This paper has been adopted by the 2nd European Consensus Workshop in Implant Dentistry University Education, organised by the Association for Dental Education in Europe, Budapest 2013
Dr. Mr. Professor Professor Professor Professor Mr. Professor Professor Mr. Professor Dr. Professor Dr. Professor Dr. Dr. Dr. Professor Dr. Professor Professor Dr. Dr.
Owen Graham Daniele Philippe Matteo Cecilia Stuart Jonathan Hugo David Nikos Jørn Klaus Kay Margareta Mark Martin Mia Soren Argyro Bjorn Antonis Sebastian Anastassia
Addison Blackbeard Botticelli Bouchard Chiapasco Christersson Conway Cowpe de Bruyn De Keyser Donos Fridrich-Aas Gotfredsen Horsch Hultin Ide Janda Jensen Jepsen Kavadella Klinge Konstantinidis Koole Kossioni
Professor Professor Mr. Professor Dr. Prof. Dr. Dr. Ms. Professor Dr. Professor Professor Professor Professor Professor Dr. Professor Ms. Professor Professor Dr. Professor Professor
Niklaus P. Nikos Torsten Joerg Sven Katalin Anders Sue Bjarni Ioannis Marc Stefan Mariano Lior Andreas Charlotte Cemal Verena Wilfried Damien Anselm Daniel Selcuk
Lang Mattheos Meyer-Elmenhorst Meyle Muhleman Nagy Nattestad Odendaal Pjetursson Polyzois Quirynen Renvert Sanz Shapira Stavropoulos Stilwell Ucer Vermeulen Wagner Walmsley Wiskott Wismeijer Yilmaz
European Journal of Dental Education ISSN 1396-5883
Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development N. Mattheos1, H. de Bruyn2, M. Hultin3, S. Jepsen4, B. Klinge3,5, S. Koole2, M. Sanz6, C. Ucer7 and N. P. Lang1,8,9 1 2 3 4 5 6 7 8 9
Faculty of Dentistry, The University of Hong Kong, Hong Kong, China, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium, Faculty of Odontology, Karolinska Institute, Stockholm, Sweden, Faculty of Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany, € University, Malmo €, Sweden, Faculty of Odontology, Centre for Oral Health Sciences, Malmo Faculty of Odontology, Universidad Complutense, Madrid, Spain, Oaklands Hospital, Salford, UK, Centre for Dental Medicine, University of Zurich, Zurich, Switzerland, Faculty of Dental Medicine, University of Berne, Berne, Switzerland
Keywords continuing professional development; dental education; dental specialist education postgraduate; undergraduate; implant dentistry; implantology. Correspondence Nikos Mattheos Department of Oral Rehabilitation, Implant Dentistry Faculty of Dentistry Prince Philip Dental Hospital The University of Hong Kong Hong Kong, SAR – China Tel: +852 2859 0526 Fax: +852 2859 0310 e-mail: [email protected] Accepted: 7 November 2013
Abstract Introduction: Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways. Methods: A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development.
doi: 10.1111/eje.12075
Results: The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper. Conclusions: Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.
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Introduction Implant therapy has been an increasingly valuable treatment modality for replacing missing teeth. It is consequently beyond doubt that a modern dentist needs to be well aware of the possibilities and limitations of implant-based reconstructive dentistry, as well as the implant-related pathology, even if he or she does not actively perform implant procedures (1). In addition, a clear post-graduation pathway must exist for those who wish to develop the related knowledge and competences to safely and effectively practice implant dentistry. In response to this need, a consensus workshop was organised in 2008 by the Association for Dental Education in Europe. At that time, a wide representation of implant dentistry clinicians and teachers from major European Universities worked together to define the rationale, aims and desired learning outcomes of a curriculum in implant dentistry (2). The consensus and position papers produced at that meeting set the benchmark for the implementation of implant dentistry in modern undergraduate curricula (3–5), but also defined postgraduation pathways to gradually and effectively pursue the necessary advanced competences (6). Five years after the initial workshop, the current landscape appears different. The implementation of implant dentistry in the undergraduate curricula has significantly improved (7); however, very few institutions have reportedly reached the benchmarks set by the 2008 consensus workshop. Furthermore, it appears that the diversity between the amount and types of teaching among the different universities remains as large as it was 5 years ago (8). Consequently, the challenge we currently face with the undergraduate curricula is not to define or review the desired competence and knowledge learning outcomes, but rather to assess the implementation, investigate obstacles and challenges and support the smooth and functional integration of implant dentistry in the existing curricula. In the postgraduate domain, things have evolved significantly and university courses dedicated to implant dentistry now appear widely available, including full-time, part-time and online flexible delivery (9). At the same time, the increased numbers of programmes on offer have introduced a diversity of learning outcomes probably unseen in any other field of dentistry. University programmes leading to a master’s degree in implant dentistry range in duration between 1 and 3 years of full-time attendance, not including the part-time and flexible alternatives. Consequently, the clinical and theoretical learning outcomes of the graduates vary significantly, to the extent that it is very difficult for both the public and the profession to define what a master’s degree in implant dentistry actually implies in terms of clinical competence. On top of that, attempts to present implant dentistry as a de facto dental specialty and increasing use of the term ‘implantologist’ add to the current confusion in the post-graduation landscape. Once again, the challenges we mainly face in postgraduate university programmes are not about defining competences, but rather about introducing transparent and comparable standards and defining clear structures. Finally, it is obvious that, at present, the great majority of practitioners of implant dentistry will develop their competence ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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in other pathways than formal university degree programmes, in the domain that we define as continuing professional development or CPD. The domain of CPD is today probably the most challenging of all, as there exist a seemingly endless variety of providers, courses and learning approaches. Combined with the diversity of regulations and legal requirements in each country, the differences in professional, cultural and demographic factors, CPD appears today as the field that will most benefit from the implementation of quality assurance and structure. A recently completed EU-funded project under the name DentCPD (10) resulted in some important points for the improvement of CPD quality in Europe, which could be seen as a good starting point for further development on implant dentistry as well. Five years after the first consensus workshop, it is clear that significant improvement has been achieved, yet the challenges we face within the teaching and learning of implant dentistry are significant and indeed of a different nature than in 2008. The three sections that follow will present the consensus statements in response to these challenges, as well as the recommendations for future action to universities, scientific and professional societies, government agencies and independent bodies. These statements have been the result of systematic study of the scientific literature, best practices and current benchmarks and are presented as agreed by all participants of the workshop.
