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Introduction In the UK, the General Dental Council specifies nine principles of professional standards that dental registrants must follow. There are views that such standards are high, patients' expectations are rising, and the professionalism of dental professionals is increasingly scrutinised. This paper explores whether the high standards expected in dentistry are justified.Methods We applied thematic analysis to 772 free-text responses from dental team members and the public to a modified Delphi survey. Respondents described their views of professional and unprofessional behaviours in dentistry. Data were obtained as part of a larger review of professionalism in dentistry.Results Two lines of argument were identified: professionalism standards are high, but justifiably so; and professionalism standards are too high. Within these, four broad themes emerged: patient trust; comparison with other professions; a culture of fear; and perfection.Conclusion High professionalism standards are justified in a profession where patient trust is paramount. However, a problem lies in the culture that surrounds professionalism in terms of litigation and dental professionals feel pressure to possess an unattainable, infallible nature. These negative impacts need minimising. We suggest that undergraduates and continuing professional development approach professionalism with care, to foster a supportive, positive and reflective culture of professionalism.

Introduction: as in other health professions, professionalism is a core concept in dentistry. Endeavours to determine a clear definition of professionalism in dentistry are widespread. However, there has been substantially less focus on the boundaries of professionalism, and what constitutes unprofessional or a lapse in professionalism.Aims: what leads a dentist’s professionalism to be called into question? An exploration of the boundaries between professional and unprofessional and the implications for maintaining professionalism in dentistry.Methods: drawing on data from a large mixed-method study, we conducted a thematic analysis of 772 open-text responses, from dental professionals and members of the public, to an online survey.Results: two lines of argument were identified for the conditions under which a dentist’s professionalism is called into question: circumstances that bear a direct influence on patient care, and circumstances that lead to the loss of patient trust. We identify and review processes that build and foster patient trust and thereby maintain professionalism.Conclusion: the findings support an approach to professionalism that mirrors a dentist’s approach to clinical practice. We provide two detailed recommendations for consideration: learned and tailored interactions, and judgement and reflection.

OBJECTIVES Most common diseases of the mouth are preventable through behavioural changes, oral hygiene routines and regular professional care. Research suggests dental professionals may prioritize clinical experience, personal values and preferences over evidence when delivering such interventions. Research also suggests variable rates of patient behaviour change following oral health education (OHE) interactions. This review explores the literature to answer the question: what factors influence the provision and reception of OHE messages and the wider OHE process? METHODS A structured search of literature was carried out with databases covering a range of academic disciplines (healthcare sciences, social sciences, education). Key words/terms were searched to elicit papers published since 1998. Citation mining (relevant citations within papers) and citation tracking (papers citing relevant papers) were also used. Recurring themes within the papers were identified and coded using NVivo12 and presented in a conceptual model. RESULTS The studies analysed tended to employ small-scale surveys, larger-scale surveys (some with low response rates), or interview studies of varying sizes. There was also a limited number of review papers. However, several key messages were identified regarding dental professionals' and patients' views on OHE and the factors that influence its provision. Factors that were identified related to the wider social and policy context (macro), community-level factors (meso), the individual practitioner and patient (micro), factors that influenced the nature of OHE interaction and any resulting behaviour change, and how the outcomes of the process influence future OHE interactions for both parties. CONCLUSIONS The literature highlighted how factors influence the OHE process before, during and after the educational interaction. The resultant conceptual model acknowledges the influence of wider 'upstream' factors alongside interpersonal and individual influences which should be taken into consideration when developing OHE interventions.

Background and aims Over the last decade, regulators have taken significant steps towards tackling perceptions that regulatory systems are burdensome. There has been much international research activity in the regulation of health and care professionals. This article reports a review of studies on health professions regulation between January 2011 and March 2020. Its chief object was to provide robust and up-to-date evidence to assist regulators in policy development and implementation. The main objectives of this study were to: Identify and retrieve research in the field of health and care professions regulation in English since 2011; Evaluate the published research, exploring its utility to regulators and practitioners, and drawing out any key messages; Draw conclusions concerning the scope and limitations of the research literature and identify areas for further research. Methods We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators’ websites to identify issues of concern and strategic priorities. We retrieved 3833 references, using a four-stage screening process to select the 81 most relevant. Results Results are reported within six key themes: harm prevention and patient safety; fitness to practise; quality assurance of education and training; registration including maintenance of registers; guidelines and standards and relations with regulatory bodies. Conclusions Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Consequently, the published evidence is diffuse and small-scale. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Few studies are able to show the impact of regulation or demonstrate a causal link between regulation and its effects. To inform their research and policy agendas health and social care regulators need to commission, interpret and apply the scholarly literature more effectively; academics need to engage with regulators to ensure that their research provides high-quality evidence with practical relevance to the regulators’ agendas. Further study is needed to explore how effective academic collaborations between regulators and researchers may be created and sustained.

