faculty - newcastle university, newcastle upon tyne, united

Monospeciality Training in Periodontology

4 Year Programme

Handbook 2003-2007

Contents

Faculty........................................................................................................................................ 3

Introduction and Entry Requirements.....................................................................................4

Overall Aims and Learning Outcomes.....................................................................................5

Outline of Programme Structure.............................................................................................. 6

Progression................................................................................................................................. 6

Programmed Hours of Training............................................................................................... 7

Sample Timetables..................................................................................................................... 9

Years 1 & 2 Overview.............................................................................................................. 10

Years 3 & 4 Overview.............................................................................................................. 12

Years 3 & 4 Periodontology Modules.....................................................................................14Full Mouth Disinfection......................................................................................................... 14Risk Factors for Periodontal Disease...................................................................................... 15Use of Lasers in Periodontology............................................................................................ 16Impact of Periodontal Disease on General Health..................................................................17Interface between Periodontitis and other Dental Specialities................................................18Advanced Implantology......................................................................................................... 19Periodontal Surgery (I and II)................................................................................................ 20Bifurcations and Trifurcations...............................................................................................21Mucogingival Surgery........................................................................................................... 22Crown Lengthening Procedures.............................................................................................23Data Interpretation of Periodontal Studies..............................................................................24Regenerative Techniques....................................................................................................... 25

Generic Modules...................................................................................................................... 26Inter-disciplinary Care........................................................................................................... 27The Medically Compromised Patient.....................................................................................28Evidence Based Learning....................................................................................................... 29Management, Team Building and Interpersonal Skills...........................................................30Clinical Governance and Audit.............................................................................................. 31The Specialist Practitioner and Education..............................................................................32Specialist Dental Practice: Management, Ethics and Medico-legal Aspects...........................33Preparation for the MRDRCS Examination (Periodontology)................................................34

APPENDIX 1..................................................................................................................35

MONOSPECIALITY TRAINING IN PERIODONTOLOGY – Handbook 2003-2007 1

Aims and Learning Outcomes: Clinical Domain...................................................................35

APPENDIX 2..................................................................................................................36

Aims and Learning Outcomes: Academic Domain................................................................36

APPENDIX 3..................................................................................................................37

Aims and Learning Outcomes: Research Domain.................................................................37

APPENDIX 4..................................................................................................................38Time commitment years 1 & 2– full time trainee...................................................................38Time commitment years 1 & 2 – part time trainee.................................................................40Analysis of years 1 & 2 and years 3 & 4 relative to 4500hrs..................................................42


Faculty

Professor R A Seymour, BDS, PhD, FDSRCS, FDSRCS (ad eundem).

Professor of Restorative Dentistry and Head of School of Dental Sciences, University of Newcastle upon Tyne. Honorary Consultant in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust. (Monospeciality Course Director).

Mr S C Barclay, BDS, MSc FDSRCS (Edin), DRD, MRDRCS(Edin)

Consultant in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust.

Professor P A Heasman, BDS, PhD, MDS, FDSRCPS, DRD

Professor of Periodontology, School of Dental Sciences, University of Newcastle upon Tyne. Honorary Consultant in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust

Mr N Paterson, BDS, FDSRCS (Edin), DRD

Specialist Practitioner in Periodontology and Visiting GDP, Department of Periodontology, Newcastle upon Tyne Hospitals, NHS Trust.

Mr D G Smith, BDS, DRD, FDSRCS Edin; FDSRCS Eng

Consultant in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust.

Dr P M Preshaw, BDS, FDSRCS (Edin), PhD

Lecturer in Restorative Dentistry, School of Dental Sciences, University of Newcastle upon Tyne. Honorary Specialist Registrar in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Trust.


Introduction and Entry Requirements

The 4-year programme at Newcastle includes the MSc in Restorative Dentistry as a foundation with further training in the chosen Monospeciality. The proportion of the Monospeciality element of training increases throughout the programme, particularly the clinical component. For details relating to the MSc in Restorative Dentistry please refer to the current MSc Course Handbook and Course Specification which should be read in conjunction with this document.

The MSc Course Handbook explicitly distinguishes between application and admission for the MSc degree programme and that for Specialist Training. It states that transfers from the MSc degree programme to a Specialist Training programme are not possible after entry to the MSc.

Applicants for Specialist Training must be in possession of MFDS, FDS or have equivalence granted by the Equivalence Sub-committee of the Joint Committee of Specialist Training in Dentistry (JCSTD). The admissions process will involve the Postgraduate Deanery to ensure compliance with entry requirements, appropriate competitive selection and allocation of a National Training Number (NTN). Specialist trainees will hold an NTN; degree-only candidates will not.

Applications are welcome from both part-time and full-time trainees up to a maximum of three trainees per year (including all Monospecialities).

The University distinguishes between part-time and full-time MSc students on the basis of a part-time student being able to submit approved and planned work carried out in practice as part of his or her course requirements. In this way it is possible for both part-time and full-time trainees to complete the MSc programme in 2 years. In the same way a proportion of specialist training can be carried out in practice during years 3 and 4 allowing both part-time and full-trainees to complete the programme in 4 years. Hence the terms part-time and full-time relate to faculty attendance and, in reality, the amount of time each type of trainee commits to the programme is not significantly different.

The part-time training posts are designed principally for dentists with GDC registration who are employed locally in practice, hospital, community services or the armed forces where a proportion of specialist training can take place. However they will be required to discuss the treatment planning and progress of all training cases, at various stages for scrutiny by their trainers in the Dental Hospital and School.

Part-time trainees are expected to spend at least 60% of their time on Faculty premises (normally 3 days a week unpaid with access to 4 clinically related sessions per week at the Dental School) and to carry out a significant proportion of research or seminar preparation out with this time.

