Observing with competence
Do not just watch, but help yourself. As the everyday life of a practicing dentist feels, Dresden dentistry students can now experience during a visitation in selected cooperation practices. After many years of intensive preparation by the university and the chamber, the starting signal was given. A project with a role model character, finds the Joint Advisory Training of DGZMK and BZÄK and calls for imitation.
Just look is not: dentistry student Julia Zimmermann assisted dr. Falk nail. Susanne Theisen
After a three-dimensional X-ray diagnostics on the diagnostic monitor of his practice Dr. med. Falk Nagel step by step through implant planning. He then explains the planned treatment of the patients. The Dresden Oral Surgeon takes a lot of time today because he has a listener: Julia Zimmermann, dental student between the ninth and the tenth semester at the Technical University (TU) Dresden.
Four wisdom teeth are already done
The 24-year-old looks over his shoulder for a day as part of an internship. And not only that, she is also actively involved in the treatments and assists the dentist – as far as her knowledge permits. The surgical removal of four wisdom teeth is already done, next is a cystectomy on. In the young patient, the anesthetic injection was being set. Nagel uses Nagel to discuss implant planning with the patient. Julia Zimmermann also there in the middle and there.
After just three hours of internship, the native of Munich has already tasted plenty of “practice air”. “Apart from the treatments, I was also present at the team meeting in the morning. An employee explained to me afterwards how the reception and the ordering system are organized and I also got an insight into the preparation of the sterile items – what needs to be done and how long the process lasts, “says the student. The most exciting thing for her so far was implant planning. “It was not clear if there was enough bone to put the implant. Dr. Nagel explained his decision on the basis of the X-ray images and I could then hear how he brought this over in the patient talk. I found that very informative. “
Experience the professional life up close
That’s what Prof. Dr. Thomas Hoffmann, Director of the Department of Periodontics at the University Hospital Carl Gustav Carus, and Dr. med. Mathias Wunsch, President of the Saxon State Dental Association, like. For their part, they came to the practice, which is located between Fetscherplatz and the Deutsches Hygienemuseum, to watch live the realization of the internship program, on which they worked together for about ten years.
“We have been offering the option of an optional internship for many years. Up to now the practice stay took place only in the Vorklinik, “reports Hoffmann, who is also Dean of Dentistry in Dresden. This time is too early, however, to gain a really intense insight into the professional life of a resident. “Students simply can not do enough and practical work is out of the question,” says Hoffmann. For this reason, the offer has now been extended under the title “Cooperation Practices of Dental Education“.
This is a multi-day internship, during which students from Dresden can volunteer during the semester break between the ninth and the tenth semester. They spend five days in a general practice, where they perform diagnostics, prevention and therapy under the supervision of the resident dentist. One day they assist in the surgery.
Zimmermann has already completed her stay in general practice. She draws a consistently positive conclusion: In addition to a dental cleaning and individual prophylaxis in a child, she was allowed to take over, among other things, a fissure seal and a filling. “I am pleased that the practice has adhered to the agreement with the university and we can really treat students,” she says. These are prophylactic activities.
Long breath is better than hauruck
Without the close cooperation between university and chamber, the idea would not have been feasible, says Hoffmann. In a hurry-back process, such a project would not be able to handle it, and even if it were joined forces, implementation would take a long time. On both sides, concerns have been removed, the green light demanded, and workable structures developed. This included, among other things, the development of a requirement profile with mandatory and target criteria for the practices, which apply as co-operation partners. The requirements profile (see box) was adopted by the Joint Advisory Council on Continuing Education of the DGZMK and the BZÄK on 22 January and is available as a recommendation.
On the genesis of the project – Three questions to Prof. Hoffmann
The project of the hospitation practices took a ten-year lead time. Why did it take so long??
The model, which was launched ten years ago, was originally intended only as an “internship” to explore the possibilities in principle. When accepted positively by both sides – practices and students alike – the first conceptual considerations were to offer a wider offer for the same period (between the ninth and the tenth semester), but with elements of practical activity. Specifically, it was the implementation of the current model in 2011. In fact, it was five years lead time.
What were the biggest challenges, what were the time-wasters??
