Membership of the Joint Dental Faculties (MJDF) Professionalism, Law, Ethics and Practice Management Syllabus

Under UK GDPR, within what timeframe must a Subject Access Request (SAR) normally be answered, and what is the fee?

Normally within one calendar month of receipt, free of charge (the previous £10 fee was abolished). It may be extended by a further two months for complex/numerous requests, and a reasonable fee may be charged only for manifestly unfounded or excessive requests.

Under UK GDPR, within what timeframe and to whom must a notifiable personal data breach be reported?

To the Information Commissioner's Office (ICO) without undue delay and within 72 hours of becoming aware, where the breach is likely to risk people's rights and freedoms. High-risk breaches must also be communicated to affected individuals without undue delay.

What four elements must a claimant prove to succeed in a clinical negligence claim?

1) A duty of care was owed; 2) the duty was breached (the standard of care fell below the acceptable level); 3) causation - the breach caused the harm; and 4) the harm/damage is not too remote (foreseeable). All must be established on the balance of probabilities.

What is the 'Bolam test' and how was it modified by the 'Bolitho test'?

Bolam (1957): a professional is not negligent if acting in accordance with a practice accepted as proper by a responsible body of relevant medical opinion. Bolitho (1997) added that the body of opinion must also be logical/defensible and withstand logical analysis by the court.

What is the standard limitation period for bringing a clinical negligence claim in England and Wales?

Generally 3 years from the date of the negligent act or from the patient's 'date of knowledge' of the injury. Exceptions: for children the clock starts at age 18 (so until their 21st birthday), and for those lacking capacity time may not run at all. The court has discretion to extend.

What is the difference between consent-related battery and negligence in dental law?

Battery (trespass) arises where there was no consent at all to the touching/procedure; negligence in consent arises where consent was given but the patient was not adequately informed of material risks/alternatives (failure of the duty to inform).

What is the recommended first-stage timeframe for acknowledging a patient complaint under the NHS complaints procedure?

A complaint should be acknowledged within 3 working days of receipt. The complainant should be offered discussion of how it will be handled and an expected response timescale; there is no fixed legal deadline for resolution but it must be timely.

What is the time limit for a patient to make an NHS complaint, and what are the two stages of escalation?

Normally within 12 months of the event or of becoming aware of it. Stage 1: local resolution by the practice. Stage 2: if unresolved, the NHS patient can escalate to the Parliamentary and Health Service Ombudsman (PHSO); private patients can use the Dental Complaints Service (DCS) run by the GDC.

What does the mnemonic 'HEAT' (or similar) suggest for handling a complaint at the chairside?

H - Hear/Halt and listen; E - Empathise (acknowledge feelings); A - Apologise and Act (take ownership, agree action); T - Thank the patient. The goal is early, open, local resolution and learning from the complaint.

What are the key features of a good clinical dental record?

Contemporaneous (made at the time), accurate, legible, dated and signed/attributable, objective and free of inappropriate comment, comprehensive (history, examination, diagnosis, treatment options, consent, risks discussed, treatment provided, advice given), and unaltered (amendments dated/initialled, originals not erased).

How long should adult dental records and radiographs be retained in the UK?

For NHS adult records, a minimum of 10-11 years after the last entry; for children, until age 25 (or 26 if the entry was made at 17), i.e. retain until they reach adulthood plus the period. Records of patients who have died should generally be kept for 8 years.

What is professional indemnity, and is it a legal requirement for GDC registrants?

Indemnity is cover (insurance or a discretionary defence-organisation membership) that protects the registrant and ensures patients can be compensated if harmed. Yes - it is a statutory requirement for registration with the GDC that an appropriate indemnity/insurance arrangement is in place.

What is the difference between an occurrence-based and a claims-made indemnity policy?

Occurrence-based (e.g. discretionary defence organisations) covers incidents that happened during the membership period regardless of when the claim is made. Claims-made (typical insurance) only covers claims made while the policy is active, so 'run-off' cover is needed after stopping practice.

What is the CQC and what are its five 'key questions' when inspecting a dental practice?

The Care Quality Commission is the independent regulator of health and social care in England. Its five key questions ask whether a service is: Safe, Effective, Caring, Responsive (to people's needs), and Well-led.

What is 'shared decision-making' in clinical practice?

A collaborative process in which the clinician and patient jointly make decisions about care, combining the clinician's evidence/expertise with the patient's values, preferences and circumstances - moving from paternalism toward partnership.

What does the 'BRAN' framework prompt patients to ask during shared decision-making?

Benefits - what are the benefits of the treatment? Risks - what are the risks? Alternatives - what are the alternatives (including doing nothing)? Nothing - what happens if I do nothing? It structures discussion of options for informed choice.

What communication adjustments support consultations with patients who have hearing impairment or limited English?

Use a professional (not family) interpreter or a British Sign Language interpreter; speak directly to the patient not the interpreter; use plain language, avoid jargon; allow extra time; use visual aids, written materials and 'teach-back'; ensure good lighting for lip-reading and minimise background noise.

Why should family members generally not be used as interpreters for clinical consultations?

Risk of inaccurate/selective translation, breaches of confidentiality, conflicts of interest, the patient withholding sensitive information, and safeguarding concerns (the family member may be the source of harm). A trained professional interpreter ensures accuracy, impartiality and confidentiality.

