BDS report and observations - VISITATION TO

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					GENERAL DENTAL COUNCIL VISITATION
OF UNDERGRADUATE DENTAL DEGREE
PROGRAMMES AND EXAMINATIONS


VISITATION OF THE BDS PROGRAMME OF
MANCHESTER DENTAL SCHOOL


UNIVERSITY OF MANCHESTER


26, 27 AND 28 APRIL 2004


REPORT OF THE VISITORS

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

DR J A BEELEY BSC MSC PHD MIBIOL
CBIOL

PROFESSOR D T HERBERT BA PHD
DLITT

MR D J TOPPIN BDS DGDP(UK)

PROFESSOR P S WRIGHT BDS PHD LDS
FDSRCS

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 Manchester
     University Dental School‟s BDS programme 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 programme and final examination visits to Manchester
     University 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 Manchester University Dental School took place on 26, 27 and 28
     April 2004. We were welcomed by Professor K D O‟Brien, the Head of the
     Dental School, and Mr P S Hull, the Associate Dean for Undergraduate
     Studies and Student Affairs. During the visit we met the Vice-Chancellor and
     senior members of University staff, representatives of the host Trust (the
     Central Manchester and Manchester Children's University Hospitals NHS
     Trust), recent graduates, current dental undergraduate students, 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


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      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 Manchester is organised into seven Faculties with some
      118 departments overall. The Dental School is based administratively in the
      Faculty of Medicine, Dentistry, Nursing and Pharmacy and is located on the
      main Manchester University campus, which is close to the city centre.

9     From October 2004 the University is merging with the University of
      Manchester Institute of Science and Technology (UMIST). We were assured
      that the merger would not have an adverse impact on the Dental School. As
      part of the financial scheme for the merger, also known as „Project Unity‟,
      funding is being provided for 25 new professorial posts across all
      departments. We were told that this funding was available to the Dental
      School to increase their research portfolio.

10    The Dean of the Dental School is the Higher Education Funding Council
      budget holder. The University operates a system through which 25% of
      Higher Education Funding Council for England (HEFCE) funding is „top-sliced‟
      for central services. In 2002/03 the School received HEFCE income for
      teaching and research amounting to £3.331m (including home fees); its
      staffing costs were £3.092m. The School received an additional £98k of
      HEFCE income in 2002/03 for the BSc Oral Health Science programme. The
      School‟s HEFCE research income has fallen from £979k in 2001/02 to £438k
      in 2002/03, due to the fact that the School‟s research rating fell from a 5 to a 4
      in the 2001 Research Assessment Exercise (RAE). Largely due to this
      reduction in HEFCE research income, the School recorded a deficit in funding
      of £551k for 2002/03. In 2000/01 the deficit was £298k and in 2001/02 the
      deficit was £243k. Although staffing costs make up the majority of the
      expenditure, factors such as central overhead and Faculty costs have
      contributed to this deficit. At present the deficit is handled within the Faculty
      of Medicine, Dentistry, Nursing and Pharmacy, the difference being made up
      with funds generated by the other Schools. The Dental School has also
      increased the numbers of overseas and post-graduate students in order to
      address the deficit. A policy of re-investment by the University in the Dental
      School has been established in the hope that the School will achieve a higher
      RAE rating in the next assessment exercise. The strong level of support for
      the Dental School from the Vice-chancellor and the Dean of the Faculty was
      impressive.

11    Dental students have use of the John Rylands University Library, which is the
      main University library facility, for private study and research. This is located
      close to the Dental School on the main campus. The library is substantial and
      modern, has large study areas and houses 230 computers which are
      available to students during opening hours. Dental books are housed in the
      Biomedical Sciences section, which has a staffed reference information desk
      where students can seek assistance. Dental journals can be found in a
      separate storage area in the basement of the building. Some dental journals
      are also available as e-journals and can be accessed from the library‟s
      website. Dental students have access to the Medical Library in the Stopford


                                          3
        Building, which is approximately five minutes‟ walk from the Dental School.
        The Medical Library, which houses additional copies of some of the books
        that are available in the main library, is bright and spacious and has an
        informal atmosphere. The Dental School has a representative on the Faculty
        Library Committee who ensures the purchase of appropriate texts. We were
        impressed with the standard of library and IT facilities available to dental
        students in the Medical School and the John Rylands Library.

The Dental School1

12      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 1999 and 2000.
        In addition the GDC visited the School of Dental Hygiene in 1998 and the
        Dental School‟s BSc in Oral Health Science programme in 2001 and twice in
        2003.

13      The Dean of the Dental School reports formally to the Dean of the Faculty
        and is supported by three Associate Deans in Research, Graduate Studies,
        and Undergraduate Studies and Students Affairs. The Dental School is
        divided into three Clinical Academic Groups (CAGs) – Restorative Dentistry,
        Oral Health and Development, and Oral and Maxillofacial Sciences.
        Management arrangements between the University and the Hospital Trust
        have been changed recently with the separation of the posts of Dean of the
        Dental School and Clinical Director. We understand that the Vice-Chancellor
        has set up a review committee to consider the managerial structure of the
        Dental School.

14      There are currently 379 students on the BDS undergraduate dental
        programme and over the last ten years an average of 79 new students were
        admitted each year. There are 90 students in the 2003/4-year. We were
        concerned to see what we consider to be the over-recruitment of dental
        students. According to HEFCE figures, Manchester is allocated 58 places
        each year for home students on the BDS course with an additional 5-7.5% of
        this figure allowed for overseas student places. The University of Manchester
        website states that the Dental School admits 65 students to the BDS
        programme each year. We were told that HEFCE monies are paid in a block
        to the University, after which the University distributes the money according to
        actual student numbers in each school. The University does not specify an
        upper limit for student numbers in each School. We saw evidence that high
        student numbers were putting pressure on staff and facilities. The over-
        recruitment at Manchester has implications nationally, in that the majority of
        Schools in the UK have kept to their quota. Deans of dental schools have,
        however, been extremely active in pointing out that there is a need for extra
        undergraduate dental places nationally.

15      The School offers a year-long BDS pre-dental programme that is identical to
        the pre-medical course and provides basic scientific training in Physics,
        Chemistry and Biology for candidates who have not studied sciences to A-
        level. There are ten places available for students who wish to go on the BDS
        course on this pre-dental programme. There are currently 27 undergraduates
        on the BDS programme who entered via the pre-dental year. The School

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


                                                4
     also runs a BSc Oral Health Science degree programme, which is organised
     and taught by Dental School staff. There are up to 12 students in each year
     of the three-year BSc in Oral Health Science programme.

16   The specific learning outcomes of the BDS programme are set out in the
     course handbooks 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 graduate dentists who have been taught through a
     curriculum that meets the educational requirements of the GDC and which
     therefore equips them with the knowledge and skills to pursue a successful
     career in dentistry. The programme also aims to provide a high quality
     learning environment and effective academic and pastoral support and
     guidance and to instil in graduates the importance of research.

17   Years one and two are each divided into two semesters. Teaching during the
     first two years is based in the Medical School (which is located approximately
     five minutes‟ walk from the Dental School) and is primarily delivered through
     the use of problem based learning (PBL). Dental students are taught
     separately from medical students. They were taught together previously but
     this was found to be unsatisfactory. Separate teaching allows a dental
     emphasis to be placed on the course and feedback has improved since PBL
     for dental students was made distinct from that received by medical students.
     Three one-hour sessions per week of PBL are scheduled during years one
     and two. Each week focuses on one particular „case‟ and students will work
     on 40 cases during these first two years. Students are divided into groups of
     approximately twelve and are assigned a PBL tutor. The tutorial sessions
     focus on group work and students are expected to research individual cases
     during allocated study time. These cases incorporate biological, behavioural
     and social factors that contribute to the maintenance of health and the
     development of disease, and the ethical and legal dimensions of dentistry.
     Current students that we spoke with did feel that PBL posed a significant
     challenge to them at the start of the BDS programme, and that it took a little
     while to become accustomed to this method of learning. However, favourable
     comments were made regarding the support systems in place for such
     problems. Academic staff at the School felt that PBL was a good method of
     delivery for the teaching of pre-clinical subjects.

18   Alongside the PBL in the first two years of the programme, students attend
     lectures and practical sessions in dental biomaterials, anatomy, dissection,
     histology, microbiology, physiology, pathology and technical skills. Students
     have seven to eight hours per week of lectures and practical sessions,
     including dissection, in the first three semesters; this reduces to five hours in
     the fourth semester. Students are required to complete two Special Study
     Modules on a range of subjects including dental topics, producing a report in
     semester two and giving a presentation in semester three. Students also
     attend a two session hands-on integrated practical course in year one which
     is held at the Dental School.

19   Years three and four are each divided into four terms. During year three
     students attend clinical sessions in Periodontics, Prosthodontics, Oral
     Medicine, Child Dental Health and Orthodontics, Radiography, Operative
     Dentistry and Endontology, spending between 4.5 and 6.5 sessions per week
     on clinics. Students also attend seminars in Oral and Maxillofacial Pathology.
     During year four these clinical sessions are continued and students spend
     three sessions per week in outreach facilities for Paediatric Dentistry,


                                         5
     Orthodontics and Restorative Dentistry. In year four there are 20 PBL
     sessions in Oral Health and Development over the four terms. Alongside the
     clinical sessions over the first six terms students receive between 38 and 40
     hours of lectures per term in Oral and Maxillofacial Surgery and Pathology,
     Oral Medicine, Oral Radiology, Restorative Dentistry, Oral Health and
     Development, Medicine and Surgery and Biomaterial Science. Lecture hours
     reduce to 25 hours in term seven, and 13 hours in term eight.

20   Year five of the BDS programme is divided into two semesters. Students
     spend three sessions per week on clinics at the Dental School during which
     they are taught integrated restorative care, one day per week for one
     semester in outreach and one morning session every other week in dental
     casualty. For each student, because of pairing of students, half of the clinical
     time spent at the Dental School is available for operating and half is spent
     assisting. Students attend the Department of Maxillofacial Surgery at the
     Manchester Royal Infirmary in groups of four for one week. Students also
     carry out a Critically Appraised Topic (CAT) in year five.

21   The development of outreach centres gives the students the opportunity to
     work in different environments. The majority of teaching in orthodontics and
     paediatric dentistry takes place in outreach, with a limited amount at the
     Dental Hospital. These arrangements appear to make it more difficult for
     students to follow treatment programmes over an extended period. Students‟
     practical experience in orthodontics appears to be limited.

22   The Dental Education and Standards Committee (DESC) is chaired by the
     Associate Dean of Undergraduate Studies and Student Affairs. The Head of
     School, Heads of CAGs, Associate Deans, Quality Assurance Officer, Head
     of the Unit of Oral Health Sciences, Senior Tutor for Undergraduate Studies
     and Student Affairs and Year Co-ordinators form this committee. Two student
     representatives are members of the committee for unreserved business. This
     committee is responsible for the delivery and quality monitoring of the BDS
     programme. DESC is responsible for suggesting any curriculum changes
     with approval from the CAG for that area of the programme.

23   The academic facilities at the Dental School are generally of a reasonable
     standard. The School has five seminar rooms, which are used for small
     group teaching, a large technical skills classroom, a clinical skills classroom
     and a smaller orthodontics teaching area. One seminar room is solely used
     for the teaching of dental radiology, oral pathology and oral medicine and
     houses modern equipment including a projector, which allows radiographs to
     be viewed in large scale. The phantom head room has 36 spaces. It was
     redesigned twelve years ago and at that time was one of the most modern in
     the country. The School recognises that the equipment in this room is now
     rather dated and we were told that there are problems with maintenance and
     breakdowns. In addition, it is not large enough to accommodate half the
     student year. They would like to improve this facility if funds become
     available. The School does not have its own lecture theatres; these are
     booked through a central reservation system. Theatres in the Coupland 3
     building, which is adjacent to the Dental School, are generally used. The
     Coupland building also houses seminar rooms, one of which is used for
     dental small group teaching. All teaching facilities and study areas used by
     dental students are in close proximity, except for those in the eight outreach
     centres used by the School. Office accommodation for staff is good, all



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     senior staff have their own office and junior staff share. Modern IT facilities
     with internet access are provided for staff.

24   The Dental School has its own cluster of 20 modern PCs and students also
     have the use of a flatbed and slide scanner and a photocopier housed in this
     room. The room was of a good decorative standard and we were told of
     plans to install air conditioning. All outreach clinics have computer facilities
     with a link to the University website.

25   The student common room is in good decorative order and the seating is in
     good condition. Recreational facilities and refreshments are provided and the
     room also houses student pigeonholes. Students have easy access to the
     refreshment and recreation facilities available on the University Campus.
     Student locker rooms are located in the basement of the School. Students
     are allocated a locker each and the facilities are of an acceptable standard.