The full-time training posts will appeal most to overseas dentists who do not have GDC registration and do not have a suitable position locally where a proportion of specialist


training can take place. Therefore full-time trainees have unpaid access of up to 6 clinically related sessions per week at the Dental Hospital.

Overall Aims and Learning Outcomes

The aim of the Monospeciality training programme in Periodontology is to enable appropriately qualified dentists to acquire advanced skills, knowledge and research experience in the field of Periodontology. This will enable them to sit the Membership in Restorative Dentistry of one of the Royal Colleges, and if successful to be issued with a certificate of completion of specialist training (CCST) and to be registered by the GDC on the specialist list in Periodontology. Satisfactory completion of the MSc in Restorative Dentistry at Newcastle School of Dental Sciences will be used to inform the Record of In-Training Assessment (RITA) at the end of year two as an indicator of satisfactory completion of the first two years of the Monospeciality programme.

The MSc programme provides trainees with most of their research requirement and, as detailed below, year two of the programme is structured to reflect the emerging specialist. The broad aims and objectives of the MSc programme are contained in the MSc Programme Specification as well as the MSc Course Handbook. These aims complement those of Monospeciality training, which are:

To acquire advanced knowledge in clinical periodontics, including non-surgical and surgical management of periodontal defects, regenerative techniques, mucogingival procedures, an analysis of occlusal factors in the expression of periodontal diseases, implantology (linked to Prosthodontics module) as well as the integration of Periodontology with other specialist care.

To demonstrate an understanding of Clinical Governance, including risk management, the ethical and medico-legal aspects of Specialist Dental Practice and practical experience of clinical audit.

To acquire knowledge about the management of Specialist Dental Practice.

To understand the importance of the educational role of the Specialist Practitioner and to have experience of Undergraduate clinical teaching, delivery of MSc seminars and involvement in the provision of Postgraduate courses.

A more detailed exposition of the aims and learning outcomes associated with the clinical, academic and research domains of the programme are contained in Appendices 1-3 while the specific aims of individual programme modules are contained in:

The MSc module guides

The module outlines specific to the Monospeciality (referred to in this document)

The module outlines generic to all Restorative Monospecialities (also referred to later).

The specialist trainee will be required to compile a log book which meets with SAC approval and to participate fully in the RITA process from the time of entry onto the Specialist training programme.


Outline of Programme Structure

The JCSTD curricula for each Restorative Monospeciality specify that training should be broad based in all aspects of restorative dentistry and clinical dental science. The MSc programme provides the broad clinical and scientific foundation to Monospeciality training. However as the programme progresses trainees will require an increasingly sharp focus on their speciality area. For this reason trainees will undertake an MSc research project in their chosen Monospeciality. In addition year 2 of the MSc programme will have:

The majority of supervised clinical sessions entirely Monospeciality based The four patients reviewed by the internal examiners at the end of the second

year chosen to exhibit treatment of Monospecialist nature (MSc students are expected to submit cases of a general restorative nature at the end of both year 1 and year 2)

Current literature review sessions to allow trainees to keep abreast of targeted journals of importance to the Monospeciality.

The modules for Years 3 and 4 have a large clinical emphasis to support specialist training. Academic topics comprise Monospeciality specific subjects (e.g. implant placement and regenerative techniques) and generic subjects common to all three Restorative Monospecialities, which have not already been introduced in years 1 and 2.

Where appropriate, subjects introduced during years 1 and 2 are extended in years 3 and 4. For instance, a trainee would be expected to attend audit and clinical governance meetings in the first year, identify a subject for audit in the second year, perform and report the audit in the third year and where possible re-audit to complete the audit cycle in the fourth year.

It should be emphasised that during years 3 and 4 trainees will be expected to engage more and more in directed self-learning.

Certain educational activities will be linked with the Restorative Trainees (e.g. current literature reviews and appreciation of evidence based dentistry).

Progression

Progression from year 1 to year 2 relies on the trainee passing the MSc written examinations and submission of the research literature review. Should a trainee fail the written papers he or she may re-sit during the month preceding re-registration for the second year (i.e. during September).

In order to progress to years 3 and 4 Trainees must complete the MSc programme as part of their training and pass the University examinations, with the possible exception of the research project oral examination. In such a case the experimental work for the project would still need to be completed in Years 1 and 2. Trainees must however MONOSPECIALITY TRAINING IN PERIODONTOLOGY – Handbook 2003-2007 6

realise that the MSc must be passed as a whole to be awarded a CCST (certificate of completion of specialist training).

Specialist trainees will participate in the RITA exercise and any future Competence assessments specified by the SAC in addition to other programme assessments of a formative and summative nature. The RITA processes are scheduled at 6, 12, 24 and 36 months.

It must be emphasised that unsatisfactory progress, including failure of one or more components of the MSc examination, would normally result in the award of a RITA ‘D’ or ‘E’ form. Award of a RITA ‘D’ would involve the trainee undertaking targeted or remedial training within the period of their training programme; while a RITA ‘E’ requires a repetition of, and an extension to training. The trainee would be responsible for funding any such extension to training. Where the RITA panel detects continued unsatisfactory performance it will recommend to the Postgraduate Dental Dean and, during years 1 and 2, the Graduate School Dean, that training is discontinued.

Programmed Hours of Training

The required numbers of hours, in the various years, to comply with SAC approval are shown in Appendix 4. In order to provide at least 4500 hours of training our Monospeciality programmes have been designed over a four-year period (see calculations in Appendix 4). Specimen weekly timetables for years 1, 2 and 3&4 are shown below. Part-time trainees are expected to use a proportion of their own clinical time to undertake training in their practice setting.

