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Is it time to review Vocational Training in UK dentistry?

Is it time to review Vocational Training in UK dentistry?

I was not an outstanding student. I had a very full 5 years at Newcastle but was not famed for my exam grades. Past form being no guide to a cup final I passed my finals.

This was before vocational training, whether voluntary or compulsory. Most of my year headed into general practice within days of graduation and kept their heads down for the next 35 or more years. If they were spared.

Inspired by MASH the movie and dreading being stuck in one place I spent two and a half years as an oral surgery resident, dealing with inpatients, impacted 8s, smashed faces and bleeding sockets. I learnt skills that would help me through my clinical career and life, once you have had to cope with gunshot injuries and Le Fort III fractures not much phases you. I coped with warring consultants, departmental politics and green-gowned theatricals but not with primary FDS. General practice was next and, like everyone else, it was in at the deep end and sink or swim. I bobbed about keeping my head above water, unsure what I was doing for many years.

The hospital service had made me open books, read journals and attend regular study days. There were no such expectations in practice, indeed any day long courses were frowned upon, as you “would not be earning”. The limit to my being mentored in practice was a dressing down when I missed caries, “you could have earned another £X here”.

Post Graduate Education (later CPD) was dominated by what was put on at the local PG centre with Section 63 and BDA section meetings, plus the very occasional trip to London for a day at the RCS.

To cut a long story short, one evening with Philip Greene changed my life and I realised that I had to know more about perio. That’s where my CPD proper started and much of it was beyond “approved by the NHS”.

Occlusion with Higson and the full BSOS year experience, with visiting speakers from the US opened my eyes wider. This coincided with my starting my first practice and nothing had prepared me for that! I found the people on the courses stimulating company who cared deeply for their patients, always looking for better ways to treat them. These people further opened my eyes to a philosophy of prevention. “What you need to remember, Alun, is that you don’t cure caries with a turbine” came as a shock, I was a dentist and I drilled teeth didn’t I?

BUOLD took me back into (mostly) university led teaching which was sometimes undergrad+ but led me to think about solutions. A week on the MGDS course made me remember how much I hated exams. Then came several years of tutelage and discipline of Mike Wise and eventually a spell with the Open University Business school MBA course that helped me to get to grips with my expanding and floundering business.

VT was a great idea but it came after my time. There was something to be said for my ad-hoc, buffet style of learning but I know I could have done it a lot better with a mentor. However VT / FD is facing major problems. Many good trainers have been forced out of a pile high / sell cheap system regretting the regular opportunity to pass on their skills and experiences but unable to square the commitment with the imposed system. The majority do not do it for the money, those who have done are left disappointed and their trainees disillusioned.

New graduates and young dentists face a changing world and it’s about time we looked to the future with a clean slate instead of reacting to the present. The department of health / NHS has responsibility for postgraduate training. The NHS is falling apart and has never taught dentists, dentists teach dentists. Is dental education really one of their priorities?

No other profession has such a poor career pathway. It’s not going to happen unless some enlightened and altruistic dentists make it happen. An independent VT system is an idea whose time has finally come. The last time it was mooted there was some enthusiastic support but the project was savagely crushed under the jackboots of Whitehall.

To take Covey’s axiom and start with the end in mind, what skills will a dentist require beyond 2030? How can these skills be learned? How can the very best be encouraged to deliver the very best care that they can and to properly lead skilled teams?

Here’s what I am starting to see in the switched-on practices. The principal has a set of values and standards that they share and instil in their associates. They help the associates to build a rolling personal development plan where, over a period of three years or so, they not only attend courses that will educate, enthuse and encourage them but also are able to put those new ideas and skills into practice. The idea is to provide a bedrock for their next 20 or more years and to imbue good habits. The associates earn reasonably well, possibly less than they would delivering UDAs but they work with great support staff, the pressures they will feel are the ones associated with doing a good job and they have no quotas to fill.

They routinely visit and observe specialists working and take part in routine, non-judgemental two-way appraisal / audit sessions. If they find that they want to pursue a further qualification they are encouraged. In addition they are shown the workings behind the practice so that they are able to understand how a successful dental business functions. Their communication and leadership skills are developed and enhanced.

How would it be if these Private trainees were able to rotate through say, 4 to 6 practices, over a three year period not unlike a registrar system and were expected to embark on a Masters degree during the latter part of their training?

There is an irony here in that the “corporates” would be better placed to provide such a system; there would be the opportunity to provide different practices for their trainees to work. Sadly they are mostly wedded to shareholder value, concentrating on servicing NHS commitments in an environment which does not encourage excellence - in spite of what they say.

So what’s going to scupper this?

•   Failure to ensure this is a win/win/win trainees/trainers/patients.

