Overseas Registration Exam (ORE) Professionalism, Ethics, Law and Practice Management Syllabus

What does 'contemporaneous' mean in record keeping, and why is it important?

Contemporaneous means records are made at the time of, or immediately after, the event. It is important for accuracy, medico-legal defensibility, continuity of care, and because records altered after the fact (without clear dated amendment) undermine credibility.

Define 'safeguarding' in the dental context.

Safeguarding is protecting children and adults at risk from abuse, neglect and maltreatment, preventing harm to their health or development, and ensuring they grow up/live in safe and effective care, while acting to enable the best outcomes.

What does the dental-specific safeguarding mnemonic/concept 'Was Not Brought' refer to, and why is the wording important?

'Was Not Brought' (rather than 'Did Not Attend') reflects that a child depends on an adult to bring them; repeated missed appointments can be a safeguarding indicator of neglect, so the child-focused language prompts appropriate concern and action.

Name the four broad categories of child abuse recognised in UK safeguarding guidance.

Physical abuse, emotional (psychological) abuse, sexual abuse, and neglect.

What dental signs may raise suspicion of physical child abuse, and what is the classic distribution?

Bruising, lacerations or burns to the face, lips, oral mucosa, frenum tears, fractured/avulsed teeth, jaw fractures, and bite marks. Injuries to the head, face, neck and ears (the 'triangle of safety') and torn labial frenum in a non-mobile infant are particularly concerning.

What should a dental professional do if they suspect a child is being abused or neglected?

Record findings carefully and objectively, follow local safeguarding procedures, discuss with the practice safeguarding lead, and refer/report concerns to children's social care or the police; consult the local safeguarding board. Acting on the child's safety overrides confidentiality.

Define a 'vulnerable adult' / 'adult at risk' under the Care Act 2014.

An adult who has needs for care and support (whether or not the authority is meeting them), is experiencing or at risk of abuse or neglect, and as a result of their care needs is unable to protect themselves from the abuse or neglect.

List the categories of abuse of adults at risk recognised under the Care Act 2014.

Physical, sexual, psychological/emotional, financial or material, neglect and acts of omission, discriminatory, organisational/institutional, domestic, modern slavery, and self-neglect.

What are the nine protected characteristics under the Equality Act 2010?

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.

Distinguish 'direct discrimination' from 'indirect discrimination' under the Equality Act 2010.

Direct discrimination: treating someone less favourably because of a protected characteristic. Indirect discrimination: applying a provision, criterion or practice that appears neutral but puts people sharing a protected characteristic at a particular disadvantage and cannot be objectively justified.

What duty does the Equality Act 2010 place on dental practices regarding disabled patients?

A duty to make 'reasonable adjustments' to remove barriers so disabled patients are not placed at a substantial disadvantage (e.g. wheelchair access, longer appointments, accessible information, ground-floor surgery).

What is 'shared decision making' in patient-centred care?

A collaborative process in which the clinician and patient work together to make decisions about treatment, combining the clinician's expertise on options/evidence with the patient's values, preferences and circumstances, so the chosen plan reflects what matters to the patient.

Describe the 'BRAN' framework used to support shared decision making.

BRAN prompts patients to ask about any proposed treatment: What are the Benefits? What are the Risks? What are the Alternatives? What if I do Nothing? It structures discussion of options to support informed, shared decisions.

What is the professional 'duty of candour' and what does it require a dental professional to do?

The duty of candour is the professional and statutory obligation to be open and honest when something goes wrong. It requires the clinician to tell the patient (or representative) when something has gone wrong, apologise, offer an appropriate remedy/support, and explain fully and promptly what happened.

Distinguish the statutory duty of candour from the professional duty of candour.

The statutory duty (CQC regulation, England) applies to organisations and is triggered by notifiable safety incidents causing moderate/severe harm or death, with formal written notification. The professional duty (GDC/joint regulators) applies to individual registrants for all levels of harm or near-misses and is about everyday openness.

What are the typical stages of a dental complaints procedure within a practice?

