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J Am Dent Assoc, Vol 135, No 7, 921-924.
© 2004 American Dental Association |
OBSERVATIONS |
The good, the bad and the ugly
Some new dentists feel that they have all the dental education they need upon graduation from dental school, and many do not attend continuing education, or CE, courses for the first few years after graduation. Others have been informed by the faculty of their schools that they are only minimally prepared when they graduate from dental school, and they seek formal CE soon after completing school. Fortunately, most practitioners soon recognize the necessity of obtaining CE, but many questions remain about how best to satisfy this important part of their professional lives.
How often should a dentist seek CE, and what type of CE should he or she obtain? That question is a personal one, since every dentist learns at a different pace and has different subject-matter strengths and weaknesses. Most states now have CE requirements. I have been involved in helping set the level of CE for some states. An average requirement of all states that stipulate the completion of CE is about 35 hours every two years.1 Some dentists earn far more credit than that, and others need to be stimulated to complete even that amount.
As a CE educator for most of my career, I have taught and participated in more than 40,000 hours of almost every imaginable form of CE. I will share my observations about the value and adequacy of the several forms of CE and make suggestions to readers about obtaining the best type of CE for their individual needs.
Hands-on treatment of live patients.
When treating live patients under the supervision of competent, experienced instructors, CE participants obtain the most significant CE experience. They can implement their learning in practice as soon as they return to their own offices. Live hands-on courses are available at some dental schools, in private CE organizations, in clinical study clubs, in clinics organized by manufacturers and at other sites that have dental operatories.
This type of course has significant limitations, including the facts that participants must bring supplies and equipment to the course; participants must be licensed to practice in the course location; suitable patients must be found and their transportation to the course site paid for; and the cost of tuition is high because of the necessarily small course size and the need for more instructors than are required to teach other types of courses. Nevertheless, when hands-on live-patient courses can be found, they usually are highly educational, and participants can apply the information in their practices immediately.
Hands-on activity in simulated clinical situations.
Accomplishing simulated treatment on models provides high-level education that is second only to learning through treatment of live patients. This type of CE has most of the advantages and does not have some of the disadvantages of the previous category. Participants may take the course wherever a simulated clinical environment is available, without regard to licensure or patient availability. The well-known negative characteristics of patient treatment are not present, including "no-shows," patients’ potential low pain threshold, time schedules and personality problems. Additionally, participants can make mistakes on models without incurring the problems associated with making the same mistakes on live patients.
Because of the high educational value of these types of courses and the relative ease of providing them, I always have had them in my educational repertoire. I feel that CE educators teaching clinical subjects need to observe course participants actually working to know if the techniques they are teaching are within the ability range of typical practitioners. This observation allows the educator to provide better subsequent lecture and seminar courses.
Live video: digital video disc.
In recent months, excellent digital video disc, or DVD, education in dentistry has become available. I am amazed at the quality and usability of some of the DVD presentations. After the learner views a presentation at his or her own pace, he or she may select and review various chapters of the program as desired. Within seconds, the specific chapters of the presentation can be brought up and observed. While learning from a DVD presentation, the learner can pause it for private contemplation. And a DVD CE program easily can be used in group meetings such as study clubs or other dental meetings. DVD has brought a whole new form of dental CE that is far beyond the level available with video home system, or VHS, videotapes.
Video presentations, either DVD or VHS, offer two challenges. The major one is the date of production of the presentation and the producer’s responsibility to either update the presentation or remove it from the market. I have made hundreds of VHS and DVD presentations. Some of the subjects go out of date within six months, and a few classics can remain in use for a few years. Most producers of dental CE video presentations do not oversee the updating of the content, and sales groups are pleased to keep selling them as long as the unknowing dental marketplace appears to be interested. It is very expensive to make a high-quality professional-level DVD presentation, and those making them must make a profit to stay in business; therefore, many companies have failed. Most VHS/DVD education companies have limited inventory, and many CE companies keep selling outdated programs. Practitioners using VHS/DVD presentations should buy from proven providers.
Another major negative factor in VHS/DVD presentations is that some producers do not produce live clinical material, but merely place previously produced slide material onto video. Although this form of production is acceptable in some situations, it generally is of less educational value than watching the actual procedure being accomplished by the moving hands of the teacher.
I strongly suggest obtaining video education provided by experienced, known educators from reliable educational organizations that have a history of quality productions. DVDs are a highly useful form of CE.
Live video: VHS tapes.
This format of video CE is less desirable than DVD for one primary reason: although the same information can be placed on a VHS tape as on a DVD, the viewer must find a subject of interest on the tape manually. This usually requires several minutes of playing the tape forward and backward while searching for the specific subject. However, VHS tapes have provided a significant portion of CE available to dentists, and I predict they will continue to do so for several years, until DVDs or other media replace them fully.
Seminars.
