continuing education: a survey of the attitudes of the dental profession in ireland

CONTINUING EDUCATION: A SURVEY OF THE ATTITUDES OF THE DENTAL PROFESSION IN IRELAND

Adrian Cowan

Federated Dublin Voluntary Hospitals.

Chairman, Commission on Dental Education, Federation Dentaire Internationale.

Summary A SURVEY of the attitude of dental surgeons in the Republic of Ireland to

continuing education was carried out by means of a Questionnaire. Replies were received from 21 per cent of the dentists in the Republic

and the questions covered qualifications; methods of keeping in touch with current knowledge and of revising previous knowledge; journals taken; attendances at lectures, group discussion and courses; opinions on courses required, on the correlation of courses and on the types of courses. It was clear that there was considerable interest in continuing education but most experience (86 per cent) over a three year period had been confined to occasional scientif ic meetings and group discussions. The numbers attending authentic courses decreased (51-23 per cent) in proportion to the length of the courses. Motivations and incentives were also considered.

Introduction Dental education should be viewed as a continuing process divided into

two closely linked phases, undergraduate and postgraduate. The shortened undergraduate courses today merely alter the cut-off point between these two phases and allow the graduate to reach a stage where he earns as he learns, a little earlier; but it also throws a heavy responsibil i ty on him to continue with his postgraduate learning (Cowan, 1973).

In the nature of the shortened course, crammed with more and more new knowledge, many subjects become postgraduate because they can only be taught in the introductory form in the undergraduate course.

It is therefore highly desirable that when he finishes his undergraduate course and receives his diploma the student will have been imbued with the idea that continuing education is a way of life, that his education so far has been basic and that it is his responsibi l i ty and duty to bring himself up to date in scientif ic and technological progress in dentistry.

Postgraduate education is divided into (i) that concerned with training to be a teacher, researcher or a specialist, which involves a course and higher qualif ications, and change of status, and (ii) the continuous improvement of existing professional understanding which, while conferring no change in status, refreshes the dentist 's knowledge, adds to his experience and expands the scope and depth of his training. This in continuing education, and it applies at the appropriate level, as much to the teacher, specialist and researcher, as to the general practitioner.

This paper will try to show the nature of the interest which exists in continuing education at present among dental surgeons in Ireland.

69

70 IRISH JOURNAL OF MEDICAL SCIENCE

If all dentists were to seek continuing education regularly the present number of courses per year would be inadequate even in the United States, where as many as 2,000 are given annually.

Accurate figures for attendance are not at present available in the United States but except in the 15 States where continuing education is mandatory, the figures are certainly very low, and there is the additional complication that courses are chiefly concentrated around the larger cantres.

In Canada, figures for Toronto show that enrolment for the 22 courses offered there is 73 per cent (equivalent to 10 per cent of the dentists in the Province) and overall figures for the country are certainly lower than this.

In Germany the estimated figure is 15-20 per cent, but in Sweden the experience is very much higher. In 1972 13 per cent took one course, 24 per cent took 2-3 courses, 26 per cent took 5 courses and only 11 per cent of the 7,000 dentists did not attend a course (Soremark, 1974).

In France in 1974 a questionnaire was sent to 25,000 dentists by the Association Dentaire Francaise to assess their reaction to organised continuing education. Eighteen per cant of the dentists replied and of these 99 per cent expressed a need for continuing education and 94 per cent felt that this should be run by the profession. Seventy-nine per cent were against the courses being organised with Sick Fund or State finances with the loss of independence that this might involve, and 82 per cent thought that uni- fication of the various sources of information would help. Forty per cent were prepared to spend s163 per year on courses and 17 per cent would spend s

Materials and Methods Copies of a Questionnaire were sent to each of the 840 dentists on the

Irish Register. The questionnaire was specially designed to allow the answers to be examined by a computer and covered seven sections.

1. Qualif ications

2. Methods of updating knowledge

3. Journals read

4. Continuing education experience 5. Assessment of courses most needed

6. Assessment of most acceptable course length

7. Opinion on most desirable agency to coordinate continuing education.

Question 4 was the key question and it was designed to allow a system of grading of continuing education experience in order to establish criteria for evaluating the signif icance of the replies. The subdivisions were not placed in order of grading in order to avoid unconscious selection.

