Survey of continuing dental education attendance in Western Australia Albert E. S. Tan, BSc, BDSc(WA), MSc(Lond), PhD(Q1d)
Key words: Continuing dental education, Western Australia: attendance, discussion of findings. Abstract A survey of attendance at continuing dental education courses convened by the University Postgraduate Dental Education Committee, University of Western Australia, and the Australian Dental Association.Western Australian Branch was collated for one calendar year. Attendances were compared relating to the number of dentists registered in the State, ADA membership, metropolitan versus rural dentists and the number of courses attended. The mandatory and voluntary options for continuing dental education are discussed in the light of the survey findings.
(Received for publication May 1991. Revised September 1991. Accepted November 1991.)
Introduction Continuing Professional Education (CPE) has been defined as the training of professionals after their initial or pre-service training and induction or licensing into professional practice.’ In dentistry, this could be termed Continuing Dental Education (CDE). As much as the undergraduate dental curriculum occupies five years of full-time tertiary study, the graduate dentist is subsequently required to practise for probably up to 40 years or more in a demanding profession. It is therefore not an unreasonable public perception that professionals must keep up-to-date with new developments and techniques in their chosen fields over such an extended period of practice. Factors such as the expansion of scientific knowledge, the rapid advances in technology, as well as social and economic changes in Australia, 296
have opened up a new public perception of the professional. Therefore some of the traditional views about ‘professionalism’are being openly questioned and challenged by a more informed, critical and consumer-orientated public. Even though there is no evidence to indicate that professionals who avail themselves of CPE become more proficient in their field, there is again the public perception that ‘up-to-date’ professionals are better informed and equipped to handle their problems. It is therefore incumbent on the professions to inform the public that, as a group, they have inbuilt mechanisms which in some way reinforce the need for CPE amongst its members. This position must apply equally to dentistry, and it may well serve as the best corporate advertisement that the profession can project in order to preserve its image as a responsible, self-regulatory body. There is little or no information on the level of attendances at CDE courses in Australia as one forum for continuing professional learning and development. This paper presents a limited survey of attendance at CDE courses convened in Perth, Western Australia, over one calendar year.
Materials and methods The data on registrants for CDE courses convened by the University Postgraduate Dental Education Committee, University of Western Australia (UPDEC) and Australian Dental Association Western Australian Branch (ADA (WA Branch)) in Perth, Western Australia were collated for one calendar year (1990). These data represented a total of 14 courses, of which three were ‘handson’ courses with limited attendance. These 14 courses accounted for more than half the total number of courses convened in Western Australia for that year. The other courses available were convened by the various ADA-affiliated Australian Dental Journal 1992;37(4):296-9.
Total
r vv
z
Resident dentists
800
ADA members 500 (78 4%)
600
g500
Nonanenders
600 In
Attenders
rl
500
c
-
fi,z
course
292
+
300
m
6 P
100
0
Results Figure 1 provides the basic data for the dental workforce in Western Australia in the year ending 1990. The total number of dentists (750) excluded those dentists on the register who were on leave of absence. There was also a small number of dentists (14) registered in the State but residing either interstate or overseas, and thus providing no dental services in the State. Subsequent calculations were therefore based on 736 ‘resident’ dentists, but in reality this figure was slightly smaller due to a number of retired members who chose to remain on the register. Australian Dental Association membership represented a ratio of approximately 8:10 dentists and registered specialists provided a ratio of 1:10 dentists. The vast majority of specialists (70) were members of ADA, with the exception of three who resided interstateloverseas and two who were in the Public Service. *Dental Board of Western Australia List of Registered Dentists, 1 July 1990 (under the Denral Act 1939-80, and Rules framed thereunder). tAusrralian Dental Association Western Australian Branch List of Members 1990. Australian Dental Journal 1992;37:4
AUA
members
(3;&)
m-200
--
100
--
0
.
