This position paper has been peer-reviewed by the participants of Group C: Continuing Professional Development (CPD) in Implant Dentistry

Transcription

1 This position paper has been peer-reviewed by the participants of Group C: Continuing Professional Development (CPD) in Implant Dentistry Group C consisted of the following: Chair Professor Margareta Hultin Chair Professor Bjorn Klinge Reviewer Professor Andreas Stavropoulos Reviewer Professor Daniele Botticelli Reviewer Professor Cemal Ucer Professor Jonathan Cowpe Mr. David De Keyser Dr. Jørn Fridrich-Aas Dr. Mark Ide Dr. Mia Jensen Dr. Argyro Kavadella Professor Antonis Konstantinidis Dr. Anastassia Kossioni Ms. Sue Odendaal Professor Bjarni Pjetursson Dr. Charlotte Stilwell Ms. Verena Vermeulen Professor Selcuk Yilmaz

2 European Journal of Dental Education ISSN Continuing professional development in implant dentistry in Europe T. C. Ucer 1, D. Botticelli 2, A. Stavropoulos 3 and J. G. Cowpe 4 1 Oaklands Hospital, Salford, UK, 2 ARDEC, Ariminum Odontologica, Rimini, Italy, 3 Faculty of Odontology, Malm o University, Malm o, Sweden, 4 School of Postgraduate Medical & Dental Education (Wales Deanery), Cardiff University, Cardiff, UK Keywords continuing professional development; implant dentistry; postgraduate dental education. Correspondence Cemal Ucer Dental Implantology University of Salford Salford, UK Tel: Fax: ucer@btconnect.com Accepted: 11 December 2013 doi: /eje Abstract Introduction: Training for dental practitioners in implant dentistry ranges from 1- or 2-day short Continuing Professional Development (CPD) courses to certificate/diploma programmes run by universities. In general, the teaching of implant dentistry in Europe lacks structure and standardisation. This paper aims to: (i) identify the current trends in CPD in implant dentistry in Europe; (ii) identify potential and limitations with regards to the design and implementation of CPD activities in implant dentistry; (iii) provide recommendations on the future structure and development of CPD activities in implant dentistry. Methods: A search of the literature was undertaken in PubMed for manuscripts published in English after 2000 reporting on CPD in dentistry and in implant dentistry in particular. In addition, an electronic survey was conducted, investigating the attitudes towards CPD among a wide group of stakeholders in implant dentistry education. Conclusions: There is a wide diversity of educational pathways towards achieving competences in implant dentistry through CPD. At present, there is a need for improving the CPD structures in implant dentistry, strengthening the quality assurance and encouraging standardisation and transparency of the learning outcomes. Development of a structured CPD system with clearly defined educational objectives mapped against specific levels of competence is recommended. Introduction The new dental graduate as well as the established dentist need to develop a wider knowledge and skills base than what is provided in their undergraduate training alone (1 3). Continuing professional development (CPD) has been defined by the European commission as a career-long process required by dentists to maintain, update, and broaden their attitudes, knowledge, and skills in a way that will bring the greatest benefit to their patients (4). CPD is now recognized as an essential professional activity for dentists to maintain their clinical skills and to keep up to date with new developments in scientific knowledge and technology and to integrate these techniques into clinical practice safely (5 12). This is particularly important in implant dentistry, as techniques and materials develop at a fast rate due to rapid advances in biomedical technology. To have any real impact on clinical practice, CPD activity should be systematically structured with reference to the specific learning needs of individual clinicians and not selected arbitrarily according to ease of access or convenience. In this respect, the personal development plan (PDP) can be used as a self-appraisal tool as it encourages reflection on clinical skills and helps to enhance the impact of CPD on clinical practice by identifying strengths and weaknesses in one s knowledge or skills (6). Recently, the DentCPD project investigated the CPD requirements for dentists in Europe (9 11). This demonstrated that only about half of the European countries had a compulsory CPD system that included mandatory core topics. The harmonisation of CPD across Europe to support the safe management of patients and promote mobility of practitioners was recommended (11). Furthermore, DentCPD made specific 34 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