26   Biomedical Sciences are taught in the Stopford Building where the Medical
     School is based. Facilities include 20 well equipped tutorial rooms which are
     used for PBL sessions and several modern lecture theatres. Practical work is
     taught in a multi-user general laboratory and an up to date dissecting room
     that the University plans to expand.

27   The Dental Hospital is owned by the University and leased to the Trust. We
     were made aware of problems within the building with regards to the
     electricity and plumbing, and the presence of asbestos. It has been predicted
     that to fully restore the building would cost £7-10m. A steering committee
     with representation from the Primary Care Trust (PCT), the Strategic Health
     Authority (SHA), the Trust, the University, the Dental School and the
     Department of Health has been formed to address this issue. A preferred
     option has been identified, details of which are being prepared by the Trust. If
     approved by stakeholders a full business case for the preferred option will be
     produced.

28   We were impressed by the academic and non-academic staff in both the
     Dental School and Hospital who are enthusiastic, involved and highly
     committed to the education of undergraduate dental students.   Their
     colleagues based in outreach clinics equally impressed us.

29   The School has experienced a net loss of 7 (full-time equivalent) members of
     staff in the last 10 years. The School has experienced particular losses in the
     field of restorative dentistry, including a professorial post. There have been
     some difficulties in recruitment, particularly because all HEFCE appointments
     are required to have a research focus. Recruitment of lecturers in restorative
     dentistry whose research reaches international levels has been particularly
     problematic; this is a nation-wide issue. This emphasis on research and the
     demands of academic and specialist training also causes problems with the
     recruitment of junior staff, as the pressure to teach and be research active is
     considerable. The School hopes to fill five posts in restorative dentistry over
     the coming academic year. We were told that three of these posts could be
     teaching-only.

30   Most of the teaching in outreach centres is provided by community dental
     officers who are employed by the various PCTs, or by General Dental
     Practitioners in a Personal Dental Service (PDS). All such staff have a



                                        7
      sessional commitment to the Dental Hospital, but their primary method of
      employment is with the PCT or PDS.

31    New full-time staff are required to attend the University Teaching and
      Learning Course for new academic staff and are encouraged to become
      members of the Institute of Learning and Teaching in Higher Education.
      Clinical teachers are experienced general practitioners, community dental
      officers or academic and hospital staff who have completed or are completing
      specialist training. Staff are encouraged to attend meetings of the specialist
      societies. The School holds a minimum of two away-days per year.
      University and Trust staff are appraised annually, non-consultant staff being
      appraised by the Head of the appropriate CAG and honorary consultant staff
      having a joint appraisal by the Trust and the University.

32    NHS consultants are involved in the running of the BDS programme and its
      development. They are invited to away-days and contribute to curriculum
      review. NHS staff are encouraged to attend the University Teaching and
      Learning Course and they have access to the School‟s intranet site and e-
      mail facilities. We were pleased to note that the School benefits from the
      commitment of NHS staff.

33    Research is co-ordinated by the Associate Dean for Research. Two main
      themes have been identified: Health Sciences and Basic Dental Sciences.
      Areas of Strength in the School‟s research profile lie in health services
      research, genetics and systematic reviews. Research staff are involved in the
      teaching of dental undergraduates and this research is integrated throughout
      the curriculum, mainly within PBL teaching, lectures and the Critically
      Appraised Topic that students carry out in year five.

34    The Vocational Training Liaison Committee provides a formal interface
      between the Dental School and Hospital and the North Western Deanery
      Vocational Training Scheme. The Committee is chaired by the Dean of
      Postgraduate Dentistry and membership includes the Chair of Dental
      Education and Standards Committee, the Vocational Training Adviser, a
      Vocational Dental Practitioner, a Vocational Trainer, the Fifth Year Co-
      ordinator, a Fifth Year teacher representative and a Fifth Year student
      representative.

The Dental Team

35    The theory of team working and the dentist as the leader of the dental team is
      taught in a PBL format during year four.

36    Dental students have very limited contact with dental hygienists and oral
      health science students within the programme. BDS students are able to
      refer to BSc students but there did not seem to be any significant interaction.
      We were told that, as the BSc programme has now been approved by the
      GDC, dental students‟ experience of working with PCDs should increase.

37    During their time on clinic at the Dental Hospital and during Restorative
      outreach, students work in pairs, the membership of which is sustained
      throughout the clinical teaching period in all but exceptional circumstances.
      This method of working was decided as a result of a pilot, which was
      undertaken partly because there were insufficient dental nurses to provide
      close support to dental students. Dental students are not routinely allocated


                                         8
      support from dental nurses and they assist each other in the practice of close
      support dentistry. Students are taught the skills required to assist their
      partner as part of the clinical skills course in year three through
      demonstrations between clinical teachers and dental nurses. During clinics a
      nurse is allocated to each group of 12 students (6 pairs) and is responsible for
      maintaining health and safety and cross infection control standards, and for
      ensuring that each unit is set up correctly. If a student was without their
      clinical partner, and booked to undertake complex work, a nurse would be
      made available to assist the student. Dental nurses can also be booked in
      advance if a need is anticipated.

38    The team approach, as advocated in The First Five Years, refers to
      interaction between dental student, hygienist, therapist, nurse and technician,
      rather than interaction between students. Whilst we appreciate that there
      may be educational benefits to students working in pairs for parts of the
      course, especially in the early clinical years, we do not think that student
      pairing is an adequate substitute for close support from a dental nurse. We
      are concerned at the limited dental nurse support that students receive in the
      Dental Hospital throughout the programme and in outreach clinics in the
      fourth year.

39    Dental students are provided with one to one dental nurse support during Oral
      Health and Development teaching in the final year. Teaching in outreach
      aims to emphasise team working and the role of the dentist within the team.
      The students that we spoke with were most appreciative of the dental nurse
      support that they received in outreach facilities. We commend this provision
      of one-to-one dental nurse support in outreach clinics, especially in the final
      year.

40    Students prescribe to in-house dental technicians and receive very good
      support from dental laboratory staff. Students are encouraged to interact with
      technicians and discuss patients‟ work with them. All the technical dental
      work in outreach centres is sent to the Dental Hospital so that the same
      standards of laboratory support that is provided in the Dental Hospital are
      available for students treating patients in outreach. Students are taught by
      technical instructors during a practical skills course in year one. Students do
      not have practical experience of the processes involved in indirect
      restorations. The number of teaching technicians has been reduced to
      extremely low levels in recent years.


THE CLINICAL ENVIRONMENT

NHS Trusts

41    The working relationships between the Dental School and the Central
      Manchester and Manchester Children's University Hospitals NHS Trust are
      good, the School and the Trusts being mutually supportive. The Clinical
      Director of the Dental Hospital is directly responsible to the Chief Executive of
      the Trust and attends monthly Trust management board meetings. There are
      meetings between the Trust, the Dean of the Faculty of Medicine, Dentistry,
      Nursing and Pharmacy and the Heads of Schools every six months.

42    The Dental Hospital falls under the Greater Manchester Strategic Health
      Authority (SHA). The Workforce Development Confederation (WDC) and the


                                          9
     SHA for Greater Manchester are integrated, the SHA having subsumed the
     WDC. The SHA recognises the importance of dentistry and the significant
     role that the Dental Hospital has in the provision of dental services to the local
     population. The Greater Manchester area has a shortfall in its dental
     workforce and it is recognised that a Dental School has a retaining effect on
     the workforce – graduates of Manchester are likely to remain in the area. A
     Greater Manchester workforce strategy group is planned which would involve
     the Dean of the Dental School and the Clinical Director. A steering group is
     currently looking at the expansion of outreach teaching in order to provide
     dental care and specialist dental services to a wider area. Plans for the
     funding of these new outreach facilities are in place. We are pleased to note
     the beneficial and productive level of interaction between the Dental Hospital
     and School and the Primary Care Trusts.

43   For the year 2003/4 the Trust received £4.117m Dental Service Increment for
     Teaching (SIFT) funding and £765k Medical for Dental SIFT, which went
     directly to the Dental Hospital, and £383k for post-graduate medicine and
     dentistry, a total of £5.265k. Expenditure is £9.1m. Service income from the
     NHS makes up the difference. The Trust provides £200k per year for
     refurbishment, this year the figure is higher at £600k but this will need to be
     spent on essential maintenance. Clinical facilities are updated if and when
     money is available.

44   There are approximately 124 chairs in the Dental Hospital, but not all of these
     are available to undergraduates. In general the clinical facilities were of a
     good standard. Undergraduates receive the majority of their clinical teaching
     in a 45-unit polyclinic. We were told that pressures could occur in this clinic
     when chairs are temporarily out of order, but that there are overflow chairs
     available to accommodate patients. We note with concern that there is a
     reduction in undergraduate clinical facilities because the prosthodontics clinic
     has become a postgraduate unit. However, we were informed that this clinic
     remains available for undergraduate teaching.

45   The dental casualty service at the Dental Hospital is operational in the
     mornings only. The first 25 patients are admitted and the remainder are
     obliged to seek treatment elsewhere. This appears to be a policy by the
     Central Manchester Hospital Trust and the Greater Manchester Strategic
     Health Authority to reduce pressure on the Dental Hospital with the intention
     of encouraging patients to go to their local GDPs or access centres. Students
     were appreciative of the experience in dental casualty (currently 12 sessions)
     and expressed the view that they would like to be allocated to casualty on a
     daily basis rather than in the morning only. We feel that the experience that
     dental undergraduates gain in dental casualty is extremely valuable and that
     this opportunity should be maximised.

46   Organisation of outreach is a complex issue, but the experience at
     Manchester has ensured an excellent network with various Trusts. This will
     be required for all Dental Hospitals with the introduction of PCTs and the
     implementation of NHS Dentistry: Options for Change (August 2002). The
     University Dental Hospital at Manchester, with its proposed Director of
     External Affairs, is well placed to benefit from a close working relationship
     with PCTs.




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Provision for Human Disease Teaching

47       The teaching of medical subjects to dental students is supported by funding
         from HEFCE and Medical SIFT for dental students. The Dental Hospital
         received £765k Medical for Dental SIFT for the year 2003/4, £69k of which
         goes to the North Manchester General Hospital towards funding for two
         consultant posts, the remainder going to the Central Manchester Trust.
         Consultants in the North Manchester General Hospital requested that more of
         the available funding be spent directly on staffing of this programme.

48       Teaching in medicine and surgery runs from March of year three to January
         of year four. Lectures are delivered in the Dental School and at the North
         Manchester General Hospital. Some of those held at the North Manchester
         General Hospital include patient demonstrations. As part of the medicine and
         surgery course students have a two week attachment in groups of eight to
         clinics at the North Manchester General Hospital. Students have a dedicated
         secretary to support them during this time, and felt that staff at the hospital
         have a good understanding of the needs of dental students. Students are
         provided with a handbook containing useful information to assist them during
         the clinical attachment and must complete a logbook as record of their
         attendance and experience. Feedback from students whom we spoke with
         about their time spent at the North Manchester General Hospital was variable,
         with some very positive and some who commented that they did not always
         feel that they were expected.

49       During year five students attend the Department of Maxillofacial Surgery at
         the Manchester Royal Infirmary in groups of four for a period of one week.
         During this attachment students observe and participate in maxillofacial and
         dental emergency service provision. This attachment is complemented by a
         lecture series on the management of the medically compromised patient.

Safety

50       Sterilisation of instruments used at the Dental Hospital takes place at a
         central sterilisation unit at the Manchester Royal Infirmary. Instruments are
         collected and delivered twice a day and instruments which are used on one
         day should be returned the following day. Staff who we spoke with were
         happy with the standard of sterilisation provided. We were told that there
         were occasional difficulties in the delivery of equipment.

51       Sterilisation in outreach centres is carried out through the use of „Little Sister‟
         bench-top autoclaves.        Dental students do not sterilise instruments
         themselves.

52       Students are taught cross infection control by clinicians and dental nurses at
         the Dental Hospital, and by dental nurses in outreach clinics.

The Extended Clinical Environment and Outreach Teaching

53       Outreach teaching forms a significant part of the BDS curriculum and
         students gain all of their clinical experience in paediatric dentistry and
         orthodontics in outreach. The School works with nine Health Centres in the
         Greater Manchester area: Harpurhey, Lance Burn, Newton Heath, Cannon
         Street, Seymour Grove, Ordsall, Cornerstone, Moss Side and Longsight. We
         visited eight of these clinics (we were unable to visit Cannon Street in Oldham


                                             11
       because of its distance from the Dental School) and we found that the
       standard of clinical facilities available in outreach varied, but overall the
       environment for students in outreach is good. Further clinics for outreach
       teaching, including another in Oldham which is approximately ten miles from
       the Dental School, are being considered as options for the future. Final
       decisions on this will be made on completion of the pilot scheme of restorative
       dentistry teaching in outreach for students in year four, in September 2004.