Introduction Research has established varying levels of efficacy of oral health education (OHE) efforts. However, little is known regarding how outcomes impact dental professionals and their OHE practice. This study explores dental professionals' reactions to varying OHE outcomes and their motivations to persist with their efforts.Methods Qualitative, semi-structured interviews were conducted with dental team members working in mainly NHS general dental practices in South Wales, UK. Interviews were conducted face-to-face pre-COVID-19 and then by telephone, transcribed and analysed thematically.Results In total, 30 interviews were conducted (17 dentists, 6 dental therapists and 7 dental nurses). Pleasure was gained from improved patient oral health. Responses to non-adherence included disappointment, frustration and acceptance. Acceptance centred around a shared responsibility for oral care between clinician and patient and reassurance that they had 'done their job'. The unpredictability of patient adherence aided OHE motivation; efforts might eventually inspire patient action or might align with patient readiness to change.Conclusions This study reveals how OHE outcomes impact on dental professionals' perceptions of their role and personal motivations for continued educational efforts with patients. Greater emphasis on both preventative dentistry and self-care, coupled with understanding of the complex factors influencing oral health behaviour, would aid motivation for OHE.

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups.Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council.Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism.Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes.

In 2018, a new practice-based small group learning (PBSGL) pilot initiative was launched in Wales to promote interprofessional learning among different primary care professionals. The aim of this study was to evaluate the initiative in order to identify its strengths and areas for improvement. Data were collected through focus groups with PBSGL groups in Wales and analysed thematically. Participants generally held positive views of PBSGL and were impressed with the variety and overall relevance of the learning materials, although concern was raised about the relevance of all learning materials to the Welsh context. The interprofessional component was valued for reducing feelings of isolation and all participants were able to contribute to discussions, an outcome helped by existing relationships among group members. Many participants reflected on occasions where they had made changes to their practice as a result of PBSGL activity. Time and funding were cited as potential barriers to continuing participation in PBSGL and there is scope to tailor material more to the context of the healthcare system in Wales.\ud \ud KEYWORDS: Interprofessional education, peer learning, small group learning, continuous professional development (CPD), primary care

Background\ud Supporting people to self‐manage their long‐term conditions is a UK policy priority. Health coaching is one approach health professionals can use to provide such support. There has been little research done on how to train clinicians in health coaching or how to target training to settings where it may be most effective.\ud \ud Objective\ud To develop theories to describe how training health professionals in health coaching works, for whom and in what circumstances, with a focus on those working with people with progressive neurological conditions.\ud \ud Design\ud Realist evaluation using mixed methods (participant observation, pre‐ and post‐training questionnaires, and telephone interviews with participants and trainers). Realist data analysis used to develop and refine theories.\ud \ud Intervention\ud Two 1‐day face‐to‐face training sessions in health coaching with 11 weeks between first and second days.\ud \ud Setting and participants\ud Twenty health‐care professionals who work with people with neurological conditions in the UK, two training facilitators.\ud \ud Results\ud Four theories were developed using context‐mechanism‐outcome configurations to describe how training triggers critical reflection; builds knowledge, skills and confidence; how participants evaluate the relevance of the training; and their experiences of implementing the training. Some participants reported a major shift in practice, and others implemented the training in more limited ways.\ud \ud Discussion\ud Fully embracing the role of coach is difficult for health professionals working in positions and settings where their clinical expertise appears most highly valued.\ud \ud Conclusions\ud Training should address the practicality of using coaching approaches within existing roles, while organizations should consider their role in facilitating implementation.

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams.\ud Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting.\ud Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each).\ud Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales.

Purpose This paper aims to evaluate the longer-term impact of the 12-month Welsh clinical leadership fellowship. Design/methodology/approach Semi-structured interviews with 10 out of 14 trainee doctors who were fellows between 2013-2016, exploring how leadership knowledge and skills were used in clinical practice, impact on patient care and influence on careers. Data, gathered in 2017 when participants had completed the fellowship between 1-3 years, were analysed thematically. Findings All found the fellowship rewarding. The experience was felt to advantage them in consultant interviews. They gained insight into the wider influence on organisations and the complexity of issues facing senior clinicians. Although subtle, the impact was significant, equipping fellows with negotiation skills, enabling them to better influence change. Indirect impact on clinical practice was evidenced by enhanced confidence, teamworking skills and progression of improvement projects. However, the use of skills was limited by lack of seniority within teams, demands of medical training and examinations. The negativity of others towards management and leadership was also noted by some. Research limitations/implications Small participant numbers limit generalisability. Practical implications The fellowship is designed to equip participants with skills to lead improvements in healthcare delivery. Those more advanced in their medical training had greater opportunity and seniority to lead change and were better placed to apply the learning. This has implications for whom the training should be targeted. Originality/value A rare study exploring the longer-term impact of a leadership programme on later clinical practice, which adds to the body of knowledge of impact and efficacy of leadership training programmes in healthcare environments.

