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1. A review of continuing professional development for dentists
in Europe*
E. Barnes1
, A. D. Bullock2
, S. E. R. Bailey1
, J. G. Cowpe1
and T. Karaharju-Suvanto3
1
School of Postgraduate Medical and Dental Education, Cardiff University, University Dental Hospital and School, Heath Park, Cardiff, UK,
2
Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Science, Cardiff University, Glamorgan Build-
ing, Cardiff, UK,
3
Institute of Dentistry, University of Helsinki, Helsinki, Finland
Introduction
Key competences required of the new dental graduate and a
European perspective on the quality assurance of undergraduate
education have been established (1). In the context of changing
patterns of oral health needs (2), an increasingly wide range of
health issues (3) and higher patient expectations (4–6), practi-
tioners need to develop a wider knowledge base than that
which can be provided by undergraduate training alone (6–10).
Continuing professional development (CPD) is the mechanism
by which dental practitioners develop their skills and knowl-
edge and maintain up-to-date practice. Definitions of CPD
(11–14) draw attention to the career-long importance of CPD
and its value for patient care.
Although rules about the required amount and content of
CPD vary across the European Union (EU) (15–17), there is
evidence of a worldwide trend towards mandatory CPD (5, 9,
18–21). The need to update clinical skills and integrate new
developments into patient care is an accepted part of profes-
sional practice and increasingly related to continued registra-
tion (22, 23). However, differences in CPD requirements mean
that patients are likely to be subject to different standards of
oral health care depending on where they live, or travel to,
within the EU (24). This paper presents a summary of the findings
Keywords
continuing professional development;
continuing education; dentistry.
Correspondence
Jonathan G. Cowpe
Dental Postgraduate Section,
Wales Deanery - School of Postgraduate
Medical and Dental Education
Neuadd Meirionnydd
Heath Park
Cardiff CF14 4YS, UK
Tel: +44 (0)29 2074 4317
Fax: +44 (0)29 2074 3960
e-mail: cowpeJG@cardiff.ac.uk
Accepted: 5 January 2012
doi:10.1111/j.1600-0579.2012.00737.x
Abstract
Aim: To summarise findings from a literature review of dentists’ engagement in
continuing professional development (CPD) and its effects on improving oral health
care for patients.
Method: The search strategy used key terms in a range of databases and an academic
literature search engine, complemented by hand searching and citation follow-up.
Results: One hundred and fourteen papers were reviewed. The majority of dentists
engaged in CPD. Factors affecting participation included time since graduation, costs,
work and home commitments, postgraduate qualification, interest and convenience.
Learning needs identification and reflection on practice were rarely evidenced. Com-
mon modes of CPD were courses and journal reading; no one delivery method proved
more effective. Few papers directly explored recommendations for topics although
suggestions related to common areas of error and gaps in knowledge or skill. Studies
of CPD effectiveness and impact-on-practice suggested that courses can result in wide-
spread new learning and considerable self-reported change in practice. However, signif-
icant barriers to implementing change in workplace practice were noted and included
availability of materials, resources and support from colleagues.
Conclusion: To ensure high standards of care, alongside recommending core or man-
datory topics, more attention should be given to reflection on learning needs, the lear-
ner’s readiness to engage with education and training and the influence of the
workplace environment.
*Article reproduced from Eur J Dent Educ 16 (2012) 166–178
European Journal of Dental Education ISSN 1396-5883
ª 2013 John Wiley & Sons A/S 5
Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17

2. of a review of the literature undertaken as part of a wider study
(‘DentCPD’ – part funded by the European Commission
(#509961-LLP-1-2010-1-UK-ERASMUS-EMHE). The review
aimed to report dentists’ engagement in CPD, focused on Eur-
ope, and its effects on the oral health care for patients. This
involved reviewing:
l the volume of CPD undertaken, factors associated with
uptake and barriers to participation;
l the range of CPD delivery methods;
l CPD topic preferences and
l what is known about CPD effectiveness and impact-on-
practice.
Method
As well as searching for papers in the scientific, medical and
nursing databases (Web of Science; OVID Medline; EMBASE;
CINAHL; SCOPUS Life Sciences, Health Sciences, Physical Sci-
ences and Social Sciences & Humanities), others were included
to capture educational (ERIC after 1996; British Education
Index) or social sciences and psychology aspects (ISI Web of
Knowledge; ASSIA after 1987; PsychInfo). Unless otherwise
indicated, there was no date limit initially, although papers
published prior to 1990 were later excluded. An academic liter-
ature search engine (Google Scholar) was also utilised. This
search was conducted in the UK and complemented by one
undertaken by colleagues in Finland who searched four data-
bases (OVID Medline; EBM Reviews – ACP Journal Club 1991
to December 2010; EBM Reviews – Cochrane Database of
Systematic Reviews 2005 to December 2010, EBM Reviews –
Database of Abstracts of Reviews of Effects 1st Quarter 2011).
All searches were conducted during February 2011.
