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Articles of Interest
Here are a selection of articles written by Dr M K
Vasant, which were published in professional dental journals.
FACE
TO FACE WITH MANNY VASANT
Independent Dentistry March 1999 |
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Kathryn
Thomas RDN, Dip DHE, is currently combining
running a dental practice management consultancy
with working as practice manager in a wholly
private single dentist practice in Limpsfield
Chart, Oxted, Surrey. She also lectures throughout
the UK and abroad to postgraduate dentists
and memebers of support teams on all aspects
of achieving success in practice.
Manny Vasant, one of the first
holders of the new fellowship in general dental
practice, explains to Kathryn Thomas why he
was motivated to take the new diploma offered
by the faculty of general dental practitioners. |
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In February 1998, 11 dentists were the first in the UK
to be successful in gaining the Faculty of General Dental
Practitioners' brand new diploma - the Fellowship in General
Dental Practice or FFGDP (UK), as it is to be known.
In this article, we
learn from one of the brave 11 precisely what motivated
him to take this examination, what it has done for
his practice and patients, and exactly why the Faculty
felt there was a place for one more diploma.
Manjul (Manny) Vasant is the principal of a practice
with four dentists and one hygienist in Norbury,
South London. He graduated in 1972 and went on to
obtain the US Board Examination and the New York
State Licence Examination in 1976. He is an ex-board
member of the Faculty of General Dental Practitioners.
His current positions include serving as a regional
adviser in General Dental Practice for the University
of London, and as a vocational training organiser.
He is also an examiner for MGDS and DGDP (Emeritus),
and he works as a staff dentist at the Mayday University
Hospital. In addition to these duties, he finds
time to sit on numerous committees. |
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| Another
success as Manny Vasant reaches Gilmans Point
on Mount Kilimanjaro |
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Why, then, does someone as busy as this, with an abundance
of commitments, and with double MGDS (England and Edinburgh)
choose to spend hundreds of hours in pursuit of more letters
after his name?
I was lucky enough to find a window in Manny's hectic
schedule to pose some questions.
Kathryn: Manny, you already have a successful,
busy practice and your existing qualifications reflect
your commitment to continued learning. Why put yourself
through what has been described as a 'baptism of fire'
and take yet another examination?
Manny: This is a familiar question! Interestingly, I went
to climb Mount Kilimanjaro a few weeks ago and the African
guide posed a similar question when he asked what people
- mostly Europeans, Americans, and Japanese - get from
this self-torture. In my case, I wanted to prove to myself,
if not my wife, that, at nearly 50 years of age, I can
still do it!
I suppose, in terms of the Fellowship, yes, it could be
considered an ego trip, but, after MGDS, I felt lowed
it to my patients to continue to maintain the standards
that I was able to attain then. In other words, the MGDS
confirms that you can do it, and the Fellowship, on the
other hand, assures that you do do it. Also, having been
actively involved in the Faculty and in the machinery
of standard setting, I felt it was appropriate to offer
myself for the test.
| The
official certificate point at Gillmans Point |
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Just to digress for a moment were you successful in your
attempt to climb Mount Kilimanjaro?
Yes, I'm pleased to say I also got that certificate this
year too. I made it to Gilmans Point - the officially
recognised summit point. I hasten to add that doing the
FFGDP (UK) is probably much safer!
So, tell me, around what stage in a dentist's
career would you suggest taking this examination?
Well, let's assume the current Vocational Training will
progress to General Professional Training in the very
near future. It would be very nice to summate this with
a Diploma in General Dental Practice - renamed Membership
in General Dental Practice (MFGDP). Membership in General
Dental Surgery (MGDS) is an established gold standard
in clinical practice and, quite appropriately, is not
available until five years after qualification to allow
enough time for polishing one's skills. This will give
certain exemptions from the clinical components of the
FFGDP. As I said earlier, the latter will confirm that
you have not only attained the gold standard, but you
also have the fabric and structure to enable you to deliver
that standard of care.
Manny, a large part of the examination seems to
revolve around something called 'Manual of Care' - can
you explain what this is?
This is now called the 'Portfolio of Evidence'. It is,
in fact, a living workbook that explains the structure,
process and outcome of everything that affects patient
care in practice on a day-to-day basis. There are some
20 sections that fundamentally encompass the Donabedian
concept of structure, process and outcome, each of which
measures quality of care. Each section has clearly laid
down criteria and evidence required to satisfy these criteria.
This makes it very user friendly and the bottom line is
that really you can't fail as such you or your mentor(s)
have as much time as you like to get it right before you
take the plunge - and you know exactly what is required
to get it right. This Portfolio of Evidence is obviously
a dynamic document that is updated on a regular basis
to comply with current good practice.
Let's take one of the areas of the Portfolio
of Evidence - the section on staff training, for example
- can you give me an example of how you satisfied the
criteria for this section?