Acknowledge the complaint (usually within 3 working days), investigate, respond in writing with findings and any apology/remedy (usually within a set period e.g. 10-20 working days or as agreed), and signpost to the next stage (e.g. NHS England/Ombudsman or the Dental Complaints Service for private patients) if unresolved.

Which body handles unresolved complaints about private dental care in the UK?

The Dental Complaints Service (DCS), funded by the GDC. For NHS dental complaints in England, escalation is via NHS England and then the Parliamentary and Health Service Ombudsman.

What key principles should be followed when working with an interpreter in a dental consultation?

Use a trained/professional interpreter (not family members or children where possible), speak directly to the patient in the first person, use short clear sentences avoiding jargon, allow extra time, ensure confidentiality, and confirm the patient's understanding and consent through the interpreter.

Why are family members generally not recommended as interpreters for consent discussions?

They may lack dental/medical vocabulary, may filter or alter information, may have conflicts of interest, may breach the patient's privacy/confidentiality, and the patient may be inhibited from sharing sensitive information — risking invalid consent.

What are the three main pillars/types of NHS dental service provision in England?

Primary care (general dental practice/GDS contracts and community dental services), secondary care (hospital dental services and specialist referral), and salaried/community dental services for patients with additional needs. Out-of-hours/urgent dental care is also commissioned.

What unit is used to measure and pay for NHS general dental treatment activity in England, and how are the main bands valued?

Units of Dental Activity (UDAs). Band 1 (exam/diagnosis/prevention) = 1 UDA; Band 2 (fillings, extractions, etc.) = 3 UDAs; Band 3 (crowns, dentures, bridges) = 12 UDAs; urgent treatment = 1.2 UDAs.

Define 'clinical governance'.

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 by creating an environment in which excellence in clinical care can flourish.

Name the commonly cited 'seven pillars' of clinical governance.

Clinical effectiveness, risk management, patient/public involvement, audit, staff management, education and training, and use of information (information management). (Sometimes 'clinical effectiveness' and 'research and development' are listed.)

What is a 'clinical audit' and what are the stages of the audit cycle?

Clinical audit is a quality-improvement process that measures practice against agreed standards. The cycle: identify the topic/set standards, observe/collect data on current practice, compare against the standard, implement change, then re-audit to close the loop and confirm improvement.

How does clinical audit differ from peer review and from research?

Audit measures current practice against an existing standard to improve care (closed loop). Peer review is colleagues critically discussing and comparing each other's practice/cases to share learning. Research aims to generate new knowledge/discover the right thing to do, often with ethics approval and hypotheses.

What is the GDC requirement regarding indemnity/insurance for dental professionals?

All registrants must have appropriate and adequate indemnity or insurance cover in place for the duration of their practice, so that patients can claim compensation if harmed. Practising without it is a breach of GDC standards and may be a criminal offence under the Dentists Act.

Distinguish a 'claims-made' (discretionary indemnity) arrangement from an 'occurrence-based' insurance policy.

Occurrence-based cover responds to incidents that occurred during the policy period regardless of when the claim is made (run-off automatically covered). Claims-made cover responds only to claims made while the policy is active, so 'run-off' or tail cover is needed after stopping work. Discretionary indemnity (dental defence organisations) provides assistance at the organisation's discretion rather than a contractual guarantee.

In risk management, what is the relationship used to prioritise clinical risks?

Risk is assessed as the product of likelihood and consequence, often expressed as $\text{Risk} = \text{Likelihood} \times \text{Severity}$. Higher scores are prioritised for control measures (eliminate, reduce, isolate, control, PPE).

What conditions must be met for a dentist to delegate a task to a dental care professional?

The task must be within the DCP's scope of practice and competence/training, the dentist must provide appropriate prescription/instruction and supervision as required, the patient's interests must come first, and the delegating clinician retains responsibility for ensuring the work is appropriately delegated. Direct access applies to certain DCP tasks without a dentist's prescription.

What is the difference between 'delegation' and 'referral' in dental team practice?

Delegation is asking a team member to carry out a task while the delegating clinician retains overall responsibility for the patient and care plan. Referral is transferring responsibility for a specific aspect of care (or the whole episode) to another professional, usually with greater expertise, who then assumes clinical responsibility for that part.