In effect there were two parts to the question. A - F represented minimal contact with continuing education, and G- I represented ascending levels of real continuing education experience. Where the maximum attendance possible could be estimated it was used to determine the percentage at-

ATTITUDES OF DENTAL PROFESSION IN IRELAND

FIG. 1

71

SURVEY ON CONTINUING EDUCATION IN DENTISTRY

1. QUALIFICATIONS B.D.S. 19 ...... L.D.S. 19 ...... B.Dent,Sc. 19 ......

F.F.D. 19 ...... F.D,S. 19 ...... M.B.B.Ch. 19 ......

2, HOW HAVE YOU KEPT IN TOUCH WITH DEVELOPMENTS IN DENTISTRY SINCE QUALIFICATION ? (CHECK MORE THAN ONE IF APPLICABLE) :

A. Trade Journals and Advert isements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. Professional Journals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Professional Associat icn Me~tings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Special ised Society Meet ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Cont inuing Educat ion Courses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F. Others (p lease speci fy) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. WHICH PROFESSIONAL JOURNAL DO YOU TAKE REGULARLY ?

J.I.D.A. J.A.D.A. J.ORAL SURGERY QUINTESSENCE

B.D.J. J.PERIO J.PROSTHETICS OTHERS

B.D.J. J.PERIO J.PROSTHETICS OTHERS

4. PLEASE INDICATE WHICH OF THE FOLLOWING YOU HAVE ATTENDED DURING THE LAST 3 YEARS :

A. I.D.A. Annual Scient i f ic Meeting (not less than 2 days) . . . . . . . . . . . . . . . . . . . . . . . . . . .

B. Other Nat ional Associat ion or F.D.I. Meet ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

C. Group Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Evening Branch Meet ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E. Academy Meet ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F. Faculty R.C.S. Meet ings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G. 1 day of Lectures, Demonstrat lons or Discussicns (2 Consecut ive I- d a y s = 1 day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

H. 1---3 days of Lectures, Demonstrat ions or Discussions . . . . . . . . . . . . . . . . . . . . . . . . . . .

I. More than 3 days Lectures, Demonstrat ions or Discussions . . . . . . . . . . . . . . . . . . . . .

5. IN WHICH 6 SUBJECTS DO YOU THINK COURSES ARE MOST NEEDED ?

ORAL MEDICINE CROWN/BRIDGE AUXILIARIES ORAL SURGERY CONSERVATION PREVENTIVE ORTHODONTICS END ODONTiCS PATHOLOGY PERIODONTICS PEDODONTICS SEDATION PHARMACOLOGY PROSTHETICS OTHERS

6, WHAT WOULD BE THE MOST CONVENIENT COURSE ?

Evening Course (2 e v e n i n g s = l day) Other Suggest ions . . . . . . . . . . . . . . .

1 - -3 Consecut ive Days . . . . . . . . . . . . . . . Weekend . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. WHAT AGENCY SHOULD INITIATE AND CO-ORDINATE REGULAR COURSES ?

A. The Profession (I.D.A.) . . . . . . . . . . . . B. Universit ies and .,.

Schools . . . . . . . . . . . . . . . . . . . . . . . .

C. Faculty R,C.S . . . . . . . . . . . . . . . . . . . . . . . . . D. Committee representat ive of

A , B & C . . . . . . . . . . . . . . . . . . . . . . . .

E. Other Suggest ions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. of Times


tendance (1, 2 and 3 b e l o w ) Where this was not known, the highest f igure received out of all the answers was used as maximum (4-6). The grading (Table I) was"

TABLE I

Grade

1. Group Discussions: Even:ng Branch Meetings 2. I.D.A. Annual: Academy Faculty 3. Other National Ass. : F.D.I. 4. 1 Day.Course 5. 1--3 ~ay Course 6. More th~n 3 Day Course

3 year Average Maximum

17.9 40* 10.1 27* 2.1 6* 2.0 10" * 2.2 12" * 2.1 6**

* Maximum Possible ** Maximum Answer Recorded

Grade 1 Group discussions and evening branch meetings were reckoned to be

the min imum involvement worth recording for general pract i t ioner problems.

Grade 2 IDA Annual Scient i f ic Meeting (at least two days at tendance) , Academy

of Medic ine (Odontological Sect ion) Meetings, and Faculty of Dentistry, Royal Col lege of Surgeons Meet ings were considered to have a consist- ently h igher scient i f ic content than Grade 1.