3 Ucer et al. CPD in implant dentistry in Europe recommendations on the structure, pedagogical elements, quality approval of the providers and educators as well as the assessment and quality assurance of CPD courses. A pan- European system of credit points to recognize CPD was also suggested. Aims and objectives This position paper aims to: a) Identify the current trends within CPD in implant dentistry by searching the existing literature and also based on the results of a specifically conducted survey of stakeholders and key opinion leaders involved in implant education in Europe. b) Produce recommendations with regards to design and implementation of CPD activities in implant dentistry. In particular, this position paper aims to respond to the following questions: 1 Who would benefit from CPD in implant dentistry? 2 What are the aims and objectives of CPD in implant dentistry? 3 What should constitute the core topics for CPD in implant dentistry? 4 What should be the structure and format of CPD in implant dentistry? 5 Should the learning outcomes be assessed? 6 Should CPD in implant dentistry have a workplace based clinical mentoring component? 7 Should CPD in implant dentistry be voluntary or compulsory? 8 Who should provide CPD in implant dentistry? 9 What should be the quality assurance criteria for course providers? 10 Who should recognise CPD in implant dentistry in Europe? Should there be a transferrable credit system? 11 Who should be eligible to be a CPD educator in implant dentistry? 12 Who should decide what CPD activity is relevant? 13 From a pedagogical perspective, should there be guidelines/limitations about the environment in which the CPD activity can take place? 14 Could the use of implant logbooks or national register of implants benefit CPD? 15 Could patient reported outcomes measures (PROMS) be an integral part of CPD? Methods Literature review A search of the literature was undertaken in PubMed for manuscripts published in English after 2000 reporting on CPD in dentistry as well as in implant dentistry using the following keywords: continuing professional development; implant dentistry; postgraduate dental education. The consensus papers from the 1st ADEE consensus meeting in university education in implant dentistry (13, 14) were also reviewed together with the papers relating to the DentCPD project (11). Furthermore, information on CPD in implant dentistry was sought from professional and scientific associations related to implant dentistry (12, 15 17). Survey of opinion leaders A survey (16) investigated the opinions of a wide group of stakeholders in implant dentistry education including academic teachers, clinicians with or without a specialist background, opinion leaders within scientific and professional dental associations, representatives of providers of CPD (e.g. European institutions, universities, national implant associations, commercial companies) and relevant scientific societies [e.g. Implant Team for Implantology (ITI), European Association of Osseointegration (EAO)]. The results of this survey are reported in detail in a separate paper (16). Definitions used in this paper Structured CPD course: sequential CPD programme leading to predetermined learning outcomes. Unstructured CPD: conferences, meetings, stand-alone (unlinked) CPD lectures or learning activities. Mentoring: direct or indirect clinical supervision of the learner by an experienced clinician who provides support and formative assessment. Results Literature review The DentCPD project was one of the most comprehensive studies found on the subject of general CPD in Europe (11). Very limited citations specific to CPD in implant dentistry were found (13, 14). Therefore, additional information on CPD in implant dentistry was sought from professional and scientific associations related to implant dentistry (12, 15 17). Definition of CPD A CPD activity can be anything from private study time to attending lectures or hands-on training courses (10 12) (Table 1). It can be aspirational or mandatory and may be voluntary or highly regulated. CPD activities are delivered in Europe by a variety of CPD providers. CPD has been classified into two categories (12): verifiable and general (non- TABLE 1. Types of CPD activity Lectures Conferences Short training courses Study clubs/journal clubs Mentoring activity (discussions/supervision by an experienced colleague at the work place) Peer review Self assessment Clinical audit Internet/journal reading Problem based learning activity e-learning Distance learning ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 35

4 CPD in implant dentistry in Europe Ucer et al. verifiable) CPD. Verifiable CPD has concise educational aims and objectives, clear anticipated outcomes, and identified quality control mechanisms. General or non-verifiable CPD includes activities such as independent study of the literature, voluntary multimedia-based learning, product training, and background research. Currently, there is a trend in Europe towards establishing a mandatory CPD system but harmonisation with a transferable credit system is still lacking (11). In some countries CPD is being linked with recertification (or revalidation) but in others it is poorly structured or not regulated at all. Quality assurance and evaluation of CPD activity There appears to be lack of consensus on how the quality of CPD should be assessed. Educational accreditation (by a regulatory body or university) is believed to be one of the