Vocational Dental Practitioners Research Articles

Engaging vocational dental practitioners in care of the dependent elderly: findings from a pilot project

Introduction A pilot project was developed whereby vocational dental practitioners (VDPs) became involved in the Caring for Smiles programme, visiting care homes and observing staff training.Aim The project aimed to explore VDPs' views and experiences of delivering oral healthcare in the care home environment.Method Qualitative data were collected via an online questionnaire and reflective logs. The data were analysed using thematic analysis to extract emerging themes.Results Six themes emerged from the data, demonstrating that the VDPs had become aware of the general health and oral health needs of the care home population, and their role as dentists in the provision of oral care. The VDPs also had an increased awareness of Caring for Smiles.Discussion The VDPs benefited from participation in the pilot; it raised their awareness but also exposed them to an environment with which many were unfamiliar. Some VDPs expressed an interest in providing oral care in care homes in the future and discussed the need for domiciliary care.Conclusion The participating VDPs gained a level of experience and familiarity with older patients, Caring for Smiles and the care home environment that may improve the care they provide to their patients.

Dental nurses as trainers and assessors: vocational dental trainer attitudes

To explore the attitudes of vocational dental trainers (VDTs) working in general dental practice to the role of dental nurses as trainers and assessors of trainee dental nurses (tDNs), vocational dental practitioners (VDPs) and vocational dental hygienist/therapists (VDHTs). This research was conducted within the context of the development of a training and assessment qualification for dental nurses. A survey was sent to all 148 VDTs in Scotland. The survey assessed VDT attitudes as to the appropriateness of dental nurses to train and assess tDNs, VDPs, VDHTs with regard to their clinical, communication-based and administrative duties. The three sets of attitudes for tDNS, VDPS and VDHTs were assessed on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The data were subjected to one way and repeated measures of ANOVA. A total of 126 VDTs responded giving an 85% response rate. For clinical, communication-based and administrative activities, VDTs had significantly greater mean scores for the appropriateness of DNs to train [F(1,57) = 45.69, P < 0.001] and assess [F(1,57) = 76.94, P < 0.001] tDNs compared with VDPs and VDHTs. Vocational dental trainers felt it was more appropriate for DNs to train and assess tDNs' clinical, communication-based and administrative activities compared with VDPs and VDHTs. Over 80% of dental trainers, however, indicated there would be benefit to their practice in having a dental nurse educated in the principles and application of training and assessment.

Attitudes of Irish dental graduates to vocational training

Vocational training (VT) is a mandatory 12 month period for UK dental graduates after graduation. Graduates of Irish Dental Schools are eligible to enter the general dental service in Ireland or obtain an NHS performers list number in the UK immediately after qualification. Reports would suggest that some graduates of Irish Dental Schools are choosing to take part in VT in the UK and find the experience beneficial. This study aimed to record the uptake of VT amongst recent graduates from University College Cork and to document their experiences. It was designed to compare the attitudes and experiences of graduates of Irish Dental Schools who undertook VT compared with those who entered the general dental service. A self-completion questionnaire was distributed by e-mail to dental graduates from University College Cork who had graduated 2001-2007. Responses were returned by e-mail or post. The response rate was 68.9%. There has been an increase in the numbers of graduates taking part in VT each year since 2004. 92.5% of Vocational Dental Practitioners (VDPs) found their experience beneficial as they received a guaranteed source of income, had a supportive peer network and worked in a positive learning environment. However, some felt that they earned a lower income than their associate colleagues, others found the pace of practice slow and that the duration of the training period was excessive. Eighty-five per cent of VDPs would choose the same position again after graduation as compared with 61.8% of associates (P < 0.001). Ninety per cent of VDPs would advise current undergraduates to take part in VT as compared with 51% of associates (P < 0.001). A larger proportion of VDPs had taken part in postgraduate studies but there was no significant difference between the two groups. Larger proportions of recent graduates are undertaking vocational training.--The majority of VDPs and associates find their initial employment position beneficial.--VDPs benefit from a guaranteed source of income, a supportive peer network and a positive learning environment.--Some associates suffered from a lack of support, feeling isolated and overwhelmed with patients.--The majority of previous VDPs and associates would recommend VT to current undergraduates.--Almost 40% of associates would now choose to take part in VT if given the opportunity.