The clarification of legal and administrative issues. This involved collusion with the Ministry as well as with the Chamber. The chamber has always been very supportive. On the chamber side, there was a need for clarification, especially with regard to questions relating to liability insurance. Finally, it was also about incorporating and regulating aspects of the safety of the participating practitioners and students.
Has your long-wind finally paid off??
Absolute! We now have a broad consensus of all involved, the demand among the students – it is indeed a voluntary event – is a great success, the dental practices are happy to participate – we look forward to many imitators in other states.
On the university and chamber side Hoffmann and Wunsch had to take different hurdles. The biggest concerns on the chamber side have been in terms of insurance. What if something happens to a student during treatment? Is the university, the student or the individual practice right now??
“The colleagues wanted to know how they are protected in this case,” says Wunsch. “We have succeeded in finding a solution with the insurance company with which the Chamber has been working for a long time. The company has agreed to offer liability cover for the internship period. “However, the practice owner’s responsibility is to accurately assess the student’s abilities before delegating tasks to him or her. And of course, nothing could happen without the explicit consent of the patient.
Hoffmann had to go a long way through the institutions to have the internship signed by the responsible state ministries and the TU. “Fortunately, I noticed that I am running open doors everywhere. The faculty immediately received support for the idea, and the Ministry of Health and Science also gave us positive feedback, “recounts the Dean of Dentistry.
35 practices were needed, 220 were reported
The dentists in Saxony are open to the project according to desire openly: To start the project ten years ago, 35 practices were needed – on the call of the chamber spontaneously reported 220th For the sake of simplicity, the internships were initially offered only in Dresden practices. For the students, they are so easy to integrate into their studies. In the meantime, practices have also been integrated in the countryside. “We want to show students that people in rural areas are no different from those in the city, and that in rural areas, some aspects of our work can even be more appealing,” says Hoffmann.
Sample requirement profile for the cooperation practices
In order to coordinate a nationwide approach to complementary, practical knowledge transfer among students, representatives of universities, scientific and professional institutions have jointly developed a sample requirements profile. It is recommended by the Joint Advisory Council on Continuing Education of the DGZMK and the BZÄK.
The aim of a university offer in the training practices should therefore be to enable the students of dentistry in the context of their studies, a complementary placement of practice procedures in a dental practice, on a voluntary basis. They should receive an early insight into daily practice with all its facets, such as practice management, patient communication or team leadership. Ideally, this will succeed in motivating students to work later in their own practice. In addition, the early contact in the practice should make a contribution to the personality development of future dentists.
The Federal Dental Association (BZÄK) also welcomes the attempt to break through the concentration of young professionals into the big cities with the help of cooperation practices. “In general, we see this as a way to increase interest in a branch. The students should feel like being bosses or bosses instead of going into employment, “says BZÄK Vice-President Prof. Dr. med. Christoph Benz, who is also acting chairman of the Joint Advisory Council of DGZMK and BZÄK.
Not just a true enrichment of the curriculum
In the view of the BZÄK, an internship as offered in Dresden is a clear win-win situation for everyone involved. Benz: “Meaningful teaching only works in exchange with practice. The offer enriches the curriculum in this sense – and the proximity of the residents to the university may increase the influx of patients to the university. “
For their part, the residents benefit from the academic input that the internships and close contact with the university bring with them. Thus Nagel is not only pleased that he is allowed to prove his practice as a certified cooperation practice – which has a positive effect on the external impact – it also appeals to the former research assistant at the TU Dresden to discuss the university with the students.
But that’s not all that motivates him: “The theoretical and practical knowledge transfer at the university is great. Nevertheless, it is difficult to completely simulate the practice procedures during the clinical courses. As a cooperation partner, I can give the students a live insight into the later professional life and, as a specialist practice, deal with specific aspects, from the practice organization to the instrument preparation to the leadership of the staff. I think that’s important and I enjoy it. “
In the morning, patients are also sitting in the waiting room, which are not ordered at all
The offer is well received. Wunsch received positive feedback from the students as part of the professional study lecture he gives at the TU Dresden. “They were all really happy to see a day in a normal practice. That, for example, in the morning patients also sit in the waiting room, which are not ordered, and then you have to work in between and that is the normal daily business, “he says. “I think it’s important that we give this knowledge to the young people in good time.”
