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DentalEducation

Alasdair G Miller

Brian Grieveson

Career Pathways in Dentistry


Abstract: This article explores the main career pathways available in the UK and the entry requirements for specialist training.
Clinical Relevance: Knowing what career options are available can be useful to all members of the profession and help to improve patient
care.
Dent Update 2010; 37: 162–167

On graduation, dentists in the UK may be Graduation


faced with a variety of choices for a career
in the profession. There are five main career
pathways in the UK open to all graduates Vocational Training
who are registered with the General Dental
Council (Figure 1): 1 year
n General practice; General Practice or Community Service or Armed Forces
n Community/salaried practitioner;
n Specialist practice;
n Hospital practice;
n Academic.
Each route has defined stages
and hurdles. This article will explore some Foundation
the main options associated with each Training
route. (formally known
UK graduates have, for the past as General
decade and more, been encouraged to Professional
undertake vocational training as their first Training)
post so that they gain a Vocational Training
Certificate which allows them to work in
Senior House Officer
NHS primary dental care, should they so Career Development Post
wish. For over 20 years there has been a Dental School or District General
desire to create a more formal training Hospital
for the first two years post graduation.
The first year has been formalized for over
15 years with vocational training. Dental Specialist
Academic Training
Training
MSc, DDS or PhD
to CCST

Alasdair G Miller, BDS, DGDP, DPDS, PRIMARY DENTAL CARE


NHS Consultant Training
FDS RCS(Ed), FAcMedEd, Regional Dental General Practice
Post CCST (Orthodontics,
Postgraduate Dean, South West England Paediatric Dentistry) Specialist Practice Community Dental Service
and acting Clinical Director, Peninsular Armed Forces Dental Service
Dental School and Brian Grieveson,
BDS, MFGDP(UK), MGDS(RCSI), PG Cert NHS Consultancy
TL, Postgraduate Dental Dean, Mersey
Deanery, N West SHA, UK. Figure 1. Career pathways diagram.

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For a small number of the


profession, about 5%, the desire to study
to become a recognized specialist is an
important career option. Over the past
decade, there have been quite a few
changes in this pathway.
It is now over a decade since
the General Dental Council created the
Specialist Lists and entered dentists on to
those lists who had either gained the right
of entry to the list by following a formal
approved training pathway or by being able
to demonstrate equivalent experience. The
majority of entrants to the Specialist Lists
working in the UK have gained entry by
a formal Deanery-managed programme.
Gaining a specialist list entry is the pinnacle
of formal training in the UK and, over the
past decade, quite a few changes have
taken place in respect of the management
Figure 2. The FGDP pathway and examinations. Reproduced by kind permission of the Faculty of General and content of training to become a
Dental Practice (UK). specialist.