An Investigation of the Attitudes and Fears of Vocational Dental Practitioners in England and Wales in 2007

The aim of this study was to investigate whether recent changes in the National Health Service (NHS) dental contract may have caused increased anxiety and concern among vocational dental practitioners (VDPs). A total of 606 questionnaires, which had previously been piloted, were distributed to VDPs across England and Wales at the end of the vocational training (VT) year in 2007. The questionnaires contained a range of questions about VDPs' attitudes and fears, the influence that they perceived the new dental contract for the General Dental Services of the NHS had on their VT training experience, and their expectations for the future. A 71% response rate was achieved. The results reflected changes in opinion about the dental profession among VDPs between when they applied for university and six years later on their completion of VT. During this period, they reported that their feelings of job security had declined from 93.1% (n=390) to 34.1% (n=145) and financial security from 94.8% (n=405) to 51.5% (n=219). Anxiety about the potential lack of funding in the NHS was felt by 77.6% (n=330). The effect of increasing numbers of dental graduates on employment prospects produced anxiety in 72.5% (n=305) of VDPs. On completion of VT, 19.4% (n=83) of VDPs did not have employment for the following year. At present, the future is more uncertain for new dental graduates than in the past. The dental profession needs to become more aware of the pressures that graduates are facing and further research is needed to investigate them and the effects that they are having on the future of dentistry.

A Question of Value: A Qualitative Study of Vocational Dental Practitioners’ Views on Oral Healthcare Systems and Their Future Careers

New dental graduates in England and Wales spend one year as vocational dental practitioners (VDPs) preparing for independent clinical practice. In recent years, they have entered a state-funded healthcare system undergoing the greatest period of change since the inception of the National Health Service (NHS) and a profession in which there has been a significant shift of care to the private sector. Against this background, the objectives of this study were to investigate VDPs' vision of their future professional career and the influences that will impact on their choice of state-funded (NHS) and/or private dentistry, and to identify what factors may attract graduates to work for the NHS. In 2004/2005, purposive sampling of a range of VDP training schemes across England and Wales was used to select the VDPs from ten schemes to take part in focus groups. To standardise data collection, a topic guide was used. Respondents' views were recorded on tape and field notes. The data were transcribed and analysed using framework methodology. Ninety-nine VDPs from all parts of England and Wales participated in ten focus groups. They identified three main categories of future practice: private, state-funded (NHS), and mixed. Private practice was perceived as providing 'professional independence', 'financial reward', 'time with patients' and 'clinical freedom'. NHS practice was associated with 'providing access to specialist training' and 'gaining clinical experience', often as preparation for private practice. Providing NHS care was attractive for VDPs who valued the ethos of public service. The VDPs considered that NHS practice could be made more attractive to young dentists by a range of factors, involving the funding, culture and philosophy of the system and the degree of fit with their personal and professional vision. They reported that they would welcome 'incentives to work in areas of high need', 'assistance with debt' and a 'culture of valuing NHS dentists'. The findings suggest that the commitment to healthcare systems of the VDPs who took part in this study was associated with being true to their values and being valued within the system. They perceived a tension between state-funded and private practice, considering the latter more likely to meet personal and professional expectations. However, they remained open to working in an enhanced and supportive state-funded system, should it correspond with their values, and demonstrate that they were valued healthcare professionals.

Factors Influencing the Career Aspirations and Preferred Modes of Working in Recent Dental Graduates in Wales

