Newsletter: December 2018

We recently completed accreditation reviews for University of Otago, AUT and orthodontic auxiliary training programmes.

University of Otago

The University of Otago offers 12 postgraduate programmes that are accredited for registration as a dental specialist or a clinical dental technician with the Dental Council in New Zealand. These include the Doctor of Clinical Dentistry programmes in 10 disciplines, a Master of Community Dentistry and a Postgraduate Diploma in Clinical Dental Technology.

A joint postgraduate accreditation review was conducted, with the site visit from 16 to 19 July 2018 at the University of Otago Faculty of Dentistry in Dunedin. The site evaluation team (SET) interviewed stakeholders that included:

• faculty and postgraduate programme staff
• programme leads
• postgraduate students
• recent graduates
• relevant professional bodies. 

This is the first New Zealand accreditation where the new Dental Council (NZ)/Dental Board of Australia dental specialist competencies were used as a benchmark for the dental specialist curriculums and assessments.

The SET consisted of a core team that reviewed all the generic accreditation standards, with discipline specific groups comprising of an international academic primarily from Australia, and a New Zealand practising dental specialist from each discipline who focussed on the individual curriculum and assessment aspects of the programmes under review. This significantly strengthened the review process with the relevant discipline expertise available to inform the process. 

Accreditation outcomes

The SET concluded that the following eight postgraduate programmes met all the accreditation standards, and were granted accreditation until 31 December 2023:

• Doctor of Clinical Dentistry (endodontics)
• Doctor of Clinical Dentistry (oral pathology)
• Doctor of Clinical Dentistry (oral surgery)
• Doctor of Clinical Dentistry (orthodontics)
• Doctor of Clinical Dentistry (periodontology)
• Doctor of Clinical Dentistry (prosthodontics)
• Master of Community Dentistry
• Postgraduate Diploma in Clinical Dental Technology.

The Doctor of Clinical Dentistry (paediatric dentistry) programme was also granted a five year accreditation period until 31 December 2023 conditional on increased clinically immersive hospital sessions and/or placements being put in place by May 2019. The reason for the condition is to increase the exposure of paediatric postgraduate students to the management of acute paediatric dental emergencies and complex paediatric cases, and experience in hospital management of paediatric patients.

Two of the DClinDent programmes did not meet the programme of study accreditation standard, and substantially met the assessment standard. These were the oral medicine and special needs dentistry programmes.

Due to the nature and extent of the shortcomings identified, the assessors considered these programmes have significant shortcomings that support a shorter accreditation period. However, the assessors considered that the programmes can put appropriate measures in place to address these shortfalls within a reasonable timeframe to ensure graduates are competent at completion of their programme.

DClinDent Oral medicine programme

The programme was granted accreditation with conditions until 31 December 2019.

Key concerns of the oral medicine programme were:

• The structure of the programme, with the medical degree not being an entry requirement. Due to the lack of fundamental medical knowledge and experience of patient management of students without a medical degree, achieving the appropriate level of knowledge and necessary clinical experience to attain all the oral medicine specialist competencies was considered challenging.
• The breadth and depth of core oral medicine clinical exposure, as well as those additional general medicine exposures of importance to oral medicine specialty training were deficient; current rotations were mostly observational rather than clinically immersive.

Conditions were put in place for the programme with strict timeframes within which evidence that these have been implemented should be provided to the Council, the last of which should be reported back by 15 November 2019.

The conditions relate to:

• strengthening and extending of clinical attachments
• medicine to become an entry criteria for the programme or completion of the medical degree early in the DClinDent programme structure (similar structure to the earlier conjoint MDS/MBChB (OM) programme)
• ensuring external examiner participation in the final assessments by a registered oral medicine specialist
• reporting on the assessment process to the Council. 

DClinDent special needs programme

The programme was granted accreditation with conditions until 31 March 2020.

Key concerns related to the special needs dentistry (SND) programme were:

• exposure to an adequate number and range of SND patients, and that the treatment complexity available to students appears to be on the lower end
• insufficient supervision of students by SND dental specialists, in particularly during outplacements. Where dentists supervises SND students, the dentists must have extensive SND experience.
• limited opportunities for joint treatment planning with other restorative dental specialist disciplines, such as endodontics, periodontics and prosthodontics.
• concerns related to the final examination processes. 

Conditions were placed on the programme relating to: establish appropriate outplacement opportunities for all SND students; revisiting and strengthening its final examination process and assuring SND external examiner participation, with an external examiner report to the Council confirming that the issues identified have been addressed. The last condition must be reported on by 31 January 2020. 

Conditions common to all programmes

Conditions applicable to all the accredited postgraduate programmes were placed relating to: 

• ongoing monitoring during the dental school building project
• embedding of cultural competence into the postgraduate programmes
• review and strengthening of the assessment strategies and standard-setting procedures
• correction and update of outdated or misleading registration information in the course materials.

Oral and maxillofacial surgery programme

The SET considered that based on the evidence provided the accreditation standards related to the programme of study and assessments were not met. Consequently, accreditation for the programme was declined.

The key concerns by the team were:

• A medical degree is not required for entry into the DClinDent OMFS programme. Within the current curriculum design, it is unclear how the programme will meet the requirements of OMFS training without the completion of a medical degree before the higher surgical training in this programme. Insufficient evidence was produced to demonstrate sufficient medical teaching of students in the absence of a medical degree. An educational approach that relied on customisable education according to the needs of the specific student, particularly whether they have completed their medical training before entering the programme or not, was described. However, this was not documented in the handbook or the primary submission document, and no evidence of how this would work was given.
• Insufficient evidence was provided to ensure all the OMFS attributes and competencies required would be attained through the course – both didactically and clinically. 
• The concerns about the very limited involvement of medical teaching and clinical staff extend to assessments.
• There is no evidence of contemporary external input or review of the programme, or benchmarking against international contemporary programmes.