A. Undergraduate education 1. Guidelines for implant dentistry in the undergraduate curriculum The use of dental implants has emerged as an important treatment modality for tooth replacement within the last decades. Integration of implant dentistry within the undergraduate dental curriculum is mandatory to prepare students for appropriate and up-to-date patient care (2), including the ability to identify indications for implant therapy, to inform patients about treatment options, to recognise limits and when to refer. Rather than an isolated discipline, implant dentistry should be considered as an integral part of comprehensive patient care and should be taught in the undergraduate curriculum accordingly. Sanz and Shapira (3) described the competencies to be achieved by a graduate dentist, related to information-gathering, diagnosis, treatment planning, treatment and prevention and evaluation of treatment. In addition, it was postulated that dentists should be competent at designing and delivering effective implant-supported restorations and have knowledge and limited clinical experience in surgical procedures at the basic (straightforward) level, based on the SAC classification (11). To avoid misinterpretation, it is recommended to use the SAC classification to indicate the level of complexity in patient cases. The didactical approach to implant dentistry education is based on three components: theoretical, pre-clinical and clinical education (7). These three components are incremental and form a line of learning from knowledge and understanding (theoretical education) to the training of clinical skills (pre-clinical education) to eventually integrating both to demonstrate competence 5
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in a clinical context (clinical education). Clinical experience in the undergraduate curriculum should incorporate diagnosis, treatment planning, surgery, restoration and maintenance, including treatment of complications. Recently, a systematic review (7) and a survey on implant dentistry education in Europe (8) have revealed that a substantial number of dental curricula have been fulfilling the 2009 recommendation to include at least limited clinical experience in implant surgery (3). However, this does not refer to surgical placement of oral implants by undergraduate students, which has not been aspired to by the great majority of institutions. In line with the previous guidelines, clinical experience in implant surgery continues to be endorsed as a valuable learning approach. Compared to 2009, clinical experience in implant prosthetics in undergraduate education has increased. More institutions have implemented prosthetic procedures for implant-supported restorations in their curricula, and more implant prosthetic procedures are performed by undergraduate students (8). There was also a decrease in the number of curricula not allowing any clinical procedures at all. Clinical exposure to implant prosthetics included assisting others and treating patients on an individual basis. Procedures allowed were most often straightforward cases in the non-aesthetic zone (12). In institutions where clinical competencies in implant dentistry have been included in the undergraduate dental curriculum, high survival rates and low biological and technical complication rates have been reported for the straightforward cases and up to a mean follow-up of 10 years (13). As regular maintenance procedures are prerequisites for a successful longterm outcome of implant therapy, it is highly desirable that future dental graduates will have clinical exposure to such procedures and to the monitoring of peri-implant health and longterm stability of the prosthesis. Straightforward cases are identified as the appropriate level of difficulty for undergraduate students in clinical education. Notwithstanding learning is optimised by presenting cases of adequate difficulty to match a student’s level of competence (14), advanced and complex cases should also be used to demonstrate differences between complexity of clinical situations. Multiple levels to expose undergraduate students to clinical practice of implant dentistry are currently used, including treating patients under one-to-one supervision, chair-side assistance and observation. It is recommended that if performing treatment is not possible, students should at least perform chair-side assistance for a variety of procedures both in surgery and prosthodontics.
2. Barriers for implementation of implant dentistry Despite the need to implement implant dentistry into the undergraduate curriculum (2) and the availability of European consensus guidelines (3), many universities are still face challenges with the integration of implant dentistry in their curriculum (8). Important barriers have been identified such as lack of available time in the curriculum, shortage of trained staff, financial and/or material resources and insufficient patient flow (7, 8, 15–18). Creating time in the curriculum can be accomplished by increasing the duration of studies or by improving the adaption 6
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of the curriculum content to current and future patient needs and to scientific and technological advances. This implies prioritising content and/or removal of duplicate content. Recruitment and retention of suitably trained faculty/staff is an important aspect of implant dentistry education. Universities must provide faculty support and development to ensure quality assurance. For supervisors, this implies the systematic provision of ‘train the trainer’ sessions to increase their teaching skills in support of an optimal learning climate (effective feedback, reflection, adequate demonstrations and assessment) (7, 19). Industry partners have an important role as they may contribute with important resources by providing financial aid, implant and educational components and other support. The decision of an educational programme to work with one or more industry partners has educational consequences for the programme and students, which should also be considered from an ethical perspective. Transparency is an essential factor to create a balanced approach to maintain academic independency and establish an optimal partnership. To provide clinical training at an undergraduate level, a sufficient flow of suitable patients is a fundamental prerequisite. To cope with possible competition with postgraduate programmes, students could acquire experience by assisting or at least observing implant procedures by their postgraduate counterparts. In support of the further development of implant dental education, best practices should be reported. Description of implant education should include information about integration in the dental curriculum, learning goals, content, methods of teaching (format, assessment and dedicated hours) and targeted student population (year in the curriculum and compulsory/elective/selective course) to allow reproduction and comparison and should be accompanied by scientific evaluation concerning learning outcomes, student perspectives and patient-reported outcome measures (PROM).
B. Postgraduate education 1. Implant dentistry as a part of comprehensive dental care Implant dentistry is a multidisciplinary field of oral health care. It combines knowledge and discoveries from many clinical and basic sciences. Implant dentistry has matured to be not only a widespread treatment modality, but also one of the most active fields of education and research and development in health care. Nevertheless, implant dentistry remains a treatment modality within the framework of oral rehabilitation and does not fulfil the requirements of a separate specialisation. Consequently, ‘oral implantology’ is a term that is to be avoided, in the sense that it implies an independent specialty within dentistry. Even more, the term ‘implantologist’ is at present ill-defined and misleading, as it is often used to describe clinicians with very diverse backgrounds and skills. A clear recommendation has been made to use consistently the term ‘implant dentistry’ to describe the sum of the dental procedures which include dental implants. Implant dentistry does not fulfil the required criteria (as introduced by the ADA) for acquiring specialty status. Indeed, ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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the scope of implant dentistry is readily subsumed within the scope of other recognised specialties, that is, oral surgery, oral and maxillofacial surgery, periodontology and prosthodontics. Furthermore, public demand for related services can be adequately met by general practitioners or the above-mentioned established specialists.
