Scotland: COVID-19 impacts dental education and training

​What impact has the pandemic had on dental education and training in Scotland? Colin Levey of the University of Dundee investigates.

The COVID-19 pandemic has made significant changes to the way dental education and training are delivered in Scotland. The effects are becoming more critical and more apparent as the pandemic continues, resulting in many challenges and some opportunities.

Supervision requirements

Among the challenges we face are in supervising dental trainees carrying out aerosol generating procedures (AGPs). Staff can no longer supervise multiple AGPs simultaneously and one-to-one supervision is required throughout the whole procedure if support is needed at all. Direct supervision is clearly essential for undergraduate trainees, but it’s also important at postgraduate level (Core Training and Specialty Training) in order to develop new skills. This is an opportunity to enhance the training experience, through close supervision and feedback, but it puts pressure on an already stretched workforce to deliver effective training alongside the delivery of key services, and will inevitably increase pressure on PPE stocks.

Capacity constraints

Clinical access for some trainees is also a challenge, depending on the local clinical environment and surgery layout. The capacity of open clinics is reduced due to social distancing and which, without some form of modification, cannot be used for AGPs. In some training centres, the capacity of waiting areas for patients is the limiting factor with staggered appointments necessary to maintain social distancing. Again, this has a negative impact on capacity for training and patient care. If anxiety among patients, particularly those at risk of serious illness if infected with COVID-19, results in higher appointment failure rates and treatment deferral, this may also negatively impact a trainee’s experience, not to mention the oral health of patients.

Some ageing buildings will not meet the requirements for effective ventilation which is the main determinant of fallow time, as outlined in the new SDCEP recommendations and subsequent national guidance. If we are to live with COVID-19, more practical measures will need to be considered to increase capacity and improve access to clinical training.

Learning opportunities

Of course, with all of these challenges come opportunities. Didactic training and e-learning has improved access to some teaching, assuming trainees or students have access to a reliable internet connection for online learning. A reduction in travelling time and costs are also more compatible with home commitments for some students. However, distance learning may reduce networking and opportunities to support colleagues and students in difficulty.

Redeployment of postgraduate trainees varied by health board area during the first wave of the pandemic. Trainees were redeployed to urgent dental care centres (UDCs), COVID assessment wards, surgical pre-admission swabbing and other roles, while academic trainees have supported the ongoing delivery of blended learning or have contributed to important research such as COVID rapid reviews or guidance.

While training opportunities have been maximised by trainees, the total impact of these periods away from specialist clinical care cannot be fully assessed until HDS services return to normal. The associated delays in completion of training may negatively impact on the future consultant and specialist workforce and prevent new trainees entering specialist training. The latter group have already suffered from reduced opportunities for training and employment and this may compound the challenges they already face establishing their careers.

Impacts on other services

Hospital Dental Service (HDS) and Public Dental Service (PDS) surgeries and outreach centres were used to increase undergraduate and postgraduate clinical training capacity prior to the pandemic. They remain an important part of undergraduate training and care provision. However, with social distancing and enhanced infection control measures now required, the capacity to deliver oral health care, whether through undergraduate clinics or HDS or PDS services, may be adversely impacted. 

Simulated teaching has expanded as a safe means of delivering hands-on dental training to undergraduates and postgraduates during this global pandemic. Simulated operative skills labs are also under increasing pressure to meet the educational demands of dental students and trainees, especially with social distancing requirements of parent organisations such as NHS Education for Scotland, universities, and local NHS Boards. Some of these facilities are now ageing and investment may be required to ensure that they operate at optimal capacity. These training opportunities remain vulnerable to changes to higher education guidance from the Scottish Government in the event of tighter restrictions.

Supporting dental students and trainees

The BDA has been in contact with dental schools across Scotland to offer support to dental students and investigate any further support that would be considered beneficial to students and trainees at this difficult and stressful time. Student members have also been using their membership to remain connected to the profession and benefit from BDA services like Health Assured. The BDA Benevolent Fund has meanwhile been supporting dental students that are in need of financial assistance.

There are many more challenges and opportunities ahead and services will need to continue to adapt and change. Reflecting the wider challenges affecting the dental profession, patient care and training capacity has been reduced and completion of training at all levels may be delayed. The long-term impact of this on the workforce, and therefore patient care, is uncertain. However, the capacity of services is likely to remain low at a time when demand may be rising. Investment in training capacity and facilities will need to be addressed to ensure that patient care and workforce development can meet the expected demand.

Colin Levey
BDA Scottish Hospital Dental Reference Group
Academic Specialty Registrar, Restorative Dentistry
University of Dundee