Context\ud Gender‐related inequality and disparity hinders efforts to develop a medical workforce that facilitates universal access to safe, just and equitable health care. Little is known about how medical students perceive the impact of their gender on their learning in clinical practice. Our aim in this study was to address this gap, establishing students’ perceptions of the impact of their gender on learning in the clinical context as part of the wider medical education community of practice.\ud Methods\ud We undertook a qualitative study that simultaneously gathered data through narrative individual interviews and online case reports from male and female students (n = 31) from different academic cohorts with prior experience of clinical practice in a Russell Group University medical school in the UK. Interviews were transcribed and analysed thematically alongside case report data.\ud Results and discussion\ud The participants revealed that there was a culture in clinical practice where their gender influenced how they were taught and supported by senior medical and surgical colleagues. Gender was also said to determine the clinical learning opportunities afforded to students, especially with regards to the care of patients of a different gender. The mentorship and support for learning provided to students in clinical practice was also said to be influenced by the medical student's gender.\ud Conclusion\ud Our findings suggest that students undergo a gendered clinical apprenticeship within what are in effect gendered communities of practice with some distinct features. These findings underscore the imperative for further work to establish how medical students of all genders can be supported to fulfil their potential in clinical practice.

Context\ud \ud Nurses are integral to patient safety, but little is known about their constructions of identity in relation to their dyadic interactions with trainee doctors about patient safety and competence during the trajectory of a medical career.\ud Aim\ud \ud We sought to examine how identities are constructed by experienced nurses in their narratives of patient safety encounters with trainee doctors.\ud Methods\ud \ud Our qualitative study gathered narrative data through semi-structured interviews with nurses of different professional standing (n=20). Purposive sampling was used to recruit the first eight participants, with the remainder recruited through theoretical sampling. Audio recordings were transcribed verbatim and analysed inductively through a social constructionist framework and deductively using a competence framework.\ud Results\ud \ud We classified seven identities that participants constructed in their narratives of dyadic interactions with trainee doctors in relation to patient safety: nurses as teacher, guardian of patient-wellbeing, provider of emotional support, provider of general support, expert advisor, navigator, and team-player. These identities related to the two key roles of nurses as educators and as practitioners. As they narrated these dyadic interactions, participants constructed identities that positioned trainee doctors in character tropes, suggesting gaps in professional competence: nurses as provider of general support was commonly narrated in the context of perceived deficits of personal or functional capabilities and nurses as team-player was mainly associated with concerns (or reassurances) around ethical capabilities.\ud Discussion and Conclusion\ud \ud We shed light on the identities that experienced nurses construct in their narratives of interactions with trainee doctors to ensure patient safety, and to facilitate learning in practice about key tenets of medical competence. Nurses' work in ensuring patient safety and support trainee doctors’ professional development merits greater formal recognition and legitimation.

ObjectivePharmacists are increasingly contributing to the skill mix of general practice surgeries to help alleviate pressures faced by UK doctors working in primary care. However, they need support in overcoming barriers to their integration. The purpose of this work was to evaluate a programme designed to support pharmacists’ transition to working in general practice settings. We explored the learning needs of pharmacists’, the barriers and enablers to their integration and provide recommendations based on our results.InterventionA qualitative evaluation of a 1-year transition programme in Wales starting in September 2018 to support pharmacists’ transition to working in general practice settings.Design and settingWe employed an interpretative phenomenological approach involving 10 pharmacists across Wales enrolled on the transition to general practice training programme, and their tutors. Data were collected across two sequential phases: in phase 1 telephone interviews were held with pharmacists midway through their training; in phase 2, focus groups were conducted with both pharmacists and tutors towards the end of the programme.ResultsPharmacists enter general practice settings with a variety of prior experience. The programme provided a framework that pharmacists found helpful to map their experience to but the programme needed to be flexible to individual learning needs. The tutor role was typically regarded as the most valuable component, but interaction with the wider general practice team was critical to ease the transition. Pharmacists encountered a lack of clarity about their role which impeded their integration into the workplace team.ConclusionsA formal programme with a designated tutor can support pharmacists’ transition into general practice settings. The programme’s competency framework facilitated reciprocal understanding of the pharmacist’s role in the team, helped to manage expectations and enhanced collaborative practice. Recommendations to facilitate pharmacist integration into general practice settings are provided.

Healthcare education is a discipline in its own right, and while each profession has its own distinctive body of clinical knowledge, in educational terms there is much that all professions share. Yet recognition for the healthcare educator role is often lacking. A more collaborative approach to the professional development of healthcare educators is needed in response to this and also to the rise of interprofessional and multiprofessional teamworking. Not all healthcare professions have guidelines for training their educators, and those that do have slightly different standards, which can lead to misunderstanding and miscommunication. It is in the interest of all healthcare professions that their professional bodies work more closely together to consider how healthcare educators can be supported as a distinct body with unique expertise and skills.\ud \ud This monograph reports on an 18-month long research project - the Healthcare Educators’ Values and Activities Study (HEVAS) – which aimed to establish the views of health professions educators, regulators, learned societies and professional bodies on the shared values and key activities undertaken by all healthcare professions educators. The project was funded by Health Education England and the Wales Deanery at Health Education and Improvement Wales.\ud \ud Nine central values and 24 activities were identified after a five-stage research process involving hundreds of participants drawn from over 20 healthcare professions. A variety of methods was used to establish a broad and clear consensus, demonstrating conclusively that healthcare professions educators share a strong set of values around the importance of professional healthcare education to safeguarding excellence in clinical practice and patient care, both now and for the future. While each profession develops its students, trainees and practitioners in its own way, the fundamental work of the healthcare educator is broadly similar, regardless of clinical specialty or profession. This new insight provides solid academic underpinning for multi-professional and interprofessional practice in healthcare education, and offers a new shared perspective on the future for healthcare education and healthcare educators.