Fig. 1 .-Registered dentists in Western Australia 1990.
specialist societies and by more recent special interest groups (for example, implantology and aesthetic dentistry) which numbered nine. Even though the data presented do not represent the complete picture, they do provide a broad cross-section of registrants in the majority of courses convened for CDE in the State. The Dental Board of Western Australia provided the register of dentists,* and the ADA (WA Branch) provided the membership list for the appropriate year. t Data pertaining to the distribution of dentists according to metropolitan, rural, overseaslinterstate designations, ADA membership, and so on, were calculated from this information.
(3967%)
4oo--
Attenders:
Fig. 2. -Total course registrants: 93.84 per cent of attenders were ADA members.
Total 292
~oo%i
Metro 974
Metro ADA members
300 250
-s z
200
.-111
n
150
Rural
Rural ADA members
(6.16%)
(6.16%)
0
z
100
50 0
Fig. 3.-Metropolitan versus rural registrants.
Figure 2 provides data for the number of course registrants who attended 2 one course (292) which represented 39.67 per cent (approximately 4: 10 dentists) of the total number of resident dentists. The vast majority of registrants were ADA members (93.84 per cent), even though the ADA membership for the corresponding period was about 80 per cent. Figure 3 represents the proportion of dentists from the metropolitan and rural areas who attended z o n e course. In this context, rural areas included centres 2 80 km (approximately 50 miles) from the commercial business district of Perth. The coastal towns of Mandurah and Rockingham were included as metropolitan since travelling time would not be prohibitive for dentists from these centres. Expectedly, the vast majority of registrants (93.84 per cent) were metropolitan-based,as compared with the number of rural registrants (6.16 per cent). However, it would appear that rural attenders had a very strong ADA affiliation, since all of them (100 per cent) were ADA members. 297
Total Metro
Nil courses 64 (78.05%)
654
-
.g
i
xt
Metro 274 (41.9%)
L o o 0
5
-1I
Attenders
400
1 course 13 (15.85%)
23 2 courses 2 (2.44%)
Total
courses 3
(3.66%)
200
100
(100%) (21.95%)
0
Fig. 4. -Proportion of metropo1itan:rural registrants (registrants t 1 course).
Nil courses
444
23 courses (20.24%)
2 courses (12.09%)
(7.34%) 0
Fig. 5.-Registrants: number of course@)attended. N = 736 resident dentists in Western Australia 1990.
From Figure 4 it is evident that the proportion of metropolitan registrants (4: 10) far exceeded the proportion of rural registrants (2: 10) when compared with the relative numbers of metropolitan and rural dentists respectively. Therefore metropolitan dentists would appear to be twice as likely to attend CDE courses as their rural counterparts. The proportion of dentists who attended one course (20.24 per cent), two courses (7.34 per cent) and 2 three courses (12.09 per cent) is represented in Fig. 5. The majority of dentists (60.33 per cent) did not attend any of the courses in this survey. The proportion of rural dentists who attended one course (15.85 per cent), two courses (2.44 per cent) and L three courses (3.66 per cent) is represented in Fig. 6. These figures were calculated from the total of 82 rural dentists, and the data indicate that the vast majority of rural dentists (78.05 per cent) did not attend any of the courses in the survey. 298
Fig. 6. -Rural registrants: number of course(s) attended. N = 82 rural dentists in Western Australia 1990.