commonest methods of quality assurance for CPD. This involves external evaluation or validation to determine whether standards are met or not (11). Direct feedback from the learner also forms part of the quality control process (12). Some course providers award CPD hours, CE points or transferrable credits for courses that meet the predetermined educational standards (12). University dental schools, professional dental associations and scientific associations/organisations have been rated as high quality providers of CPD, whereas private organisations were given the lowest scores (11, 16). Application of knowledge to practice For CPD activity to be beneficial it should lead to application of theory and knowledge to clinical practice. Quality assurance and monitoring of outcome of the CPD activity is therefore imperative (e.g. student feedback and possibly a pre- and postcourse test of knowledge) to determine the effectiveness of CPD education and its impact on practice (11). CPD for specialist dentists The CPD requirements for European dentists have been summarised in the DentCPD project (11). It would appear that where mandatory CPD applies, it is only to general dentistry and there are no compulsory CPD requirements for specialist dentists. Implant dentistry Implant dentistry is practised by dentists with a large spectrum of skills, experience or qualifications ranging from general dental practitioners to multi-disciplinary teams of specialists. The necessary skills and competences which should be targeted by undergraduate and postgraduate education in implant dentistry was the subject of the 1st ADEE workshop on university education in implant dentistry (13, 14). A graduate dentist, before he/she could offer implant treatment independently, must first acquire the necessary clinical skills through attendance at postgraduate courses so that he or she can provide treatment within his/her clinical competence (12, 15). Currently three separate pathways of training opportunities are available to dentists who wish to practise implant dentistry in Europe (13 16): A) Attendance of a university postgraduate degree programme dedicated to implant dentistry. These include various levels of postgraduate diplomas or master s degrees in implant dentistry. B) Completion of established specialist training programmes that lead to recognised specialist status according to national legislation (e.g. Periodontology, Oral Surgery, Prosthodontics etc.). C) Acquiring the necessary skills through CPD courses (Figs 1 and 2). This form of training is generally poorly structured with little regulation or harmonisation across Europe. Accreditation or quality control of CPD education also shows a great variance from one country to another (16). The practice of implant dentistry in Europe Training that is commonly followed by practitioners ranges from 1- or 2-day short courses to fully structured certificate/ diploma programmes (16). Universities, national or international dental organisations or faculties, private individuals and implant manufacturers all provide courses in implant dentistry. The General Dental Council (GDC) the UK s regulatory body of dentists, in recognition of the general inadequacy of undergraduate training in implant dentistry in the UK, has declared: A UK qualified dentist would not be expected to be competent to practise implant dentistry without undertaking structured postgraduate training and assessment of competence, and endorsed the Training Standards in Implant Dentistry (TSID) guidelines published by the Faculty of General Dental Practice (FGDP UK) (12, 15). These guidelines are now an authoritative source of training standards in implant dentistry for postgraduate education providers, and dentists who wish to acquire skills for the practise of implant dentistry. The GDC and the legal courts also refer to TSID, when assessing patient complaints against dentists who, allegedly, practise implant dentistry beyond the limits of their competence (12, 15). In most European countries, CPD in medicine/dentistry is perceived to be regulated by a national organisation. In Italy [Educazione Continua in Medicina (ECM)] regulates the CPD activity which requires a minimum of 150 credits in three yearly cycles (18). CPD course providers can be accredited to deliver courses under the control of the Ministry of Health. For example, ARDEC in Italy has been training dentists in implant dentistry for many years using traditional as well as innovative techniques such as the Visual Training System (VTS) and supervised clinical teaching (17). Credit systems are often linked with the length and structure of the courses. Assessment of learning activity and quality of courses are regulated. Furthermore all courses are included in the ECM s central database. CPD activities undertaken abroad can also be accredited within the ECM system (18). Mentoring Acquisition of clinical skills, under supervision of a mentor at the workplace, is now a requirement for dentists wanting to provide implant treatment in the UK (12, 15). To address this, several organisations in the UK offer mentoring programmes to 36 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

