Article
Baby and the bathwater
The recent decision by the Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh is a classic example of throwing the baby out with the bathwater.
Already in 1976, with the old DOrth still in place, a number of my colleagues had realized the value of presenting full records of personally treated cases to each other for discussion and established a Treatment Study Group within the BSSO to promote this idea.1 The Group's subsequent table demonstrations at the British Orthodontic Conference, and its members' publications over the next 5 years, were instrumental in convincing our colleagues of the need to incorporate this component into a future UK specialist examination.2,3,4 When in 1994, Britain was forced to comply with the European Directives on Specialist Training in Dentistry, the ‘accord’ established between the Colleges, the Universities and the GDC, negotiated by Dame Margaret Seward, resulted in an agreed MOrthRCS (Edin and Eng)/MDO RCPS qualification being brought into being. Since then, our UK specialist qualifications, overseen by the Specialist Advisory Committee (SAC) in Orthodontics and meeting European standards,5 have gained international respect.
Given that ‘acceptability’ is an area of on-going debate, Professor Taylor's reasons for the recent change in the MOrthRCS Edin Part B are really three-fold.
Those concerning validity relate to how much assistance a candidate may have had from his or her supervisors in the management of their submitted cases. In my experience, this soon becomes apparent during discussion with the candidates, but now without these records, this will in future remain completely unknown to the Edinburgh examiners. Such concerns might be well founded if all that was being assessed in the case presentation section was the standard of treatment achieved, when what should be assessed is the candidate's overall understanding and clinical competence.
As to concerns about ‘educational impact’, I cannot accept Professor Taylor's view that ‘time spent perfecting the presentation of a small select group of cases’ has a negative effect. Rather, for only a small expenditure of time, it has very positive effect by emphasizing the importance of the collection, maintenance and analysis of adequate clinical records.
On the matter of reliability there is some justification for Professor Taylor's concerns, but I would argue, as others have implied, that the benefit of including case presentations in the MOrth is gained in the months before the examination. As Professor Ruth Beard observes in her seminal work, Teaching and Learning in Higher Education:6
‘A good system of assessment, after all, should encourage a student to work at precisely what is important in a course…’
This is exactly what the case presentation component achieves by encouraging analysis and reflection, leading to self-criticism and greater understanding. Furthermore, knowing that in due course they will have to describe and comment on what was undertaken and achieved, candidates soon realize the value of discussion with colleagues, and will come to appreciate that, in many cases, there were alternative treatment options to be considered.
However, given inter-examiner variability and variation in the complexity of cases selected by individual candidates, in my view, it is inappropriate to assign a score to this part of the examination. This then takes care of Professor Taylor's worries about feasibility.
What I find so sad is that past and recent changes introduced unilaterally in both IMOrth and now the MOrthRCS Edin examinations risk dividing our specialty and lowering the international standing of our UK qualification. In my opinion, these changes have more to do with rivalry between vested interest groups than the wish to improve UK specialty training. Could I therefore urge the BOS, which since 1994 has represented the whole of the orthodontic specialty and has within its charitable objects the requirement ‘to maintain and improve professional standards in orthodontics…’, to now exert its considerable influence to ensure that these past and present differences of opinion are now resolved within the SAC, as was originally intended.