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    Endodontic Handbook Endodontic Handbook Document Transcript

    • Monospeciality Training in Endodontics 4 Year Programme Handbook 2003-2007
    • ContentsFaculty ...........................................................................................................................................3Introduction and Entry Requirements........................................................................................4Overall Aims and Learning Outcomes........................................................................................5Outline of Programme Structure.................................................................................................6Progression.....................................................................................................................................6Programmed Hours of Training..................................................................................................7Sample Timetables.........................................................................................................................9Years 1 & 2 Overview..................................................................................................................10Years 3 & 4 Overview..................................................................................................................12Years 3 & 4 Endodontic Module ..............................................................................................15 Advanced endodontics and traumatology..................................................................................16Generic Modules..........................................................................................................................19 Inter-disciplinary Care...............................................................................................................20 The Medically Compromised Patient........................................................................................21 Evidence Based Learning..........................................................................................................22 Management, Team Building and Interpersonal Skills.............................................................23 Clinical Governance and Audit.................................................................................................24 The Specialist Practitioner and Education.................................................................................25 Specialist Dental Practice: Management, Ethics and Medico-legal Aspects ...........................26 Preparation for the MRDRCS Examination (Endodontics)......................................................27APPENDIX 1....................................................................................................................28Aims and Learning Outcomes: Clinical Domain......................................................................28APPENDIX 2....................................................................................................................29Aims and Learning Outcomes: Academic Domain..................................................................29APPENDIX 3....................................................................................................................30Aims and Learning Outcomes: Research Domain...................................................................30APPENDIX 4....................................................................................................................31 Time commitment years 1 & 2– full time trainee.....................................................................31 Time commitment years 1 & 2 – part time trainee....................................................................33MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 1
    • Analysis of years 1 & 2 and years 3 & 4 relative to 4500hrs....................................................35Faculty ...........................................................................................................................................3Introduction and Entry Requirements........................................................................................4Overall Aims and Learning Outcomes........................................................................................5Outline of Programme Structure.................................................................................................6Progression.....................................................................................................................................6Programmed Hours of Training..................................................................................................7Sample Timetables.........................................................................................................................9Years 1 & 2 Overview..................................................................................................................10Years 3 & 4 Overview..................................................................................................................12Years 3 & 4 Endodontic Module ..............................................................................................15 Advanced endodontics and traumatology..................................................................................16Generic Modules..........................................................................................................................19 Inter-disciplinary Care...............................................................................................................20 The Medically Compromised Patient........................................................................................21 Evidence Based Learning..........................................................................................................22 Management, Team Building and Interpersonal Skills.............................................................23 Clinical Governance and Audit.................................................................................................24 The Specialist Practitioner and Education.................................................................................25 Specialist Dental Practice: Management, Ethics and Medico-legal Aspects ...........................26 Preparation for the MRDRCS Examination (Endodontics)......................................................27APPENDIX 1....................................................................................................................28Aims