Oh, yes! This is my pet subject and was by far the easiest
task for me. As it happens, we have in place a very practical
staff training system. Allow me to show you the various
manuals we use for this.
Our staff manual is very comprehensive, as is our manual
on system operating procedures. Essentially, these manuals
tell us how to do things. I'm sure most practices have
similar manuals, but the question is how to get the staff
to read them - and this is where we scored. Together with
my associates and senior nurses, I produced a 'Practice
Development Portfolio'. Each member of staff is given
a copy to keep. The manual is divided into five modules,
with each module consisting of about 20 questions. Every
new member of staff is required to answer the questions
at home in their own time, using the manuals when necessary.
The emphasis is on learning a task rather than just regurgitating
an answer. Staff are required to submit their answers
to two people drawn from senior nurses, associates or
hygienists in the practice, at which time they may also
be asked to perform some practical tasks such as generating
a recall on the computer or mixing a dental material.
The modules for new staff must be taken at intervals of
one, three, six, 12, and 18 months and each module earns
a practice certificate that has pay rises and certain
other benefits attached to it - these are the incentives!
Involving staff at different levels gives them control
of their own progress. When they have completed the five
modules successfully, they are encouraged to sit the National
Examination for Dental Nurse!
It sounds like quite a lot of work! Your practice
has a large NHS component. Is it really possible to attain
these standards under the present fee structure?
I think it would be misleading I were to say it isn't
a lot of work. I would also not be telling the truth if
I said the NHS fee scale would keep a practice afloat.
However, of the two new cases that I had to present for
the assessment, one was, in fact, an NHS case. Also, if
you have all the systems set in place, you will make the
practice more efficient and productive anyway.
I think the current climate shows practices are changing
patients are beginning to appreciate quality and are opting
to have certain treatments done privately. This is very
encouraging and attaining the Fellowship is a positive
step towards reassuring patients of the quality of care
they can expect. - it's akin to the ISO 9002 in industry.
We need to aim for the highest levels of quality care
and never budge from this - let the patients or the politicians
find the money to pay for the high standards.
How do patients know that you have this diploma?
In an ideal world, it would be nice if the national press
listed the names of dentists who have not undertaken any
peer review, but this is not feasible! More seriously,
though, this is where the FGDP needs to do some work.
I am hoping that in due course, Which? and other
magazines would pick up on the meanings of these diplomas.
Perhaps the FGDP may be able to suggest a press release
for those awarded the diploma and the recipients can then
use the publicity to promote their practice.
What was the most challenging aspect of the assessment?
And what advice would you give to anyone thinking of taking
this step?
I have to say that the clinical module was probably the
most challenging part. In theory, it is possible to approach
this examination without having attained the MGDS first.
To my mind, this would be foolhardy and frustrating, except
for a select few who may be exempt from some of the clinical
modules by virtue of their other postgraduate qualifications
approved by an appropriate committee. But, for the vast
majority of people, it would be sensible to attain the
MGDS first, get exemption from these and then undertake
the Portfolio of Evidence, clinical audits and interpersonal
skills components which form part of the FFGDP assessment.
You were a kind of guinea pig, as well as one
of the architects of the assessment. How different is
the subsequent exam going to be?
I think it is fair to say that, as assessors, we were
required not simply to design a suitable assessment for
later use, but we were required actually to live it. We
tried many different things and some assessments proved
too time consuming. However, every stage was monitored
closely by the Faculty Board and an independent chairperson
so, in fact, we ended up doing more than is required by
the syllabus that was finally decided upon.
I understand that people who have been awarded
the diploma will now act as mentors for future candidates.
How does this work?
It's a sort of buddy system, where a candidate is teamed
up with an assessor who provides support, advice, and
a degree of hand-holding. A reasonable amount of encouragement
is given as the process develops.
The aim is for the mentor to be with the candidate every
step of the way. They will usually meet at the candidate's
practice where the mentor will offer practical recommendations
on how the candidate can best achieve the goal.
Would you say that it has been a positive experience
for you and your patients?
Yes, definitely. Apart from my own huge sense of achievement,
I think it has really improved the way in which the practice
is run and I hope it is reflected in improved patient
care. So much time is saved by having a properly structured
system of management within the practice, where each member
of staff is quite clear about his or her role. We were
reasonably well organised before, but the Portfolio of
Evidence made us more focused and more critical.
So, what's next?
Very shortly we'll be moving premises. This will enable
me to put in place many of the things that I think are
important in terms of the fabric of a practice. And I'll
still be involved in assessment, albeit on the other side
of the table this time! My son is going into dentistry
so no doubt there will be some mentoring to be done on
that front too.
Manny, thank you for your time.
You're welcome - I just hope that some people reading
this will be encouraged to do what did and take the plunge.
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