Grade 3 Attendance at the meeting of another national associat ion (usual ly Brit-

ish Dental Associat ion) or a Federat ion Dentaire Internat ionale meeting entai ls suff ic ient interest to travel to another country and a greater possi- bi l i ty of hear ing overseas or internat ional speakers and demonstrators.

Grade 4 One day (or its equivalent) of lectures, demonstrat ions and discussions.

Grade 5 1-3 days of lectures, demonstrat ions and discussions.

Grade 6 More than 3 days (usual ly 4-7) of lectnres, demonstrat ions and discus-

sions. The repl ies were fed into a computer and the relevant f igures were

extracted with the aid of Mr. David Abrahamson, B.A., B.A.I., Computer Department, Tr ini ty College, Dublin.

Results The total number of replies to the quest ionnaire was 178 (21 per cent)

of which 6 were discarded because of inaccuracies such as fai lure to indicate qual i f icat ions or dates, leaving 172 valid replies.

Question 1 The pr imary qual i f icat ions were BDS (National Universi ty of Ireland)

(134); LDS (Royal College of Surgeons in Ireland) (30), and B.Dent.Sc.

ATTITUDES OF DENTAL PROFESSION IN IRELAND 73

(Universi ty of Dubl in) (9). Twenty-one dent ists had FFDRCS Irel. d ip lomas in addit ion, 22 had FDSRCS Eng/Edin and 12 had full medical qual i f icat ions (Table II).

TABLE II

No. No. %

BDS 134

LDS 30

B DENT SC 9

FFD 21

FDS 22

MB 12

FDS4-MB 6

BDS4- FDS 4- MB

LDS4- FDS + MB

B DENT SC4-FDS4-MB

BDS"F FFD

LDS 4- FFD

B DENT SC4-FFD

BDS-F FDS

2 1.4

1 3

3 33

13 9

5 16

3 33

16 11

2 6

4 44

3 2.2

5 16

4 44

LDS 4- FDS

B DENT SC4-FDS

BDS+MB

LDS4-MB

B DENT SC 4- MB

These results were used for the establ ishment of age groups for study in relation to the answers to other quest ions. Taking a round f igure of 25 for age of qual i f icat ion, the age group could be worked out from the dates of pr imary qual i f icat ion and they were div ided into ages 25-30, 30-35, 35-45, 45-50 and 50+.

Question 2 Method of keeping in touch : The number of dentists who have endeav-

oured to keep in touch with d~velopments in dent istry since qual i f icat ion, and the methods which they used dur ing the last three years were as fol- lows: 118 (68 per cent) used trade journals and advert isements; 163 (94 per cent) used professional journals; 161 (93 per cent) attended professional associat ion meetings; 106 (61 per cent) attended specia l ised society meetings (e.g. oral surgery, per iodontology, orthodont ics, etc.); 122 (70 per cent) attended cont inu ing educat ion courses. Twenty-nine (16 per cent) were involved in other methods (e.g. addi t ional hospital exper ience or actual postgraduate courses) .

Question 3 Which professional journals were taken regularly ? Table III (average

co lumn) shows that 81 per cent read the JIDA (Journal of the Irish Dental Associat ion) and 58 per cent read the BDJ (Bri t ish Dental Journa l ) . Twenty- seven per cent. read special ist journals (i.e. relating to special t ies in den- t i s t ry - -per iodonto logy , oral surgery, prosthet ics and others). Thir ty-four


per cent Quintessence (a digest magazine) and 32 per cent other journals - - for example dealing with orthodontics, dental public health and other subjects, supplementing the specialist list.

TABLE III

Basic 4- Bas ic 4- AV. BDS LDS B DENT SC FFD FDS

% Reading JIDA 81 82 8:) 66 90 81

% Read;ng BDJ 58 55 70 55 85 86

% Reading "Special" 27 29 26 44 76 72

% Readng Quint 34 30 50 44 52 40

% Reading "Others" 32 28 40 55 42 54

Number 172 134 30 9 21 2.2

Figures were then examined to investigate the influence of qualification on the journals read. The basic qualifications maintain a similar level for JIDA except in the B D~,nt Sc group where it is much lower (but B Dent Sc shows the highest level for "specialist" journals of the primary degrees - -44 per cent). Dentists with FFD (Fellowship of the Faculty of Dentistry Royal College of Surgeons in Ireland) or FDS (Fellowship in Dental Surgery Royal College of Surgeons of England, Glasgcw or Edinburgh) both show a sharply different pattern. The figure for BDJ (average 58 par c~nt) rises to 85 per cent and specialist journals (average 27 per cent) to greater than 70 per cent.