Interprofessional teamwork between healthcare professionals is integral to the delivery of safe high-quality patient care in all settings. Recent reforms of medical education curricula incorporate specific educational opportunities that aim to foster successful interprofessional collaboration and teamwork. The aim of this study was to explore the impact of curriculum reform on medical students’ perceptions of their interactions and team-working with nurses. We gathered data from 12 semi-structured individual narrative interviews with a purposive sample of male (n = 6) and female (n = 6) medical students from fourth year (n = 6 following an integrated curriculum) and fifth year (n = 6 following a traditional curriculum). Data were subject to narrative analysis which was undertaken using NVivo software. Overall, there was no notable difference in the responses of the participants on the traditional and integrated curricula about their interactions and team work with nurses. However, the introduction of an integrated medical curriculum was viewed positively but a lack of interprofessional education with nursing students, removal of a nursing placement and shorter clinical placements were perceived as lost opportunities for the development of educationally beneficial relationships. The participants reported that nurses play a number of roles in clinical practice which underpin patient safety including being medical educators who provide a valuable source of support for medical students. The participants highlighted different factors that could hinder or foster effective working relationships such as a lack of understanding of nurses’ different professional roles and mutual respect. Medical education needs to provide students with more structured opportunities to work with and learn from nurses in clinical practice. Further research could explore how to foster positive relationships between medical students and nurses.

Professional identities research in medical education has made significant contributions to the field. However, what comprises professional identities is rarely interrogated. This research tackles this relatively understudied component of professional identities research by understanding emergency medicine physicians’ perspectives on the important elements that comprise their professional identities. Q-methodology was used to identify different clusters of viewpoints on professional identities; by extension, the core components that comprise emergency medicine physicians’ professional identities are disclosed. Thirty-three emergency medicine physicians were recruited, through purposive sampling, from five hospitals across Taiwan. R software was used to analyse the Q-sorts, determine loadings on each viewpoint and formulate the viewpoint array. Analysis of interview data enhanced our understanding of these viewpoints. In total, twenty-five emergency medicine physicians loaded onto four distinct viewpoints, reflecting dominant perspectives of emergency medicine physicians’ understanding of their professional identities. These distinct viewpoints demonstrated what emergency medicine physicians deemed significant in how they understood themselves. The viewpoints comprised: skills acquisition, capabilities and practical wisdom; coping ability and resilience; professional recognition and self-esteem; and wellbeing and quality of life. All viewpoints stressed the importance of trust between colleagues. These findings demonstrate the multitude of ways in which seemingly unified professional identities diverge across groups of individuals. An enhanced understanding of speciality work culture is gained. By understanding facets of professional identities, the development of future educational interventions and departmental initiatives, which might support key components of professional identities, can be explored.

Background: To facilitate a stronger recognition of the importance of the healthcare educator role and clearer communication regarding IPE, consensus is needed regardingn the values and areas of activity that all healthcare educators share, regardless of professional group.Methods and findings: A five-phase consensus process was used, consisting of a survey and search to identify guidance documents, a literature review and text analysis, a face-to-face consensus meeting, a novel workshop to develop organizing principles, and a two-stage Delphi consultation. This consensus process resulted in a nine-item list of shared values and 25 activities sorted into four domains.Conclusion: This article reports the development of a rigorous and collective consensus statement on the core values and activities shared by all healthcare educators. This is a necessary preliminary to establishing the groundwork on which interprofessional educational initiatives can be built.

Introduction Dental core training (DCT) is an optional, postgraduate programme with a duration of one to three years that dentists in the UK can pursue to further strengthen their skillset.\ud \ud Aims To understand career motivations and preferences of trainees pursuing DCT, and their perceptions and experiences of the programme.\ud \ud Methods Data were gathered from 176 DCT trainees across England through focus groups or individual paper-based responses to questions, as well as telephone interviews with ten associate postgraduate dental deans/training programme directors.\ud \ud Results Trainees were generally positive about their overall DCT experience. They developed confidence, self-reliance and skills in teamwork and clinical aspects, gaining from exposure to conditions uncommon in general practice. Limitations and challenges varied by post and unit. The importance of broad, cross-specialty experience was recognised. Although run-through training would eliminate unwelcome annual relocation, it was deemed unsuitable for all trainees, particularly those intending a career in general practice.\ud \ud Conclusion DCT appears to be advantageous for those intending careers in general dental practice, those aiming for specialist practice and those uncertain of their future career trajectory. Although trainees reported positive training experiences and significant gains, future considerations are suggested, including maintaining flexibility to accommodate different motives for DCT and limiting across-unit variation.