Year 1

Based on academic year

Module Activity Weekly sessions

Total hrs+

Clinical Personal patient treatment 4 342

Diagnostic clinics 1# 120

Academic Restorative literature seminars 1 563

Research Lit rev and programme of work 1 310


Year 2

Based on academic year


Total hrs+

Clinical Personal patient treatment 3* 420

Diagnostic clinics 1 30

Undergraduate teaching 1# 60

Academic Current literature review 1 255

Research Complete project and write-up 1 450

Years 3 & 4

Based on 40 hour week


Total hrs (2 years)

Clinical Personal patient treatment 4 *

1680 (full time)

1320 (part time) *

Diagnostic clinic 1

Undergraduate, postgraduate and Section 63 teaching

1

Academic Thematic literature 1 610

Current literature 1

Research ** 25hrs/yr

# For Full-time trainees only

* Part-timers can see patients 2 of these sessions/week in practice. Only one third of the total time spent in practice during the programme is recognised as training time where there is no specialist practice trainer (JCSTD A Guide to Training and Training Posts in Restorative Dentistry Sept. 2001, Appendix 5, p39). If this option is taken part-timers will have 1320 hours of clinical time in the hospital compared with 1680 hours for full-timers.

** It is assumed that 3rd and 4th year trainees will continue to be engaged in research activity, such as the preparation of research papers, review articles, case reports and preparation for scholarly presentations. This is over and above the formal research component of training detailed in years 1 and 2.+ Total hours takes account of directed self learning and non-clinical modules.


Sample Timetables

Changes may be made to suit the needs of individuals

Year 1

Monday Tuesday Wednesday Thursday Friday

am Seminars Personal treatment

Diagnostic clinic # Personal

treatmentSeminars/ Research

pm DSL# Personal

treatmentDSL

# Personal treatment

DSL#

Year 2


am DSL# Personal

treatment / DSLDiagnostic clinic Personal

treatmentDSL

#

pm DSL# Personal

treatment /

Diagnostic clinic

DSL# Personal

treatmentUndergraduate

Teaching#

Years 3 & 4


am Study/admin# Personal

treatment#

Personal Treatment Personal treatment

Personal

treatment#

pm Current literature

Undergraduate clinical teaching

Thematic literature Diagnostic clinic

Study/admin#

# for full-time trainees only

DSL Directed Self Learning


Years 1 & 2 Overview

Clinical DomainClinical activity comprises:

Clinical skills training during 1st term

A laboratory course during 1st term with trainees encouraged to make some indirect restorations for their patients

Supervised personal treatment.During the first year patients are allocated to trainees by their clinical supervisors in Conservation, Endodontics, Periodontics and Prosthodontics to give broad Restorative experience. During the second year patients are allocated to focus experience in the Monospeciality.

Attendance at diagnostic clinics.

Undergraduate teaching (for full-time trainees) See generic module The Specialist Practitioner and Education.

Weekly Case Discussion Forum.

The following modules are undertaken during years 1 and 2:

Introduction to Implantology.

Occlusal management

TMD management

Introduction to sedation

And the following modules listed on p18 are started:

Clinical governance and audit

Interdisciplinary care

Management of the medically compromised patient

Evidence based dentistry

Academic Domain

Restorative literature reviewSeminars based on chapters from texts and key journal publications. Trainees are expected to prepare revision notes on each topic and essays on selected topics. Trainees are expected to present some seminars within Dental Materials Science.

Medical statisticsA series of 13 seminars complementing the research dissertation.

Research DomainTrainees are allocated a supervised research project within their chosen Monospeciality that should be completed within two years (see note on extended projects p6). The dissertation is written up as a literature review combined with a manuscript ready for submission to a targeted journal.


Assessment

Formative:

1. Quality of clinical skills work [Term 1]

2. Feedback from clinical trainers and patients [Sessional]

3. Essay writing and practice for MSc examination [Year 1]

4. Literature review [Year 1]

Summative:

1. MSc written papers [Year 1]

2. Verbal presentation of 4 treated cases [Annual]

3. Fully documented restorative case presentation [Year 2]

4. MSc vivas [Year 2]

5. MSc dissertation [Year 2]

6. RITA


Years 3 & 4 OverviewClinical DomainClinical activity comprises:

Supervised personal treatment.Patients are allocated to trainees by the Course Director according to training requirements.

Attendance at diagnostic clinics.

Undergraduate teaching. See generic module The Specialist Practitioner and Education.

Treatment carried out either in practice or in a paid hospital post under the guidance of a specialist trainer.

Weekly Case Discussion Forum.

The following clinical modules are undertaken throughout years 3 and 4:

Further non-surgical management of patients with moderate to advanced periodontitis, including the adjunctive use of local (controlled release) antimicrobials and full mouth disinfection

Basic periodontal surgical techniques, including: gingivectomy, replaced flap, modified Widman flap, crown lengthening procedures and the apically repositioned flap

Mucogingival surgery, including: free gingival grafts, frenectomy, coronal advancement flaps, connective tissue grafts

Regenerative surgery

Implantology

Aims and learning outcomes are detailed below.

Academic Domain

Thematic literature reviewBased on chapters from texts and key journal publications. Trainees prepare summary sheets on each topic.

Current literature reviewOne session per month will be devoted to reviewing current literature from a list of journals held in the library. Articles may be added to the thematic literature review.

Research DomainIt is assumed that 3rd and 4th year trainees will continue to be engaged in research activity, such as the preparation of research papers, review articles, case reports and preparation for scholarly presentations. This is over and above the formal research component of training detailed in years 1 and 2.