The figures were further examined to investigate the influenca of age on the journals read (Table IV). JIDA levels were not significantly altered (average 81 per cent) for age except in the 25-30 age group (92 per cent). BDJ levels remained average (58 per cent) until the 30-35 group where there was a drop to 42 per cent followed by a sharp rise to 73 per cent in the over 50 group. This BDJ pattern was repeated for specialised journals with a drop from the average of 27 per cent to 16 per cent for the 30-35 group and a ris~ to 48 per cent for the 50+ group. Quintessence

TABLE IV

Age AV. 25-30 30-35 35-45 45-50 50 4- % % % % % %

JIDA 81 92 85 78 79 84

8DJ 58 53 42 80 58 73

SPECIALS 27 30 16 27 23 48

QUINT 34 14 32 39 30 42

OTHERS 32 23 32 37 33 23

TOTAL 172 13 28 66 39 26


(average 34 per cent) was read by only 14 per cent in the 25-30 age group and was more popular in the 35-45 and 50+ groups. The addit ional reading was lowest (23 per cent) in the youngest and old~st groups.

Quest ion 4

Meet ings, g roup d iscussions and courses a t tended dur ing the preced ing three years. The sections of this question (Fig. 2) and the grading system adopted have already been explained. The percentage of dentists partici- pating in the various grades was as fol lows :

FIG. 2

4. PLEASE INDICATE WHICH OF THE FOLLOWING YOU HAVE ATTENDED No of DURING THE LAST 3 YEARS Times

A. I.D.A. Annual Scientific Meeting (not less than 2 days) ........................ B. Other Nat!onal Association or F.D.I. Meetings ....................................... C. Group Discussions ........................................................................ D. EvEn!ng Branch Meet'ngs ............................................................... E. Academy Meetings ........................................................................ F. Faculty R.C.S. Meetings ................................................................. G. 1 day of Lectures, Demonstrations or Discussions (2 Consecutive ~ days=

1 day) .......................................................................................... H. 1--3 days of Lectures, Demonstrations or Discussions ........................... I. More than 3 days Lectures, Demonstrations or Discussions .....................

Grade 1. (45 per cent





Grade 6.

86 per cent of the d3ntists attended an average of 18 meetings of maximum of 40). 77 per cent of the dentists attended an average of 10 meetings of a maximum of 27). 29 per cent of the dentists attended an average of 2 meetings of a maximum of 6). 51 per cent of the dentists attended an average of 2 meetings of a maximum of 10). 59 per cent of the dentists attended an average of 2 meetings of a maximum of 12). 23 per cent of the dentists attended an average of 2 meetings

(33 per cent of a maximum of 6). Almost all replying indicated that they had been involved in more than

one grade and an analysis of these combinat ions of grades was carried out relating them to (i) qual i f icat ions and (ii) age groups.

Qual i f ica t ions 1. Those taking a combination of grades 1 and 4" (Fig. 3) were about

equal in number for all qual i f icat ions except for B Dent Sc and FFD groups which were lower. Those taking grades 1+5 were highest (~-70 per cent) in LDS, B Dent Sc and FDS groups.

Those taking grades 1 + 6 were highest (28-33 per cent) in LDS and FDS groups.


2. Those taking a combination of grades 2 + 4 (Fig. 4) were highest (58 per cent) for LDS, lowest for FFD and FDS groups.

Those taking grades 2 + 5 were highest (70 per cent and 83 per cent) for LDS and B Dent Sc.

Those taking grades 2 + 6 were slightly higher (33 per cent) for B Dent Sc groups.

3. Those taking a combination of grades 3 + 4 (Fig. 5) were highest (75 per cent) in LDS and B Dent Sc groups. Those taking 3 + 5 were highest in LDS and B Dent Sc groups and generally high anyway (average 74 per cent). Those taking 3 + 6 were highest in B Dent Sc, lowest in FFD and FDS groups.