We welcome the feedback (1) and dialogue about our study (2). We will clarify our perspective and its ontological, epistemological and axiological underpinnings. We concur about the perils of a cisnormative worldview and the imperative for gender diversity in medical education as evinced by our earlier commentary (3). Our participants identified exclusively as male or female (2), therefore it was untenable to relate their narratives more broadly to people who are transgender, non‐binary gender or gender fluid.

ObjectivesThis paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD.DesignA scoping review.Search strategyWe conducted a search of UK health and social care regulators’ websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession.ResultsCPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning.ConclusionsOur review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.

Purpose UK fellowship schemes have been set up to address low-level engagement of doctors with leadership roles. Established in 2013, the Welsh Clinical Leadership Fellowship (WCLF) programme aims to recruit aspiring future clinical leaders and equip them with knowledge and skills to lead improvements in healthcare delivery. This paper aims to evaluate the 12-month WCLF programme in its first two years of operation. Design/methodology/approach Focused on the participants (n = 8), the authors explored expectations of the programme, reactions to academic components (provided by Academi Wales) and learning from workplace projects and other opportunities. The authors adopted a qualitative approach, collecting data from four focus groups, 20 individual face-to-face or telephone interviews with fellows and project supervisors and observation of Academi Wales training days. Findings Although from diverse specialties and stages in training, all participants reported that the Fellowship met expectations. Fellows learned leadership theory, developing understanding of leadership and teamwork in complex organisations. Through workplace projects, they applied their knowledge, learning from both success and failure. The quality of communication with fellows distinguished the better supervisors and impacted on project success. Research limitations/implications Small participant numbers limit generalisability. The authors did not evaluate longer-term impact. Practical implications Doctors are required to be both clinically proficient and influence service delivery and improve patient care. The WCLF programme addresses both the need for leadership theory (through the Academi Wales training) and the application of learning through the performance of leadership roles in the projects. Originality/value This work represents an evaluation of the only leadership programme in Wales, and outcomes have led to improvements.

Introduction Recent developments in European dental education are student-focused, concerned with competency-based and problem-based learning. The development of dental educators has so far received little consideration. This study aimed to agree curriculum content for developing dental educators so that they are better able to support changing undergraduate dental education. Methods Adopting consensus methodology, a 2-round Delphi was conducted in 2012. Fifty-three dental educators and 39 dental students across Europe volunteered to take part. The Delphi questionnaire was developed based on literature, piloted and sent to participants to gather opinions and seek consensus on educational content using rating scales and open-ended questions. Numeric data were analysed using descriptive statistics, and qualitative data were analysed thematically. Results and Discussion This study revealed 7 domains of curriculum content for dental educators. Four of these domains were considered essential: educational principles; educational practice in dentistry; curriculum, quality and improvement; and educational professionalism. Three domains were viewed as optional and could be tailored to local needs: educational principles in relation to specific contexts, educational research, and educational and healthcare management. When developing training for dental educators, factors which need consideration were identified as the academic position and teaching experience of educators, and the nature of clinical dental education. Conclusion The results are beneficial for individual educators to inform professional development plans; institutions to devise faculty developments; ADEE to inform policies on developing European dental educators; and other disciplines to inform training for their educators.

Objectives Current policy in Southeast Asian dental education focuses on high-quality dental services from new dental graduates and the free movement of dental practitioners across the region. The Southeast Asian Nations (ASEAN) Dental Councils has proposed a set of ‘Common Major Competencies for ASEAN General Dental Practitioners’ to harmonize undergraduate dental education. This paper discusses how ASEAN competencies were developed and established to assist the development of general dental practitioners with comparable knowledge, skills and attitudes across ASEAN. Methods The competencies were developed through four processes: a questionnaire about current national oral health problems, a 2-round Delphi which sought agreement on competencies, a panel discussion by representatives from ASEAN Dental Councils, and data verification by the representatives after the meeting. Numeric data were analyzed using descriptive statistics and qualitative data were analyzed thematically. Key themes of the ASEAN competencies were compared with the competencies from USA, Canada, Europe, Australia, and Japan. Results Thirty-three competency statements, consistent with other regions, were agreed. Factors influencing the ASEAN competencies and their implementations include: oral health problems in ASEAN, new knowledge and technology in dentistry, limited institutional resources, underregulated dental schools, and uneven distribution of dental practitioners. Conclusions The ASEAN competencies are the foundation for further development in ASEAN dental education including: policy development, curriculum revision, quality assurance, and staff development. Collaboration amongst stakeholders is essential for the successful harmonization of ASEAN dental education.

