Place Of Qualification Research Articles

The management of deep caries in UK primary care: A nationwide questionnaire-based study.

To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p≤.2 were selected for binary logistic regression modelling. A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65, 1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24, 1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), whilst non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12, 1.17-3.87). This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.

Differential attainment in the MRCPsych according to ethnicity and place of qualification between 2013 and 2018: a UK cohort study

Purpose of the studyTo explore if differential pass rates exist in the clinical component of the UK postgraduate clinical psychiatry exam, the Clinical Assessment of Skills and Competencies (CASC), according...

An investigation into how general dental practitioners in Leeds manage complex tooth wear cases.

Introduction Restoring complex tooth wear (TW) cases is technically challenging and not well-remunerated under the NHS General Dental Service (GDS) contract. Therefore, numbers of referrals to secondary care are increasing, but these are often rejected as dental hospitals have a high workload. This may make it difficult for patients with TW to access appropriate care unless paying privately, which may be costly for them.Aim The aim of this investigation was to understand how general dental practitioners (GDPs) in Leeds manage complex TW cases.Methods A postal questionnaire was designed and piloted before postal distribution to all GDPs with a Leeds postcode (n = 289). Non-responders were sent reminders to complete the questionnaire. The questionnaire included questions on the place of qualification and experience of the dentists, their management of an example complex TW case and the potential barriers to management of similar cases. The resulting data were statistically tested using Kruskal-Wallis and Mann-Whitney tests.Results A total of 148 (51%) responded to the questionnaire. There was low confidence in restoring complex TW cases with a mean score of 4.65 out of 10 (0 being not confident at all and 10 being very confident). Only 30 respondents (21%) reported that they would treat complex TW cases under the current NHS GDS contract, and 90 (62%) reported that they had experienced difficulty referring these cases to hospital. Kruskal-Wallis testing showed increased confidence in restoring by those with a diploma or MSc (p = 0.004 and p = 0.014 respectively). Mann-Whitney testing showed those undertaking a higher percentage of NHS work were less likely to restore these cases (U = 2,100; p = 0.02).Conclusion These results suggest that Leeds patients with complex TW may have difficulty in accessing appropriate care under the current NHS GDS contract. The results highlight the benefits of postgraduate education on confidence in restoring complex TW cases.

The appropriateness of oral surgery referrals and treatment in contracted intermediate minor oral surgery practices in East Kent.

Objectives To assess the appropriateness of oral surgery referrals, after triage, to intermediate minor oral surgery (IMOS) practices in East Kent and whether or not referrals vary according to the referring general dental practitioner's (GDP's) place of qualification and experience.Design A retrospective study of the records of 441 triaged referrals sent to three IMOS practices in East Kent, over a ten-week period. An assessment tool was developed in line with local and national referral guidelines. Information on all referrals was obtained from the IMOS provider and referral records. Descriptive analysis of the data was performed.Results The most common reason for referral was for extraction of teeth requiring bone removal (n = 155; 35%). However, the majority of teeth removed were recorded as a non-surgical extraction (n = 363; 82%). Medical histories were included appropriately in the referral communications, with only 0.2% of all referrals being inappropriate. The proportion of appropriate and inappropriate referrals was very similar and it was found that referral rate was lower from dentists who had been qualified for more than ten years. GDPs working in the same location as the IMOS provider made a greater total number of referrals as well as more inappropriate referrals.Conclusions In the group of GDPs and IMOS providers studied, a wide variation was observed between the GDP's reason for referral and the treatment provided. It may be concluded that the vast majority of extractions were safely completed in an IMOS dental practice in a primary care setting.