5 Ucer et al. CPD in implant dentistry in Europe CPD: DEVELOPING AND MAINTAINING COMPETENCE IN ID GRADUATE DENTIST Pathway 1 Pathway 2 Postgraduate University Education in ID Full or Part Time Self-Directed CPD in ID Modular One or Multiple Provider(s) Course Provider Core competencies Predetermined Learning Objectives PDP & Learning needs Postgraduate Diploma MSc PhD Recognised Educators/ Tutors/Mentors Training by the industry Complexity based course structure and design Specialist Training Assessment and feedback Clinical attachments at the Workplace Transferable Credits LOGBOOK PDP Clinical Audit Life Long CPD in ID Life Long CPD in ID NATIONAL REGISTER OF IMPLANT & COMPLICATIONS Fig. 1. A framework for CPD in implant dentistry (ID) for the graduate dentist. Pathway 1: formal directed university postgraduate education. Pathway 2: Self-directed postgraduate education in ID. accompany their CPD courses in implant dentistry in line with the UK s TSID guidelines (12, 15, 19, 20). Similar arrangements are available in other European countries but there is little regulation of the mentoring activity. It is not clear what, if any, mentoring requirements exist elsewhere in Europe. Group C position statements Based on the current literature review and the results of the survey of European opinion leaders (16) the following position statements were formulated. 1 Who could benefit from CPD in implant dentistry? Should it be for the whole team? It is desirable that CPD in implant dentistry is available to all members of the dental team engaged in provision of implant dentistry; dentists, dental nurses, hygienists and dental technicians. 2 What are the aims and objectives of CPD in implant dentistry? a) The main objective of CPD in implant dentistry is to enable clinicians to gain and update their clinical skills and knowledge, which should underpin and strengthen ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 37

6 CPD in implant dentistry in Europe Ucer et al. Life Long CPD in ID Course Providers Modular CPD Blended Learning e-learning & Webinars National Body of Accreditation with Transferrable Credit System Pre-determined Learning outcomes Number of hours of learnuing or CPD credits Recognised Educators Mentors formative assessment Logbooks ADEE/National Organisations Training Guidelines and core competencies Feedback LEARNER PROMS Patients Product Training Implant Manufacturers PERSONAL DEVELOPMENT PORTFOLIO (PDP) Self-appraised, & self-directed needs based re lective learning Fig. 2. A framework for lifelong CPD in implant dentistry (ID) for those with core competencies or experience in implant dentistry. [PROMS: patient reported outcome measures]. iii their clinical practice. This should ensure that the treatment they provide is patient-centred and conforms to areas of best practice and current clinical consensus (12). b) CPD should enable clinicians to employ evidence based decision-making processes, by enhancing their skills and keeping their knowledge current. In addition, it should strengthen their ability to critically appraise and evaluate new products and techniques before utilising them in their clinical practice (12, 15). c) CPD should be structured to provide dentists with opportunities to i gain the necessary initial knowledge and skills in relation to straightforward implant dentistry procedures. ii enhance their competence in more advanced procedures; and continue to extend their level of expertise through CPD activities which support the philosophy of lifelong professional learning in implant dentistry. 3 What should constitute the core topics for CPD in implant dentistry? a) Core topics, including precise learning objectives for CPD in implant dentistry should be determined in advance. b) It is recommended that the following topics be included (12, 14, 15): i assessment and treatment planning; ii diagnostic imaging; iii audit and outcome measures and patient feedback; iv restorative and surgical competencies with reference to a complexity of treatment classification (21, 22); v informed consent; vi pathological processes; vii management of complications; viii professionalism and communication skills; ix pharmacology; x management of hard and soft tissue defect; xi monitoring and treatment of peri-implant diseases; xii management of medically compromised patient. 4 What should be the structure and format of CPD in implant dentistry? a) It is perceived that the most common type of CPD in implant dentistry in Europe is provided by commercial implant companies in the form of 1- to 2-day short courses. Study club meetings have been rated as the second common source of CPD in implant dentistry. Structured, modular CPD programmes with clinical 38 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