Assessment

Formative:

1. Contribution at Case Discussion Forum [Weekly]

2. Contribution at current literature review groups [Monthly]

3. Feedback from clinical trainers and patients [Sessional]

4. Summary sheets on thematic literature [Termly]

Summative:

1. Essays on thematic literature [Termly]

2. Written documentation of 3 treated cases [Annual]

3. RITA [Annual]

4. MRD


Years 3 & 4 Periodontology Modules

Full Mouth Disinfection

IntroductionFull mouth disinfection involves a combination of root surface debridement and adjunctive use of chlorhexidine spray, gel and mouthrinse over a short time frame (24 hours). The seminar will focus on the rationale, methodology, and outcomes of this procedure

AimsTo provide:

The biological basis and indications for full mouth disinfection.

To discuss the responses of the periodontal tissues to such treatment and the factors that can affect outcome

Learning OutcomesOn completion of this seminar, the Trainee will have an understanding of:

The indications for full mouth disinfection

The biological basis for such treatment

The advantages, disadvantages and outcomes of full mouth disinfection

The factors that can effect the outcomes of this form of periodontal treatment

Leader Dr N Patterson


Risk Factors for Periodontal Disease

IntroductionThere are many recognised risk factors for periodontal disease, including certain medical conditions, environmental factors and stress. Such factors contribute to the expression of periodontal disease or render the patient more at risk from periodontal breakdowns.

AimsTo provide:

A knowledge and understanding of the risk factors for periodontal disease.

Learning OutcomesOn completion of this seminar, the trainee will have an understanding of:

The various risk factors that are associated with the expression of periodontal disease

The mechanisms whereby such factor render the patient more susceptible to periodontal disease

The impact of such factors on diagnosis and patient management.

LeaderProfessor R A Seymour


Use of Lasers in Periodontology

IntroductionLasers have a variety of uses in dentistry. However, there are many periodontal applications. These include a variety of surgical uses, root planing and treatment of dentine hypersensitivity.

Aims To provide rationale and evidence for the use and efficacy of lasers in the management of a variety of periodontal applications.

Learning OutcomesOn completion of this seminar, the trainee will have an understanding of:

The application of lasers in dentistry with particular reference to use in Periodontology

The advantages and disadvantages of laser in the management of a variety of periodontal conditions.



Impact of Periodontal Disease on General Health

IntroductionRecent evidence suggests that the extent and nature of periodontal disease may be a significant risk factor for a variety of systemic conditions, notably coronary artery disease, pre-term low birth weight babies and respiratory diseases.

In this seminar, the links between periodontal disease and these various systemic conditions will be further explored and possible mechanisms elucidated.

AimTo provide:

An update on the association between oral health and various systemic conditions

ObjectivesOn completion of this seminar, the trainee will have an understanding of:

The epidemiological evidence that links periodontal disease as a risk for coronary artery disease, pre-term low birth weight babies and respiratory disease

The putative mechanisms that links periodontal disease with these systemic conditions.



Interface between Periodontitis and other Dental Specialities

SynopsisThe periodontal tissue can be affected by a variety of local factors. These include poorly fitting restorations, malocclusions, pulpal pathology, ill-fitting prostheses and the gingival manifestations of various oral medical conditions.

AimsTo provide:

An overview of the various local factors that can act as a risk for gingival inflammation, periodontal breakdown and/or alveolar bone loss.

Learning Outcomes On completion of this seminar, the trainee will have an understanding of:

The role of various local factors in the prevalence and expression of periodontal disease

The management of such local factors and their prevention to ensure periodontal health.

Leader

To be confirmed


Advanced Implantology

IntroductionThis module is designed to provide advanced training in implantology to supplement the basic training provided during years one and two (the MSc course).

AimsTo provide:

A thorough knowledge of the scientific basis of osseointegration An in-depth understanding of patient selection, systemic considerations and treatment planning for dental

implants An awareness of the role of additional specialists in implant provision Theoretical and practical experience of surgical procedures as they relate to the provision and reparative

management of intra-oral implant borne restorations A familiarisation with maintenance requirements and implant complications.

Learning OutcomesBy the end of the course the trainee will be expected to:

Identify and advise patients who may benefit/seek implant restorations. Carry out thorough assessment, including appropriate investigations, for patients who may benefit from

dental implant restorations. Undertake the surgical procedures necessary to provide dental implant restorations. Instigate and carry out an appropriate maintenance regime for patients with dental implant restorations.

Clinical Attendance at designated interdisciplinary implant planning and surgical clinics.

Academic Completion of thematic reading summary sheets and contribution at current literature review sessions.

Formative: Contribution at Case Discussion Forum [Weekly] Feedback from clinical trainers and patients [sessional] Summary sheets on thematic literature [Termly]

Summative: Essays on thematic literature [termly] Written documentation of treated cases [Annual] RITA [Annual] MRD


Periodontal Surgery (I and II)

IntroductionIndications for periodontal surgery include recontouring the gingival tissues, access to root surfaces, in the treatment of early onset periodontal conditions, and in conjunction with the management of furcation lesions (see later). This seminar will discuss the various surgical procedures, the outcome and healing responses of the periodontal tissues.

AimsTo discuss:

To discuss the rationale and specific indications for completing periodontal surgery, have a detailed knowledge of gingivectomy, modified Widman flap and apically repositioned flap, their indications and the responses of the tissues to such procedures.

Learning OutcomesOn completion of this seminar the students should have knowledge of:

The various types of periodontal surgical procedures together with their indications The short and long-term responses of the periodontal tissues to the different surgical procedures.