54     The School began teaching paediatric dentistry in outreach clinics in 1974.
       This was due to the fact that, after the demolition of a residential area nearby,
       the Dental Hospital was not getting a sufficient quantity and range of walk-in
       patients, especially for restorative dentistry. The teaching of restorative
       dentistry in outreach began as a three-year pilot in 2001/02 and is to be
       continued. This year two groups of students were unable to attend restorative
       clinics in outreach due to a lack of clinic availability and instead received
       equivalent teaching in this discipline in the Dental Hospital.

55     Students attend outreach in groups of eight, spending two sessions (one day)
       per week in outreach clinics during year four where they are taught restorative
       dentistry and one session per week on alternating weeks on paediatric
       dentistry including orthodontics. During year five students spend one day per
       week for one semester in outreach being taught family dentistry. For each
       area of teaching (restorative, paediatric and family dentistry) students are
       assigned to one particular clinic. Teaching in outreach is carried out by
       Community Dental Officers (CDOs), General Dental Practitioners (GDPs) and
       Dental School staff. Outreach staff are involved in School activities including
       away-days. The marking scheme for practical procedures is the same in
       outreach as it is for clinics at the Dental Hospital. Students begin by treating
       two patients per session, progressing to three or four as they gain more
       experience. Students with whom we spoke to were appreciative of the
       teaching that they received in outreach and complimentary about the support
       and facilities available there. We commend the School‟s understanding of the
       outreach philosophy and the innovative way that outreach is delivered.


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 Handbooks.

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 programme aims to equip students with the requisite knowledge and
       skills to enable them to pursue a successful career in dentistry.

59     Clinical sessions in periodontics, prosthodontics, oral medicine, surgery and
       radiology and operative dentistry and endodontics take place in the Dental


                                          12
      School in years three and four. Students also attend clinics in restorative
      dentistry, paediatric dentistry and orthodontics in outreach. A course in
      clinical operative techniques runs throughout year three. During year five the
      emphasis of clinical sessions is on integrated whole patient care. We feel
      that there are gaps in clinical experience in the final year in oral surgery, oral
      medicine and orthodontics.

60    Students and recent graduates with whom we spoke with felt that more
      clinical skills teaching in years one and two would be beneficial.

61    During the fifth year students are allocated patients and are encouraged to
      complete the whole course of treatment for that patient, if possible. Students
      are monitored to ensure that they have experience in a wide range of patients
      and treatments and provision is made for students who need to increase their
      experience in certain areas. Students are required to have completed a
      minimum of four cases, all of which should be suitable for presentation, during
      the year five course in integrated restorative dentistry in order to be able to sit
      the 5th BDS Examinations.

62    The student handbook for restorative dentistry states that by the end of the
      fifth year course in Integrated Restorative Care students should have met the
      requirement of a minimum of five completed case, all of which should be
      suitable for presentation, and that as a minimum, for each case, students
      should have completed a significant treatment in more than one of the
      restorative disciplines and have a preventative regime for the patient.
      However, we feel that there is a lack of clarity on the levels of recommended
      clinical experience required in restorative dentistry in the programme, both in
      years 3/4 and year 5.

63    Students are assessed at each clinical session on knowledge, manual skills,
      management and motivation and attendance on an A-E scale. Grades are
      combined at the end of each term to provide an overall performance grade,
      which cannot be considered as a test of competency. Grades are monitored
      throughout the year and any students who get two or more D or E grades are
      required to have a review interview in order to identify problems and decide a
      course of action. Objective Structured Clinical Examinations (OSCEs) are
      held in the year three and clinical performance, case presentations and set
      essays contribute to the professional examinations.

Practical Procedures

64    The programme aims to equip students with practical skills to undertake the
      dental care of patients in a safe, effective manner by applying established
      techniques.

65    During year one a technical skills course is run for one half-day session per
      week; this is based in the Dental School. Workbooks are completed to
      ensure that students have a record of their learning in this area. These are
      used when teaching in technical skills re-commences in year three as an aide
      memoire. Students receive no teaching in technical skills in year two. We
      were told that the School wished to include more teaching in practical skills in
      year two, but staff resources were not sufficient for this development to take
      place. Dental students do not carry out their own laboratory work, but
      prescribe to in-house dental technicians.           Due to staff shortages



                                          13
       approximately 10% of work is sent to outside laboratories. Students interact
       with laboratory staff with regard to the design and construction of appliances.

66     Cardio-Pulmonary Resuscitation skills are taught and examined in each year
       of the BDS programme. Students must have satisfactorily completed this
       aspect of the course to be able to sit their 4th BDS Part I examinations.

67     Students gain the majority of their experience in conscious sedation during
       teaching in oral and maxillofacial surgery in years three and four. In year
       three students work in pairs for approximately six clinical sessions of
       intravenous sedation and this is accompanied by small group teaching and
       lectures in sedation and general anaesthesia. In year four students attend
       approximately five clinical sessions of inhalation sedation, again in pairs, and
       a further six clinical sessions of intravenous sedation in oral surgery.
       Students also attend general anaesthesia clinical sessions in the oral surgery
       day case unit at the Manchester Royal Infirmary during year four. The
       programme aims to provide students with the experience of observing ten
       cases of inhalation sedation and administering ten, and of observing ten
       sessions of intravenous sedation and administering ten.              The GDC
       questionnaire of May 2000 on the teaching of pain and anxiety control
       showed that recent graduates felt that they had almost reached these targets,
       but subsequent staff changes may have compromised this achievement.

Patient Investigation

68     Core teaching in dental radiography and radiology occurs during two ten-
       session blocks of teaching in year three. Students work in pairs and receive
       intensive tutoring from a radiographer. Students gain experience in taking
       radiographs of their own patients during clinical practice. Students are
       required to produce radiographs and corresponding reports as part of their
       presentation case for the 5th BDS Final Examinations. We were pleased to
       note the good close-support teaching and reinforcement of skills in radiology
       and radiography.

Patient Management

69     The programme aims to ensure that students are able to recognise personal
       limitations in patient management and know when to refer patients. Students
       are taught how to assess patients and how to obtain informed consent.
       Students gain experience of the delivery of dental care to a wide range of
       patients in different communities through their clinical work in outreach
       facilities.

70     During clinical attachments at the North Manchester General Hospital and the
       Manchester Royal Infirmary students gain experience of history taking, of
       carrying out examinations and can observe the dental treatment of medically
       compromised patients.         Students complete logbooks recording the
       procedures that they have observed and carried out and receive feedback
       from clinicians on their performance. Students attend a lecture series on the
       management of the medically compromised patient in year five and are
       assessed in this area in the 5th BDS Final Examinations.




                                         14
Health Promotion and Disease Prevention

71    The programme aims to integrate the theory and practice of health promotion
      and disease prevention in all teaching and clinical work. All clinical courses
      have an emphasis on reducing the risk of the first occurrence of an oral
      disease or problem, particularly the paediatric dentistry course. Within PBL in
      years one and two, students gain an understanding of the social, cultural and
      environmental factors which contribute to dental health or illness. The course
      in dental public health in year four is also a contributor to students‟ knowledge
      in this area. Students are assessed on dental public health through written
      assignments in year four, which contribute to the 4th BDS Part Two marks and
      by a sign-up viva for the 4th BDS Part Two Examinations.

Communication

72    We found that the students and recent graduates we met were mature,
      reflective and good communicators. This view was also expressed by
      vocational trainers, who felt that in general the graduates with whom they had
      had experience communicated well with patients.

73    Teaching in communication skills is integrated throughout PBL in years one
      and two of the programme and in year four as part of oral health and
      development. Because students work in groups and are required to present
      information regularly during PBL tutorials, students are expected to develop
      confident and articulate communication techniques.

74    Because of the limited amount of interaction that takes place between dental
      students and dental hygienists and therapists, dental students do not gain
      significant experience of communication with these members of the dental
      team.

Data and Information Handling Skills

75    The programme aims to equip students with the intellectual skills to be able to
      prepare and present written and verbal reports using the appropriate
      information technology. As part of PBL, students are expected to attain
      certain skills objectives related to the use of resources in the John Rylands
      Library and the Medical Library. Students‟ library skills are assessed as part
      of the literature based special study modules and the critical appraisal topic in
      year five.

76    Students are expected to attain a proficient level of skill in the use of
      information technology by the end of year one. These skills are assessed by
      PowerPoint presentations which students are required to carry out during
      year two for their special study module and year five for their CAT.

Understanding of Basic & Clinical Sciences and Underlying Principles

77    The programme aims to provide students with knowledge and understanding
      of the broad principles of scientific thought, including scientific design. The
      main pre-clinical part of the programme is entitled „Biological and Behavioural
      Basis of Dentistry‟ and is delivered through PBL cases during years one and
      two. This course includes the biological and behavioural basis of medicine
      where it is relevant to dentistry. In each of the four semesters a particular
      area is focussed on: semester one - nutrition and digestion, semester two -


                                         15
      cardiorespiratory fitness, semester three - defence, abilities and disabilities
      and semester four - development and metabolism. Although there is some
      input into the first two years by Dental School staff, there appeared to be little
      direct integration with the clinical curriculum.

78    The School aims to ensure that the curriculum is informed by research
      throughout the BDS programme. The majority of staff members who have
      been recognised by an internal research review as being national or
      international level researchers provide direct input into the teaching of dental
      undergraduates. Those research active staff who are not directly involved in
      teaching do influence the content of the curriculum, particularly the PBL
      elements. The Research Elective in year five has been recently replaced with
      a Critically Appraised Topic, which is co-ordinated by staff closely affiliated
      with the Cochrane Oral Health Group.

79    Students are assessed through the use of slide-based examinations, during
      which a picture is projected onto a screen and candidates are asked
      questions on it, and Multiple Choice Questions (MCQ) examinations at the
      end of each semester and seen case presentations at the end of each year
      (semester two and semester four). Dental biomaterials are taught in years
      two and three and examined in year three.

80    We could find little evidence of oral microbiology teaching in the first two
      years of the programme. There appears to be a shortfall in oral biology staff
      at the School. The loss of a teacher in Behavioural Sciences had caused a
      short-term problem this year. However, we were told of two new research
      appointments in oral biology which are due to commence at the start of the
      2004/5 academic year who will have an involvement in undergraduate
      teaching.

Appropriate Attitudes, Ethical Understanding and Legal Responsibilities

81    The programme aims to provide students with knowledge and understanding
      of the legal and ethical requirements for the practice of dentistry and the
      profession‟s wider responsibilities towards the community as a whole.

82    Teaching in these areas is embedded in PBL. A programme of lectures in
      law and ethics is given in year five. Attendance at these lectures is
      compulsory and failure to do so can result in students not being allowed to be
      signed up for the 5th BDS Final Examinations. Professionalism is graded as
      part of the A-E assessment of clinical procedures. The vocational trainers we
      met felt that the graduates with whom they had had experience had a good
      knowledge of legal and ethical issues and demonstrated a professional
      attitude.

Appropriate Decision Making, Clinical Reasoning and Judgement

83    The programme aims to equip students with knowledge and understanding of
      the safe and effective care of patients, the intellectual skills to recognise their
      clinical limitations and to know when to refer patients for specialist advice
      and/or management. Vocational trainers that we met considered that the
      graduates with whom they had had experience had variable levels of clinical
      skills but recognised their limitations.




                                          16
84    Students gain knowledge of treatment planning during clinical practice and
      outreach teaching in restorative and paediatric dentistry and orthodontics.
      Students are assessed at each clinical session and receive informal feedback
      on their performance. Case presentations in the 5th BDS Final Examinations
      assess students‟ abilities in treatment planning and clinical care in restorative
      dentistry.

Professional Development

85    The programme aims to ensure that students have knowledge and
      understanding of the profession‟s wider responsibilities towards the
      community as a whole. Students receive a good theoretical grounding in their
      prospective legal and ethical responsibilities towards both patients and
      colleagues. They are made aware of the regulatory function of the GDC
      through lectures during year five. Students and recent graduates that we met
      believed that teaching in this area allowed them to develop their professional
      knowledge and understanding. In our view there could be more teaching on
      the concept of the dentist as leader of the dental team.


Personal Development

86    Students have good opportunities to interact with staff during PBL and clinical
      sessions at the Dental Hospital and in outreach facilities, allowing them to
      monitor their personal development and seek assistance where necessary.
      Student pairing for clinical sessions encourages discussion between
      undergraduates on their progress and provides informal support throughout
      the clinical programme.


