Dentist Under 40 Quality Assurance Program Webinar 29 May 2017 Participant Feedback Report
2 Dentist under 40 Quality Assurance Program Webinar The QA Program working group hosted a webinar for dentists under 40 because it had yet to hear from the younger demographic of dentists. This group has a unique perspective on the profession and the revised program will affect them. The webinar took place on Monday, 29 May 2017 from 7 to 8:30 pm. Presenters: The webinar was facilitated by engagement specialist, Susanna Haas Lyons. There were two presenters from the QA Program Working Group: Dr. Ash Varma, Chair of the QA Committee and QA Program Working Group Dr. Alexander Hird, Chair of the Registration Committee and member of the QA Program Working Group Webinar format: The webinar began with a short presentation by the members of the QA Program Working Group. They described the opportunities and challenges of quality assurance, and what they ve learned so far. The presentation included examples of other health colleges QA programs. Throughout the webinar, the presenters posed questions to the participants in two ways: 1. Poll Questions: Multiple choice poll questions appeared on participants screens and the facilitator could track and display the poll results. 2. Discussion Questions: Participants could answer the discussion questions in two ways: By putting up their hand in which the facilitator would unmute the participants microphone so they could answer the question, or By typing their response into an instant messaging feature. Feedback: The feedback from the webinar is collated below. It includes all of the poll questions and typed-in responses to the discussion questions. Following the webinar, the facilitator emailed participants a survey with an evaluation of the webinar and additional questions regarding the QA Program. The survey results are included at the end of the report. QA Program Working Group Dentist Under 40 Webinar Feedback 2
3 Participants: - 22 registered - 17 attended QA Program Working Group Dentist Under 40 Webinar Feedback 3
4 Who s here? QA Program Working Group Dentist Under 40 Webinar Feedback 4
5 QA Program Working Group Dentist Under 40 Webinar Feedback 5
6 What do you think of online courses? Which types of courses should be available online? Comments: I think online courses are a great opportunity for those that don't live in major cities to accomplish CE, especially in the areas of practice management, record keeping, oral medicine etc. I have found online courses to be particularly useful with regards to diagnostics, treatment planning, and practice management In addition to the subjects mentioned, diagnostics and radiology could work well online I've watched a number of online seminars (but never for CE hours). Anything that can be presented in lecture can be presented online. Obviously this would not be equivalent to hands-on. Hi Ash & Alex, to give feedback on the earlier question, as hospital staff we take online courses regularly for "handwashing" and "medication safety" etc. and I think frankly educational value is quite poor. Not comparable to in-person or hands-on teaching. To comment on online CE being poor, I've seen plenty of poor lectures. Some form of QA is required. QA Program Working Group Dentist Under 40 Webinar Feedback 6
7 What ideas do you have about effective ways to maintain dental knowledge and skills? Comments: My other choice would be study clubs/peer engagement Self-assessment seems too variable to me - someone may be very critical of themselves while another may be very lax on their evaluation. Peer assessment could also create biases - and in smaller or remote areas you would need an outsider to come in to prevent conflicts of interest. I wonder if we do have any data in regards to the efficiency of practice audits and its correlation to the amount of complains or law suits. For instance in Quebec, they do audit every single registrant on a mandatory 3 to 5 year period, yet they have the same amount of patient complaints. Study club/peer engagement Self-assessments can be incorporated in a study club setting making it a powerful tool. members often present cases which encourage feedback from other study club members Study club mentors can help provide self-assessments I like the idea of giving people the option where they choose between different mandatory options; e.g. you must either partake in a hands on clinical peer reviewed study club, or elect to have an audit. A hands on study club is not a welcoming environment for all personality types, and the same for an audit. I feel like most of these ideas are difficult to standardize, which becomes challenging to implement. I am not a huge fan of the CPH, but at least it is standardized. Sorry I don t mean to be a pessimist I think we all recognize that there's a wide range in the quality of CE courses I realize this is not quite related but I think it has a place in this discussion- do we have clear standard of care guidelines for each field of dentistry (ex. CDSBC guidelines for endo)? With the increase in dentists from other provinces and abroad it seems essential to have clear guidelines be a part of this QA discussion Practice audit is a cynical choice but an honest choice because those seeking easiest path can always find 90hrs of "fluff" CE. Practice Audit is the only one of the 5 that allows for external review. In hospital practice, peer review of each other's work is commonplace for this reason. Clear guidelines can help achieve competence and help ensure standards are upheld and thus boost trust among the public What about creating a program of peer review audits as a manner of ensuring competency while minimizing the cost of the program? I like the option of choice of options to prove competency is a good idea, because everyone has different circumstances. For example, I feel that I may differ in the QA Program Working Group Dentist Under 40 Webinar Feedback 7
8 value I place for myself on hands on workshops and study clubs as I am in a group practice with dentists of different generations, but we are all current and push each other and mentor each other. So I have not personally found hands on to be very beneficial for me personally as I get this from my practice environment. Therefore I would place more importance on CE from in person lectures etc. I think that good policy will take into account the very thing that we value about our profession, that is, a certain professional freedom. We are all difference people and should be able to prove our competency in different ways. This is one reason why CE credit hours are good because we can all choose what type and reach our CE quotas Comments: I heard a quote once that some people say they have 20 years experience but they really have 1 year experience repeated 20 times. It doesn't matter how long you've done something if you're not learning or growing. While I believe practicing is essential it doesn't imply competence. I've been singing my whole life but it doesn't make me talented. Moreover, 300 hours a year doesn't seem like much- it boils down to 5 weeks of work. No, but there is a value Is there any consideration to women who may take a maternity leave? Or people winding down in their career? QA Program Working Group Dentist Under 40 Webinar Feedback 8
9 It does 'push' people to a certain extent to continue doing dentistry and not taking long breaks etc. where they could get 'out of touch' with being current clinically and didactically in dentistry there should be correlation between hours practiced and competence, however, the fact that hours are worked does not imply competence The definition of practice is quite open-ended. I think we need to take the individual into consideration for the continuous practice question though... I know maternity leave, and complications in pregnancy etc., as well as chronic illness or injury can lead to challenges in getting the continuous hours in the time allotted. If so, what were some of the benefits and challenges? Are study clubs easily accessible? If not, why have you chosen not to participate in a study club? Comments: There is a wonderful trend in Vancouver where you have several specialists from multiple specialties providing multidisciplinary and comprehensive discussion - I wonder how the GP's feel about this That is an interesting point, there are a ton of changes happening now especially with the advances in technology etc. It also would vary with what type of clinician you are, if you are just doing fillings all day long it would be different than if you were dipping your hands in all facets of clinical dentistry QA Program Working Group Dentist Under 40 Webinar Feedback 9
10 I have partaken in study clubs with around 40 people - a lecture and dinner type thing. It has been very informative but at times, not much different than a lecture. If you're not a person who speaks up and finds it easy to get involved, it can be overwhelming, especially for younger practitioners without a wealth of experience. For this reason, smaller study clubs are more beneficial. I've been to study clubs of 3hrs of active and productive discussion, and I've been to study clubs of 20minute superficial lectures followed by 2.5hrs of socializing and fine dining. It's hard to use it as a barometer because experiences vary. I agree with the need to take initiative. I have found a void in my area on the type of study club I am looking for and have found a group of young practitioners with whom I will start my own club. The model in mind is case presentations, and have different mentors come in every week. This allows more of a comfort level for people with the same level of experience. Peter Walford with the BCDA online web based study group was excellent and of high quality As mentioned, there are many types of study clubs. Quality is highly varied. I find the most useful study clubs concentrate on a particular topic. I have been participating in a prosthodontics study club for the past couple of years which has been tremendously helpful in diagnosing, planning, and treating complex cases The study group setup is powerful with video based meetings I was invited to join the study club by a local Prosthodontist who runs it. Unfortunately, there is high demand for the study club and space is limited It allows easy self-assessment and opportunity for self-improvement particularly for solo practitioners. The discussions always go well beyond the topics at hand. I look for a knowledgeable group that is open to sharing their ideas and their work and are willing to help create a sense of community and the profession locally Sometimes you have to take up the initiative yourself. It seems that the best ones I have taken part in our ones that are organized by the group members and not specifically by a mentor. We've had a few surgical groups where we actually brought in mentors as needed for the topic at hand Just a note... study clubs are tricky in small towns for patient privacy issues haha...everyone knows everyone QA Program Working Group Dentist Under 40 Webinar Feedback 10
11 Comments: Rather than employing paid committee staff each dentist could volunteer a couple of days a year to audit a randomly selected practice of another dentist in the region The more venues available to have your work assessed by someone else the better - asking peers how could I have done this better? How would you have done it? This may be done online for some or in person in a large practice for others. One of the difficulties of self vs. peer assessment and standardized questions is that many dentists ultimately choose to limit their clinical practice. For example, some general dentists do not treat children, or do not do surgical procedures or Endodontics, etc. How do you manage competency in knowledge and skill over such a diverse landscape? With general practice being so broad, i.e. some dentists do not perform dentures or endodontics, etc. Their knowledge base in these particular areas would be lacking. However, given our autonomy of practice, is this really an issue? Food for thought. How are the peers chosen and would it be anonymous? How would we ensure good quality in the peer review? QA Program Working Group Dentist Under 40 Webinar Feedback 11
12 Dentist QA webinar (Completion rate: 70.0%) Which region are you located in? Response Chart Percentage Count Fraser Valley (District 1) 12.5% 1 North (District 2) 0.0% 0 Southern Interior (District 3) 37.5% 3 Vancouver (District 4) 12.5% 1 Vancouver Island (District 5) 37.5% 3 Other, please specify... 0.0% 0 Total Responses 8 Which region are you located in? (Other, please specify...) # Response What type of dentist are you? Response Chart Percentage Count General dentist 87.5% 7 Certified Specialist 12.5% 1 Educator 0.0% 0 Other (please specify): 0.0% 0 Total Responses 8 What type of dentist are you? (Other (please specify): ) # Response QA Program Working Group Dentist Under 40 Webinar Feedback 12
13 How would you rank this webinar on a scale of 1 to 5? Response Chart Percentage Count 1 - Poor 0.0% 0 2 12.5% 1 3 12.5% 1 4 50.0% 4 5 - Excellent 25.0% 2 Total Responses 8 I had adequate opportunities to express my views. Response Chart Percentage Count Strongly agree 25.0% 2 Agree 62.5% 5 Neutral 12.5% 1 Disagree 0.0% 0 Strongly Disagree 0.0% 0 Total Responses 8 Would you participate in another webinar? Response Chart Percentage Count Yes 87.5% 7 No 12.5% 1 Total Responses 8 What did you like most about the Quality Assurance Program webinar? The 4 response(s) to this question can be found in the appendix. What could have been improved about the webinar? The 5 response(s) to this question can be found in the appendix. QA Program Working Group Dentist Under 40 Webinar Feedback 13
14 Do you have any other comments to share about the format of the webinar? The 5 response(s) to this question can be found in the appendix. Thinking about the current QA program, please indicate your level of agreement or disagreement with the following statements: Strongly agree Agree Neutral Disagree Strongly disagree Total Responses It is effective at ensuring registrants maintain entrylevel competence. 1 (14.3%) 4 (57.1%) 0 (0.0%) 2 (28.6%) 0 (0.0%) 7 It is effective at helping registrants develop and enhance their professional skill set beyond entry-level competence. 0 (0.0%) 2 (28.6%) 2 (28.6%) 3 (42.9%) 0 (0.0%) 7 It produces improved patient outcomes. I am confident that every registrant who meets the requirements of the current QA program is competent to deliver quality dental care to the public. 0 (0.0%) 3 (42.9%) 2 (28.6%) 1 (14.3%) 1 (14.3%) 0 (0.0%) 0 (0.0%) 3 (42.9%) 2 (28.6%) 2 (28.6%) 7 7 What else could enhance the competencies of a healthcare professional? The 5 response(s) to this question can be found in the appendix. Please provide any additional comments you have about revisions to the QA Program: The 3 response(s) to this question can be found in the appendix. QA Program Working Group Dentist Under 40 Webinar Feedback 14
15 Appendix What did you like most about the Quality Assurance Program webinar? # Response 1. Very good topics are being covered - the scope that was covered was very good. 2. Openness and consultation before creating a significant change to our QA program 3. It was nice to get some perspective from CDSBC about what they are thinking about the QAP. 4. It was good to learn a bit more about it, I hadn't thought about the fact that the existing program was limited to CE hours and practice hours. I think it's good that it's being looked at because I think it's totally inadequate the way it is. I think the profession has a lot of room to improve! What could have been improved about the webinar? # Response 1. I think that for such a short webinar (not that it should be longer), there was a lot of speaking being done by the admins. In my view this should be an opportunity to gather as much information as possible from the people that attended. Perhaps organizing it in such a way that everyone gets a moment to speak on each topic. As much information that can be gained from the participants the better and this can then be compiled and evaluated by the administrators. Allowing some debate between participants on certain points would also produce valuable comments. 2. Nothing. Just some technical details about the web interface and slides not advancing correctly 3. By the time responses were read, it was usually out of context of what was being discussed. The individual reading the responses would paraphrase and change the meaning of what was written. The slides weren't updated in a timely matter. 4. Webinars are great because people can meet from all over the place, but they are not the same as meeting in person. I had to step out for a bit during the middle of the webinar, so I am sure some of my questions were answered during that time. I appreciated that effort put forth from the college to give the members a chance to speak up and address concerns. I didn't feel like we really accomplished a lot, but that is probably the way these things go. 5. I think it was pretty good, other than a few technical difficulties that made it a bit hard to follow along with the topics and I think made it run a bit long as well. QA Program Working Group Dentist Under 40 Webinar Feedback 15
16 Do you have any other comments to share about the format of the webinar? # Response 1. Thank you for taking the time to reach out! 2. Great work by the working group 3. A better format for this discussion would have been a round-table in person. 4. Thanks! 5. I'm not sure how to do it but it would've been good to encourage more people to actually participate via webcam, or at least audio, instead of typing comments and having them read out. I think there would be limitations on the size of the group that could use that format though. What else could enhance the competencies of a healthcare professional? # Response 1. Continued peer discussion and self-evaluation. Promotion of communities through study groups 2. More peer feedback. More discussion of negative outcomes that happen on a day to day basis. 3. This is challenging as you can only mandate so many things. It is challenging to make rules for dentists to follow that aren't supported by evidence or cannot be standardized. Of all the ideas yesterday, the CPA seems to be the easiest to monitor (even though it has its flaws). I was wondering why we are sticking with 900 hours if it is just a historic number. As dentists, we are expected to practice in an evidence based manner. I think we should be able to expect that the college behaves in the same manner. I can't tell patients I am completing treatment because this is how it is done historically, with no other evidence to support it. I would be curious to know what other professions (engineers, physiotherapists, doctors, etc.) due to ensure quality within the profession. 4. I think there needs to be a massive paradigm shift in our thinking about health care. I think the quality assurance program needs to somehow start at the dental school level. The minimum, "entry-level" requirements are extremely sub-standard in my opinion. If you're serious about raising the standards of the profession I would love to come to the college and present some ideas. 5. skills assessments larger CE requirements hands on course requirements QA Program Working Group Dentist Under 40 Webinar Feedback 16
17 Please provide any additional comments you have about revisions to the QA Program: # Response 1. I really liked the idea of polishing the apples, not focusing on the bottom of the curve. This is a challenging task for the college, as it really comes down to a personal responsibility of each dentist, to strive to improve and provide the best oral health care for their patients. I am confident that if there was evidence to support which ever decision is made, the members will be much more accepting. 2. I'd really like to work with the college to create a mandatory course to shift the thinking of the profession! 3. I believe I mentioned this in the webinar, but I really feel that we need to ensure that we are not limiting all practitioners with rules and regulations that will actually impede good dentists from returning to work after maternity leave, pregnancy and complications, injury, illness etc. Generally, the equivalent to one day of work/week would be quite easy to maintain, however, if one has complications in pregnancy followed by another pregnancy soon after, this could actually be quite hard to accomplish in a three year cycle. Therefore I do believe that we need some different options available to prove competency beyond the practice hours. Also, there are different abilities and skill levels out there. Some dentists might need 2-3 days/week of practice to maintain competency where as a more gifted or talented dentist may need way less. Let us not lose good professionals because of bad policy and umbrella regulations. QA Program Working Group Dentist Under 40 Webinar Feedback 17