2. Implant dentistry as part of established specialist training programmes Implant dentistry is today a significant component of established specialist training programmes, namely the training of the periodontist, prosthodontist and oral/oral maxillofacial surgeon. The education in implant dentistry within established specialist training programmes should develop specific levels of competence and proficiency according to the scope of the individual specialty. Nevertheless, all specialty programmes should
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Be evidence based and focus on patient-centred outcome measures with special emphasis on prevention. Emphasise tooth preservation and comprehensive dental care. Provide knowledge of the basic sciences relevant to implant dentistry and establish the clinical application of this knowledge. Acknowledge diagnosis, indication and treatment planning as the basis of implant therapy. Provide competence to maintain oral health in patients with dental implants, including the long-term maintenance of their prosthesis. Provide competence in diagnosis and management of a wide variety of biological, technical and aesthetic complications to a high standard. Require significant exposure to and profound understanding of research related to implant dentistry.
Conclusively, the periodontist, oral/oral maxillofacial surgeon and prosthodontist should have a thorough understanding of each others’ domains within implant dentistry. Consequently, knowledge and clinical exposure to periodontology, oral surgery and prosthetic dentistry are essential for all established specialty programmes that include implant therapy. Depending on the complexity of the clinical situation and the level of the required competences, the team approach is advocated to optimise the treatment outcome.
3. Postgraduate programmes dedicated to implant dentistry There currently exists a wide diversity of university programmes dedicated to implant dentistry, which conclude with the award of a master’s degree of some kind. These programmes range from 3-year full-time to 1-year part-time attendance. A master’s degree is an academic degree awarded after graduation from a university. It is awarded to individuals who have demonstrated mastery or high-order overview of a specific field of study or area of professional practice. Within this area, graduates must demonstrate the possession of advanced knowledge of a specialised body of theoretical and applied topics, a high ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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order of skills in analysis, critical evaluation and professional application, as well as the ability to solve complex problems and think rigorously and independently. A scientific thesis or publication is a prerequisite for completion of the degree. Consequently, a programme dedicated to the clinical practice of implant dentistry, which concludes with the award of a master’s degree, should
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Be conducted under the responsibility of a university. The university should have the full responsibility for the curriculum, assessment and an appointed programme director. Be at least of 2-year full-time duration or equivalent to 120 ECTS if the learning outcomes intend to cover straightforward and advanced procedures (SAC classification Dawson 2009, Donos 2009). If the programme learning outcomes intend to lead to competence within complex surgical and restorative aspects of implant dentistry, a 3-year full-time programme is recommended. Provide a well-defined set of competences, which should cover the diagnostic, surgical and restorative aspects of implant dentistry. Be evidence based and focus on patient’s overall well-being with special emphasis on prevention. Emphasise tooth preservation and comprehensive dental care. Assess the candidates’ performance involving at least one independent/external examiner and cover both theoretical and clinical competences. Provide knowledge of the basic sciences relevant to implant dentistry and establish the clinical application of this knowledge. Acknowledge diagnosis, indication and treatment planning as the basis of implant therapy. Consequently, adequate knowledge and exposure to periodontology, oral surgery and prosthetic dentistry are essential for all programmes dedicated to implant dentistry. For clinical situations extending beyond the competence level of the individual treatment provider, a team approach is advocated to optimise the treatment outcome. Provide competence to maintain oral health in patients with dental implants, including the long-term maintenance of their prosthesis. Provide competence in diagnosis and management of a wide variety of biological, technical and aesthetic complications to a high standard. Provide a thorough understanding of the scientific literature within implant dentistry. Include the undertaking of independent research within implant dentistry by completion and defence of a researchbased thesis or peer-reviewed publication. Demonstrate proof of accreditation, according to national/ international legislation.
4. Other university programmes providing education in implant dentistry Programmes that do not fulfil the requirements as stated above, including purely theoretical/research-based/academic programmes, 7
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short duration, modular education, solely e-learning/distance learning education should be considered as part of dental continuing professional development and regulated accordingly. These programmes should not be considered by universities and regulatory bodies as master’s degrees, as defined above (postgraduate programmes dedicated to implant dentistry).
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C. Continuing professional development 1. Definition of continuing professional development in implant dentistry
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Continuing professional development in implant dentistry is a key professional activity that helps dentists to acquire and maintain the currency of their clinical skills in implant dentistry and to keep up to date with new developments in scientific knowledge and technology (3, 20–23). Currently, there are distinct pathways of developing and maintaining competence through CPD by a undertaking directed formal academic postgraduate education (see Postgraduate education); b developing knowledge and skills, through self-directed informal postgraduate education/training, ideally in conjunction with a reflective personal development portfolio (1, 20, 24–26). It is desirable that CPD in implant dentistry is available to all members of the dental team engaged in provision of implant dentistry – dentists, nurses, hygienists and dental technicians.
3. Structure and content of CPD in implant dentistry
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2. Aims and objectives of CPD in implant dentistry
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The main objective of CPD in implant dentistry is to enable clinicians to acquire, maintain and update their clinical skills and knowledge, which should underpin and strengthen their clinical practice. This should ensure that the treatment they provide is patient-centred and conforms to areas of best practice and current clinical consensus. CPD should aim to enable clinicians to employ evidencebased decision-making processes, by enhancing their skills and keeping their knowledge current. In addition, it should strengthen their ability to critically appraise and evaluate new products and techniques before utilising them in their clinical practice (24–26). CPD in implant dentistry should be structured to provide dentists with opportunities: a To gain the necessary initial knowledge and skills in relation to ‘straightforward’ implant dentistry procedures; b To enhance their competence in more advanced procedures; c To continue to extend their level of expertise through CPD activities that support the philosophy of lifelong professional learning in implant dentistry. The defined aims and objectives of a CPD activity for implant dentistry should be clearly ‘mapped’ to the competences identified by ADEE (6). They should also utilise a case complexity classification such as SAC (11), which should in turn provide guidance in support of clinicians
aiming to work within the limits of their clinical competence. It is recommended that self-directed CPD in implant dentistry should include the following core topics (6, 26): a patient assessment and treatment planning; b supportive implant treatment; c diagnostic imaging; d audit and outcome measures and patient feedback; e restorative and surgical competencies with reference to, for example, the SAC classification (11); f informed consent; g pathological processes; h management of complications; i professionalism and communication skills; j pharmacology; k management of hard and soft tissue defect; l recognition and management of peri-implant diseases; m management of medically compromised patients.