and Learning Outcomes: Clinical Domain......................................................................28APPENDIX 2....................................................................................................................29Aims and Learning Outcomes: Academic Domain..................................................................29APPENDIX 3....................................................................................................................30Aims and Learning Outcomes: Research Domain...................................................................30APPENDIX 4....................................................................................................................31 Time commitment years 1 & 2– full time trainee.....................................................................31 Time commitment years 1 & 2 – part time trainee....................................................................33 Analysis of years 1 & 2 and years 3 & 4 relative to 4500hrs....................................................35MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 2
    • FacultyDr JM Whitworth PhD, BChD, FDSRCSEd, FDSRCS(Rest)Senior Lecturer in Restorative Dentistry, School of Dental Sciences, University ofNewcastle upon Tyne. Honorary Consultant in Restorative Dentistry/RegisteredSpecialist in Endodontics, Newcastle upon Tyne Hospitals NHS Trust. (Monospecialityprogramme director).Mrs M Corson BDS, MSc, FDSRCS, FDSRCS(Rest)Consultant in Restorative Dentistry/Registered Specialist in Endodontics, Newcastleupon Tyne Hospitals NHS Trust.Dr GV Seccombe PhD, BDSRegistered Specialist Practitioner in Endodontics and Visiting Endodontist, Departmentof Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 3
    • Introduction and Entry RequirementsThe 4-year programme at Newcastle includes the MSc in Restorative Dentistry as afoundation with further training in the chosen Monospeciality. The proportion of theMonospeciality element of training increases throughout the programme, particularlythe clinical component. For details relating to the MSc in Restorative Dentistryplease refer to the current MSc Course Handbook and Course Specificationwhich should be read in conjunction with this document.The MSc Course Handbook explicitly distinguishes between application and admissionfor the MSc degree programme and for Specialist Training. It indicates that transfersfrom the former to the latter are not possible after entry.Applicants for Specialist Training must be in possession of MFDS, FDS or haveequivalence granted by the Equivalence Sub-committee of the Joint Committee ofSpecialist Training in Dentistry (JCSTD). The admissions process will involve thePostgraduate Deanery to ensure compliance with entry requirements, appropriatecompetitive selection and allocation of a National Training Number (NTN). Specialisttrainees will hold an NTN, degree only candidates will not.Applications are welcome from both part-time and full-time trainees up to a maximum ofthree trainees per year (including all Monospecialities).The University distinguishes between part-time and full-time MSc students on the basisof a part-time student being able to submit work carried out in practice as part of his orher course requirements. In this way it is possible for both part-time and full-timetrainees to complete the MSc programme in 2 years. In the same way a proportion ofspecialist training can be carried out in practice during years 3 and 4 allowing both part-time and full-trainees to complete the programme in 4 years. Hence the terms part-timeand full-time relate to faculty attendance and, in reality, the amount of time each type oftrainee commits to the programme is not significantly different.The part-time training posts are designed principally for dentists with GDC registrationwho are employed locally in practice, hospital, community services or the armed forceswhere a proportion of specialist training can take place. However they will be requiredto discuss the treatment planning and progress of all training cases, at various stagesfor scrutiny by their trainers in the Dental Hospital and School.Part-time trainees are expected to spend at least 60% of their time on Faculty premises(normally 3 days a week unpaid with access to 4 clinically related sessions per week atthe Dental School) and to carry out a significant proportion of research or seminarpreparation out with this time.The full-time training posts will appeal most to overseas dentists who do not have GDCregistration and do not have a suitable position locally where a proportion of specialisttraining can take place. Therefore full-time trainees have unpaid access of up to 6clinically related sessions per week at the Dental Hospital.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 4
    • Overall Aims and Learning OutcomesThe aim of the Monospeciality training programme in Endodontics is to enableappropriately qualified dentists to acquire advanced skills, knowledge and researchexperience in the field of Endodontology. This will enable them to sit the Membership inRestorative Dentistry of one of the Royal Colleges, and if successful to be issued with acertificate of completion of specialist training (CCST) and to be registered by the GDCon the specialist list in Endodontics. Satisfactory completion of the MSc in RestorativeDentistry at Newcastle School of Dental Sciences will be used to inform the Record ofIn-Training Assessment (RITA) at the end of year two as an indicator of satisfactorycompletion of the first two years of the Monospeciality programme.The MSc programme provides trainees with most of their research requirement and, asdetailed below, year two of the programme is structured to reflect the emergingspecialist. The broad aims and objectives of the MSc programme are contained in theMSc Programme Specification as well as the MSc Course Handbook. These aimscomplement those of Monospeciality training which are:• To acquire advanced knowledge in clinical endodontics including non-surgical primary and retreatment, endodontic surgery, and dental traumatology as well as the integration of endodontic and other specialist care.• To demonstrate an understanding of Clinical Governance, including risk management, the ethical and medico-legal aspects of Specialist Dental Practice and practical experience of clinical audit.• To acquire knowledge about the management of Specialist Dental Practice.• To understand the importance of the educational role of the Specialist Practitioner and to have experience of Undergraduate clinical teaching, delivery of MSc seminars and involvement in the provision of Postgraduate courses.•A more detailed exposition of the aims and learning outcomes associated with theclinical, academic and research domains of the programme are contained inAppendices 1-3 while the specific aims of individual programme modules are containedin:• The MSc module guides• The module outlines specific to the Monospeciality (referred to in this document)• The module outlines generic to all Restorative Monospecialities (also referred to later).The specialist trainee will be required to compile a log book which meets with SACapproval and to participate fully in the RITA process from the time of entry onto theSpecialist training programme.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 5