Eyesight: a study of the staff of a dental school

Objectives/Aims:The aim was to investigate the vision of all 90 dentally qualified staff at a dental school.Materials and Methods:Ethical approval was obtained and a questionnaire-based survey conducted. Data were screened and analysed using Stata 13.1. The χ2 and Fisher’s Exact tests were used to test for significance with an alpha level of 0.05.Results:The participation rate was 95.6%. Most of the teachers (92%) considered their eyesight was satisfactory to practice dentistry. Of the 97% who had been tested at some stage, 15% had their eye examination due to sight deterioration with 22% needing correction. Almost two-thirds were myopic and a third were hyperopic. Forty-nine per cent wore spectacles only, with about a quarter of this group alternating between spectacles and contact lenses. Of those with corrected vision, 80% followed their optometrist’s recall advice. Four participants reported that they were colour blind. While 4% had had laser-eye surgery, a further 27% were interested in this. Magnification was used by 72% with no significant differences between genders, age of staff member, place of qualification or registration status. Most of the staff (81%) thought that screening of dental student’s eyesight should be mandatory, and regular eye examinations as a condition of dental practice was supported by 67%.Discussion:The number of teachers reporting recent vision tests was encouraging; nevertheless, a worrying 8% surveyed were unsure if their eyesight was satisfactory for work. The commonest vision problem was myopia, with almost half of the teachers wearing spectacles. It is clear that visual standards for dentistry would be helpful. Magnification use was high, with many non-users indicating their intention to buy loupes.Conclusions:Within the limits of this study the teachers were conscientious regarding their eye care, irrespective of their training and age. There was strong support for the mandatory testing of vision for all dentists and especially dental students.

Gender, Migration and Place of Qualification of Doctors in the UK: Perceptions of Inequality, Morale and Career Aspiration

This article draws on a large British Medical Association (BMA) survey which allows the comparison of doctors who qualified in the UK with International Medical Graduates (IMG) who qualified overseas. It does this with respect to inequality, morale and career aspiration. The paper argues that the human-capital protection of qualifications, profession and status is not sufficient to equal the experiences of migrant doctors with those of doctors who qualified in the UK. Moreover, the article provides a gendered analysis which demonstrates clear differences between women and men and shows that place of qualification intensifies the gendered experience of a medical career. Drawing on intersectional insights shows that women IMGs are the most disadvantaged despite the apparent protection of high human capital.

Hospital consultants breaking bad news with simulated patients: An analysis of communication using the Roter Interaction Analysis System

Objective To explore how experienced clinicians from wide ranging specialities deliver bad news, and to investigate the relationship between physician characteristics and patient centredness. Methods Consultations involving 46 hospital consultants from 22 different specialties were coded using the Roter Interaction Analysis System. Results Consultants mainly focussed upon providing biomedical information and did not discuss lifestyle and psychosocial issues frequently. Doctor gender, age, place of qualification, and speciality were not significantly related to patient centredness. Conclusion Hospital consultants from wide ranging specialities tend to adopt a disease-centred approach when delivering bad news. Consultant characteristics had little impact upon patient centredness. Further large-scale studies are needed to examine the effect of doctor characteristics on behaviour during breaking bad news consultations. Practice implications It is possible to observe breaking bad news encounters by video-recording interactions between clinicians and simulated patients. Future training programmes should focus on increasing patient-centred behaviours which include actively involving patients in the consultation, initiating psychosocial discussion, and providing patients with opportunities to ask questions.

The mobility of optometrists practising in Australia in 2005: Do optometry graduates move to states without schools of optometry?