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It is recommended that CPD should be well structured and preferably delivered in modular format with tangible benefits such as a ‘transferrable credit system’. This would allow the participants some element of learner control over time, place, direction and content of learning which should be based on their individual needs and career aspirations. CPD programmes should ideally be designed to incorporate a blended teaching and learning methodology. They could include the application of interactive webinars and e-learning techniques as well as face-to-face traditional learning opportunities. Importantly, there should be clinical experiential learning with supervision from an experienced mentor/supervisor. Direct and indirect mentor supervision of clinical skills development in implant dentistry is highly desirable. It is recommended that this activity is documented using personal development plans (PDPs) with an appropriate input through formative assessment by the mentor. Self-assessed and self-directed reflective learning activity, recorded in a practitioner’s portfolio, which is based on their PDP, is highly desirable as a CPD tool for identifying clinical strengths and weaknesses. It should identify their educational needs and contribute to planning areas of development in clinical practice. CPD in implant dentistry should conform to and follow guidelines on nationally agreed predetermined learning objectives and achievable learning outcomes. Ideally, these should be subjected to a suitable assessment process (20).
4. Predetermined learning outcomes
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It is recommended that CPD activities in implant dentistry include clear identification of learning outcomes for quality assurance purposes. Learning outcomes should match the needs of the learners and be mapped against the experience and qualifications of the participants, as well as different categories of treatment ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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complexity. Learning outcomes should match the content and structure of each CPD activity. Delivery of learning outcomes and educator performance should be assessed and analysed for each CPD activity. The assessment could involve different methods to test acquisition and application of knowledge (5) as recommended by the dental CPD project (20).
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5. Providers and educators of CPD in implant dentistry Providers of CPD in implant dentistry: CPD can be delivered by a variety of recognised providers who should comply with appropriate national or European quality assurance criteria. These may include the universities, national or international scientific implant organisations (such as the European Association for Osseointegration, EAO, and the European Federation of Periodontology, EFP), private organisations, other dental educational stakeholders and in some cases appropriately trained individual providers. Ideally, it should be an essential requirement that all providers of CPD in implant dentistry are recognised according to defined guidelines at a national and/or European level. Industry-led CPD activities can concentrate on ‘product training’, which may include relevant basic/clinical science and biological aspects. When there is major sponsorship of CPD events and/or exclusivity arrangements between CPD providers and industry, these arrangements must be openly and transparently declared.
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Educators who deliver CPD in implant dentistry: Educators should be able to demonstrate relevant qualifications and pedagogical experience (20, 27). Although accreditation or approval of CPD educators, at a national or European level is highly desirable, it may be unrealistic for this aspiration to be achieved across all European countries at the present time. To ensure minimum standards, it is recommended that guidelines which provide eligibility criteria for CPD educators, such as the generic standards published by COPDEND (27), are established at a European level (20). As part of educational recognition process, the relevant educational activities of CPD educators should be subject to quality monitoring including periodic audit. CPD educators should declare any conflicts of interest that might influence their professional impartiality.
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It would be desirable for those university taught/recognised programme modules, which are accessible to dental practitioners to undertake as stand-alone CPD modules, to contribute to the process of accreditation of prior experiential learning (APEL) as defined within a university’s regulations and within a pre-defined timeframe. The opportunity to complete such a module(s) could encourage practitioners into academia (28, 29). In turn, this could provide a recognised avenue for a practitioner to build on their self-directed education and training and enter the direct formal pathway provided through a validated university delivered programme. In addition, this could contribute to the free movement of professionals based on verifiable and transferrable CPD activities.
7. Quality assurance criteria for self-directed CPD activities The following criteria, proposed by the DentCPD (20) project, are recommended: Predetermined learning objectives of CPD activities should match the contents and educational needs of learners at each category of treatment complexity. The CPD educators should have suitable teaching experience and qualifications. Educators and CPD providers should fulfil the eligibility criteria set nationally. There should be appropriate learning material(s) to match the learning objectives and contents of the CPD programme. CPD activity should be delivered in an appropriate learning environment or facilities suitable for teaching and learning. There should be feedback from learners/participants which should be audited and analysed and reported back to learners/participants. There should be a formal assessment of learning outcomes. Availability of a clearly defined and structured national- or European-level ‘CPD credit system’ is highly desirable. Credits awarded in one European country should be recognised in other countries (30). It is recommended that the use of a voluntary quality assessment credit review system for self-directed CPD in implant denstistry is adopted using pre-defined criteria such as those established by Swiss College of Dental Medicine (SFZ) (29) or the European Council (European Credit Transfer System – ECTS) (30). This could be the responsibility of a European organisation, such as the ADEE in collaboration with relevant European specialist and scientific associations (e.g. oral surgery, periodontology), who could undertake this task through a peer-review process.
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6. Recognition of attendance of CPD activities
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Completion of a CPD activity could be assessed in a variety of ways. These include: a accreditation of educational hours b assessment of learning outcomes (at knows, knows how, does or higher levels) c award of transferrable (national or European level) credits Although mandatory self-directed CPD in implant dentistry is desirable, it would be difficult to enforce. Availability of a transferrable credit system would be desirable.
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Conflicts of interest The authors declared no conflicts of interest.
References 1 Mattheos N, Albrektsson T, Buser D, et al. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus. Eur J Dent Educ 2009: 13 (Suppl. 1): 10–17.
