300k. The funding is non-recurrent and the School will need to bid
      for future funding from service commissioners and the WDC. The Dental
      School reimburses students‟ travel and accommodation expenses whilst in
      distance outreach facilities at a cost of £1k per student, £55k in total for
      2004/5.

46    Students attend a local CDS facility for one day per week for ten weeks in the
      fifth year. Seven CDS facilities are used, located in Liverpool, Chester and
      the Wirral.    Students attend induction sessions at the start of their
      attachments that cover the role of the CDS, Trust infection procedures and
      protocols, emergency procedures and confidentiality and consent. Students
      see approximately five patients per session.

47    The 2004/5 pilot involves students attending a PDS facility for one day per
      week for ten weeks in the fifth year. The practices being used for the pilot
      have been VT training practices during the last three years and have
      therefore been inspected against the VT trainer practice criteria. The School
      plans to put in place additional criteria for practices to be classified as suitable
      for inclusion in the student outreach programme. This will be implemented
      through joint practice inspection visits with Dental School and Postgraduate
      Deanery staff. 21 practices are used for outreach placements, the majority
      being local to Liverpool. Students treat six to ten patients per day and are
      expected to do routine dental treatment including: restorations; dentures;
      simple extractions; single root endodontics; simple crowns; and routine
      periodontal treatment.       Students may have opportunities to observe
      orthodontic treatment.

48    The pilot in distance outreach involves students spending four weeks in
      distance outreach locations either in Lancaster and Morecambe Bay or
      Blackburn and Burnley. Students on the Lancaster and Morecambe Bay
      placement spend two weeks gaining experience in oral surgery at the Royal
      Lancaster Infirmary and the Westmoreland General Hospital and two weeks
      at the Morecambe Dental Access Centre and CDS facility treating patients
      with access problems and observe those with special needs being treated. A
      new Education Centre, initially for the teaching of medical students, was
      opened recently on the Royal Lancaster Hospital site. It has impressive
      seminar rooms, library and IT facilities. Dental students, whilst in Lancaster,
      have access to this Education Centre. The journals on display in the library
      were almost exclusively related to medical topics. Only one dental journal
      (Dental Update) appeared to be available on the shelves. There were two



                                           9
     surgeries available for the teaching of oral surgery to dental students,
     providing good opportunities for students to gain oral surgery experience.

49   Students on the Blackburn and Burnley placement treat CDS and PDS
     patients at a variety of locations, treat patients under general anaesthesia,
     and attend emergency dental clinics. Eight facilities are used in Blackburn
     and Burnley. Students are provided with an induction pack for each distance
     outreach site which includes their timetable, covers accommodation, travel
     and local support issues, and provides guidance on health and safety.

50   Students are provided with dental nurse support where appropriate whilst at
     outreach facilities, and during the PDS and CDS placements efforts are made
     to ensure that students work with the same dental nurse throughout.
     Emphasis is placed on students gaining experience in team working, both
     within the dental field and in the wider field of health services.

51   The equipment at the outreach facilities we visited was of a good standard
     overall. We were particularly impressed with the track record of the St
     Catherine‟s Community Dental Service in the education of dental
     undergraduates.

52   Whilst students are in outreach placements they are supervised by staff from
     the Community and Personal Dental Services, Dental Access Centre staff,
     and NHS consultants. These staff and their senior dental nurses attend a
     two-day training session at the School and are given honorary tutor
     appointments. The training session includes input from School staff and
     includes presentations on assessment, the clinical logbook, the BDS
     curriculum as a whole, and student welfare whilst on outreach attachments.
     Honorary tutors are required to shadow a restorative dentistry teacher in the
     Dental School for several sessions, or will have been involved in clinical
     departments in the Dental School whilst undertaking a modular MDentSci.
     Some tutors undertake regular sessions supervising students in the Dental
     School. Honorary tutors are encouraged to take the Teaching and Learning
     certificate provided by the University. Study days are held annually for
     outreach tutors and these cover clinical and educational themes.

53   Students work under supervision during all of the outreach placements and
     each item of work is assessed by a tutor, as either „Becoming Competent‟
     (BC) or „Competent‟ (C). Students are required to keep a log of their clinical
     experience and record what they have observed in logbooks. The logbooks
     also require students to reflect on their experiences. Students undertake two
     in-course assessments during the CDS placement. They are required to
     complete a written report on a patient case study, and are assessed on their
     communication skills during the treatment of a patient towards the end of the
     placement. Each of these assessments contributes 10% of the marks in the
     oral health component of the Final BDS Examination.

54   Clinicians involved in outreach supervision are asked to feed comments back
     on the students they have supervised, and students are also asked for
     feedback. CDS placement clinicians report back via meetings of the Unit of
     Oral Health. Formal structures for feedback on the PDS and distant outreach
     placements are in development.

55   The experience that Liverpool students gain in outreach is extensive.
     However, we do have some concerns. The cost of teaching in outreach is


                                       10
       considerable and continued funding of the PDS and distance outreach
       schemes following the pilot study is uncertain. It is important to ensure that
       students in outreach experience the same quality of teaching and equipment
       as they would if they were at the Dental Hospital. The quality assurance
       procedures for the new outreach placements are developing, but need
       strengthening and more formal structures need to be put in place. The
       School should have its own arrangements for determining the suitability of
       PDS and CDS sites for the teaching of dental students.


SUBJECTS AND TOPICS, SPECIFIC LEARNING OUTCOMES

56     The aims and outcomes of the current programme are clearly set out in the
       Student Handbook and in individual course descriptions.

57     The following paragraphs of the report address the skills, knowledge and
       attitudes required by dentists at graduation using the Dental Domains in The
       First Five Years: A Framework for Undergraduate Dental Education (2nd
       Edition). This is not intended to be a comprehensive account of provision
       under each subject. The visitors have highlighted areas of good practice and
       drawn attention to areas where improvement and development should be
       considered.

Clinical Skills

58     The aim of the programme is to provide students with an awareness and
       understanding of the clinical and technical aspects of dental practice, and the
       skills associated with these aspects of dental practice. Students receive
       tuition in basic and advanced dental techniques throughout the programme in
       the clinical skills laboratory. This begins in the first year with the four-week
       Introduction to Clinical Skills course during which students work on phantom
       heads and are introduced to the theory and practice of simple conservative
       dentistry. In the second year students undertake the Introduction to Clinical
       Practice course which includes observation of clinical sessions and prepares
       students for their entry on to the restorative dentistry clinic. Students are
       introduced to history taking and treatment planning during this course.
       Students treat their first patients towards the end of this year. Courses in
       prosthetic dentistry and paediatric dentistry also run in the second year,
       during which students are introduced to the design of complete and partial
       dentures and indirect restorations.

