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  1. 1. DENTISTS & COMMUNITY Hong Kong Dental Journal 2007;4:67-70 HK DJ Dental Surgery Assistants in Hong Kong: history of training May-Ying Chung *, Dip EDDSA Jenney Lai-Kuen Leung *, BBA Kenneth Kwok-Kuen Hui †, BDS, MSc, FHKAM (Dental Surgery), FCDSHKTraining of dental surgery assistants before Development Advisory Committee 1973, Further 1970 Development of Medical and Health Services in Hong Kong tabled in the Legislative Council in July 1974, and theBefore 1970, “four-handed dentistry” was the privilege of, 1979 Review of the Medical Development Programme) and confined to, larger private dental clinics and public dental to establish the DSA training program to complement theinstitutions, such as the Dental Service of the then Medical founding of the Faculty of Dentistry, University of Hong and Health Department, Government of Hong Kong. Kong, in order to train and provide dental personnel to be able to meet local needs. No literature describing the training of dental surgeryassistants (DSAs) at or before that time exists. At that time, Training provided by the Prince Philip Dentalonly a few hundred dentists registered in Hong Kong were Hospitalworking in the private sector. Most of these were working perhaps solely, with or without a receptionist, and with In 1980, the first structured and organized DSA trainingor without a DSA. Those who did employ a DSA might program, a 2-year full-time diploma course organized, notexpect the DSA to serve also as the receptionist, accounts at the Prince Philip Dental Hospital (PPDH), but at theclerk, chairside helper, among other duties. These DSAs then Hong Kong Polytechnic, began. During the samehad variable competencies and their ‘training’ has been year, the first batch of undergraduate dental studentsdescribed as “blossom of a hundred flowers”, with each commenced their studies at the PPDH.bearing a different kind of fruit. From 1983 onwards, PPDH took over and started their Nevertheless, the anticipated duties of a DSA may own 1-year full time certificate course for DSA trainees.include, but were not limited to, those illustrated in All these DSA trainees were given a nominal salary, as Appendix 1. were pupil nurses at that time. Basically, all were offered employment by the PPDH after they passed the qualifyingChanges after the 1970s examination, though a few of them might have chosen a career elsewhere or as something different. Details of the In the 1970s, it was recommended (Report of the Medical training course and the role of a DSA at PPDH can be found in Appendix 2.* Chairperson, Hong Kong Association of Dental Surgery Assistants, Training provided by the Government Dental Service Hong Kong* Secretary, Hong Kong Association of Dental Surgery Assistants, Hong Kong By the late 1970s, DSA trainees were being recruited† Department of Health, Hong Kong periodically by the Dental Service of the then Medical and Health Department, and given a trainee’s salary, likeCorrespondence to: pupil nurses. The number of DSAs to be recruited wasMs May-Ying Chung, Prince Philip Dental Hospital, 34 Hospital Road, dependent on the number of new surgeries planned, asHong KongTel : (852) 2859 0325 well as levels of natural wastage.Fax : (852) 2547 0164e-mail : mychung2003@yahoo.com.hk At the very beginning of their training career, a 2- to Hong Kong Dent J Vol 4 No 1 June 2007 67
  2. 2. Chung et al3-week attachment program was arranged for every new dentists estimated that there were at least 1500 part-recruit, usually at multi-surgery-clinics throughout the time and full-time DSAs working in the private sector, three regions of Hong Kong. Then they embarked on a most of whom had no formal training. It was believed2-year probation period with on-the-job training. that if a curriculum-based part-time DSA program held on two to three evenings per week over 12 to 13 At the end of the probation period, they had to months could be organized, there should be plenty ofundertake and pass a formal, organized, strengthened, demand for it.and intensive 3-week “probationary course” conductedat the Tang Shiu Kin Dental Therapists’ Training School From 1998 to 2001, three groups of DSAs, each of the Government Dental Service. If they passed the numbering around 80, were trained at and graduated fromwritten and practical examinations at the end of that the Caritas Francis Hsu College. Trainees were required tocourse they were awarded permanent and pensionable pay a tuition fee and all fees collected were spent on cost-status. Contents of the training program are summarized recovery items such as dental materials for their practical in Appendix 3. sessions, hiring training venues, and two “tutor-trainers” who were paid a nominal monthly salary to