STUDENT SUPPORT AND PROGRESS

87    Students who are accepted onto the BDS programme are sent induction
      packs which contain material produced specifically for dental students relating
      to the PBL course: a guide to this type of teaching and learning, details of the
      first PBL case that students will work on, a reading list and an induction
      booklet which is prepared with the assistance of existing dental students.
      Also included in the induction packs is a questionnaire entitled „Preparing for
      Problem Based Learning‟, designed to encourage students to reflect on their
      existing skills and focus on their future personal development. This
      questionnaire forms the basis of the students‟ first meeting with their personal
      tutor. The induction booklet has information on support and guidance
      systems for dental students. In their first week students receive sessions of
      training in group learning and the methods involved in PBL, with involvement
      from PBL tutors and student mentors.

88    First year students are supported by a Peer Assisted Study Scheme (PASS).
      Second and third year students volunteer to receive training and take on the
      role of a PASS leader. These leaders hold sessions throughout the first year
      on key themes identified as being of significance to first year students.
      Personal Academic Development Plans were introduced in 2001 to enhance
      the existing academic support for students, which is recognised as being
      mainly reactive. It is hoped that this will encourage a more proactive
      approach.



                                         17
89   Students are assigned two personal tutors whose role is to provide support on
     academic and personal matters. Tutors are advised to meet with their tutees
     twice a year. The senior tutor is responsible for co-ordinating formal and
     informal student support and has an open door policy is in operation in the
     senior tutor‟s office. Issues that arise which might affect a student‟s progress
     are drawn to the attention of the Progress Committee. We commend this
     strong and caring network for student support.

90   Students receive information and guidance on careers through talks given in
     the final year from dental professionals including Vocational Trainers. An
     annual „Job Shop‟ for dental students is held. A student representative is a
     member of the VT liaison committee.


ASSESSMENT

91   Specific modes of assessment within the programme have been mentioned in
     earlier paragraphs.       Summative, formative and evaluative methods of
     assessment are used. These are supplemented by the use of logbooks and
     by the Personal Academic Development Plans. With respect to the A-E
     grading used for in-course assessment of clinical sessions, we were told that
     staff had been reluctant to use the full range of grades, particularly the D and
     E grades which resulted in a failure to identify students who were having
     difficulties in certain courses. The criteria have now been redefined and staff
     are encouraged to use the full range of grades. However, these grades
     remain awarded by group teachers without moderation, except during Year 5
     Integrated Restorative Dentistry case assessment.

92   The use of the in-course assessment grades to determine exemption from the
     4th BDS Part two practical skills assessment is not moderated by external
     examiners. There is therefore no involvement of external examiners in the
     assessment of practical skills, except for those students who receive poor
     practical in-course assessment.

93   University examination regulations are available on the University website
     and assessment guidelines for dental students are included in the course
     handbooks and are available on the Dental School intranet. Recently, the
     BDS Part 3 examination was changed at short notice causing concern to
     some students.

94   We are concerned that the final assessment of many practical skills in
     Restorative Dentistry and of clinical skills in all other disciplines at the end of
     year four is premature and note that BDS Part 5 only assesses practical and
     clinical skills by completed case presentations in Restorative Dentistry.


QUALITY ASSURANCE AND CURRICULUM ENHANCEMENT

95   The University policy on quality assurance in teaching and learning is
     contained in the Academic Standards Code of Practice. This policy is applied
     in the Dental School. In accordance with this code a five yearly review of the
     BDS programme was carried out in 1999, and in 2004. These reviews make
     recommendations of improvement to the School, and the School then has the
     opportunity to respond. Evaluation of the programme is carried out annually
     by the Year co-ordinators and their findings go to the Dental Education


                                         18
      Standards Committee, as do reports from external examiners. Individual
      courses are evaluated at regular intervals and this information is discussed at
      the Clinical Academic Group Boards.

96    External examiner reports generally expressed satisfaction with the BDS
      assessment but the response to occasional helpful suggestions could not be
      ascertained because these were not available.

97    We were provided with a draft copy of the University internal five-year review
      report for 2004, which concerned the BDS, and BSc programmes. This
      recognised many areas of good practice and made some recommendations.
      Among other things, it suggested that the aims and objectives of the
      programme needed to be articulated more clearly, that the extension of
      practical work to year two should be implemented as soon as possible and
      should not await the outcome of the Curriculum Working Party, that the BDS
      curriculum needed to be more integrated and consideration be given to a
      „unitised‟ course, that levels be introduced for the programmes to facilitate the
      measurement of student progression, that there should be more structured
      teaching of legal issues, and that a clear learning and teaching strategy be
      drawn up.

98    We were aware that the draft five-year review that we were given had not
      been discussed within the Dental School. We agreed the review by the
      University contained many positive comments about the current state of the
      Dental School, and also highlighted issues that needed further consideration.

99    A joint meeting is held annually between Dental School staff, Vocational
      Trainers and Vocational Trainees. This provides direct feedback from
      graduates and their employers. Students are able to give feedback on
      courses through the use of questionnaires and the Staff Student Liaison
      Committee, which reports annually to the Divisional Management Team.

100   The clinical governance structure encourages patient and public involvement
      and is working to enhance the communication structures between them and
      the Dental School and Hospital. Waiting times are regularly audited and
      patient surveys are carried out. There is a patient representative on the
      Divisional Management Team.

101   The current curriculum is at present being examined by a Curriculum Review
      Working Party. As part of its remit, this review is looking at introducing a
      practical dental component into year two, at increasing the focus of clinical
      sessions to whole patient care rather than subject based teaching, and
      evaluating the issues raised by the fact that some subjects are not taught in
      year five, so students can graduate without recent experience of these
      disciplines. The School states that the BDS course is gradually evolving into
      a five-year programme, and we were told on a number of occasions of the
      curriculum review taking place. We believe that a clear strategy about the
      pathway to change for the BDS programme must be developed.




                                         19
OVERVIEW

102   Manchester BDS programme is gradually evolving into a true five year
      programme. The first two years of the programme are spent mainly in the
      Medical School, where Biomedical Sciences are taught by Problem Based
      Learning. The next two years of the programme are heavily dependent on
      clinical facilities provided in eight outreach centres. Students also attend
      clinics in the Dental Hospital, where they work in pairs. The final year
      involves outreach teaching and clinical sessions in restorative dentistry in a
      well-designed polyclinic. However, the current curriculum is poorly integrated
      and a review of the current curriculum is now being undertaken.




                                        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

    Admissions procedures need to be reconsidered in the light of substantial over-
     recruitment with respect to the HEFCE quota for the School of 58 home students
     per year (14).
    Staffing needs to be addressed, especially in Restorative Dentistry where a
     professorial post has been lost as well as other staff in that discipline (29).
    The concept of team dentistry needs to be developed further. The limited dental
     nurse support for students in the Dental Hospital should also be addressed,
     within the concept of the dental students‟ interaction with PCDs (36 & 38).
    Students should be given more opportunity to work in Dental Casualty through an
     increase in the number of patients admitted and an extension of opening hours.
    The development of the curriculum needs to be continued, with emphasis on
     continuing care for patients in paediatric dentistry, orthodontics and restorative
     dentistry over the three clinical years, and addressing the shortfall in the teaching
     of some clinical subjects in the final year (59).
    Clinical skills and patient care should be introduced earlier in the curriculum (60).
    Integration of the basic biomedical sciences with the clinical curriculum should be
     improved (77).
    The content of PBL teaching needs to be reviewed, especially with respect to
     Oral Microbiology and Oral Biology (80).
    The in-course assessment of practical skills used for exemption of candidates
     from practical assessment in BDS Part 4 should be moderated by an external
     examiner (92).
    Clinical and practical skills in all major disciplines should be formally assessed
     later in the BDS programme (94).

3.       To the University

    The funding arrangements for the Dental School need to be reviewed, particularly
     with respect to the recruitment of students over the HEFCE quota (10 & 14).
    The annual deficit must be addressed. It has varied from 250k to 500k in the last
     three years (10).
    The review of the management arrangements needs to be concluded speedily
     and effectively in order to give direction to the further development of the Dental
     School (13).
    Procedures for dealing with external examiners reports should be reviewed (96).

4.       To the NHS Agencies

    A decision on the preferred option for dealing with the problems concerning the
     Dental Hospital building is required urgently (27).
    The funding and contractual arrangements between staff employed by the
     Primary Care Trusts and Personal Dental Services engaged in teaching and


                                            21
     supervising students in outreach centres, and the University, which is responsible
     for dental education, should be clarified (30).
    Proper disbursement and transparency of the Medical for Dental SIFT allocation
     should be achieved (47).

5.      To the Strategic Health Authority

    The Strategic Health Authority, having subsumed the responsibilities of the
     Workforce Development Confederation, needs to be actively engaged in all
     workforce issues concerning the dental team (42).




                                          22
     Annex 1

     GDC Visitors’ Programme

     List of meetings held and people we met in formal meetings.

     (We met other staff and students during the tours).

Day 1 – Monday 26 April 2004

     Meeting with the Head of the Dental School and the Associate Dean for
     Undergraduate Studies
     Professor K D O‟Brien, Head of the Dental School
     Mr P S Hull, Associate Dean for Undergraduate Studies

     Meeting with teachers of biomedical subjects
     Professor D Watts, Professor of Dental Biomaterials Science (Associate Dean for
     Graduate and Postgraduate Studies)
     Prof M Dixon, Professor of Dental Genetics (Assistant Dean for Education, Faculty
     Biological Sciences)
     Dr CA Shuttleworth, Reader in Medical Biochemistry (co-ordinator of Years
     1&2 BDS Programme)
     Dr R Small, Reader in Pharmacology (Examinations Officer for Years 1 and 2 BDS
     Programme)
     Dr W McLean, Lecturer in Developmental Biology
     Dr R McMahon, Senior Lecturer/Honorary Consultant in Pathology
     Dr I Gouldborough, Teaching Fellow (Anatomy)
     Dr T Speake, Teaching Fellow (Physiology)

     Meeting with staff involved with the teaching of Medicine and Surgery
     Dr M Patrick, (North Manchester General)
     Mr W Tate, (North Manchester General)
     Dr M Pemberton, Honorary Lecturer in Medicine in Dentistry
     Mr Bob Woodward, (North Manchester General)

Day 2 – Tuesday 27 April 2004

     Meeting with the Vice-Chancellor
     Professor Sir Martin Harris

     Meeting with Heads of Clinical Units
     Mr PS Hull, Periodontics
     Professor K Horner, Oral and Maxillofacial Radiology
     Dr A Qualtrough, Operative Dentistry and Endodontology
     Professor F McCord, Prosthodontics
     Dr R Craven, Dental Public Health
     Dr D Bearn, Orthodontics
     Dr I Mackie, Paediatric Dentistry
     Dr P Brunton, Integrated Restorative Care
     Dr P Coulthard, Oral and Maxillofacial Surgery
     Dr M Pemberton, Oral Medicine
     Dr A Mellor, Primary Dental Care
     Professor P Sloan, Oral Pathology


                                              23
     Meeting with Workforce Development Confederation and Strategic Health
     Authority Representatives
     Mr C Jeffries, Workforce Development Confederation Representative
     Dr M Tickle, Strategic Health Authority Representative
     Mr N Ward, Regional Adviser in Dental Public Health

     Meeting with Lead Primary Care Trust Representatives
     Mr M Burrows
     Mrs J Duxbury

     Meeting with Instructors in Dental Technology and Radiology
     Mr R Richmond, Instructor in Restorative Dentistry
     Mr J Smith, Instructor in Restorative Dentistry
     Mr A Jack, Instructor in Orthodontic Dentistry
     Mrs A Carson, Instructor in Radiography

     Meeting with PCD Representatives
     Ms L Allen, Dental Hygienist
     Ms A Wilde, Dental Therapist
     Mr I McLeod, Laboratory Manager
     Ms P Heap, Dental Nurse
     Mrs E. Maher, Dental Nurse
     Miss L Taylor, Dental Nurse

     Meeting with recent Graduates
     Ms S Khan (Graduated July 2003)
     Ms R Nashi (Graduated July 2003)
     Mr M Bala (Graduated July 2003)
     Mr G Paysden (Graduated July 2003)
     Mr J Hobkirk (Graduated July 2003)
     Mr C Waith (Graduated July 2002)
     Mr J Seehra (Graduated July 2002)