Specialist training
Vocational Training, first introduced in the to undertake formal training and also
Since 1996, the GDC has kept
1970s, became mandatory in 1994 for those prepare to sit Membership Examinations of
the Specialist Lists and entered dentists
wishing to work in the NHS. Whilst it is not the Dental Faculties of the Royal Colleges.
on to the lists who have completed formal
mandatory for those who never intend to The Conference of Dental Postgraduate
training on the recommendation of Dental
work in NHS primary dental care, it is seen Deans and Directors (COPDEND)1 produced
Postgraduate Deans. In 2006, with changes
as desirable for entry into specialist training. ‘A curriculum for UK Dental Foundation
in legislation, the GDC became the sole
Organizing the first two Training’ in 2007. The curriculum, along
competent body responsible for Specialist
years’ post graduation into a structured with structured assessments that have
Training and the Royal Colleges took on a
programme, General Professional Training been introduced, allow graduates to gain
more advisory role. The GDC established
(GPT) has been available on a voluntary experience and show evidence of their
its Specialty Dental Advisory Board (SDEB)
basis for well over a decade and links posts competence so that they can use it to
to advise the GDC Education Committee
in vocational training to those in hospitals demonstrate their suitability to undertake
on matters pertaining to specialist
and the community service in a formal way higher training, if they so wish.
training. SDEB approves the curriculum
to give a structured two-year programme Having undertaken vocational
for each specialty, the entry requirements
which helps prepare dentists for college training, a graduate can then work in
to the training and the criteria for the
membership exams and to apply for entry primary care either in general practice
award of a Certificate of Completion of
into specialist training. Whilst this training or the salaried service. Within the NHS in
Specialist Training (CCST) that marks the
is not yet mandatory for new dental England and Wales, this is as a performer
end of training. The Specialty Advisory
graduates, it is seen as a fasttrack route on a PCT/Health Board Performers List.
Committees of the Royal Colleges develop
to specialist training and programmes are The salaried dental service now has a
the curriculum for the SDEB to approve
offered in most Deaneries; some are less more formal career structure leading to
and act in an advisory capacity to Dental
structured than others but all offer a range Senior Dental Officer and head of the
Postgraduate Deans, who are responsible
of experience. In medicine, these first two service. General Practice remains a little less
for managing the delivery of specialist
years are referred to as Foundation Training structured. One can work as an associate or
training in their area.
and this is now the term used to describe one can purchase a practice/partnership,
What does this mean to dentists
GPT in dentistry. It is an aspiration by and for some they may become clinical
wishing to undertake specialist training?
many within the profession that eventually leads in dental corporate practices. The
There are two major changes that have
Dental Foundation Training will become Faculty of General Dental Practitioners (UK)
arisen:
mandatory − it is voluntary at present published its career pathway in 1999 which
n It is no longer an essential requirement
and may well remain that way for a few allows practitioners to gain qualifications
to have passed a Royal College’s
more years. Dental Foundation Training and evidence which allows dentists to gain
membership examination (MFGDP or
offers those who undertake it the chance the Fellowship of the FGDP (Figure 2).
MFDS) to apply for specialist training.
April 2010 DentalUpdate 163
DentalEducation

Training Programme Requirements Essential Desirable

Qualifications
Basic BDS or equivalent1 MJDF/MFDS or equivalent experience
Registration with the GDC1 At the closing date for applications1
Postgraduate

Experience A minimum 24 months’ experience in Able to demonstrate at least 6 months’


dentistry, both primary and secondary experience at SHO level in an OMFS
care since Registration1,2 department in the UK1
Have completed dental vocational
training or equivalent1

Ability
Knowledge Consistent with MJDF/MFDS1,3 Hold a current certificate in BLS2

Clinical Skills and Technical Skills Skills in dento-alveolar surgery Be aware of how to assess patient’s
competence to consent for a
Ability to make good and legible clinical procedure3,4
notes1,4
Ability to gain appropriate consent from Be able to liaise with hospital staff
patients3,4 to organize operating time2,3,4
ECDL1
IT Proficient in the use of Word, Powerpoint
and email1,2

Motivation Commitment to Oral Surgery3 Ability to organize own learning as


demonstrated via professional
Commitment to learning2,3,4 portfolio2

Punctual4 Able to demonstrate initiative3

Personality Potential to cope with stressful situations Able to cope with stress and to have
and undertake responsibility3,4 leadership qualities3,4

Good communication skills2,3,4

Ability to work as part of a multi-disciplinary


team3,4

Audit Understands principles of Audit and can


demonstrate evidence of participation1,2,3

Research Understands principles and gives evidence Able to demonstrate evidence of


of enthusiasm or participation in relevant presentations and publications1,2,3,4
research1,2,3,4

Management Ability Capable of managing day-to-day clinical Shows interest, enthusiasm or


management in the unit1,2,3,4 demonstrates ability3,4

Able to construct a junior staff rota2,3

Other Requirements Meets requirements of Occ. Health An interest and knowledge of adult
Understands the principles of Clinical education2,3
Governance1,3

Assessed by:
1 2 3 4
Application form Portfolio Interview Structured reference
Table 1. Person specification for a Specialist Registrar in Oral Surgery.