Discussion The limitations of this survey have been alluded to, namely: 1. It only represents courses convened by UPDEC and ADA (WA Branch) in one calendar year, and is therefore not comprehensive. However, the courses surveyed accounted for well over half the total number of courses convened in Western Australia in that calendar year. 2. The Register of Dentists and ADA membership do not represent an accurate number of practising dentists in the State because a number of retired dentists remain on both registers, but do not necessarily participate in dental activities. No attempt was made to exactly identify these dentists. 3. No5 attempt was made to validate the attendance of course registrants, or that they attended for the duration of the course. It was assumed that all registrants attended the course(s). The distribution of metropolitan and rural dentists (approximately 10: 1) reflects the demography of Western Australia, where 1.02 million of the population is concentrated in Perth and Fremantle (approximately 5306 km2).The other 0.4 million is spread (unevenly) throughout a remaining area of approximately 2 520 000 square kilometres. The total State population represents only 8 per cent of the total Australian population, even though it occupies one-third of its total land area. Due to the 'tyranny of distance', it is not surprising that so few rural dentists avail themselves of CDE courses. Easier access to courses for rural dentists should be a high priority for any CDE programme. This may be achieved by conducting course(s) in rural centres or organizing extended courses (for example, over several days, including weekends) in the metropolitan area, so that frequency of travel and time away from practices can be kept to a minimum. The annual ADA Country Convention Australian Dental Journal 1992;37:4.
addresses this problem to a limited degree. Other avenues of ‘distance education’can also be explored, for example, audio-visualformats, journal clubs and teleconferencing. However, the viability of these possibilities remains undocumented. In the light of the data relating to CDE attendance by rural dentists, any consideration for mandatory CDE will be very difficult to enforce in such a group. It would be counterproductive to further handicap the already limited dental workforce serving the widespread rural communities by imposing mandatory CDE. The problem may not be as acute in other states where distances are not as great and where the rural dentist: population ratio may not be as unbalanced as in Western Australia. The fact that the majority of dentists are ADA members and that ADA members appear to be more committed to CDE may indicate a more positive role for the ADA in promoting CDE for its membership. One recommendation could be a method of accreditation for its members who acquire some level of CDE attendance (for example, 20-25 hours per year) or other supplementary method(s) of CDE assessment. A simple method of annual accreditation for CDE may be desirable from several standpoints. 1. It would provide recognition for dentists who avail themselves of CDE, but remain completely voluntary. 2. It would provide the public with the perception that there is a mechanism within the profession whereby practising dentists can try to keep ‘up-todate’, and would be indirectly an advertisement for the dentist and the profession. 3. It would provide governmental bodies with some evidence that the profession is responsible and self-regulatory on this important issue. This may obviate the future need for imposition of other CDE options by statutory bodies remote from the profession. It is clear that CDE will continue to be a controversial issue in the future and the profession will require more information on the pattern ofCDE ‘behaviour’ on a national basis. However, the data presented here would indicate that the majority of dentists do not avail themselves of any CDE courses at all, and even those who do, generally attend only
Australian Dental Journal 1992;37:4.
one course per year. Admittedly, other modes of CDE (for example, journals, textbooks, audio-visual tapes, teaching, research, and so on) are equally important but are more difficult to quantify. The experience of CDE attendances in Western Australia may not necessarily reflect the situation in the other states of Australia, and hopefully this survey may prompt others to provide further information for discussion and future policy formulation.
Conclusion Only the various state and territorial Dental Boards in Australia have the prerogative to introduce mandatory CDE for the re-licensing of dentists. More than a dozen states in the USA have taken the option of mandatory CDE for re-licensing. In lieu of the mandatory option, a voluntary accreditation scheme may be a method to encourage CDE within the profession. The ADA could play a central role in promoting a voluntary CDE accreditation scheme for its members. Acknowledgements The author would like to acknowledge the members of the University Postgraduate Dental Education Committee, University of Western Australia, for their contribution in convening the CDE courses for the profession and University Extension for their administrative work. I would also express my appreciation to the Registrar of the Dental Board of Western Australia and the Secretary of the Australian Dental Association Western Australian Branch for providing the necessary information on the Register of Dentists and ADA membership. References 1. Brennan B, ed. Continuing professional education. Promise and performance. Australian Council for Educational Research Series. Aust Educ Rev 1990; 30: 1-5.
Address for correspondence/reprints: Suite 2, 20 Altona Street, West Perth, Western Australia, 6005.
299