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Participation in continuing education by employed dental hygienists in British Columbia Kline, Carolyn 1975

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PARTICIPATION IN CONTINUING EDUCATION BY EMPLOYED DENTAL HYGIENISTS IN BRITISH COLUMBIA by CAROLYN KLINE R.D.H. , B . S c , U n i v e r s i t y of Washington, 1958  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n the FACULTY OF EDUCATION (Adult Education)  We accept t h i s thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA August, 1975  In p r e s e n t i n g t h i s  thesis  an advanced degree at the I  Library shall  f u r t h e r agree  for  this  written  the U n i v e r s i t y of B r i t i s h  make i t  freely available  that permission  for  the requirements f o r  Columbia,  I agree  r e f e r e n c e and  for e x t e n s i v e c o p y i n g o f  representatives. thesis  for  It  this  f i n a n c i a l gain s h a l l  permission.  University of B r i t i s h  2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5  that  study. thesis or  is understood that copying o r p u b l i c a t i o n  Department of The  fulfilment of  s c h o l a r l y purposes may be granted by the Head of my Department  by h i s of  in p a r t i a l  Columbia  not be allowed without my  i  ABSTRACT The study reported on the p a r t i c i p a t i o n patterns of dental h y g i e n i s t s i n the Province of B r i t i s h Columbia during the period of March 1971 to March 1974.  The study surveyed 163 dental h y g i e n i s t s  r e g i s t e r e d and l i c e n c e d with the College of Dental Surgeons of B r i t i s h Columbia i n 1973 who were resident and employed i n the Province at the time of the study.  These 163 h y g i e n i s t s represented 76.2 per cent of  dental h y g i e n i s t s r e g i s t e r e d and l i c e n c e d i n B r i t i s h Columbia i n 1973. Eleven v a r i a b l e s were selected f o r study: age, m a r i t a l s t a t u s , number of c h i l d r e n , years of post-secondary  education, year and place  of graduation, place of residence, work towards f u r t h e r dental or nondental q u a l i f i c a t i o n s , employment status and p r i n c i p a l type of employment.  Of these v a r i a b l e s only three were found to d i f f e r e n t i a t e between  p a r t i c i p a n t s and non-participants which were: place of graduation, work towards non-dental q u a l i f i c a t i o n s and p r i n c i p a l type of employment. The courses attended were grouped i n t o four categories: c l i n i c a l s k i l l s , p a t i e n t e v a l u a t i o n , dental health education and p r a c t i c e management.  The eleven v a r i a b l e s were tested against the four  course categories to determine whether any of the c h a r a c t e r i s t i c s influenced p a r t i c i p a t i o n i n the d i f f e r e n t types of courses.  In four  instances s i g n i f i c a n t differences were found: age was r e l a t e d to attendance i n c l i n i c a l s k i l l s courses; the number of years of postsecondary education was r e l a t e d to p a r t i c i p a t i o n i n c l i n i c a l s k i l l s  ii courses and p a t i e n t evaluation courses; and m a r i t a l status was  related  to p a r t i c i p a t i o n i n p r a c t i c e management courses. The findings of t h i s study i n d i c a t e that the socio-economic v a r i a b l e s considered had l i t t l e influence on the p a r t i c i p a t i o n patterns of dental hygienists and emphasizes the need f o r future research concerning the r o l e of psychological and other f a c t o r s i n f l u e n c i n g p a r t i c i p a t i o n i n continuing education programs.  iii  TABLE OF CONTENTS Chapter 1  2  Page INTRODUCTION  1  THE PROBLEM  3  METHOD  4  Sample  4  Survey Instrument  4  Data A n a l y s i s  5  DEFINITION OF TERMS  6  PLAN OF STUDY  7  REVIEW OF THE LITERATURE  8  DEFINITIONS OF CONTINUING EDUCATION CONTINUING EDUCATION IN DENTISTRY  8 .  11 /  Definitions i n Dentistry  11  Emergence of Continuing Dental Education  12  P a r t i c i p a t i o n of Dentists i n Continuing Education .  15  CONTINUING EDUCATION IN DENTALY HYGIENE  16  D e f i n i t i o n s of Continuing Education i n Dental Hygiene Emergence of Continuing Dental Hygiene Education P a r t i c i p a t i o n of Dental Hygienists i n Continuing Education Continuing Education f o r Dental Hygienists i n B r i t i s h Columbia SUMMARY  16 .  17 19 20 21  iv Chapter 3  Page ANALYSIS OF DATA CHARACTERISTICS OF PARTICIPANTS AND NON-PARTICIPANTS  22 . 