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7, 8, 9 & 10 FEBRUARY 2005




                LHMC DIP DENT THERAPY








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 four-day visit to the BDS programme of the
           Cardiff University Dental School1 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 examinations for the outgoing BDS curriculum. After the second visit has
           taken place, the visitors will make a recommendation to the Council on whether
           the programme and examination are „sufficient‟ (the term used in the Dentists
           Act) for the protection of patients.

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

6          After the reports of the BDS programme and final examination visits to Cardiff
           School of Dentistry 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.


7          The visit to Cardiff University Dental School took place on 7, 8, 9 and 10
           February 2005. We were welcomed by Professor M L Jones, Dean of the School
           and General Manager of the NHS Dental Service Group. During the visit we met

    The Visitors also inspected the Dental Hygiene and Dental Therapy programmes at Cardiff. There is a
    separate report on that provision.

      the Vice-Chancellor and senior members of University staff, senior members of
      the host Trust (Cardiff and Vale NHS Trust), the Chief Dental Officer for Wales,
      representatives of the National Assembly for Wales, 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 received are attached as Annex 2).
      We thank all concerned for their help, hospitality and courtesy during the visit.


The University

8     Prior to 1 August 2004, the teaching of dentistry in Cardiff was provided
      collaboratively by two constituent institutions of the federal University of Wales:
      Cardiff University and the University of Wales College of Medicine (UWCM). On
      1 August 2004 these two institutions merged to form the enlarged Cardiff
      University, within which there is a two-College structure. The partners in the
      provision of dental and related teaching and learning are the Dental School and
      the School of Biosciences; both are members of the Wales College of Medicine,
      Biology, Life and Health Sciences.

9     The newly merged Cardiff University comprises 28 Schools of study and has
      over 20,000 undergraduate and postgraduate students and a similar number of
      students pursuing courses in continuing education and professional
      development. There are more than 5,200 members of staff. The School of
      Biosciences and many of the major facilities of the University are sited close to
      the city centre on the Cathays Park campus but the Dental School and Hospital
      building is on the Heath Park campus, which includes the University Hospital of
      Wales and the Medical School, situated some two miles north of the city centre.

10    Although Cardiff University is no longer a constituent institution of the federal
      University of Wales, the BDS degree will continue to be awarded by the
      University of Wales for the time being through linked institution status and a
      memorandum of agreement. We were given to understand, however, that it is
      intended for Cardiff University to become the awarding body when formal
      arrangements can be completed.

11    The Wales College of Medicine, Biology, Life and Health Sciences is headed by
      the Provost, who provides the primary link into the administrative structures of
      Cardiff University. This role is particularly crucial in the immediate post-merger
      period because the University has had comparatively little previous experience of
      the requirements and complications of health-related courses and the associated
      interactions with the National Health Service. We were pleased to learn from both
      the Vice-Chancellor and the Provost of their strong support for the Dental School
      and for the leadership provided by the Dean. It was clear to us that the Dean of
      the Dental School had ready access to senior officers in the University and
      enjoyed their confidence. It is acknowledged by all parties that the recent merger
      of two large institutions has not resulted in a completely seamless transition to
      new administrative and managerial structures but we were impressed by the
      commitment to identify and implement best practice. We were concerned to
      learn, for example, that on a recent occasion the Dental School had not received

      a satisfactory level of human resources support from the University when making
      a new staff appointment. We noted that allocation of University human resources
      staff is currently being reviewed and that more support may be made available at
      School level.

12    Cardiff University‟s recognition of teaching excellence in its promotion
      procedures for staff is welcomed by the visitors. We trust that anxieties amongst
      some Dental School staff over the implementation of this principle will prove to be
      unfounded. A structured University Staff Development Programme is
      complemented by both the Dental School and the School of Biosciences
      providing specific staff development opportunities. Membership of the Higher
      Education Academy and further professional study are strongly encouraged.

13    The University receives funding for undergraduate dental education from the
      Higher Education Funding Council for Wales (HEFCW), together with income
      from tuition fees; this is subject to a variety of different top-slicing processes
      (between 25% and 39%) for the support of central costs within the University‟s
      internal resource allocation model before the remainder becomes available for
      the Dental School to manage. Income raised by the School from other sources is
      subject to a lower rate of top-slicing outside the formula allocation model and the
      School also has the opportunity to bid for certain central initiative funds. For the
      University‟s financial year 2004/05, the Dental School‟s income was calculated at
      £4256k and its expenditure at £4790k, representing a projected deficit of £534k.
      Although by January 2005 this had been reduced to £329k on account of
      additional income received, savings of a further £297k remain to be made. The
      latter include a notional £60k to be transferred to appropriate departments
      outside the Dental School for the teaching of Human Disease, representing a
      reduction from the £300k allocated annually for this purpose prior to merger and
      previously held within the Medical School annual budget.

14    We were informed that the University‟s strategy is for all of its 28 Schools to be in
      balance within five years and that in discussions with the HEFCW it is making
      strong representations to obtain increased income for dentistry by increasing the
      unit of resource for the second year of the programme to the clinical level of
      resource used for subsequent years of the programme (as is the case for English
      schools). There is also a case being made by Cardiff University for the general
      unit of HEFC resource for dentistry to be increased for all of the clinical years.
      We strongly support these efforts to recognise the true costs of teaching dental
      students. One aspect which an estate allocation model accounts for is physical
      space requirements for each School. The model indicates that the Dental School
      needs to expand beyond its existing physical site.

The Dental School

15    The last GDC visit to the BDS programme took place in 1994. Since this date
      the GDC has engaged in two follow-up monitoring exercises, one in 1996 and
      another in 1999. The Final BDS examination was visited in 2000. In addition the
      GDC visited the (then titled) Dental Auxiliary School in 1999.

16    Currently the Dental School is divided into three departments: Adult Dental
      Health; Dental Health and Biological Sciences; and Oral Surgery, Medicine and

     Pathology. The Board of Dental Studies, chaired by the Dean, oversees all
     aspects of the management of the BDS programme. The Executive Committee of
     the Board, linking to the Dental Strategy Co-ordinating Group, ensures focused
     strategic overall School and Service Group management.

17   There are currently 294 students on the BDS undergraduate dental programme
     (this includes five students on the Preliminary Year programme – see paragraph
     19 below). Until recently the School has normally aimed to admit annually 54 UK
     and EU undergraduate students funded by HEFCW and four overseas students.
     In addition, in the current academic year the Welsh Assembly Government
     (WAG) has funded a further nine undergraduate places. At the time of the visit it
     was unclear whether this additional 2004/05 WAG funding would become
     recurrent. In addition the School has a current cohort of eight Dental Hygiene
     students, nine Dental Therapy students and around 30 taught Masters and
     research students. Further expansion of dental and Professionals
     Complementary to Dentistry (PCD) student numbers forms part of the School‟s
     strategy. Accommodation resources are a major issue for the ongoing delivery of
     the BDS programme. Whilst this is in part being addressed through the
     development of outreach teaching, additional central accommodation provision
     (particularly teaching rooms for small groups) needs to be planned in line with the
     proposed expansion of student numbers. Several staff recruitment and retention
     initiatives were noted during the visit; these also clearly need to address the
     resource issues that expanded student numbers present.

18   The BDS programme is in transition, between the final year (2004/05) of the
     outgoing curriculum (current BDS Year 6 students) and the revised curriculum
     (current BDS Year 0 - 4 students). The visitors were provided with
     comprehensive documentation about the new revised curriculum, which was
     consistent with The First Five Years, but had less information about the outgoing
     programme. We understand that there have been several difficulties for the
     School while the two curricula have been running together but that good liaison
     and co-operation between Heads of Departments and theme leaders has helped
     to overcome most of these. We were not so convinced, however, that more junior
     academic staff, support staff and students had always been kept as informed as
     they would have wished, or needed, in respect particularly of late changes to the
     programme or timetables. The School should review the effectiveness and
     timeliness of its internal cascade of information.

19   The outgoing BDS programme is five years in duration with an additional pre-
     dental year (1st BDS) for a small number of students without the traditional
     science based A levels Students following this route undertake modules in
     Chemistry, Biology and Mathematics and an optional module such as Physics.
     The pre-clinical programme (2nd BDS) is of one year duration and is organised
     and delivered by the School of Biosciences. The central themes of the pre-
     clinical programme are Anatomy, Biochemistry and Physiology.          The clinical
     dental programme (3rd, 4th, 5th and 6th BDS) runs for four years and is organised
     and delivered by the Dental School, with additional outreach teaching taking
     place across Wales. This programme continues to teach basic dental sciences,
     which are integrated with the clinical components of the programme. The
     majority of teaching in the first clinical year (3rd BDS) is undertaken in the
     Phantom Head and Prosthetic Laboratories as students follow the Conservative

     and Prosthetic Dentistry courses. Clinical exposure to patients begins with
     complete denture cases in the February of the 3rd BDS year and then continues
     in Operative Dentistry in June of the same year. Following this, students proceed
     to treat patients in Restorative Dentistry, Paediatric Dentistry & Orthodontics,
     Oral Surgery, Oral Medicine, Radiology and in the Exam and Emergency clinic.
     In their final years students develop clinical skills in a number of outreach
     programmes organised by community dental clinics, district general hospitals and
     general dental practices; these are designed to broaden the range of clinical
     material to which students are exposed and enable them to gain more
     experience in treating child and adult patients.