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It is possible to apply for entry if one


Specialist List Training Time to Post CCST
is an experienced clinician who can
CCST (years) Training to
demonstrate equivalent experience to
consultant ( years)
that which would have been gained by
sitting for membership. This opens up
the opportunity for dentists who have Dental Public Health 4
been qualified for a number of years Endodontics 3
to apply for specialist training without Oral Medicine* 4
having a Membership qualification, as
Oral & Maxillofacial Pathology 3
long as they can demonstrate equivalent
knowledge. However, as long as entry to Oral Microbiology 3
formal specialist training remains very Oral & Maxillofacial Radiology 3
competitive, a well structured CV with Orthodontics 3 2
evidence of postgraduate qualifications
Oral Surgery 3
remains very desirable. In future years it is
likely that completion of the Foundation Paedodontics 3 2
Training Portfolio assessments will be Periodontics 3
required from most applicants. Table Prosthodontics 3
1 shows the person specification for
Restorative Dentistry 5
Oral Surgery Specialist Training in one
deanery. It is essential that applicants can
demonstrate that they meet the essential *Oral Medicine currently requires the applicant to hold a medical degree.
criteria and as many of the desirable Oral & Maxillofaclial Surgery is a medical specialty and its list is administered by the
criteria to maximize one’s chances to be General Medical Council.
shortlisted for interview. Table 2. Training pathways with the duration of the Specialty Training.

Membership of a Royal
College by Examination Specialist Training in Dentistry trainers. Certainly, in Special Care Dentistry
Until 2006 for a UK graduate it is very likely that much of the training will
In 2008, the GDC reviewed its
it was deemed essential to have passed take place in primary care as this is where
specialist lists and determined that there
the Membership Examination of a Faculty the majority of patients are already being
was no longer the need to have two lists
of Dental Surgery (England, Edinburgh, treated, and the same may apply to Oral
related to surgical dentistry and academic
Glasgow or Dublin) MFDS to be eligible Surgery in due course.
oral surgery so, from 2008, just one list
to apply for a specialist training post. In
exists for the specialty of Oral Surgery
2006, the Colleges agreed that it was no
and the new specialist list of Special Care Consultant training
longer essential to have undertaken a
Dentistry was created. The other change
year in an approved Senior House Officer Table 2 shows the training
that has evolved as the GDC has taken
post in a hospital or the community pathways and gives the duration of
over being the sole competent body for
service to sit the exam. This made it the Specialty Training. As can be seen,
specialist training in dentistry is that the
possible for practitioners later in their orthodontics and paedodontics have
focus on training is towards entry on to the
career, who had not undertaken an SHO training to CCST level and then a further
specialist list for a given subject, not the
post, to sit the examination. In 2007, the two years to consultant level. This might be
training to consultant as that is deemed to
Faculty of General Dental Practitioners a model that other specialties develop in
be an NHS matter. The GDC’s responsibility
(UK) and the Faculty of Dental Surgery time.
is to oversee and quality assure the training
of the Royal College of Surgeons of
to Certificate of Completion of Specialist
England agreed that two membership
Training (CCST) and entry on to the Career pathways in each craft
examinations seemed unnecessary as
appropriate list. area
they were both designed to measure
skills and knowledge at about two years General dental practice
post graduation, so they developed a What do these changes mean? Currently, there are no
single new examination, Membership At present, these changes on mandatory pathways in general practice.
of the Joint Dental Faculties (MJDF). The their own do not have a great impact but, One can undertake specialist training and
Colleges in Scotland and Ireland have in the longer term, it may be that more then work in specialist practice. For those
maintained their MFDS examinations but training towards CCST could be delivered in wishing to demonstrate their commitment
all are deemed equal when it comes to both primary and secondary care settings, to further study, one can study for the
consideration for specialist training. assuming that there are enough suitable Fellowship of the Faculty of General Dental
April 2010 DentalUpdate 165
DentalEducation

Qualification Awarding Body Initials

Membership of Joint Dental Faculties Royal College of Surgeons of MJDF


England & FGDP(UK)

Membership of the Faculty of Dental Surgery Dental Faculties MFDS


Edinburgh, Glasgow, Dublin

Diploma in Restorative Dentistry FGHDP(UK) DRD

Masters Degree in Clinical Dentistry Various universities MClinDent

Master degree & Diploma in Dental University of Bristol MSc


Postgraduate Studies DPDS

Masters/Diploma Degrees in Implantology Various universities & FGDP MSc

Masters degree in Public Health Various Universities MPH & DPH


Medical Law (LLM) LLM

Dip Forensic Dentistry All Royal Colleges DipFDent


Fellowship of Dental Faculties

Masters degree, diploma or Certificate in Various universities MEd


Medical Education Dip & Cert Ed

Diploma in Restorative Dentistry Faculty of Dental Surgery MRD

Cert Dental Health Service Leadership & Management FGDP(UK)

Certificate in Practice Appraisal FGP(UK)

Table 3. Additional qualifications (part-time study).

Practitioners (UK). One can also study Salaried and community dentistry profession, so higher degrees and the
and sit the range of higher diplomas Career pathways have been possibility of specialist training are available
and masters degrees now on offer from formalized more in this service in the in the services, according to the needs of
universities, many of which are modular past two years, with the new contract for the service and the length of an officer’s
and well suited to the busy practitioner. salaried service being introduced in 2007. commission.
Looking to the future There are now defined stages in working
it seems likely that, to maximize towards being a Senior Dental Officer. The
Academic dentistry
one’s options in the profession by opening of the Specialist List in Special
This is one of the toughest
taking part-time posts in addition Care Dentistry will create opportunities.
career pathways and currently not many
to working in primary care, gaining Within the salaried service one can also
are entering it. To be eligible to apply to
additional qualifications will be seen gain additional qualifications to assist with
be a professor one normally needs to have
as a demonstration of professional appointments such as a Senior Dental
gained one’s CCST in the relevant specialty,
commitment and so may give one Officer or Dentist with a Special Interest.
have gained a PhD, attracted research
the edge when applying to be a
grants and have published a number of
Vocational Trainer, Dentist with a
Armed forces dental service scientific papers. For those wishing early in
Special Interest, Staff Grade Practitioner,
The dental division of the armed their careers to sample this area of work,
Clinical Supervisor, Dental Vocational
forces has worked across all three branches most dental schools have a funded clinical
Advisor, Dental Practice Advisor and
of the forces for over a decade and offers fellow post which will allow one to develop
Postgraduate Dean.
all the training opportunities that are one’s academic and research experience.
Additional qualifications that
available to other members of the dental The Department of Health has become
are available are shown in Table 3.

166 DentalUpdate April 2010


DentalEducation

become concerned at the low numbers of doctors and dentists


pursuing academic careers and the risk this poses to undergraduate
education in the long term. The Department has, through the
Strategic Health Authorities in England, released funding to support
potential academics to work towards studying for a PhD and
undertake the relevant specialist training. Sadly, there are not many
of these posts, but they are advertised from time to time. They are
regulated by advice from the NIHR.

Hospital practice
There are some dentists employed at Staff Grade or
Patient safety
Associate Specialist level in district general hospitals, usually
providing minor oral surgery, orthodontics or restorative/prosthetic
rests in your hands
dentistry services, either on a part-time or full-time basis. Currently,
there are no mandatory postgraduate qualifications needed to For effective infection control, the
hold these posts, but it is unlikely that one would be appointed to UltraClean II Washer Disinfector Dryer
Associate Specialist without additional relevant qualifications, such
as College Membership, Specialist listing or a relevant diploma. helps you protect your patients, your
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Career advice
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better than many other FGGFDUJWFDMFBOJOH
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methods. Fast, efficient
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References spotless and ready for r "VUPNBUFEQSPDFTTVTJOH
sterilization. UIFTQFDJBMDMJQUSBZT
1. COPDEND 2007. A Curriculum for Dental Foundation Training –
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COPDEND 2007. www.copdend.org.uk
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For more information
Tel: 01254 844 103
Further information
Committee of Postgraduate Dental Deans and Directors
− www.copdend.org.uk E: sales@prestigemedical.co.uk
General Dental Council www.prestigemedical.co.uk
− www.gdc-uk.org
Faculty of General Dental Practice
− www.fgdp.org.uk/career_pathway/
Dentists with Special Interests
− www.fgdp.org.uk/dwsi/ INTEGRATED
Dental Faculties of Royal Colleges DECONTAMINATION
England SOLUTIONS

− www.rcseng.ac.uk/
Edinburgh
− http://www.rcsed.ac.uk Visit us on
stand F12
Glasgow College of Physicians and Physicians The Dentistry Show
19-20 March 2010
− www.rcpsg.ac.uk NEC Birmingham
Dublin
− www.rcsi.ie

April 2010 DentalUpdate 167