Introduction\ud \ud Dental educators are important people who contribute to the development of every aspect of dental education. In part due to the lack of understanding of their roles and competences, dental educator development has so far received little consideration. With the aim of enhancing the dental profession's contribution to the development of undergraduate dental education, this article explores common roles of educators of undergraduate dental students and the competences needed to be effective educators. \ud \ud \ud Methods\ud \ud This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on roles and competences of educators. \ud \ud \ud Results and discussion\ud \ud Roles of educators of undergraduate dental students typically encompass four areas: teaching, research, administration and providing healthcare. Educators may not be involved in every role; they normally perform the roles relevant to their work contexts. Competences for dental educators based on the four main roles comprise 12 domains: educational theories and principles; modes of education; learner issues; educational materials and instructional design; assessment and feedback; curriculum matters; evaluation; educational research; educational management; quality assurance; patient care and healthcare system and professionalism. Not all competences are required by all educators although educators need to be competent in the areas related to their roles and duties. \ud \ud \ud Conclusion\ud \ud Understanding the roles and competences for educators of undergraduate dental students can help individual educators to improve their personal effectiveness and institutions to tailor staff development programmes appropriate to the needs of their staff. Faculty development contributes to sustained enhancement of undergraduate dental education.

Changing patient demographics raise important challenges for healthcare providers around the world. Medical generalists can help to bridge gaps in existing healthcare provision. Various approaches to medical generalism can be identified, for example, hospitalists in the US and the restructuring of care away from medical disciplines in the Netherlands, which have different implications for training and service provision. Drawing on international debates around the definition and role of generalism, this article explores one manifestation of generalism in the UK to understand how abstract ideas work in practice and some of the benefits and challenges. Broad-based training is a two-year postgraduate training programme for doctors recently piloted in England. The programme provided 6-month placements in four specialties (general practice, core medicine, psychiatry and paediatrics) and aimed to develop broad-based practitioners adept at managing complex and specialty integration. Our longitudinal, mixed methods evaluation of the programme demonstrates that although trainees value becoming more holistic in their medical practice, they also raise concerns about being perceived differently by co-workers, and report feeling isolated. Using identity theory to explore the interplay between generalism and existing boundaries of professionalism in healthcare provision, we argue that professional identity, based on disciplinary structure and maintained by boundary work, troubles identity formation for generalist trainees who transcend normative disciplinary boundaries. We conclude that it is important to address these challenges if generalism in secondary care settings is to realise its potential contribution to meeting increasing health service demands.

The authors offer an analysis of “gendered ways of thinking” that stand as barriers to enabling a gender diverse and competent workforce.

Introduction\ud \ud Health professionals worldwide are required to maintain their knowledge and skills through continuing education. However, there is limited evidence that the accumulation of hours of educational activity enhances practice. The aim of this study was to review evidence of the impact of continuing professional development (CPD), best educational practice and new models of CPD requirements.\ud Methods\ud \ud We conducted a rapid evidence synthesis, reviewing literature and websites on continuing education for healthcare and non‐healthcare professionals.\ud Results\ud \ud We extracted data from 184 publications. Evidence of changed practice and improved patient care is uncommon in studies of CPD. What evidence there is suggests that activities are more likely to have impact if a combination of methods is used and if they are aligned with learning needs. Impact is also affected by the learner and their work environment. In terms of CPD requirements, we identified three models: input‐based; outcomes‐based and mixed models. We found a clear shift from quantitative, time‐serving, input‐models to outcomes‐focused models which emphasise the identification of learning needs, selection of educational activity relevant to practice and reflection on practice improvement. Across a range of professions, recently updated CPD regulations no longer require registrants to accumulate CPD hours/points/credits.\ud Conclusion\ud \ud Outcomes‐based models support registrants’ engagement in relevant, meaningful CPD which holds greater potential to positively impact on practice and strengthen patient safety. In funding this study, the UK General Dental Council exemplifies its commitment to reviewing its CPD requirments.

The authors highlight the importance of exploring the role that nurses and other healthcare professionals play in supporting medical students and doctors to develop their emotional competence.

ObjectiveWhile previous studies have begun to explore newly graduated junior doctors’ preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders’ conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors’ preparedness (or unpreparedness) using innovative qualitative methods.DesignA multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries.SettingFour UK settings: England, Northern Ireland, Scotland and Wales.ParticipantsEight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period.ResultsWe identified 2186 narratives across all participants (506 classified as ‘prepared’, 663 as ‘unprepared’, 951 as ‘general’). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors’ preparedness for the General Medical Council’s (GMC)outcomes for graduates. Stakeholders’ conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders’ perceptions of medical graduates’ preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not).ConclusionOur narrative findings highlight the complexities and nuances surrounding new medical graduates’ preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates’ preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.