     Meeting with Deputy Postgraduate Dean, Regional Adviser in Vocational
     Training and Vocational Trainers
     Mr N Ward, Deputy Postgraduate Dean
     Mr D Read, Regional Adviser in Vocational Training
     Mr M Milne, Vocational Trainer
     Ms J Jacott, Vocational Trainer




Day 3 – Wednesday 28 April 2004

     Meeting with the Head of Clinical Division and the Divisional General Manager
     Professor F McCord, Head of Clinical Division
     Mrs B Watson, Divisional General Manager

     Meeting with the Chief Executive of the NHS Trust Others
     Mr M Deegan, Chief Executive of the NHS Trust




                                           24
Meeting with Student Representatives
We met with two representatives from each of the five years of the BDS programme

Meeting with Non-professorial Staff
Dr R Oliver, Lecturer in Oral and Maxillofacial Surgery
Dr I Mackie, Senior Lecturer and Honorary Consultant in Paediatric Dentistry
Ms E Theaker, Lecturer in Oral Medicine
Dr V Rushton, Senior Lecturer in Oral and Maxillofacial Radiology
Mr J Satterthwaite, Lecturer and Honorary Specialist Registrar in Restorative
Dentistry
Dr N Mandell, Senior Lecturer and Honorary Consultant in Orthodontics
Dr T MacFarlane, Lecturer in Dental Statistics
Ms A-M Glenny, Lecturer in Evidence Based Oral Care and Systematic Review
Mr A Hopwood, Clinical Teacher in Restorative Dentistry
Ms C Potter, Clinical Teacher in Restorative Dentistry and Outreach
Ms F Murray, Clinical Teacher in Outreach

Meeting with NHS Clinical Staff involved in teaching Dental Students
Mr M Ashley, Teacher in Restorative Dentistry
Mr D Eldridge, Teacher in Restorative Dentistry
Mr R Middlehurst, Honorary Clinical Teacher and Consultant Oral and Maxillofacial
Surgeon
Dr M Pemberton, Honorary Lecturer in Medicine in Dentistry
Mr D Moore, Teacher in Restorative Dentistry

Meeting with the Dean of Faculty of Medicine, Dentistry, Nursing and Pharmacy
Professor D Gordon




                                       25
Annex 2

Details of the Documents provided by the School

     Information received ahead of the visit

     Self Evaluation Document
     Information Pack for prospective dental students
     Undergraduate Prospectus entry for Dentistry
     Dental School Handbook
     Dental School Organisation
     Management structures in the Dental School
     Committee structures
     Information on the structure and content of the BDS Programme
     Details on Clinical Activity
     Course Handbooks:
     - Year‟s 1 & 2 2003/4
     - Medicine and Surgery 2003
     - Oral and Maxillofacial Pathology 2003
     - Restorative Dentistry 2003/4
     - Oral Health and Development 2003/4
     Staffing Information
     Undergraduate Student Numbers
     Admissions Tutor‟s Report
     Student Progression and Achievement
     University Examination Regulations
     Details of the BDS Examinations
     External Examiners‟ Details
     External Examiners‟ Reports for 2000/1, 2001/2, 2002/3
     University Five Year Review of the Bachelor of Dental Surgery (Feb 1999)
     Course Monitoring Reports
     QAA Subject Review Report (Feb 2000)

     Information received during the visit

     Details on NHS Funding (Dental SIFT and Medical for Dental SIFT) and the School‟s
     Expenditure
     HEFCE funding for Undergraduate Dentistry with relation to numbers of dental
     students
     Dental Aspects of the Greater Manchester StHA franchise plan
     Figures for Dental Units in the Dental Hospital and their principal users
     Information on the Management Structure for the Department of Dental Medicine and
     Surgery
     Information on Committee Membership and Remit
     A Draft of the Report of the Five Year Review of Undergraduate Programmes for the
     School of Dentistry
     A Review of Prevention and Health Promotion in the Undergraduate Curriculum at
     The University Dental Hospital of Manchester
     BDS Programme Handbook 2003-2004 for the Dental Public Health Course
     BDS Programme Handbook – Basic Principles in the Management of the Paediatric
     Patient, Introduction to Paediatric Dentistry Course
     Oral Medicine Course Manual, 3rd and 4th Year Dental Students, March 2003.
     Handbook for the Clinical Attachment at the North Manchester General Hospital
     Dental Casualty Undergraduate Teaching Manual


                                               26
The aims and objectives of the Integrated Clinical Practical Sessions for Year 1
Dental Students in Semester 1 of 2003: Nutrition and the Digestive System
Problem-Based Learning Book for Tutors of the Integrated Dental Public Health,
Paediatric Dentistry and Orthodontic Course, 4th Year
Procedures Manual for Students at the Manchester Dental Hospital (for the course in
Integrated Primary Care Dentistry)
Procedures Manual for Students at the Ordsall Clinic (for the outreach course in
Restorative Dentistry)
Information on teaching in the control of pain and anxiety during the BDS programme
Example of an Emergency Medical Admission Form
Example of a satisfaction survey circulated to patients at the Ordsall Dental Student
Clinic
Information on the John Rylands University Library of Manchester
Examples of information provided for disabled and dyslexic students
Figures for International/National Research Rated Staff Contact Hours and details on
how research informs the undergraduate dental curriculum
Job descriptions for the posts of Director of Research, Director of Graduate
Education and Research and Director of External Affairs at the School of Dentistry.
CVs for all staff.
Personal tutoring handbook for staff

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




                                           27
PROFESSOR KEVIN O’BRIEN
    Head of the School

TEL: 44(0)161 275 6601
    Fax:       44(0)161 275 6604
    Email:     kevin.o’brien@man.ac.uk

                                                                                                           16 September 2004
    KOB/SH/IR

    Mr Antony Townsend
    Chief Executive & Registrar
    General Dental Council
    37 Wimpole Street
    London
    W1G 8DQ


    Dear Mr Townsend

             THE DENTAL SCHOOL, UNIVERSITY AND NHS AGENCIES RESPONSE TO THE
             VISITATION
             OF THE BDS PROGRAMME OF MANCHESTER DENTAL SCHOOL 26, 27 AND 28 APRIL
             2004

    We would like to thank the General Dental Council Visitors for their report. This has been considered by
    the Dental Education and Standards Committee and the Dental Senior Management Team in
    preparation for this response.

    We are pleased that the visitors were able to report positively on many aspects of our BDS programme,
    particularly our use of Problem Based Learning, longstanding outreach delivery of teaching, standard of
    communication of our undergraduates, student support and the enthusiasm of our staff. These factors
    were also recognised in the award of a maximum score at the last QAA visitation to the School.

    Following this assessment we decided to review our curriculum and the GDC visitation took place just
    before the final report of our Curriculum Review Group. We are confident that this addresses many of
    the recommendations made by the GDC.

    We noted that the visitors did make some recommendations and we are pleased to take this opportunity
    to address these. In order to facilitate cross referencing we have used the same section numbering as
    in the Report of the Visitors and the text in italics has been taken directly from the report.

    2.       To the Dental School

    14.      There are currently 379 students on the BDS undergraduate dental programme and over the
             last ten years an average of 79 new students were admitted each year. There are 90 students
             in the 2003/4-year. We were concerned to see what we consider to be the over-recruitment of
             dental students. According to HEFCE figures, Manchester is allocated 58 places each year for
             home students on the BDS course with an additional 5-7.5% of this figure allowed for overseas
             student places. The University of Manchester website states that the Dental School admits 65
             students to the BDS programme each year. We were told that HEFCE monies are paid in a


                                                      28
         block to the University, after which the University distributes the money according to actual
         student numbers in each School. The University does not specify an upper limit for student
         numbers in each School. We saw evidence that high student numbers were putting pressure
         on staff and facilities. The over-recruitment at Manchester has implications nationally, in that
         the majority of Schools in the UK have kept to their quota. Deans of Dental Schools have,
         however, been extremely active in pointing out that there is a need for extra undergraduate
         dental places nationally.



The number of Home and Overseas students recruited for the Dental Programme is determined on
advice from the Faculty. These numbers have been at a level above the HEFCE allocation of places in
order to bring some financial stability to the Dental School following our loss of income as a result of the
last RAE. The School is aware of the pressure this places on the staff and we are negotiating with the
Faculty to reduce the number of students admitted.

29        School has experienced a net loss of 7 (FTE) members of staff in the last 10 years. The
         School has experienced particular losses in the field of restorative dentistry, including a
         professorial post. There have been some difficulties in recruitment, particularly because all
         HEFCE appointments are required to have a research focus. Recruitment of lecturers in
         restorative dentistry whose research reaches international levels has been particularly
         problematic; this is a nation-wide issue. This emphasis on research and the demands of
         academic and specialist training also causes problems with the recruitment of junior staff, as
         the pressure to teach and be research active is considerable. The School hopes to fill five
         posts in restorative dentistry over the coming academic year. We were told that three of these
         posts could be teaching-only.

The University and the Faculty have strict criteria for the recruitment of HEFCE funded staff. All new
appointees must be research active, preferably at an International level. As a result of this requirement,
we have experienced particular problems in recruiting staff in the area of Restorative Dentistry. We
have addressed this by creating two new Restorative Dentistry teaching posts, jointly with a Primary
Care Trust. These posts are classified as teaching only and the post holders will not be returnable at
the RAE.

36       Dental students have very limited contact with dental hygienists and dental hygiene students
         within the programme. BDS students are able to refer to BSc students but there did not seem
         to be any significant interaction. We were told that, as the BSc programme has now been
         approved by the GDC, dental students’ experience of working with PCDs should increase.

Now that the BSc programme has been approved by the GDC we will increase interaction between the
PCDs and the Dental Students during their programmes. The concept of Team Dentistry is going to be
developed further in the new curriculum.

38       The team approach, as advocated in The First Five Years, refers to interaction between dental
         student, hygienist, therapist, nurse and technician, rather than interaction between students.
         Whilst we appreciate that there may be educational benefits to students working in pairs for
         parts of the course, especially in the early clinical years, we do not think that student pairing is
         an adequate substitute for close support from a dental nurse. We are concerned at the limited
         dental nurse support that students receive in the Dental Hospital throughout the programme
         and in outreach clinics in the fourth year.

Within the Dental School the normal allocation of dental nurses is one to 6 operating student pairs.
Students work with a dental nurse in 4th Year Outreach in Oral Health and Development and in 5th
Year in “Family Dentistry”.



                                                    29
45       Dental casualty service at the Dental Hospital is operational in the mornings only. The first 25
         patients are admitted and the remainder are obliged to seek treatment elsewhere. This
         appears to be a strategic policy by the Central Manchester Hospital Trust and the Greater
         Manchester Strategic Health Authority to reduce pressure on the Dental Hospital with the
         intention of encouraging patients to go to their local GDPs or access centres. Students were
         appreciative of the experience in dental casualty (currently 12 sessions) and expressed the
         view that they would like to be allocated to casualty on a daily basis rather than in the morning
         only. We feel that the experience that dental undergraduates gain in dental casualty is
         extremely valuable and that this opportunity should be maximised.

The School recognises the benefits of the experience gained in Dental Casualty. Negotiations are taking
place with the PCTs to fund an extension to the opening hours of Dental Casualty so that students can
attend for longer periods. Students do see casual patients in Outreach Clinics so their experience of
Casualty is not confined to the Dental hospital.


59       Clinical sessions in periodontics, prosthodontics, oral and maxillofacial pathology, surgery and
         radiology and operative dentistry and endodontics take place in the Dental School in years
         three and four. Students also attend clinics in restorative dentistry, paediatric dentistry and
         orthodontics in outreach. A course in clinical operative techniques runs throughout year three.
         During year five the emphasis of clinical sessions is on integrated whole patient care. We feel
         that there are gaps in clinical experience in the final year in oral surgery, oral medicine and
         orthodontics.

These recommendations will be considered as we adopt our new 5 year curriculum. This will, in the
long term, address the problems outlined above. We have, however, already instituted changes to the
programme that will result in the teaching of Oral Medicine, Oral Surgery and Orthodontics in the Final
Year. These subjects will be included in a new Finals Examination commencing in 2005.

60       Students and recent graduates with whom we spoke with felt that more clinical skills teaching
         in years one and two would be beneficial.

A course in technical skills is now held in Year 1. Adoption of the new curriculum will further increase
clinical skills teaching in Years one and two.

77       The programme aims to provide students with knowledge and understanding of the broad
         principles of scientific thought, including scientific design. The main pre-clinical part of the
         programme is entitled ‘Biological and Behavioural Basis of Dentistry’ and is delivered through
         PBL cases during years one and two. This course includes the biological and behavioural
         basis of medicine where it is relevant to dentistry. In each of the four semesters a particular
         area is focussed on: semester one - nutrition and digestion, semester two - cardiorespiratory
         fitness, semester three - defence, abilities and disabilities and semester four - development
         and metabolism. Although there is some input into the first two years by Dental School staff,
         there appeared to be little direct integration with the clinical curriculum.