7 Ucer et al. CPD in implant dentistry in Europe experience under mentor supervision are relatively rare (16). b) It is recommended that CPD in implant dentistry should be well structured and preferably delivered in a modular format with tangible benefits such as a recognised credit system. This would allow the participants some element of learner control over time, place, direction and content of learning, which should be based on their individual needs and career aspirations. c) CPD programmes should be designed to incorporate a blended teaching and learning methodology. This could include the application of interactive webinars and e-learning techniques, as well as face-to-face traditional learning opportunities. Importantly, there should be clinical experiential learning with supervision from an experienced mentor/supervisor. d) It is recommended that CPD in implant dentistry include clear identification of learning objectives and achievable learning outcomes for quality assurance purposes. 5 Should the learning outcomes be assessed? a) It is highly desirable that the learning outcomes of CPD for implant dentistry are assessed formatively as part of each activity (11, 12, 15) b) The assessment could involve different methods (23, 24) to test different aspects of acquisition and application of knowledge as recommended by Dental CPD project (11). c) Regular clinical audit together with reflective learning activity should be used to document the application of CPD to clinical practice 6 Should CPD in implant dentistry have a workplace based clinical mentoring component? Implant dentistry is a highly technical treatment modality that requires the development of clinical operative skills both in the restorative and surgical sciences across all domains of a dentist s competence. Therefore, CPD in implant dentistry should include a workplace based clinical component with an emphasis on a needs-driven reflective learning activity (12, 15). It is recommended that such activities are documented using PDPs with an appropriate input through formative assessment by the mentor. 7 Should CPD in implant dentistry be voluntary or compulsory? a) CPD in implant dentistry should be structured and follow appropriate guidelines to facilitate approval or accreditation by a national or European level organisation. That latter is the ideal but may be an aspiration that will be difficult to achieve at present. b) It is desirable that practitioners involved in provision of implant dentistry demonstrate a substantial commitment to CPD with documentary evidence of ongoing activity (e.g. PDPs and clinical portfolios). c) Although desirable, mandatory CPD in implant dentistry would be difficult to enforce. 8 Who should provide CPD in implant dentistry? a) CPD in implant dentistry can be delivered by a variety of appropriately recognised providers (Table 2). These may include the universities, national or international TABLE 2. Providers of CPD activity Government or private organisations Universities Royal Colleges (UK) Professional dental associations Scientific dental organisations Private individuals/experts Industry/commercial company (product training) scientific implant organisations, private organisations other dental educational stakeholders (e.g. Royal Colleges-UK, Postgraduate Institutions/Organisations) and appropriately trained individual providers (15). b) Currently, the universities and national scientific organisations lead the way as the providers of accredited CPD in implant dentistry in most European countries. However there is a perception that such European CPD programmes/courses lack standardisation or structure (16). c) Ideally, it should be an essential requirement that all providers of CPD in implant dentistry are recognised according to defined guidelines at a national level (e.g. universities, scientific implant associations, the Ministry of Health or equivalent etc.) and/or at a European level. d) It is desirable that industrial partners focus their CPD input to product training which may include basic science and biological issues relevant to clinical practice of implant dentistry. In cases where sponsorship and exclusivity arrangements associated with industrial partners exist, these must be openly and honestly declared. e) Given the low level of demand or resources, in some countries, organising structured CPD courses in implant dentistry could be non-viable. In such cases, courses run by industry may be the only source of CPD activity. It would therefore be desirable that courses such as this, delivered by industrial partners, are accredited at a national or European level. 9 What should be the quality assurance criteria for course providers? Continuing professional development in implant dentistry could be delivered in a modular format. It is recommended that the CPD programme should be available sequentially leading to predetermined learning outcomes consistent with the stated educational aims and objectives. The following criteria for CPD in implant dentistry are recommended (11): a) Predetermined learning objectives of the CPD programme should match the contents and educational needs of learners at each category of clinical competence or complexity of treatment (14, 15, 21, 22) b) Learning outcomes of CPD should clearly be mapped against the competencies in implant dentistry identified by ADEE (14, 15). c) CPD courses should utilise a complexity classification (21, 22), which should in turn provide guidance in support of clinicians working within the limits of the clinical competence. ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 39