In England and Wales, National Health Service (NHS) primary dental care services are now commissioned on a local basis. In planning for the future, it is important that commissioning authorities have a clear understanding of the perspectives of recent dental graduates: vocational dental practitioners (VDPs). This study investigated the career aspirations and preferred modes of working of VDPs in Wales. Data were collected via a postal questionnaire, comprising 37 closed and open questions, mailed to all 59 VDPs in Wales. A total of 53 (90%) VDPs participated, of whom 47 saw their future in general dental practice: 5, 35, and 7 indicating a preference to work in the NHS, mixed (NHS and private), and private sector, respectively. None selected the Community Dental Service as their preferred vocation. More than half of all respondents intended to undertake a postgraduate qualification within the next five years and 22 wished to specialise. Of the 53 VDPs, 44 were concerned that lack of NHS contracts would limit where they could practise, and agreed that family and other social commitments were a significant influence on choice of practice location. Access to high-quality premises and continuing professional development were agreed as important by 41 VDPs. A majority (37) agreed that private dentistry was an attractive alternative to NHS dentistry. Of the respondents, 38 (22 females, 16 males) expected to work part-time at some point in the future and 14 said they would consider a career outside dentistry. Only nine VDPs agreed that they would be happy working in a single-handed practice and even fewer (six) indicated they would be happy working for a corporate body. Numerous factors impact on the career aspirations of VDPs. These factors have been quantified in this study, and healthcare-commissioning bodies need to be aware of them when planning future dental care provision in Wales.

Summary of: Morale of vocational dental practitioners in the United Kingdom

Objective This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. Design Postal questionnaire survey. Setting Dental vocational training schemes in the UK. Subjects Vocational dental practitioners. Method A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. Results A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. Conclusion The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

Morale of vocational dental practitioners in the United Kingdom

This study was undertaken to devise a suitable survey instrument to measure morale, and to undertake an assessment of morale amongst vocational dental practitioners (VDPs) in the UK. Postal questionnaire survey. Dental vocational training schemes in the UK. Vocational dental practitioners. A confidential postal questionnaire was used to measure levels of morale among all VDPs in the UK in 2007. A response rate of 76.7% was achieved. The mean morale score for Scottish VDPs was significantly higher than that of the Northern Irish VDPs, which in turn was significantly higher than those of the VDPs in England or Wales. In England and Wales females recorded higher morale scores than males. Lowest morale scores were associated with statements referring to concerns about future changes to NHS dentistry, and the limits on treatment within the NHS system. The highest scores were associated with good working relationships. The use of an appropriately tested questionnaire has provided a convenient objective measure of morale. The morale of VDPs in the United Kingdom was lower than expected. Scottish VDPs recorded higher morale scores than other VDPs and responded more positively in the survey instrument. The most negative responses from all VDPs were regarding the effect of the NHS system on treatment and concerns about future changes to the NHS.

An Investigation of Trainers’ and VDPs’ Views in the Mersey Deanery of the FGDP(UK) Key Skills in Primary Dental Care and Assessment of Vocational Training

To investigate the views of vocational dental practitioners (VDPs) and trainers in the Mersey Deanery on the Faculty of General Dental Practice (UK) Key Skills in Primary Dental Care and other means of assessing satisfactory completion of vocational training (VT). An anonymous four-part questionnaire survey was delivered to all 48 dental vocational trainers and VDPs at the final day of the educational day-release programme in the Mersey Deanery. There was a 100% response rate from VDPs and a 91% response rate from their trainers. Overall the VDPs and trainers thought the FGDP(UK) Key Skills were a good idea but the VDPs felt completion of all the key skills during the VT year was time-consuming. Eighty-one per cent of trainers but only 52% of VDPs felt there should be a formal assessment of the VT year. Neither group unanimously agreed that completion of key skills alone was a marker of successful completion of the VT year. For assessment of clinical performance the only areas of agreement were direct observation of performance, review of patients following treatment, and tutorial sessions. The FGDP(UK) Key Skills have an important role in assessing competence in a number of important areas for VDPs. However, satisfactory completion of the key skills alone fails to assess clinical performance. Other methods of assessment of completion of VT will need to be considered in the light of the principles of assessment as laid down by the Postgraduate Medical Education and Training Board (PMETB).