•   Egos.

•   Involvement of medical educationalists.

•   No long term plan.

•   No leadership.

•   Allowing the NHS within a hundred miles of this idea.

•   Not enough people with the vision to make it real.


Now who’s going to run with it and safeguard the future?


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Recent Comments
Ian Gordon

Let's rescue what we have

Alun. Excellent article. I have been involved with VT since 1990 , as a Trainer 13 time , as a VT Advisor for 7 years and now as ... Read More
Thursday, 13 April 2017 09:18
Alun Rees


Hi Ian Thanks for taking the time to respond. I think we're in agreement about most things. The problems that you describe are par... Read More
Friday, 14 April 2017 07:13
Ian Gordon

In defence of Corporates!

Thanks Alun. You are of course right that not all Corporates/groups are the same - but from time I have spent with CEOs and CDs of... Read More
Friday, 14 April 2017 08:13
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“A high quality learning pathway”

A high quality learning pathway

“I was keen to take the Inman Aligner training course after attending an inspirational lecture by Dr. Tif Qureshi on ‘Align, Bleach and Bond’ at the FGDP,” says Dr. Rima Patel, who works at dental practices in Crystal Palace and Carshalton.


“Associates in both practices I work in had previously attended and begun offering the appliance to their patients – so there were always enquiries about it. I wanted to develop my skills, in order to also be able to offer patients what they wanted, rather than having to refer them to a colleague.


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To discover what you could learn, contact the friendly IAS Academy team today.


For more information on upcoming IAS Academy training courses, including the Inman Aligner,

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‘A very impressive course’ – from the IAS Academy

A very impressive course – from the IAS Academy

Dr. James Tinning of Pinfold Dental Practice, Cheshire took the London Inman Aligner hands-on training course.

“Following a seminar I attended presented by Tif Qureshi, I quickly realised that being able to offer patients the Inman Aligner system would be a great skill to add to my armamentarium.


“The course was excellent and very impressive – not only an informative and interesting day, but also a really enjoyable one as well. Instructors Tif Qureshi and James Russell were very professional and they were happy to spend time discussing potential cases.


“The appliance itself is very simple to use in practice and I have been able to use both the online support forum and help from NimroDENTAL laboratory to develop my knowledge of the Inman Aligner and treating more complex cases.


“I was impressed by the IAS academy hands-on training course and I would definitely recommend it to other colleagues.”


Committed to providing the highest quality of training and support, IAS Academy runs courses for the Inman Aligner, ClearSmile Aligners and ClearSmile Braces. To find out more, contact the team today.



For more information, go to, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 0845 366 5477.

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UCL Eastman Dental Institute - Restorative Dental Practice MSc

Time is running out to register for our Restorative Dental Practice MSc - to start this programme in January 2016, you must complete your application by 16 October 2015. Find out more>>

This part-time, four-year Master’s programme enhances students’ ability to provide high-quality and comprehensive restorative management for the majority of patients. Students are able to assess, plan and provide quality treatment at an advanced level, forming a sound foundation for the restoration or rehabilitation of a compromised dentition in their own clinical practice.

The programme is delivered through seminars, lectures and practical sessions in state-of-the-art skills laboratories, providing a highly supportive learning experience. Assessment is through practical, clinical and oral examinations including written papers, presentation of clinical cases and a dissertation.

Graduates use the qualification to improve their prospects of moving to better dental practices, setting up their own dental practices, progressing to full-time Master's programmes and Specialty Training, progressing to PhD level, and developing careers in teaching

Year One: two taught modules, 60 credits, exit with Postgraduate Certificate. There are 28 contact days in Year One, including a compulsory induction and enrolment day on 6 January 2016.

Years Two and Three: four taught modules, +60 credits, exit with Postgraduate Diploma. There are 12 contact days in each year.

Year Four: dissertation, +60 credits, exit with MSc. There is a short (three-to-four day) preparatory course at the beginning of Year Four.  Thereafter, students undertake a self-directed research project during Year Four.


UCL Eastman Dental Institute is the largest postgraduate dental school in Europe and has a reputation as one of the world’s leading academic centres for dentistry. As part of UCL – London’s Global University – the Institute welcomes UK and international students.

With a focus on translational research, postgraduate education and training, the Institute offers a wide range of study opportunities – Master's degrees, specialty training, certificates, diplomas, research doctorates and CPD courses – from its twin sites in central London. Find out more on our website>>


CPD Survey

Do you think CPD is valuable to you? Are you interested in having your say on CPD? Then you will be glad to know UCL Eastman is carrying out a nationwide survey to find out your views on the current state of CPD.

If you have an opinion and wish to complete the online survey visit

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