Aim To investigate dental foundation (DF) educational supervisors' (ES) expectations of the level of clinical ability expected of a foundation dentist (FD) on entry into foundation training. Methods Following ethical approval, a pre-piloted online questionnaire was circulated to ESs across England and Northern Ireland (n = 959), requiring respondents to rate their expectations of their FDs' ability at the beginning of the training year, in relation to undertaking 104 clinical skills. A five-point scale and descriptors were provided, ranging from 'on own with confidence' to 'unable to undertake'. Respondents were invited to comment further. Data were imported into IBM SPSS (v20) and descriptive analysis was undertaken. Expectations were assigned values and a mean, 'skill rank score' was generated for each skill. A ranking score closer to five indicated high expectation; closer to one indicated low expectation. Results A total of 510 (53%) questionnaires were completed. The study highlighted a range of expectations which were used to identify 'upper-level' (core) skills expected of a new FD. The majority of expectations were in line with UG curriculum guidance; however, certain skills were identified as having overly high expectations and these may need to be modified to align with current guidance. Conclusions Understanding the expectations ESs have of a new FD is useful for both dental schools and those involved in DF training. Findings add to the existing evidence base and should generate discussion for those within the education continuum to enhance the successful development of the FD.

Introduction\ud \ud Policy changes regarding the role of Dental Hygienist-Therapists (DTs) have been implemented in recent years with a view to promoting delivery of oral health-care through a more preventive-focused, team work approach.\ud \ud Aims\ud \ud To explore i) treatments led by dentists and DTs, and ii) patients' satisfaction with the care they received.\ud \ud Materials and methods\ud \ud Six case-studies of general dental practices in Wales, UK: three with, and three without a DT. For each participant, a patient-satisfaction questionnaire and a staff-member-completed appointment record form were completed. We sought to recruit 150 patients seeing a dentist and 100 patients seeing a DT, per case-study practice.\ud \ud Results\ud \ud 1,224 patients were recruited in total (314 DT and 910 dentist appointments). Preventive work accounted for nearly half of all treatments. Dentists, in practices with a DT, undertook significantly less preventive and restorative work, and significantly more extractions and advanced treatment (p

Objective Changing patient demographics make it ever more challenging to maintain the quality and safety of care. One approach to addressing this is the development of training for generalist doctors who can take a more holistic approach to care. The purpose of the work we report here is to consider whether a broad-based training programme prepares doctors for a changing health service.\ud \ud Setting and participants We adopted a longitudinal, mixed-methods approach, collecting questionnaire data from trainees on the broad-based training (BBT) programme in England (baseline n=62) and comparator trainees in the same regions (baseline n=90). We held 15 focus groups with BBT trainees and one-to-one telephone interviews with trainees post-BBT (n=21) and their Educational Supervisors (n=9).\ud \ud Results From questionnaire data, compared with comparator groups, BBT trainees were significantly more confident that their training would result in: wider perspectives, understanding specialty complementarity, ability to apply learning across specialties, manage complex patients and provide patient-focused care. Data from interviews and focus groups provided evidence of positive consequences for patient care from BBT trainees’ ability to apply knowledge from other specialties. Specifically, insights from BBT enabled trainees to tailor referrals and consider patients’ psychological as well as physical needs, thus adopting a more holistic approach to care. Unintended consequences were revealed in focus groups where BBT trainees expressed feelings of isolation. However, when we explored this sentiment on questionnaire surveys, we found that at least as many in the comparator groups sometimes felt isolated.\ud \ud Conclusions Practitioners with an understanding of care across specialty boundaries can enhance patient care and reduce risks from poor inter-specialty communication. Internationally, there is growing recognition of the place of generalism in medical practice and the need to take a more person-centred approach. Broad-based approaches to training support the development of generalist doctors, which is well-suited to a changing health service.

Introduction\ud \ud In the United Kingdom, policy and guidance changes regarding the role of Dental Therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive‐focussed, teamwork approach. However, success in the adoption of this model of working has been varied.\ud \ud \ud Aims\ud \ud Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances.\ud \ud \ud Materials and Methods\ud \ud The research comprised two stages. (i) A structured literature search, dual‐coding papers for high‐level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill‐mix operates in the general dental service. (ii) Six case studies of general dental practices (three with a Dental Therapist/three without a Dental Therapist) employing a range of skill‐mix models incorporating semi‐structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature.\ud \ud \ud Results\ud \ud Eighty‐four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider, and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories.\ud \ud \ud Conclusion\ud \ud Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.

Context\ud \ud Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs.\ud \ud \ud Methods\ud \ud We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory.\ud \ud \ud Results\ud \ud Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries.\ud \ud \ud Conclusion\ud \ud The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational constraints) influences this process. Proactively addressing potential contextual barriers may facilitate implementation. These findings could be applied to other types of training designed to shift attitudes amongst HCPs.

Context\ud \ud Medical educators often have prior and primary experience in other academic and clinical disciplines. Individuals seeking successful careers in the education of medical students and doctors must, at some point in their development, make a conscious transition into a new identity as a medical educator. This is a necessary move if individuals are to commit to acquiring and maintaining specialist expertise in medical education. Some achieve this transition successfully, whereas others struggle and may even lose interest and abandon the endeavour. We explored senior educators' experiences of achieving the transition into medical education and their views on what helps and what hinders the process.\ud \ud \ud Methods\ud \ud In 2015 we conducted three focus groups with 15 senior medical educators. All focus group discussions were audiorecorded and transcribed verbatim. We applied transition theory to guide our deductive analysis, using Schlossberg's Four S (4S) framework to code and report participants' self‐reported perceptions of those factors relating to Self, Situation, Support and Strategy that had assisted them to make a successful transition to a fully acknowledged medical educator identity. Through inductive analysis, we then identified 17 explanatory sub‐themes common to all three focus groups.\ud \ud \ud Results\ud \ud Background and circumstances, individual motivation, a sense of control, organisational support, and effective networking and information‐seeking behaviour were factors identified as contributing to successful transition into, and maintenance of, a strong self‐identity as a medical educator.\ud \ud \ud Conclusions\ud \ud The experiences of established medical educators and, in particular, an exploration of the factors that have facilitated their transition to an acknowledged self‐identity as a medical educator could assist in supporting new educators to cope with the changes involved in developing as a medical educator