59     During the third year students attend clinics in conservative dentistry, oral
       surgery (extractions), paediatric dentistry, periodontology and prosthetic
       dentistry. Attendance at clinical sessions is based on a two-week rotation
       through the six clinics, which occurs each term, with students spending six
       sessions per week on clinics during each two-week period. The proportion of
       clinical training increases throughout the programme and students are
       timetabled into clinical sessions in the majority of disciplines; a few specialist
       clinics require students to sign up in order to attend. During the fifth year
       students spend time in Dental Accident and Emergency and at various
       outreach facilities and so undertake clinical work in a variety of settings.

60     The concept of integrated restorative dental care was introduced in 2004/5.
       Students now provide the full range of restorative dental treatment, with
       straightforward periodontic, prosthetic and operative procedures all being


                                          11
      performed on one clinic, so as to allow comprehensive oral care to be better
      realised during clinical teaching. Staff from all specialties in restorative
      dentistry will contribute to this clinic. We believe that progress towards
      implementing total patient care needs to be maintained and developed
      further.

61    The first year clinical skills course is assessed by a summative 22-station
      OSCE examination at the end of the first year to confirm students‟ safety and
      suitability to go forward and treat patients on clinics. Continuous assessment
      is used to assess clinical skills, both on clinics and in teaching laboratories.
      Each item of work is graded and entered onto computer records. The use of
      logbooks in the fifth year provides summative assessment on each clinical
      procedure undertaken.          Clinical skills are assessed formatively in
      examinations at the end of the third and fourth years, and summatively in the
      Final BDS Examination by written and practical examinations.

Practical Procedures

62    Students learn the core practical operative techniques in restorative dentistry,
      prosthetic dentistry, orthodontics, paediatric dentistry, and oral surgery over
      the course of the second, third and fourth years. Practical clinical work is
      supported by lectures, demonstrations, observation and class tutorials.
      Treatment planning is taught within the restorative dentistry, paediatric
      dentistry and orthodontics courses. The attachment to Dental Accident and
      Emergency in the fifth year aims to consolidate students‟ skills in making case
      presentations, including history taking, and treatment planning for emergency
      patients.

63    Students attend a series of lectures and tutorials in oral surgery and basic
     surgical techniques during the third year, further lectures in the fourth year and
     an advanced surgical techniques course in the fifth year. The administration of
     local and block analgesia is taught during the Introduction to Clinical Practice
     course in the second year. Students are timetabled on to clinical sessions in
     oral surgery during the third, fourth and fifth years. Suitable patients are
     allocated to students; junior staff and visiting dental practitioners treat some
     patients who are not recommended for student teaching. Once a quota has
     been filled, patients requiring emergency dental care are referred to Access
     Centres in Liverpool.

64   During the third year students complete practical courses in endodontics and
     crowns, and an orthodontic techniques course. Students learn advanced
     clinical restorative techniques during the fourth year bridge course and also
     complete a laboratory course in prosthetic dentistry. The teaching is delivered
     through lectures, seminars, practical demonstrations and clinical exercises.
     Students are required to complete the treatment of 12 patients needing
     removable prostheses for eligibility to the Final BDS Examination. Prosthetic
     dentistry is examined in the restorative dentistry part of the Final BDS
     Examination.       There are also clinical requirements for conservative
     procedures, which must include one bridge, and students must have
     completed at least one report of a patient that they have examined on a new
     patient consultant orthodontic clinic.

65   Training in cardiopulmonary resuscitation and medical emergencies is carried
     out in each year of the course. Medical emergency scenarios are included in
     PBL in the first, second and third years. During the final year students attend a


                                         12
      four-day block course in medical emergencies which consists of a series of
      didactic lectures, individual skills stations and scenario practice using manikins
      and simulators. Students complete the skills stations and scenarios in groups
      of six with two supervising members of staff. Students are assessed at the
      end of the course by a Multiple Choice Question (MCQ) written paper and a
      practical test on a manikin.

66    We found that students gain limited experience in orthodontics in the BDS
      programme. One senior academic is responsible for the delivery of this part of
      the programme. A course of lectures is given in the third year, but the
      students do not carry out any orthodontic treatment on their own patients and
      there appears to be little opportunity to see the progress of orthodontic
      treatment over a reasonable period of time. Final year students observe
      specialist registrars carrying out fixed appliance treatment.

Patient Investigation

67    The programme aims to produce students who understand the principles of
       radiation protection and who have achieved a level of skill in radiography and
       radiographic interpretation relevant to general dental practice.

68    The theory of dental radiography and radiology is taught through a series of
      lectures and tutorials in the third and fourth years. Students attend the
      Radiography Department for three days in the third year and two days in the
      fourth year to receive practical instruction in radiology and radiography.
      Students are encouraged to bring patients to the radiography department
      throughout their clinical training. They are taught how to write reports.
      Theoretical knowledge in this area is assessed formatively in the third and
      fourth year examinations and the Oral Disease written paper of the Final BDS
      Examination includes questions on dental radiography and radiology.

69    The professional examinations at the end of the BMS and OSM courses are
      based on Observed Structured Clinical Examinations (OSCEs), but we were
      informed that the examination material consisted mainly of clinical slides.
      There appeared to be limited learning and assessment centred on practical
      examination and investigation of general surgical and medical patients.

Patient Management

70     Students are introduced to history taking, examination and treatment planning
       during the Introduction to Clinical Skills course in the second year. These
       skills are developed on the restorative dentistry clinics where students are
       encouraged to undertake and complete complex programmes of treatment.
       In the fifth year students consolidate their skills in these areas, including
       knowing when and how to justify further investigations and refer patients, as
       part of the Examinations course that takes place in Dental Accident and
       Emergency.

71     It is intended that the week-long placements at the Maxillofacial Department
       of Aintree University Hospital in the fourth and fifth years provide students
       with knowledge of the management of acute infections and familiarity with:
       the principles of assessment and management of maxillofacial trauma; the
       diagnosis of oral cancer and the principles of tumour management; and the
       principles of treatment of dento-facial anomalies including the common
       orthodontic/maxillofacial procedures involved. During these attachments


                                          13
      students attend clinics and theatre sessions and complete a logbook and
      make notes on patients whom they see.

