Select Committee on Education and Employment Appendices to the Minutes of Evidence


APPENDIX 21

Memorandum from the British Dental Association (HE 128)

EXECUTIVE SUMMARY

Aspects of student experience which affect retention. For example, financial considerations, the amount of paid work undertaken by students during term-time, the nature of the curriculum and qualification structures

  The British Dental Association (BDA) is concerned that the latest BDA survey of 13 UK dental schools highlights overwhelming evidence that on completion of their degrees dental students will have an average debt of £10,700.

  The BDA believes that student grants should be re-introduced.

  The BDA believes that dentistry should be representative of society as a whole and that if the risk of high debts were reduced, it would open up the profession to a wider strata of society.

Quality of teaching as it relates to student retention. For example, the appropriate level of academic support for students, the quality of teaching, how the relationship between teaching and research affects student retention, factors which affect the recruitment of highly qualified teachers in higher education.

   Clinical academic teaching is not seen as an attractive profession, because of the time constraints on clinical academics to do teaching (and associated preparation), research and an NHS commitment of at least six session per week.

  The BDA want immediate implementation of the 12th point on the clinical lecturers pay scale, which was agreed in 1980.

  The BDA believe that issues, which were identified in the Sir Rex Richards Report, the Clinical Academic Section of the Independent Review into Higher Education Pay & Conditions and the Dental Schools & Dental Hospitals Priorities Group must be addressed.

Aspects of the current debate on higher education funding which are relevant to student retention

  The BDA believes that it is necessary for additional educational resources to be found to support dental undergraduate curriculum requirements of the GDC.

  The BDA is concerned over the lack of transparency with regard to the use of SIFT (Service Increment for Teaching) funds going to host NHS Trusts.

  The BDA believe that the NHS Executive should review arrangements for Dental Hospital access to capital for improvement programmes.

  We offer the following detailed comments to the three specific aspects.

Aspects of student experience which affect retention. For example, financial considerations, the amount of paid work undertaken by students during term-time, the nature of the curriculum and qualification structures

  1. There are two main points that the Committee should bear in mind with regard to the study of dentistry. Firstly, there is the duration of the course itself, which lasts five years instead of the "standard" degree course in England of three years. These additional study years may therefore result in dental students accumulating a higher level of debt overall. Secondly, undergraduates studying for a dental degree are required to undertake their studies on a full-time 9-5 basis, with additional evening study. Additionally, the course has shorter vacations with up to a 45-week academic year, compared to 30 weeks for other disciplines. Much of their time is spent treating real patients under supervision, which is inevitably stressful.

  2. For the reasons outlined above, the intensity of a degree in dentistry has ramifications as far as self-support is concerned, with less opportunity for dental students to secure part-time or vacation work and thus contribute to their own living costs. The latest BDA survey of thirteen UK dental schools on dental student debt shows that the average dental student debt amounts to £10,700-a 10.3 per cent increase on the previous year. Over five years, dental students spend an estimated £27,900 on average on equipment, transport, rent, overseas study and entertainment. Dental students also have to pay rent for the entire 12 months of the year because of the long terms. However, it appears from the evidence collected that the risk of high levels of debt on completion of the course does not deter either applications or continuation on the course.

  3. The majority of dental schools are oversubscribed with applications and use the high scores attained in A-level, Scottish Highers or equivalent examinations as a screening process. All dental schools interview prospective students, with the aim of filtering out unsuitable candidates. For example those who have been encouraged by their schools/parents to apply for the course, rather than it being an individual career choice. The BDA believes that there is a need to encourage applications from those from disadvantaged backgrounds and from mature students. It may be necessary for dental schools to work with local communities and secondary schools to achieve this.

  4. The dental degree is a demanding one and students are required to spend at least two years in the study of biological and clinical medical and dental sciences, as well as mastering a large number of manual dexterity skills. First year dental students quickly realise if they have made the correct career choice, if the academic work is beyond them and if they can attain the necessary level of manual dexterity. It is in years one and two that the majority of withdrawals from the course occur. We have undertaken a limited survey of dental schools and have found that main reasons are: exam failure, realisation that dentistry is not for them and consequent transfer to another course and personal health/family problems. In later years of the course, drop out may be due to poor clinical skills and exam failure. However, there is evidence to show that once a student has completed the first two years of the dental degree course, the drop out rate is negligible.

  5. The General Dental Council are currently reviewing the undergraduate dental curriculum-The First Five Years. We have responded to their request for comments and we believe that it is important to emphasise that the undergraduate curriculum should provide a foundation for lifelong learning and continuing professional development, which with the introduction of specialist lists would now include training in specialist practice.