22  Age  23  M a r i t a l Status  23  Number of Children  25  Place of Residence  25  Year of Graduation  27  Place of Graduation  28  Post-Secondary Education  29  Other Dental Q u a l i f i c a t i o n s  31  Non-Dental Q u a l i f i c a t i o n s  32  Employment Status  33  P r i n c i p a l Type of Employment  34  EXTENT OF PARTICIPATION  35  Hours of Attendance  35  Number of Courses Attended  37  C l i n i c a l and N o n - C l i n i c a l Courses  37  TYPES OF COURSES  37  Clinical Skills  37  Patient Evaluation  38  Dental Health Education  39  P r a c t i c e Management  39  C h a r a c t e r i s t i c s of P a r t i c i p a n t s  40  Age and C l i n i c a l S k i l l s Courses  42  V  Chapter  Page Post-Secondary Education and C l i n i c a l S k i l l s Courses M a r i t a l Status and P r a c t i c e Management Courses  43 ...  44  Post-Secondary Education and Patient Evaluation Courses SUMMARY 4  SUMMARY, CONCLUSIONS AND IMPLICATIONS . . .  45 46 48  SUMMARY  48  CONCLUSIONS . . .  49  Place of Graduation  49  P a r t i c i p a t i o n i n Other Areas  50  P r i n c i p l e Type of Employment  50  Age  51  M a r i t a l Status and Number of Children  52  Place of Residence  52  Year of Graduation  53  Post-Secondary Education  53  IMPLICATIONS  53  Administration  54  Sponsorship . . .  55  Facilities  55  Budget  55  Faculty  55  Curriculum  56  Educational Methodology  58  vi Chapter  Page Evaluation  58  AREAS FOR FUTURE RESEARCH  59  IN CONCLUSION  61  REFERENCES  62  APPENDIX  66  vii  LIST OF TABLES Table 1 2 3 4 5 6  Page Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Age  23  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by M a r i t a l Status  24  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Number of Children .  25  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Place of Residence  26  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Year of Graduation  27  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Place of Graduation  28  7  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Number of Years Post-Secondary Education. 30  8  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Work Towards Other Dental Q u a l i f i c a t i o n s .  9 10 11 12  13  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Work Towards Non-Dental Q u a l i f i c a t i o n s  31  . 32  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by Employment Status  33  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and NonP a r t i c i p a n t s by P r i n c i p a l Type of Employment  35  Number of Par!leipants I n Each of Four Categories of Continuing Dental Hygiene Education Courses from March 1971 to March 1974  38  Summary of Chi-Square Values and S i g n i f i c a n c e Levels f o r P a r t i c i p a n t C h a r a c t e r i s t i c s by Course Categories  . . 41  viii Table 14  15  16  17  Page Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n C l i n i c a l S k i l l s Courses and P a r t i c i p a n t s i n Other Courses by Age  42  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n C l i n i c a l S k i l l s Courses and P a r t i c i p a n t s i n Other Courses by Number of Years of Post-Secondary Education . . . .  43  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n P r a c t i c e Management Courses and P a r t i c i p a n t s i n Other Courses by M a r i t a l Status  44  Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n P a t i e n t Evaluation Courses and P a r t i c i p a n t s i n Other Courses by Number of Years Post-Secondary Education  45  ix  LIST OF FIGURES Figure 1  Page Number of Hours of Continuing Dental Hygiene Education by P a r t i c i p a n t s  36  ACKNOWLEDGMENTS  Sincere thanks are tendered to the w r i t e r ' s husband, two daughters and one son f o r graciously allowing the infringement of t h i s paper on t h e i r way of  life. S p e c i a l appreciation and thanks go to members  of the w r i t e r ' s advisory committee, Dr. Coolie Verner, Dr. Gary Dickinson and Mrs. Joan Voris f o r t h e i r guidance, encouragement and patience. A debt of thanks i s expressed to Dr. Donald 0. Anderson, head, D i v i s i o n of Health Services Research and Development and h i s s t a f f , Richard S h i l l i n g t o n , Gordon Muir, Margaret Wertz and R u s s e l l Nakonsbey f o r t h e i r invaluable advice and assistance.  PARTICIPATION IN CONTINUING EDUCATION BY EMPLOYED DENTAL HYGIENISTS IN BRITISH COLUMBIA  CHAPTER 1  INTRODUCTION  The  d e l i v e r y o f h i g h q u a l i t y h e a l t h s e r v i c e s i s the primary  aim o f a l l h e a l t h p r o f e s s i o n s .  I n r e c e n t years  has been expressed about the a b i l i t i e s maintain in  i n c r e a s i n g concern  o f the h e a l t h p r o f e s s i o n s to  and improve the competency o f p r a c t i t i o n e r s who a r e i n v o l v e d  the d e l i v e r y o f h e a l t h s e r v i c e s .  