The UK team employed the following search terms:
dent* AND CPD
dent* AND CPD AND Europe
dental AND education
dental AND education AND continuing
dental AND education AND Europe
dental AND education AND continuing AND Europe
The terms employed by the Finland team were:
dent* AND continuing education
education, dental, continuing/legislation & jurisprudence,
standards
Additional papers were identified by the DentCPD research
team through reviewing the reference lists of retrieved articles
and hand searching the European Journal of Dental Education
and the British Dental Journal.
Titles and abstracts, if available, of each reference were
scanned for relevance or further investigation. Only papers
focusing on CPD for general dentists were included. This
excluded papers focusing on dental care professionals (DCPs),
undergraduate education, vocational training or assessment
rather than continuing education. Papers published before 1990
and those advertising courses or events were also excluded.
Papers including empirical evidence, reviews, summaries or
opinion articles were included. Papers were first categorised by
EB (UK) and TKS (FI). Uncertain cases were cross-checked
with AB (UK).
Results
Initial database searches identified 1764 potentially relevant
papers of which 119 were judged to be relevant. An additional
27 were included from reference lists and hand searches. Of
these, 105 were read in full, abstracts were only available for
nine, and 32 could not be accessed. Eighty-three of these were
empirical, and 31 were summary papers, reports, literature
reviews or opinion pieces (see Figure 1). A full list of papers
included and excluded are available upon request.
Continuing professional development uptake
A number of studies have reviewed the amount of CPD under-
taken by dental practitioners. Table 1 provides a summary.
Most typically, information on the amount of CPD undertaken
has focused on course attendance and has been gathered by
questionnaire survey.
These studies show that uptake varies considerably and
several report a small proportion of dentists not participating
in any courses (4, 31, 33, 39). However, it is difficult to make
comparisons because studies report a variety of modes of CPD
delivery and even where courses alone are considered, the type
(e.g. lecture, hands-on) and duration (e.g. half-day, full-day)
differ or are not specified. Furthermore, although the majority
of these studies looked at courses undertaken in the previous
year (4, 25, 31, 33, 34, 39–41, 43), some looked over a 2-year
period (28, 29, 35, 36) and one considered intentions (10).
Databases
searched
2546 duplicates
removed
1764
titles/abstracts
screened
4310 papers
retrieved
118
papers
relevant
32 could not
access
1646
papers
excluded
103 full
papers
9
abstracts
only
114
sources
included
26 from
other
sources
Comprising:
83 empirical papers
8 reports
7 literature reviews
4 opinion pieces
12 topic summaries
Fig. 1. Literature selection process.
Review of CPD for dentists Barnes et al.
6 ª 2013 John Wiley & Sons A/S
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3. TABLE 1. Studies reporting amount of continuing professional development (CPD) undertaken by dental practitioners
Authors Country Main method, numbers Context, subjects Key findings
Walmsley and Frame (25) UK Audit, 1700 GDPs Data collected from records held by West Midlands
Regional Postgraduate Dental Education Committee
on attendance at courses
41% attended at least one course during previous
academic year.
Age variation, reduced uptake amongst older
practitioners.
Buckley and Crowley (26) Ireland Audit, 146 dentists Sample of dentists participating in CDE in the South
and Mid-West regions of Ireland
Low level of involvement in some modes of CPD.
Allen et al. (27) Worldwide Questionnaire 24 returns 26 selected national dental associations 10 countries reported hands-on courses were taken
by <10% of dentists, four countries reported
20-40%.
Johnson, Johnson et al. (28) UK Questionnaire 200 returns Practitioners attending day courses 74% attended at least five courses over the
preceding 2 years.
Kuthy, Bean et al. (29) USA Audit 507 returns Dentists on Ohio register Mean of 10 courses (56 CPD hours), mode 6, max
37. This related to a mean of 56 CPD hours over
the previous 2 years.
Baldwin et al. (31) UK Questionnaire 183 responses 2 cohorts – 1 qualified just before mandatory DVT
and 1 qualifying just after its introduction from the
Scottish Dental School in 1991 and 1994
98% attended a mean of 5.6 sessions in the previous
year. 15% attended none. No differences by year of
graduation or gender.
Buckley and Gloster (32) Ireland Questionnaire, 90 responses Sample of dentists on the Irish Dental Council
register in the South West region
92% attended at least one course and more than
65% had attended more than three courses.
Mercer, Long et al. (33) UK Questionnaire 307 returns GDPs taking part in clinical audit in Yorkshire In previous year, 82% attended ‡1 State funded
course; 50% ‡ 1 private course. 13% attended
zero. 20% involved in study groups.
Ireland et al. (34) UK Questionnaire 514 returns Dentists on Health Authority lists in two regions In the previous year: 99% attended one
postgraduate session, 89% attended ‡ 2, 53%
attended ‡ 4.
Kuthy et al. (35) USA Audit 507 returns Dentists on Ohio register Mean of 10 courses taken over the previous 2 years.
42% took at least one course provided by a dental
school and 67% took at least one from a local
dental society.
Al Fouzan (36) Saudi Arabia Questionnaire 298 returns GDPs in eight urban cities within Kingdom of Saudi
Arabia
Within the previous 2 years 46% attended only one
or two courses.
