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I have just read the latest announcement from the Royal College of Surgeons of Edinburgh that they will drop the case presentation section.1
In which universe would it be a good idea to stop requiring orthodontic trainees to fully reflect on each and every step they have taken to treat a significant malocclusion to as near perfection as they can possibly manage?
Presenting their own treated cases means that they will have spent tens of hours studying the initial records of between five and ten different malocclusions from which they select their chosen exam cases. They have analysed all of the cephalograms and other radiographs, and decided what each and every measurement means, and how it might effect the approach to treatment. They have hopefully done a space analysis and understood the exact requirements of the case, and worked how to meet these detailed space requirements. They have considered the treatment approach selected, and also decided why other possible alternatives were rejected. And they can now fully justify each and every decision reached.
In addition they will have analysed each set of photographs taken, on a visit-by-visit basis, over 2 or more years, and determined whether things have improved at each visit and, if so, why. If the situation has deteriorated, they will also have an explanation for this temporary setback. This allows them to learn so much about the actual mechanics of orthodontics. As trainee orthodontists, they will probably learn more to enhance their orthodontic skills from this small group of cases, than from any other cases they ever treat throughout their practising lives.
During professional medical and dental training, so much emphasis is now put on the value of ‘reflection’. With the removal of the requirement for presentation of trainees' own clinical cases, this invaluable opportunity for reflection is stolen from our postgraduates.
Do we just want to produce a bunch of theoretical orthodontists who can just ‘talk the talk’. Anybody can do this. Theory can be learned from well written textbooks. Surely in the 21st century, when we are so mired in the blame culture, we need clinicians who can actually ‘walk the walk’. We need them to prove they can not only produce the goods, but that they actually understand each and every intricacy of the treatment provided.
I would urge every trainee to avoid taking any examination that fails to fully assess their real clinical abilities and understanding.
Next thing, they'll be opening up the membership examination to any Tom, Dick or Harry who wants to take it!