72    Teaching in the theory and administration of therapeutic drugs, including
      those used for sedation and local analgesia, is included in the OSM PBL
      course in the second and third years. Lectures in oral disease in the fourth
      year aim to equip students with knowledge and understanding of the influence
      of systemic disease and therapeutics on dental treatment and include
      sessions on drug interactions in dentistry. In the fourth and fifth years
      students are required to attend one consultation clinic for anxious patients
      and adult patients with learning disabilities.

73    In the fifth year students are timetabled to attend three sedation sessions over
      two consecutive days. Following observation of a member of staff, students
      prepare the drugs and documentation, obtain consent, sedate and treat
      patients with the assistance of a tutor and a nurse. Students have the
      opportunity to gain practical experience of inhalational and intravenous
      sedation during clinical sessions at the Dental Hospital and at outreach
      facilities. The Questionnaire on the Teaching of Pain and Anxiety Control that
      was carried out by the GDC in June 2000 reported that Liverpool students
      observed, on average five cases of intravenous sedation and administered
      0.9 cases during the BDS programme. Recent graduates told us that they
      had experienced „one or two intravenous cases‟. We were not able to
      quantify whether the student experience in inhalational and intravenous
      sedation had increased since June 2000.

74    Students have the opportunity to treat patients from a wide variety of
      backgrounds during the placements at outreach facilities, both in the CDS
      and at facilities involved in the current pilot distance and PDS outreach
      programmes, including those with special needs and apprehensive patients.
      The outreach placements aim to provide students with experience of
      managing patients from different social and ethnic backgrounds. Those
      students who attend St Catherine‟s CDS clinic on the Wirral treat patients
      referred from a drug rehabilitation unit. Time is set aside during sessions for
      students to reflect on their experiences with a tutor. Whilst on the CDS
      placement, students are required to complete a project which is based on a
      case study. This study looks at the patient‟s history, family background and
      the social influences on their oral health and use of healthcare services.

75    Formative assessment is carried out on all aspects of patient management on
      clinics at the dental hospital and in outreach. This area is also covered in the
      Final Examination. The mark from this project contributes to the Final BDS
      Examination.

Health Promotion and Disease Prevention

76    The programme aims to increase students‟ understanding of the principles
      and practice of dental public health and to give students an understanding of
      public health approaches relevant to the provision of care in primary dental
      settings.

77    The prevention of oral disease is a theme of PBL in the programme. During
      the second year students undertake visits to schools or residential homes
      under the supervision of a community dental health education team and
      complete a behaviour change project in groups which is then presented to the


                                        14
      year group as a formative assessment. Teaching in Dental Public Health is
      delivered by lectures in the final year. Students complete an essay at the end
      of the lecture course and are assessed summatively in this area within the
      Oral Health written paper component of the Final BDS Examination.

Communication

78    On graduation, it is expected students will be competent at communication
      with patients and other members of the team and other health professionals.

79    Students undertake a Communication Skills course in the first year during
      which they work through a series of 11 scenarios of patient encounters. They
      are assessed summatively at the end of the first year by an Objective
      Structured Video Examination (OSVE). Teaching         in   the     behavioural
      sciences, including the way in which they relate to communication, is included
      in PBL, particularly in the second year when some scenarios include
      elements of clinical psychology and sociology. Students gain experience in
      communicating with patients from diverse ethical and social backgrounds
      during placements at outreach facilities, including children and those with
      special needs.      Communication skills are included in the formative
      assessment carried out at the end of each item of work or clinical session and
      marks are recorded in students‟ logbooks. In addition, a summative
      assessment of Communication Skills contributes to the Final Examination.

Data and Information Handling Skills

80    The first year PBL Introduction to Basic Medical Sciences course aims to give
      students an appreciation of the principles of scientific thought and argument
      and develops students‟ skills in research, analysis, problem solving and
      presentation of information. This aim is continued into the PBL-based Oral
      Sciences and Medicine courses in the second and third years. Students are
      required to work in groups and individually to research PBL case scenarios
      and present their findings. This study is supported by virtual posters on the
      School intranet and students are required to enter their findings for each
      scenario into VITAL, the University‟s virtual learning web-based software.

81   During the Law and Ethics course in the fourth year the necessity of
     maintaining full accurate clinical records is emphasised.

82    Data and information handling are taught in the fourth year as part of the
      preparation for the elective project. This part of the programme aims to
      ensure that students are competent at using information technology. A range
      of statistical techniques, including critical reading, electronic data
      management and presentation skills is taught through lectures, tutorials and
      workshops. Students are expected to use these techniques in their elective
      reports. Students must have submitted satisfactory elective reports in order
      to sit the Final BDS Examination.

Understanding of Basic & Clinical Sciences and Underlying Principles

83   Teaching in Basic Medical Sciences is delivered initially through a PBL course
     which is taken in conjunction with medical students in the first year. The
     course consists of 11 modules of two to three weeks‟ duration, each module
     leading to a presentation on a clinically-relevant topic in a short case scenario.
     Dental students work in groups of six to eight on these scenarios, the groups


                                         15
     are not mixed with medical students, and are required to generate learning
     objectives. Groups meet for three PBL tutorials per module. These meetings
     are chaired by a student and the group is required to share and discuss its
     learning experiences as progress is made on exploring the case scenario.
     These sessions are overseen by a PBL tutor, whose role is to guide the group
     and ensure that the discussion is relevant and focused and the learning
     objectives are achieved. PBL learning is supported by a series of plenary
     sessions which focus on individual topics. As part of the PBL case scenarios,
     students attend two-hour sessions in anatomy at the Human Anatomy
     Resource Centre. Students do not do dissection (though there is the
     opportunity to observe some dissection) but use 3D models, written material
     and specimens. Dental students sit the same examinations as medical
     students in the Basic Medical Sciences, which take place at the end of the first
     year in the form of two written papers. Staff from the Dental School mark the
     examinations taken by dental students.

84   An Oral Science and Medicine (OSM) course is delivered during the second
     and third years. This course is taught only to dental students. During the
     second year teaching in OSM is equivalent to three days per week and
     includes a distinct human anatomy course which focuses on the head and
     neck. The third year OSM course is equivalent to two days per week and has
     a greater emphasis on clinical medicine. Students are assessed in this area by
     written examinations at the end of the second and third years. The PBL course
     appeared to be integrated and there is a range of support to facilitate
     scenarios. We had difficulty in ascertaining the depth to which some subjects
     are assessed in the PBL modules.