However, many people in academia are skeptical about the practical aspects, especially about the dental treatment, Hoffmann knows. But he can only refute this reservation: “I hear again and again that the teaching staff is concerned that the doctrine is counteracted by the dental reality in practice. I say: even if that were so, that is not negative. Instructors will be able to discuss the approach they have followed in practice for an entire year. So you do not lose influence, but you increase it. “
As a university you have to show initiative
As you know, the dental licensing regulations have not been fundamentally changed for more than 60 years. “As a university, therefore, you have to show initiative in order to be able to offer modern teaching,” says Hoffmann. Practical stays, as they are organized in Dresden and at various other universities (see boxes) for the students are part of him. He does not conceal that their implementation requires additional time and commitment on the part of the teaching staff.
Benz sees in the pre-state examinations a central lever to improve the quality of dental education. The BZÄK would therefore welcome it if such projects were increasingly initiated: “We certainly do not want to interfere with regional powers. Rather, we see our task as creating good framework conditions for chambers and universities that want to set something in motion in this direction. We want to inform and encourage. “
Although the individual implementation may look different, the Joint Advisory Council on Continuing Education recommends, however, to observe a few standards, including the aspect “quality of practical training”. Therefore, the cooperation practices should be selected on the basis of the developed requirement profile and evaluated by the students after the internship. “And one more thing we consider important: The time frame for the internship should not be kept too short and the time should be set as far as possible after the Vorklinik,” adds Benz. “Then chances are good that the impulses gained will not be lost until the end of the studies.”
Three other examples of student internships
Frankfurt: individual tutorial
The Department of Dentistry at the Goethe University Frankfurt am Main started in December 2010 the pilot project “Individual Tutoring in Dental Hospice Practices”. The aim was to establish and evaluate tutorials in dental practices for the first time in the Frankfurt area. A total of 36 dentists agreed to welcome second semester students to their practice for five days each. On the student side, there were 13 interested parties who took advantage of the voluntary offer.
The subsequent evaluation showed that the project was rated as very positive by both sides. That the participation of the students was so small was attributed to their heavy use of the syllabus and to the voluntary nature of the offer. In addition, the evaluation of the pilot project found that “train-the-teacher” seminars for practice owners helped to improve the offer, and above all, the crucial exchange between university and practice. However, financial resources had not been approved in advance.
Currently, the Department of Dentistry plans a further development of the project “Hospitationspraxen”. Information on the current state of the Frankfurt internship program can be found at this link:
The State Dental Association Rhineland-Palatinate in cooperation with the Clinic for Dental, Oral and Maxillofacial Diseases of the University of Mainz in 2013 called a Famulaturbörse to life. The residents of the country were asked to give students the opportunity to watch over their work at work for two weeks between the second and third semester. Almost 50 practices spontaneously agreed to volunteer, and according to the LZK, new volunteers are constantly being added.
Initially, the organization of the internship was in the hands of the students, so that the LZK and the university could learn little about the use and quality of the internship. Currently, the offer – in close cooperation with the Saxon colleagues – revised. The practice stay should now take place at the beginning of the clinical study period and be organized by the university so that an evaluation is possible. As a further amendment, it is envisaged that the interested practices will attend a compulsory introductory seminar in which they will be informed about their mission, insurance questions and the work that is allowed to be done by the students. These include activities such as calculus removal or prophylactic education. Furthermore, insights into the areas of team leadership, medical confidentiality or dealing with patients should be taught.
Greifswald: Community Dentistry
Students of dentistry at the Center for Dental, Oral and Maxillofacial Surgery of the University Medical Center Greifswald have been undergoing the teaching unit “Early Patient Contact” for more than 20 years. The goal is to make dentistry studies patient-oriented and transparent at an early stage. The individual modules are distributed over the first four semesters of the preclinical study section. In addition to visiting kindergartens (in cooperation with the Greifswald Juvenile Dentistry Service) and senior citizens’ institutions (as part of geriatric dentistry), a two-day internship with a resident dentist is also included in the third semester. Currently, nearly 25 dental practices in the region participate in the program.
The students do not self-medicate but observe and observe what interactions take place in practice, especially between the dentist, the assistant and the patient during the dental consultation, counseling and treatment. But the procedures and the communication outside the treatment room – such as at the reception at the appointment, in the laboratory or in the case of billing – should get to know the students during the internship in the dental practice.
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