8 CPD in implant dentistry in Europe Ucer et al. d) The CPD Educators and providers should fulfil the eligibility criteria set nationally. e) There should be appropriate learning material to match the learning objectives and contents of the CPD programme. f) CPD activity should be delivered in an appropriate learning environment or facilities suitable for teaching and learning. g) Learners should provide structured feedback at the end of each CPD activity on the effectiveness of the course and educator performance (11). h) There should be formal assessment of learning outcomes. 10 Who should recognise CPD in implant dentistry in Europe? Should there be a transferrable credit system? a) CPD activities should be regulated by a national organization such as a scientific implant association, or Ministry of Health or similar. b) Completion of CPD activities could be recognised in a variety of ways. These include: i ii Educational hours. Assessment of learning outcomes (at knows, knows how, does or higher levels) (23). iii CPD credits (national or European level) (11). c) Availability of a transferrable credit system would be highly desirable. i ii iii It is recommended that the use of a voluntary quality assessment credit review system for self-directed CPD in implant dentistry is adopted using predefined criteria such as those established by Swiss College of Dental Medicine (25). This could be the responsibility of a European organisation, such as the ADEE in collaboration with relevant European specialist and scientific associations, who could undertake this task through a peer review process. Alternatively, CPD activities on a European level could also be recognised, for example, through a credit transfer mechanism such as the European Commission s European Credit Transfer and Accumulation System (ECTS) (26). ECTS has been available to make teaching and learning in higher education more transparent across Europe and to facilitate the recognition of all studies. The system aids curriculum design and quality assurance and allows for the transfer of learning experiences between different institutions, greater student mobility and more flexible routes to gain degrees. It would also be desirable for those university taught/ recognised programme modules, which are accessible to dental practitioners as stand-alone CPD, to contribute to accredited prior learning (APEL) (27, 28) as defined within a university s regulations and within a pre-defined timeframe. The opportunity, to complete such a module(s), could encourage practitioners into academia. In turn, this could provide a recognised avenue for a practitioner to build on their self-directed education and training and enter the direct formal pathway provided through a validated university delivered programme. In addition, this could contribute to the free movement of professionals based on verifiable and transferrable CPD activities. 11 Who should be eligible to be a CPD educator in implant dentistry? a) CPD in implant dentistry should be delivered by educators of adequate qualifications and pedagogical experience (29,30). b) Although accreditation or approval of CPD educators, at a national or European level is highly desirable, it may be unrealistic for this aspiration to be achieved across all European countries at the present time. Nevertheless, to ensure minimum standards, it is recommended that guidelines which provide eligibility criteria for CPD educators are established at a European level. c) As part of educational recognition process, the relevant educational activities of CPD educators should be subject to quality monitoring including periodic audit (including summary of feedback from learners and be subject to peer review). This information should be made available to learners. d) CPD educators should declare any conflicts of interest that might influence their professional impartiality. 12 Who should decide what CPD activities are relevant? a) Self-assessed and self-directed reflective learning activity, recorded in a practitioner s portfolio, which is based on their Personal Development Plan (PDP), is highly desirable as a CPD tool for documenting clinical strengths and weaknesses. It should periodically identify their educational needs and contribute to planning areas of development in clinical practice. b) This requires the learner to continuously and critically assess his/her knowledge, skills and actions through reflection and clinical audit and use these to identify and guide future learning needs (31). c) It is highly desirable that reflection, clinical audit and professional and patient feedback is included in PDPs to document the impact of CPD activity on clinical practice. 