    • Outline of Programme StructureThe JCSTD curricula for each Restorative Monospeciality specify that training shouldbe broad based in all aspects of restorative dentistry and clinical dental science. TheMSc programme provides the broad clinical and scientific foundation to Monospecialitytraining. However as the programme progresses trainees will require an increasinglysharp focus on their speciality area. For this reason trainees will undertake an MScresearch project in their chosen Monospeciality. In addition year 2 of the MScprogramme will have: • The majority of supervised clinical sessions entirely Monospeciality based • The four patients reviewed by the internal examiners at the end of the second year chosen to exhibit treatment of Monospecialist nature (MSc students are expected to submit cases of a general restorative nature at the end of both year 1 and year 2) • Current literature review sessions to allow trainees to keep abreast of targeted journals of importance to the Monospeciality.The modules for Years 3 and 4 have a large clinical emphasis to support specialisttraining. Academic topics comprise Monospeciality specific subjects (e.g. painmanagement, traumatology) and generic subjects common to all three RestorativeMonospecialities which have not already been introduced in years 1 and 2.Where appropriate, subjects introduced during years 1 and 2 are extended in years 3and 4. For instance, a trainee would be expected to attend audit and clinicalgovernance meetings in the first year, identify a subject for audit in the second year,perform and report the audit in the third year and where possible re-audit to completethe audit cycle in the fourth year.It should be emphasised that during years 3 and 4 trainees will be expected to engagemore and more in directed self-learning.Certain educational activities will be linked with the Restorative Trainees (e.g. currentliterature reviews and appreciation of evidence based dentistry).ProgressionProgression from year 1 to year 2 relies on the trainee passing the MSc writtenexaminations and submission of the research literature review. Should a trainee fail thewritten papers he or she may re-sit during the month preceding re-registration for thesecond year (i.e. during September).MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 6
    • In order to progress to years 3 and 4 Trainees must complete the MSc programme aspart of their training and pass the University examinations, with the possible exceptionof the research project oral examination. In such a case the experimental work for theproject would still need to be completed in Years 1 and 2. Trainees must howeverrealise that the MSc must be passed as a whole to be awarded a CCST (certificate ofcompletion of specialist training).Specialist trainees will participate in RITA and any future Competence assessmentsspecified by the SAC in addition to other programme assessments of a formative andsummative nature. RITA assessments are scheduled at 6, 12, 24 and 36 months.It must be emphasised that unsatisfactory progress, including failure of one or morecomponents of the MSc examination, could result in the award of a RITA ‘D’ or ‘E’.Award of a RITA ‘D’ would involve the trainee undertaking a specified period ofremedial training, while a RITA ‘E’ implies an extension to training. The trainee wouldbe responsible for funding any such extension to training. Where the RITA paneldetects continued unsatisfactory performance it will recommend to the PostgraduateDental Dean and, during years 1 and 2, the Graduate School Dean that training isdiscontinued.Programmed Hours of TrainingThe required numbers of hours, in the various years, to comply with SAC approval areshown in Appendix 4. In order to provide at least 4500 hours of training ourMonospeciality programmes have been designed over a four year period (seecalculations in Appendix 4). Specimen weekly timetables for years 1, 2 and 3&4 areshown below. Part-time trainees are expected to use a proportion of their own clinicaltime to undertake training in their practice setting.Year 1Based on academic yearModule Activity Weekly Total hrs+ sessionsClinical Personal patient treatment 4 342 Diagnostic clinics 1# 120Academic Restorative literature seminars 1 563Research Lit rev and programme of work 1 310MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 7
    • Year 2Based on academic yearModule Activity Weekly Total hrs+ sessionsClinical Personal patient treatment 3* 420 Diagnostic clinics 1 30 Undergraduate teaching 1# 60Academic Current literature review 1 255Research Complete project and write-up 1 450Years 3 & 4Based on 40 hour weekModule Activity Weekly Total hrs sessions (2 years)Clinical Personal patient treatment 4* Diagnostic clinic 1 1680 (full time) Undergraduate, postgraduate and 1 Section 63 teaching 1320 (part time) *Academic Thematic literature 1 610 Current literature 1 Research ** 25hrs/yr# For Full-time trainees only* Part-timers can see patients 2 of these sessions/week in practice. Only one third of the total timespent in practice during the programme is recognised as training time where there is no specialistpractice trainer (JCSTD A Guide to Training and Training Posts in Restorative Dentistry Sept. 2001,Appendix 5, p39). If this option is taken part-timers will have 1320 hours of clinical time in the hospitalcompared with 1680 hours for full-timers.** It is assumed that 3rd and 4th year trainees will continue to be engaged in research activity, such as thepreparation of research papers, review articles, case reports and preparation for scholarly presentations.This is over and above the formal research component of training detailed in years 1 and 2.+ Total hours takes account of directed self learning and non-clinical modules.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 8