85   Students are taught about the routine restorative materials during the Special
     Dental Module in the first year. Teaching in dental materials becomes more
     advanced later in the programme through the Restorative Dentistry and Dental
     Materials Science course in the third year and the Restorative Dentistry
     (Bridge) course in the fourth year. Dental materials are assessed summatively
     by written papers at the end of the first and fourth year, and questions on the
     applied use of dental materials can appear in the Restorative Dentistry paper in
     the Final BDS Examination. The applied use of materials is a frequent point of
     discussion in the restorative clinical examination which is also part of the Final
     BDS Examination.

86    Teaching in oral microbiology is integrated throughout the programme and is
      included in PBL courses in the first, second and third years.            Oral
      microbiology is taught by lectures, tutorials and clinics as part of the Oral
      Diseases course in the fourth year, during which students learn the relevant
      concepts of oral infection and its treatment. In the fifth year students
      consolidate the practical elements of oral microbiology through clinical work
      and clinical placements in oral surgery and oral medicine. Oral microbiology
      is tested formatively throughout the programme and summatively as part of
      the Oral Diseases component of the Final BDS Examination.

Appropriate Attitudes, Ethical Understanding and Legal Responsibilities

87    Teaching in these areas is integrated throughout the course and is introduced
      in PBL in the first year. All second year PBL modules require a consideration
      of behavioural science, and this aspect of the course is supported by
      dedicated plenary sessions. The fourth year Law and Ethics course focuses
      substantially on this area. This course aims to inform students of their


                                         16
      professional responsibilities to their patients, healthcare colleagues and the
      profession, and to inculcate high ethical and professional standards in the
      students. Formative assessment related to a case study is undertaken at the
      end of the course and summative assessment is undertaken in several
      aspects of the written and clinical examinations in the Final BDS Examination.

Appropriate Decision Making, Clinical Reasoning and Judgement

88    The areas of conservation, periodontolgy and prosthetic dentistry are
      incorporated into a restorative clinic to provide comprehensive patient care for
      dentate and partially dentate adult patients. Students are encouraged to
      provide initial phase periodontal treatment and planning of removable
      prostheses before commencement of conservative treatment. This approach
      was adopted in October 2004 and it has been agreed that a presentation of
      completed comprehensive care should contribute to the Final BDS
      Examination as of 2006. An aim of the outreach placements in the fifth year
      is to consolidate awareness and develop students‟ skills in the provision of
      comprehensive dental care for a range of patients. Students may have the
      opportunity to observe the treatment of medically compromised patients
      during outreach placements and placements at the Maxillofacial Department
      of Aintree University Hospital.

Professional Development

89    The programme aims to equip students with high professional and ethical
      standards and awareness of their professional responsibilities.

90    Teaching in this area is integrated throughout the programme in the relevant
      clinical areas and specifically in the fourth year Law and Ethics course.
      Professional attitudes are reinforced by staff throughout the programme and
      assessed at each clinical session.

91    The Primary Preparation course, which is delivered prior to outreach
      placements in the fifth year, aims to provide a basic understanding of
      business issues as they are relevant to the delivery of patient care and
      students are expected to demonstrate an adaptable approach to problem
      solving in management and clinical practice.

Personal Development

92    The programme aims to develop in students the attitudes and skills necessary
      to cope with the changing demands of professional practice through an
      awareness of the factors that influence dentistry and the community which it
      serves.

93    Students and recent graduates we met were mature, articulate and
      thoughtful. They offered excellent feedback on the positive experience
      gained at the Dental School and University.


STUDENT SUPPORT AND PROGRESS

94    During the first week of the BDS programme students attend an induction
      which includes tours of the School and the University, meetings with staff and
      the dissemination of general information. Students are issued with the


                                        17
      programme handbook and other relevant documents. The Dental Students‟
      Society runs a mentoring scheme for first year students.

95    Students are allocated personal tutors whose role is to provide personal
      support and academic guidance. Arrangements are made for all new
      students to see their personal tutors within their first few days at the Dental
      School and tutors are then expected to meet their tutees twice a semester,
      more frequently if necessary. If students do not wish to talk to staff
      associated with the School there are a variety of points of contact within the
      University. Whilst on residential outreach placements students may get in
      touch with a local contact person if they have any minor questions or issues.
      Major issues are referred to the Senior Tutor at the Dental School.

96    The Personal Tutor system and student mentoring appear to work well. Staff
      are very accessible and students told us that they have no difficulty in
      obtaining help and advice. E-mail is used effectively as part of the support
      mechanism, particularly when students are in outreach.

97    Students felt that they had a significant input into the Staff Student Liaison
      Committee and that their views were taken into account. The Periodic
      Review of Dental Studies by the Faculty of Medicine (which took place on the
      7 & 8 October 2004) recommended that the School should satisfy itself that
      the arrangements for providing pastoral support for students on outreach
      placements were adequate. The students we met told us that they felt well
      supported during outreach placements.

98    The School and Deanery organise a careers advice day in the fifth year which
      details the various opportunities open to graduates. The Postgraduate Dental
      Dean gives a series of lectures during the fifth year on the structure and
      workings of the NHS to assist the transition from undergraduate to Vocational
      Training and postgraduate study. The University has a careers guidance
      department that is available to all students.

99    The School works closely with the University‟s Welfare and Advisory Service
      to both identify and support students with specific learning requirements.
      Comprehensive advice is available for disabled students.

100   We reviewed the progress of BDS student cohorts, graduating from 2001 to
      2004. The 1996/7 intake lost five students (two withdrew and three failed) in
      the first year, but then had very few failures, ending up with a 93% completion
      rate. Those graduating in 2002 (1997/8 intake) had a 75% completion rate,
      with only 43 students graduating that year. Completion rates for 2003 and
      2004 were 96% and 86% respectively. We were assured that the School will
      continue to monitor the BDS student cohorts‟ progression.


ASSESSMENT

101   University examination regulations are available on the main website and
      assessment guidelines for the BDS Programme are provided to students in
      the student handbook and are available on the Dental School‟s Intranet.

102   Specific modes of assessment within the programme have been mentioned in
      earlier paragraphs.   Summative, formative and evaluative methods of



                                        18
      assessment are used. These are supplemented by the use of logbooks for
      clinical sessions in the fifth year.