coordinate Training provided by non-government the program. The lecturers were volunteer dentists who organizations were given no remuneration. The course contents are summarized in Appendix 4.It is interesting to learn that there is a Dental Group within the Hong Kong St. John Ambulance Brigade, which is said More recently, a similar but much condensed DSAto be the only one, among all the St. John’s Ambulance program has been set up at the Caritas Bianchi CollegeBrigades in the world, providing dental services to deprived of Careers. Although the course contents are said to and special needs clients free of charge. be similar to those provided by the Caritas Francis Hsu College, no further information was made available before The Dental Group started as the Dental Penetration submission of this article.Squad in 1950, and they established their own dentalclinic in 1960; so they have been in operation for more Training provided by the private commercial marketthan 55 years, and kept a really low profile. Annually theygive their clients over 1000 dental appointments and As mentioned before, there are still a lot of serving DSAs,more than 100 special schools, organizations, and care both part-time and full-time, who have not received anyhomes have registered with them. The Group is staffed formal training. This has given the commercial sector by around 38 local registered dentists and another 40-plus an opportunity to meet the demand. As this involves members who act as DSAs; all of them are volunteers. commercial elements, readers are advised to use internet All the members have their own careers, most of which search engines to retrieve information from the relevant have nothing to do with dentistry. So it is impressive to websites, as it is not appropriate to compare or evaluatelearn that the Group can operate such an effective and their courses in this article.efficient service, something that should be attributed to awell-structured DSA course. Training of dental surgery assistants after 2000 In order to become and remain a member (DSA) ofthe Dental Group, each candidate has to attend and pass The 1997 Report of the Health and Medical Development the annual first-aid course, as well as a “DSA course”. Advisory Committee recommended that training of all dental personnel should be “under one roof ”. Details of their training program will not be given inthis article, in order to respect their wish to both retain So from the year 2000 onwards, the Dental Service their “low-profile” status and not be compared to, nor of the Department of Health ceased to train their own seen to be in competition with, any other training bodies. DSAs. From that year on, all new recruits had to possess a Certificate of Proficiency in Dental Surgery AssistingTraining provided by non-profit organizations granted by the PPDH, or a Certificate previously issued by the Department of Health, Hong Kong SARDuring the late 1990s, a small group of dedicated Government, or an overseas equivalent.68 Hong Kong Dent J Vol 4 No 1 June 2007
  3. 3. History of dental surgery assistants training From the same year onward PPDH became the It is hoped that in the foreseeable future most DSAsdesignated training center for all ancillary dental personnel working in the private sector will have the proper (DSA, dental technician, dental hygienist, and dental qualifications and competencies needed to perform theirtherapist), under the “training under one roof ” policy. As duties; meanwhile those who are experienced, but notfar as DSA training is concerned, all trainees have to pay a properly qualified, will be phased out naturally. This willtuition fee and, after qualifying, practically all have to seek safeguard the interests of all dentists in the private sector, jobs in the open market, including vacancies in the public maintain and uphold the image of the dental profession, and sector and the Faculty of Dentistry. ensure a quality service is delivered to our dental clients. Appendix 1 Anticipated duties of dental surgery assistants Handling patient reception and front-desk duties Booking appointments Answering telephone enquiries Handling payments Stock keeping and ordering Chairside assisting Handling sterilization and disinfection of instruments and the clinic Conducting oral health education and postoperative instructions Handling X-ray procedures (not necessarily a generic duty) Appendix 2 Dental surgery assistants (DSAs) training at the Prince Philip Dental Hospital (PPDH) One-year full-time or 2-year part-time day certificated course Requirements 1. Five passes in the Hong Kong Certificate of Education Examination in the secondary school or equivalent 2. Fluent in written and spoken Chinese and English 3. Applicants who do not have the academic qualification