The Dental Board of Australia mandates that registrants complete a minimum of 60 hours of continuing professional development over a three-year cycle.[1] With the onus on you to only choose courses that are fit for purpose, how do you know which these are? And what happens if you complete CPD that is not? Dr Annalene Weston, Dentolegal Consultant at Dental Protection, considers the issue
At first blush, the parameters for selecting appropriate CPD are relatively straightforward – no less than 60 hours over a three-year cycle, with at least 80% of those hours being deemed scientific.[2] The Dental Board gives reasonably comprehensive guidance on how to choose appropriate CPD activities:
You should choose activities that demonstrate the following characteristics:
- Open disclosure about monetary or special interest the course provider may have with any company whose products are discussed in the course
- The scientific basis of the activity is not distorted by commercial considerations. For example, be aware of embedded advertising and direct commercial links
- The learning objectives, independent learning activities and outcomes
- Articles from peer-reviewed journals and/or be written by a suitably qualified and experienced individual
- Address contemporary clinical and professional issues, reflect accepted dental practice or are based on critical appraisal of scientific literature
- The content of CPD activities must be evidence-based
- Where relevant, select CPD activities where you can enquire, discuss and raise queries to ensure that you have understood the information
- If the CPD activity includes an assessment or feedback activity this should be designed to go beyond the simple recall of facts and seek to demonstrate learning with an emphasis on integration and use of knowledge in professional practice, and
- an opportunity to provide feedback to the CPD provider from participants on the quality of the CPD activity.
CPD programs alone cannot be used to increase scope of practice. You must be aware that undertaking a single CPD activity may not provide you with sufficient clinical experience to incorporate techniques and procedures into your practice. CPD relied upon to improve or broaden knowledge should provide experience in the technique or procedure. This may be in a simulated environment.[3]
Many people select CPD in the field of dentistry they work in, or simply because they are interested in the topic. Price and convenience are also considerations. It is extraordinary to think that something so straightforward as CPD can become so contentious in the eyes of the regulator – and yet, at Dental Protection we see this issue arise often.
Are you audited for your CPD?
AHPRA routinely audit whether practitioners have completely the required hours of CPD. More commonly, however, discrepancies or gaps in CPD first become apparent during the course of a complaint, as it is common practice for AHPRA to request a copy of a practitioner’s CPD logbook as part of the investigation of the patient’s complaint.
An alarming number of practitioners do not have a logbook in the first instance, breaching this basic requirement. When they do then collate their CPD appropriately, they often uncover a limited amount of CPD that does not satisfy AHPRA as being appropriate in either amount, content or route of administration. There is an expectation that your CPD will cover a broad spectrum of relevant subjects, including infection control, and that some of this CPD would be face-to-face (so not reading articles or watching YouTube videos alone).
The following points are important, should a practitioner be found to have breached the Standard for Continuing Professional Development:
- The Board can impose a condition or conditions on your registration or can refuse an application for registration or renewal of registration, if you do not meet a requirement in an approved registration standard for the profession (sections 82, 83 and 112 of the National Law)
- A failure to undertake the CPD required by this standard is not an offence but may be behaviour for which health, conduct or performance action may be taken by the Board (section 128 of the National Law), and
- Registration standards, codes or guidelines may be used in disciplinary proceedings against you as evidence of what constitutes appropriate practice or conduct for dental practitioners (section 41 of the National Law).[4]
Not fit for purpose
While the guidance regarding the nature and type of courses a practitioner should choose seems in many ways to be self-explanatory, many practitioners find during the course of a complaint to the regulator that the investment of time and money they have made appears to have been misplaced, and that all that glittered was truly not gold.
Case study
Dr W was interested in orthodontics and undertook several short courses designed for GDPs. They found this somewhat unsatisfactory because they really wanted to learn more, at a deeper level. A company they respected advertised a course featuring an international guest speaker. The description looked good and Dr W’s interest was piqued. The course was in-depth and approached orthodontics in a fresh way. Dr W felt the outcomes were outstanding and could quickly see the application for their practice. Mentorship was offered from the speaker and, with this in place, Dr W confidently moved forwards and prescribed some orthodontic treatment using this approach and the recommended appliances. Everything went well, although the amount of expansion did seem concerning. Reassurance from the mentor led Dr W to push on.
A letter was received from a specialist orthodontist, stating that patient A had been overexpanded: their upper 4-4 were no longer contained within bone, the lateral incisors had resorbed to such a level that they required immediate extraction, the prognosis of the upper 3s and 4s – plus one of the upper centrals – was guarded, and the appliance and rapid expansion had caused this significant harm. Dr W was shattered.
Two more letters arrived in quick succession: one from the regulator and one from a lawyer. Following an investigation, the regulator made a finding of unsatisfactory professional conduct and placed conditions on Dr W that they could not practise orthodontics without supervision from a specialist orthodontist. The lawyer’s letter set out a claim in negligence that had the potential to reach into a six-figure pre-court settlement sum, with the matter needing to stay out of the public arena. The work was ultimately indefensible.
Stretching the boundaries
CPD, such as a course about a new technique or procedure, will help you:
- maintain, improve and broaden your expertise, experience and competence
- develop the personal and professional qualities you will need throughout your career.
However, you must choose your CPD based on your division’s scope of practice and understand its limits. For example, dental hygienists, dental prosthetists, dental therapists and oral health therapists cannot become dentists through CPD courses.[5]
Case study
Ms D, a registered oral health therapist, had undertaken a unit on orthodontics at dental school. She had enjoyed this course and sought work at a practice that mostly provided orthodontics, including growth appliances and orthopaedic appliances. Ms D attended a clear aligner course with her colleagues, registering herself on the course as an OHT. During the course, she timidly raised her hand to advise she was an OHT and would not be able to provide the appliances to patients – she was just there to learn. The course convener told her this was untrue as she had studied orthodontics at dental school, and consequently this fell within her scope of practice. With the encouragement of those around her, Ms D began to prescribe aligners for her patients, following the diagnostic formula provided by the course.
Patient Q was unhappy with their care and reported Ms D to AHPRA. On discovery of the treatment provided, AHPRA took immediate action and suspended Ms D.
Dr W and Ms D are not alone. Good, ethical practitioners across Australia have found to their horror that treatment courses they have attended and been mentored in have been found wanting when their training is examined by the regulator. These two practitioners happen to have been affected in the field of orthodontics, but the issue is not limited to this discipline of dentistry.
We encourage all practitioners to critically appraise any CPD they are considering and apply the guidance from AHPRA to their course selection. Also, ask around – there are many more Dr Ws and Ms Ds in the dental community than you may think, and they will gladly share their stories so others do not have to go through all they have suffered.
[1] Registration Standard: Continuing Professional Development. www.dentalboard.gov.au/Registration-Standards.aspx
[2] Guidelines: Continuing Professional Development. www.dentalboard.gov.au/Codes-Guidelines.aspx
[3] Ibid
[4] Ibid 1
[5]Guidelines for scope of practice. Dental Board of Australia. 1 July 2020