20   The pre-dental year is modular and all compulsory modules must be passed in
     order to proceed to the pre-clinical year. During the pre-clinical year, students
     are assessed through in-course assessments, coursework and end-of-year
     examinations. During the clinical years students are assessed continuously,
     grades being collated twice a year by departments under the categories of
     Academic Ability, Manual Skill and Professional Attitude. Departments
     accumulate information regarding students‟ progress from written assignments,
     periodic class tests, attendance on clinics, attitudes to patients and staff,
     performance during seminars and through the quantity and quality of laboratory
     and clinical work. Students are assessed prior to entry onto clinics in order to
     determine their fitness to treat patients, with the major assessment being
     conducted in 3rd BDS as part of the Operative Dentistry course. Professional
     written and clinical examinations are held during the clinical years.

21   The visitors welcomed the School‟s decision to radically change what had
     become a rather old-fashioned course of study, lacking integration, but had no
     particular concerns about its general content.

22   The revised curriculum is taught via five theme areas (Foundation; Oral
     Ecosystem; Human Diseases; Clinical Dentistry; and Dentistry in The Wider
     Community) delivered across the School of Biosciences and the three Dental
     School departments. The theme approach was developed to achieve a more
     integrated overall curriculum outcome supported by staff theme panels, which
     have replaced distinct department-based curriculum development and delivery.
     Year 1 students are largely based at the School of Biosciences for the beginning
     of the Foundation theme, which introduces the basic dental sciences. Clinical
     observation begins at the Dental School and key administrative and conceptual
     aspects of the Clinical Dentistry theme are introduced. The Oral Ecosystem and
     the Dentistry in the Wider Community themes also commence in Year 1. A
     substantial IT component in Year 1 concludes with completion of the European
     Computer Driving Licence in Year 2. These curriculum themes continue
     throughout Year 2, when the Human Diseases theme commences. Clinical
     Dentistry, already a substantial curriculum component in Year 2 and where
     integration with dental hygiene and dental therapy students begins, becomes the
     central component in Years 3 and 4. Dentistry in the Wider Community continues
     throughout Years 3 and 4, focusing specifically on dental public health, statistics
     and a family study. Further outreach experience (which includes visits to general
     dental practices) and clinical practice are the main focus of Year 5. Final year
     research projects (which replace the elective projects of the outgoing curriculum)
     are School-based for revised curriculum students. Students expressed concern

     that elective options, as detailed in the School prospectus, were not actually
     available to them.

23   A key aspect of the revised curriculum is the linkage of curriculum learning
     outcomes to competency statements. These statements, which cover all clinical
     aspects of the curriculum, address The First Five Years and QAA Dentistry
     benchmark statement requirements. Students are assessed on these
     competencies by both Objective Structured Clinical Examinations (OSCEs) and
     Structured Clinical Operative Tests (SCOTs) throughout the BDS programme.
     The intention of the programme is that the final BDS written examinations are to
     be taken at the beginning of Year 5, with a Final Year Project being assessed in
     April of the final year and clinical examinations at the end of final year.

24   A central objective of the revised curriculum is to allocate self–directed and
     directed self-study time amounting to approximately 25% of the BDS timetable
     for each year of study. Foundation theme staff thought self-directed learning time
     was well used and that it released time for more individual student support and
     led to students producing high quality project work. Perception of students in later
     course years was that self-directed learning was not clearly identified within the

25   In the remaining sections of this report references to the BDS programme relate
     to the revised curriculum.

26   The visitors noted and welcomed the School‟s intention to reintroduce a Dental
     BSc intercalated programme in the 2005/06 academic year. There is existing
     provision for students to leave the BDS programme with a BDSc on completion
     of three years of study (following completion of the academic component of the
     Intermediate BDS exams). This is an appropriate mechanism.

27   The Dental School and Hospital building was opened in 1966. The external
     appearance is now showing signs of age but internally the facilities have been
     well maintained. Locker rooms and showers have recently been refurbished. The
     main non-clinical facilities include the two lecture theatres with capacities for 80
     and 220 students. Seminar room space is at a premium in the building. The
     teaching environment is well supported with IT facilities, dental teaching and IT
     combining with the eight new DenSim phantom head units. Some phantom head
     teaching in Periodontology is carried out in the temporary annex where phantom
     heads are fitted to dental chairs and dental students are paired with a hygiene or
     therapy student.

28   The Brian Cooke Dental Library is an excellent resource, reopened in its fourth
     floor location in July 2000, with 70 reading places and 36 computers in a
     dedicated IT room. There is a substantial stock of hardcopy and electronic
     journals. The library is open from 9 am to 5.30/6.00 pm each weekday, it is
     closed at weekends. In addition, study facilities on the Heath Park site are
     available at the 24-hour Duthie Library. It was noted that library resources for
     BDS students are under greater pressure given the emphasis in the revised
     curriculum on self-directed learning and individual student research. The
     dedicated Dental Library plays a crucial role in facilitating self-directed learning in
     the Dental School.

29      The School of Biosciences is situated at the Cathays Park campus. This facility
        includes five large lecture theatres. There is a well-resourced human dissecting
        room and substantial laboratory space, including a large physiology laboratory
        with good IT support. The School also houses a Teaching and Learning
        Resource Centre which includes two IT rooms, each comprising 30 computer
        terminals. It was noted that whilst many other University students access these
        facilities, Dental School students have sufficient allocated use. Library facilities
        for BDS students at the School of Biosciences would in future be limited to core
        course book resources only.

30      Academic, clinical and technical support staff at the Dental School, the School of
        Biosciences, the various outreach centres, visiting general practitioners and
        related School of Medicine staff are clearly committed to the BDS programme
        and motivated to review, refine and develop it. Eighteen Community Dental
        Service staff contribute to outreach teaching. An appropriate balance of staffing
        has been maintained across the BDS programme despite the departure of five
        senior staff since 2000. Nonetheless the current staff age profile indicates that
        over a third of senior clinical academic staff posts could be vacated over the next
        five years. The School is planning ahead to address these challenges,
        specifically through a recruitment and retention strategy but also through detailed
        reviews of staff post requirements, integration of dental team teaching and
        through CAL and remote-learning resources.

31      The School works closely with the Regional Postgraduate Dental Dean to assist
        with vocational training across Wales. Vocational Trainers have effective
        opportunities to meet BDS students in both Years 4 and 5. There is good
        communication between the School and the Trainers, including meetings to
        discuss any particular concerns. However, students find the arrangements for
        applying for VT placements problematic and seek a clearer, better planned,
        application process.

     The Dental Team

32      Students focus on team-working issues specifically during BDS Years 1 and 2 in
        the Clinical Dentistry theme. Combined BDS/Dental Hygiene and Therapy
        student clinical experience in periodontology starts in Year 2. However,
        opportunities for BDS students to study or work with other dental team
        professionals or students are limited. In some cases, whilst BDS students and
        PCD students may be in the same lecture theatre or clinic, there is little
        stimulation for them to engage educationally with each other. In particular there
        are very limited opportunities for BDS students to work with dental nurses at the
        Dental School. There is an over-reliance on „student pairing‟. Although we were
        informed that the dental nurse establishment is acceptable, students and recent
        graduates did not appear to have received the level of dental nurse support that
        such a statement would indicate.

33      PCD teaching and support staff appear a degree removed from BDS curriculum
        planning and development. Opportunities to maximise integration of dental and
        PCD student teaching and learning are therefore being missed. This includes
        resources to deliver team-focused training, which may not be being utilised as

        efficiently as they otherwise could be. With on-site training of dental nurses,
        hygienists, therapists and technicians taking place there should be further
        opportunities to broaden BDS curriculum dental team experience. A notable
        exception to these aspects of Cardiff provision is the very positive experience of
        team working which Year 4 and 5 students in particular obtain at the Primary
        Dental Care Unit at St David‟s Community Hospital in West Cardiff.


     NHS Trusts

34      Cardiff and Vale NHS Trust is the Dental Hospital‟s host Trust. The joint
        Trust/School Dental Strategy Coordinating Group (DSCG) oversees both
        provision of Trust dental services and BDS programme delivery. Group members
        include the Dean and the Vice Deans and Heads of Departments of the School.

35      Trust representatives sit on the Executive Committee of the Board of Dental
        Studies, which oversees School financial and strategic management. Trust
        representatives were supportive of the present arrangements combining the dual
        role as Dean of the Dental School and General Manager of the Dental Service
        Group. Visitors noted the positive working relationship which exists between the
        Trust, the School and Cardiff University. This is manifest, for example, in access
        for NHS Consultants and other NHS staff to University Staff Development
        opportunities. Trust funding for the dental services is allocated on a five-year
        revenue and capital planning cycle. We were told that the Trust expects to
        finalise its post-merger strategy for dental services with the University by summer
        2005 and that this would include its strategy for dental services.