    • Sample TimetablesChanges may be made to suit the needs of individualsYear 1 Monday Tuesday Wednesday Thursday Friday #am Seminars Personal treatment Diagnostic clinic Personal treatment Seminars/ Research # # #pm DSL Personal treatment DSL Personal treatment DSLYear 2 Monday Tuesday Wednesday Thursday Friday # #am DSL Personal treatment / DSL Diagnostic clinic Personal treatment DSL # #pm DSL Personal treatment / DSL Personal treatment Undergraduate # Teaching Diagnostic clinicYears 3 & 4 Monday Tuesday Wednesday Thursday Friday #am Study/admin Personal # Personal Treatment Personal treatment Personal # treatment treatment #pm Current literature Undergraduate clinical teaching Thematic literature Diagnostic clinic Study/admin# for full-time trainees onlyDSL Directed Self LearningMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 9
    • Years 1 & 2 OverviewClinical DomainClinical activity comprises:• Clinical skills training during 1st term• A laboratory course during 1st term covering core non-surgical techniques for endodontic primary and re-treatment• Supervised personal treatment. During the first year patients are allocated to trainees by their clinical supervisors in Conservation, Endodontics, Periodontics and Prosthodontics to give broad Restorative experience. During the second year patients are allocated to focus experience in the Monospeciality.• Attendance at diagnostic clinics.• Undergraduate teaching (for full-time trainees) See generic module The Specialist Practitioner and Education.• Weekly Case Discussion Forum.The following modules are undertaken during years 1 and 2:• Introduction to Implantology.• Occlusal management• TMD management• Introduction to sedation• And the following modules listed on p18 are started:• Clinical governance and audit• Interdisciplinary care• Management of the medically compromised patient• Evidence based dentistryAcademic DomainRestorative literature reviewSeminars based on chapters from texts and key journal publications. Trainees are expected toprepare revision notes on each topic and essays on selected topics. Trainees are expected topresent some seminars within Dental Materials Science.Medical statisticsA series of 13 seminars complementing the research dissertation.Research DomainTrainees are allocated a supervised research project within their chosen Monospeciality whichshould be completed within two years (see note on extended projects p6). The dissertation iswritten up as a literature review combined with a manuscript ready for submission to a targetedjournal.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 10
    • AssessmentFormative: 1. Quality of clinical skills work [Term 1] 2. Feedback from clinical trainers and patients [Sessional] 3. Essay writing and practice for MSc examination [Year 1] 4. Literature review [Year 1]Summative: 1. MSc written papers [Year 1] 2. Verbal presentation of 4 treated cases [Annual] 3. Fully documented restorative case presentation [Year 2] 4. MSc vivas [Year 2] 5. MSc dissertation [Year 2] 6. RITAMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 11
    • Years 3 & 4 OverviewClinical DomainClinical activity comprises:• Supervised personal treatment. Patients are allocated to trainees by the course director according to training requirements.• Attendance at diagnostic clinics.• Undergraduate teaching. See generic module The Specialist Practitioner and Education.• Treatment carried out either in practice or in a paid hospital post under the guidance of a specialist trainer.• Weekly Case Discussion Forum.The following clinical activities are undertaken throughout years 3 and 4:• Advanced endodontics (non-surgical and surgical)• Traumatology•Aims and learning outcomes are detailed below.Academic DomainThematic literature reviewBased on chapters from texts and key journal publications. Trainees prepare summary sheetson each topic.Current literature reviewOne session per month will be devoted to reviewing current literature from a list of journalsheld in the library. Articles may be added to the thematic literature review.Research DomainIt is assumed that 3rd and 4th year trainees will continue to be engaged in research activity,such as the preparation of research papers, review articles, case reports and preparation forscholarly presentations. This is over and above the formal research component of trainingdetailed in years 1 and 2.AssessmentFormative: 1. Contribution at Case Discussion Forum [Weekly] 2. Contribution at current literature review groups [Monthly] 3. Feedback from clinical trainers and patients [Sessional] 4. Summary sheets on thematic literature [Termly]MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 12
    • Summative: 1. Essays on thematic literature [Termly] 2. Written documentation of 3 treated cases [Annual] 3. RITA [Annual] 4. MRDMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 13
    • MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 14
    • Years 3 & 4 Endodontic ModuleIndividual module specifications (combined clinical and academic) follow for years 3and 4:• Advanced endodontics and traumatology All aspects of non-surgical and surgical endodontic treatment, pain management and traumatology relevant to endodontics will be supported by the thematic literature assignments and literature which emerges from the Current Literature Review. The main areas of the thematic literature assignments include: • Non-surgical treatment. • Paediatric endodontics, outcome assessment, procedural errors, prognosis, surgical retreatment. • Epidemiology, pathology & diagnosis of endodontic disorders; endodontic emergencies. • Acute & chronic pain; aetiology, diagnosis, management. • Restoration of root-treated teeth, trauma.To ensure comprehensive coverage, trainees will be given detailed readingassignments for the various components of these main subject areas.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 15