T h i s concern i s shared by a l l  health professions, i n d i v i d u a l p r a c t i t i o n e r s , educational governments and, more r e c e n t l y , consumers.  institutions,  There i s e v i d e n c e  that  t h e r e i s o f t e n a gap between t h e knowledge and s k i l l s a t t a i n e d f o r graduation gap  and those o f the p r a c t i c i n g p r o f e s s i o n a l and that  tends t o i n c r e a s e each y e a r .  there i s , apparently,  sciences  a growing need f o r a l l p r a c t i t i o n e r s to be  c o n s t a n t l y r e v i s i n g and updating taken.  I n a d d i t i o n , i n the h e a l t h  this  the v a r i o u s  forms o f s e r v i c e s under-  The i n f o r m a t i o n e x p l o s i o n combined w i t h i n c r e a s i n g  pressure  from s o c i e t y on h e a l t h p r o f e s s i o n a l s t o d e l i v e r b e t t e r c a r e t o more p e o p l e , make i t i m p a r a t i v e continuing education  to d i s c o v e r more e f f i c i e n t ways t o p r o v i d e  to h e a l t h p r o f e s s i o n a l s .  of the o l d w i l l n o t do.  Simply d e l i v e r i n g more  O p p o r t u n i t i e s which p r o v i d e  of competence and a c q u i s i t i o n o f new i n f o r m a t i o n made a v a i l a b l e .  1  f o r maintenance  and s k i l l s must be  2  Dentistry  i s one o f  expanded  rapidly.  include:  postgraduate  at u n i v e r s i t y  types  of  continuing education i n  and g r a d u a t e  programs  of  a year  that  o r more  o c c a s i o n a l l e c t u r e s o r c l i n i c s by v i s i t i n g  club a c t i v i t i e s ; j o u r n a l s ,  closed c i r c u i t  reprints,  t e l e v i s i o n programs;  grams o f v a r i a b l e  l e n g t h t o meet  textbooks;  however,  that  a r e b e i n g f o u n d t o many i m p o r t a n t tration,  organization,  education for dentists fully will  audio  and h i g h e r q u a l i t y  poorly  or  community  r e l a t i n g to  the  adminis-  answers  the  These  competency  continuing  for  for  c o l l e g e l e v e l to perform c l i n i c a l  the  and p r e v e n t i v e  They a r e l i c e n c e d t o p r o v i d e  clinical  under  the s u p e r v i s i o n of  d e n t a l h y g i e n e p r o f e s s i o n h a s b e e n i n f l u e n c e d by r e c e n t and the  delegation of  Some e d u c a t i o n a l p r o g r a m s h a v e k e p t r e v i s e d c u r r i c u l a and c l i n i c a l  practitioners  dental hygienists  and d e n t a l h e a l t h e d u c a t i o n . s e r v i c e s to p a t i e n t s  hope-  public.  D e n t a l h y g i e n i s t s have been e d u c a t e d a t  u t i l i z a t i o n patterns  Answers  and d e n t a l a u x i l i a r i e s .  Continuing education s p e c i f i c a l l y these concerns.  conducted.  of  dental services for  pro-  objectives  the s i t u a t i o n i s changing.  l e v e l s of  or  individual participants.  p l a n n e d and  questions  few  tape  r e s p o n s i b i l i t y and methodology  l e a d t o more e f f e c t i v e  a  specialists;  Many c o n t i n u i n g d e n t a l e d u c a t i o n p r o g r a m s h a v e b e e n v a g u e ,  There i s e v i d e n c e ,  given  and u p g r a d i n g o r r e t r a i n i n g  the needs of  have been i l l - d e f i n e d , and programs  has  dentistry  or i n a t e a c h i n g h o s p i t a l ; r e f r e s h e r courses of  days o r weeks; study  Many  the h e a l t h science p r o f e s s i o n s  abreast  these  university dentistry  direct  a dentist. changes  a d d i t i o n a l new of  share  The in  functions.  changes and  teaching a c c o r d i n g l y , however,  have  many  3  have not.  Many p r a c t i c i n g h y g i e n i s t s and those temporarily r e t i r e d  from the work force may not be aware of these changes and the need for continuing education not only to maintain competency but to provide new information and s k i l l s . The basic questions f a c i n g the dental hygiene profession i n c l u d e : How can a profession insure optimum q u a l i t y performance once i t s members have l e f t t h e i r formal t r a i n i n g programs?  How can i t maintain  members' knowledge and s k i l l s as new developments are found?  How can  new information and s k i l l s be more e f f e c t i v e l y communicated?  