McGimpsey et al. (37) Northern Ireland Questionnaire, no n given Sample of Northern Ireland GDPs 90% of respondents fulfilled contractual requirement
by attending at least two courses annually. 60%
attend 5+ events a year.
Wiskott, Borgis et al. (38) Switzerland Audit of records, questionnaire
(unclear – 40-60% of 1300)
Geneva Only 20% of the required course hours were
undertaken.
Barnes
et
al.
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4. TABLE 1. Continued
Authors Country Main method, numbers Context, subjects Key findings
Best and Messer (39) Australia Questionnaire 396 returns.
Review of records
Dental practitioners in Victoria 52% belonged to a study group; 67% subscribed to
‡ journal; 89% regularly discussed work with
colleagues; 99% assessed their own work but 13%
did not attend CPD courses and 18% did not
complete any courses within the previous year.
Buck and Newton (40) Ireland Questionnaire 379 returns Dentists on general dental council (GDC) register 50% attended 5+ days in the previous year. 87%
read journals once per month.
Tseveenjav, Vehkalahti et al. (12) Mongolia Questionnaire 245 returns Dentists in the capital city In last 2 years 38% undertook some form of CPD.
Firmstone, Bullock et al. (41) UK Questionnaire 2082 returns GDPs in three English deaneries 97% ‡ one 2.5 h course; 43% 15+ hours in the
previous year.
Burke, Wilson et al. (4) UK Questionnaire 701 returns GDPs in Scotland and North West England In previous year: 41% 5+ courses; 27% 3-4; 27%
1-2; 5% zero.
Chang, Ng et al. (10) Hong Kong Questionnaire 514 returns Dentists attending 26th Asia Pacific Dental Congress 96% intended to attend CPD courses within next
5 years.
Kossioni, Tzoutzas et al. (42) Greece Questionnaire 21 returns Greek Dental Associations (DAs) 18 DAs had organised CPD courses in previous
3 years. Attendance was 21-50% (11 DAs), 70%
(three DAs).
Nieri and Mauro (43) Italy 123 telephone interviews Dental practitioners in Prato In previous year: mean two courses, consulted 31
books, 53 journal papers (mainly national), accessed
internet information 16 times, 44 consultations with
colleagues.
Hopcraft et al. (44) Australia Questionnaire 552 returns Dentists on register During 2007 more than half of respondents attended
20+ hours of CPD. 93% attended a course, 85%
read journals, 68% discussed practice with
colleagues and 68% attended a conference. Only
5% took part in distance learning, 8% clinical audit
and self-assessment (16%).
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5. To understand more about the reasons for the variation in
engagement with CPD, studies that reported factors relating to
CPD uptake were scrutinised. Table 2 provides a summary of
the findings.
A number of these studies report a curvilinear relationship
between age/experience and CPD: less CPD seemed to be
undertaken by both younger or more recently qualified practi-
tioners as well as older or more experienced practitioners. Leg-
gate and Russell (51) suggest that more recent graduates may
not participate beyond the minimum requirements because
they have recently qualified and may be reluctant to pay for
CPD because of the financial demands of building a clinical
practice whilst managing educational debts. Provision, costs
and the professional’s time may restrict the practitioners’ will-
ingness to participate in CPD (41, 46, 50, 54). Older dentists
may only seek out activities which fulfil a perceived clinical
need, such as new techniques or materials, or ones that provide
an opportunity for an increased income (29). Other factors
affecting uptake include domestic commitments, gender and
whether the practitioner holds a postgraduate qualification (12,
46, 52, 55, 57).
Some studies have looked at reasons for attending courses or
engaging in other forms of CPD (Table 3).
A key dimension is whether choice of CPD activity is needs-
driven or convenience- and/or interest-led. Although these
studies provide evidence of dentists selecting CPD on the basis
of the content and a desire to improve skills or knowledge
(which may or not be linked with an analysis of learning need),
the literature also provides evidence of dentists selecting CPD
on the basis of factors such as location, the speakers or need to
fulfil CPD requirements.
In summary, a number of empirical studies have explored
CPD uptake and factors that recur include: the age of the prac-
titioner and time since graduation, the costs of taking part,
work and home commitments, whether the practitioner holds a
postgraduate qualification, the practitioner’s desire to improve
their practice as well as their interest and convenience-related
factors.
Continuing professional development modes of
delivery
Several papers focused on how CPD is delivered. The modes
commonly reported include: courses (including hands-on, sem-
inars and lectures); reading journals or books; e-learning/inter-
net usage; distance learning; and audit (8, 38, 54). The General
Dental Council (GDC) surveyed dentists’ opinions shortly after
the introduction of mandatory CPD in the UK and found that
commonly respondents thought that effective methods of verifi-
able CPD included reading journals (93%) lectures (89%), and
hands-on courses (88%). They were observed to undertake peer
review (62%), audit (54%) and use dental education websites
(39%) less often (63). This finding echoed an earlier survey
reported by Bullock et al. (52) who observed that the most fre-
quently undertaken forms of CPD within their UK sample were
journal reading (98%) and courses (97%) whilst the least fre-
quently undertaken were clinical audit (11%) and distance
learning (9%). Chan et al. (10) discovered that respondents at
the Asia Pacific conference preferred formal lectures (82%),
with self-learning approaches such as distance learning (29%)
and Internet courses (29%) also mentioned. Regular discussion
with colleagues was also reported as a common form of contin-
ued learning. Abbott et al. (56) found that half of the courses
taken by their Australian participants were lecture courses or
seminars with the remainder incorporating practical and clini-
cal components. However, when Woolfolk et al. (64) presented
participants with a choice of CPD formats, 42% selected dis-
tance learning methods whilst only 17% chose traditional for-
mal lecture courses.