36      The wider Trust financial environment is problematic. Visitors were concerned to
        note that there is a 3.1%/£15M revenue shortfall across the Trust for the financial
        year 2005/06 but received assurance from Welsh Assembly commissioning
        representatives that the efficiency savings required of the Trust would not
        undermine dental service funding. In particular we were told that transparent and
        equitable funding arrangements would continue. The Dental SIFT budget
        remains ring-fenced within the wider Trust.

37      For the year 2004/05 the allocation of Dental Service Increment for Teaching
        (DSIFT) is £7.605M. Medical SIFT for Dental Students (MSIFT) is not defined.
        The visitors understand that the Human Resources Division of NHS Education
        and Training Wales is investigating what proportion of total SIFT monies should
        be allocated to the Dental Hospital in respect of MSIFT. If an MSIFT allocation is
        to be made, it will initially be made in the 2006/07 School budget year. In
        addition, visitors were advised that further Capital SIFT monies will be allocated
        to the School in the 2006/07 budget year to address short and medium-term
        space needs. A sub-group of the DSCG, the Dental Capital and Equipment
        Strategy Group, is responsible for the allocation of rolling re-equipment Trust
        funding of £0.5M. This funding may be used to upgrade estate as well as plant.

38      Overall the Dental Hospital clinical facilities are of a good standard. Despite clear
        space constraints ongoing capital funding is ensuring that plant and the estate,
        within existing physical limits, are well maintained, a wide range of clinical

      facilities having been recently refurbished or added. In particular the visitors
      noted the recent sedation suite addition, housing 6 dedicated RA sedation units.
      The visitors welcomed the School‟s intention to refurbish the Skills laboratories
      and the Oral Health Clinic in the near future. The visitors noted student concern
      at the limited dental hospital access to patients with active dental disease. In
      addition students questioned the efficacy of patient screening for the optimum
      allocation of patients to 4th and 5th year students.

Provision for Human Disease Teaching

39    Human disease teaching by Medical School staff was previously funded through
      HEFCW. Pre-merger, UWCM applied a £300K top-slice to HEFCW dental
      funding which was transferred to the Medical School. In addition there should be
      additional funding to support the Human Disease programme theme through
      MSIFT. Clarification of the future University and Trust funding arrangements for
      the Human Disease theme is required.

40    The Human Disease theme runs throughout Years 2 and 3 covering medical,
      pharmacological, pathological and surgical topics. Students attend lectures and
      undertake self-directed learning in addition to having the opportunity to attend the
      local Accident and Emergency department and to see patients on the wards.
      Students receive no human disease teaching in a clinical skills laboratory.

41    The visitors understood that 2004/05 was the first year in which a revised
      curriculum Human Disease theme had run. Assessment of the theme material is
      primarily via Multiple Short Answers (MSAs) and an OSCE.

42    Diagnosis of medical disorders, medical emergencies and interpretation of
      findings from a medical history are taught primarily by lecture. Students‟
      experience of lectures in the Human Disease theme was that these varied in
      quality. The dental relevance of some specific lectures was not always clear to
      them and they estimated that about one-quarter of those scheduled were not

43    Visitors were advised that observational opportunities in Accident and
      Emergency and on the wards delivered far less experience to students than they
      had anticipated and opportunities for examination of patients (other than dental
      patients) with respect to systemic disease were very limited. It was not clear
      whether all students had the opportunity to attend all of their designated on-site
      hospital visits. Experience of on-site hospital attendance varied and staff were
      not always able to receive the students adequately nor to engage with and
      monitor them in a meaningful way. However, Accident and Emergency
      Consultants‟ enthusiasm to contribute to this theme was evident to the visitors.
      The student experience indicates an unstructured and largely observational
      approach in relation to their interaction with patients who have systemic
      diseases. The visitors were also told that little discernable change had occurred
      in response to earlier student feedback. The students‟ experience of all aspects
      of the Human Diseases theme needs to be more carefully and more closely
      monitored against the intended learning outcomes and the effectiveness of
      course delivery. The School should give high priority to a review of the Human
      Diseases theme.


44       At the Dental Hospital sterilisation of instruments, including those used by BDS
         students, is undertaken at a recently refurbished Dental Sterilisation and
         Decontamination Unit (DSDU). Existing small clinic-based sterilisation units are
         in the process of being withdrawn. There is a computerised traceability system
         for instruments. Some small autoclaves have been retained in the DSDU for
         training purposes. In CDS facilities used for outreach, teaching of sterilisation of
         instruments is carried out by means of small autoclaves.

45       Cross-infection control is taught and assessed at a two-day symposium for BDS
         and PCD students. For BDS students, this symposium forms part of the Year 2
         Clinical Dentistry theme.

The Extended Clinical Environment and Outreach Teaching

46       Outreach is a substantial feature of the Cardiff BDS programme, encompassing
         clinical treatment at up to 12 Community Dental Service (CDS) centres and the
         St David‟s Hospital Primary Dental Care Unit; students also observe at a number
         of local general dental practices. Of the CDS outreach centres utilised by BDS
         students, most are in the area covered by Cardiff and Vale NHS Trust with the
         most distant being Wrexham. (The outreach centres are detailed at Annex 2 to
         this report). The Cardiff and Vale Trust Community Dental Service is overseen by
         the Dental Service Group, of which the Dean is General Manager. Therefore the
         majority of Community Dental Service outreach provision is accountable to the
         Dean of the School. Currently no charge is made to the Dental Hospital for
         provision of these outreach resources for students.

47       Student numbers attending these centres vary from one to twelve or more from
         Year 4 and Year 5. Outgoing curriculum students attend two-week blocks of
         outreach. Block attendance in outreach is also planned for revised curriculum
         students who currently attend for one to three sessions weekly, according to their
         Year 4/Year 5 timetable. In addition, larger facilities such as St David‟s also
         accommodate students from earlier years of the programme undertaking

48       Access to a breadth of patient cases is uneven across the outreach sites.
         Students are supervised either by hospital staff or by Senior Dental
         Officers/Dental Officers in CDS Centres. It appeared to the visitors that
         supervision and assessment of students was not always consistent with that in
         the dental hospital. The School should take further steps to develop consistency
         and integration in the educational practice and philosophy of those who
         supervise and assist the dental students. Individual student attendance and work
         undertaken is recorded on a standard host Trust pro-forma, of which the School
         receives a copy. In addition the School is advised, on an „exceptional reporting‟
         basis, of instances of excellent or poor performance by students.

49       Facilities at outreach centres were of at least a satisfactory standard at all sites
         visited. It was noted that a number of centres were due for refurbishment or
         replacement by a new facility. Information on cross – infection control procedures

       and sterilisation facilities was sought at all centres visited and found to be

50     The visitors especially commend the St David‟s Community Hospital Primary
       Dental Care Unit. This is a state of the art facility with twelve teaching units and
       two community surgeries. Estate, plant and staff offer students an excellent
       supervisory and learning experience, especially of team working and treatment
       planning. This facility is funded separately from other host Trust Dental Services,
       as an extra Dental SIFT allocation from the Welsh Assembly Government.
       Visitors noted that travel to outreach centres was often left to students to
       organise individually. They therefore missed out on the efficiencies which small
       to medium group travel would offer.


51     The aims and outcomes of the current programme are clearly set out in the
       Learning Outcomes for each year of the curriculum and in individual Course

52     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

53     Clear documentation is available to staff and students outlining the intended
       learning outcomes and specific competencies required in respect of clinical skills:
       these are in line with The First Five Years. The revised curriculum is organised
       by theme rather than by department, permitting closer integration of disciplines.
       The Clinical Dentistry theme starts in Year 1 with observational attachment to
       clinics and continues through the course, although students‟ first clinical
       treatment of patients does not occur until the latter stages of Year 2. Clinical
       attachments are organised longitudinally.

54     The basic skills of history taking and examination are learned by clinical
       observation in Years 1 and 2, backed up by lectures, seminars and ongoing
       clinical experience.

55     Visitors were advised that students in Years 1 to 4 have all received annual
       practical instruction in cardiopulmonary resuscitation. Experience of the current
       Year 5 students, however, had been confined to one or two exercises during their

56     Aseptic technique and infection control are taught partly by observation in early
       parts of the course and more formally in the Human Disease theme. Students are
       instructed in the use of small autoclaves available in some departments and in
       the outreach setting. Visitors saw evidence that appropriate emphasis is placed
       on infection control throughout the course.

57   Integration of clinical restorative disciplines is taught from Year 3, but is
     reinforced in outreach facilities, particularly at the St David‟s Primary Care Dental

58   Fitness to start clinical work on patients is determined partly by sessional
     assessments in Years 1 and 2 but also by specific tests of competence following
     Periodontology and Operative Dentistry technique courses in Year 2.

59   Within the dental school clinical performance is monitored sessionally. Visitors
     gained the impression that in some of the smaller outreach clinics, ongoing
     monitoring and reporting of activity and performance is not always consistent with
     procedures in the Dental Hospital.

60   Clinical skills are formally assessed against a detailed list of competencies in a
     variety of clinical competency tests throughout Years 2 to 5. Each of these tests
     must be passed if a student is to progress. At present there is little central
     coordination of these assessments, which have varied titles and structures, but
     visitors were advised that adverse student performance would be reported to and
     reviewed by the Academic Review Committee. Visitors acknowledge that such
     tests may reasonably vary from one clinical area to another.