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17 McAndrew R, Ellis J, Lynch CD, Thomason M. Embedding implants in undergraduate dental education. Br Dent J 2010: 208: 9–10. 18 Atashrazm P, Vallaie N, Rahnema R, Ansari H, Shahab MP. Worldwide predoctoral dental implant curriculum survey. J Dent (Tehran) 2011: 8: 12–18. 19 Subramanian J, Anderson VR, Morgaine KC, Thomson WM. Effective and ineffective supervision in postgraduate dental education: a qualitative study. Eur J Dent Educ 2013: 17: e142–e150. 20 Dental CPD. Dental continuing professional development (CPD) reference manual. Ed: J G Cowpe. Eur J Dent Educ 2013: 17 (Suppl. 1): 1–84. 21 Schleyer T, Eaton KA, Mock D, Barach V. Comparison of dental licensure, specialization and continuing education in five countries. Eur J Dent Educ 2002: 6: 153–161. 22 Bullock A, Firmstone V, Fielding A, et al. Participation of UK dentists in continuing professional development. Br Dent J 2003: 194: 1. 23 Buck D, Newton T. Continuing professional development amongst dental practitioners in the United Kingdom: how far are we from lifelong learning targets? Eur J Dent Educ 2002: 6: 36–39. 24 Royal College of Surgeons of England. Personal development plan. Available at: www.rcseng.ac.uk/fds/nacpde/overseas-qualified/ personal-development-plan (last accessed 2 11 2013). 25 General dental Council. Continuing professional development. Available at: http://www.gdcuk.org/Dentalprofessionals/CPD/ Documents/GDC%20CPD%20booklet.pdf (last accessed 2 11 2014). 26 Dental Postgraduate Education in Wales. Continuing Professional Development (CPD) portfolio. Available at: http://www. walesdeanery.org/images/stories/Files/Documents/dental/CPD/ resources/cpd-portfolio.pdf (Last accessed 2 11 2013). 27 UK Committee of Postgraduate Dental Deans and Directors (COPDEND). Standards for dental educators. May 2013. Available at: http://www.copdend.org/data/files/Downloads/ COPDEND_Standards%20high%20resolution.pdf (Last accessed 2 11 2013). 28 European Commission. Recognition of prior non-formal and informal learning in higher education. http://eacea.ec.europa.eu/ education/eurydice/documents/focus-on/152.pdf. 29 Regulations for certifying continuing education courses in Dental Medicine in Switzerland. Available at http://www.sfz.ch/english% 20version/pdf_e/Certifying%20only_e.pdf (Last accessed 2 11 2013). 30 European Commission- Life Long Learning. European Credit Transfer and Accumulation System (ECTS). Available at: http://ec. europa.eu/education/lifelong-learning-policy/ects_en.htm (Last accessed 2 11 2013).
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Dr. Mr. Professor Professor Professor Professor Mr. Professor Professor Mr. Professor Dr. Professor Dr. Professor Dr. Dr. Dr. Professor Dr. Professor Professor Dr. Dr.
Owen Graham Daniele Philippe Matteo Cecilia Stuart Jonathan Hugo David Nikos Jørn Klaus Kay Margareta Mark Martin Mia Soren Argyro Bjorn Antonis Sebastian Anastassia
Addison Blackbeard Botticelli Bouchard Chiapasco Christersson Conway Cowpe de Bruyn De Keyser Donos Fridrich-Aas Gotfredsen Horsch Hultin Ide Janda Jensen Jepsen Kavadella Klinge Konstantinidis Koole Kossioni
Professor Professor Mr. Professor Dr. Prof. Dr. Dr. Ms. Professor Dr. Professor Professor Professor Professor Professor Dr. Professor Ms. Professor Professor Dr. Professor Professor
Niklaus P. Nikos Torsten Joerg Sven Katalin Anders Sue Bjarni Ioannis Marc Stefan Mariano Lior Andreas Charlotte Cemal Verena Wilfried Damien Anselm Daniel Selcuk
Lang Mattheos Meyer-Elmenhorst Meyle Muhleman Nagy Nattestad Odendaal Pjetursson Polyzois Quirynen Renvert Sanz Shapira Stavropoulos Stilwell Ucer Vermeulen Wagner Walmsley Wiskott Wismeijer Yilmaz
European Journal of Dental Education ISSN 1396-5883
Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development N. Mattheos1, H. de Bruyn2, M. Hultin3, S. Jepsen4, B. Klinge3,5, S. Koole2, M. Sanz6, C. Ucer7 and N. P. Lang1,8,9 1 2 3 4 5 6 7 8 9
Faculty of Dentistry, The University of Hong Kong, Hong Kong, China, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium, Faculty of Odontology, Karolinska Institute, Stockholm, Sweden, Faculty of Medicine, Center of Dento-Maxillo-Facial Medicine, University of Bonn, Bonn, Germany, € University, Malmo €, Sweden, Faculty of Odontology, Centre for Oral Health Sciences, Malmo Faculty of Odontology, Universidad Complutense, Madrid, Spain, Oaklands Hospital, Salford, UK, Centre for Dental Medicine, University of Zurich, Zurich, Switzerland, Faculty of Dental Medicine, University of Berne, Berne, Switzerland
Keywords continuing professional development; dental education; dental specialist education postgraduate; undergraduate; implant dentistry; implantology. Correspondence Nikos Mattheos Department of Oral Rehabilitation, Implant Dentistry Faculty of Dentistry Prince Philip Dental Hospital The University of Hong Kong Hong Kong, SAR – China Tel: +852 2859 0526 Fax: +852 2859 0310 e-mail: [email protected] Accepted: 7 November 2013
Abstract Introduction: Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways. Methods: A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development.
doi: 10.1111/eje.12075
Results: The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper. Conclusions: Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.
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Introduction Implant therapy has been an increasingly valuable treatment modality for replacing missing teeth. It is consequently beyond doubt that a modern dentist needs to be well aware of the possibilities and limitations of implant-based reconstructive dentistry, as well as the implant-related pathology, even if he or she does not actively perform implant procedures (1). In addition, a clear post-graduation pathway must exist for those who wish to develop the related knowledge and competences to safely and effectively practice implant dentistry. In response to this need, a consensus workshop was organised in 2008 by the Association for Dental Education in Europe. At that time, a wide representation of implant dentistry clinicians and teachers from major European Universities worked together to define the rationale, aims and desired learning outcomes of a curriculum in implant dentistry (2). The consensus and position papers produced at that meeting set the benchmark for the implementation of implant dentistry in modern undergraduate curricula (3–5), but also defined postgraduation pathways to gradually and effectively pursue the necessary advanced competences (6). Five years after the initial workshop, the current landscape appears different. The implementation of implant dentistry in the undergraduate curricula has significantly improved (7); however, very few institutions have reportedly reached the benchmarks set by the 2008 consensus workshop. Furthermore, it appears that the diversity between the amount and types of teaching among the different universities remains as large as it was 5 years ago (8). Consequently, the challenge we currently face with the undergraduate curricula is not to define or review the desired competence and knowledge learning outcomes, but rather to assess the implementation, investigate obstacles and challenges and support the smooth and functional integration of implant dentistry in the existing curricula. In the postgraduate domain, things have evolved significantly and university courses dedicated to implant dentistry now appear widely available, including full-time, part-time and online flexible delivery (9). At the same time, the increased numbers of programmes on offer have introduced a diversity of learning outcomes probably unseen in any other field of dentistry. University programmes leading to a master’s degree in implant dentistry range in duration between 1 and 3 years of full-time attendance, not including the part-time and flexible alternatives. Consequently, the clinical and theoretical learning outcomes of the graduates vary significantly, to the extent that it is very difficult for both the public and the profession to define what a master’s degree in implant dentistry actually implies in terms of clinical competence. On top of that, attempts to present implant dentistry as a de facto dental specialty and increasing use of the term ‘implantologist’ add to the current confusion in the post-graduation landscape. Once again, the challenges we mainly face in postgraduate university programmes are not about defining competences, but rather about introducing transparent and comparable standards and defining clear structures. Finally, it is obvious that, at present, the great majority of practitioners of implant dentistry will develop their competence ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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in other pathways than formal university degree programmes, in the domain that we define as continuing professional development or CPD. The domain of CPD is today probably the most challenging of all, as there exist a seemingly endless variety of providers, courses and learning approaches. Combined with the diversity of regulations and legal requirements in each country, the differences in professional, cultural and demographic factors, CPD appears today as the field that will most benefit from the implementation of quality assurance and structure. A recently completed EU-funded project under the name DentCPD (10) resulted in some important points for the improvement of CPD quality in Europe, which could be seen as a good starting point for further development on implant dentistry as well. Five years after the first consensus workshop, it is clear that significant improvement has been achieved, yet the challenges we face within the teaching and learning of implant dentistry are significant and indeed of a different nature than in 2008. The three sections that follow will present the consensus statements in response to these challenges, as well as the recommendations for future action to universities, scientific and professional societies, government agencies and independent bodies. These statements have been the result of systematic study of the scientific literature, best practices and current benchmarks and are presented as agreed by all participants of the workshop.
