Diploma of the Faculty of Dental Surgery (MFDS) Professionalism, Ethics, Law and Practice Governance Syllabus

Explain the 'Bolam' and 'Bolitho' tests in the context of negligence.

Bolam (1957): a clinician is not negligent if their actions are supported by a responsible body of skilled professional opinion. Bolitho (1997) qualified this: the body of opinion must also be capable of withstanding logical analysis (it must be reasonable/logical), so courts can reject a practice that is illogical.

Distinguish between the roles of dental indemnity and the purpose of indemnity cover.

Indemnity (via a defence organisation or insurance) provides professional protection and financial cover for claims of clinical negligence, plus support for GDC investigations and complaints. Holding adequate and appropriate indemnity is a legal requirement (Health Care and Associated Professions Order / GDC registration condition) for all practising dentists.

What is 'Gillick competence' and what does it allow?

Gillick competence (from Gillick v West Norfolk, 1985) is the principle that a child under 16 can consent to their own medical/dental treatment if they have sufficient maturity and intelligence to fully understand the nature, purpose and implications of the proposed treatment. A Gillick-competent child can give valid consent without parental involvement.

What are the 'Fraser guidelines' and how do they differ from Gillick competence?

The Fraser guidelines specifically relate to providing contraceptive/sexual health advice and treatment to under-16s without parental consent. Gillick competence is the broader test of a child's capacity to consent to any treatment. Fraser guidelines are a specific application; Gillick is the general competence principle.

In England, can a Gillick-competent child's refusal of treatment be overridden, and by whom?

Yes. While a competent child can consent, a refusal of treatment by a person under 18 can, in England and Wales, be overridden by someone with parental responsibility or by the court if the treatment is in the child's best interests. (This differs from a competent adult, whose refusal cannot be overridden.)

What are the five statutory principles of the Mental Capacity Act 2005 (England & Wales)?

(1) Presumption of capacity; (2) individuals must be supported to make their own decisions; (3) an unwise decision does not itself indicate lack of capacity; (4) anything done for someone lacking capacity must be in their best interests; and (5) the least restrictive option of their rights and freedoms must be chosen.

State the two-stage test for assessing mental capacity under the Mental Capacity Act 2005.

Stage 1 (diagnostic): Is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional): Because of that, is the person unable to understand, retain, weigh/use the relevant information, or communicate their decision? Inability in any one of these means they lack capacity for that specific decision.

Define 'clinical audit' and state its core purpose.

Clinical audit is a quality-improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit standards (criteria), followed by the implementation of change. Its purpose is to measure current practice against best/agreed standards and improve it.

List the stages of the audit cycle in order.

(1) Identify/choose a topic and set standards/criteria; (2) measure current performance (collect data); (3) compare results against the standard; (4) identify changes and implement them; (5) re-audit (close the loop) to assess whether practice has improved against the standard. It is a continuous cycle.

What is the difference between clinical audit and research?

Research aims to generate new generalisable knowledge and discover the right thing to do (hypothesis-driven, often requires ethical approval). Audit measures whether existing best-practice standards are being met and seeks to improve local care; it does not generate new knowledge and generally does not require ethical approval.

What is 'significant event analysis' (SEA)?

SEA (significant event audit) is a structured, reflective process in which an individual case or event — adverse, near-miss or notable good practice — is examined in detail by the team to learn lessons, identify what went well or wrong, and implement changes to improve patient safety and care quality.

Outline the typical steps of a significant event analysis meeting.

(1) Identify and describe the event (what happened); (2) gather and analyse the facts; (3) explore why it happened (contributory factors); (4) decide what can be learned; (5) agree and implement an action plan with changes; and (6) follow up/review the outcome. The approach should be a no-blame, systems-based learning culture.

Define 'risk management' in the dental setting and name two proactive tools used.

Risk management is the systematic identification, assessment and control of risks to patients, staff and the practice to reduce the likelihood and impact of harm. Proactive tools include risk assessments (e.g. COSHH, fire), checklists, significant event analysis, incident reporting systems, and audit.

What is the 'Swiss cheese model' of accident causation in patient safety?

Reason's Swiss cheese model depicts system defences as slices of cheese with holes (latent and active failures). An accident occurs only when the holes in successive layers momentarily align, allowing a hazard to pass through all defences. It emphasises a systems approach rather than blaming individuals.

Distinguish between 'active failures' and 'latent conditions' in patient safety.

Active failures are unsafe acts (errors or violations) committed by people at the 'sharp end' with immediate effect (e.g. wrong tooth extraction). Latent conditions are underlying systemic weaknesses (e.g. poor design, understaffing, inadequate training) that lie dormant and predispose to error.

Define 'clinical effectiveness' and 'evidence-based dentistry'.

Clinical effectiveness is the application of the best available evidence to ensure that interventions do what they are intended to do — maintain and improve health and secure the greatest benefit. Evidence-based dentistry integrates the best current research evidence with clinical expertise and the patient's values/preferences.

What does CPD stand for, and what is the GDC's enhanced CPD requirement (hours) for dentists over a 5-year cycle?

CPD is Continuing Professional Development. Under the GDC's enhanced CPD scheme, dentists must complete a minimum of 100 hours of verifiable CPD over a 5-year cycle, with no more than a 2-year gap (and a minimum of 10 hours in any 2-year period). Dental care professionals have differing totals (e.g. 75 hours for many DCPs).

List the GDC's recommended CPD development outcomes / highly recommended topics for dental professionals.

Recommended topics include: medical emergencies (recommended ~10 hours per cycle), disinfection and decontamination, radiography and radiation protection. Other recommended areas include legal and ethical issues, complaints handling, oral cancer detection, and safeguarding.

What is the hierarchy of evidence in evidence-based dentistry, from strongest to weakest?

From strongest to weakest: systematic reviews/meta-analyses of randomised controlled trials > individual randomised controlled trials (RCTs) > cohort studies > case-control studies > case series/case reports > expert opinion / mechanistic reasoning.

Outline the steps a professional should take when raising a concern (whistleblowing) about patient safety.

(1) Raise the concern promptly, usually first with a line manager or through local clinical governance channels; (2) if not resolved or if local channels are inappropriate, escalate to a more senior level or external regulator (GDC, CQC); (3) keep a written record; (4) act in good faith and in patients' interests. The GDC requires you to raise concerns if patients are at risk.

What statutory protection exists for whistleblowers in the UK, and what does it require?

The Public Interest Disclosure Act 1998 (PIDA) protects workers from detriment or dismissal for making a 'protected disclosure' (qualifying disclosure made in the public interest) about wrongdoing such as risks to health and safety. The disclosure must be made in good faith and through appropriate channels.

Distinguish between 'cleaning', 'disinfection' and 'sterilisation'.

Cleaning physically removes visible soil/organic matter and most microorganisms (a prerequisite for the others). Disinfection reduces the number of viable microorganisms but may not inactivate bacterial spores. Sterilisation destroys or removes all microorganisms including bacterial spores.

What is the standard autoclave (steam steriliser) cycle parameter for sterilising dental instruments, and name the two main types of benchtop steriliser.

A common parameter is $134\,^{\circ}\mathrm{C}$ at approximately $2.1\ \mathrm{bar}$ for a minimum holding time of 3 minutes (an alternative is $121\,^{\circ}\mathrm{C}$ for 15 minutes). The two main benchtop types are: Type N (non-vacuum, for solid unwrapped instruments) and Type B/Type S (vacuum, capable of sterilising wrapped, hollow and lumened instruments).

In UK dental decontamination guidance (HTM 01-05), what are the two standards of compliance practices aim for?

HTM 01-05 (Health Technical Memorandum 01-05) sets out 'essential requirements' (the minimum mandatory standard all practices must meet) and 'best practice' (a higher standard practices should aspire to and progress towards). It governs the decontamination of reusable dental instruments.

What are 'standard infection control precautions' (SICPs) and to whom do they apply?

SICPs are the basic infection prevention measures applied to ALL patients at ALL times, regardless of known or suspected infection status, because not all infections are identifiable. They include hand hygiene, use of PPE, safe management of sharps, respiratory hygiene, safe disposal of waste, and environmental cleaning.

List the WHO 'Five Moments for Hand Hygiene'.

(1) Before touching a patient; (2) before a clean/aseptic procedure; (3) after body fluid exposure risk; (4) after touching a patient; (5) after touching patient surroundings.

Classify dental clinical waste streams and give the colour coding for each.

Orange bags = infectious/clinical waste (may be treated then disposed). Yellow bags = highly infectious/clinical waste requiring incineration. Yellow with red lid sharps box = anatomical/medicinal sharps. Orange-lidded sharps box = non-medicinal contaminated sharps. Yellow-lidded sharps box = sharps with medicines. Blue lid = pharmaceutical/medicinal waste. White containers = amalgam/dental waste (with mercury suppressant). Black bags = domestic/non-clinical waste.

How must waste dental amalgam be handled and disposed of, and why?

Waste amalgam (and amalgam-containing extracted teeth, capsules, excess) must be stored in a dedicated, sealed, mercury-vapour-suppressant white container and collected by a licensed/authorised waste contractor — never placed in clinical waste, sharps bins or general waste, and never down the drain. An amalgam separator is required on the suction system. This is because mercury is a toxic environmental hazard.

What does IR(ME)R stand for, and what is its primary purpose?

IR(ME)R = the Ionising Radiation (Medical Exposure) Regulations (2017 in the UK). Its purpose is to protect patients from the hazards of ionising radiation during medical/dental exposures by ensuring exposures are justified, optimised and authorised, and that doses are kept as low as reasonably practicable.

Name the four duty-holder roles defined under IR(ME)R 2017.

Employer (sets out written procedures/protocols), Referrer (provides clinical justification information and requests the exposure), Practitioner (justifies and takes responsibility for the exposure), and Operator (carries out practical aspects, e.g. exposing and processing the radiograph). One person may hold more than one role.

Distinguish between IR(ME)R 2017 and IRR 2017 in dental radiography.

IRR 2017 (Ionising Radiations Regulations) protects staff, the public and the environment (occupational/workplace safety — e.g. controlled areas, local rules, radiation protection supervisor/adviser). IR(ME)R 2017 protects the patient undergoing the medical exposure (justification, optimisation, duty holders).

What does the ALARP/ALARA principle mean in radiation protection?

ALARP = 'As Low As Reasonably Practicable' (also ALARA, 'As Low As Reasonably Achievable'). It is the principle that radiation doses to patients and staff should be kept as low as reasonably possible while still achieving the diagnostic objective, balancing dose against benefit, time, cost and effort.

State the three core principles of radiation protection underpinning IR(ME)R.

Justification (the benefit of the exposure must outweigh the risk — every exposure must be justified), Optimisation (doses kept ALARP while achieving the diagnostic purpose), and Limitation/Dose limits (applying limits, though dose limits apply to staff/public rather than to justified patient exposures).

What is the main UK statute placing a general duty on employers and employees for workplace health and safety, and what is the employer's key duty?

The Health and Safety at Work etc. Act 1974 (HSWA). The employer's key duty is to ensure, so far as is reasonably practicable, the health, safety and welfare at work of all employees (and to protect others affected by the work), including safe systems, equipment, training and a written health and safety policy if 5 or more employees.

What does COSHH stand for and what does it require in a dental practice?

COSHH = Control of Substances Hazardous to Health Regulations. It requires employers to assess, prevent or control exposure to hazardous substances (e.g. mercury, disinfectants, etchants, X-ray chemicals, dusts). This means carrying out COSHH risk assessments, providing safety data sheets, control measures, PPE, training and health surveillance where needed.

Name two other key health and safety regulations relevant to the dental workplace besides HSWA and COSHH.

Examples include: RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations — reporting injuries/incidents including significant sharps/inoculation injuries), the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013, the Regulatory Reform (Fire Safety) Order 2005, PUWER, RIDDOR, and the Management of Health and Safety at Work Regulations 1999.

What must be reported under RIDDOR in a dental practice?

RIDDOR requires reporting of work-related deaths, specified serious injuries, injuries causing more than 7 days' incapacity, certain occupational diseases, dangerous occurrences (near misses), and certain incidents such as a sharps/needlestick injury that exposes a worker to a blood-borne virus. Reports go to the HSE.

Name and describe two adult learning principles relevant to teaching in dentistry (andragogy).

Andragogy (Knowles): adults are self-directed, draw on prior experience, are problem-/relevance-centred, and are internally motivated. A related concept is Kolb's experiential learning cycle (concrete experience → reflective observation → abstract conceptualisation → active experimentation), emphasising learning through doing and reflection.

What is Miller's pyramid of clinical competence?

Miller's pyramid describes levels of clinical competence assessment, from base to apex: 'Knows' (knowledge) → 'Knows how' (applied knowledge/competence) → 'Shows how' (performance in a test setting, e.g. OSCE) → 'Does' (actual performance in real practice, e.g. workplace-based assessment).

Describe a recognised model for giving constructive feedback to a learner.

Examples: Pendleton's rules (learner says what went well, teacher adds what went well, learner says what could improve, teacher adds improvements, then agree an action plan); the 'feedback sandwich' (positive–constructive–positive); or SET-GO/the One-Minute Preceptor. The key features are: timely, specific, balanced, behaviour-focused (not personal), and action-oriented.

List four characteristics of effective feedback.

Effective feedback is: timely (given close to the event); specific and descriptive (focused on observable behaviour, not personality); balanced (strengths and areas to improve); non-judgemental and constructive; based on first-hand observation; and concludes with an agreed, achievable action plan.

Name two contrasting leadership styles and a recognised dental leadership framework.

Contrasting styles include transactional (reward/exchange-based, task-focused) versus transformational (inspiring, vision-driven, develops followers); and autocratic versus democratic/laissez-faire (Lewin). The NHS Healthcare Leadership Model and the concept of 'shared/distributed leadership' are widely used frameworks; clinical leadership emphasises leading by example and putting patients first.

What are the characteristics of an effective dental team, and name one model of team development.

Effective teams have clear shared goals, defined roles, good communication, mutual trust and respect, and effective leadership. Tuckman's model of team development describes the stages: forming, storming, norming, performing (and adjourning/mourning).

Why is non-technical (human factors) skill important in dental teamworking and patient safety?

Human factors / non-technical skills (communication, leadership, situational awareness, decision-making, teamwork) influence performance and error. Many adverse incidents result from communication and teamworking failures rather than lack of clinical knowledge, so good team behaviours (e.g. checklists, closed-loop communication, flat hierarchy for speaking up) reduce error and improve safety.

What is a professional portfolio and what is its purpose in dental career development?

A portfolio is a structured collection of evidence documenting a professional's learning, achievements, reflection, CPD, assessments and competencies over time. Its purpose is to support reflective practice, demonstrate competence and progression, inform appraisal/revalidation, and guide ongoing professional and career development.

Describe the structure and purpose of a reflective learning cycle used in portfolios (e.g. Gibbs).

Gibbs' reflective cycle: Description (what happened) → Feelings (what you thought/felt) → Evaluation (what was good/bad) → Analysis (what sense you can make of it) → Conclusion (what else could you have done) → Action plan (what you would do next time). Its purpose is to turn experience into structured learning and improved future practice.

Define 'SMART' objectives as used in personal development planning.

SMART objectives are Specific, Measurable, Achievable (Attainable), Relevant (Realistic), and Time-bound. They are used in personal development plans (PDPs) to set clear, trackable goals for learning and career development.

What is 'professional resilience' and why is it important for dental practitioners?

Resilience is the capacity to adapt positively to, recover from, and maintain wellbeing despite stress, adversity or setbacks. It is important because dentistry is high-stress (clinical pressure, complaints, litigation, isolation), and resilience protects against burnout, supports sustained performance, and helps maintain patient safety and professional standards.

Define 'burnout' and name its three classic dimensions (Maslach).