61   Students are required to make case presentations and to monitor their own
     activity and skill level in personal portfolios. Portfolios reviewed by visitors
     displayed a varied level of detail of information recorded, suggesting that not all
     students have fully embraced this approach to personal development. Students
     also expressed some concern that despite a competency test in Oral Surgery,
     they were still expected to perform a specific number of procedures after passing
     the test; the justification for this requirement may need to be clarified with the

62   There are Objective Structured Clinical Examinations in Years 2 and 3, with a
     „Spotter‟ examination in year 1, as well as a separate OSCE       for Human
     Disease. These end-of-year examinations must be passed for a student to
     progress to the next year.

63   The variety and style of summative assessments of clinical skills are

64   Adequate clinical time and numbers of patients are available for the development
     of a satisfactory level of skill in the restorative disciplines, but visitors are
     concerned at the apparent proportion of their clinical time for which students
     assist each other. Whereas there is some benefit to be derived from the
     observation of a colleague undertaking clinical work and from learning the skills
     necessary for the dental nurse, there is no substitute for a student undertaking
     the clinical work themselves. There would be benefit if students spent more time
     being assisted in their operating by dental nurses. Visitors urge the school to
     review the balance of direct clinical work to assisting for clinical students.

Practical Procedures

65     Students learn practical operative techniques in restorative dentistry,
       orthodontics, paediatric dentistry and local anaesthesia beginning in the Clinical
       Dentistry theme in Year 2 and running through Years 3 and 4.

66     Oral Surgery is comprehensively addressed in Years 3 and 4, initially through a
       symposium in Year 3 and through the development of clinical competencies in
       Year 4.

67     Students commence Prosthodontics in Year 2 with extended theoretical learning
       and clinical competency development in Years 3 and 4.

68     Introduction to periodontal (and operative dentistry) skills occurs in laboratory-
       based skills courses in Year 2 (jointly with Hygiene and Therapy students). The
       laboratory is reasonably equipped for the purpose and there have recently been
       installed eight sophisticated model systems that permit recording and viewing of
       the operator‟s action from a variety of directions. This is likely to be a valuable
       resource in developing students‟ and staff abilities to judge skills.

69     There is satisfactory teaching of the skills for removal of teeth, minor oral surgery
       and orthodontics.

Patient Investigation

70     By the end of Year 4 students are expected to be competent to make suitable
       and effective arrangements and plans for the investigation of patients.

71     Teaching of radiography and radiology is thorough and uses mixed teaching
       methods including 10 sessions attached to the radiology department, with
       opportunities to practise radiographic technique on a manikin and take a range of
       radiographs on patients. Every radiograph taken by a student is assessed and
       students keep a logbook of their experience. The course is examined by multiple
       short answer questions and OSCEs. There is experience of digital radiography
       both at the Dental Hospital and at the St David‟s Primary Care Dental Unit.

Patient Management

72     Clinical experience of inhalational and intravenous sedation is gained in
       attachments to the well-equipped Sedation Unit and in the outreach attachment
       at Wrexham. Some experience of inhalational sedation is gained at other
       outreach facilities. There is a high level of RA and IV sedation staff support.
       However, the visitors gained the impression that although hands-on experience
       of inhalational sedation was adequate, students had rarely given intravenous
       sedation or treated patients sedated in this way at the Dental Hospital.
       Experiences at Wrexham seemed to have been entirely positive. Treatment of
       patients under general anaesthesia is very limited.

73     Student experience of access to relevant patients was that this was weaker at
       the Dental Hospital (despite a central waiting list system) but much better at the

      St David‟s facility and at some of the outreach sites. The “clinical families”
      approach to patient management may alleviate these patient access problems.

Health Promotion and Disease Prevention

74    The Dentistry in the Wider Community theme is undertaken throughout the five-
      year programme. The theme includes Dental Public Health, a Family Study and
      Statistics. While the Family Study is an innovative aspect of the module, it has
      proved to be difficult for many students to make appropriate arrangements with
      their allocated family so that they can complete this project. Monitoring and
      evaluation of the outcome of the Family Study component are clearly important

75    Students experience a variety of placements external to the Dental School giving
      the opportunity for them to be exposed to the provision of healthcare in the

76    Preventive techniques are taught jointly with students of Hygiene and Therapy.
      The dental students informed us that aspects of health promotion arose regularly
      through the programme but they were not aware of any formally designated
      teaching sessions under this title apart from one epidemiology lecture. However,
      the Visitors were shown a timetable for lectures and seminars which appeared to
      cover this subject satisfactorily.


77    The programme gives ample opportunity for students to develop their
      communication skills with patients in a variety of settings. These opportunities
      are especially evident in the Clinical Dentistry and Dentistry in the Wider
      Community themes. It is clear that students are thoroughly engaged in BDS
      programme appraisal with staff, which in turn develops student communication

78    The students and recent graduates we met were able to communicate well and
      this was a view supported by vocational trainers and outreach teachers.

Data and Information Handling Skills

79    Cardiff graduates are expected to be competent in all basic aspects of modern
      data and information access, handling, management and presentation. At the
      start of the BDS programme students receive a comprehensive introduction to
      library and IT resources available to them at Cardiff University. All Year 1
      students have their computer competence assessed. Students undertake all
      modules of the European Computer Driving Licence (ECDL) in Years 1 and 2 in
      addition to online medical and dental database training (eg Statistics and Data
      Analysis in Year 3). Overall, students acquire good data handling and IT

80    It was noted that despite the comprehensive IT infrastructure available to
      students there were heavy demands on the availability of IT resources, especially
      at the Brian Cooke Dental Library at the Dental Hospital.

Understanding of Basic & Clinical Sciences and Underlying Principles

81    The Foundation theme teaching is very well organised and is largely based on
      didactic lectures with little problem-based learning. Allocation of self-directed
      learning time has led to more individual consultation between students and staff.
      There is good tutorial support for students and we were told that students
      produce superb projects. They work on these projects in groups and some
      students find it disappointing that marks are awarded to the group as a whole
      rather than on an individual contribution to group work. There is only occasional
      involvement of basic science teachers in Years 2, 3 and 4 but it is planned that
      they should be heavily involved in the final year projects. Teaching in anatomy,
      which involves comprehensive dissection classes, was particularly commended
      by the students.

82    Core mechanisms related to human disease are taught in second year almost
      entirely by lectures; there are now no practical classes in pathology or
      microbiology. Dental Biomaterials is taught in the revised curriculum as a
      component of the Clinical Dentistry Theme from Year 2 onwards.

Appropriate Attitudes, Ethical Understanding and Legal Responsibilities

83    Students showed a good understanding of the legal and ethical obligations of
      registered practitioners and of the dental team. In particular they understood and
      were aware of patients rights regarding confidentiality, informed consent, and of
      how to deal with comments and complaints

84    The Clinical Dentistry theme and, especially, the Dentistry in the Wider
      Community theme address these areas fully over the course of the programme.

Appropriate Decision Making, Clinical Reasoning and Judgement

85    Statistical method and the application of an evidence-based approach are taught
      in the theme entitled Dentistry in the Wider Community and by project work at a
      number of points in the course. It is expected that the final year project for the
      revised curriculum will help to crystallise learning in this area.

86    Integrated restorative dental care is taught from Year 3, but there are also
      separate allocations of students to individual clinical departments during Years 3
      and 4. Opportunities to extend skills in comprehensive oral care are more
      prominent in Year 5 with attendance at the St David‟s Primary Care Dental Unit
      and other outreach sites. Visitors were impressed that these approaches are
      valued by students and teachers alike.

87    Clinical decision making is assessed in OSCE examinations and in the clinical
      components of written examinations.

Professional Development

88    Students begin to address the requirements of professional working practices in
      Year 1. GDC guidance in this area is particularly covered in Years 1 and 2 of the

89    Students showed an understanding of the professional standards and regulatory
      functions which will underpin their registration with the GDC.

Personal Development

90    Personal development is recognised as an aim of the revised curriculum. A
      significant proportion of the programme in each year is intended for self-directed
      learning, encouraging a mature approach to personal development and the
      habits required for lifelong learning. However, it is not always clear to students
      where time for this activity has been identified amongst their other scheduled

91    Students experience a variety of teaching methods helping them to develop and
      enhance an enquiring approach to learning. They undertake projects in small
      groups in the first year, encouraging teamwork and the Family Study offers
      individuals the opportunity to work independently in a community setting.
      Reflective logbooks are used in each department but could be more effective by
      being integrated across all disciplines and departments, including in outreach

92    Students have limited opportunities to work with all members of the dental team
      in the Dental School.


93    Documents available to students prior to admission are attractive and
      informative. There is also information available on the website and the School
      holds two Open Days each year. Course year booklets are supplemented by
      documents for individual courses: these documents include intended learning

94    The Academic Review Committee receives termly assessments of performance
      of all students in all areas and develops overall judgements on their progress,
      distinguishing those who are making satisfactory or good progress, those who
      require remedial action and those whose progress is causing serious concern.
      Reports of unsatisfactory progress causing serious concern are reported to the
      Academic Progress Committee. All individual reports are made available to
      relevant tutors and students themselves.