Integration of the Basic Biomedical Sciences into the clinical curriculum has improved since the current
curriculum was introduced. This has been achieved by separating the teaching from Medicine and
introducing more dentally relevant topics. We are aware that more integration is necessary and this is
being addressed by the Curriculum Review Working Party. An integrated 5 year curriculum will be
introduced.

80       We could find little evidence of oral microbiology teaching in the first two years of the
         programme. There appears to be a shortfall in oral biology staff at the School. The loss of a
         teacher in Behavioural Sciences had caused a short-term problem this year. However, we



                                                   30
         were told of two new research appointments in oral biology which are due to commence at the
         start of the 2004/5 academic year who will have an involvement in undergraduate teaching.

Oral Microbiology is discussed in the context of plaque and caries and is supplemented with 1 practical
and 4 lectures. These are timed to coincide with the students’ first clinical experience when they learn
about caries and cross-infection control. This is further supplemented in the clinical courses in Oral
Medicine, Periodontology and Operative Dentistry and Endodontology. We appreciate that due to the
integrated nature of the PBL course it is not always possible to separate out individual subjects, such as
Oral Microbiology and Oral Biology but these are included in the new curriculum.

92       The use of the in-course assessment grades to determine exemption from the BDS Part 4
         practical skills assessment is not moderated by external examiners. There is therefore no
         involvement of external examiners in the assessment of practical skills, except for those
         students who receive poor practical in-course assessment.

This Examination is being discontinued following the present sitting in September 2004. We will discuss
with the External Examiners their role in the sign-up procedures for the new Final BDS Examination and
follow their advice.

94       We are concerned that the final assessment of many practical skills in Restorative Dentistry
         and of clinical skills in all other disciplines at the end of year four is premature and note that
         BDS Part 5 only assesses practical and clinical skills by completed case presentations in
         Restorative Dentistry.

This has been raised on several occasions by the External Examiners. DESC has considered this
matter and has already introduced changes to the examinations for the BDS programme. A new Finals
Examination will be held in 2005 which will be the final assessment for the clinical skills in all disciplines.


2.       To the University

10       The Dean of the Dental School is the Higher Education Funding Council budget holder. The
         University operates a system through which 25% of HEFCE funding is ‘top-sliced’ for central
         services. In 2002/3 the School received HEFCE income for teaching and research amounting
         to £3331k (including home fees); its staffing costs were £3092k. The School received an
         additional £98 K of HEFCE income in 2002/3 for the BSc Oral Health Science programme.
         The School’s HEFCE research income has fallen from £979 K in 2001/2 to £438k in 2002/3,
         due to the fact that the School’s research rating fell from a 5 to a 4 in the 2001 Research
         Assessment Exercise. Largely due to this reduction in HEFCE research income, the School
         recorded a deficit in funding of £551k for 2002/3. In 2000/01 the deficit was £298k and in
         2001/02 the deficit was £243k. Although staffing costs make up the majority of the
         expenditure, factors such as central overhead and Faculty costs have contributed to this
         deficit. At present the deficit is handled within the Faculty of Medicine, Dentistry, Nursing and
         Pharmacy, the difference being made up with funds generated by the other Schools. The
         Dental School has also increased the numbers of overseas and post-graduate students in
         order to address the deficit. A policy of re-investment by the University in the Dental School
         has been established in the hope that the School will achieve a higher RAE rating in the next
         assessment exercise. The strong level of support for the Dental School from the Vice-
         chancellor and the Dean of the Faculty was impressive.

With respect to student recruitment, the full funding for our existing numbers is of the highest priority.
This will take precedence over any additional expansion of student places.

With respect to finance, it should be noted that the Dean of the Faculty is the budget holder, however in
practice, the day to day management of the budget is devolved to the Head of School.


                                                     31
The funding model within the University, and consequently the Faculty, is in the process of change
because of the establishment of a new institution on 1st October 2004. The interim arrangements for
2004/05 have led to a predicted budget deficit of about £400,000 for the Dental School. The outcomes
of the budget forecasts for 2005/06 are unknown, as the funding model has not yet been finalised.

Notwithstanding this, the budgetary unit of the new institution will remain as the Faculty. Within this unit,
not only are the Dental School deficits written off, but the Faculty, in collaboration with all constituent
schools, provides funds for academic development which will allow (in due course) such deficits to be
extinguished within this model. The Faculty will always resource worthwhile academic development
which supports the strategy of the School.

13       The Dean of the Dental School reports formally to the Dean of the Faculty and is supported by
         three Associate Deans in Research, Graduate Studies, and Undergraduate Studies and
         Students Affairs. The Dental School is divided into three Clinical Academic Groups (CAGs) –
         Restorative Dentistry, Oral Health and Development, and Oral and Maxillofacial Sciences.
         Management arrangements between the University and the Hospital Trust have been changed
         recently with the separation of the posts of Dean of the Dental School and Clinical Director.
         We understand that the Vice-Chancellor has set up a review committee to consider the
         managerial structure of the Dental School.

The review committee on the management structure for the Dental School has reported and the new
Dental School Senior Management Team has already started implementing the recommendations.

96       External examiner reports generally expressed satisfaction with the BDS assessment but the
         response to occasional helpful suggestions could not be ascertained because these were not
         available.

The procedure for dealing with the External Examiners reports is well established. The reports are
considered by DESC and a formal reply sent to the External Examiner by the Associate Dean for
Undergraduate Studies. These replies are prepared by the Secretary to the Dental School.
Unfortunately these replies were stored on the Secretary’s computer and no paper copy was retained.
These were erased when he was transferred to a new department. Procedures are now in place to
retain a hard copy of the reply with the External Examiners report.

4.       To the NHS Agencies

27       The Dental Hospital is owned by the University and leased to the Trust. We were made aware
         of problems within the building with regards to the electricity and plumbing, and the presence
         of asbestos. It has been predicted that to fully restore the building would cost £7-10 m. A
         steering committee with representation from the Primary Care Trust (PCT), the Strategic
         Health Authority (SHA), the Trust, the University, the Dental School and the Department of
         Health has been formed to address this issue. A preferred option has been identified, details
         of which are being prepared by the Trust. If approved by stakeholders a full business case for
         the preferred option will be produced.

An option appraisal and costing has been completed and all stakeholders are due to meet before the
end of the year so that a considered decision can be taken.

30       Most of the teaching in outreach centres is provided by community dental officers who are
         employed by the various PCTs, or by General Dental Practitioners in a Personal Dental
         Service (PDS). All such staff have a sessional commitment to the Dental Hospital, but their
         primary method of employment is with the PCT or PDS.




                                                    32
Outreach teaching takes place in community clinics situated in Manchester, Salford, Trafford and Oldham
Primary Care Trusts. In addition, a joint community/PDS scheme under the control of Salford PCT provides
teaching sessions supervised by a senior dental officer.

Most of the teaching staff are employed by the Primary Care Trusts and have honorary University
appointments. Two teachers are joint appointments with the University, but their contracts are held by the
NHS. All outreach teachers meet on a formal basis with the Dental School staff to ensure consistency of
teaching standards.

47       The teaching of medical subjects to dental students is supported by funding from
         HEFCE and Medical SIFT for dental students. The Dental Hospital received £765k
         Medical for Dental SIFT for the year 2003/4, £69k of which goes to the North
         Manchester General Hospital towards funding for two consultant posts, the remainder
         going to the Central Manchester Trust. Consultants in the North Manchester General
         Hospital requested that more of the available funding be spent directly on staffing of
         this programme.

This has also been highlighted by the University in the recent review of the Dental School. Negotiations
are underway to establish between the Trust and the University a means of disbursement of the Medical
for Dental SIFT that is both proper and transparent.

To the Strategic Health Authority

41       The Dental Hospital falls under the Greater Manchester Strategic Health Authority. The
         Workforce Development Confederation and the SHA for Greater Manchester are integrated,
         the SHA having subsumed the WDC. The SHA recognises the importance of dentistry and the
         significant role that the Dental Hospital has in the provision of dental services to the local
         population. The Greater Manchester area has a shortfall in its dental workforce and it is
         recognised that a Dental School has a retaining effect on the workforce – graduates of
         Manchester are likely to remain in the area. A Greater Manchester workforce strategy group is
         planned which would involve the Dean of the Dental School and the Clinical Director. A
         steering group is currently looking at the expansion of outreach teaching in order to provide
         dental care and specialist dental services to a wider area. Plans for the funding of these new
         outreach facilities are in place. We are pleased to note the beneficial and productive level of
         interaction between the Dental Hospital and School and the Primary Care Trusts.

The Strategic Health Authority are kept aware of the workforce issues concerning Dentistry by the
dental member of the Authority who is also a member of the Dental School senior staff.

CONCLUDING COMMENT

We hope that we have addressed the recommendations that were raised by the Visitors.

The GDC Visitation has been helpful to the Dental School and many of the recommendations have
been fed into our curriculum review. We are sure that our innovation and ability to lead change will
keep us at the forefront of undergraduate education in the UK.

Yours sincerely


PROFESSOR KEVIN O’BRIEN
Cc:  Professor Sir M. Harris
     Vice-Chancellor



                                                   33
   Response of the School of Dentistry

                   to


    GENERAL DENTAL COUNCIL
 VISITATION OF UNDERGRADUATE
DENTAL DEGREE PROGRAMMES AND
          EXAMINATIONS


     VISITATION OF THE BDS
  PROGRAMME OF MANCHESTER
        DENTAL SCHOOL


 THE UNIVERSITY OF MANCHESTER

        26, 27 AND 28 APRIL 2004



   REPORT OF THE VISITORS

              JANUARY 2005




                   34
BACKGROUND TO RESPONSE

The Response to this Report is set against the background of the letter sent to
Professor Alan Gilbert on the 2nd December 2004 by Anthony Townsend.

The GDC Visitors to the School, together with the Report of the Visitors to our Final
BDS Examination, had made us aware of the issues relating to the Final BDS
Examination. We have worked hard to rectify these concerns. We were, however,
surprised to read:-

“The Committee endorsed the visitors‟ opinion that the reports identify problems with
the structure and delivery of the BDS programme….”
“The adequacy of the education….., is in question.”

The letter goes on to state:-
“Reports should be sought from the University on the proposed reforms to the
curriculum…”
“The GDC will….request reports on the proposed changes to the curriculum before
this visitation”.

The letter implies that we have problems with the delivery and structure of our current
curriculum and we do not give an adequate educational experience for our
undergraduate students.

On reading the Report of the Visitors to the Visitation of the BDS Programme of
Manchester Dental School we did not get the impression that our BDS Programme
was not sufficient.

As a result we would like to present a detailed Response to the Reports of the
Visitors. We would like to emphasise that we are introducing a new curriculum which
will start in September 2006. We have enclosed details of our new curriculum in the
“Interim Report of the Curriculum Review Working Party of the Dental Education and
Standards Committee, School of Dentistry, The Victoria University of Manchester.
July 2004.”


SCHOOL OF DENTISTRY PROCESS FOR THIS RESPONSE

A meeting of the Undergraduate Programme Committee was held on the 20th
December 2004. The Head of School attended and we carefully analysed the Report
of Visitors.

For this Response we have taken excerpts from the Report of the Visitors together
with their relevant section number. These are given in italics. Our Response follows
each section.

For the sake of completeness we have also included excerpts which illustrate our
strengths and good practice. We feel that the GDC Reports should highlight areas of
good practice so that these can be shared by other Schools.


1.

     11. Dental students have use of the John Rylands University Library, which is the
         main University library facility, for private study and research. This is located


                                           35
        close to the Dental School on the main campus. The library is substantial
        and modern, has large study areas and houses 230 computers which are
        available to students during opening hours. Dental books are housed in the
        Biomedical Sciences section, which has a staffed reference information desk
        where students can seek assistance. Dental journals can be found in a
        separate storage area in the basement of the building. Some dental journals
        are also available as e-journals and can be accessed from the library’s
        website. Dental students have access to the Medical Library in the Stopford
        Building, which is approximately five minutes’ walk from the Dental School.
        The Medical Library houses additional copies of some of the books that are
        available in the main library, is bright and spacious and has an informal
        atmosphere. The Dental School has a representative on the Faculty Library
        Committee who ensures the purchase of appropriate texts. We were
        impressed with the standard of library and IT facilities available to dental
        students in the Medical School and the John Rylands Library.

The School was pleased that the Visitors were impressed with these facilities.
Students following our new curriculum will be making even more use of ICT.

2.