Quality of teaching as it relates to student retention. For example, the appropriate level of academic support for students, the quality of teaching, how the relationship between teaching and research affects student retention, factors which affect the recruitment of highly qualified teachers in higher education

  6. The clinical academic teaching role differs from that of the traditional university lecturer. The majority of dental academics spend at least 60 per cent of the working week in clinical chair side teaching that is, working sessions in the National Health Service. Whilst the majority of clinical academics are employees of universities, they also hold honorary NHS contracts with associated NHS hospital Trusts. A limited number of clinical academic posts in dentistry are NHS-funded. The result is that clinical academic staff find themselves subject to career progression pressures from both sectors, and serve two masters. As mentioned above the clinical academic year is 45 weeks, so as a consequence there are considerable time constraints for clinical academic staff to do research, career development and the preparation of teaching material. Both the Sir Rex Richards Report and the Independent Review into Higher Education Pay and Conditions "Bett Committee" highlighted these pressures on clinical academics and acknowledged the demands of teaching, patient care and research. A report to the Department of Health by the Dental Schools and Dental Hospitals Priorities Group was published in January 2000. The Group made nine recommendations, some of which related to difficulties in recruiting staff at all levels and resource issues, which we will raise under section 3. Despite these pressures on clinical academic staff, dentistry performed extremely well in the recently completed Teaching Quality Assessment Exercise undertaken by the Higher Education Funding Councils Quality Assurance Agency. We were heartened to read in the Department of Health paper Modernising NHS Dentistry-Implementing the NHS Plan the statement in paragraph 4.2 "Dentists who qualify in this country have rigorous training and can be proud of their skills and professional standards". The BDA believe that it is high-time the issues identified by Richards and Bett and the Dental Schools and Dental Hospitals Priorities Group were addressed, since continued reliance on the "goodwill" of staff and the chronic under-funding of dental hospitals is no longer sustainable.

  7. The award to the basic pay scales recommended annually by the Doctors' and Dentists' Review Body to NHS staff is automatically translated to clinical academic staff each year. However, this has only been the case since 1996, when the Department of Education and Employment wrote to HEFCE stating that it was a condition of grant that this must take place. The threat to parity contributed to recruitment and retention problems within clinical academic departments. It is crucial that this automatic translation of basic pay scales continues each year. The BDA believe that if this parity were lost, there would be an immediate and steady loss of clinical academic staff to other fields of practice.

  8. When the present arrangements were negotiated in early 1980, salary "latch points" were agreed for use in the process of translation. It was recognised that the clinical lecturer scale should have a further (12th) point. Although agreed in principle that it should be paid as soon as resources were available, it has never been implemented. There are increasing numbers of part-time teachers in dentistry and it is these groups who are badly affected.

  9. Opportunities for promotion have become more restricted, as financial restraints reduce the number of promotions that are available and clinical staff are frequently competing with staff from other faculties where teaching commitments are substantially less and research opportunities greater. Recently, the situation has been determined by the Research Assessment Exercises (RAE). The pressures on time for research are particularly high in dentistry, because the nature of undergraduate dental education demands a high staff: student ratios. Research now carries far greater weight than teaching in terms of funding from the HEFCs, and as the RAE requires research quality to be increased, any consequent reduction of staff by it, results in greater pressure on clinical academics. It should also be recognised that clinical academic staff are under pressure to increase their involvement with Continuing Education at the same time as delivering undergraduate and taught postgraduate education, secondary and tertiary care and research.

Aspects of the current debate on higher education funding which are relevant to student retention

  10. Significant funding for dental education within the dental schools is provided by the NHS through the SIFT mechanism (Service Increment For Teaching) to the host NHS Trust. The BDA is concerned about the wide variety of transparency of the use of this funding as identified in the report of the Dental Schools and Dental Hospitals Priorities Group.

  11. The BDA shares with the deans of dental schools their concerns about being unable to identify money specifically allocated to dentistry for capital improvement programmes. Capital expenditure in dental hospitals has declined by nearly 50 per cent since 1994-95. If this trend were to continue and there continues to be a decline in the standard of accommodation and facilities, many students may choose either not to apply to dental school or switch courses/departments, which may have better infrastructures. The BDA believe that the NHS Executive should review arrangements for Dental Hospital access to capital.

  12. There needs to be a recognition of the necessity for additional educational resources to be found to support undergraduate curriculum requirements of the GDC and also its initiatives in reaccreditation, recertification and life-long learning.

  13. The BDA would encourage the Education and Employment Committee to review the contents of the Sir Rex Richards Report, the Clinical Academic section of the Independent Review into Higher Education Pay and Conditions and the report by the Dental Schools and Dental Hospitals Priorities Group.

  14. The BDA would be happy to expand on any of the issues we have raised and to provide oral evidence to the committee.

British Dental Association

January 2001


 
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