95    The Dental School has a robust procedure to provide pastoral and academic
      support. On arrival each student is allocated tutors both within the Biological
      Sciences Institute and in the Dental School. The former is predominantly for
      academic purposes, while the latter covers both academic and pastoral support
      and is kept for the whole course. Students are expected to meet with their tutors
      each term after the Academic Review Committee meeting and to discuss the
      contents of their portfolio. Students value the support of tutors but also feel free
      to discuss matters with other staff members. Visitors gained the impression that
      great effort was made to maximise the feeling of integration of Year 1 students
      with the remainder of the Dental School. There is also a scheme run by the

      Dental Students Society by which new students are paired with more senior ones
      for initial support.

96    The University‟s Student Advisory Unit can provide support to all students. The
      Students‟ Union also offers welfare support.

97    There is excellent, enthusiastic support for students in terms of library services
      and information technology.

98    The School offers opportunities for international exchange under the Erasmus
      scheme to a variety of countries in the final year. Visitors were able to review
      reports from students who had taken this opportunity in the last three years. For
      the most part these students had clearly valued highly the experience they had
      obtained and the degree of support they had found locally. A few reports
      indicated poorer organisation in the host country and possibly less than ideal
      preparation by the Dental School before students departed. For instance,
      students arrived in Paris not realising they required specific insurance for
      undertaking clinical work, whereas Scandinavian visitors at the same site came
      with that insurance in place. The Dental School is aware of these problems, but
      should ensure that every effort is made to support students on overseas
      placements, particularly if large numbers of students are going to a variety of
      places for a period of months. The School must continue to assure itself that the
      specific learning objectives of these visits are met for all students.

99    A Careers Symposium is held in the final year and there are opportunities for
      students to discuss their career choices with the Associate Dean for General
      Professional Training, whose office is within the Dental School.

100   Progression rates for students on the revised course over the past four years
      have been extremely good, with only two withdrawals and five students deferred
      to the following year due to academic failure. There were seven withdrawals and
      two deferrals for personal reasons over the same period. This represents a good

101   The Bachelor of Dental Science degree that is available at the end of Year 3 to
      students who have failed to achieve the required clinical standard, or who did not
      wish to pursue clinical dentistry, has been awarded to two students over the past
      10 years. This is a valuable provision, allowing students to leave the BDS
      programme before completion but with something to show for their academic


102   University and Dental School regulations were provided in documentation for the
      visitors. Assessment details for each year of the course are set out in the yearly
      Coursebooks. A breadth of formative and summative assessment mechanisms is
      detailed. The linkage of revised curriculum learning objectives to competency
      statements, and the assessment of these, is addressed at paragraph 23 above.

103   The Academic Review Committee process for monitoring of formative
      assessments was noted by the Visitors.


104   Through the Dental Academic Quality Assurance Committee, the Board of Dental
      Studies was previously linked into the UWCM‟s Academic Standards and Quality
      Committee. It is expected that similar institutional quality assurance may operate
      through Cardiff University‟s Annual Programme Review and Evaluation process,
      linking internal School quality assurance to the University‟s Quality Assurance
      Committee. The School‟s Dental Teaching Committee and Departmental
      Teaching Committees report to the Board of Dental Studies. In the „revised‟ BDS
      curriculum theme panels report to the Transitional Management Group (TMG),
      which is responsible for all immediate curriculum delivery and management
      issues. The TMG comprises representatives from each theme panel and from the
      PCD Training and Education Centre (TEC); it reports to the Dental Teaching
      Committee. While there appears to be satisfactory opportunity for students and
      academic staff to provide views on curriculum and teaching matters, the visitors
      formed the impression that additional valuable opinions could be obtained from
      PCDs who provide support for teaching in one way or another.

105   The Board of Dental Studies considers all aspects of the quality assurance
      process for the School and receives data on recruitment, admissions,
      registration, progression, assessment, conduct and discipline of students.
      External examiners‟ reports are also drawn to the attention of the Board.

106   Dental education in Cardiff benefits from the positive relationships connecting the
      University, the Trust, the School of Biosciences and the Dental School and
      Hospital. The University and staff themselves give a priority to student teaching.
      The innovative new BDS curriculum, which has a strong emphasis on self-
      directed learning and outreach clinical experience, can be developed further to
      integrate the biosciences and clinical learning and to engage with the PCDs
      working and studying in the dental hospital. Students currently receive very
      limited dental nurse support. The well-maintained clinical facilities and dental
      library are assets, but there is a growing problem of space which should be
      addressed. With some increase in student numbers, structured co-ordination of
      the many teachers and clinicians participating in Human Disease teaching and at
      outreach centres will become more important to maximise the student learning


107      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 University

        communicate with the GDC when the timetable becomes clear for the proposed
         transfer of the BDS degree-awarding powers from the University of Wales (10);

        provide an adequate level of human resources management support to the
         Dental School (11);

        ensure that the Dental School has sufficient physical space within which to carry
         out its necessary educational functions (14, 17);

        clarify the funding arrangements for the academic teaching of human disease
         subjects (39).

3.       To the Dental School

        continue to develop and implement a coherent staff recruitment and retention
         strategy (17);

        investigate the effectiveness and timeliness of the School‟s internal cascade of
         information, particularly on programme and timetabling matters (18);

        in consultation with the GDC, ensure that the proposed format for the Final BDS
         examination under the revised curriculum is consistent with the requirements of
         The First Five Years (23);

        work with relevant parties to improve the students‟ experience of obtaining a
         vocational training placement by reducing the stressfulness and complexity of the
         process (31);

        review the deployment of dental nurses to increase the support for dental
         students undertaking clinical work (32);

        develop further the opportunities for dental students to learn team-working skills
         in a more integrated and comprehensive manner (32, 33, 92);

        work with the local Trust to ensure that students gain sufficient exposure to
         patients with active dental disease (38);

        review thoroughly the learning opportunities for dental students in respect of the
         contents of the Human Diseases theme, including their contacts with patients
         who have systemic diseases, and institute a system whereby their experience in
         this area is recorded and carefully monitored (42, 43);

        ensure that CDS clinic staff involved in outreach teaching are provided with
         sufficient opportunity to become fully integrated into the educational philosophy
         and practice of the Dental School (48, 59);

        reconsider the balance of time spent by clinical students undertaking clinical work
         for patients directly as opposed to providing chairside support for colleagues

        improve students‟ experience of the administration of intravenous sedation (72);

        carefully review the effectiveness of the Family Study (74);

        consider the implementation of a more consistent approach to the use of
         reflective log-books (91);

        invite views from PCDs on the BDS curriculum and its delivery as part of the
         School‟s quality assurance procedures (104).

4.       To the NHS Agencies

        make appropriate arrangements for the transparent allocation of funding for the
         additional NHS costs attributable to the teaching of medical subjects to dental
         students (37, 39).

Annex 1

GDC Visitors’ Programme

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

(We met other staff and students during tours of the School and related sites).

Monday 7 February 2005

Meeting with Dean of the School of Dentistry & General Manager of the NHS
Dental Service Group
Professor M L Jones

Meeting with Dean, School Facilitators and Senior Clinical Staff
Professor M L Jones, Dean
Professor D H Edmunds, Vice Dean Learning & Teaching
Mrs G Jones, Director, PCD TEC
Miss J L Hamlin, Assistant Registrar

Meeting with the Provost (Wales College of Medicine) and the Pro-Vice Chancellor,
Teaching (Cardiff University)
Professor S Tomlinson, Provost
Professor N Palastanga, Pro-Vice Chancellor

Meeting with Heads of Dental Departments
Professor P M H Dummer, Adult Dental Health
Professor S Richmond, Dental Health and Biological Sciences
Professor M A O Lewis, Oral Surgery, Medicine and Pathology

Meeting with Senior Hospital Managers
Mr P Durning, Clinical Director, University Dental Hospital Directorate
Dr B Hunter, Associate Medical Director, Dental Service Group
Mrs M Lloyd, Clinical Director, Community Dental Services Directorate
Mrs H Stratford, Assistant General Manager, Dental Service Group

Meeting with BDS Curriculum Management Team
Dr R Oliver, Reader and Chair of the Curriculum Management Group
Professor M A O Lewis, Theme Leader, Human Disease
Professor B J Moxham, Theme Leader, Foundation
Professor P M H Dummer, Theme Leader, Clinical Dentistry
Professor D P Aeschlimann, Theme Leader, Oral Ecosystem
Professor E Treasure, Theme Leader, Dentistry and the Wider Community
Professor D H Edmunds, Vice Dean Teaching
Mrs G Jones, Director PCD TEC
Dr V Sivarajasingham, Year 1 Clinical Co-ordinator
Mr M Brennan, Lecturer in Dental Education
Miss J L Hamlin, Assistant Registrar

Meeting with the PCD Curriculum Management Team
Mrs G Jones, Director PCD TEC

Miss I Cunningham, Deputy Director PCD TEC
Mr M Fugill, Lecturer
Mrs C Harris, Lecturer/Principal Hygiene Tutor