Age In the combinations of Grade 1 (Fig. 6) the newly qualified show great

enthusiasm for Grades 1 + 4 and 1 + 5 group. Very few of the younger people appear to be interested in the grade 6 courses, but interest is highly active with the 35-45 group reducing and levelling off after 45. A very similar pattern starting at a slightly lower level is observed with combinations of Grade 2 (Fig. 7). Grades 2 + 4 and 2 + 5 are much closer together

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40-

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Sr. .~ -

\,, \ \ \ .4-1 5"~

BbS

[-.--

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INFLUENCE OF- bEGREE ON C_OUP,,%~%

GP-.AbF_% l + 4 j 1+5, t+G FIG, 3

6 1 1 4 1 5 ~ . . ~

, I | I . . . .

F F b

than for the Grade 1 combinations but the pattern for 2 + 6 is almost iden- tical with 1 + 6 again peaking in the 35 age group region.

Some variations on the pattern occur in the Grades 3-4 and 3-5 combinations (Fig. 8). They start at a very high level with the young people dropping very sharply to a low of 50 per cent at the 45-50 years groups after which they recover gradually. But in Grades 3 + 6, which represent the top


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INFLUENCE OF bE~P.EE ON C_OUP-.%ES

7 I ~45[~ 4

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C~..RbE% 2_-* "4 ~ 2 - + 5 ~ ?-+ G FIG. 4

level of both categories, one would expect to find the most dedicated practitioner, and the highest level for Grade 6 is reached yet again at the 35 age level.

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s176 I ~ ' - , "

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~JqbEs 1 + 4 - i J+E~ I+6

FIG. 6

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Q4. INFLUENCE OF AEiE ON COUKSFZS -FB, KEN

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FIG. 7


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~ 4 , INFLUENCE OF-I~GF (-#N CJOOK~C~S TAKEF~

FIG. 8

Question 5

Subiects in which courses are most needed? This question was planned to elicit the six subjects thought by the respondents to be most needed. When the six most popular subjects are expressed for each age group, it is apparent (Table V) that preventive, cown and bridge, periodontics and conservation are always featured. The average overall order is shown in the first column of the Table and the analysis for each age group in the succeeding columns. Endodontics was missing completely from the 25-30 age group, but was highly placed in all the others. Sedation took a high place in the 25-30, 30-35 and 45-50 groups but it lay 8th or 9th respectively in the 35-45 and 50+ groups. Prosthetics was low in favour until 45-50, rising higher still at 50+. Oral surgery tenden high at 25-30 but was low at 35-50 and oral medicine was somewhat similar. Orthodontics barely made the first 6 in 25-30 and 45-50 groups and remained low in all the others, usually fairly close to pedodontics. Interest in pedodontics appeared to be increasing especially among younger dentists. Pharmacology showed some impetus, but pathology maintained an unenviable position at the bottom of the list.

Question 6 The most convenient type of course ? The type of course most preferred

was 1-3 days (including weekends) and the next most popular was the evening course. These are, as one might expect, influenced by time away from practice.

Question 7 What agencies should initiate and coordinate regular coures ? The

agency favoured was very clearly a combination of the representatives of


TABLE V

Overall 25-30 30-35 35-45 45-50 50 +

Prey 114 Prey 9 Prev 20 Prev 46 Prev 24 Prey 15

C/B 90 C/B 9 Sed 19 Cons 39 C/B 24 Cons 15

Cons 88 Sed 7 Perio 15 C/B 32 Endo 22 Endo 14

Perio 82 Cons 6 Endo 13 Perio 31 Perio 19 Pros 14

Endo 78 Perio 6 Cons 13 Endo 29 Sed 18 C/B 12

Sed 74 Oral/M 5 C/B 13 Orlho 28 Pros 16 Perio 11

Ortho 60 Oral/S 4 Oral/S 11 Pedo 26 Cons 15 Oral/S 11

Pros 59 Pedio 4 Pharm 9 Sed 24 Ortho 15 Oral/M 10

Oral/S 58 Ortho 4 Ortho 7 Pros 20 Oral/S 14 Pedo 9

Sample 172 13 28 66 39 26

the profession (The Irish Dental Associat ion), the universities and schools and the Faculty of Dentistry, Royal College of Surgeons. Forty-eight per cent were in favour of this combination and the voting for the individual sections of it (36 per cent, 18 per cent and 6 per cent respectively) indicated very precisely the proport ions of 6 : 3 : 1 in its composition.