Smoking, alcohol and drug use among vocational dental practitioners in 2000 and 2005

To estimate the prevalence of tobacco smoking, alcohol and drug use among UK vocational dental practitioners (VDPs) in 2005, and compare these with prevalence in 2000. Cross-sectional survey using an anonymous self-report questionnaire. All 767 VDPs who started practice in the summer of 2004 were sent a questionnaire in order to obtain data on the frequency and amount of tobacco, alcohol, cannabis and other illicit drugs used before and during vocational training (VT). The same survey had been conducted on VDPs five years earlier. The analysis was based on 502 subjects who responded and completed the questionnaire in 2005 and 534 subjects in 2000. Regular tobacco use (10+ cigarettes per day) was reported by 5.4% of males and 4.0% of females in 2005. This is lower than reported in 2000 (9%) and a statistically significant reduction in males. Eighty-two percent of males and 81% of females reported alcohol use; a statistically significant reduction from 2000 (89% males and 88% females). Reported 'binge drinking' remained high with 44% of males and 39% of females drinking at least half the recommended weekly units of alcohol in one session, similar to those levels seen in 2000. Thirty-eight percent of males and 26% of females reported cannabis use during their VT, similar to levels seen in 2000. Reported use of illicit drugs other than cannabis was less than in 2000. Reported illicit drug use was associated with alcohol drinking, and particularly with tobacco use. This study has found the level of alcohol, tobacco and illicit drug use (excluding cannabis) among VDPs decreasing since 2000, but levels of binge drinking and cannabis use remaining similar.

Dentistry - a professional contained career in healthcare. A qualitative study of Vocational Dental Practitioners' professional expectations.

BackgroundNew graduates in the UK presently spend one year in training as Vocational Dental Practitioners (VDPs) in preparation for primary dental care. There is a growing recognition that the emerging workforce has very different professional expectations to those of earlier generations, with implications for the profession, patients and the performance of health systems. The objectives of this study were to investigate why VDPs' in England and Wales perceive they chose dentistry as a professional career; how they perceive their vision has changed and the implications for their professional career plans, both short- and longterm.MethodsPurposive sampling of schemes was undertaken to include urban, rural and metropolitan schemes, schemes in areas with and without dental schools and geographic coverage across England and Wales. All VDPs in these schemes were initiated to participate in this qualitative study using focus groups. A topic guide was utilised to standardise data collection. Informants' views were recorded on tape and in field notes. Data were transcribed and analysed using Framework Methodology.ResultsA total of 99 VDPs participated in the 10 focus groups. Their choice of dentistry as a professional career was motivated by multiple categories of influence: 'academic', 'healthcare', 'lifestyle', the influence of 'family', 'friends', 'careers advice' and 'work experience'. Consideration of the features of the 'professional job' appears to have been key to their choice of dentistry and the 'active rejection of medicine' as an alternative career.Entry into the profession was proving a challenging process for some but not all VDPs. Informants perceived that their vision had been moderated as a result of 'personal student debt', 'national workforce initiatives', 'limitations on clinical practice' and the 'cost of additional training'.Short term goals focused around 'recovery from the past' and 'preparation for the future'. Longterm goals covered the spectrum of opportunities within dentistry. Factors influencing VDPs longterm career plans fell into six main categories: professional, personal, financial, political, social and cultural.ConclusionVDPs chose dentistry because they perceived that it provides a financially lucrative, contained career in healthcare, with professional status, job security and the opportunity to work flexibly. They perceive that their vision is challenged by changes affecting education and the healthcare system. Longterm professional expectations were closely linked with their personal lives and support a vision of a favourable work/life balance.

Dental vocational training: identifying and developing trainer expertise

The aims of the study were two fold: to determine the influence of trainer expertise on the Vocational Training (VT) experience, particularly in terms of providing Vocational Dental Practitioners (VDPs) with positive role models; and to ascertain if it is possible to identify attributes of expertise that can signpost a successful path for new/less expert trainers. Thirty-five VDPs and each of their Vocational Trainers participated in the study. All training took place in the South East of England. The participants were followed through the 12 months of their VT year. Semi-structured interviews were conducted with both trainers and VDPs on two occasions, during the year and once VT had been completed. It was also possible to observe practice sessions and VT Study Day teaching. The descriptive analysis of the training partnerships has been previously described. The original data were revisited through a constant comparative analysis of the interview transcripts and observation notes. The influence of training expertise is identified and discussed as is the VDP view of the trainer as a role model. Attributes of training expertise are highlighted and presented as a guiding path for new/inexpert trainers. The training expertise of a trainer has a significant influence on the VT experience for both trainer and VDP. Expertise has the potential to be harnessed and used to good effect in VT.