Meeting with recent BDS graduates
Ms R James
Ms S Middleton
Ms E Barker
Mrs S Farrier
Mr D Griffiths
Ms B Parry

Tuesday 8 February 2005

Meeting with Dean of School and School Facilitators
Professor M L Jones, Dean
Professor D H Edmunds, Vice Dean Learning & Teaching
Mrs G Jones, Director PCD TEC
Miss J L Hamlin, Assistant Registrar

Meeting with Foundation Theme Leader and with teachers in basic science
subject disciplines
Professor B Moxham, Deputy Director, BIOSI
Mrs H Tasker, Deputy Sub-Dean; Anatomist
Dr K Philips, Physiologist
Dr J Bedwani, Physiologist
Dr T Higgins, Biochemist

Meeting with Vice-Chancellor of Cardiff University and senior officers responsible
for planning/resources
Dr D Grant, Vice-Chancellor
Mrs L Casella, Director of Planning
Mr M Davies, Director of Finance

Meeting with recent PCD diplomates
Miss R Jenkins
Miss S Bingham
Miss J Grant
Miss C Bowd
Miss K Park

Meeting with group of employers of recently qualified PCDs from the Diploma
Mr P Ash, Lead Clinician, St David‟s PCDU
Mr D Hannington, GDP/ITP Tutor and VT Trainer
Mr M James, GDP
Mrs B Geddes, GDP

Wednesday 9 February 2005

Meeting with Dean of School and School Facilitators
Professor M L Jones, Dean
Professor D H Edmunds, Vice Dean Learning & Teaching
Mrs G Jones, Director, PCD TEC
Miss J L Hamlin, Assistant Registrar

Meeting with the Chief Executive and the Director of Finance of the Cardiff and
Vale NHS Trust
Mr H Ross, Chief Executive
Mr P Davies, Director of Finance

Meeting with Dean of Medicine, Heads of Department and a teacher from each
non-dental clinical subjects
Professor D Wynford Thomas, Acting Dean of Medicine
Professor H Houston, Vice-Dean
Mr I Doyle, School Manager, School of Medicine
Professor M A O Lewis, Theme Leader, Human Diseases
Dr J Wilson, Lecturer in Human Diseases, Pharmacology

Meeting with teachers and instructors in Dental Technology and Radiography
Mr N Drage, Consultant in Dental Radiography
Mr P Beere, Superintendent Radiographer
Mr G Yarlett, Manager of Dental Sterilisation and Disinfection Unit
Mr P Wilward, Lecturer in Dental Technology and Biomaterial Science
Mr D Stone, Senior Dental Instructor
Mr P Adams, Chief Dental Technologist (Education) Cardiff and Vale NHS Trust

Meeting with two BDS/PCD student representatives from each year of the

Meeting with PCD representatives who support the teaching of BDS students
Ms J Davies, Principal Therapy Tutor/Lecturer
Mrs C Harris, Principal Hygiene Tutor/Lecturer
Mrs M Hillard, Hygiene Tutor
Ms V Eveleigh, Senior Dental Nurse, Prosthetics
Ms L Driscoll, Senior Dental Nurse, Orthodontics
Mr R Maggs, Chief Orthodontic Technician
Mr P Barrett, Senior Chief Dental Technician

Meeting with the Director of Postgraduate Dental Education, Regional Adviser in
Vocational Training and VT representatives
Mr E Nash, Director of Postgraduate Dental Education
Mr R Herbert, Regional Adviser and VT Trainer
Mr D Hannington, ITP Tutor and VT Trainer
Mrs H Maynard, PCD Co-ordinator
Dr R Oliver, Leader of VT Liaison Committee
Mr B Webber, VT Advisor for Central Wales/VT Trainer

Meeting with Dental Therapy graduates
Miss S Owens
Miss G Jones

Thursday 10 February 2005

Meeting with Dean of School and School Facilitators
Professor M L Jones, Dean
Professor D H Edmunds, Vice Dean Learning & Teaching
Mrs G Jones, Director PCD TEC
Miss J L Hamlin, Assistant Registrar

Meeting with Chair and representatives of the Cardiff and Vale NHS Trust Board
Mr S Jones, Chair of the NHS Board
Mr J Davies, Director of Operations
Mr I Rogers, Senior Assistant Finance Director (Dental Service Group)

Meeting with commissioners of training and workforce planning
Mr P Langmaid, Chief Dental Officer, Wales
Mrs M Gilbert, Senior Executive Officer, NHS Education and Training, Welsh Assembly
Mr M Riley, Head of Financial Planning and Contracting, HR Division, NHS Wales,
Welsh Assembly Government
Mr D Thomas, Adviser for Dental Public Health

Meeting with representatives of all grades of non-professorial dental teachers
Dr A Gilmour, Senior Lecturer, Adult Dental Health
Dr K Stewart, Lecturer, Dental Health and Biological Sciences
Mrs C Harris, Lecturer, PCD TEC/Adult Dental Health
Dr I Cunningham, Lecturer, PCD TEC/Adult Dental Health
Mr J Llewellyn, Lecturer, Adult Dental Health
Dr M Wilson, Senior Lecturer in Oral Surgery, Medicine and Pathology
Dr D Williams, Lecturer, Oral Surgery, Medicine and Pathology
Dr R Waddington, Senior Lecturer, Dental Health and Biological Sciences
Mr J Sweet, Senior Lecturer, Adult Dental Health
Mr R McAndrew, Senior Lecturer, Adult Dental Health
Mr J Wilson, Senior Lecturer, Adult Dental Health
Dr M L Hunter, Senior Lecturer, Paediatric Dentistry
Dr R Oliver, Reader, Orthodontics
Dr J Potts, Senior Lecturer, Oral Pathology
Dr P Stephens, Reader , Oral Surgery, Medicine and Pathology

Meeting with NHS dental clinical staff who are involved in teaching dental
Mr A Cronin, Consultant in Oral and Maxillofacial Surgery
Mr W McLaughlin, Consultant and Honorary Senior Lecturer, Restorative Dentistry
Dr E Absi, Consultant in Examination and Emergency and Honorary Senior Lecturer,
Oral and Maxillofacial Radiology
Dr P Atkin, Consultant in Oral Medicine
Mr N Drage, Consultant in Oral and Maxillofacial Radiology

Mr P Durning, Clinical Director, University Dental Hospital Directorate
Dr G Osbourne, GDP
Ms J Gyton, Senior Dental Officer, Community Dental Service

Meeting with Vice Deans
Professor J Shepherd, Vice Dean, Executive and Student Affairs
Annex 2

BDS outreach sites inspected by the Visitors.

The Visitors split into three sub-groups to visit the outreach sites listed below:

The Hollies CDS Centre, Merthyr Tydfil – 6 surgeries;

Broad St CDS Centre, Barry – 2 surgeries;

Llanedeyrn CDS Centre – 1 surgery;

Tonypandy CDS Centre – 2 surgeries;

Grangetown CDS Centre – 1 surgery;

Wrexham CDS Centre – 7 surgeries;

Pontypridd CDS Centre – 3 surgeries;

Park View CDS Centre, Ely – 2 surgeries;

Roath CDS Centre – 2 surgeries;

Splott CDS Centre – 2 surgeries:

St David‟s Community Hospital – Primary Dental Care Unit, West Cardiff – 14 chairs;

Prince Charles Hospital, Merthyr Tydfil – 4 chairs.

Annex 3

Details of the Documents provided by the School

Information Received ahead of the Visit

Self Evaluation Document
Dental School and Service Group Strategic Plan 2003 – 2008
School Committee Structure
University Committee Structure
List of Committees
Structure of Cardiff and Vale NHS Trust Dental Services Group Management Team
Aims of Cardiff BDS programme
Revised BDS Curriculum Outline and Timetable
Outline Structure of PCD Courses
Action Plan for Recommendations from GDC June 2000 Examinations Visitation
Timeline of External Reviews, Visitations and Quality Assurance Exercises
BDS (Hons) Learning Outcomes
Diploma in Dental Therapy and Diploma in Dental Hygiene Learning Outcomes
Cardiff Dental School Prospectus Entry
Cardiff Dental School BDS Brochure
Cardiff Dental School PCD Diploma Brochure
Cardiff University Academic Regulations Handbook for Students
BDS Year 0 Course Handbook
BDS Year 1 Course Handbook
BDS Year 2 Course Handbook
BDS Year 3 Course Handbook
BDS Year 4 Course Handbook
PCD Diploma Course handbook
Admission Tutor‟s Reports for the Past Three Years – BDS
Council of Deans of Dental Schools Return for Past Three Years – BDS
Undergraduate BDS Student Numbers
PCD Diploma Student Numbers
Cardiff University Strategic Plan
Proposal for Expansion of Dental Undergraduates and Professionals Complementary to
Dentistry September 2003
The Quality Assurance Agency for Higher Education Quality Assessment Report 1997
and Dental School Action Plan
DentEd Visitation 2000 Response and Action Plan
Monitoring of BDS/BCHD Courses in the United Kingdom 1999
GDC Visitation of the Dental Auxiliary School 1999
BDS Annual Scheme Monitoring Reports 2000/01 – 2002/03
PCD Annual Scheme Monitoring Reports 2000/01 – 2002/03
Annual Scheme Monitoring Summary and Procedure
Dental Academic Quality Assurance Committee Annual Review