Discussion There is certainly evidence of interest in keeping up to date among the

profession in Ireland, but at present this interest is largely confined to reading journals and attending the occasional meeting. That there is a real need for furtherence of continuing education is expressed in the response to Question 5 (course subjects favoured), in different emphasis and at different levels for the various age groups. Figures for journal readers were uniformly high and the effect of qualification was mostly noticeable in those with Fellowships. Whether the Fellowship stimulated greater activity or whether people who study for Fellowships naturally read more, is a moot point. Age has its influence as shown in the reading habits of the 30-35 group and the 50+ group. The age findings suggest more discriminating reading among the mature dentists, and a clearer idea of where to find it.

Regarding continuing education experience, at first sight the numbers involved in individual grades appear quite high, but two factors have to be appl ied--average attendance and the three year period. In this context, the average experience in real continuing education courses (grades 4-6) is very low indeed and the figures decrease as the criteria rise (except for grade 5). At the top level only 23 per cent of those answering attend at all, and then only an average of 2 courses in three years; so that in a single year the attendance could conceivably be as low as 8 per cent attending one course.

The only grades which show signs of reasonable attendances are Grades 1 and 2 (86 per cent and 77 per cent) the lowest, but even in the former, 45 per cent attendance over three years is hardly satisfactory.


The need for incentive and innovations in teaching methods is all too obvious if any improvement in attendance is to be anticipated.

When qualifications were applied to test the effect on those results, the LDS and B Dent Sc graduates showed the highest levels for grade 5 and combination of grade 5 and 6 with 1, 2 and 3, while BDS showed highest incidence in grade 4.

No clear pattern emerged for basic qualifications, but it is noted that LDS and B Dent Sc graduates showed very favourably in both the journal dis- tribution and at least one of the higher continuing education grades (5). It has been reported before (Cowan, 1973) that these two schools had the highest proportion of graduates going on to take medical qualifications (LDS 9 per cent; B Dent Sc 18 per cent) and it was suggested that this may be because they both had, up till this year, a compulsory medical basic science course for dental students which required them to take the full anatomy, physiology and biochemistry course and examinations with the medical students. Although this lengthens the course it has made for more medically orientated graduates with wider interests, and in the author's considered opinion the shortening of the course to a reduced anatomy and physiology is a retrograde step in these two colleges.

As for the effects of age on continuing education experience, the peak age group is 35-45 for the top level, with no interest among the newly qualified and a sharp falling off at 50+ - - precisely the experience observed in the US, Australia and United Kingdom (Cowan, 1975). Where grade 5 (1-3 day course) is involved in combination with grades 1,2 or 3, the figures are high in the youngest group dropping at 30-45 and rising gently at 50; only grade 3 + 4 shows any noticeable revival at 50+. Translated, this suggests that younger dentists concentrate on meetings and group discussions together with 1-3 day courses. The 35-45 group makes the largest contribution to courses of more than 3 days and the 50+ group is at its best level attending other association meetings (e.g. United Kingdom and Federation Dentaire Internationale meetings and 1-3 day courses) possibly because they are interested enough to go to other meetings, are prepared to travel a little and can afford to.

Some indication of what is needed in the course can be filtered from the answers to Question 5. It is encouraging to see preventive and sophisticated (crown and bridge, cons and perio), restorative and para preventive meas- ures at the top level of requirement. The omission of endodontics from the youngest group is intriguing. Does it mean that the feed back from graduates has caused such an improvement in the teaching of endodontics that the new graduates are confident that they know it all ? Just as the 50+ group realising that they never had this opportunity now ask for updating.

What of intravenous sedation ? Do the young people see it as a practice builder (25-35) and are the older men who have always managed without it likely to change now ? On the other hand intravenous sedation is almost certainly one of the factors in awakening of interest in pharmacology, together with the increased understanding of the importance of taking a medical history and of the dangers of using drugs which may be incompat- able with those a patient is receiving from his medical practitioner. Pros- thetics, once the top seller, has dropped right down on the lists. Is this because modern teaching stresses prevention ?