13 From a pedagogical perspective, should there be guidelines/ limitations about the environment in which the CPD activity can take place? Course providers and educators should ensure that CPD courses are delivered in a pedagogically suitable environment for teaching and learning. When clinical activities take place as part of CPD in implant dentistry, these should conform to national and European standards of clinical practice. 14 Could the use of implant logbooks or national register of implants benefit CPD? The current survey results indicate that availability of a national/european level register of dental implants (similar to that of orthopaedic medical devices registers) would be highly desirable in identifying areas of concern with the performance of dental implants and needs for future training (16). Such a register/logbook would encourage outcome based or reflective practice in CPD. 15 Could patient reported outcome measures (PROMS) be an integral part of CPD? There is an increasing emphasis on the use of patient reported outcome measures (PROMS) in medicine and surgery. These measure the outcome of treatment delivered to 40 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

9 Ucer et al. CPD in implant dentistry in Europe patients from the patient perspective (32, 33). The use of clinical audit and patient centred outcomes would be highly desirable for guiding the development of CPD in implant dentistry and improving clinical standards. Discussion The recent survey (16) conducted by ADEE, has indicated that, in most European countries, there is some form of CPD in implant dentistry ranging from product training by industrial partners to accredited university courses (excluding formal qualifications), although currently this is perceived to be mostly unregulated, poorly structured and with no recommended hours of study or accreditation in most countries. On the basis of the available data and the outcomes of a survey of the European opinion leaders and stakeholders (16), the following conclusions can be supported: Structure and regulation of CPD in implant dentistry, at least at a national level, is highly desirable. This would ensure that dental health-care practitioners are up to date and competent at each level of care they practise. Furthermore, this would facilitate mobility of dental healthcare professionals, as well as patients seeking initial or follow up implant dentistry treatment across Europe. To be educationally effective, CPD in implant dentistry should be centrally accredited either at a national or, desirably, at a European level (e.g. European Credit Transfer System- ECTS) (26). CPD should be clinically relevant and courses should match the different learning needs of practitioners working at different levels of treatment complexity. CPD should be readily available with as little barriers as possible in a modular, transparent format with tangible benefits and quality assurance of its educational outcomes by regulatory authorities or universities or academic institutions. Most importantly, CPD in implant dentistry should be flexible, self-directed and should be applicable to clinical practice with demonstrable benefits to the patients. In this respect, the use of logbooks, portfolios and PDPs are highly desirable as tools of self-appraised and self-directed lifelong reflective learning activity. There is a strong case for recommending the development of a structured CPD system in Europe with clearly defined educational objectives mapped against each level of competence (21) and the incorporation of some or all of the following quality assurance elements: Predetermined learning objectives. European body. Assessment of learning outcomes (both summative and formatively) and feedback from learners. Accreditation of CPD providers by a national or a central Blended teaching with a good mix of theory with practice. Clinical experience at the workplace under supervision of clinical mentors (using objective clinical assessment tools). Transferrable credits that can be accumulated towards a tangible learning outcome or recognition of CPD activity. Course providers and educators should be recognised by a national or European body. Course providers and tutors/educators in implant dentistry should declare any conflicts of interest prior to teaching. Courses should be held in an environment that is conducive to efficient teaching and learning activity. Implant industry should confine their teaching to product training. Conflicts of interest Professor C. Ucer is involved in delivery of postgraduate university degree courses and CPD courses in implant dentistry in the UK. He is also involved in development of clinical audit systems. Professor D. Botticelli is involved in delivery of postgraduate private courses for continuing education in implant dentistry. Professors A. Stavropoulos and J. G. Cowpe did not report any conflicts of interest. References 1 Schleyer T, Eaton KA, Mock D, Barac h V. Comparison of dental licensure, specialization and continuing education in five countries. Eur J Dent Educ 2002: 6: Sanz M, Saphira L. Competencies in implant therapy for the dental graduate. Appropriate educational methods. Eur J Dent Educ 2009: 13 (Suppl. 