103   We became aware of a number of issues with respect to assessment,
      including:

             a. fifth year students told us that there had been significant changes to
             the curriculum during their BDS programme. They felt the changes
             would benefit subsequent years;
             b. Liverpool University has taken a policy decision to discontinue
             pass/fail and merit/distinction vivas. A number of external examiners
             expressed regret at this decision. We were told that the compensation
             allowed across the different components of the Final Examination was
             „generous‟, and that a viva was not necessary. It is important to
             monitor the impact of compensation in the new marking system. The
             School notes that the BDS examination boards that have taken place
             since the abolition of vivas in 2003/4 have run smoothly and to the
             satisfaction of the external examiners;
              c. There is no professional examination in any aspect of clinical
             dentistry after the practical examination in the first year, until the Final
             Examination at the end of the fifth year.


QUALITY ASSURANCE AND CURRICULUM ENHANCEMENT

104   The University‟s main mechanism of quality assuring teaching is the annual
      programme review which requires that part of a department‟s provision is
      reviewed in detail each year for four years, so that by the time the department
      undergoes periodic review in the fifth year, all of its provision will have been
      reviewed. Every department in the University undergoes review once every
      six years.

105   The School recognises a weakness in the administration of Problem Based
      Learning. The administration of education by PBL is labour intensive, and so
      is very sensitive to staff absence through illness or other reasons. The
      School has very limited spare capacity to cover for such absences. There is
      a problem with the short notice cancellation of plenary lectures by outside
      staff. From time to time this has been attributed to the increased teaching
      load of staff in the Faculty, caused by the expansion of medical student
      numbers. This problem has been recognised at Faculty level and a dedicated
      School of Medical Education has been established. The Dental School is
      looking at the curriculum as a whole to consider which areas of PBL teaching
      should be brought in-house, to ensure continued support of this course. We
      consider this to be a significant teaching issue which has implications for the
      delivery of the BDS programme.

106   We were informed that outreach teaching within the Personal Dental Services
      may have an impact on the availability of training practices for vocational
      dental practitioners. The funding arrangements with the PDS are such that
      £85k is allocated for a training practice. The impact of this allocation is yet to
      be determined.

107    We were not aware of the results of any patient surveys on their experience
      of being treated by dental students. We were told that these would be carried
      out in due course.


                                         19
108   The curriculum for the BDS programme is undergoing considerable change.
      Lessons have already been learned and the School has worked with the
      Postgraduate Dental Deanery, PCTs and Cheshire and Merseyside Strategic
      Health Authority on the management of outreach.


OVERVIEW

109   The BDS programme in Liverpool has undergone considerable changes since
      the last GDC visitation, and is still in a period of transition. The decision, in
      1997, to adopt a Problem Based Learning course, especially in the first two
      years, involved a considerable commitment from members of staff across the
      Faculty. The increase in the intake of medical students has also added to the
      complexity of developing the BDS curriculum, because medical and dental
      students follow a similar PBL programme initially. The School has now
      embarked on a major outreach programme in the final year, with placements
      up to 60 miles from the Dental School and Hospital. The financial,
      educational and quality assurance issues of the extended outreach
      programme, which also involves many Personal Dental Service Practices,
      continue to be developed. Hard working, committed staff provide excellent
      educational and pastoral support to their students.




                                         20
RECOMMENDATIONS

The key areas for action identified by the visitors are summarised below. Additional
comments are contained within the body of the report itself. We ask the School to
respond to the report as a whole and to the specific recommendations detailed here.

1.     To the GDC
(To be determined after the completion of the visit to the Final Examination)

2.     To the Dental School

Imminent retirements will cause considerable pressure on the Dental School and
    Hospital, unless appropriate appointments can be made (28).
Shared learning with dental students and other members of the dental team should
    be increased (33).
Quality assurance of the outreach experience must be developed (55).
The School should have its own arrangements for determining the suitability of PDS
    and CDS sites for the teaching of dental students (55).
The implementation total patient care in restorative dentistry needs to be developed
    further (60).
There is a need to consider the student experience in some clinical disciplines,
    including sedation and orthodontics (66, 73).
Learning and assessment centred on the practical examination of general surgical
    and medical patients needs to be developed further (69).
Greater transparency in the depth to which some subjects are assessed in the PBL
    modules is needed (84).
Completion rates in the BDS programme should continue to be monitored (100).
Staffing issues with respect to the delivery of PBL teaching need to be resolved
    (105).

3.     To the University

The funding deficit from HEFCE and the relatively low QR income must both be
   sources of concern for the School and the University. We would welcome
   attempts to address these issues but urge the need to protect the quality of the
   teaching curriculum and its delivery (9).
Resources devoted to dentistry in the Harold Cohen Library, and in outreach
   facilities, need to be reviewed (10, 48).
The amount of the top slice from HEFCE funding for the Dental School and Hospital
   for central University costs needs to be reviewed, bearing in mind that the
   accommodation is owned and resourced by the NHS (26).

4.     To the NHS Agencies

The working of the Dental Hospital, in terms of access to care, patient base and case
   mix, needs to be reviewed (38).
Dental nurse support for dental students in the Dental Hospital needed to be
   increased (34).
The allocation of the Medical for Dental SIFT budget should be clarified (40).
The Educational needs of dental students must be borne in mind when the future
   location of the Royal Hospital is being considered (39).
The source of the funding of outreach teaching and recurrent nature of such funding
   must be subject to scrutiny (55).
     Annex 1

     GDC Visitors’ Programme

     List of meetings held and people we met in formal meetings and on tours of the
     outreach facilities

     (We met other staff and students during the tours of the University and Dental School
     and Hospital)

Additional day for visits to outreach facilities – Monday 24 January 2005

     Professors J Murray and E Odell visited the following outreach facilities: Queen
     Victoria Health Centre, Morecambe; Lancaster Royal Infirmary; and Montague Health
     Centre, Blackburn.
     They met with various members of staff at each facility, including the following:
     Mr D Young (Lecturer in Dental Public Health)
     Dr S Davies (Acting Lead Clinician at Queen Victoria Health Centre, Morecambe)
     Mr P Dyer (Consultant Maxillofacial surgeon at Lancaster Royal Infirmary)
     Dr H Whitehead (Director of Community Dental Services, East Lancashire)

Day 1 – Tuesday 25 January 2005

     Meeting with Dean of School
     Professor C Pine (Dean of Dental Studies)