Orthodontics is certainly not as popular a choice in Ireland as in the North of England (Newcastle) where Gilbert (1975) reports the first six choices as orthodontics, oral surgery, prosthetics, crown and bridge, I.V. sedation and preventive--a marked difference even from the overall figures in Table V. Different also from South Thames Region (Awtey, 1975) where the popularity is emergencies in dentistry, crown and bridge, practice man- agement and general anaesthesia, foliowsd by preventive, advanced cons and materials.

The type of course preferred is always one that will interfere least with a busy practic~ and 1-3 day courses, preferably over weekends seem to be the most popular in Ireland.

The most desirable arrangement suggested for an agency to coordinate courses in Ireland has been indicated in the answers to Question 5. In the UK (Farmer, 1974) continuing dental education is sponsored by the gov- ernment and organised by the universities and RCS. The universities ap- point a post graduate dental dean who works with a committee consisting of representatives from hospital, general practice and community dentistry. In England there are 14 regions, each with its own post graduate committee. Since 1962 a number of post graduate medical centres have been built (now 280) with libraries and lecture rooms, and audio-visual aids. Courses from {- days up to several weeks are held, and attendance expenses are allowed to participants in many instances. There is no planning of continuing education courses except the postgraduate ones run by the Royal College of Surgeons and attendance is poor (about 6,000 in 1974, representing about one-third of those eligible).

What can be done to provide incentive to overcome this low attendance? There is a primary aim to establish the desire to seek further knowledge

and to keep abreast of modern developments, at undergraduate level. In these early requirements of his undergraduate career the dentist can be helped and inspired by his teachers, full time and part time. Students tend to model themselves on teachers whose work they have admired and who have themselves proved these points by taking advancgd postgraduate training and qualifications. But what of the problem of encouraging continuing education among those who have not been so inspired ?

For the practitioner asking "What's in it for me ?" is it enough to explain the stimulation to read professional journals, to fill gaps in old knowledge and learn new techniques, to develop better sense of assessment of his work, to know where to find the reference he needs, to have the confidence to play his part in scientific discussion, to take pride in being a member of a respected profession whose image he is helping to enhance ?

The majority of practitioners will go to courses of some sort because they want to, or because they feel they ought to. The motivation of the average practitioner is coloured by his ambitions, the success and standard of his practice, the stimulation of his professional education, his age, the demands on his time, and finance. Broadly speaking, the main groups could be: 1. Desire for knowledge, new or complementary, for the benefit of greater

confidence such knowledge may bring, or for the status professionally, or both.


2. Job satisfaction : the pure satisfaction of being competent to cope with the challenge of the work.

3. Particular interest in one branch of dentistry.

4. The desire to improve techniques or to learn new techniques in order to keep up with colleagues, in other words, competition.

5. Financial gain.

If these points are going to be applied to encourage attendance, it is desirable that courses should be coordinated through a central agency or by regular conference so that standards may be maintained, feed back gathered, overlapping of courses reduced and rotation through subjects pursued.

As to compulsory continuing education, the author supports the principle that the dentist should want to learn rather than be forced to learn, but no one should be offended by compulsory attendance at a fixed number of well prepared, well organised courses over a period of say five years, nor by the need to produce evidence of attendance, and there is little doubt that such a system must come eventually. On the other hand, a system based upon passing an examination for relicensure is surely to be depre- cated, but if the profession does not provide and fulfill its own charter for continuing education, then one may be thrust upon it, especially in the field of publicly funded dentistry, by aloof and faceless departments uninterested in the dignity of this profession.

References

Awtey M. and Balk, T. 1975. D~ntal practitioners' attitudes to postgraduate educaticn in the South East Thames region. Brit. dent. J. 139, 111.

Cowan, A. 1973. Some observations from a survey of undergraduate curricula in 26 co-n~- ries. Int. dent. J. 23, 267.

Cowan, A. 1975. General comments on Continuing Education. Int. dent. J. 25, 1. Farmer, E. D. 1974. The delivery of Continuing Education. Int. dent. J. 24, 427. Gilbert, R. N. 1975. An investigaticn into postgraduate dental educatlon in the Newcastle

regions. J. dent. 3, 73. Soremark, R. 1974. Personal communication.

continuing education: a survey of the attitudes of the dental profession in ireland

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