    • •Advanced endodontics and traumatologyIntroductionThis module is designed to provide advanced training in endodontology to supplement the basic trainingprovided during years one and two (the MSc course).AimsTo provide:• core academic knowledge required for the safe and effective diagnosis, case selection, non-surgical and surgical treatment, follow-up and prognostication for endodontic cases managed in specialist practice.• foundations for life-long learning and critical self-appraisal.• insight to deficiencies in the current research base, and the need for ongoing research and audit.• opportunities for clinical practice of increasing complexity in a supportive environment• opportunities to master a full range of contemporary endodontic materials, methods and techniques• opportunities to develop constructive self criticism and an understanding of limits in the management of clinical cases.• opportunities for multi-disciplinary management and perspectives on the management of a specialist practice.Learning OutcomesBy the end of the course the trainee will be expected to have developed:• Ability to communicate verbally and in writing with colleagues and patients.• Refined skills in endodontic case selection, diagnosis, surgical and non-surgical treatment, case review and after-care.• Ability to critically self-appraise.• Ability to evaluate innovations in practice and critically appraise the guidance of dental manufacturers and retailers.• Ability to keep clear, succinct records, and document cases for presentation purposes.• Understanding of special issues relevant to patient management in a specialist practice• Ability to assimilate and critically appraise clinical and scientific literature.• Sound understanding of the mechanisms, prevention, diagnosis, clinical treatment and evaluation of endodontic disorders.• Ability to find reference information when needed.• Ability to critically evaluate developments in materials, techniques and clinical practice based on a sound knowledge of current scientific evidence.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 16
    • Assigned tasksClinical• Attendance at prescribed clinics• effective management of clinical time• accurate documentation of cases• good clinical record keeping• documentation of 20 presentation cases each yearAcademic• Completion of assigned thematic reading• preparation of summary sheets• attendance and contributions at current literature discussion groups • termly thematic literature essays• presentation of cases for discussion with trainee colleagues from all specialities of Restorative Dentistry and established specialist trainers at Case Discussion ForumMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 17
    • EvaluationFormative: • Contribution at Case Discussion Forum [Weekly] • Contribution at Current Literature Review groups [Monthly] • Feedback from clinical trainers and patients [Sessional] • Summary sheets on thematic literature [Termly]Summative: • Essays on thematic literature [Termly] • Written documentation of treated cases [Annual] • RITA [Annual] • MRDMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 18
    • Generic ModulesThe generic modules which follow are common to all monospeciality trainingprogrammes.• Interdisciplinary care• Management of the medically compromised patient• Evidence based dentistry• Management, team building and interpersonal skills• Clinical audit, quality assurance and clinical governance• The specialist practitioner and education• Specialist dental practice: management, ethics and medico-legal aspects• Revision for the MRDRCS examinationMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 19
    • Inter-disciplinary CareIntroductionThis module is based on the importance of knowledge in the other disciplines that makeup restorative dentistry in order to diagnose, treatment plan and execute treatment thatis appropriate to the patient and to the constraints under which the clinician or patientmay find him/herself. The module emphasises the need for every treatment plan to takeinto account possible future dental disease and the need to plan for mechanical failure.Experience is also gained of patients who require management by dental specialitiesoutside restorative dentistry. The trainee(s) will share learning with trainees in the otherRestorative monospecialities as well as with Restorative Specialist Registrars. Thismodule will facilitate the documentation of cases required for the MRD exam.AimsTo provide: • The opportunity of attending inter-disciplinary treatment planning and review clinics in Restorative Dentistry. • The environment where treatment plans and the stages in execution of treatment can be discussed with other trainees, technical staff and with established specialists. • To provide the opportunity of being closely involved with any laboratory stages of treatment in order to appreciate the importance of communication with the laboratory.Learning OutcomesBy the end of the course the trainee will be expected to: • Understand the role of inter-disciplinary teams in the management of selected patient groups. • Fully appreciate the importance of taking into account disease susceptibility and modes of failure in relation to treatment planning.Assigned tasksClinical • Attendance at designated inter-disciplinary Restorative planning and review clinics.Academic • Presentation of cases for discussion with trainee colleagues from all specialities of Restorative Dentistry and established specialist trainers at Case Discussion Forum.EvaluationFormative: • Contribution at Case Discussion Forum [Weekly] • Feedback from clinical trainers and patients [Sessional]Summative: • Written documentation of treated cases [Annual] • RITA [Annual] • MRDMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 20
    • The Medically Compromised PatientIntroductionThere are several medical conditions that can impact upon the delivery of dental care.Furthermore, increasing life expectancy will have a significant impact on the prevalenceof medically compromised patients attending for routine dental care. Medicalconditions and the accompanying drug treatment that have the potential to affect dentaltreatment include: valvular heart diseases, anticoagulant therapy, organ transplantpatients, patients with impaired haemostasis, patients on long-term corticosteroids andthose with primary immunosuppressive disorders.AimsTo provide: • An evidence-based review on the effect of various medical conditions on the delivery of dental care.Learning OutcomesOn completion of this seminar, the trainee will have an understanding of: • The need for chemoprophylaxis in patients at risk from dental procedure – induced bacteraemia; • The management of patients on anticoagulant therapy and long-term corticosteroids; • The oral and dental problems of solid organ transplant patients and their management; • The oral and dental problems of patients with primary immunosuppression and management strategies for such patients.LeaderProfessor R A SeymourSuggested reading • Seymour R A, Lowry R, Whitworth J M, Martin M V. Infective endocarditis, dentistry and antibiotic prophylaxis: time for a rethink? Br Dent J 2000;189: 610-616. • Seymour R A, Thomason J M, Ellis J S. Oral and dental problems in the organ transplant patients. Dental Update 1994 (June): 209-212. • Thomason, J M, Girdler N M, Kendall-Taylor, P et al. An investigation in organ transplant patients undergoing gingival surgery. J Clin Periodontol 1999; 26: 577-582. •MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 21