     Meeting with senior staff of the University
     Professor D Bone (Vice-Chancellor of Liverpool University)
     Ms V Goddard (Director of Academic Planning & Teaching Quality)

     Meeting With Dean Of Medical Faculty
     Professor J Caldwell (Dean of the Faculty of Medicine)

     Meeting with senior hospital managers
     Ms M Culkin (Dental Hospital Manager)
     Mr R Howell (Clinical Director)
     Dr A Field (Clinical Director designate)

     Meeting with teachers concerned with teaching pre-clinical subjects
     Professor A Garden (Head of School of Medical Education)
     Dr P Dangerfield (Senior Lecturer in Human Anatomy)
     Dr R Lynch (Senior Lecturer in Human Anatomy)
     Dr S Christmas (Senior Lecturer in Immunology)
     Dr B Young (Senior Lecturer in Clinical Psychology)
     Dr P Hodgson (Lecturer in Primary Care)
     Dr K Last (Senior Lecturer in Periodontology and BDS Programme Director)
     Dr P Smith (Senior Lecturer in Oral Biology and OSM Course Director and
     Webmaster)
     Dr L Mair (Head of Division of Dentistry)
     Professor P Winstanley




                                              22
    Tour of Local Community Dental Service and Personal Dental Service

    We visited the following outreach facilities: Walton Community Dental Clinic,
    Liverpool; and Orchard Road PDS Practice, the Wirral.

Day 2 – Wednesday 26 January 2005

    Meeting with Dean and Administrators
    Dr M Wainwright (Dental School Administrator)
    Mr S Smitton (Dental School Administrator)
    Meeting with Pro-Vice Chancellor
    Professor J Saunders

    Meeting with the Heads of academic departments in the Dental School
    Dr N Pender (Head of Unit of Oral Health)
    Professor C Youngson (Head of Unit of Restorative Dentistry)
    Professor J Field (Head of Unit of Maxillofacial and Oral Diseases)
    Professor S Higham (Head of Unit of Basic Dental Sciences)
    Dr L Mair (Head of Division of Dentistry)

    Meeting with recent graduates
    Miss A O‟Connor (2003 graduate)
    Mr D Baker (2004 graduate)
    Miss S Zaidi (2004 graduate)
    Miss S Allen (2004 graduate)
    Mr A Booth (2004 graduate)

    Tour of Local Community Dental Service and Personal Dental Service

    We visited the following outreach facilities: St Catherine‟s Hospital Dental Clinic, the
    Wirral; and Archway Road PDS Practice, Liverpool.

    Meeting with representatives of the SHAs
    Ms J Normie (Dental Development Lead for Cheshire and Merseyside SHA)
    Mr A Sainsbury (Deputy Head of Finance for Cheshire and Merseyside SHA)

    Meeting with representatives of the PCT
    Mrs D Edwards (Consultant in Public Health)
    Mrs L Gough (Director of Salaried Primary Care Services, North Liverpool PCT)
    Mrs C Temple (Director of Salaried Primary Care Services, Halton PCT)
    Dr R Harris (Senior Lecturer in Dental Public Health)
    Professor C Pine (Dental Public Health and Primary Dental Care)

    Meeting with Dental Instructors
    Ms L Jones (Laboratory Superintendent)
    Mr H Babakhan (Instructor Technician)
    Mr L Blundell (Instructor Technician)
    Mrs A Burge (Superintendent Radiographer)

    Meeting with representatives of Professionals Complementary to Dentistry
    Miss P Bickerton (Tutor Hygienist)
    Mrs V Payne (Clinical Technician)



                                               23
     Ms C Heaton (Subdirectorate nurse in A & E)
     Mrs K O‟Donovan (Subdirectorate nurse in Orthodontics and Paedodontics)
     Ms G Myers (Senior nurse in Restorative Dentistry)

     Meeting with programme director for the combined Hygiene/Therapy Diploma
     Dr A Preston (Programme Director for the combined Hygiene/Therapy Diploma)

     Meeting With The Postgraduate Dental Dean, Regional Adviser In Vocational
     Training and VT Trainers and distant outreach representatives
     Dr B Grieveson (Postgraduate Dental Dean)
     Dr M Williams (Regional Advisor for Vocational Training)
     Dr N Cooper (Vocational Training Advisor)
     Dr A Wylie (PDS practitioner and VT Trainer)
     Dr P Sherrard (PDS practitioner and VT Trainer)
     Dr M Robertson (PDS practitioner and VT Trainer)
     Dr B O'Gorman (PDS practitioner and VT Trainer)
     Mr P Dyer (Consultant Maxillofacial Surgeon, Lancaster)
     Dr H Whitehead (Clinical Director, Community Dental Services, East Lancs CDS,
     Blackburn / Burnley)
     Miss C Balmer (Associate Postgraduate Dental Dean and Mersey lead for
     modernising medical careers)

Day 3 – Thursday 27 January 2005

     Meeting with Chief Executive and Chair of parent NHS Trust Board
     Ms M Boyle (Chief Executive of the Royal Liverpool and Broadgreen University
     Hospitals Trust)
     Mr R James (Chairman of the RLBUHT)
     Mr A Wilks (Deputy Chief Executive/Executive Director of Finance)

     Meeting with current students
     We met two representatives from each of the five years of the BDS programme.

     Meeting with representatives of non-professorial staff
     Dr M Martin (Senior Lecturer in Oral Microbiology)
     Miss E Theil (Lecturer in Periodontology and Senior Tutor and advisor to the elective
     programme)
     Mr G Lee (Senior Lecturer in Paediatric Dentistry and Admissions Tutor)
     Dr F Jarad (Lecturer in Conservative Dentistry)
     Mr D Adams (Senior Lecturer in Prosthetics)
     Mr P Farrelly (Lecturer in Dental Prosthetics & Chairman of Health & Safety
     Committee)
     Dr K Fox (Lecturer in Restorative Dentistry)
     Mr S Rimmer (Lecturer, part-time, in Conservative Dentistry)
     Dr N Pender (Senior Lecturer in Orthodontics)
     Mrs L Arch (Honorary Clinical Tutor)
     Dr R Harris (Senior Lecturer in Dental Public Health)
     Dr J Risk (Lecturer in Dental Genetics & Chair of the Information Services Committee)

     Meeting with NHS Dental Clinical Staff involved in teaching dental students
     Dr A Milosevic (Consultant in Restorative Dentistry)
     Dr L Longman (Consultant in Restorative Dentistry)
     Dr J Harrison (Consultant in Orthodontics)
     Mr P Hardy (Consultant in Oral Surgery)
     Mr R Llewelyn (Consultant in Paediatric Dentistry)