Undergraduate BDS Validation Report and Action Plan 2001
PCD Diploma in Dental Hygiene Validation Report 1999
GDC Dental Staffing Inquiry Proforma
Numbers of HEFCW Funded Academic Staff in the Dental School
Overall Staffing Information for University Dental Hospital Cardiff
Dental Service Group/Dental School – Recruitment and Retention Action Plan
PCD Diploma Curricula Overview
BSc Intercalated Course Proposal – new course
Pass/Fail Statistics BDS & PCD Diplomas
BDS Regulations
PCD Diploma Regulations and Schedule of Assessment
BDS Schedules of Assessment – Revised Curriculum
BDS Schedules of Assessment – Outgoing Curriculum (Years 4 and 5 only)
List of Internal Examiners
List of External Examiners
External Examiner Comments and School Response/Action Plan
Cardiff University Resource Allocation – Overview and Dental School data
Student Appraisal of Teaching
SWOC Analysis for GDC Visitation
Findings on Medical SIFT for Dentistry
University Dental Hospital, Cardiff – Activity and costs in 2002/03

Information Received during the Visit

Visit Welcome Information Pack (entitled: Cardiff University Dental School – GDC
Visitation 7th – 10th February 2005)
BDS Year 1 – 2 Poster Titles
Questionnaire: Class of 2002 – 6th BDS Students, Cardiff Dental School
Letter from the Dean to Professors Cryer and Woodhouse, dated: 4 February 2005 and
headed: The Award of University of Wales Degrees
KC64 and „exceptional reporting‟ pro formas used to record work undertaken by students
in outreach
Assessment of Clinical Competency – Overview document
Assessment of Clinical Competency – Endodontics
Assessment of Clinical Competency – Periodontology
Assessment of Clinical Competency – Oral Surgery
Assessment of Clinical Competency – Orthodontics and Paediatric Dentistry
Human Disease Theme – Staff Co-ordinators diagram
School of Postgraduate Medical and Dental Education – Dental Postgraduate
Department Quality Manual

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

Information Received after the Visit

BDS Cardiff University Prospectus section

Documents entitled:
Secondments to District General Hospitals
External General Practice Teaching
Wrexham Community Outreach

BDS 3rd Year Course
BDS 4th Year Course
Preclinical Dental Course 1999/2000 Schedule of Assessment
2nd BDS 2000/2001 Year 1 Timetable

Year 2000 2nd BDS Examination papers:
Human Anatomy for Students of Dentistry
2nd BDS Lab Spot Exam
2nd BDS DR Spot Exam

Year 2001/2002 3rd BDS Examination papers:
Basic Dental Science
Pathological Science

Year 2002/2003 4th BDS Examination papers:
Human Diseases
Clinical Dental Surgery

Year 2002/2003 4th BDS Syllabi:
Human Diseases
Clinical Dental Surgery

Mr Alan Townsend
Chief Executive and Registrar
General Dental Council
37 Wimpole Street


28 September 2005

Dear Mr Townsend,

Re: Response to the GDC visit to the undergraduate dental degree programme at Cardiff University

This constitutes the requested single unified response to the GDC report following the visit from 7 th to 10th
February 2005 by the GDC visitation team. It includes observations agreed from the Dental School, the
NHS Dental Service Group, the University, NHS agencies and the Welsh Assembly Government.

May we commence our response by complimenting the GDC on the quality and helpfulness of the report
and also compliment the visitors for their courtesy and hard work during the four days that they were in
Cardiff in early February. We feel it is important to state at the outset that all of the bodies mentioned
above are content with the report and are grateful for the opportunity that it gives to assist in the
development and improvement of the teaching of dentistry in Wales.

Although we have already made a number of minor corrections on the draft which we are grateful to see
included in the report, there are a couple of minor corrections that have been spotted on this further read
through which are noted on a separate attached hard copy for the consideration of the visitors.

Perhaps it would be most appropriate to deal with the recommendations one by one, whilst giving the GDC
our response and plans for dealing with any issues that have been raised. To
assist with this I have taken the opportunity to number each of the recommendations.

2.       To the University

         (i)      Communicate with the GDC when the timetable becomes clear for the proposed
                  transfer of the BDS degree-awarding powers from the University of Wales

                  The Dental School, on behalf of Cardiff University, wrote to the Education Committee of
                  the General Dental Council on 23rd February 2005. The response received on 29 th April
                  2005 advised that the proposed transfer of the BDS degree from the University of Wales
                  to Cardiff University should be steered by the Chief Dental Officer for Wales, using his
                  links to the Department of Health and the Privy Council if that should prove necessary.
                  On 31st May 2005 the Dean of the School of Dentistry wrote to Paul Langmaid, the Chief
                  Dental Officer to ask if he would lead in this matter. A follow up letter has been written
                  to confirm that progress is being made in this regard on 11 th July 2005. The plan is for
                  the transfer of degree-awarding powers in dentistry to come into effect by the October
                  2006 student entry to the undergraduate programme in dentistry. When we receive a
                  letter from the CDO confirming progress we will forward it to the GDC.

(ii)    Provide an adequate level of human resources management support to the Dental

        Following merger of the two universities in the summer of 2004 there have been a
        number of substantial challenges that have required addressing as various administrative
        systems are co-ordinated and merged. It has been identified that there is an issue
        regarding human resource support in the University, particularly with regard to the
        recruitment and selection process. The Vice-Chancellor has established a Process
        Review Steering Group which he chairs, and of which the Dean of the School of
        Dentistry is a member. The Cardiff University project group looking to develop a ‘best
        practice’ recruitment and selection process for the newly merged University is being
        chaired by the Dean of the School of Dentistry and has prepared a draft new recruitment
        and selection process which will lead to devolution of a substantial proportion of the
        operational aspects associated with this process. The School of Dentistry will be one of
        six pilot sites in the University for the new process starting in October 2005. It is
        intended that this newly proposed approach should address the issues surrounding human
        resource support to the 28 Schools within the University.

(iii)   Ensure that the Dental School has sufficient physical space within which to carry
        out its necessary educational functions

        Following merger, Cardiff University has established an Estates Task Group which is
        examining the whole issue regarding a strategy for both developing and expanding the
        estate support for research and teaching in the University. The Dean of Dentistry is a
        member of the Estates Task Group representing the Wales College of Medicine. The
        University has identified the School of Dentistry as being one of the Schools with the
        highest priority to expand both research and teaching space as well as the need to provide
        more office space both for academic and administrative staff.

        Since the visit of the GDC the Dental School has been successful in the award of £1.65m
        SRIF 3 monies to build a Dental Translational Research Facility. This would include a
        new dental clinical trials unit on the second floor and a ‘new build’ research facility on
        the roof of the Dental School/Hospital. Obviously, there is some opportunity for backfill
        and reorganisation of space through the School as a result. In addition, there is an agreed
        5-year Dental School/Hospital estate programme for the use of the NHS Rolling Re-
        equipment Monies. This will give an opportunity to make maximum use of the space
        available within the footprint of the building, whilst giving the opportunity to address
        some of the more acute issues surrounding space for ‘small group’ teaching. The visitors
        will be aware that the Welsh Assembly Government has also assigned approximately
        £500,000 Discretionary Capital Monies, linked to the increase in student numbers to
        allow some further work on the estate to expand teaching facilities, particularly with
        regard to lecture theatres and, to a limited extent, seminar rooms.

        Nonetheless, it is recognised within the University that further space is required on the
        Heath Park site and there are discussions ongoing with partners about the possibility, in
        the future, to expand the footprint of the building behind the Dental School/Hospital in
        the area of the current annexe.

(iv)    Clarify the funding arrangements for the academic teaching of human disease

        We are pleased to note that in the meeting with Welsh Assembly Government officials
        some assurances were given to the GDC visitors that the matter of the lack of an NHS
        funding stream entitled ‘Medical SIFT for Dentistry’ was to be addressed in the near
        future. Since that time there have been meetings with the Welsh Assembly Government
        to confirm monies to support this area from 2005. We await full written confirmation

             from the Welsh Assembly Government with regard to the exact sum proposed but would
             anticipate that it would approximate £1m per year, which would be consistent with
             similar sized Schools/Hospitals in England. The Welsh Assembly Government has
             agreed a process whereby the money will be assigned as a ring-fenced sum to the NHS
             Dental Service Group which will be responsible for the spend of the resource. In a
             similar manner to the management of Medical SIFT elsewhere, the Dental School will be
             responsible to review and assess the way that the resource is used and will write an
             annual report in this regard. An outline of how Medical SIFT for Dentistry is to be spent
             is included with this response, but essentially it will support all aspects of human disease
             teaching, clinical attachments to regional and district NHS hospitals, student mobility
             around Wales, all aspects of student outreach in Wales and the necessary infrastructure to
             support these areas within the Dental School/Hospital offices.