    • Evidence Based LearningIntroductionAs with medicine there is an increasing need to use evidence based on clinical trialsand other scientific studies to influence current practice. This module will beincorporated as part of the thematic and current literature reviews in eachMonospeciality. Trainees will be expected to consider the quality of the evidence basefor clinical practice during each seminar. In addition they will be expected to chooseone of their previous review areas and within that area consider evidence supportingclinical practice and the quality of such evidence. This exercise, which is scheduled foryear three, will extend to trainees in the other Restorative Monospecialities as well asRestorative Specialist Registrars. Each trainee will make an assessed presentation atthe end of year three lasting no more than 30 minutes. Trainees with a particularinterest may wish to attend a specific course on EBD (e.g. Oxford University:http://www.conted.ox.ac.uk/health) but this is not a specific requirement. A mentor willbe assigned to trainees so that they can discuss their EBD learning requirements on anindividual basis.AimsTo provide: • An introduction to the concepts of EBD • A familiar context to expound the concepts of EBD • Experience in making a presentation • An opportunity to communicate EBD between specialitiesLearning OutcomesBy the end of the course the trainee will be expected to: • Have accessed information on EBD (e.g. http://www.nature.com/ebd http://www.cche.net) • Understand the terminology related to evidence based dentistry • Know the merits and limitations of the various types of study • Be familiar with the idea of using meta-analysisAssigned tasks • Identification of a suitable subject to make an evidence based presentation • 30 minute presentation to trainers and other traineesEvaluationFormative: • Feedback from trainees and trainers during literature review sessions [Sessional] • Summary sheets on thematic literature [Termly]Summative: • Evaluation of quality of 30 minute presentation [end of year 3] • MRDMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 22
    • Management, Team Building and Interpersonal SkillsIntroductionIt is acknowledged that trainees will become team leaders in their chosen field. They will need genericskills in management, team building and interpersonal communication for effective and enjoyable workingin both the Hospital and Specialist practice environments.AimsTo provide: • Opportunities for structured training in management skills including: time management, working in meetings, managing a team, delegation, influencing, persuasion, negotiation and managing others. Delivered by professional management trainers from the region. • An understanding of the current structure and funding of the NHS • A supportive environment for applying the skills learntLearning OutcomesBy the end of the course the trainee will be expected to: • Understand basic management theory • Have had opportunities of applying facets of management skill to their daily work • Have had the opportunity of becoming involved with Monospeciality training course organisational issues where appropriateAssigned Tasks • Attend appropriate management training courses.EvaluationFormative: • Feedback from trainees, ancillary staff and trainersMONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 23
    • Clinical Governance and AuditIntroductionAcross medicine and dentistry, there is an increasing emphasis on clinical governanceand audit as tools to improve the quality of our practice and the service provided topatients. Trainee attendance at all Restorative clinical governance and audit meetingsis mandatory from the start of the programme.Trainees will be expected to consider the various aspects of governance (qualityinformation, evidence based healthcare and clinical guidelines, clinical performanceassessment and professional / managerial relationships) and audit and theirrelationship to clinical practice. In addition they will be expected to identify a topic forclinical audit, possibly associated with one of their previous review areas, to be carriedout and reported on. Ideally, there should be a re-audit of the chosen topic to completethe audit cycle and determine if recommendations have been effective.A mentor will be assigned to trainees so that they can discuss their clinical governanceand audit learning requirements on an individual basis.AimsTo provide: • An introduction to the concepts of Clinical Governance and audit • Experience in designing and carrying out a clinical audit project • Experience in presenting the results of such a project • Experience in completing the audit cycle and implementing change.Learning OutcomesBy the end of the course the trainee will be expected to: • Have accessed information on clinical governance and audit • Understand the terminology related to clinical governance and audit • Know the merits and limitations of the audit process • Be familiar with the concepts of clinical governanceAssigned Tasks • Identification of a suitable subject to audit (years 2 and 3) • 30 minute presentation to trainers and other trainees / department clinical governance and audit meeting (year 3) • re-audit (year 4)EvaluationSummative: • Evaluation of quality of 30 minute presentation [year 3] • MRD •MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 24
    • The Specialist Practitioner and EducationIntroductionThis module is designed to provide the required theoretical and practical opportunitiesfor the understanding and practice of teaching, learning and presentation skillsappropriate to the specialist practitioner.AimsTo provide: • To ensure that the trainee has a sound basis from which to approach the educational activities likely to form part of a future specialist career.Learning OutcomesBy the end of the course the trainee will be expected to: • Understand the learning process and the limitations of educational formats including lectures, seminars, and practical work. • Have the ability to select appropriate techniques from a range of teaching, learning and assessment skills. • Have experience of the process of peer review of teaching, and of effective methods for communicating feedback. • Be confident in planning and delivery in the appropriate format. • Become familiar with educational technologies currently available for teaching and learning in clinical dental subjects.Assigned Tasks • Attendance at courses delivered by educational specialists. • Presentation at case discussion seminars • Leading topic based MSc seminars (years 3 and 4) • Delivery of lectures • Delivery of post-graduate courses including hands-on elementsEvaluationFormative: • Contributie to the teaching facet of Case Discussion Forum [Weekly] • Feedback from participants at assigned educational activities.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 25
    • Specialist Dental Practice: Management, Ethics and Medico-legal AspectsIntroductionMost monospeciality trainees enter training in order to pursue private specialistpractice. Whilst the hospital is well equipped to provide didactic education and clinicalexperiences, exposure to specialist practice and practitioners is essential to groundtrainees in the ethical, medicolegal and managerial issues of establishing and running asuccessful specialist practice. This module will allow trainees to visit specialistpractices, to experience management systems and protocols, and to discuss the pitfallsand particular considerations of specialist private practice.AimsTo provide: • Opportunities for trainees to spend time in a number of private and specialist practices. • Opportunities to witness systems for patient and business management, record keeping and relationships with referring dentists in successful specialist practices. • Opportunities to discuss emergent issues with experienced specialist practitioners.Learning OutcomesBy the end of the course the trainee will be expected to: • Understand the special issues in establishing a specialist referral practice. • Understand the special ethical and medicolegal considerations in managing referred private patients. • Have improved communication skills in correspondence with referring practitioners. • Have improved business sense for running a successful private specialist practice.Assigned Tasks • Attend a number of private and specialist practices (years 3 and 4) • Attend discussion/seminar groups with specialist practitioners. • Incorporate elements of private patient management and developing relationships with referring practitioners during hospital and practice-based clinical activity.EvaluationFormative: • Feedback from practices visited. • Contributions to discussion/seminar groups. • Observation of hospital-based patient management, time management, correspondence with referring practitioners.MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 26
    • Preparation for the MRDRCS Examination (Endodontics)IntroductionScheduled sessions to ensure that trainees have adequate curriculum time fortopic-based revision of subjects identified by themselves or by teachers.AimsTo provide: • The aim is to prepare for a success at the written and verbal parts of MRD examination and to ensure preparation of appropriate presentation material.Learning OutcomesBy the time of taking the MRD the trainee will be expected to: • Have the ability to locate, recall and organise specialist knowledge included in the curriculum to provide well-structured, coherent and focused answers to questions posed verbally or in writing. • Have the skills required to analyse verbal and written questions and frame an argument that will address the elements of the question in an efficient manner. • To be able to effectively evaluate clinical data, records, photographs, radiographs, casts etc. of endodontic relevance without preparation time.Assigned Tasks • Revision sessions in selected areas of the curriculum. • Essay practise from past papersEvaluationFormative:• Evaluation of performance at revision seminars.Summative• Results of essay practise from past papers. •MONOSPECIALITY TRAINING IN ENDODONTICS – Handbook 2003-2007 27
    • Appendix 1Aims and Learning Outcomes: Clinical DomainGeneral educational aim:To provide opportunities for clinical practice of increasing complexity in a supportiveenvironment; provide opportunities to master a full range of contemporaryendodontic materials, methods and techniques; develop a spirit of constructive selfcriticism and an understanding of limits in the management of clinical cases. Tocommunicate effectively with colleagues and patients. To highlight the deficiencies incurrent research base, and the need for ongoing investigation. To encourage thedevelopment of clinical academic inquiry.On completion, the trainee should be able to demonstrate thefollowing skills/knowledge:• Ability to communicate verbally and in writing with colleagues and patients.• Ability to integrate endodontic and other restorative management within the context of total patient care.• Refined skills in endodontic diagnosis, treatment, case review and after-care.• Ability to critically self-appraise.• Ability to evaluate innovations in practice and critically appraise the guidance of dental manufacturers and retailers.• Ability to keep clear, succinct records, and document cases for presentation purposes.• Understanding of special issues relevant to patient management in a specialist practice which are developed further in the generic module: Specialist Dental Practice: Management, Ethics and Medico-legal Aspects.The assigned tasks in achievement of these learning outcomes are:Attendance at prescribed clinics and weekly Case Discussion Forum; effectivemanagement of clinical time; accurate documentation of cases; good clinical recordkeeping; verbal presentation of 4 cases (years 1 and 2), 1 full written case report(year 2), and 20 full written case reports each year (years 3 and 4).Evaluation of the achievement of these learning outcomes will berealised by:Formative: General feedback from clinical teachers and patients; contribution at weekly Case Discussion Forum. Feedback from treatment planning and progress discussions with educational supervisors/specialist trainers.Summative: End of year documented clinical cases.MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 28
    • Appendix 2Aims and Learning Outcomes: AcademicDomainGeneral educational aim:To provide, in addition to the requirements of the MSc in Restorative Dentistry, coreacademic knowledge required for the safe and effective diagnosis, treatment, follow-up and prognostication for complex restorative and endodontic cases managed inspecialist practice. To provide foundations for life-long learning and critical self-appraisal. To highlight the deficiencies in current research base, and the need forongoing investigation. To encourage the development of academic inquiry.On completion, the trainee should be able to demonstrate thefollowing skills/knowledge:• Ability to assimilate and critically appraise clinical and scientific literature.• Sound understanding of the prevention, diagnosis, clinical treatment and evaluation of patients with endodontic problems/disorders.• Sound understanding of materials science.• Sound understanding of related laboratory procedures.• Ability to find reference information when needed.• Ability to critically evaluate developments in materials, techniques and clinical practice based on a sound knowledge of current scientific knowledge.The assigned tasks in achievement of these learning outcomes are:• Completion of MSc• Completion of assigned thematic reading• Preparation of summary sheets;• Attendance and contribution at current literature review groups• Termly thematic literature essays.Evaluation of the achievement of these learning outcomes will berealised by:Formative: evidence of reading; participation in current literature review; summary sheets on thematic literature review.Summative: MSc written papers, essays on thematic literature.MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 29