Lectures are acknowledged as a useful method for dissemi-
nating information as well as providing an opportunity to meet
up with colleagues (28, 51). Seminars require the dentist to
take a more active part in the session. Interaction between
tutors and the audience, and amongst the group itself, can aid
learning but relies on the skills of the facilitator (53). Bullock
et al. (65) found that hands-on courses were well received by
participants.
Professional dental journals are a source of information with
high potential value to practitioners (53). The array of journals
available, the range of topics covered within them and a lack of
interest in, or relevance to their practice of some topics means
that their impact can be lessened without careful review (53).
Tredwin et al. (66) observed that this is rarely the dentist’s only
form of CPD.
Self-assessment and clinical audit are not only mechanisms
for identifying gaps in knowledge but, as Redwood et al. (62)
argue, should involve monitoring and reflection on clinical
practice. This was also found as an important factor in the
recent view of CPD impact untaken by the GDC (67).
The internet is now a well-accepted source of information
for both practitioners and patients (68–70), and e-learning is
a common and well-received method of distance learning
(71, 72). In 2000, Kuthy et al. (73) found that at least 25%
of the dentists they audited had taken part in distance learn-
ing courses and just over 5% achieved all their required
CPD hours via this method. In some studies, participants
have requested greater access to IT-based courses (52), partic-
ularly younger dentists (51). In 2003, Clark (74) found more
than 300 courses for dentists available online and concluded
that use of e-learning would continue to rise. However,
Schleyer and Pham (75) reported that online courses could
be hard to search as there was no consistency in the terms
used by the sites, and most web pages did not state which
dental boards would accept accreditation of this form of
CPD. Websites can also remain online, unchanged, for many
years resulting in out-of-date information (53, 75). Another
disadvantage is the limited opportunity for human interaction
(76–78). Eaton and Hammick (71) made recommendations
for distance learning programmes. A noted potential limita-
tion of e-learning is the limited potential for teaching clinical
skills (79).
Overall, lectures are reported as cost-efficient, acceptable and
effective but their passive nature may hinder learning. Hands-
on activity is good for learning skills and journal reading can
be a valuable adjunct if the reader knows how to filter informa-
tion. Peer review and self-assessment are recommended compo-
nents for CPD (15, 62), not just for identifying gaps in
knowledge but also reflecting on own practice. In addition,
Barnes et al. Review of CPD for dentists
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6. TABLE 2. Studies reporting factors relating to continuing professional development (CPD) uptake
Authors Country Main method, numbers Context, subjects Key findings
Bean (45) USA Audit of 507 GDPs and data
from American Dental Directory
Dentists on Ohio register Mean age of those undertaking CPD was 46.9 years,
graduating 20.2 years ago. 73% claimed to work
more than 30 h a week.
Mouatt et al. (46) UK Questionnaire 1670 returns Dentists on English register Least likely to attend courses: age 30 and 50.
Young and Rudney (47) USA Questionnaire 357 returns Sample of practising dentists within a six state
regions of the upper Midwest
Cost and distance were less important factors than the
quality of the courses.
Buckley and Crowley (26) Ireland Audit 146 dentists Sample of dentists participating in CDE in the South
and Mid-West regions of Ireland
Dentists belonging to a number of organisations and
subscribing to various journals also tended to be the
most frequent attendees at relevant courses,
conferences and meetings.
With some exceptions, specialists and hospital-based
dentists were more likely to be involved in CPD
activities.
Kuthy et al. (29) USA Audit 507 returns Dentists on Ohio register Curvilinear relationship between age and CPD.
Baldwin et al. (31) UK Questionnaire 183 responses 2 cohorts – 1 qualified just before mandatory DVT
and 1 qualifying just after its introduction from the
Scottish Dental School in 1991 and 1994
The number of sessions attended was significantly
associated with feelings of competence.
Ireland et al. (34) UK Questionnaire 514 returns Dentists on Health Authority lists in two regions Travelling up to 30 miles for a one-off session was
acceptable to 27%.
Newton et al. (48) UK Questionnaire 1798 returns Dentists on GDC register Least likely to attend courses: female.
Ralph et al. (49) UK Questionnaires 154 returns Dental graduates of University of Leeds Completing a postgraduate vocational year had little
impact on later amount of CPD activity.
Best and Messer (39) Australia Questionnaire 396 returns,
review of records
Dental practitioners in Victoria Most likely to attend courses: Association members
and mid-career dentists.
Belfield et al. (50) UK Discussion paper n/a Two main types of costs of CPD: (a) provision costs
and (b) opportunity cost of professionals’ time.
