By Dr. Tahera Ayub
Re-licensure a new word in Pakistan but it is used in the West, particularly in the States, United Kingdom and Canada, when one wishes to practice in developed countries. Without it, no one is authorized to work, let alone hold any faculty position in dentistry. So what is re-licensure all about?
Re-licensure is renewal of licence to practice officially. PMDC registration is the licensing issuance body in Pakistan, once certain minimum basic competency has been achieved by graduate who have already acquired Certification from Universities. Licensing & Certification is one of the ways to assure society that Dental Surgeon entering practice has the profession’s basic minimum requirements for knowledge, skills, behavior, and judgment, which, for the sake of brevity, we call competency.
Mandatory continuing education (CE) is a major factor in re-licensure, being licensed to practice for a specific period with the license either being renewed at the end of that period or being forfeited, in the United States. Since 1969, an increasing number of state dental boards require dentists to complete a defined number of CE hours (30-50/ yr) preference of the state as a precondition for re-licensure.
Continuing Professional education (CPE) or Continuous Education (CE) is the means by which people maintain their knowledge and skills related to their professional lives. This is postsecondary education method.
Almost all of the estimated 173,574 professionally active dentists in the US are required to earn a specified number of new CE credits every one to three years-depending upon the state in which they practice. Currently 47 out of 50 states in which they could practice have some requirement for CE in order for them to maintain their licenses; Colorado, Wisconsin and Wyoming do not, although the latter does require dental professionals to have basic life support certification.
Pakistan, however, has no criteria set for re-licensure. A dentist working in Pakistan works in a clinical practice and has all the freedom to do so as long as he wills without the need of acquiring further education, or, as west puts in, continuing education.
There are number of ways to earning CE and the recent to join the lists are the computers and internet. Steps on improving the quality of computer-based methods are being carried out in USA. Though computer-based instruction is a work in progress, many states in US have already implemented it among the activities to qualify for CE hours.
Pakistan, being the sixth largest population of the world, and according to PMDC statistical data of September 2012, it has only 11372 registered General Dental Surgeon and 913 Specialist Dental Surgeons. According to the world statistics 2012 released by WHO, Pakistan has less than one Dentist (0.6) per 10,000 Population. Neighbouring country India has a total 51,012 registered Dentists although it is far less figure to provide Dental services to their huge Population. Despite of lack of renewal of license in India, Indian Dental Association is maintaining CDE programmes for continuing dental development, so that dental fraternity remain with up to date knowledge and skills. Developed countries, like UK, have 5.3 Dentists/ 10,000 population and Greece have 13.2 Dentists/ 10,000 population.
Monitoring & Controlling of Pak Dental Surgeons should not be a big issue as being so small a population of dentists in the country, However, question arises as to who will assure and monitor for Continuous Education in Pakistan , as consensus the so many issues has never been made. PMDC or PDA, HEC – who will be responsible for Clinical and Non clinical CE regulations? There are various questions that the Governing Dental bodies owe to the practitioners.
At present, there is no Dental Regulatory Authority/Licensing body in Pakistan to monitor the license of general practitioners. Hence, the growth of quacks is sporadically increasing in most of the cities in the country. The low literacy rate in the Pakistan, combined with raising inflation, is discouraging the individuals to continue education and making the continuing education mandatory for the purpose of re-licensure would mean there may be scarcity of general practitioners in the future.
Generic quality for all Professional is competence, including relationships with patients, teamwork, participation in continuing professional development, and a commitment to maintaining performance alongside the traditional competence in diagnosis, management, and practical skills that make up good clinical care. Which is lacking in some part of Pakistan because of the lack of continuing education for Professional .
Regulatory bodies have to take certain steps to improve quality patient service by dental community and to start with Mandatory CE would be the possible effort. Starting with 30hrs/year for CDE may be a crucial step by them. Registered Dental Surgeons are not that huge figure practicing yet in Pakistan to have difficulty in occupying them for earning Mandatory CDE – points. Guideline should be formed for the possible mediums for obtaining CE like, Presenting Scientific Paper, on-site Courses, Attending Multidisciplinary Symposiums, Presenting Posters, Table Clinic, Publishing journal; Writing books or chapters in the book and Independent Study Courses including Distant Learning through Computers. Attending Dental Board meetings, Association & Dental Society meetings, Organizing Clinical & Nonclinical events for Dental Professionals all should be considered for CE.
Identification of accrediting bodies is essential and once the importance of continuous education is delegated among all Dental professionals through that body. Courses should be organized in every province of the country keeping in mind easy access for all GDPs, then the future step for re-licensure is advisable in Pakistan .
The writer is an Assistant Professor, Department of Maxillofacial Surgery, Liaquat College of Medicine & Dentistry, Karachi.