The assessors identified a number of areas that the programme must address to enable the programme to meet the required accreditation standards. This will allow the programme to address the deficiencies. The Faculty can resubmit the programme for accreditation once they consider that the accreditation standards are met. Revisiting the accreditation of the programme can then occur. There was no active DClinDent OMFS student in the programme at the time of the visit.

What do shortened accreditation or accreditation declined mean?

The three programmes with conditions must report on their conditions to the Dental Council by the timeframes stipulated. All reports will be submitted to the ADC/DC(NZ) Accreditation Committee, following which the Dental Council will consider whether the conditions have been met. Accreditation of programmes may be revoked if the Council considers that the conditions have not been met.

The programmes with shortened accreditation periods or where accreditation was declined, will communicate the accreditation outcome to existing students and future applicants to the programmes. Graduates from unaccredited New Zealand programmes are not eligible for registration with the Dental Council.

Accreditation report
The full report  is available on  our website. Section 2.1 relates to the accreditation standards common across all programmes, and the programme-specific commentary follows in section 2.2.

Overall, the Council was concerned about the level of serious deficiencies identified in a number of programmes. With the Faculty being the sole dentist and dental specialist training provider in New Zealand, the Council saw this as a risk for the education of the dental workforce. The Council believes that it is in the best interest of patient care to have access to a range of dental specialty educational programmes to serve the oral health needs of the New Zealand population, but it must ensure that the graduates entering the profession are competent and safe to practise within their respective scope of practice.

To this end the Council is committed to work with the Faculty to ensure that the programmes where serious deficiencies have been identified, are brought back up to standard.

Auckland University of Technology Bachelor of Health Science in Oral Health accreditation 2018

The Bachelor of Health Science (oral health) programme gained full accreditation in 2008, ending on 31 December 2018. The site visit was conducted on 20 and 21 September 2018 at the Faculty in Auckland.

During the site visit, the site evaluation team (SET) held interviews with the Faculty and programme leadership teams, staff from all years, most clinical educators, students from all years, recent graduates, Māori and Pasifika specialist advisors, clinic managers, chair of the advisory committee and professional bodies. 

The new AUT University Akoranga Integrated Health Clinic, Buckland Road clinic and pre-clinical space were visited by the SET.

The SET considered that all the accreditation standards were met, but made a number of quality improvement suggestions to ensure that the programme continued to meet the accreditation standards and improve programme delivery.

The primary areas of focus for the programme are:

• With the increase of student numbers, ensuring appropriate programme resources. These include adequate patient numbers and student operator experiences, sufficient and functional pre-clinical and clinical equipment and adequate material, clinical and administration staff, and adequate clinical supervision.
• Revisit the overall vision of the type of practitioner that the programme wants to deliver in light of the role that oral health therapists can play in the delivery of New Zealand’s oral health care.
• Progress the integration of oral health care delivery within the programme, moving away from the historically separated restorative and periodontal clinics.
• Explore further opportunities for outplacements to broaden the students’ clinical and practice experiences. 
• Increased academic staff members would allow the Department a greater opportunity to contribute towards oral health care research; a workforce review to rationalise the small fractional appointments would enable holistic and consistent contributions to programme delivery and benefit student learning. 
• Explore strategies for oral health students to engage and participate in the School of Clinical Sciences’ interprofessional education.
• Develop and use clearly defined selection criteria and a transparent process for the appointment of clinical educators.
• Standardise the requirement for patients, or their representative, to reconfirm consent for treatment for each appointment and especially when another student continues the treatment at follow-up appointments, and assuring the recording of all informed consent in patient treatment notes.
• Explore ways to generate clinical activity summary sheets, ideally digital, to more effectively monitor students’ progress and to identify any gaps in clinical exposure in a timely fashion.

New Zealand Association of Orthodontists - Orthodontic Auxiliary Training Programme

The New Zealand Association of Orthodontists - Orthodontic Auxiliary Training Programme (NZAO OATP) leads to the Certificate of Orthodontic Assisting and enables successful trainees to register as orthodontic auxiliaries with the Dental Council in New Zealand.

The programme was developed by the NZAO to address the workforce needs for auxiliary staff to assist orthodontists, and was granted its first accreditation in 2010. Training is undertaken in-house in orthodontic practices, and trainees are supervised by approved orthodontists.

The site visit was conducted on 31 August 2018 during the final assessment held at the Faculty of Dentistry Department of Orthodontics in Dunedin. Interviews were held with the programme leadership, administrator, supervisors, clinical evaluator, chief examiner, examiners, and current and recent trainees.

The site evaluation team (SET) considered that all accreditation standards have been met.

A number of focus areas have been identified to ensure the programme continues to meet the accreditation standards, along with some suggested improvements. These include:

• Ensure updated online course material that reflects contemporary practice within the New Zealand context.
• Strengthen the cultural competence module and its assessment.
• Introduce written individualised feedback to trainees after the final assessment.
• Explore opportunities to increase the availability of the final assessments to three per year.
• Encourage voluntary short-term outplacements in other NZAO approved training practices, under supervision of that orthodontist, to increase exposure to different clinical approaches, techniques, equipment and broader patient and case mix. Such placements, if occurring, should be under signed agreements with clearly defined educational objectives and appropriate clinical supervision arrangements.
• Update the transmissible major viral infections (TMVI) evidence requirement during the application phase.
• Ongoing focus on improvement of communication with trainees and supervisors, in particular what to expect during the final assessment process.

The Council granted accreditation until 31 December 2023.