A. Undergraduate education 1. Guidelines for implant dentistry in the undergraduate curriculum The use of dental implants has emerged as an important treatment modality for tooth replacement within the last decades. Integration of implant dentistry within the undergraduate dental curriculum is mandatory to prepare students for appropriate and up-to-date patient care (2), including the ability to identify indications for implant therapy, to inform patients about treatment options, to recognise limits and when to refer. Rather than an isolated discipline, implant dentistry should be considered as an integral part of comprehensive patient care and should be taught in the undergraduate curriculum accordingly. Sanz and Shapira (3) described the competencies to be achieved by a graduate dentist, related to information-gathering, diagnosis, treatment planning, treatment and prevention and evaluation of treatment. In addition, it was postulated that dentists should be competent at designing and delivering effective implant-supported restorations and have knowledge and limited clinical experience in surgical procedures at the basic (straightforward) level, based on the SAC classification (11). To avoid misinterpretation, it is recommended to use the SAC classification to indicate the level of complexity in patient cases. The didactical approach to implant dentistry education is based on three components: theoretical, pre-clinical and clinical education (7). These three components are incremental and form a line of learning from knowledge and understanding (theoretical education) to the training of clinical skills (pre-clinical education) to eventually integrating both to demonstrate competence 5
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in a clinical context (clinical education). Clinical experience in the undergraduate curriculum should incorporate diagnosis, treatment planning, surgery, restoration and maintenance, including treatment of complications. Recently, a systematic review (7) and a survey on implant dentistry education in Europe (8) have revealed that a substantial number of dental curricula have been fulfilling the 2009 recommendation to include at least limited clinical experience in implant surgery (3). However, this does not refer to surgical placement of oral implants by undergraduate students, which has not been aspired to by the great majority of institutions. In line with the previous guidelines, clinical experience in implant surgery continues to be endorsed as a valuable learning approach. Compared to 2009, clinical experience in implant prosthetics in undergraduate education has increased. More institutions have implemented prosthetic procedures for implant-supported restorations in their curricula, and more implant prosthetic procedures are performed by undergraduate students (8). There was also a decrease in the number of curricula not allowing any clinical procedures at all. Clinical exposure to implant prosthetics included assisting others and treating patients on an individual basis. Procedures allowed were most often straightforward cases in the non-aesthetic zone (12). In institutions where clinical competencies in implant dentistry have been included in the undergraduate dental curriculum, high survival rates and low biological and technical complication rates have been reported for the straightforward cases and up to a mean follow-up of 10 years (13). As regular maintenance procedures are prerequisites for a successful longterm outcome of implant therapy, it is highly desirable that future dental graduates will have clinical exposure to such procedures and to the monitoring of peri-implant health and longterm stability of the prosthesis. Straightforward cases are identified as the appropriate level of difficulty for undergraduate students in clinical education. Notwithstanding learning is optimised by presenting cases of adequate difficulty to match a student’s level of competence (14), advanced and complex cases should also be used to demonstrate differences between complexity of clinical situations. Multiple levels to expose undergraduate students to clinical practice of implant dentistry are currently used, including treating patients under one-to-one supervision, chair-side assistance and observation. It is recommended that if performing treatment is not possible, students should at least perform chair-side assistance for a variety of procedures both in surgery and prosthodontics.
2. Barriers for implementation of implant dentistry Despite the need to implement implant dentistry into the undergraduate curriculum (2) and the availability of European consensus guidelines (3), many universities are still face challenges with the integration of implant dentistry in their curriculum (8). Important barriers have been identified such as lack of available time in the curriculum, shortage of trained staff, financial and/or material resources and insufficient patient flow (7, 8, 15–18). Creating time in the curriculum can be accomplished by increasing the duration of studies or by improving the adaption 6
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of the curriculum content to current and future patient needs and to scientific and technological advances. This implies prioritising content and/or removal of duplicate content. Recruitment and retention of suitably trained faculty/staff is an important aspect of implant dentistry education. Universities must provide faculty support and development to ensure quality assurance. For supervisors, this implies the systematic provision of ‘train the trainer’ sessions to increase their teaching skills in support of an optimal learning climate (effective feedback, reflection, adequate demonstrations and assessment) (7, 19). Industry partners have an important role as they may contribute with important resources by providing financial aid, implant and educational components and other support. The decision of an educational programme to work with one or more industry partners has educational consequences for the programme and students, which should also be considered from an ethical perspective. Transparency is an essential factor to create a balanced approach to maintain academic independency and establish an optimal partnership. To provide clinical training at an undergraduate level, a sufficient flow of suitable patients is a fundamental prerequisite. To cope with possible competition with postgraduate programmes, students could acquire experience by assisting or at least observing implant procedures by their postgraduate counterparts. In support of the further development of implant dental education, best practices should be reported. Description of implant education should include information about integration in the dental curriculum, learning goals, content, methods of teaching (format, assessment and dedicated hours) and targeted student population (year in the curriculum and compulsory/elective/selective course) to allow reproduction and comparison and should be accompanied by scientific evaluation concerning learning outcomes, student perspectives and patient-reported outcome measures (PROM).