Bifurcations and Trifurcations

IntroductionIntra-radicular bone and attachment loss can be classified I, II, or III, depending on severity. Furcation lesions can be managed by a variety of techniques including non-surgical debridement, GTR root amputation and hemisection or tunnel preparation. Such lesions can be combined with endodontic lesions and/or compromised tooth vitality. This seminar will discuss the diagnosis, classification and management of furcation lesions.

Aims To examine and discuss: The diagnosis and criteria for classifying furcation lesions The various treatment options and rationale supporting these options The perio/endo interface associated with furcation lesions.

Learning OutcomesOn completion of this seminar the students should have an understanding of:

Clinical and radiographic features of furcation lesions The classification of furcation lesions The various treatment modalities and their prognosis The interrelationship between furcation lesions and pulpal pathology.

Module LeaderMr D G Smith


Mucogingival Surgery

IntroductionMucogingival surgery is essentially concerned with either preserving or increasing the width of attached gingiva. Many of the problems arise as a consequence of inappropriate toothbrushing causing gingival recession or abnormal frenal attachments. Mucogingival procedures include frenectomies, free gingival grafts, and coronal advancement flaps.

AimsTo describe:

The various mucogingival problems that can affect the periodontium. To discuss the pathogenesis of these problems, the rationale for their management, and the long-term outcome of the various procedures.

Learning OutcomesOn completion of this seminar, the students should have a knowledge and understanding of:

The various mucogingival problems that can affect the periodontium and the pathogenesis of such problems

The various procedures that can be carried out to correct mucogingival defects and the long-term prognosis.

Module LeaderMr D G Smith


Crown Lengthening Procedures

IntroductionCrown lengthening is an important part of any periodontist’s training. Crown lengthening is required in several clinical situations, including the restoration of teeth in which restoration margins would otherwise be placed too far subgingivally and the management of the worn dentition in which increased crown height is necessary for providing adequate retention for coronal restorations. Important considerations in crown lengthening include dental anatomy (so that furcations are not inadvertently exposed, for example), the width of attached gingiva and the concept of biological width.

AimsTo provide:

Instruction in the techniques of crown lengthening by reference to the literature An awareness of application, risks and benefits of crown lengthening.


The surgical techniques for crown lengthening The importance of preserving the biological width Crown and root anatomy of relevance to crown lengthening procedures.

LeaderTo be confirmed


Data Interpretation of Periodontal Studies

IntroductionPeriodontal research is an ever-expanding field. It is important that periodontists remain abreast of current developments in periodontal research, and can critically appraise and evaluate data presented in scientific articles in the literature. This requires an understanding of the methods of clinical and basic science research in Periodontology, including study design, use of appropriate outcome measures, correct and appropriate statistical analyses, and an understanding of statistical significance in relation to clinical significance.

AimsTo provide:

Knowledge and understanding of how research is conducted in Periodontology The ability to critically evaluate published research.


How periodontal research is undertaken Concepts such as statistical and clinical significance, and an understanding of statistical methods How to read a scientific article and critically appraise it.

LeaderDr P M Preshaw


Regenerative Techniques

IntroductionRegeneration of lost periodontal ligament and alveolar bone remains the ultimate aim of periodontal therapy. New techniques and materials are continually being developed and researched to enhance new attachment following periodontal procedures. Key concepts include guided tissue regeneration (GTR) and guided bone regeneration (GBR). These techniques can be applied at natural teeth or implants.

AimsTo provide:

Instruction in the techniques of periodontal regeneration by reference to the literature and ensure awareness of application, indication, risks, benefits and limitations of regenerative techniques.


The surgical techniques for periodontal regeneration (including GTR and GBR); The indications for regenerative procedures; The healing responses occurring following regeneration The materials available for regenerative techniques.

LeaderTo be confirmed


Generic Modules

The generic modules which follow are common to all monospeciality training programmes.

Interdisciplinary care

Management of the medically compromised patient

Evidence based dentistry

Management, team building and interpersonal skills

Clinical audit, quality assurance and clinical governance

The specialist practitioner and education

Specialist dental practice: management, ethics and medico-legal aspects

Revision for the MRDRCS examination


Inter-disciplinary Care

Introduction

This module is based on the importance of knowledge in the other disciplines that make up restorative dentistry in order to diagnose, treatment plan and execute treatment that is appropriate to the patient and to the constraints under which the clinician or patient may find him/herself. The module emphasises the need for every treatment plan to take into account possible future dental disease and the need to plan for mechanical failure. Experience is also gained of patients who require management by dental specialities outside restorative dentistry. The trainee(s) will share learning with trainees in the other Restorative monospecialities as well as with Restorative Specialist Registrars. This module will facilitate the documentation of cases required for the MRD exam.

Aims

To provide: The opportunity of attending inter-disciplinary treatment planning and review clinics in Restorative

Dentistry. The environment where treatment plans and the stages in execution of treatment can be discussed with

other trainees, technical staff and with established specialists. To provide the opportunity of being closely involved with any laboratory stages of treatment in order to

appreciate the importance of communication with the laboratory.

Learning Outcomes

By the end of the course the trainee will be expected to: Understand the role of inter-disciplinary teams in the management of selected patient groups. Fully appreciate the importance of taking into account disease susceptibility and modes of failure in relation

to treatment planning.

Assigned tasks

Clinical Attendance at designated inter-disciplinary Restorative planning and review clinics.

Academic Presentation of cases for discussion with trainee colleagues from all specialities of Restorative Dentistry

and established specialist trainers at Case Discussion Forum.