    • Appendix 3Aims and Learning Outcomes: ResearchDomainGeneral educational aim:To provide, as part of the requirements of the MSc in Restorative Dentistry,experience in reviewing the literature, carrying out, analysis, writing up and reportingof a research project related to the Monospeciality area. Whilst most of this work willbe carried out in years 1 and 2 trainees should expect to continue some researchactivity in years 3 and 4.On completion, the trainee should be able to demonstrate thefollowing skills/knowledge:• Ability to critically review scientific literature relevant to the proposed study.• Ability to formulate a hypothesis and devise methods of testing it• Ability to establish clear aims and objectives for a research project• Ability to work in a structured scientific manner, record findings systematically in a research log book and prepare a research manuscript• An understanding of statistics relevant to the research undertaken• Ability to analyse data and make valid conclusions• Ability to compare results with those of other workers• An appreciation of the clinical relevance and shortcomings of the workThe assigned tasks in achievement of these learning outcomes are:• Completion of MSc literature review• Completion of a contemporaneous laboratory log book• Completion of one or more manuscripts for journal submission• Presentation of research findings locally, nationally and, where appropriate, internationallyEvaluation of the achievement of these learning outcomes will berealised by:Formative: MSc literature review criticised by internal examiners after one year Presentation of research findings to facultySummative: MSc dissertation (including lab book, literature review and manuscript). MSc dissertation viva Journal reviewers’ reportsMONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 30
    • Appendix 4Time commitment years 1 & 2– full time traineeThe tables below show the number of sessions and full-time student contact/preparation hoursover the first and second years of the course including the MSc in Restorative Dentistry.(colour coding: Clinical, Academic, Research) . Year 1 No. of Mean session Student contact hours sessions Duration (hrs) (B) Total (A) x (B) (A)Seminars 14Cons 9Endo 25Interrelated subjects 19Materials Science 13Phantom Head 21Perio 10ProsthoTotal 112 1.5 seminar 168 1.5 preparation 168Phantom HeadPractical 13 2 26Lab Course 12 3 36 1 preparation 12Clinic terms 2,3 20Cons 20Endo 20Perio 20Prostho 80 3 240Total 20 2 40Case presentation/waxingStatistics 13 1.5 19.5Research ProjectLiterature review 20 5 100Practical 30 3 90Tutorials 10 2 20Combined practitionerCoursesOcclusion & restorations 4TMD 3Implant 4Sedation 2Total 13 3.5 45.5Revision 50 3 150(Including essaypractice)Total contact hrs 1115MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 31
    • Year 2 No. of Mean session Student contact sessions Duration (hrs) hours (B) (A) Total (A) x (B)Review of Monospeciality 10 1.5hr seminar 15current literature 3 hrs 30 preparationTeaching experience 20 3 60Clinic terms 4,5,6 100 3 300Monospeciality :Restorative 3:1*Diagnostic Clinics 40 3 120Research ProjectPractical 40 8 320Tutorials 15 2 30Writing-up 20 5 100Revision 50 3 150Total contact hrs 1225* spread flexibly between years 1 and 2(colour coding: Clinical, Academic, Research) .MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 32
    • Time commitment years 1 & 2 – part time traineeThe tables below show the number of sessions and part-time student contact/preparationhours over the first and second years of the course including the MSc in Restorative Dentistry(colour coding: Clinical, Academic, Research). Year 1 No. of Mean session Student contact hours sessions Duration (hrs) (B) Total (A) x (B) (A)Seminars 14Cons 9Endo 25Interrelated subjects 19Materials Science 13Phantom Head 21Perio 10Prostho 1.5 seminar 168Total 112 1.5 preparation 168Phantom HeadPractical 13 2 26Lab Course 12 3 36 1 preparation 12Clinic terms 2,3 20Cons 20Endo 20Perio 20ProsthoTotal 80 3 240Case presentation/waxing 20 2 40Statistics 13 1.5 19.5Research ProjectLiterature review 20 5 100Practical 30 3 90Tutorials 10 2 20Combined practitionerCoursesOcclusion & restorations 4TMD 3Implant 4Sedation 2Total 13 3.5 45.5Revision 50 3 150(Including essaypractice)Total contact hrs 1115MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 33
    • Year 2 No. of Mean session Student contact sessions Duration (hrs) hours (B) (A) Total (A) x (B)Review of Monospeciality 10 1.5hr seminar 15current literature 3 hrs 30 preparationTeaching experienceClinic terms 4,5,6Monospeciality : 80 3 240Restorative 15 2 30 3:1 30 2 60Practice caseCase presentation/waxingDiagnostic Clinics 20 3 60Research ProjectPractical 40 8 320Tutorials 15 2 30Writing-up 20 5 100Revision 50 3 150Total contact hrs 1035(colour coding: Clinical, Academic, Research)MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 34
    • Analysis of years 1 & 2 and years 3 & 4 relative to 4500hrsFull time specialist trainee 4500hrs over 3y Years 1 & 2 Years 3 & 4 @ 60% clinical (inc. 2 year MSc) 25% academic 15% researchClinical 2700 762 1938Academic 1125 818 307Research 675 660 15Total 4500 2240 2260Part time specialist trainee 4500hrs over 3y Years 1 & 2 Years 3 & 4 @ 60% clinical (inc. 2 year MSc) 25% academic 15% researchClinical 2700 732 1968Academic 1125 758 367Research 675 660 15Total 4500 2150 2350NB 4500 hours is the minimum time a trainee would spend on the programme. The figuresare not intended to be absolute but to give a guide to how the balance of time spent inclinical, academic and research activities changes between years 1-2 and years 3-4.The research component is front loaded as an MSc requirement at the beginning of thecourse. Depending on the nature of the project more or less time may be spent during years1-2. However, the trainee would be expected to submit at least one manuscript for scientificjournal publication during years 3-4.MONOSPECIALITY TRAINING IN PROSTHOENDODONTICS – Handbook 2003-2007 35