     13. The Dean of the Dental School reports formally to the Dean of the Faculty
         and is supported by three Associate Deans in Research, Graduate Studies,
         and Undergraduate Studies and Students Affairs. The Dental School is
         divided into three Clinical Academic Groups (CAGs) – Restorative Dentistry,
         Oral Health and Development, and Oral and Maxillofacial Sciences.
         Management arrangements between the University and the Hospital Trust
         have been changed recently with the separation of the posts of Dean of the
         Dental School and Clinical Director. We understand that the Vice-Chancellor
         has set up a review committee to consider the managerial structure of the
         Dental School.

The review has been completed and the School has adopted a flat management
structure and abolished its Clinical Academic Groups. The School is managed along
its three main roles of undergraduate education, postgraduate education and
research. The separation of the posts of Dean and Clinical Director have enabled
the Head of School to concentrate on University matters. This has resulted in more
effective management.

3.

     17. Current students that we spoke with did feel that PBL posed a significant
         challenge to them at the start of the BDS programme, and that it took a little
         while to become accustomed to this method of learning.             However,
         favourable comments were made regarding the support systems in place for
         such problems. Academic staff at the School felt that PBL was a good
         method of delivery for the teaching of pre-clinical subjects.

We are delighted that the support systems received favourable comments. This is
something upon which we have worked very hard. When PBL commenced we
listened to student feedback, and with their help put in place the support systems.




                                          36
4.

      21. The development of outreach centres gives the students the opportunity to
          work in different environments. The majority of teaching in orthodontics and
          paediatric dentistry takes place in outreach, with a limited amount at the
          Dental Hospital. These arrangements appear to make it more difficult for
          students to follow treatment programmes over an extended period. Students’
          practical experience in orthodontics appears to be limited.

4.1

The outreach centres do indeed give the students experience of working in different
communities. We think that this is a great strength. The students work in deprived
inner city white, black and asian areas seeing both child and adult patients.

4.2

The arrangements do make it more difficult for students to follow treatment
programmes over an extended period. However for children and adults the students
usually complete a treatment plan from start to finish during their time in an outreach
clinic. In their next year they could be timetabled to another outreach clinic to
experience a different environment, a different teacher and different patients.

Undergraduate dental students used to follow fifteen child patients from Year 3 to
Year 5. By the end of Year 4 and into Year 5 all the students were doing were recalls
and reinforce advice. Now with outreach the students are completing treatment
plans in Years 3, 4 and 5 for different children. We feel that this longitudinal
experience on different patients is more beneficial than longitudinal care of the same
patients.

We do not agree that the students‟ practical experience in orthodontics is limited.
The students gain orthodontic experience that is relevant to the role of general dental
practitioners in the provision of contemporary orthodontic care. We clearly satisfy the
requirement outlined in the First Five Years. This has been recognised by our
external examiners reports.

4.3

It is interesting to note that some Schools in the UK are undertaking block outreach
teaching. In these blocks the students have difficulty completing a treatment plan.

5.

      28. We were impressed by the academic and non-academic staff in both the
          Dental School and Hospital who are enthusiastic, involved and highly
          committed to the education of undergraduate dental students. Their
          colleagues based in outreach clinics equally impressed us.

We would whole-heartedly agree with this statement and are pleased that our staff
impressed the Visitors. Our staff are one of our strengths.

6.

      29. The School has experienced a net loss of 7 (full-time equivalent) members of
          staff in the last 10 years. The School has experienced particular losses in


                                          37
         the field of restorative dentistry, including a professional post. There have
         been some difficulties in recruitment, particularly because all HEFCE
         appointments are required to have a research focus. Recruitment of
         lecturers in restorative dentistry whose research reaches international levels
         has been particularly problematic; this is a nation-wide issue. This emphasis
         on research and the demands of academic and specialist training also
         causes problems with the recruitment of junior staff, as the pressure to teach
         and be research active is considerable. The School hopes to fill five posts in
         restorative dentistry over the coming academic year. We were told that three
         of these posts could be teaching-only.

Following the development of a school strategic and operational plan, we have
recently advertised two lecturer posts shared with Salford PCT and we are due to
advertise a Senior Lecturer and Lecturer based in Restorative Dentistry. We are also
planning on advertising three further posts in the summer.

7.

      32. NHS consultants are involved in the running of the BDS programme and its
          development. They are invited to away days and contribute to curriculum
          review. NHS staff are encouraged to attend the University Teaching and
          Learning Course and they have access to the School’s intranet site and
          email facilities. We were pleased to note that the School benefits from the
          commitment of NHS staff.

This builds on the comment in Point 5. Our NHS staff are excellent.

8.

      36. Dental students have very limited contact with dental hygienists and oral
          health science students within the programme. BDS student are able to refer
          to BSc students but there did not seem to be any significant interaction. We
          were told that, as the BSc programme has now been approved by the GDC,
          dental students’ experience of working with PCDs should increase.

8.1

The BDS and BSc students do share lectures of relevance to both groups, radiology
teaching, teaching facilities and social facilities.

8.2

Dr Mackie was awarded a National Teaching Fellowship from the Higher Education
Authority in September 2004. The Project involved with this is Teaching Team
Dentistry. The time scale for this is two years.

8.3

The School of Dentistry has had fruitful preliminary discussions with the Manchester
Metropolitan University (MMU) and their Dental Technology course leaders so that
we can form collaboration and develop teamwork between our students.

8.4

The new curriculum will place emphasis on team-working.


                                          38
9.

      38. The team approach, as advocated in the The First Five Years, refers to
          interaction between dental student, hygienist, therapist, nurse and technician,
          rather than interaction between students. Whilst we appreciate that there
          may be educational benefits to students working in pairs for parts of the
          course, especially in the early clinical years, we do not think that student
          pairing is adequate substitute for close support from a dental nurse. We are
          concerned at the limited dental nurse support that students receive in the
          Dental Hospital throughout the programme and in outreach clinics in the
          fourth year.

The Clinical Head of Division has reviewed dental nurse numbers and is evaluating
more effective deployment of nursing staff. We are, however, concerned with the
retention of nursing staff because of pay differentials between the hospital and
general dental practice. We would also like to point out that this problem is not
unique to Manchester School of Dentistry.

9.1

In an ideal world with sufficient funding we are sure that all Dental Schools in the UK
would like to be able to offer dental students full dental nurse support.

9.2

In some Schools dental students work on their own, but we feel that this is
unacceptable from a health and safety point of view. Students should at least be
paired.

9.3

In the outreach clinics, in the fourth year, students work with their own dental nurse
during the Oral Health and Development sessions.

9.4

The Head of School, the Clinical Head of Division and Directorate Manager have
met to discuss this issue and they are looking at ways of improving dental nurse
support, but this may be difficult due to financial constraints and problems in
attracting suitable applicants to dental nurse posts.

10.

      39. Dental students are provided with one to one dental nurse support during
          Oral Health and Development teaching in the final year. Teaching in
          outreach aims to emphasise team working and the role of the dentist within
          the team. the students that we spoke with were most appreciative of the
          dental nurse support that they received in outreach facilities. We commend
          this provision of one-to-one dental nurse support in outreach clinics,
          especially in the final year.

We are delighted with this commendation. We hope we can build on this on and
bring in true team-working (see Section 8).



                                            39
11.

      40. Students prescribe to in-house dental technicians and receive very good
          support from dental laboratory staff. Students are encouraged to interact
          with technicians and discuss patients’ work with them. All the technical
          dental work in outreach centres is sent to the Dental Hospital so that the
          same standards of laboratory support that is provided in the Dental Hospital
          are available for students treating patients in outreach. Students are taught
          by technical instructors during a practical skills course in year one. Students
          do not have practical experience of the processes involved in indirect
          restorations. The number of teaching technicians has been reduced to
          extremely low levels in recent years.

As mentioned in section 8.3 we are in discussions with Manchester Metropolitan
University. This was discussed at Dental School Management Team on 22.12.04
and it was agreed that we continue to investigate this collaboration.

12.

      44. There are approximately 124 chairs in the Dental Hospital, but not all of these
          are available to undergraduates. In general the clinical facilities were of a
          good standard. Undergraduates receive the majority of their clinical teaching
          in a 45-unit polyclinic. We were told that pressures could occur in this clinic
          when chairs are temporarily out of order, but that there are overflow chairs
          available to accommodate patients. We note with concern that there is a
          reduction in undergraduate clinical facilities because the prosthodontics clinic
          has become a postgraduate unit. However, we were informed that this clinic
          remains available for undergraduate teaching.

The change of the prosthodontic clinic from undergraduate to postgraduate was part
of a programme to redistribute the available clinical facilities. Chairs used by
postgraduate students in the ground floor clinic have been released for use by
undergraduates. Thus instead of having undergraduates isolated and separated in a
small first floor prosthodontic clinic they are integrated together in the large ground
floor clinical area. The postgraduate students have been brought together in the first
floor clinic.

We feel that this is a positive move in integration.
In common with many other Schools we do have pressures on clinical facilities. We
have recognised this and have been proactive in expanding outreach.

13.

      45. The dental casualty service at the Dental Hospital is operational in the
          mornings only. The first 25 patients are admitted and the remainder are
          obliged to seek treatment elsewhere. This appears to be a policy by the
          Central Manchester Hospital Trust and the Greater Manchester Strategic
          Health Authority to reduce pressure on the Dental Hospital with the intention
          of encouraging patients to go to their local GDPs or access centres.
          Students were appreciative of the experience in dental casualty (currently 12
          sessions) and expressed the view that they would like to be allocated to
          casualty on a daily basis rather than in the morning only. We feel that the
          experience that dental undergraduates gain in dental casualty is extremely
          valuable and that this opportunity should be maximised.


                                            40
We appreciate that students would like more time in dental casualty, just as they
would like more time in many other clinical disciplines, especially the outreach clinics.
However we have to balance their clinical experiences across all elements of the
curriculum. We feel that the students‟ experience of seeing emergencies not only in
Dental Casualty, but also in the outreach clinics is sufficient exposure.

14.

      46. The teaching of medical subjects to dental students is supported by funding
          from HEFCE and Medical SIFT for dental students. The Dental Hospital
          received £765k Medical for Dental SIFT for the year 2003/4, £69k of which
          goes to the North Manchester General Hospital towards funding for two
          consultant posts, the remainder going to the Central Manchester Trust.
          Consultants in the North Manchester General Hospital requested that more of
          the available funding be spent directly on staffing of this programme.

The Medical for Dental SIFT allocation funds two consultant posts at North
Manchester, and one consultant post in the Dental Hospital. The remainder is used
to fund other clinical teaching posts within the Hospital.

15.

      47. Teaching in medicine and surgery runs from March of year three to January
          of year four………Feedback from students whom we spoke with about their
          time spent at the North Manchester General Hospital was variable with some
          positive and some who commented that they did not always feel that they
          were expected.

We are delighted that our students gave some positive comments on their medicine
and surgery course. The point about students not always being expected is in
common with most of the other Schools in the UK for their medicine and surgery
courses. However, the Undergraduate Programme Committee will feedback the
students comments to the team at North Manchester who will look at ways to rectify
the students‟ concerns.

16.

      55. Students attend outreach in groups of eight……..Students with whom we
          spoke to were appreciative of the teaching that they received in outreach and
          complimentary about the support and facilities available there. We commend
          the School’s understanding of the outreach philosophy and the innovative
          way that outreach is delivered.

We are pleased that the GDC Visitors commend our understanding and philosophy
of outreach and the way it is delivered. Our philosophy is outlined in Sections 4.1 and

4.2.

We feel that GDC point 55 seems to contradict to some extent the comment in
Section 4, GDC point 21 about treatment over an extended period.




                                           41
17.

      59. Clinical sessions in ……. We feel that there are gaps in clinical experience in
          the final year in oral surgery, oral medicine and orthodontics.

We agree with the Visitors as regards Oral Surgery and Oral Medicine and can
confirm that this will be addressed in the new curriculum. Meanwhile five sessions of
Oral Medicine have been scheduled into the current fifth year.
Regarding orthodontics, this is a continuum through years 3,4 and 5. In the fifth year
it is part of comprehensive oral care for children and there are no gaps in clinical
experience.

      60. Students and recent graduates with whom we spoke with felt that more
          clinical skills teaching in years one and two would be beneficial.

We agree with our students and recent graduates and the new curriculum will ensure
this occurs.

18.

      62. The student handbook….we feel that there is a lack of clarity on the levels of
          recommended clinical experience required in restorative dentistry in the
          programme, both in years 3/4 and year 5.

Recommended clinical experience is given in writing in the Handbooks. However,
we do agree with the Visitors that there is a historical issue here. In the new
curriculum we will be moving into levels of competencies which should address this
issue.