In describing a seminar, I refer to a situation in which there is interaction between the presenter and the audience, and among the members of the audience. The question-and-answer periods, group discussions, breakout groups and other similar interactive situations available in a seminar setting are beneficial. Seminars provide useful information and usually make participants feel that they are an important part of the educational experience. However, they are far less effective than the previously discussed forms of CE, because the participant must develop the necessary digital skills without supervision. Of high importance in seminars is the presence of an excellent facilitator. If such a person is not available to conduct the seminar, the experience can be time-consuming, ineffective and frustrating for participants.
Lectures.
In lectures, the presenter makes a presentation—oral, visual or both—and the audience merely observes it. In my opinion, the value of lectures, of which I have done thousands, is minimal. Lectures require participants to expend some, but precious little, mental activity themselves. However, excellent lecturers can enhance the influence of their lectures by using a form of the Socratic teaching method, asking questions that the participant will answer to himself or herself, thereby stimulating individual mental activity. Because of the nature of many dental CE meetings and the large groups that attend them, lectures unfortunately dominate the dental CE marketplace.
Dental journals.
Every month, numerous dental journals and commercial dental magazines make their way into dental offices. Some arrive as requested by subscription, and some come unsolicited. Many journals contain information of high potential value to practitioners. However, after many years of serving as an editor or consultant to numerous journals, and writing hundreds of articles myself, I question the CE value of many of the dental publications currently available and the manner in which most practicing dentists use them. Practitioners are overwhelmed with the volume and the repetition of the material in the literature. In any given month, a practitioner will see many articles on the same subject, often written by the same author in more than one journal. Furthermore, too many of the articles are on subjects of minimal or no interest or value to practitioners. A visit to a typical dental office usually reveals a pile of dental "literature" at least a foot high that may or may not ever be read.
I suggest that practitioners select a few trustworthy dental publications and eliminate their names from the mailing lists of publications that are of little interest to them or are too commercial in nature. I also suggest that dentists scan journals, identify and remove pertinent articles of interest from them and file the articles by subject. They then can find the information in the files at a later time and retrieve it for implementation in practice. Files should be purged at least once every five years to remove out-of-date material.
Journals are useful only if dentists organize the articles from them into areas of their own interest and commit themselves to conscientious review of the material as the topics emerge in practice.
Internet.
The constantly evolving CE format of Internet-based education undoubtedly will become a major source of dental CE. I have placed several pieces of CE on the Internet in the past several years. The influence of Internet-based dental CE has been questionable to date, because of several factors: some practitioners do not use the Internet; the difficulty of retrieving information can be formidable to a dentist inexperienced in using the Internet; the images are often second-class at best; in many cases, the information is placed on the Internet and allowed to remain there without modification until it is totally out of date; and the inanimate nature of the Internet does not satisfy some dentists. In recent years, several well-meaning, well-financed Internet-based dental CE programs have come and gone, because of lack of interest and use. I suggest that the potential of this source of CE is great, but there still is a maturation process that is necessary for success.
Audiotapes.
This is a popular method of dental CE, and most large dental meetings contract with commercial groups to record the courses that are delivered in live CE meetings. Because I have been recorded hundreds of times in dental meetings, my observations on this CE format may be of help. Visual educational tools accompany almost all dental lectures or seminars in dental meetings. As a result, the practitioner who listens to a dental course on audiotape receives only the oral part of the program. (Granted, he or she does benefit from at least some portion of the program.) I have often thought, as I have tried to project and discuss a difficult subject in a dental conference or lecture, that the listener to the audiotape of my presentation has little chance of learning the concept about which I am speaking. Audiotapes made without visual accompaniment, for the sole purpose of being sold as audiotapes, can be useful. But, as with video presentations, they soon can become out of date.
Trial and error.
Although some will not like to admit it, much of the learning of most practitioners comes from trial and error in subjects about which they initially know only a small amount. Most practitioners will admit that practice is called "practice" because the dentist is learning by continued repetition of clinical tasks. I will admit candidly that my expertise in implant surgery, complex fixed prosthodontics, third-molar extraction, apicoectomies, provision of complete dentures and many other difficult subjects has come from careful, thoughtful dental practice and repetition. Accomplishing a few clinical procedures in any given aspect of dentistry is only the beginning of learning. Long-term repetition is necessary for clinical competence.
TYPES OF CE
TOP
TYPES OF CE
SUMMARY
REFERENCES
The following list of CE options is in decreasing order of adequacy related to my own observations of thousands of dentists as they complete CE courses. I strongly suggest obtaining video education provided by experienced, known educators from reliable educational organizations that have a history of quality productions.
The constantly evolving format of Internet-based education undoubtedly will become a major source of dental continuing education.
SUMMARY
TOP
TYPES OF CE
SUMMARY
REFERENCES
Dental CE is mandatory for ongoing competency in dental practice. There are numerous methods of obtaining CE, some of which are highly successful and others that are of minimal value. In this article, I have described and prioritized the various methods of obtaining CE according to their effectiveness as I perceive it. CE in dentistry can be enjoyable, will allow dentists to serve their patients at a higher level of competency and will keep practitioners mentally stimulated as they learn new concepts and techniques.
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FOOTNOTES |
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REFERENCES |
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TOPTYPES OF CESUMMARYREFERENCES |
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