1): Mattheos N, Albrektsson T, Buser D, et al. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European Consensus. Eur J Dent Educ 2009: 13 (Suppl. 1): Tseveenjav B, Vehkalahti MM, Murtomaa H. Attendance at and self-perceived need for continuing education among Mongolian dentists. Eur J Dent Educ 2003: 7: Department of Health. A first class service: quality in the new NHS. London: Department of Health, Bullock A, Firmstone V, Fielding A, Frame J, Thomas D, Belfield C. Participation of UK dentists in continuing professional development. Br Dent J 2003: 194: 1. 7 Buck D, Newton T. Continuing professional development amongst dental practitioners in the United Kingdom: how far are we from lifelong learning targets? Eur J Dent Educ 2002: 6: Polyzois I, Claffey N, Attstrom R, Kelly A, Mattheos N. The role of the curriculum and other factors in determining the medium- and long-term attitude of the practicing dentist towards life-long learning. Eur J Dent Educ 2010: 14: Barnes E, Bullock AD, Bailey SER, et al. A review of continuing professional development for dentists in Europe. Eur J Dent Educ 2012: 16: Bullock A, Bailey S, Cowpe J, et al. Continuing professional development systems and requirements for graduate dentists in the EU: survey results from the DentCPD project. Eur J Dent Educ 2013: 17: e77 e DentCPD. Dental continuing professional development (CPD) reference manual. Cowpe JG, ed. Eur J Dent Educ 2013: 17 (Suppl. 1): General Dental Council. Continuing professional development. Available at Documents/GDC%20CPD%20booklet.pdf (last accessed 30 December 2013). 13 Koole S, Vandeweghe S, Mattheos N, De Bruyn H. Implant dentistry education in Europe: 5 year after the ADEE consensus report. Eur J Dent Educ 2014: ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 41

10 CPD in implant dentistry in Europe Ucer et al. 14 Donos N, Mardas N, Buser D. An outline of competencies and the appropriate postgraduate educational pathways in implant dentistry. Eur J Dent Educ 2009: 13 (Suppl. 1): Training standards in implant dentistry. FGDP Available at 20documents/implant%20training%20stds%20jun%2012.pdf (last accessed 2 November 2013). 16 Ucer C, Botticelli D, Stavropoulos A, Mattheos N. Current trends and status of continuing professional development (CPD) in implant dentistry in Europe. Eur J Dent Educ 2014: 18 (Suppl. 1): Botticelli T, et al. The effectiveness of video support in the teaching of manual skills related to initial periodontal therapy tested on phantoms. Int J Comput Dent 2005: 8: Educazione Continua in Medicina (ECM). Available at salute.gov.it/ecm/ecm.jsp (last accessed 14 November 2013). 19 Association of dental implantology (ADI) mentor register. Available at (last accessed 14 November 2014). 20 Implant Centres of Excellence Institute. The Mentee School. Available at mentor-school-leaflet.pdf (last accessed 14 November 2013). 21 Dawson A, Chen S (eds). The SAC classification in implant dentistry. Berlin: Quintessence, Cologne risk score. EDI/BDIZ. Available at CologneABC.pdf (last accessed 14 November 2013). 23 Mattheos N, Ucer C, Van de Velde T, Nattestad A. Assessment of knowledge and competencies related to implant dentistry in undergraduate and postgraduate university education. Eur J Dent Educ 2009: 13 (Suppl. 1): Mattheos N, Schoonheim-Klein M, Walmsley AD, Chapple IL. Innovative educational methods and technologies applicable to continuing professional development in periodontology. Eur J Dent Educ 2010: 14 (Suppl. 1): Regulations for certifying continuing education courses in Dental Medicine in Switzerland. Available at 20version/pdf_e/Certifying%20only_e.pdf (last accessed 2 November 2013). 26 European commission- life long learning. European credit transfer and accumulation system (ECTS). Available at education/lifelong-learning-policy/ects_en.htm (last accessed 14 November 2013). 27 Adam S. The Recognition of prior learning in Europe. University of Westminister. Available at S_Adam_background_report.pdf (last accessed 14 November 2013). 28 European Commission. Recognition of prior non-formal and informal learning in higher education. eurydice/documents/focus-on/152.pdf (last accessed 30 December 2013). 29 UK Committee of Postgraduate Dental Deans and Directors (COPDEND). Standards for dental educators. May Available at COPDEND_Standards%20high%20resolution.pdf (last accessed 2 November 2013). 30 Dental postgraduate education in Wales. Continuing professional development (CPD) portfolio. Available at walesdeanery.org/images/stories/files/documents/dental/cpd/ resources/cpd-portfolio.pdf (last accessed 2 November 2013). 31 Leisnert L, Mattheos N. The interactive examination in a comprehensive oral care clinic: a three-year follow up of students self-assessment ability. Med Teach 2006: 28: Patient reported outcome measures. Department of Health. Available at (last accessed 14 November 2013). 33 Patient reported outcome measures (PROMs). NHS England. Available at statistical-work-areas/proms/ (last accessed 14 November 2013). 42 ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd