House of Commons - Innovation, Universities, Science and Skills Committee

Students and Universities - Innovation, Universities, Science and Skills Committee Contents

Memorandum 71

Submission from the British Dental Association

INQUIRY INTO STUDENTS AND UNIVERSITIES

1. The British Dental Association (BDA) is the professional association and trade union for dentists practising in the UK. Its 23,000-strong membership is engaged in all aspects of dentistry including general practice, salaried services, the armed forces, hospitals, academia and research and students.

EXECUTIVE SUMMARY

2. The current system of admissions to dental courses in the UK relies heavily on academic achievement. This can negate the importance of skills and abilities vital to a successful career in dentistry, such as communication skills and dexterity. Some attempts to move away from admissions based exclusively on academic performance have been made, and these must be developed further.

3. There are significant pressures on the balance between teaching and research in dental academia, not least the competing pulls of the academic institutions and the NHS organisations that employ staff. To maintain quality in both fields it is important that teaching and research do not become divorced from one another. Ensuring a supply of high quality applicants wishing to undertake dental academic careers is vital to this.

4. Degree classification could be subject to change because of the proposed two-cycle structure, which would lead to a Bachelor degree to be awarded after three years and a Masters degree to be given after the final two years. If any changes are to be made, it will be important that the impact of the different funding streams at different stages of dental qualifications in the UK is properly considered.

5. Funding for dental students has been the subject of change in recent years, with the parental income threshold for qualification being altered. The BDA's own 2008 Student Debt Survey demonstrates that students on dental courses are incurring significant debts as a result of loans and relying heavily of parental contributions to allow them to complete their courses.

ADMISSIONS

6. Dentistry remains a popular career choice for many university applicants and selection for dental courses is challenging[219] with a ratio of eight applicants per dental place. 1,195 students began courses in dentistry in October 2007.[220] Basing judgments of students' suitability for dental school solely on educational attainment, such as A-levels, is proving difficult as an increasing number of candidates for dental schools are achieving the highest grades possible. Futhermore, evidence suggests that educational attainment is not a good predictor of the future ability of dentists. A study conducted by St Georges Medical School (University of London), found that following their adjusted criteria admission scheme, "students from poor-performing schools who are accepted with lower grades do just as well as their higher-grade peers".[221] It is clear that an admissions procedure which relies on educational attainment alone, neglects significant potential talent.

7. At present, UK dental schools select students using a combination of academic achievement, cognitive behaviour testing (UKCAT[222]), personal statements which indicate personal motivation and background knowledge of dentistry (such as work experience) and face-to-face interviews. Such stringent selection procedures are essential to ensure that students will be capable not only of academic success, but also of assuming professional responsibility for the treatment and care of patients early in their university careers.

8. The value of cognitive behaviour tests, which are used by admissions departments in many UK dental schools, is undermined by their limitations. For example, such tests are unable to assess dexterity, a particularly important skill for future dentists. In 2007 the BDA raised concerns about the UKCAT system and the validity of tests as a tool for admission to dental school. It remains unclear as to the validity of the scheme as UKCAT data will not become available for assessment until the initial phase of research has been conducted by UKCAT Board.[223] The BDA is also concerned that UKCAT Board member, Professor Chadwick, reinforces such criticism by stating, "we currently do not select students—rather restrict entry".

9. In order to educate the future generation of dental professionals, dental schools must have the flexibility to recruit the best students, rather than having to rely on the comparison of educational attainment across a particular cohort or adopting quotas or financial incentive systems that are counterproductive and restrict high quality candidates from accessing courses in dentistry.

WIDENING PARTICIPATION

10. HEFCE's Strategic Plan for 2006-11 details the commitment to ensure that funding is available for the Government's widening participation initiatives.[224] In response to these initiatives, many universities are forming partnerships with local schools and further education colleges. Admission to dental school can then be based on a suitable combination of academic merit or through studying at a partner college.[225] The BDA is therefore concerned that students who do not study at colleges partnered with dental schools may face greater barriers to entry, should they wish to apply for dentistry courses.

11. In addition, studies have shown that many students choose to study at a university close to where they live, which can be a result of finance, social networks or cultural background.[226] In England there are only 12, dental schools, three graduate entry and nine undergraduate schools, therefore the choice of institutions is relatively limited. Given that students increasingly wish to stay at home whilst studying,[227] the opportunity to study dentistry can be restricted. This creates the risk that many high quality candidates may not even submit an application, thereby denying the profession future talent.

12. Candidates applying to dental school must pay for the UKCAT test and receive reimbursement for the cost. In addition to the cost of UKCAT testing, attendance/travel to interviews is also perceived as being a barrier to applicants, even though financial support is available those from lower socio-economic backgrounds.

13. The BDA is concerned that the above factors all serve to undermine the ability of dental schools to recruit the highest quality candidates from a wide background. Accountable, transparent and flexible admissions procedures are needed to ensure student confidence in the application process.

STUDENT SUPPORT

14. In 2007 the Government announced financial incentives, designed to recruit students from lower socio-economic groups and increase financial support for those students with a parental income of between £17,500 and £60,000 per annum. This was to support the widening particpation agenda. It was estimated that one third of students would qualify for a full grant and one third for a partial grant. However, in October 2008, the Government cut the total funding available to students by restricting access to grants by reducing family income to qualify for a grant from £60,000 to £50,000 per annum.[228] A statement by John Denham, Minister for the Department for Innovation,[229] Universities and Skills revealed that 40% of students had in fact qualified for the increased student support (full grant) in 2008-09 rather than the predicted, 33%.[230]

15. Evidence gathered by the BDA 2008 Student Debt Survey shows a dental student completing a standard five year degree, graduates with debt of approximately £24,860 and a quarter of students accumulating debt of over £30,000. This is significantly higher than other students attending university undertaking non clinical courses.

16. At the time of the 2007 government announcement on incentives the Institute for Fiscal Studies (IFS) criticised the move for not supporting those students coming from families which live below the £17,500 threshold. The IFS has further argued that investing in improved school results was preferable to increased subsidies for students.[231] The BDA would like to see those high calibre students in the lowest socio-economic background, those with parental income under £17,500, be given full access to the opportunity of dental school as well as reintroducing support for those in the £50-£60,000 bracket. The dental profession requires high calibre students regardless of socio-economic background in order to produce high quality graduates.

17. The BDA is concerned that high student debt on graduation along with the recent reversal by the Department, will seek to prevent many students entering higher education and in particular dental school.

THE BALANCE BETWEEN TEACHING AND RESEARCH

18. UK dental schools have a long history of excellence and innovation in both teaching and research. The quality of undergraduate dental education in the UK is monitored through the Quality Assurance Agency (QAA) and the General Dental Council (GDC).

19. Dental schools face considerable challenges in maintaining an appropriate balance between the expectations of their host universities (particularly with regard to research); their NHS commitments to deliver clinical services; and education of dental students.

20. Dental clinical academics are obliged to maintain a commitment to treating patients within the NHS as a practicing clinician, alongside teaching responsibilities and academic research. The "triple threat"[232] often results in conflicting interests and pressures being placed on clinical dental academics to stratify the three masters of, research, clinical provision and education. Currently there are particular difficulties with the recruitment of dental clinical academics because of the pressures on time as a result of NHS commitments (including postgraduate supervision and training of junior clinical staff) and university organisational changes to maximise output such as the metrics required for Research Assessment Exercises. There is a serious risk that these pressures may cause lasting damaging to UK dental research with undergraduate teaching increasingly being undertaken by dental teachers who are not engaged in academic research. With the recent 25% increase in dental undergraduate students and the opening of three new dental schools, this has exacerbated the pressures on the few dental academic staff. Dental schools have been recruiting "new" staff from existing dental schools rather than new dental academics. Despite the additional new schools and increased student numbers the DSC[233] survey shows only minimal change in overall staff numbers.

21. Research has shown that an ideal staff to student ratio is six to one, as dental undergraduates routinely perform irreversible surgical procedures on the general public. Many schools are struggling to achieve this supervision ratio and this places additional pressures on staff and potentially places patients at risk.

22. The BDA is concerned that this trend in reduced staff to student ratio will adversely impact on the dental curriculum.

23. There is a lack of applications for dentists entering academia as a career, essential for the future of academic teaching and research. There are significant financial differences between academic salaries and of those in general practice. However barriers to recruitment are not always financial. Experience is vital in securing a clinical academic post and those who do not gain this experience early in their career find it difficult to enter academia. Studies have also shown that students perceive an adverse relationship between effort and reward in careers in academia compounded by a lack of career advancement and poor advice available on academia when choosing career paths. In 2008 the Dental Schools Council also highlight the gender imbalance noting that females were under-represented in dental academia and as part of this it is vital that the issue of female under-representation is addressed.[234]

24. Recruitment and retention of staff is vital as the current pool of clinical academics continues to decline.

DEGREE CLASSIFICATION

25. The BDA supports a transparent Higher Education Academic Record for students using degree descriptors to demonstrate competency. This would assist the transition to vocational training, revalidation and life-long learning. However, there are problems with implementing a number of the Bologna initiatives within dentistry such as portability across the EU area. Due to the varied nature of the dental curriculum and its delivery, it would be too easy for a "mobile" student to miss vital parts of the curriculum as very few dental schools have identical curriculum structures.

26. The BDA would welcome the adoption of the dental degree at Masters level. The QAA already recognises that the current BDS degree is at Masters level, although consideration must be given to the adoption of either a single or a two stage course. In the UK, funding would become an issue as HEFCE has recently reduced finance for Equivalent or Lower Level courses.

STUDENT DEBT

27. The current system of student support available to dental students is overseen by two Government Departments. The Department for Innovation Universities and Skills oversees student support for the first four years (first year for a graduate entry course) of an undergraduate dental degree by way of Student Loans. The Department of Health oversees the NHS Bursary Scheme in year five onwards (years two to four of a graduate entry course). When students reach either year five of an undergraduate degree or year two of a graduate entry degree, the Department of Health NHS Bursary pays the tuition fees for all medical and dental students and offers a reduced rate loan and a means-tested bursary. As discussed above the 2008 BDA Student Debt Survey[235] demonstrates that a dental student completing a standard five year degree, graduates with debt of approximately £24,860 and with a quarter with over £30,000.

28. Research by Staffordshire University has shown that students from lower income families are more likely to be put off higher education by potential debt. Such high levels of debt for dental students upon graduation may well deter the debt averse. In 2008 82% of dental fifth year students had received financial support from their parents and the average parental contribution was £18,320. In terms of financial profile, this is a worrying development as this does not necessarily reflect parental income levels in relation to parental contribution. If this is considered in terms of the 2004 BDA Student Debt Survey, the results show that parental income to parental contribution is not necessarily in proportion. 73% of fifth-year students questioned in 2004 had a combined parental income of below £60,000 the figure by which the Government set the 2008-09 threshold for financial support eligibility.

29. Within UK dental schools, there is a low rate of attrition however this has a major workforce implication. Dentistry is a vocational course and, unlike many other standardised degree courses, a graduate's career path extremely likely to be within dentistry. On qualification, UK graduates undertake a year of Vocational Training and all dental practitioners undertake continuing professional development (CPD). The Department of Health must understand the necessity for effective workforce planning to ensure that there are adequate work places available for those graduating and as such the proposals for effective workforce planning under Medical Education England have clear potential. Dental students can only practise dentistry at the end of the course, so projected workforce figures which take five or six years to manifest must be robust and fit for purpose. A shortfall between projected and actual workforce figures would see subsequent implications for the both the population and public finances.

30. In 2009 a review of variable fees will take place[236] and it is vital that all the implications of such a review are considered. Any removal of the upper cap on fees for "home" dental students will have ramifications on the student profile, an impact upon the funding system across the two Government departments and ultimately affect the future dental workforce.

STUDENT ENGAGEMENT

31. It has been observed that "students tend to be more demanding of their university than 10 years ago",[237] a view reinforced by the findings of HEFCE, following the 2006-2007[238] introduction of variable tuition fees. Students are now seen as consumers who are more financially aware and demand value for money and high quality educational experience. The National Student Survey conducted by HEFCE across the university population seeks input directly from the student, the consumer. With an average response rate of over 50% of the student population[239] the view of the student is paramount. The student survey has been a success in seeking the opinions of students within the dental school but variable results across dental schools show that time will be needed to adjust to this system.

CONCLUSION

32. We urge the committee to consider the points we have raised and in particular the key issues of concern for both dental students and clinical academics:

— The difficulties clinical academics face in maintaining an appropriate balance between teaching, NHS clinical practice and research

— Difficulties in recruitment and retention of clinical academics to the triple threat of research-teaching-clinical provision and the increase in dental students and dental schools

— Student debt and student experience of students undertaking demanding and extended vocational training.

ORAL EVIDENCE

33. The BDA would be pleased to give oral evidence to the committee if it would be helpful to the inquiry.

December 2008

219 Nicholson, S. (2008) Emerging trends in admissions. European Journal of Dental Education. Vol 12 No 3 p194-195 Back

220 Ibid Back

221 Ramrayka, L. (26/11/2008) Opening up the playing field. The Guardian Back

222 United Kingdom Clinical Aptitude Test Back

223 UKCAT Board (2008) Annual Report 2006. Back

224 HEFCE (May 2008) Strategic Plan 2006-11. Back

225 Attwood, R (20 Nov 2008) No awards for equity. Times Higher Education. Pp.30 Back

226 Davies, P,. Slack, K,. Hughes, A,. Mangan, J,. Vigurs, (2008) Knowing Where to Study? Fees Bursaries and Fair Access. Institute for Educational Policy Research and Institute for Access Studies. Staffordshire University, UK Back