Burnout is a syndrome of chronic, unmanaged workplace stress. Maslach's three dimensions are: emotional exhaustion, depersonalisation/cynicism (detachment from patients/work), and a reduced sense of personal accomplishment/efficacy.

List four practical self-care strategies to support wellbeing and prevent burnout in dental practice.

Examples include: maintaining work–life balance and taking breaks; peer support, mentoring and supervision; reflective practice and recognising early stress signs; physical health (sleep, exercise, ergonomics to prevent musculoskeletal strain); mindfulness/stress-management techniques; and seeking professional help/occupational health when needed.

What is the difference between 'consent', 'assent' and 'best interests' in treating a young child who is not Gillick competent?

For a child who is not Gillick competent, valid legal consent is given by a person with parental responsibility (or the court). The child's 'assent' (agreement/cooperation) should still be sought to involve them, but is not legally sufficient alone. All treatment must be in the child's best interests.

What is meant by 'parental responsibility', and who automatically holds it?

Parental responsibility (Children Act 1989) is the legal rights, duties and authority a parent has regarding a child, including the right to consent to treatment. The mother automatically has it; the father has it if married to the mother or (for births registered after Dec 2003 in England/Wales) named on the birth certificate; others may acquire it via agreement or court order.

What is 'safeguarding', and what should a dental professional do if they suspect child abuse or neglect?

Safeguarding is protecting vulnerable people (children and adults at risk) from abuse, neglect and harm. If abuse is suspected, the dentist should recognise and record concerns objectively, follow local safeguarding procedures, seek advice from the practice safeguarding lead/named professional, and refer to social services/relevant authorities as appropriate. Safeguarding is a professional and statutory duty.

What is the GDC's role and its primary statutory purpose?

The General Dental Council (GDC) is the UK statutory regulator for the dental team (established under the Dentists Act 1984). Its primary purpose is to protect patients and the public by maintaining the dental register, setting standards of conduct and education, assuring the quality of dental education, and managing fitness-to-practise concerns.

What are the possible outcomes of a GDC fitness-to-practise hearing?

Outcomes range from no action/no impairment found, to a reprimand/warning, conditions on registration, suspension of registration (for a set period), or erasure (removal) from the register. Interim orders (suspension or conditions) can also be imposed during an investigation to protect the public.

What is 'informed refusal' and how should it be documented?

Informed refusal is when a patient with capacity declines recommended treatment after being informed of the risks and consequences of not proceeding. It must be respected for a competent adult, and the discussion (the recommendation, the risks of refusing, and that the patient understood) must be clearly documented in the records.

Explain the difference between 'express' and 'implied' consent, with a dental example.

Express consent is explicitly given, verbally or in writing (e.g. signing a consent form for an extraction or surgical procedure). Implied consent is inferred from a patient's actions or cooperation (e.g. opening their mouth for an examination). Significant or invasive procedures require express, preferably written, consent.

What is 'clinical governance' and what are some of its components/pillars?

Clinical governance is the framework through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Its components (pillars) include: clinical audit, clinical effectiveness/evidence-based practice, risk management, education and training/CPD, patient and public involvement, using information, and staffing/staff management.

In statistics for evidence appraisal, what does a 'p-value' represent and what is the conventional significance threshold?

The p-value is the probability of obtaining the observed result (or one more extreme) if the null hypothesis were true. The conventional threshold for statistical significance is $p < 0.05$, meaning less than a 5% probability the result occurred by chance under the null hypothesis.

Define 'sensitivity' and 'specificity' of a diagnostic test and give their formulas.

Sensitivity is the proportion of true positives correctly identified by the test: $\text{Sensitivity} = \frac{TP}{TP + FN}$. Specificity is the proportion of true negatives correctly identified: $\text{Specificity} = \frac{TN}{TN + FP}$, where TP = true positive, FN = false negative, TN = true negative, FP = false positive.

What is a 'confidence interval' (e.g. a 95% CI) and how is it interpreted?

A 95% confidence interval is a range of values within which we can be 95% confident the true population parameter lies. A narrower CI indicates greater precision. If a 95% CI for a difference includes 0 (or for a ratio includes 1), the result is generally not statistically significant at the 5% level.