B. Postgraduate education 1. Implant dentistry as a part of comprehensive dental care Implant dentistry is a multidisciplinary field of oral health care. It combines knowledge and discoveries from many clinical and basic sciences. Implant dentistry has matured to be not only a widespread treatment modality, but also one of the most active fields of education and research and development in health care. Nevertheless, implant dentistry remains a treatment modality within the framework of oral rehabilitation and does not fulfil the requirements of a separate specialisation. Consequently, ‘oral implantology’ is a term that is to be avoided, in the sense that it implies an independent specialty within dentistry. Even more, the term ‘implantologist’ is at present ill-defined and misleading, as it is often used to describe clinicians with very diverse backgrounds and skills. A clear recommendation has been made to use consistently the term ‘implant dentistry’ to describe the sum of the dental procedures which include dental implants. Implant dentistry does not fulfil the required criteria (as introduced by the ADA) for acquiring specialty status. Indeed, ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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the scope of implant dentistry is readily subsumed within the scope of other recognised specialties, that is, oral surgery, oral and maxillofacial surgery, periodontology and prosthodontics. Furthermore, public demand for related services can be adequately met by general practitioners or the above-mentioned established specialists.
2. Implant dentistry as part of established specialist training programmes Implant dentistry is today a significant component of established specialist training programmes, namely the training of the periodontist, prosthodontist and oral/oral maxillofacial surgeon. The education in implant dentistry within established specialist training programmes should develop specific levels of competence and proficiency according to the scope of the individual specialty. Nevertheless, all specialty programmes should
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Be evidence based and focus on patient-centred outcome measures with special emphasis on prevention. Emphasise tooth preservation and comprehensive dental care. Provide knowledge of the basic sciences relevant to implant dentistry and establish the clinical application of this knowledge. Acknowledge diagnosis, indication and treatment planning as the basis of implant therapy. Provide competence to maintain oral health in patients with dental implants, including the long-term maintenance of their prosthesis. Provide competence in diagnosis and management of a wide variety of biological, technical and aesthetic complications to a high standard. Require significant exposure to and profound understanding of research related to implant dentistry.
Conclusively, the periodontist, oral/oral maxillofacial surgeon and prosthodontist should have a thorough understanding of each others’ domains within implant dentistry. Consequently, knowledge and clinical exposure to periodontology, oral surgery and prosthetic dentistry are essential for all established specialty programmes that include implant therapy. Depending on the complexity of the clinical situation and the level of the required competences, the team approach is advocated to optimise the treatment outcome.
3. Postgraduate programmes dedicated to implant dentistry There currently exists a wide diversity of university programmes dedicated to implant dentistry, which conclude with the award of a master’s degree of some kind. These programmes range from 3-year full-time to 1-year part-time attendance. A master’s degree is an academic degree awarded after graduation from a university. It is awarded to individuals who have demonstrated mastery or high-order overview of a specific field of study or area of professional practice. Within this area, graduates must demonstrate the possession of advanced knowledge of a specialised body of theoretical and applied topics, a high ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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order of skills in analysis, critical evaluation and professional application, as well as the ability to solve complex problems and think rigorously and independently. A scientific thesis or publication is a prerequisite for completion of the degree. Consequently, a programme dedicated to the clinical practice of implant dentistry, which concludes with the award of a master’s degree, should
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Be conducted under the responsibility of a university. The university should have the full responsibility for the curriculum, assessment and an appointed programme director. Be at least of 2-year full-time duration or equivalent to 120 ECTS if the learning outcomes intend to cover straightforward and advanced procedures (SAC classification Dawson 2009, Donos 2009). If the programme learning outcomes intend to lead to competence within complex surgical and restorative aspects of implant dentistry, a 3-year full-time programme is recommended. Provide a well-defined set of competences, which should cover the diagnostic, surgical and restorative aspects of implant dentistry. Be evidence based and focus on patient’s overall well-being with special emphasis on prevention. Emphasise tooth preservation and comprehensive dental care. Assess the candidates’ performance involving at least one independent/external examiner and cover both theoretical and clinical competences. Provide knowledge of the basic sciences relevant to implant dentistry and establish the clinical application of this knowledge. Acknowledge diagnosis, indication and treatment planning as the basis of implant therapy. Consequently, adequate knowledge and exposure to periodontology, oral surgery and prosthetic dentistry are essential for all programmes dedicated to implant dentistry. For clinical situations extending beyond the competence level of the individual treatment provider, a team approach is advocated to optimise the treatment outcome. Provide competence to maintain oral health in patients with dental implants, including the long-term maintenance of their prosthesis. Provide competence in diagnosis and management of a wide variety of biological, technical and aesthetic complications to a high standard. Provide a thorough understanding of the scientific literature within implant dentistry. Include the undertaking of independent research within implant dentistry by completion and defence of a researchbased thesis or peer-reviewed publication. Demonstrate proof of accreditation, according to national/ international legislation.
4. Other university programmes providing education in implant dentistry Programmes that do not fulfil the requirements as stated above, including purely theoretical/research-based/academic programmes, 7
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short duration, modular education, solely e-learning/distance learning education should be considered as part of dental continuing professional development and regulated accordingly. These programmes should not be considered by universities and regulatory bodies as master’s degrees, as defined above (postgraduate programmes dedicated to implant dentistry).
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C. Continuing professional development 1. Definition of continuing professional development in implant dentistry
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Continuing professional development in implant dentistry is a key professional activity that helps dentists to acquire and maintain the currency of their clinical skills in implant dentistry and to keep up to date with new developments in scientific knowledge and technology (3, 20–23). Currently, there are distinct pathways of developing and maintaining competence through CPD by a undertaking directed formal academic postgraduate education (see Postgraduate education); b developing knowledge and skills, through self-directed informal postgraduate education/training, ideally in conjunction with a reflective personal development portfolio (1, 20, 24–26). It is desirable that CPD in implant dentistry is available to all members of the dental team engaged in provision of implant dentistry – dentists, nurses, hygienists and dental technicians.