What essential information should a referral letter contain?

Patient identifiers (name, DOB, address, NHS number), referrer details, date, urgency, reason for referral and specific question asked, relevant medical history and medications, dental history/findings, what has been discussed with the patient, radiographs/investigations enclosed, and patient consent to refer.

What is the SBAR tool used for in inter-professional communication?

SBAR structures clinical handover/communication: Situation (what is happening now), Background (relevant context/history), Assessment (what you think the problem is), Recommendation (what you want done). It improves clarity and patient safety in handovers and referrals.

What is the SPIKES protocol for breaking bad news?

S - Setting up the interview; P - assessing the patient's Perception; I - obtaining the patient's Invitation (how much they want to know); K - giving Knowledge/information; E - addressing Emotions with empathic responses; S - Strategy and Summary (agreeing a plan).

Define 'evidence-based dentistry' (EBD).

The integration of the best available scientific evidence with the clinician's clinical expertise and the patient's treatment needs, values and preferences, to make decisions about individual patient care (Sackett's definition adapted for dentistry).

What is the traditional hierarchy of evidence, from strongest to weakest?

From strongest to weakest: systematic reviews/meta-analyses of RCTs, individual randomised controlled trials, cohort studies, case-control studies, case series/case reports, then expert opinion and basic/laboratory research. (GRADE now refines this by quality assessment.)

What does the 'PICO' framework structure when forming a clinical question?

P - Patient/Population/Problem; I - Intervention; C - Comparison/Control; O - Outcome. It frames a focused, answerable clinical question for literature searching and critical appraisal.

In critical appraisal, define 'sensitivity' and 'specificity' of a diagnostic test.

Sensitivity is the proportion of true positives correctly identified, $\text{Sensitivity}=\frac{TP}{TP+FN}$. Specificity is the proportion of true negatives correctly identified, $\text{Specificity}=\frac{TN}{TN+FP}$.

Define 'Number Needed to Treat' (NNT) and give its formula.

NNT is the number of patients who must receive a treatment for one additional patient to benefit (avoid one adverse outcome). It is the reciprocal of the absolute risk reduction: $\text{NNT}=\frac{1}{\text{ARR}}$, where $\text{ARR}=|\text{risk}_{control}-\text{risk}_{treatment}|$.

What does a p-value of $p<0.05$ conventionally indicate in a clinical study?

It indicates the result is statistically significant at the 5% level - there is less than a 5% probability that an effect as large as observed would arise by chance if the null hypothesis were true. It does not measure clinical importance or effect size.

What is a 95% confidence interval, and how do you interpret one that crosses a relative risk of 1?

A 95% CI is the range within which the true population value is expected to lie with 95% confidence. For a relative risk or odds ratio, if the 95% CI crosses 1 (includes 1), the result is not statistically significant (no demonstrated difference between groups).

What are the stages of the clinical audit cycle?

1) Identify a topic and set standards/criteria (against best practice); 2) Measure current performance (collect data); 3) Compare performance against the standard; 4) Implement change to improve; 5) Re-audit (close the loop) to confirm improvement. It is a continuous cyclical process.

What is the difference between clinical audit and research?

Research aims to discover new knowledge - what is the right thing to do (generalisable, often requires ethical approval). Audit measures whether current practice meets an already-established standard - are we doing the right thing right (local, quality improvement, no ethics approval needed).

What does the PDSA cycle stand for in quality improvement?

Plan (a change/test), Do (carry it out on a small scale), Study (analyse the results/data), Act (adopt, adapt or abandon). It is an iterative method for testing and implementing improvements.

How many hours of verifiable CPD must a UK dentist complete over a five-year cycle, and is there an annual minimum?

Dentists must complete a minimum of 100 hours of verifiable CPD over each 5-year cycle, with a recommended minimum of 10 hours in any two-year period. (Dental therapists/hygienists require 75 hours; dental nurses 50 hours.) Verifiable CPD needs concrete aims/objectives, anticipated outcomes and documentary evidence/feedback.

What is 'reflective practice' and which model uses the stages Description-Feelings-Evaluation-Analysis-Conclusion-Action plan?

Reflective practice is the deliberate process of analysing one's experiences to learn and improve future practice. The Gibbs Reflective Cycle uses six stages: Description, Feelings, Evaluation, Analysis, Conclusion, and Action plan.

What is a Significant Event Analysis (SEA) and what are its key steps?

SEA is a structured team-based review of an individual event (good or bad) to learn and improve patient safety. Steps: 1) identify and report the event; 2) gather facts; 3) meet to discuss and analyse (what happened, why, what can be learned); 4) agree and implement change/action; 5) document and follow up/share learning.

In patient safety, what is the difference between an 'error', a 'near miss' and an 'adverse event'?

An error is a failure of a planned action or use of a wrong plan. A near miss is an error/incident that was caught before reaching or harming the patient. An adverse event is an incident that resulted in actual harm to the patient.

What is the difference between a 'systems approach' and a 'person approach' to patient safety incidents?

The person approach blames individuals for errors (focus on carelessness/forgetfulness). The systems approach (just culture) accepts that humans are fallible and focuses on the conditions/latent factors that allowed the error, building defences and barriers - this is the modern preferred safety philosophy.