Background: Three schools of optometry in the eastern states of Australia provide optometrists for the entire country. Concerns have been expressed about attracting optometrists to practise in the other states. This paper analyses the source of optometric qualification of optometrists practising in each state, to assess the proportion who have chosen to practise in a state different from that in which they qualified and to determine whether there are gender differences in preparedness to move to a different state.Method: Data on year and school of qualification, primary professional activity and current state or territory of practice were extracted from the Optometrists Association Australia database to determine a profile of place of qualification of optometrists in each state or territory of Australia in 2005.Results: More than 77 per cent of practising optometrists from Australian schools practised in the state where they graduated. The majority of optometrists for the Australian Capital Territory (ACT), South Australia (SA) and Western Australia (WA) were New South Wales graduates; the majority of Tasmanian optometrists were Victorian graduates. Optometrists from overseas accounted for 17.3, 24.6 and 19.9 per cent of optometrists in practice in SA, Tasmania and WA, respectively, but less than 7.5 per cent elsewhere. The highest number of optometrists who had qualified outside Australia practised in NSW. Female graduates from 2000 and later were more likely to move interstate than their male counterparts.Discussion: Approximately 14 per cent of practising optometry graduates practised in states without schools, where 21 per cent of the population resided. This indicates some degree of mobility but the market needs to work further to match supply of optometric services to demand at state level. Further analysis is necessary to determine patterns of graduate movement in the years following graduation, to determine whether movement to different states is short‐ or long‐term.

A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control

The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated. Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test. Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates. Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.

Local anaesthetic use among GDPs

Objective The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (≤5 years) and more experienced practitioners were investigated. Material and methods Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test. Results Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates. Conclusions Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.

Explaining variation in antidepressant prescribing rates in east London: a cross sectional study

Rates of depression and anxiety in south Asian populations are lower than expected. It remains uncertain whether this reflects a real difference in prevalence or differences in case recognition and management. To examine whether concordance of culture or ethnicity between doctors and patients affects the prescribing rates for antidepressant and anxiolytic medications in general practice populations, taking into account demography, practice size and organization. A cross-sectional general practice study, using practice and demographic data from primary care trusts, doctors' place of qualification from the General Medical Council, combined with practice level prescribing data from the prescription pricing authority (PACT) for the period 2000-2002. Set in 139 practices in the east London primary care trusts (PCTs) of Tower Hamlets, Hackney and Newham, multiethnic areas with large populations of south Asian residents and doctors. The main outcome measure was the annual prescribing rates for each group of drugs, calculated as the mean of two years average daily quantities (ADQs) for each medication, divided by the practice population. In east London the median prescribing rate (ADQs) for all antidepressants was 7.97 (inter-quartile range 4.91-10.76), for all anxiolytics and hypnotics 2.27 (interquartile range 1.11-3.96). There were significant differences in prescribing rates between practices with UK trained GPs and practices with south Asian trained GPs, with the highest rates of antidepressant prescribing in practices with UK trained GPs and low proportions of south Asian patients. No differences were found in anxiolytic and hypnotic prescribing rates between these practices. 57% of the variation in prescribing between practices could be explained by a model including the place of GP qualification, the proportion of registered women, older (>65) patients, and the list size per full time GP. Compared with previous studies prescribing rates for antidepressants have almost doubled over five years, the greatest increase being for selective serotonin re-uptake inhibitors (SSRIs). There is a modest fall in prescribing rates for anxiolytics and hypnotics. Concordance between south Asian practice populations and doctors from similar south Asian cultures is not associated with an increase in antidepressant prescribing. Lower rates of prescribing in practices with south Asian trained doctors occur regardless of the ethnic composition of the practice population. Reasons for these differences are uncertain, but may include differences in explanatory models for presenting symptoms, and management strategies which rely less on a biomedical paradigm.

The Early Career Patterns of Men and Women in Australian Universities

The career development of men and women who took up lectureships in Australian universities within four disciplinary groupings (behavioural sciences, education, humanities, social sciences) in 1962–64 or in 1975–76 was studied. Attrition and mobility rates were similar for the two sexes. However, proportionately more men than women gained early promotion. For the 1962-64 cohort, 68 per cent of men but only 30 per cent of women were senior lecturers within seven years of initial appointment. For the 1975–76 cohort, the comparable values were 48 per cent and 30 per cent. Multivariate analysis showed that the likelihood of promotion varied with sex even when allowance was made for research output and for level and place of qualification. However, even though sex differences in career development exist, it is difficult to identify the specific processes through which women have been disadvantaged.

Overseas-born doctor migration 1962-66.

Overseas-born doctor migration 1962-66.