                                              24
     Dr A Field (Consultant in Oral Medicine)
     Dr C Butterworth (Consultant in Oral Rehabilitation)
     Miss C Balmer (Associate Specialist in Oral Surgery and Associate Postgraduate
     Dental Dean)
     Dr R Allen (Specialist Registrar in Oral Medicine)
     Mr P Nixon (Consultant in Radiography)
     Ms H Stevenson (Specialist Registrar in Orthodontics)
     Mr M Forde (Lecturer in Oral Disease)


Additional day for visits to outreach facilities – Friday 28 January 2005

     Professors J Murray and A Harrison visited the following outreach facilities: Martins
     Lane PDS Practice, the Wirral; and Victoria Central Hospital Dental Clinic, the Wirral.
THEY MET WITH VARIOUS MEMBERS OF STAFF AT EACH FACILITY.Annex 2

Details of the Documents provided by the School

     Information Received Ahead of the Visit

     Self Evaluation Document
     Dental School Learning and Teaching Strategy
     Organisation and committee structure of the Dental School
     Programme structure of the BDS and aims, objectives and content of BDS
     component courses
     Student intake data for the BDS programme, 2003/4 and 2004/5
     Document detailing changes introduced in response to previous GDC visitations and
     monitoring
     Document detailing mechanisms for change to existing programmes
     Information on IT facilities
     Dental Hospital and School income and expenditure
     Accommodation and clinical facilities in the Dental Hospital
     Progression rates for cohorts graduating from 2001-2004
     Details of clinical activity data for 2001/02, 2002/03 and 2003/4
     20004/05 Strategic Plan for the Sheffield School of Clinical Dentistry
     QAA Subject Review Report May 2000
     Annual monitoring reports for 2001/2 and 2002/3
     Periodic review of the Dental School October 2004
     Staff list by department/subject area
     Information on staff changes
     PCD staff list
     Liverpool and University Dental Hospital and School of Dentistry |Infection Control
     Policy 2004
     BDS programme student handbook for 2004/5
     BDS programme specification
     Logbook for final year students
     Outreach logbook for final year students
     Details of the outreach programme
     Information on assessment in the BDS programme
     List of external examiners
     External examiners reports for 2001/02, 2002/03 and 2003/04
     Pass/fail statistics for BDS summative assessments for the last three years

     Information received during the Visit


                                                25
Further details on dental chairs, clinic refurbishments and capital expenditure
Further information on dental nurse provision
Further details of Dental Hospital activity
Further details on the outreach programme
Attendance rota for the attachment to the Regional Maxillofacial Unit of University
Hospital Aintree
Further details on the teaching of human diseases
Further details on the non-clinical course
Details on the teaching of dental materials
Details on total patient care in restorative dentistry
Details on the teaching of oral radiology and radiography
Details on the teaching of orthodontics
Second year BDS Oral Sciences and Medicine Course tutor study guides (first and
second semesters) 2004/5
Third year BDS Oral Sciences and Medicine Course tutor study guides (first and
second semesters) 2004/5

During the visit additional information was available to the visitors in the Baseroom.




                                           26
PDB/GDC

7 July 2005


Mr A D Seth-Smith
Education Directorate
General Dental Council
37 Wimpole Street
London
W1G 8DQ




Dear Mr Seth-Smith,

RE: RESPONSES TO RECOMMENDATIONS IN THE REPORT OF THE GDC
VISITORS

Please find attached responses from the NHS Agencies, Dental School and University in
respect of the recommendations made in the General Dental Council Visitors’ Report after the
visits earlier this year. I hope that you find these positive and helpful.

I would like to thank you once again for a constructive and useful interaction, we found the
visits very helpful.

If you have any further queries please contact the Dean of the Dental School in the first
instance.

Yours sincerely




Professor D Bone
Vice-Chancellor




                                              27
2.       To the Dental School

        Imminent retirements will cause considerable pressure on the Dental School
         and Hospital, unless appropriate appointments can be made (28).

Response:
At the time of the Visit, three members of staff were due to retire. Since then, 2 of the
3 posts have been re-filled successful, and, the third member of staff is planning to
return part-time following early retirement. This latter post has been retained within
the School’s baseline staffing allocation and will be advertised in due course.

        Shared learning with dental students and other members of the dental team
         should be increased (33).

Response:
This recommendation is noted and welcomed by the School since it forms part of the
School’s future plans for curriculum development. The School plans to take this
forward in developing joint teaching and learning opportunities for dental
undergraduates and PCDs both within the Dental Hospital & School and on outreach
placements.

        Quality assurance of the outreach experience must be developed (55).

Response:
This recommendation is noted and welcomed by the School and further aspects of
quality assuring the outreach teaching programme have been undertaken since the
Visit and are on-going. A Study Day was held in June for all outreach tutors and
dental nurses focussing on Preparing Students for Outreach Teaching, Clinical
Governance and Assessment. Plans are in place for Dental School staff to be
timetabled to provide regular visits and support to Outreach Placements.
.
     The School should have its own arrangements for determining the suitability
        of PDS and CDS sites for the teaching of dental students (55).

Response:
This recommendation has already been acted upon and the School now has in place
joint inspections with the Postgraduate Deanery of all PDS practices that are part of
the new outreach programme.

        The implementation of total patient care in restorative dentistry needs to be
         developed further (60).

Response:
This recommendation is noted and welcomed by the School since it forms part of the
School’s future plans for curriculum development.

        There is a need to consider the student experience in some clinical
         disciplines, including sedation and orthodontics (66, 73).

Response
As part of the plans for expanding student numbers, new, dedicated facilities are
planned for sedation teaching, together with the planned appointment of Senior
Clinical Teachers in Restorative Dentistry and in Surgical Dentistry. The focus of
orthodontic teaching is on understanding the development of the dentition,



                                           28
developing knowledge of appropriate referral for specialist care and progress of
orthodontic treatment. The teaching programme aims to provide the opportunity to
see the progress of orthodontic treatment over a 18 month period during the 4th and
5th years with individual observation by each student of a single patient treated with
fixed appliances by a Specialist Registrar. In the light of the Visitors’ comments, the
delivery of this programme will be reviewed.

        Learning and assessment centred on the practical examination of general
         surgical and medical patients needs to be developed further (69).