ObjectivesTo examine how burnout across medical student to junior doctor transition relates to: measures of professional identity, team understanding, anxiety, gender, age and workplace learning (assistantship) alignment to first post.DesignA longitudinal 1-year cohort design. Two groups of final-year medical students: (1) those undertaking end-of-year assistantships aligned in location and specialty with their first post and (2) those undertaking assistantships non-aligned. An online questionnaire included: Professional Identity Scale, Team Understanding Scale, modified Hamilton Anxiety Rating Scale and modified Copenhagen Burnout Inventory. Data were collected on four occasions: (T1) prior to graduation; (T2) 1 month post-transition; (T3) 6 months post-transition and (T4) 10 months post-transition. Questionnaires were analysed individually and using linear mixed-effect models.SettingMedical schools and postgraduate training in one UK country.ParticipantsAll aligned assistantship (n=182) and non-aligned assistantship students (n=319) were contacted; n=281 (56%) responded: 68% (n=183) females, 73% (n=206) 22–30 years, 46% aligned (n=129). Completion rates: aligned 72% (93/129) and non-aligned 64% (98/152).ResultsAnalyses of individual scales revealed that self-reported anxiety, professional identity and patient-related burnout were stable, while team understanding, personal and work-related burnout increased, all irrespective of alignment. Three linear mixed-effect models (personal, patient-related and work-related burnout as outcome measures; age and gender as confounding variables) found that males self-reported significantly lower personal, but higher patient-related burnout, than females. Age and team understanding had no effect. Anxiety was significantly positively related and professional identity was significantly negatively related to burnout. Participants experiencing non-aligned assistantships reported higher personal and work-related burnout over time.ConclusionsImplications for practice include medical schools’ consideration of an end-of-year workplace alignment with first-post before graduation or an extended shadowing period immediately postgraduation. How best to support undergraduate students’ early professional identity development should be examined. Support systems should be in place across the transition for individuals with a predisposition for anxiety.

Transferring and mobilising knowledge from research into healthcare delivery is an enduring international challenge. Our aim was to explore how knowledge sources were used to advance healthcare practice. We analysed data from 28 interviews with senior representatives from Health Boards and an Academic Health Science Partnership in Wales. Although all recognised the need to keep up to date with research evidence, knowledge mobilisation activities were largely individually-driven, rather than embedded within organisations. Lack of time, limited management support, and coordination-failure between different professions (within/outside the organisation) hindered knowledge mobilisation. Enablers included a supportive infrastructure, good leadership and management at all levels. Alongside embedding knowledge mobilisation as an intrinsic part of everyone’s role, enhancing the knowledge broker role of identified individuals was recommended to provide visibility and structure.

Interviewing is a method that belongs to the qualitative research family and in medical education research, it is one of the most common Methods of gathering qualitative data.[1] My focus in this p...

Objectives In a bid to promote high-quality postgraduate education and training and support the General Medical Council’s (GMC) implementation plan for trainer recognition, the Wales Deanery developed the Educational Supervision Agreement (EdSA). This is a three-way agreement between Educational Supervisors, Local Education Providers and the Wales Deanery which clarifies roles, responsibilities and expectations for all. This paper reports on the formative evaluation of the EdSA after 1 year. Design Evaluation of pan-Wales EdSA roll-out (2013–2015) employed a mixed-methods approach: questionnaires (n=191), interviews (n=11) with educational supervisors and discussion with key stakeholders (GMC, All-Wales Trainer Recognition Group, Clinical Directors). Numerical data were analysed in SPSS V.20; open comments underwent thematic content analysis. Participants The study involved Educational Supervisors working in different specialties across Wales, UK. Results At the point of data collection, survey respondents represented 14% of signed agreements. Respondents believed the Agreement professionalises the Educational Supervisor role (85%, n=159 agreed), increases the accountability of Educational Supervisors (87%; n=160) and health boards (72%, n=131), provides leverage to negotiate supporting professional activities’ (SPA) time (76%, n=142) and continuing professional development (CPD) activities (71%, n=131). Factor analysis identified three principal factors: professionalisation of the educational supervisor role, supporting practice through training and feedback and implementation of the Agreement. Conclusions Our evidence suggests that respondents believed the Agreement would professionalise and support their Educational Supervisor role. Respondents showed enthusiasm for the Agreement and its role in maintaining high standards of training.