Dental vocational training: some aspects of the selection process in the South East of England

To explore aspects of the dental vocational training (VT) selection process. Thirty-five vocational dental practitioners (VDPs) and each of their trainers. The descriptive analysis of the VT year as experienced by these subjects has been previously described. Using a semi-structured interview format, the participants were interviewed once the prospective VDPs had secured a VT position. The interview transcript data were subject to a constant comparative analysis and a model of the typical selection experience was developed. The selection experience of the partnership that best fits the model is presented and where appropriate this is compared to the other VT partnerships. VDPs favoured practices close to their homes. A degree of formality within a pleasant atmosphere would result in an offer being accepted. For the trainer, again a local applicant was favoured, but above all else the prospective VDP had to fit into the practice team. The VT selection experience is not an easy one for VDPs - neither is it for trainers. The more effort participants put into the selection process, the more they are likely to achieve what they want. This is true not only for prospective VDPs finding a practice of their choice, but also for trainers finding a VDP who will become a successful member of the team.

The perceived barriers of vocational dental practitioners in London to specialisation

To investigate the short- and long-term career aspirations and barriers to postgraduate study of recently qualified vocational dental practitioners (VDPs). One hundred and eight vocational dental practitioners in London were asked to complete a questionnaire survey. The questionnaires were completed by 94 respondents (85%) and results indicated that the majority of the VDPs wanted to continue to work in general dental practice after vocational training (VT). Nearly 80% of the VDPs were considering undertaking further postgraduate studies in the form of the MFDS examination and 25% were seriously considering undertaking specialist training. Perceived barriers to specialist training included the time, cost and requirement of gaining the MFDS. The questionnaire showed that despite recently completing their undergraduate education, VDPs were considering obtaining further qualifications and potentially following a pathway leading to specialist training.

A Longitudinal Study into Changing Ethical Attitudes of Newly-Qualified Dentists in South-East England

To report the ethical stances taken by newly-qualified dental graduates working in the south-east of England and how these changed over their first two years in practice. A longitudinal self-completed questionnaire-based study using scenarios and closed questions was completed by an initial group of 135 vocational dental practitioners at the very beginning of their vocational training year, at the end of the year, and, finally, at the end of the subsequent year. Their answers were then analysed to see whether or not their views had changed during this period. At the commencement of the study in 2003, 133 (99%) newly-qualified dental graduates completed the questionnaire and answered the closed questions. The following year, 129 (96%) completed these documents and in 2005, at the end of the study, this figure was 97 (72%). There was considerable variation in the attitudes taken by the responding dentists. Reported attitudes changed over the study period in seven of the nine scenarios. Responses to the scenarios used could be grouped into three categories: those in which there was no change; those in which the change happened following completion of vocational training; and those in which there was a continual change. Answers to the four closed questions indicated a growing negativity to practice within the National Health Service over the study period. Dental educators need to be aware of the findings from this study. The importance of the ethical attitudes held and the reasons underpinning them should be explored if problems with delivery of care are to be avoided in the future.

VT experience in South East England

Aim To determine aspects of the 'lived experience' of dental vocational training (VT) for vocational dental practitioners (VDPs) and their trainers. Design A qualitative study: semi-structured interviews were conducted with the participants halfway through VT and once the VT year had been completed. Participants Two consecutive cohorts of 13 and 22 VDPs and their trainers. Results The experience of VT for the VDPs and their trainers is presented together with a model of VDP progression through the VT year. Conclusion VT is a success for VDPs and their trainers. Not one VDP would have wanted to enter general practice without VT. With very few exceptions the trainers considered VDPs capable of independent practice, post VT. Trainers were considered as positive role models by their VDPs. VT facilitates the transition of novice dentists into competent practitioners.

Aspects of the dental vocational training experience in the South East of England

To determine aspects of the 'lived experience' of dental vocational training (VT) for vocational dental practitioners (VDPs) and their trainers. A qualitative study: semi-structured interviews were conducted with the participants halfway through VT and once the VT year had been completed. Two consecutive cohorts of 13 and 22 VDPs and their trainers. The experience of VT for the VDPs and their trainers is presented together with a model of VDP progression through the VT year. VT is a success for VDPs and their trainers. Not one VDP would have wanted to enter general practice without VT. With very few exceptions the trainers considered VDPs capable of independent practice, post VT. Trainers were considered as positive role models by their VDPs. VT facilitates the transition of novice dentists into competent practitioners.