3. Structure and content of CPD in implant dentistry
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2. Aims and objectives of CPD in implant dentistry
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The main objective of CPD in implant dentistry is to enable clinicians to acquire, maintain and update their clinical skills and knowledge, which should underpin and strengthen their clinical practice. This should ensure that the treatment they provide is patient-centred and conforms to areas of best practice and current clinical consensus. CPD should aim to enable clinicians to employ evidencebased decision-making processes, by enhancing their skills and keeping their knowledge current. In addition, it should strengthen their ability to critically appraise and evaluate new products and techniques before utilising them in their clinical practice (24–26). CPD in implant dentistry should be structured to provide dentists with opportunities: a To gain the necessary initial knowledge and skills in relation to ‘straightforward’ implant dentistry procedures; b To enhance their competence in more advanced procedures; c To continue to extend their level of expertise through CPD activities that support the philosophy of lifelong professional learning in implant dentistry. The defined aims and objectives of a CPD activity for implant dentistry should be clearly ‘mapped’ to the competences identified by ADEE (6). They should also utilise a case complexity classification such as SAC (11), which should in turn provide guidance in support of clinicians
aiming to work within the limits of their clinical competence. It is recommended that self-directed CPD in implant dentistry should include the following core topics (6, 26): a patient assessment and treatment planning; b supportive implant treatment; c diagnostic imaging; d audit and outcome measures and patient feedback; e restorative and surgical competencies with reference to, for example, the SAC classification (11); f informed consent; g pathological processes; h management of complications; i professionalism and communication skills; j pharmacology; k management of hard and soft tissue defect; l recognition and management of peri-implant diseases; m management of medically compromised patients.
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It is recommended that CPD should be well structured and preferably delivered in modular format with tangible benefits such as a ‘transferrable credit system’. This would allow the participants some element of learner control over time, place, direction and content of learning which should be based on their individual needs and career aspirations. CPD programmes should ideally be designed to incorporate a blended teaching and learning methodology. They could include the application of interactive webinars and e-learning techniques as well as face-to-face traditional learning opportunities. Importantly, there should be clinical experiential learning with supervision from an experienced mentor/supervisor. Direct and indirect mentor supervision of clinical skills development in implant dentistry is highly desirable. It is recommended that this activity is documented using personal development plans (PDPs) with an appropriate input through formative assessment by the mentor. Self-assessed and self-directed reflective learning activity, recorded in a practitioner’s portfolio, which is based on their PDP, is highly desirable as a CPD tool for identifying clinical strengths and weaknesses. It should identify their educational needs and contribute to planning areas of development in clinical practice. CPD in implant dentistry should conform to and follow guidelines on nationally agreed predetermined learning objectives and achievable learning outcomes. Ideally, these should be subjected to a suitable assessment process (20).
4. Predetermined learning outcomes
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It is recommended that CPD activities in implant dentistry include clear identification of learning outcomes for quality assurance purposes. Learning outcomes should match the needs of the learners and be mapped against the experience and qualifications of the participants, as well as different categories of treatment ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 18 (Suppl. 1) (2014) 3–10
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complexity. Learning outcomes should match the content and structure of each CPD activity. Delivery of learning outcomes and educator performance should be assessed and analysed for each CPD activity. The assessment could involve different methods to test acquisition and application of knowledge (5) as recommended by the dental CPD project (20).
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5. Providers and educators of CPD in implant dentistry Providers of CPD in implant dentistry: CPD can be delivered by a variety of recognised providers who should comply with appropriate national or European quality assurance criteria. These may include the universities, national or international scientific implant organisations (such as the European Association for Osseointegration, EAO, and the European Federation of Periodontology, EFP), private organisations, other dental educational stakeholders and in some cases appropriately trained individual providers. Ideally, it should be an essential requirement that all providers of CPD in implant dentistry are recognised according to defined guidelines at a national and/or European level. Industry-led CPD activities can concentrate on ‘product training’, which may include relevant basic/clinical science and biological aspects. When there is major sponsorship of CPD events and/or exclusivity arrangements between CPD providers and industry, these arrangements must be openly and transparently declared.
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Educators who deliver CPD in implant dentistry: Educators should be able to demonstrate relevant qualifications and pedagogical experience (20, 27). Although accreditation or approval of CPD educators, at a national or European level is highly desirable, it may be unrealistic for this aspiration to be achieved across all European countries at the present time. To ensure minimum standards, it is recommended that guidelines which provide eligibility criteria for CPD educators, such as the generic standards published by COPDEND (27), are established at a European level (20). As part of educational recognition process, the relevant educational activities of CPD educators should be subject to quality monitoring including periodic audit. CPD educators should declare any conflicts of interest that might influence their professional impartiality.
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It would be desirable for those university taught/recognised programme modules, which are accessible to dental practitioners to undertake as stand-alone CPD modules, to contribute to the process of accreditation of prior experiential learning (APEL) as defined within a university’s regulations and within a pre-defined timeframe. The opportunity to complete such a module(s) could encourage practitioners into academia (28, 29). In turn, this could provide a recognised avenue for a practitioner to build on their self-directed education and training and enter the direct formal pathway provided through a validated university delivered programme. In addition, this could contribute to the free movement of professionals based on verifiable and transferrable CPD activities.
7. Quality assurance criteria for self-directed CPD activities The following criteria, proposed by the DentCPD (20) project, are recommended: Predetermined learning objectives of CPD activities should match the contents and educational needs of learners at each category of treatment complexity. The CPD educators should have suitable teaching experience and qualifications. Educators and CPD providers should fulfil the eligibility criteria set nationally. There should be appropriate learning material(s) to match the learning objectives and contents of the CPD programme. CPD activity should be delivered in an appropriate learning environment or facilities suitable for teaching and learning. There should be feedback from learners/participants which should be audited and analysed and reported back to learners/participants. There should be a formal assessment of learning outcomes. Availability of a clearly defined and structured national- or European-level ‘CPD credit system’ is highly desirable. Credits awarded in one European country should be recognised in other countries (30). It is recommended that the use of a voluntary quality assessment credit review system for self-directed CPD in implant denstistry is adopted using pre-defined criteria such as those established by Swiss College of Dental Medicine (SFZ) (29) or the European Council (European Credit Transfer System – ECTS) (30). This could be the responsibility of a European organisation, such as the ADEE in collaboration with relevant European specialist and scientific associations (e.g. oral surgery, periodontology), who could undertake this task through a peer-review process.
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6. Recognition of attendance of CPD activities
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Completion of a CPD activity could be assessed in a variety of ways. These include: a accreditation of educational hours b assessment of learning outcomes (at knows, knows how, does or higher levels) c award of transferrable (national or European level) credits Although mandatory self-directed CPD in implant dentistry is desirable, it would be difficult to enforce. Availability of a transferrable credit system would be desirable.
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Conflicts of interest The authors declared no conflicts of interest.
References 1 Mattheos N, Albrektsson T, Buser D, et al. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus. Eur J Dent Educ 2009: 13 (Suppl. 1): 10–17.
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