3.   To the Dental School

     (i)     Continue to develop and implement a coherent staff recruitment and retention

             As the GDC visitors will be aware, under the auspices of the joint Dental Strategy Co-
             ordinating Group there is a joint recruitment and selection plan which is being
             implemented by a working group. This matter is well advanced and had been clearly
             identified in the Dental School and Dental Service Group Joint Strategy of 2003.

             Nonetheless, we are not complacent and realise that, similar to other Dental Schools and
             Hospitals in the UK, there will be a significant challenge for the recruitment of staff in a
             number of areas including academic teachers and also Dental School staff that support
             clinical teaching.

     (ii)    Investigate the effectiveness and timeliness of the School’s internal cascade of
             information, particularly on programme and timetabling matters

             A number of briefing and training sessions on the new curriculum have been run over the
             last three years linked to staff development days. Unfortunately these have not always
             been as well attended as the School would have liked and therefore certain staff have not
             been as engaged with the planning of the new curriculum. It is intended that all staff
             associated with the teaching, both within the School and NHS will have the opportunity
             to be engaged more fully in the Cardiff University quality assurance review process of
             the new curriculum after the first cohort of students have completed in 2006.

             In addition, the School realises that there have been short-term operational issues around
             the details of timetabling which have posed a communication problem both within the
             School and between the School and the Dental Hospital. Now that the timetable for the
             final year of the new curriculum is complete we intend to bring the operational
             management and administration of the curriculum to the School Office and there is an
             intention to appoint a new administrative post in the School to support all aspects of
             timetabling. Included in their remit is their communication to School staff and to
             Hospital and Community clinics. In the meantime, there still remains the opportunity for
             all members of the various theme groups to cascade information to their respective areas.

             However, again, we are not complacent and are aware that communication remains an
             ongoing challenge in such a complex organisation. However, we feel that the necessary
             apparatus is in place and this view would be supported by the two recent communications
             assessments by Investors in People where uniquely we hold IIP status on both sides of the
             organisation, both the Dental School and Dental Service Group.

(iii)   In consultation with the GDC ensure that the proposed format for the final BDS
        examination under the revised curriculum is consistent with the requirements of
        The First Five Years

        The Dean of the Dental School wrote to the Education Committee of the GDC on 24th
        February 2005 on this matter, which was first raised in the oral feedback from the visitors
        at the end of the visit. Of course the timing of Final BDS has been part of the
        documentation for the proposed new curriculum for a number of years and did form part
        of the package that passed through the validation process. The School tried to achieve
        some early GDC engagement through having one of the members of the Education
        Committee on the validation panel.

        However, we understand why the GDC may have some concerns in this regard,
        particularly in the light of experience elsewhere in the UK. So far the response from the
        GDC Education Committee is that they might like to view the new Finals examination in
        the future and it has been suggested to them that the most appropriate time would be the
        second diet of the new Finals exam in 2007. As well as giving the opportunity for the
        examination to bed in and respond to the initial comments of external examiners, this
        would also avoid a clash with the University quality assurance programme which will be
        including BDS Finals in 2006 in their programme of work. Following the visit of the
        GDC we will, of course, respond to any recommendations that are made with regard to
        the timing and nature of the new Finals examination.

(iv)    Work with relevant parties to improve the students’ experience of obtaining a
        vocational training placement by reducing the stressfulness and complexity of the

        The School is aware that this is not a problem unique to Wales. The matter will be
        discussed with the Director of the Dental Postgraduate Unit in the near future. As the
        visitors noted, we have very good communications with the Postgraduate School, and the
        Dental Unit in particular, and so the apparatus exists to explore a solution to the problem,
        if indeed one exists.

(v)     Review the deployment of dental nurses to increase the support for dental students
        undertaking clinical work

        The deployment of dental nurses will be reviewed within the Dental Hospital and if an
        issue of capacity is identified the matter will be pursued with the Welsh Assembly

(vi)    Develop further the opportunities for dental students to learn team-working skills in
        a more integrated and comprehensive manner

        As may have been noted by the GDC visitors, the Dental School is determined to
        improve its professional education and training within the dental team. This was one of
        the reasons for the Dental School taking responsibility for the PCD TEC on 1 st August
        2002 and the subsequent work that has been done to integrate education and training as
        far as possible within the existing limitations of timetabling, clinical facilities and the
        varying structures of the two courses. The School recognises that there is still more work
        to be done in this area and it will form part of the curriculum review in 2006.

(vii)   Work with the local Trust to ensure that students gain sufficient exposure to
        patients with active dental disease

        The School and Service Group were surprised that the GDC visitors felt that students
        were not being sufficiently exposed to active dental disease. The outreach programme

         and the commitment to the building of Primary Dental Care Units have been pursued to
         help address this issue, amongst others, in the teaching of primary care dentistry. We will
         take this comment away, assess the evidence and address the issue. Of course the
         ongoing work with the Welsh Assembly Government to build more Primary Dental Care
         Units in Wales will help to provide further exposure to communities with active disease.
         This opportunity arises in the response to meeting the significant shortfall in the dental
         workforce in Wales as student numbers continue to increase.

(viii)   Review thoroughly the learning opportunities for dental students in respect of the
         contents of the Human Disease theme, including their contacts with patients who
         have systemic diseases, and institute a system whereby their experience in this area
         is recorded and carefully monitored

         The opportunity has come to review human disease teaching, particularly in the light of
         the clarity that has now been achieved around the funding stream to support this
         important area of teaching and training. We are currently in the process of agreeing a
         Service Level Agreement with the Medical School with regard to human disease teaching
         and as part of that process there will be the opportunity to conduct an initial review of the
         course. Obviously, in the medium term it will form part of the wider review of the new
         curriculum to be conducted in 2006.

(ix)     Ensure that CDS clinic staff involved in outreach teaching are provided with
         sufficient opportunity to become fully integrated into the educational philosophy
         and practice of the Dental School

         We fully agree with the need for further integration of CDS staff into the educational
         philosophy of the School and that more work needs to be done. This should be more
         effective now that extra funding has become available to support outreach teaching
         (forming part of Medical SIFT for Dentistry).

(x)      Reconsider the balance of time spent by clinical students undertaking clinical work
         for patients directly as opposed to providing chairside support for colleagues

         The matter of students acting as chairside support for their colleagues will be reviewed as
         part of the wider curriculum review in 2006. Obviously, the matter is linked to the issues
         of dental nurse support (see earlier recommendations).

(xi)     Improve students’ experience of the administration of intravenous sedation

         We note the comments of the visitors particularly around IV sedation. We are pleased
         with the supportive comments with regard to the teaching in Wrexham and the sedation
         teaching facilities now available in the Dental Hospital. We will review this matter as a
         matter of urgency. There are opportunities with the refurbishment of a number of areas
         in the future, to expand conscious sedation facilities and this may form part of the
         solution. We are grateful for the comments of the GDC and will give the matter due and
         careful consideration.

(xii)    Carefully review the effectiveness of the Family Study

         The Family Study is a progressive and ambitious part of the new curriculum. It is still at
         a relatively early stage of implementation and there is still work to be done in this area.
         The School will review this part of the curriculum, both in the immediate short term and
         as part of the 2006 review.

(xiii)   Consider the implementation of a more consistent approach to the use of reflective

                   The implementation of reflective log-books is at an early stage of implementation in the
                   School but there is a clear commitment to this area both by the School and the new
                   Cardiff University. Those leading the project in the School are sharing their experience
                   both at national and European levels and we will continue to work to achieve ‘best’ (and
                   consistent) practice in this area.

        (xiv)      Invite views from PCDs on the BDS curriculum and its delivery as part of the
                   School’s quality assurance procedures

                   The Head of the PCD TEC sits on the Board of Dental Studies and the Board of Dental
                   Studies Executive and has an input into a number of the teaching theme areas,
                   particularly clinical dentistry. But there is no doubt that there may be an opportunity for
                   more involvement of the PCDs in the quality assurance of the BDS course and the School
                   is happy to explore the suggestions of the GDC in this regard.

4.      To the NHS Agencies

        (i)        Make appropriate arrangements for the transparent allocation of funding for the
                   additional NHS costs attributable to the teaching of medical subjects to dental

                   A clear commitment was made to the visitors by Welsh Assembly Government officers
                   that Medical SIFT for Dentistry would be assigned to the Dental Service Group to
                   support human disease teaching and all aspects of clinical outreach and attachment
                   teaching.    This matter has already been discussed earlier in our response to
                   recommendations. We are currently awaiting written confirmation of the funding from
                   the Welsh Assembly Government and will forward a copy to the GDC once we have
                   received it.

May we conclude by thanking the officers of the General Dental Council associated with the visit and also
the visitors themselves for all of the time and effort that they put into reading the documentation and
meeting with various colleagues in the different agencies associated with the delivery of the programme.
We were particularly pleased to receive the comments with regard to the quality of the students that are
being produced and their interpersonal and communicative skills.

If there are any matters that the GDC wish to discuss further concerning the GDC report we would be
grateful if they could be forwarded through to Professor Malcolm Jones, the Dean of the School of
Dentistry and General Manager of the NHS Dental Service Group who would be pleased to co-ordinate any
response that might be required.

Yours sincerely,

Dr David Grant


Description: Principal Financial Group Dental document sample