but have at least 1-year full-time working experience as a DSA can also apply Training course provided at the PPDH Teaching and examination is in English. The teaching includes lectures and small group demonstrations and practice. Usually there are mid-day lectures at 11:30 am. The student rotates between different disciplines (Reception and Primary Clinic, Oral Radiology, Oral and Maxillofacial Surgery, Pedodontics and Orthodontics, Conservative Dentistry, Periodontology, and Public Health and Oral Rehabilitation) for a 2-week period. Before the student rotates to the next discipline they have an assessment. The student has an intermediate examination and final examination after they have rotated to all the areas in the first and second semester. The students also visit and observe treatment carried out in the operating theatres at the Queen Mary Hospital and the Duchess of Kent Children’s Hospital. Visits to dental health education projects and local private dental practices are arranged for the students as well. The Intermediate and Final examinations include a written test, Spotter test, viva, practical, and charting. The student is awarded the Certificate of Proficiency in Dental Surgery Assisting if they pass all sections of the examination. Role of DSAs in the PPDH In the PPDH, DSAs have also played an important role in the BDS and postgraduate training by providing chairside assistance, simulation of laboratory work, and examinations and helping with the research projects for postgraduates and faculty staff members. When training and projects are carried out in the Queen Mary Hospital, the Duchess of Kent Children’s Hospital, and projects in Kwong Wah Hospital, Tung Wah Eastern Hospital and outreach programs in different centers, the PPDH DSAs are assigned to support these activities. Appendix 3 Contents of the probation course provided by the Dental Service, Department of Health Basic Dental Science Dental Radiography, Radiation Health and Safety Occupational Safety and Health Materia Medica and Therapeutics Dental Caries, Periodontal Disease and other Pathological Conditions Oral Anatomy, including eruption and shedding of teeth Minor Oral Surgery and Dental Anesthesia (L.A. & G.A.) Dental Emergency and Resuscitation General Administration Supplies Procedure Instruments, Equipment and Materials Four-handed Dentistry Surgery Routine, including records and charting Oral Health Education, including prevention of dental diseases, fluoride and water-fluoridation Applied Dental Science Course Pediatric Dentistry Periodontology Restorative Dentistry and Endodontics Orthodontics Public Health Dentistry Dental Implantology Prosthetic Dentistry Oral and Maxillofacial Surgery Infection Control—Hand-on Course Hong Kong Dent J Vol 4 No 1 June 2007 69
  4. 4. Chung et al Appendix 4 Contents of the dental surgery assistants training provided by a non-profit organization (Source: curriculum documents from Caritas Francis Hsu College; 1998-9, 1999-2000, and 2000-1) Curriculum of Course A A-1 Professional Ethics A-2 Dental Terminology Curriculum of Course B: Basic Sciences B-1 General Anatomy & Physiology B-2 Oral Anatomy & Physiology B-3 Microbiology B-4 Pathology B-5 Etiology & Pathology of Dental Caries B-6 Etiology & Pathology of Periodontal Disease B-7 Oral Pathology & Oral Manifestations of Systemic Diseases B-8 Preventive Dentistry B-9 Behavioral Science B-10 Health Education Skills B-11 Public Health B-12 Plaque Control Curriculum of Course C: Clinical Theory in Dental Surgery Assisting Level I C-1 Restorative: Technique & Materials C-2 Prosthodontics: Technique & Materials C-3 Periodontics C-4 Endodontics C-5 Pedodontics C-6 Orthodontics C-7 Oral and Maxillofacial Surgery C-8 Pain and Anxiety Management C-9 Dental Radiography Curriculum of Course C: Clinical Theory in Dental Surgery Assisting Level II C-10 Operatory Setup C-11 Maintenance of Equipment C-12 Moisture Control C-13 Arrangement for Patient Referral C-14 Clinical Information Recording C-15 Chairside Assisting C-16 Communication with Dental Laboratory C-17 Presentation of Post-treatment Instruction C-18 Practical Training for C-1 to C-17 Curriculum of Course D D-1 Medical Problems in Dentistry D-2 Medical Emergencies in General Dental Practice D-3 CPR and First Aid D-4 Pharmacology & Safe Handling of Drugs D-5 Occupational Health and Safety D-6 Infection Control Corrigendum “Sexually transmitted infections, human immunodeficiency virus infection, and their manifestations in the oral cavity” (2006;3:98-106). We have been informed by the author of this paper that the affiliation of the third author, Catriona Ooi, should be School of Medicine & Public Health, Faculty of Health, The University of Newcastle, Australia.70 Hong Kong Dent J Vol 4 No 1 June 2007