Buck and Newton (40) Ireland Questionnaire 1550 returns Dentists on GDC register Reading journals: those qualified longest were least
likely to read professional journals.
Leggate and Russell (51) UK Questionnaire General dental practices in Scotland Views on CPD benefits: skill enhancement (those with
further qualification); career prospects
(those 30 years of age).
Bullock, Firmstone et al. (52) UK Questionnaire 2082 returns GDPs in three English Deaneries More likely to complete recommended amount of
CPD: postgraduate qualification; part-time related
work (e.g. tutor). Least likely: longer in practice;
single-handed.
Tseveenjav, Vehkalahti et al. (12) Mongolia Questionnaire 245 returns Dentists practising in the capital city Perceived need for CPD: less clinical experience,
working in general practice, having a postgraduate
degree and other CPD attendance during the time
period.
Firmstone, Bullock et al. (41) UK Questionnaire 2082 returns All GDPs in three English Deaneries Four main constraints on participation: cost; personal
and staff issues; time and restraints owing to
regulating body.
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7. e-learning has potential and is becoming a common aspect of
blended techniques.
Continuing professional development prefer-
ences
Many countries have no regulation about the content of CPD
and currently allow their dentists the freedom to make their
own choice of CPD topics: selection of CPD activity is left to
an individual’s professional judgement. Other European coun-
tries mandate that certain core topics are studied.
There is a relative dearth of information on the essential sub-
ject areas for dentists’ CPD. Some studies report on what topics
dentists want to study rather that what might be judged essen-
tial. Vaughan (80) found that respondents wanted courses to
focus on, in order, theory, clinical demonstration, practical
work and the laboratory work. Mouatt et al. (46) found that
their participants wanted more information on practice man-
agement, hands-on training, computer use, restorative tech-
niques, preventative treatment and oral surgery. Wiskott et al.
(38) reported that their participants requested more courses on
risk assessment in medically compromised patients, communi-
cation with attending physicians, medical emergencies and for-
mal courses on topics such as otolaryngology, pharmacology,
haemostasis and antibiotics. Chan et al. (10) found that partici-
pants requested CPD in oral implantology, cosmetic dentistry
and root canal therapy. Similarly, Hopcraft et al. (20), in a sur-
vey of Australian dentists, asked what areas they required more
CPD which elicited the response implantology (39%), end-
odontics (39%) and aesthetic/cosmetic dentistry (37%).
In terms of what may be required, Shanley et al. (24) claimed
that most dental mistakes are made because of inadequate
cross-infection control, incorrect use of ionising radiation, fail-
ure to recognise the early signs of serious diseases such as can-
cer and incorrect management of a medically compromised
patient. They suggested CPD should focus on reinforcing these
topics. When Wright and Franklin (81) conducted a significant
event analysis workshop, they found that incidents fell into
three main themes: those involving clinical treatment, incidents
involving the running of the practice, and those related to the
relationships between members of the team and members of
the team and patients. Walker et al. (82) found their respon-
dents identified gaps in their specialised clinical skill knowledge
but relatively few reported gaps in general clinical skills, com-
municating with patients, acute care of dental patients or
continuing care of dental patients. Christensen (8) based his
discussion of core topics on content that he considered insuffi-
ciently addressed in undergraduate training. He concluded that
practice management, practical occlusion concepts, aesthetic
dentistry, implant prosthodontics and implant surgery, ortho-
dontics, diagnosis and treatment planning should be core top-
ics.
The movement of dentists around Europe would be facili-
tated by a recognised core education available to all European
dentists, although as Blinkhorn et al. (19) highlight, harmonisa-
tion of CPD should accommodate diversity and innovation.
Promoting consistency in approach to training programmes,
argues Scott (83), should ultimately lead to a convergence of
high standards of the delivery of patient care. However, mandatory
TABLE
2.
Continued
Authors
Country
Main
method,
numbers
Context,
subjects
Key
findings
Christensen
(53)
USA
Opinion
article
Effectiveness
of
different
forms
of
CPD
Dentists
tend
not
to
attend
CPD
courses
for
the
first
few
years
after
education.
Best
et
al.
(16)
Australia
Questionnaire,
n
undisclosed
Members
of
key
dental
organisations
in
17
countries.
Costs
of
CPD
involve
not
only
the
direct
cost
of
courses
and
other
activities
but
also
indirect
costs
such
as
travelling
and
accommodation
expenses
and
loss
of
earnings.
John
and
Parashos
(54)
Australia
Questionnaire
108
responses
Practitioners
attending
day
courses
Only
dentists
without
a
postgraduate
qualification
tend
not
to
attend
CPD
courses
for
the
first
few
years
after
education.
Kossioni,
Tzoutzas
et
al.
(42)
Greece
Questionnaire
21
returns
Greek
Dental
Associations
(DAs)
More
likely
to
attend
courses:
40
year
of
age.
Abbot,
Burgess
et
al.
(55)
Australia
Audit
Data
collected
from
University
Continuing
Dental
Education
Committee
(UCDEC)
Curvilinear
relationship
between
age
and
CPD.
Polyzois,
Claffey
et
al.
(56)
Ireland
Questionnaire
235
returns
12
cohorts
of
dentists
who
had
qualified
in
Dublin
Less
CPD
undertaken
by
those
with
child(ren).
More
CPD:
working
full-time.
General
practitioners
less
likely
to
attend
conferences
than
specialists.
Those
in
rural
areas
found
accessing
CPD
harder.
Barnes et al. Review of CPD for dentists
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8. TABLE 3. Studies reporting reasons for choosing continuing professional development (CPD) activity
Authors Country Main method, numbers Context, subjects Key findings
Patterson and Thompson (57) Canada Questionnaire 650 returns Dentists practising in Alberta and Atlantic Canada Most important factors in decision making: course content
(91%), identity of the speaker (72%) and location/travel
time of venue (39%).
Johnson, Johnson et al. (28) UK Questionnaire 200 returns Practitioners attending day courses Influenced by, title and content of the courses as
advertised, personal recommendation of a colleague,
geographic location.
Vlitos et al. (30) UK Questionnaire 16 returns Pre-, post- and 6 months post-programme
assessment of dentists attending a year-long
restorative techniques course.
Choice influenced by desire to improve skills (100%), to
learn new skills (94%), build confidence (100%) and
work under expert supervision (88%). Also break from
routine (63%) and contact with other GPs (75%) were
important.
Renehan (58) Ireland Questionnaire 657 returns Dentists on Irish register Choice related to improving skills and knowledge
associated with work.
Ireland et al. (34) UK Questionnaire 514 returns Dentists on Health Authority lists in two regions The cost was not as important a factor as the quality of
the course.
Johnson (59) USA Questionnaire 8 returns Practitioners attending alumni day Delivery method least important factor in decision making.
Best and Messer (39) Australia Questionnaire 396 returns,
review of records
Dental practitioners in Victoria Topics of the course and the identity of the tutor were
most important factors.
Leggate and Russell (51) UK Questionnaire General dental practices in Scotland Views on CPD benefits: skill enhancement (those with
further qualification); career prospects (those 30 years of
age)
Firmstone, Bullock et al. (41) UK Questionnaire 2082 returns GDPs in three English Deaneries Selection of CPD on basis of a review of learning need
was rare. More commonly choice was convenience-led
plus consideration of other factors (e.g. new
developments, colleagues’ suggestions and views on
quality).
Sutton et al. (60) UK Questionnaire 75 returns GDPs working in Merseyside area, 99% attended CPD courses out of interest in a particular
dental discipline and only one because of a personal
learning need.
John and Parashos (54) Australia Questionnaire 108 returns Practitioners attending day courses Choice influenced by course presenters.
Hopcraft, Marks et al. (20) Australia Questionnaire 451 returns Dentists on Victoria, Australia register 54% chose courses to improve knowledge; 27% to fulfil
CPD requirements; 11% to learn new skills; 3% for
personal satisfaction; 2% to mix with colleagues; 1% to
increase patient numbers.
Hopcraft et al. (44) Australia Questionnaire 552 returns Dentists on Victoria, Australia Register Selection factors included: the topic (94%), the identity of
the speaker (66%), the day of the week it was held
(57%) and travel time (54%).
Redwood, Winning et al. (61) Australia Summary paper The role of self-assessment in CPD Choice influenced by who are course presenters.
Review
of
CPD
for
dentists
Barnes
et
al.
12
ª
2013
John
Wiley
Sons
A/S
Eur
J
Dent
Educ
17
(Suppl.
1)
(2013)
5–17

9. CPD creates challenges, not least for the quality assurance of
courses and programmes (19, 20) as well as the need for inter-
national recognition of activities (16). Over-prescription
beyond the inclusion of core topics risks de-motivating practi-
tioners (84). Prior to any Europe-wide agreement on CPD,
targeted CPD for migrating dentists, rather than a system based
on free choice, may be a useful interim mechanism for achiev-
ing harmonisation (54, 85).
Continuing professional development effective-
ness and impact-on-practice
As well as maintaining regular CPD activities, it is important,
perhaps more so in mandatory systems, that CPD is effective
(54, 66, 86, 87). Effective CPD is that which enables the partici-
pants to gain new knowledge and/or skills. CPD can be said to
have had an impact where an improvement in practice results
from the application of new knowledge or skills (20). The value
of CPD confirming that current practice is up-to-date has also
been noted (41).
The effectiveness and impact of CPD are difficult to evaluate.
Many CPD programmes do not assess learning gain, for exam-
ple, through pre- and post-testing (3), and changes may not
occur immediately post-learning but emerge some time after
participation, after reflection, or emerge in a way that is diffi-
cult to quantify (18). It is unsurprising that there is relatively
little literature on CPD effectiveness or the impact of CPD on
practice. Absi et al. (88, 89) published two studies exploring
the pre- and post-course scores achieved over a series of 1-day
radiation protection courses. Participants showed a improve-
ment (88, 89) although the authors noted that improvement in
scores is not evidence of improved clinical performance.
O’Flynn et al. (90) asked attendants of courses ‘Will you apply
what you learned to your practice?’ and found that the major-
ity would at least apply it a little. However, this is an indication
of intention rather than behaviour. Cohen et al. (91) measured
changes in clinical performance immediately and 6 months
after taking part in a 1-day AIDS awareness course in the USA.
At 6 months, they found an increase in use of gloves, masks
and protective eyewear.
As reported above, dentists may select CPD on a conve-
nience-led or interest basis (20). However, it has been observed
that the impact-on-practice is greater when CPD targets a den-
tist’s learning needs (52, 67). Bullock et al. (92) investigated the
use of personal development plans (PDPs) with UK dentists
and found that those who were supported in the process had a
clearer view of their learning needs and that learning from a
CPD activity was more likely to be applied in the workplace.
Courses have been found to be effective in improving knowl-
edge and understanding (93, 94). Based on a survey of dentists
in Scotland, Maidment (94) reported that courses and reading
journals were both thought to be better for enhancing knowl-
edge whilst other modes of CPD were better at changing prac-
tice. Mercer et al. (33) asked GDPs about CPD activities that
had impacted on the way they practised. Eighty per cent
claimed that participation in courses had led to change, fol-
lowed by journals (9%) and peer review activity (7%). Over
three quarters of respondents reported a change in techniques,
use of materials and/or methods of treatment. Tredwin et al.
(66) observed that as well as increasing knowledge, more than
two-thirds of their respondents felt that an element of their
clinical practice had changed as a result of taking part in a Brit-
ish Dental Journal CPD initiative which entailed the self-com-
pletion of quizzes related to papers in every edition. Paterson
et al. (95) reported that between 28% and 44% of participants
identified a change in their practice after using ‘Trends’, an
illustrated guidebook. In 1994, Holt et al. (96) found that den-
tists reported a change in practice in providing detailed
descriptions to dental technicians, using a surveyor and tooth
preparation and choice of design after viewing a video on par-
tial denture design.
John and Parashos (55) surveyed the effectiveness of CPD
programmes in endodontics and implant dentistry, using ques-
tionnaires on three occasions, pre-, post-course and delayed
(3 months later). Participation in these courses was voluntary
and the courses self-selected. Significant numbers of partici-
pants felt that their practice had changed (90% of the 60
respondents who had attended endodontic courses and 53% of
the 19 implant course participants).
Vlitos et al. (30) evaluated participants pre-course, immedi-
ately post-course and 6 months after completing a course. They
found that the topics that were rated to have the least impact-
on-practice were also those which were seen to have the lowest
relevance to their practice. Facilitators of change included per-
ceived financial benefit, regular patient attendance, particularly
a compliant core patient group, staff loyalty, open communica-
tion and access to peer support (97).
Collado et al. (98) studied the effectiveness of a year-long
training course on conscious sedation in France. Forty-five den-
tists, with five or more years of clinical experience, attended
four 2–3 day long sessions which comprised both theory and
practical learning. Both trainees and trainers reported on each
treatment session via standardised forms. Post-course there was
no significant difference between the trainers’ and trainees’
ability to successfully complete treatment under conscious seda-
tion; however, there was a higher number of minor adverse
effects reported by trainees.
Such studies, largely based on self-report, suggest that
courses in particular have led to widespread new learning and
in some cases considerable changes in practice have been
claimed. However, significant barriers to implementing change
in everyday practice have also been noted and include issues
such as the availability of materials and resources or support
from colleagues in their practice (84). As for the value of par-
ticular CPD delivery modes, Best et al. (54) comment that ‘in
general, evidence shows that no approach for transferring evi-
dence to practice is superior to all changes in all situations.’
Discussion
In the context of movement of graduate dentists across coun-
tries within the EU, there is a clear need to review education
and training provided through CPD, so that patients can be
assured of high quality care as a result of dentists undertaking
additional education and training. That review of undergradu-
ate education has been undertaken by the DentEd programme
(99–101). Following that, the DentCPD project has focused on
CPD and this review is part of that project.
Barnes et al. Review of CPD for dentists
ª 2013 John Wiley Sons A/S 13
Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17

10. Although care was taken to provide comprehensive coverage
of the topic, it is feasible that areas of the literature will have
been missed and the review should not be considered exhaus-
tive or systematic in the formal sense. However, we can report
with confidence that a variety of learning modes are open to
graduate dentists in their pursuit of continuing education,
including both formal and informal activity and that there
appears to be a role for different CPD types, the most common
of which include courses and reading journals. How much
CPD is undertaken by different dental practitioners varies but
comparisons across studies are difficult because of the different
measures employed and this makes it hard to draw summary
conclusions. We have learned, however, that common factors
affecting updating relate to age or years experience and that the
relationship is not linear. We know that reasons for selecting
CPD activity also vary and that some activities are selected on
the basis of interest or convenience rather than led by some
reflection on learning need. This has been shown to have an
effect on the difference that CPD can make to practice. The lit-
erature reported here has drawn attention to some of the fac-
tors that may enable or impede the implementation of new
learning and our findings generally concur with those in the
recent review of CPD impact undertaken by the GDC (67).
The introduction of a mandatory system of CPD is based on
the argument that CPD will ensure that dental practitioners’
knowledge and skills are up-to-date and by implication that
CPD contributes to high-quality dental care. In considering
what methods or modes of delivery might enhance the develop-
ment of knowledge and skills, in this review, we have chosen to
take a limited focus on the dental education literature and so
have not included the wealth of literature from the medical
educational field that we know is extensive in terms of provid-
ing evidence on factors affecting CPD impact-on-practice
(102). Touching on this wider literature here, we know that
more effective CPD is undertaken over a period of time, when
it is interactive, and includes on-the-job opportunities to rein-
force learning in practice. Multi-method and multi-phased
(more than a one-off) events are more likely to bring about
change (103–105). On-the-job opportunities to practise can
result in improvements, and the workplace has been recognised
as a key site for professional learning (106–108). Didactic, tra-
ditional lecture sessions on their own have been shown to have
little impact (109) although more generally, mode of delivery
or type of activity (e.g. lecture, web-based, reading, discussion
with colleagues, audit) is less critical than the match between
the CPD and the learning need (110–112).
Harmonisation of dental CPD is needed to ensure that
patient care across Europe is provided at similar high standards
regardless of where that care is received. But it is not simply
sufficient to know what is up-to-date ‘best’ practice. The practi-
tioner needs to engage in a process of reflection so that that
new learning may be applied and the CPD used to improve the
standards of patient care for all. What is evident from our den-
tistry focused review is that to make a difference to clinical
care, it is necessary that the learner, the dental practitioner,
engages in a process of reflection on the new learning or skills
acquisition that might arise from an educational input.
In a system of harmonisation, we need to attend to what
CPD (content) must be undertaken and this should be largely
driven by patient safety concerns. We need also to address how
CPD is delivered and what methods or modes may be more
and less effective. We know something about more and less
valuable approaches to CPD from medical education literature,
as noted above. A drive towards harmonisation also needs to
be informed by an understanding of learning processes, how
they occur and how they may be best supported. Looking to
the healthcare management literature can provide information
on effective processes and systems of knowledge transfer (113).
Phillips and Phillips (84) have reviewed factors that promote
change and stage-of-change models have been suggested which
recognise the importance of the context in which change is
expected to occur, including the support of others, which in
our case would include other members of the dental team
(114). Key to models of change is the notion that the learning
programme or intervention needs to fit with the participants’
‘readiness-to-change’ level. Here, there is value in reviewing
what may be learned from the work of psychologists and others
in studies of inventions designed to address addictive behav-
iours. Prochaska et al. (115), for example, describe a five stage
model from precontemplative, through contemplative, prepara-
tion, action and maintenance. They concluded that ‘probably
the most obvious and direct implication of our research is the
need to assess the stage of a client’s readiness for change and to
tailor interventions accordingly (p1108)’. In studies of learning
effectiveness, what is often overlooked is the importance of
what the learner – in this case the dental practitioner – brings
to the learning situation and their readiness to engage with the
educational input.
Parent et al. (113) write about a knowledge transfer capacity
model which includes what they label as an absorptive capacity’
which brings together a number of elements relevant to this
discussion. They describe this capacity as the ability to do three
key things in relation to new knowledge, namely recognise its
value, assimilate it and then apply it. They identify that this
capacity is typically found in certain environments, those pos-
sessing ‘prior related knowledge, a readiness to change, trust
between partners, flexible and adaptable work organisations
and management support’ (p87). Clearly, in addition to attend-
ing to CPD content, delivery method and what the learner
brings, a fourth element that requires consideration is the
workplace context. The workplace environment is an important
variable affecting the application of learning and a workplace
climate that promotes learning (including the informal learning
from self-reflection and problem-solving with colleagues) can
support the application of that learning to practice, to the ben-
efit of all, including patients (102, 116).
Conclusion
Our review has described the range of factors that have been
found to affect participation in CPD. We have noted that a
variety of modes of CPD delivery are available and that the
level of learner engagement and the match with learning need
can make a difference to the effectiveness of the CPD. It can be
hard for dentists to implement change in practice but they can
be helped by supportive colleagues. The discussion draws on
the medical education literature in better understanding how
dental CPD may lead to improved patient care. We conclude
Review of CPD for dentists Barnes et al.
14 ª 2013 John Wiley Sons A/S
Eur J Dent Educ 17 (Suppl. 1) (2013) 5–17

11. that more attention should be given to the importance of prac-
titioner reflection, the state of the learner’s readiness to engage
with education and training and the influence of the workplace
environment.
Acknowledgements
This review was undertaken as part of the ‘DentCPD’ project,
supported by colleagues in the University of Helsinki (Kimmo
Suomalanien), National and Kapodistrian University of Athens
(Argyro Kavadella, Anastassia Kosioni), Academic Centre for
Dentistry, Amsterdam (Henk Kersten, Eva Povel), Association
for Dental Education in Europe (Majella Giles, Damien Walms-
ley) and Riga Stradinš University (Una Soboleva, Ilze Akota,
Andra Liepa) and part funded by the European Commission
(#509961-LLP-1-2010-1-UK-ERASMUS-EMHE). The authors
would like to thank Wendy Hardyman (CUREMeDE) for her
critical comment.
Conflicts of interest (added after original publi-
cation)
The authors have no conflicts of interest to declare.
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