Career development lead and associate dentist, Andrea Ogden outlines the issues facing foundation dentists and talks to an FD in training about the impact of the current crisis on his future.
The COVID-19 pandemic has brought an array of challenges to the dental profession. However, for those in foundation training, it has presented unforeseen issues for a career that has barely begun.
Clinical experience for foundation dentists was suspended only six months into their training. Those young dentists are now experiencing increased anxiety, a drop in confidence and escalating fears about their future prospects.
We spoke to current FD, Onkar Mudhar about the impact of the COVID-19 crisis on his training and the questions that FD’s are desperate to have answered.
Reduced clinical experience
"Those completing foundation training this year will have had less clinical exposure than previous cohorts."
The reduction in patient exposure, as a result of the Coronavirus, has led to a significantly reduced clinical output. Consequently, the current cohort are less likely to achieve the clinical requirements necessary to complete their year. To mitigate this, the requirements for the Final Review of Competency (FRCP) have been amended.
However, this still means that those completing foundation training this year will have had less clinical exposure than previous cohorts.
“I just want to know if we are at a disadvantage to previous years? And if so, how do we make sure we have the same level of training as previous FDs? How do we ensure that employers don’t perceive us as less capable?”
Less clinical performance evaluation
Normally by March foundation dentists confidently complete their routine cases and are focusing on more complex work. However, with this crucial part of the year having been spent in lockdown, a number of complex ADEPTS (a dental evaluation of performance tool) - where the supervisor oversees an aspect of a clinical procedure - have not been completed.
“Before lockdown, I felt I was scoring quite highly with my assessments. But now I no longer have clinical assessments in the room with my educational supervisor. I feel not being able to have a thorough ADEPT assessment could affect my confidence.”
A contracting job market
"There’s a lot of uncertainty… What types of dentistry will we be doing? What will we be paid? Will we have a target?"
While the profession awaits contract clarification from NHS England, there is a growing unease over the availability of associate roles. Dental associates are usually employed either to replace an existing associate or because the practice is expanding. With fallow time and social distancing measures affecting patient numbers, the need to replace existing associates has been significantly reduced, while any plans to expand may now be delayed. Foundation dentists looking for associate positions might need to look further afield.
“It’s more competitive now. There is a lot of uncertainty. Everyone is saying associate positions will be harder to find. What types of dentistry will we be doing? What will we be paid? Will we have a target?”
Worry about Outcome 6C
To reflect the loss of face-to-face experience, Health Education England have introduced a new outcome for the FRCP. Outcome 6C is a conditional entry to the national performer list and is for individuals who cannot demonstrate outstanding requirements before their training contract ends in August.
Although the revised FRCP will hopefully result in most students passing with the required satisfactory outcome (Outcome 6), there is anxiety over any long-term repercussions for those who do receive an Outcome 6C.
“It feels like a red mark against my name for potential employers. We have two years to gain additional supervision and complete the outstanding requirements. If you lack a restorative requirement, how are you going to get that 6C outcome removed if you’re in a DCT post and are not planning on doing restorative work during that time? My educational supervisor has been really supportive, but I feel like I’ve been left in the dark by those at the top.”
Reassurance form HEE on Outcome 6C
"In general, the expectation is that most dentists with an Outcome 6C should not be disadvantaged."
Health Education England have stated that dentists with an Outcome 6C will be able to make up the missing experience within a maximum of five months. Additional funding for supervised support will be available for two years and extensions will be granted on the discretion of the local postgraduate dental dean. Where possible, provisions will be made for completing those requirements during dental core training.
It is still unclear what the requirements will be for those supervising a dental professional with an Outcome 6C, or how the financial renumeration package will be allocated. If an FD cannot achieve the missing competencies within two years, they might need to undertake a short period of vocational training by equivalence (PLVE). In general, the expectation is that most dentists with an Outcome 6C should not be disadvantaged.
FRCP outcomes across the UK
Northern Ireland have also introduced an Outcome 6C, however it is worth noting that it includes additional options to that in England. In Wales, there will be no Outcome 6C. Entry to the performer list does not have an option for conditional entry post foundation training. It is still to be confirmed whether or not those who achieve an Outcome 6C in England can still go on to work in Wales.
In Scotland, vocational trainees (VTs) have all been awarded satisfactory completion and have been asked to make a personal development plan with their trainer that could be passed on to a new employer.
Advice and support
"If you need to complete requirements whilst on your DCT year, speak to your educational supervisor who may be able to offer you access to a surgery to do these treatments"
If you are concerned about the implications of a potential Outcome 6C, your training programme director will be best to discuss your further options.
If you need to complete requirements whilst on your DCT year, please speak to your educational supervisor who may be able to offer you access to a surgery to do these treatments. Even in these last few weeks of the foundation year, developing skills in managing urgent care, triaging patients on the phone and treatment planning is still possible.
The BDA has published blogs on mental wellbeing and webinar recordings on understanding your well-being in a COVID-19 world. Members also have access to our 24/7 counselling and emotional support helpline. Dentists can also access the NHS Practitioner Support Programme, Dentists' Health Support Trust, and ConfiDental. If you urgently need support, Samaritans are always there and willing to listen. Please do reach out and don’t suffer alone.
The BDA is acutely aware of the challenges faced by young dentists leaving foundation training and we are liaising with the relevant authorities, to ensure that no matter where you are in the UK, your education is not compromised.
BSc BDS MJDF RCS (Eng.) PGcert
Undergraduate and Career Development Lead