Professor Jonathan Cowpe FFGDP(UK), who led the review into professionalism in dentistry and healthcare, shares further detail on some of the key messages.
The professionalism review identified four research areas (RA) to investigate, through the four different methodologies – rapid evidence assessment, interviews with research areas experts, focus groups with dentists, dental care professionals and the public, and a two stage Delphi survey. I felt it would help readers to see a selection of ‘key messages’ relevant to the four RAs. Although, as one might expect, some of the messages are relevant to more than one of the RAs.
RA1: Public’s expectations and their perception of what constitutes ‘lapses’ in ‘professionalism’
1. We found that members of the public held mixed views in terms of what professionalism looked like in the context of the dental care setting. Many of their perceptions about dental care, were often ‘consumer experience’ focussed. They considered communication, trustworthiness, patient involvement in decision making and care within a timely fashion to be positive professional traits.
2. The consensus was that safety (relevant to the environment and to patient expectations), high standard of clinical skills, good training, and evidence of good teamwork, were pivotal to professionalism.
3. Opinion was divided on demonstrating professionalism out with the working environment. Members of the public took a more lenient view than dental professionals about their activities away from the workplace.
4. Communication and appropriate interaction with patients were considered crucial to putting patients at ease and strengthening feelings of trust between professionals and their patients.
5. In most cases breaches in professionalism were framed as ‘lapses’, meaning that behaviour in a particular situation may be unprofessional without implying that the person is inherently unprofessional. There was a recognition that everyone makes mistakes, usually when confronted with challenging situations, and that the important thing is to learn from the experience.
RA2: Categories of professionalism suggested by both healthcare professionals and members of the public
1. Key areas of professionalism relate to the patient’s expectation of service experience, their experience of interactions with dental professionals, and the personal and professional divide.
2. Some aspects around professionalism appeared clear-cut but others are less clear. Behaviours such as not discriminating against patients or making sexual advances in the workplace, the importance of gaining patient consent and making care decisions based on the patient’s best interest appear well defined. However, aspects such as the outward appearance of dental registrants and the separation between professional and personal life are much more subjective.
3. The relevance of context in relation to the multifaceted construct of professionalism was highlighted through both the focus groups and the survey. Whether an action or behaviour is considered to be unprofessional is dependent on a number of aspects. This may include one of more of the following: cultural or religious factors, environment and setting, the observer or individual the action is directed towards and their perception, and whether the scenario was a one-off event or a patterned behaviour.
4. Dental professional focus groups discussed the impact of regulations, financial pressures, and isolation on professionalism. They felt that complaints posed a serious challenge facing every dentist and talked about ‘defensive dentistry’ and a ‘climate of fear’. The public focus groups gave examples of switching to a new dentist, but interestingly, no examples of complaints made against dentists.
RA3: Variations within the different groups of dental professionals and between dental professionals and other healthcare professionals
1. Comparisons of the views of dentists, dental care professionals (DCPs) and members of the public towards professionalism in dentistry often revealed significant differences. Generally, in the workplace, DCPs appear to be the most vigilant. Whereas overall whether in the professional or personal environment, members of the public seemed to have a more pragmatic and lenient approach to the views exhibited by professionals.
2. Focus Group participants made comparisons with other healthcare workers and other professions. Overall, both professionals and members of the public suggested that professionalism is similar in dentistry, the medical allied medical professions, and other professions such as teaching. Ultimately it all revolves around public trust.
RA4: Education & training in professionalism across the continuum of education
1. There was little evidence to show which are the best approaches for teaching professionalism, but studies have highlighted the alignment of theory and practice and a range of approaches to support learning including role modelling, mentoring, awareness of the hidden curriculum, reflective practice, and effective communication.
2. The thematic analysis, of responses from the scoping interviews, suggests that professionalism is developed through observation and reflection and can be challenging to assess.
The full report and executive summary of the review into professionalism in dentistry and healthcare is available here.
The views and opinions, expressed above, are those of the author and do not necessarily reflect the views of the GDC.