Evaluation

Formative: Contribution at Case Discussion Forum [Weekly] Feedback from clinical trainers and patients [Sessional]

Summative: Written documentation of treated cases [Annual] RITA [Annual] MRD


The Medically Compromised Patient

Introduction

There are several medical conditions that can impact upon the delivery of dental care. Furthermore, increasing life expectancy will have a significant impact on the prevalence of medically compromised patients attending for routine dental care. Medical conditions and the accompanying drug treatment that have the potential to affect dental treatment include: valvular heart diseases, anticoagulant therapy, organ transplant patients, patients with impaired haemostasis, patients on long-term corticosteroids and those with primary immunosuppressive disorders.

Aims

To provide: An evidence-based review on the effect of various medical conditions on the delivery of dental care.

Learning Outcomes

On completion of this seminar, the trainee will have an understanding of: The need for chemoprophylaxis in patients at risk from dental procedure – induced bacteraemia; The management of patients on anticoagulant therapy and long-term corticosteroids; The oral and dental problems of solid organ transplant patients and their management; The oral and dental problems of patients with primary immunosuppression and management strategies for

such patients.

Leader

Professor R A Seymour

Suggested readingSeymour R A, Lowry R, Whitworth J M, Martin M V. Infective endocarditis, dentistry and antibiotic prophylaxis: time for a rethink? Br Dent J 2000;189: 610-616.Seymour R A, Thomason J M, Ellis J S. Oral and dental problems in the organ transplant patients. Dental Update 1994 (June): 209-212.Thomason, J M, Girdler N M, Kendall-Taylor, P et al. An investigation in organ transplant patients undergoing gingival surgery. J Clin Periodontol 1999; 26: 577-582.


Evidence Based Learning

Introduction

As with medicine there is an increasing need to use evidence based on clinical trials and other scientific studies to influence current practice. This module will be incorporated as part of the thematic and current literature reviews in each Monospeciality. Trainees will be expected to consider the quality of the evidence base for clinical practice during each seminar. In addition they will be expected to choose one of their previous review areas and within that area consider evidence supporting clinical practice and the quality of such evidence. This exercise, which is scheduled for year three, will extend to trainees in the other Restorative Monospecialities as well as Restorative Specialist Registrars. Each trainee will make an assessed presentation at the end of year three lasting no more than 30 minutes. Trainees with a particular interest may wish to attend a specific course on EBD (e.g. Oxford University: http://www.conted.ox.ac.uk/health) but this is not a specific requirement. A mentor will be assigned to trainees so that they can discuss their EBD learning requirements on an individual basis.

Aims

To provide: An introduction to the concepts of EBD A familiar context to expound the concepts of EBD Experience in making a presentation An opportunity to communicate EBD between specialities

Learning Outcomes

By the end of the course the trainee will be expected to: Have accessed information on EBD (e.g. http://www.nature.com/ebd http://www.cche.net) Understand the terminology related to evidence based dentistry Know the merits and limitations of the various types of study Be familiar with the idea of using meta-analysis

Assigned tasks Identification of a suitable subject to make an evidence based presentation 30 minute presentation to trainers and other trainees

Evaluation

Formative: Feedback from trainees and trainers during literature review sessions [Sessional] Summary sheets on thematic literature [Termly]

Summative: Evaluation of quality of 30 minute presentation [end of year 3] MRD


http://www.cche.net/

http://www.nature.com/ebd

http://www.conted.ox.ac.uk/health

Management, Team Building and Interpersonal Skills

IntroductionIt is acknowledged that trainees will become team leaders in their chosen field. They will need generic skills in management, team building and interpersonal communication for effective and enjoyable working in both the Hospital and Specialist practice environments.

Aims

To provide: Opportunities for structured training in management skills including: time management, working in

meetings, managing a team, delegation, influencing, persuasion, negotiation and managing others. Delivered by professional management trainers from the region.

An understanding of the current structure and funding of the NHS A supportive environment for applying the skills learnt

Learning Outcomes

By the end of the course the trainee will be expected to: Understand basic management theory Have had opportunities of applying facets of management skill to their daily work Have had the opportunity of becoming involved with Monospeciality training course organisational issues

where appropriate

Assigned Tasks Attend appropriate management training courses.

Evaluation

Formative: Feedback from trainees, ancillary staff and trainers


Clinical Governance and Audit

Introduction

Across medicine and dentistry, there is an increasing emphasis on clinical governance and audit as tools to improve the quality of our practice and the service provided to patients. Trainee attendance at all Restorative clinical governance and audit meetings is mandatory from the start of the programme.

Trainees will be expected to consider the various aspects of governance (quality information, evidence based healthcare and clinical guidelines, clinical performance assessment and professional / managerial relationships) and audit and their relationship to clinical practice. In addition they will be expected to identify a topic for clinical audit, possibly associated with one of their previous review areas, to be carried out and reported on. Ideally, there should be a re-audit of the chosen topic to complete the audit cycle and determine if recommendations have been effective.

A mentor will be assigned to trainees so that they can discuss their clinical governance and audit learning requirements on an individual basis.

Aims

To provide: An introduction to the concepts of Clinical Governance and audit Experience in designing and carrying out a clinical audit project Experience in presenting the results of such a project Experience in completing the audit cycle and implementing change.

Learning Outcomes

By the end of the course the trainee will be expected to: Have accessed information on clinical governance and audit Understand the terminology related to clinical governance and audit Know the merits and limitations of the audit process Be familiar with the concepts of clinical governance

Assigned Tasks Identification of a suitable subject to audit (years 2 and 3) 30 minute presentation to trainers and other trainees / department clinical governance and audit meeting

(year 3) re-audit (year 4)

Evaluation

Summative: Evaluation of quality of 30 minute presentation [year 3] MRD


The Specialist Practitioner and Education

Introduction

This module is designed to provide the required theoretical and practical opportunities for the understanding and practice of teaching, learning and presentation skills appropriate to the specialist practitioner.

Aims

To provide: A sound basis from which to approach the educational activities likely to form part of a future specialist

career.

Learning Outcomes

By the end of the course the trainee will be expected to: Understand the learning process and the limitations of educational formats including lectures, seminars,

and practical work. Have the ability to select appropriate techniques from a range of teaching, learning and assessment skills. Have experience of the process of peer review of teaching, and of effective methods for communicating

feedback. Be confident in planning and delivery in the appropriate format. Become familiar with educational technologies currently available for teaching and learning in clinical

dental subjects.

Assigned Tasks Attendance at courses delivered by educational specialists. Presentation at case discussion seminars Leading topic based MSc seminars (years 3 and 4) Delivery of lectures Delivery of post-graduate courses including hands-on elements

Evaluation

Formative: Contributie to the teaching facet of Case Discussion Forum [Weekly] Feedback from participants at assigned educational activities.


Specialist Dental Practice: Management, Ethics and Medico-legal Aspects

Introduction

Most monospeciality trainees enter training in order to pursue private specialist practice. Whilst the hospital is well equipped to provide didactic education and clinical experiences, exposure to specialist practice and practitioners is essential to ground trainees in the ethical, medicolegal and managerial issues of establishing and running a successful specialist practice. This module will allow trainees to visit specialist practices, to experience management systems and protocols, and to discuss the pitfalls and particular considerations of specialist private practice.

Aims

To provide: Opportunities for trainees to spend time in a number of private and specialist practices. Opportunities to witness systems for patient and business management, record keeping and relationships

with referring dentists in successful specialist practices. Opportunities to discuss emergent issues with experienced specialist practitioners.

Learning Outcomes

By the end of the course the trainee will be expected to: Understand the special issues in establishing a specialist referral practice. Understand the special ethical and medicolegal considerations in managing referred private patients. Have improved communication skills in correspondence with referring practitioners. Have improved business sense for running a successful private specialist practice.

Assigned Tasks Attend a number of private and specialist practices (years 3 and 4) Attend discussion/seminar groups with specialist practitioners. Incorporate elements of private patient management and developing relationships with referring

practitioners during hospital and practice-based clinical activity.

Evaluation

Formative: Feedback from practices visited. Contributions to discussion/seminar groups. Observation of hospital-based patient management, time management, correspondence with referring

practitioners.


Preparation for the MRDRCS Examination (Periodontology)

Introduction

Scheduled sessions to ensure that trainees have adequate curriculum time for topic-based revision of subjects identified by themselves or by teachers.

Aims

To provide: The aim is to prepare for a success at the written and verbal parts of MRD examination and to ensure

preparation of appropriate presentation material.

Learning Outcomes

By the time of taking the MRD the trainee will be expected to: Have the ability to locate, recall and organise specialist knowledge included in the curriculum to provide

well-structured, coherent and focused answers to questions posed verbally or in writing. Have the skills required to analyse verbal and written questions and frame an argument that will address

the elements of the question in an efficient manner. To be able to effectively evaluate clinical data, casts, records, photographs, radiographs etc. of

prosthodontic relevance without preparation time.

Assigned Tasks Revision sessions in selected areas of the curriculum. Essay practise from past papers

Evaluation

Formative: Evaluation of performance at revision seminars.

Summative Results of essay practise from past papers.


Appendix 1

Aims and Learning Outcomes: Clinical Domain

General educational aim for this element:

To provide opportunities for clinical practice of increasing complexity in a supportive environment; to provide opportunities to master a full range of periodontal procedures, methods and techniques; develop a spirit of constructive self-criticism and an understanding of limits in the management of clinical cases. Provide opportunities for multi-disciplinary management and perspectives on the management of a private referral practice.

On completion of this element, the trainee should be able to demonstrate the following skill/knowledge: Ability to communicate verbally and in writing with colleagues and patients Refine skills in periodontal diagnosis, treatment, case review and after-care Ability to critically self-appraise Ability to evaluate new techniques and innovations in the practice of

periodontology and critically appraise these for the benefit of colleagues and patients

Ability to keep clear, succinct records, and document cases for presentation purposes

Understanding of special issues relevant to patient management in a Private Specialist Practice

The assigned tasks in achievement of these learning outcomes are:

Attendance at prescribed clinics; effective management of clinical time; accurate documentation of cases; good clinical record keeping; documentation of 3 presentation cases per year.

Evaluation of the achievement of theses learning outcomes will be realised by:

Formative: Feedback from clinical teachers and patients; contribution at weekly Case Discussion Forum.

Summative: End of year documented clinical cases.


Appendix 2

Aims and Learning Outcomes: Academic Domain

General educational aim for this element:

To provide core academic knowledge required for the safe and effective diagnosis, treatment, follow-up and prognostication for periodontal cases managed in specialist practice. To provide foundations for life-long learning and critical self-appraisal. To highlight the deficiencies in current research base, and the need for ongoing investigation. To encourage the development of academic inquiry.

On completion of this module, the trainee should be able to demonstrate the following skills/knowledge:

Ability to assimilate and critically appraise clinical and scientific literature.

Sound understanding of the prevention, diagnosis, clinical treatment and evaluation of patients with periodontic problems / disorders.

Ability to find reference information when needed.

Ability to critically evaluate developments in materials, techniques and clinical practice based on a sound knowledge of current scientific knowledge.

The assigned tasks in achievement of these learning outcomes are: Completion of assigned thematic reading Preparation of summary sheets Attendance and contribution at current literature discussion groups Termly thematic literature essays.

Evaluation of the achievement of these learning outcomes will be realised by:

Formative: evidence of reading; participation in current literature review discussion; summary sheets on thematic literature review.

Summative: Essays on thematic literature.


Appendix 3

Aims and Learning Outcomes: Research Domain

General educational aim:To provide, as part of the requirements of the MSc in Restorative Dentistry, experience in reviewing the literature, carrying out, analysis, writing up and reporting of a research project related to the Monospeciality area. Whilst most of this work will be carried out in years 1 and 2 trainees should expect to continue some research activity in years 3 and 4.

On completion, the trainee should be able to demonstrate the following skills/knowledge:

Ability to critically review scientific literature relevant to the proposed study.

Ability to formulate a hypothesis and devise methods of testing it

Ability to establish clear aims and objectives for a research project

Ability to work in a structured scientific manner, record findings systematically in a research log book and prepare a research manuscript

An understanding of statistics relevant to the research undertaken

Ability to analyse data and make valid conclusions

Ability to compare results with those of other workers

An appreciation of the clinical relevance and shortcomings of the work

The assigned tasks in achievement of these learning outcomes are: Completion of MSc literature review Completion of a contemporaneous laboratory log book Completion of one or more manuscripts for journal submission Presentation of research findings locally, nationally and, where appropriate,

internationally

Evaluation of the achievement of these learning outcomes will be realised by:

Formative: MSc literature review criticised by internal examiners after one year

Presentation of research findings to faculty

Summative: MSc dissertation (including lab book, literature review and manuscript).

MSc dissertation viva

Journal reviewers’ reports


Appendix 4

Time commitment years 1 & 2– full time traineeThe tables below show the number of sessions and full-time student contact/preparation hours over the first and second years of the course including the MSc in Restorative Dentistry. (colour coding: Clinical, Academic, Research) .

Year 1No. of sessions

(A)

Mean sessionDuration (hrs)(B)

Student contact hours

Total (A) x (B)

Seminars

ConsEndoInterrelated subjectsMaterials SciencePhantom HeadPerioProstho

Total

1492519132110

1121.5 seminar1.5 preparation

168168

Phantom Head Practical 13 2 26

Lab Course 12 31 preparation

36 12

Clinic terms 2,3

ConsEndoPerioProstho

TotalCase presentation/waxing

20202020

8020

32

240 40

Statistics 13 1.5 19.5

Research ProjectLiterature reviewPracticalTutorials

203010

532

100 90 20

Combined practitionerCoursesOcclusion & restorationsTMDImplantSedationTotal

434213 3.5 45.5

Revision (Including essay practice)

50 3 150

Total contact hrs 1115



(A)



Total (A) x (B)

Review of Monospeciality

current literature10 1.5hr seminar

3 hrs preparation

15 30

Teaching experience20 3 60

Clinic terms 4,5,6

Monospeciality : Restorative 3:1

100 3 300

*Diagnostic Clinics40 3

120

Research ProjectPracticalTutorialsWriting-up

401520

825

320 30 100

Revision50 3 150


* spread flexibly between years 1 and 2(colour coding: Clinical, Academic, Research) .


Time commitment years 1 & 2 – part time traineeThe tables below show the number of sessions and part-time student contact/preparation hours over the first and second years of the course including the MSc in Restorative Dentistry (colour coding: Clinical, Academic, Research).


(A)



Total (A) x (B)

Seminars

ConsEndoInterrelated subjectsMaterials SciencePhantom HeadPerioProstho

Total

1492519132110

1121.5 seminar1.5 preparation

168 168

Phantom Head Practical 13 2 26

Lab Course 12 31 preparation

36 12

Clinic terms 2,3

ConsEndoPerioProstho

Total

Case presentation/waxing

20202020

8020

32

240 40

Statistics 13 1.5 19.5

Research ProjectLiterature reviewPracticalTutorials

203010

532

100 90 20

Combined practitionerCoursesOcclusion & restorationsTMDImplantSedation

Total

4342

13 3.5 45.5Revision (Including essay practice)

50 3 150




(A)



Total (A) x (B)

Review of Monospeciality

current literature10 1.5hr seminar

3 hrs preparation

15 30

Teaching experience

Clinic terms 4,5,6

Monospeciality : Restorative 3:1Practice caseCase presentation/waxing

801530

322

240 30 60

Diagnostic Clinics20 3

60

Research ProjectPracticalTutorialsWriting-up

401520

825

320 30 100

Revision50 3 150


(colour coding: Clinical, Academic, Research)


Analysis of years 1 & 2 and years 3 & 4 relative to 4500hrs

Full time specialist trainee4500hrs over 3y@ 60% clinical 25% academic 15% research

Years 1 & 2 (inc. 2 year MSc)

Years 3 & 4

ClinicalAcademicResearch

27001125 675

762 818 660

1938 307 15

Total 4500 2240 2260

Part time specialist trainee

4500hrs over 3y@ 60% clinical 25% academic 15% research

Years 1 & 2 (inc. 2 year MSc)

Years 3 & 4

ClinicalAcademicResearch

27001125 675

732 758 660

1968 367 15

Total 4500 2150 2350

NB 4500 hours is the minimum time a trainee would spend on the programme. The figures are not intended to be absolute but to give a guide to how the balance of time spent in clinical, academic and research activities changes between years 1-2 and years 3-4.

The research component is front loaded as an MSc requirement at the beginning of the course. Depending on the nature of the project more or less time may be spent during years 1-2. However, the trainee would be expected to submit at least one manuscript for scientific journal publication during years 3-4.


faculty - newcastle university, newcastle upon tyne, united

Documents

learning outcomes

periodontology modules

clinical domain

periodontal disease

periodontology handbook

commitment years

academic domain

research domain