An audit of the UK national cancer referral guidelines for suspected oral mucosal malignancy

To carry out an in depth evaluation of the vocational training year.Qualitative structured focus groups and interviews.Three regional vocational training schemes in the south of England.Each scheme provided a group of six vocational dental practitioners (VDPs) who met with researchers at three points in the training year. Additionally one of the researchers interviewed advisers and trainers.and recommendations Possible improvements were identified in the appointment process, induction, tutorials, assessment of clinical knowledge, technical skill, social and communication skills and development of the skills of reflective practice.The vocational training year is a very good learning experience, which could be further enhanced to make it excellent.

Undergraduate training as preparation for vocational training in England: a survey of vocational dental practitioners' and their trainers' views

To compare the views of new vocational dental practitioners (VDPs) and their trainers regarding how undergraduate dental education has prepared them for their vocational training (VT) in England. This study also aims to identify areas of relative weakness in dental undergraduate education that could influence the future training needs of vocational trainees. Structured postal questionnaires were completed by VDPs and trainers from five Deaneries in England. The usable response rate was 71% (n = 186 VDPs and 186 trainers). The vast majority of VDPs and trainers perceived the undergraduate training in history taking, diagnosis and treatment planning for general practice to have been covered 'well' or even 'very well'. Undergraduate training in routine restorative dentistry, oral pathology and paediatric dentistry was also perceived to have been covered well. However, a large proportion of VDPs and trainers reported that they felt that undergraduate training in orthodontics, molar endodontics, surgical endodontics and surgical extraction of teeth had not adequately prepared them for VT. Newly qualified dentists appear to lack certain competencies recommended by the General Dental Council in The First Five Years. This has implications for dental undergraduate education, but also highlights current training needs during VT.

Why do dentists struggle with removable partial denture design? An assessment of financial and educational issues

Published studies in the international dental literature illustrate that the quality of prescription and fabrication of cobalt-chromium removable partial dentures (CCRPDs) by general dental practitioners frequently fail to comply with ethical and legal requirements. The reasons cited for this in the past have broadly related to either financial or educational issues. The aim of this investigation is to determine the effect of financial and educational factors on the quality of CCRPD design and fabrication by general dental practitioners. This investigation was completed in two parts. (1) A pre-piloted pro-forma was distributed to a number of dental laboratories throughout the UK and Ireland. These sought information relating to the quality of written instructions for CCRPDs received by these laboratories, and details of the remunerative scheme under which they were being provided. Three categories of remunerative scheme were considered, private CCRPDs in Ireland, private CCRPDs in the UK, and CCRPDs being provided by salaried NHS practitioners. (2) A pre-piloted questionnaire was distributed to vocational dental practitioners in the UK and Ireland. This sought information relating to their attitudes, opinions, and educational and clinical experiences of CCRPD design and fabrication. (1) Three hundred completed pro-formas were returned from dental laboratories, 100 of which related to each of the three remunerative schemes. Poor or no written instructions were provided in 47% (n = 47) of CCRPD cases funded privately in the UK, 46% (n = 46) of CCRPD cases funded privately in Ireland, and 50% (n = 50) of CCRPDs being provided by salaried NHS practitioners. (2) One hundred and seven completed questionnaires were returned from vocational trainees. Vocational dental practitioners had completed fewer CCRPDs during VT than in dental school (dental school: median = 4, inter-quartile range = 3 to 5; VT: median = 2, inter-quartile range = 1 to 4). One-fifth of respondents (n = 22) had not completed any CCRPDs during VT. Nine per cent of VT practices (n = 10) had a surveyor on their premises. Only 15% (n = 16) of respondents felt the time they had spent in VT had increased their confidence in the design of CCRPDs. Financial factors did not have as significant an effect on the quality of prescription and fabrication of CCRPDs as did educational factors. Serious deficiencies in the teaching of CCRPDs during vocational training were identified.