19.

      67. Students gain the majority of their experience in conscious sedation….. The
          GDC questionnaire of May 2000 on the teaching of pain and anxiety control
          showed that recent graduates felt that they had almost reached these targets,
          but subsequent staff changes may have compromised this achievement.

In the GDC‟s questionnaire on the Teaching of Pain and Anxiety Control, Recent
Dental Graduates (September 2000) it could be seen that Manchester Students were
1st equal for the number of IV sedations administered and 2nd highest for IHS
administered.

We did realise that if we were to maintain or even exceed these we needed a
dedicated member of staff to lead on sedation. Dr Mellor, Senior Lecturer and
Honorary Consultant, has just successfully completed his Diploma in Dental Sedation
and will now lead on conscious sedation teaching.

20.

      68. Core teaching in dental radiography and radiology……..We were pleased to
          note the good close-support teaching and reinforcement of skills in radiology
          and radiography.

We are pleased that the Visitors noted this. It links in with Sections 5 & 7 and our
support from the NHS.



                                           42
21.

      74. Because of the limited amount of interaction that takes place between dental
          students and dental hygienists and therapists, dental students do not gain
          significant experience of communication with these members of the dental
          team.

We would agree with the Visitors, please see Section 8 on how we are addressing
this. However, this issue is not unique to Manchester Dental School.

22.

      77. The programme aims to provide students with knowledge and understanding
          of the broad principles of scientific thought, including scientific design. The
          main pre-clinical part of the programme is entitled ‘Biological and Behavioural
          Basis of Dentistry’ and is delivered through PBL cases during years one and
          two. This course includes the biological and behavioural basis of medicine
          where is it relevant to dentistry. In each of the four semesters a particular
          area is focussed on: semester one – nutrition and digestion, semester two –
          cardiorespiratory fitness, semester three – defence, abilities and disabilities
          and semester four – development and metabolism. Although there is some
          input into the first two years by Dental School staff, there appeared to be little
          direct integration with the clinical curriculum.

Regarding the last reference we would agree with the Visitors. The new curriculum
will lead to major changes in this area and address this issue of integration.
However, we would like to point out that this is by no means unique to Manchester.

23.

      80. We could find little evidence of oral microbiology teaching in the first two
          years of the programme. There appears to be a shortfall in oral biology staff
          at the School. The loss of a teacher in Behavioural Sciences has caused a
          short-term problem this year. However, we were told of two new research
          appointments in oral biology which are due to commence at the start of the
          2004/5 academic year who will have an involvement in undergraduate
          teaching.

23.1

Oral microbiology is embedded in the whole five years of the BDS Programme. It
can be difficult to identify it as an individual “ology” as it is integrated into the
curriculum. We believe that there is as much oral microbiology in our programme as
on other BDS Programmes in the UK.

23.2

Because of the integrated curriculum and problem-based learning we do not
necessarily employ staff with specific “ologies”. Our staff teach across subjects.

23.3

We can confirm that two new full time staff in Basic Dental Sciences have been
appointed and are in post.



                                             43
24.

      85. The programme aims to ensure that students have knowledge and
          understanding of the profession’s wider responsibilities…..In our view there
          could be more teaching on the concept of the dentist as leader of the dental
          team.

Yes. We agree with the Visitors. This will be incorporated in our new curriculum.

25.

      91. Specific modes of assessment within the programme….However, these
          grades remain awarded by group teachers without moderation, except during
          Year 5 Integrated Restorative Dentistry case assessment.

These grades are now used as formative grades and immediate feedback given to
the students. We are going to ensure that only robust assessments can be used in a
summative manner.

26.

      42. The use of the in-course assessment grades to determine exemption from
          the 4th BDS Part two practical skills assessment is not moderated by external
          examiners. There is therefore no involvement of external examiners in the
          assessment of practical skills, except for those students who receive poor
          practical in-course assessment.

4th BDS Part one remains, but will simply be known as 4th BDS. Part two has been
discontinued.   Elements have been incorporated into the new Final BDS
Examination.

27.

      93. University examination regulations are available on the University website
          and assessment guidelines for dental students are included in the course
          handbooks and are available on the Dental School intranet. Recently, the
          BDS Part 3 examination was changed at short notice causing concern to
          some students.

Several months prior to the examination the students were consulted about the
proposed changes in format of the paper. The changes did not involve any
alterations in subject matter being examined, but a change from essay to MCQ
assessment. All students agreed and signed up to the change.

We hope that the GDC will not criticise us for making major changes to the Final BDS
Examination at short notice.

We have informed the students of the changes we are making to address the GDC
Visitation of Final BDS Examination of Manchester Dental School on 9, 10 and 11
June 2004. However, the final year students are understandably concerned.

28.

      94. We are concerned that the final assessment of many practical skills in
          Restorative Dentistry and of clinical skills in all other disciplines at the end of


                                              44
          year four is premature and note that BDS Part 5 only assesses practical and
          clinical skills by completed case presentations in Restorative Dentistry.

The new Final Examination in June 2005 will address this concern.

29.

      97. We were provided with a draft copy of the University internal five-year review
          report for 2004, which concerned the BDS, and BSc programmes. This
          recognised many areas of good practice and made some recommendations.
          Among other things, it suggested that the aims and objectives of the
          programme needed to be articulated more clearly, that the extension of
          practical work to year two should be implemented as soon as possible and
          should not await the outcome of the Curriculum Working Party, that the BDS
          curriculum needed to be more integrated and consideration be given to a
          ‘unitised’ course, that levels be introduced for the programmes to facilitate the
          measurement of student progression, that there should be more structured
          teaching of legal issues, and that a clear learning and teaching strategy be
          drawn up.

29.1

A new Programme Specification has been introduced which articulates the aims and
objectives more clearly.

29.2

The New Curriculum will address the extension of practical work in year 2. The new
curriculum will commence in September 2006.

29.3

A new Learning and Teaching strategy will be drawn up to fit with the strategy of the
Faculty of Medical and Human Sciences and the new University.

30.

      101. The current curriculum is at present being examined by a Curriculum
           Review Working Party. As part of its remit, this review is looking at
           introducing a practical dental component into year two, at increasing the
           focus of clinical sessions to whole patient care rather than subject based
           teaching, and evaluating the issues raised by the fact that some subjects
           are not taught in year five, so students can graduate without recent
           experience of these disciplines. The School states that the BDS course is
           gradually evolving into a five-year programme, and we were told on a
           number of occasions of the curriculum review taking place. We believe that
           a clear strategy about the pathway to change for the BDS programme must
           be developed.

The Curriculum Review Working Party has produced its document on the new
curriculum. This has been accepted by the Undergraduate Programme Committee
and the Dental Senior Management Team.

The Working Party has completed its task.



                                             45
There is now a Curriculum Implementation Working Group in place and working hard
to have the new curriculum in place for September 2006.

31.

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
(From Manchester Dental School to the GDC)

1. In their Final Report could the GDC also highlight the strengths and good
practices of UK Dental Schools.

2. The GDC revisits the issue of continuing care in the light of more dental education
and clinical experience being gained in Outreach. (81.TFFY)

32.

2.        To the Dental School

32.1

         Admissions procedures need to be reconsidered in the light of
          substantial over-recruitment with respect to the HEFCE quota for the
          School of 58 home students per year (14).

The issue of our student intake is presently being addressed by the Head of School.
The student intake will be modified according to the arrangement currently being
negotiated with the Department of Health and HEFCE.

32.2

         Staffing needs to be addressed, especially in Restorative Dentistry
          where a professorial post has been lost as well as other staff in that
          discipline (29).

This has been addressed in Section 6 of this Response.

32.3

         The concept of team dentistry needs to be developed further. The
          limited dental nurse support for students in the Dental Hospital should
          also be addressed, within the concept of the dental students’ interaction
          with PCDs (36 & 38).

This has been addressed Sections 8 and 9 of this Response.




                                         46
32.4

      Students should be given more opportunity to work in Dental Casualty
       through an increase in the number of patients admitted and an
       extension of opening hours.

This has been referred to in Section 13 of this Response.

Dental Casualty opens in the mornings. Increasing patients admitted in the morning
session would not benefit students as they already see the maximum number
possible on the session. Indeed this would lead to a detrimental learning experience
as they would be put under extreme patient pressures. The possibility of opening
Dental Casualty in the afternoon is being explored with the Head of Clinical Division.

32.5

      The development of the curriculum needs to be continued, with
       emphasis on continuing care for patients in paediatric dentistry,
       orthodontics and restorative dentistry over the three clinical years, and
       addressing the shortfall in the teaching of some clinical subjects in the
       final year (59).

Regarding continuing care for patients in paediatric dentistry and orthodontics we
have commented on this in Sections 4, 16 and 17. We believe that the many
benefits of our current learning and teaching experience for students in paediatric
dentistry and orthodontics outweigh the few benefits of continuing care.

Regarding continuing care for restorative dentistry patients treated in the Dental
Hospital; we have revisited the arrangements for these patients. We used to have 3rd
year patients, 4th year patients and 5th year patients. At the end of year 4 the
students had their patients reallocated and took on new ones. We have now
stopped this practice and the students will keep their adult patients throughout the
three years.

32.6

      Clinical skills and patient care should be introduced earlier in the
       curriculum (60).

This will be addressed with the new Curriculum. See Section 17 of this Response.

32.7

      Integration of the basic biomedical sciences with the clinical curriculum
       should be improved (77).

This will be addressed in the new Curriculum. See Section 22 of this response.

32.8

      The content of PBL teaching needs to be reviewed, especially with
       respect to Oral Microbiology and Oral Biology (80).




                                         47
In Section 23 of this Response we comment fully on this recommendation.

The new Curriculum will be looking at content through all the five years of the BDS
Programme.

32.9

        The in-course assessment of practical skills used for exemption of
         candidates from practical assessment in BDS Part 4 should be
         moderated by an external examiner (92).

Section 26 of this Response confirms that this examination has been discontinued.

32.10

        Clinical and practical skills in all major disciplines should be formally
         assessed later in the BDS programme (94).

This has been addressed in Section 28 of this Response.

32.11

3.       To the University

        The funding arrangements for the Dental School need to be reviewed,
         particularly with respect to the recruitment of students over the HEFCE
         quota (10 & 14).

This has been addressed in point 32.1

32.12

        The annual deficit must be addressed. It has varied from 250k to 500k in
         the last three years (10).

The School is currently in deficit mostly due to the loss of income that resulted in
dropping a grade at the last RAE. We are currently taking all possible steps to rectify
this situation. Furthermore, the creation of the University of Manchester and the
adoption of the University, Faculty and School‟s strategic plan will optimise income
generation that should also reduce the School‟s deficit.

32.13

        The review of the management arrangements needs to be concluded
         speedily and effectively in order to give direction to the further
         development of the Dental School (13).

This has been concluded and new effective management structures were introduced
on 1st October 2004. The Clinical Academic Groups have been abolished and we
have adopted a flat management structure with the School being managed along our
main activities of education and research. This change has been welcomed by most
staff. The appointment of a new Head of School and adoption of a School strategic
plan has given clear direction to the further development of the School.




                                          48
32.14

        Procedures for dealing with external examiners reports should be
         reviewed (96).

This has been done. The School and the Director of Undergraduate Programmes
will keep copies of External Examiner Reports, actions taken and responses sent to
Examiners.

32.15

4.       To the NHS Agencies

        A decision on the preferred option for dealing with the problems
         concerning the Dental Hospital building is required urgently (27).

The Head of School and Faculty Dean have attended meetings with the Trust to
ensure that progress is being made with this issue.

32.16

        The funding and contractual arrangements between staff employed by
         the Primary Care Trusts and Personal Dental Services engaged in
         teaching and supervising students in outreach centres, and the
         University, which is responsible for dental education, should be clarified
         (30).

We are unsure about what this recommendation actually means. We have studied
Section 30 of the Report of the Visitors but this does not give us any indication as to
what needs clarifying.

Could the GDC please clarify this recommendation?

32.17

        Proper disbursement and transparency of the Medical for Dental SIFT
         allocation should be achieved (47).

This has been addressed in Section 14 of this Response.

32.18

5.       To the Strategic Health Authority

        The Strategic Health Authority, having subsumed the responsibilities of
         the Workforce Development Confederation, needs to be actively
         engaged in all workforce issues concerning the dental team (42).

The Director of External Affairs for the School of Dentistry is in close contact with the
WDC and as a member of the SHA Workforce Planning Group he is able to ensure
that the Dental Schools outreach teaching plans and PCD education initiatives are
part of the SHA‟s overall workforce strategy.




                                           49

				
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