Response

This recommendation is noted by the School and the teaching in this area will be
reviewed in this regard.

        Greater transparency in the depth to which some subjects are assessed in
         the PBL modules is needed (84).

Response

The curriculum content and subject coverage for PBL modules are reviewed
annually. The Visitors’ comments will inform the next review.

        Completion rates in the BDS programme should continue to be monitored
         (100).

Response
The School will continue to monitor completion rates in the BDS programme.

        Staffing issues with respect to the delivery of PBL teaching need to be
         resolved (105).

Response
This recommendation is welcomed and reinforces the School’s approach in working
closely with the School of Medical Education and the Faculty in its current review of
teaching support aimed at ensuring that the PBL programme is delivered efficiently.

3.       To the University

The funding deficit from HEFCE and the relatively low QR income must both be
   sources of concern for the School and the University. We would welcome
   attempts to address these issues but urge the need to protect the quality of the
   teaching curriculum and its delivery (9).

Response
The University is welcoming the proposal to expand dental numbers, as once these
are fully resourced, it will alleviate the current funding deficit The University
recognised the importance of Dental Accreditation by continuing to support the area
to a substantial extent over and above the level of income generated.. New
appointments to the School at Senior Lecturer and Chair level are to be made with a
strong focus on research activity and will assist in the QR income stream.

Resources devoted to dentistry in the Harold Cohen Library, and in outreach
   facilities, need to be reviewed (10, 48).



                                          29
      Response
      Since the Visit, the University has reviewed the resources devoted to dentistry for
      books in the Harold Cohen library and a significant number of new books have been
      ordered. The facilities in Outreach are the subject of review this September.

      The amount of the top slice from HEFCE funding for the Dental School and Hospital
         for central University costs needs to be reviewed, bearing in mind that the
         accommodation is owned and resourced by the NHS (26).

      Response
      The University is working with the Trust to review the disposition of Dental SIFT to
      include current leasing costs, re-charge through SIFT and by the University. In
      addition, the introduction of Full Economic Costing in the University will enable
      greater transparency of indirect costs. This review will assist in identifying any
      redundancy in the charge and if facilities costs are being “double counted”, this will
      be identified and addressed.


Additional Comments

Recognition of Support of the Faculty, University and NHS agencies for the delivery of
dental undergraduate teaching

      The University welcomes the recognition by the Visitors of the support provided by
      the University to the Dental School (11).The School welcomes the Visitors’
      recognition of the strong support provided by the Faculty of Medicine and the Royal
      Liverpool and Broadgreen NHS Trust (12)

      The University is very pleased to note that the Visitors considers the Dental School
      has “an open management style”, “with good leadership”, and “a sense of the School
      moving forward with a common purpose and shared goals”(14).

      The Dental Hospital benefits from strong support from the senior officers of the
      Trusts. Good communication structures are in place between the Dental School and
      Hospital and relevant NHS agencies, from whom the School receives very positive
      support which facilitates the development of outreach teaching (35).

 Recognition of Teaching Facilities

      The University is pleased to note that the Visitors “were impressed by the Human
      Anatomy Resource Centre”, which they noted as “an excellent facility” (19).
      Similarly, that “ the teaching facilities in the Dental School are well equipped” (27).

 Commendation for Dental School Staff

      The University strongly welcomes the statements that the Visitors “were impressed
      by the academic and clinical support staff in both the Dental School and Hospital who
      are supportive, committed and enthusiastic teachers, and accessible to students”(28)
      and that, “hard working, committed staff provide excellent educational and pastoral
      support to their students” (109). The University notes that the Visitors considered
      that “the Personal Tutor system and student mentoring appear to work well”; and that
      “staff are very accessible” with students having “no difficulty in obtaining help and



                                                30
      advice” (96). Further, that “students felt that they had a significant input into the Staff
      Student Liaison Committee and that their views were taken into account “(97).

      Value of the Outreach programme

      While recognising that this is a developing programme, the School is pleased to note
      that the Visitors considered that “the experience that Liverpool students gain in
      outreach is extensive” (55); that “students felt well supported during outreach
      placements” (97); that “the equipment at the outreach facilities we visited was of a
      good standard overall”; and “were particularly impressed with the track record of the
      St Catherine’s Community Dental Service in the education of dental undergraduates.”
      (51).

Recognition of the Diversity and Quality of Liverpool Dental Students

      The University works consistently to widen access to its degree programmes while
      maintaining academic rigour and the University welcomes the Visitors’ conclusion of
      the University’s success in this field in its comments that “The School makes
      particular efforts to recruit from diverse educational backgrounds and accepts a
      significant number of Access students and graduates; on average these students
      make up 20% of each cohort”. (15).

      The University is very pleased to note that the Visitors considered that the “students
      and recent graduates were mature, articulate and thoughtful” and that “they offered
      excellent feedback on the positive experience gained at the Dental School and
      University” (93).


      4.     To the NHS Agencies

      The working of the Dental Hospital, in terms of access to care, patient base and case
         mix, needs to be reviewed (38).

      Response
      This refers to a reduction in the number of patients coming through to the A&E
      Department and the knock-on effects on the availability of patients for students. This
      is a developing priority and senior staff within the Dental School are working closely
      with the Clinical Director and local PCTs to ensure an appropriate case mix is
      available within the patient base for dental students.

      Dental nurse support for dental students in the Dental Hospital needed to be
         increased (34).

      Response
      This is a recognised issue in the Dental Hospital and will be reviewed as part of plans
      to increase student numbers. An immediate response has been to recognise an
      appropriate allocation of dental nurse support for students needs to be made..

      The allocation of the Medical for Dental SIFT budget should be clarified (40).

      Response
      The Dental School works closely with both the Trust and the Strategic Health
      Authority concerning the appropriate disposition of Medical for Dental SIFT. During
      plans for the expansion on student numbers the University is developing closer links
      on discussion of appropriate and effective use of Dental SIFT.


                                                  31
The Educational needs of dental students must be borne in mind when the future
   location of the Royal Hospital is being considered (39).

Response
The Faculty of Medicine (and hence, the Dental School) is represented in the project
group considering the implications of any potential future re-location of the Royal
Hospital

The source of the funding of outreach teaching and recurrent nature of such funding
   must be subject to scrutiny (55).

Response
As advised by the Chief Dental Officer, future, outreach teaching is to be funded from
DSIFT with support form host PCTs. Collaborative work on the funding base will
continue to ensure that adequate funding is available for this purpose.




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