What  procedures might increase the p r o b a b i l i t y that p r a c t i c i n g dental h y g i e n i s t s would be motivated  to attend continuing education courses  i n order to maintain and up-grade t h e i r performance? THE PROBLEM This study i s an attempt to provide some meaningful information about the p a r t i c i p a t i o n of dental h y g i e n i s t s i n continuing education. I t was designed to discover whether or not there i s a d i f f e r e n c e between those dental h y g i e n i s t s who do p a r t i c i p a t e and those who do not p a r t i c i p a t e i n continuing dental hygiene education programs. I n seeking to answer t h i s question the study sought to i d e n t i f y the s o c i o economic c h a r a c t e r i s t i c s which d i f f e r e n t i a t e p a r t i c i p a n t s from nonp a r t i c i p a n t s , and to determine i f the choice of course t o p i c was r e l a t e d to any s p e c i f i c c h a r a c t e r i s t i c s of the p a r t i c i p a n t s . Furthermore i t sought to i d e n t i f y some items which might i n f l u e n c e p a r t i c i p a t i o n i n continuing  education.  4 The v a r i a b l e s examined were: age, m a r i t a l s t a t u s , number of c h i l d r e n , place of residence, year and place of graduation, post-secondary education, work towards dental and/or non-dental q u a l i f i c a t i o n s , employment status and p r i n c i p a l type of employment. categorized i n t o four groupings:  The course topics were  c l i n i c a l s k i l l s , p a t i e n t evaluation,  dental health education and p r a c t i c e management. METHOD Using the r e g i s t e r and m a i l i n g l i s t of the College of Dental Surgeons of B r i t i s h Columbia, a questionnaire was mailed to a l l dental h y g i e n i s t s r e g i s t e r e d i n the province along w i t h the l i c e n c e renewal form.  These were mailed on January 10, 1974 to 221 dental h y g i e n i s t s .  From t h i s m a i l i n g , 158 (71%) r e p l i e s were received.  A second m a i l i n g  was sent the middle of February which produced t h i r t y a d d i t i o n a l responses.  A t h i r d m a i l i n g r e s u l t e d i n 26 more returns f o r a t o t a l of  214 responses received and a response rate of 96.8 per cent.  No  questionnaires were r e j e c t e d because of incomplete data. Sample A f t e r the returns were received, a group of 163 respondents were selected who were both RESIDING and EMPLOYED i n the Province of B r i t i s h Columbia at the time of the survey. Survey Instrument The data were c o l l e c t e d by means of a mailed questionnaire (Appendix 1) designed to provide information requested by S t a t i s t i c s Canada and the  5 B r i t i s h Columbia Dental Hygienists' A s s o c i a t i o n .  The format used f o r  the questions followed that developed by S t a t i s t i c s Canada to ensure that the data could be incorporated i n t o t h e i r Dental Manpower Data Bank.  In developing the questionnaire  consultations were held with  resource persons i n Adult Education, Health Care and Epidemiology, Dentistry and Dental Hygiene.  I n a d d i t i o n , the questionnaire was pre-  tested on twelve a c t i v e l y employed dental h y g i e n i s t s . Data A n a l y s i s The data were transferred to tapes f o r computer a n a l y s i s . B i v a r i a t e and m u l t i - v a r i a t e tabulations were made and eleven socioeconomic c h a r a c t e r i s t i c s (the dependent v a r i a b l e s ) were cross-tabulated against the independent v a r i a b l e s ; p a r t i c i p a t i o n and n o n - p a r t i c i p a t i o n i n continuing dental hygiene education courses.  Further  tabulations  were conducted against the same eleven socio-economic c h a r a c t e r i s t i c s on those hygienists who p a r t i c i p a t e d i n courses. The data processing was done at The U n i v e r s i t y o f B r i t i s h Columbia Computing Centre on the LMB System 370, Model 178. square t e s t was conducted on a l l cross-tabulations. l e v e l of .10 was used.  The c h i -  The s i g n i f i c a n c e  This was judged to be appropriate  f o r t h i s study  as i t was an exploratory study seeking to i d e n t i f y needs f o r future research and approaches to program development. DEFINITION OF TERMS Continuing  Education.  For purposes of t h i s study the term continuing  education i s applied only to short, formal programs offered on  6  a non-credit b a s i s .  These courses were o f f e r e d u n i - p r o f e s s i o n a l l y  to dental h y g i e n i s t s as a group, or m u l t i - p r o f e s s i o n a l l y where the dental h y g i e n i s t s p a r t i c i p a t e d w i t h d e n t i s t s or w i t h other dental a u x i l i a r i e s . Course and Program.  The terms course and program are used interchangeably  to r e f e r to those l e a r n i n g experiences that were planned and implemented to achieve behaviourally defined objectives w i t h i n a given time period. Clinical.  The term c l i n i c a l i s used to describe those courses which  included opportunities f o r c l i n i c a l a p p l i c a t i o n of m a t e r i a l and s k i l l s presented. Non-Clinical.  The term n o n - c l i n i c a l i s used to describe those courses  that d i d not involve d i r e c t c l i n i c a l a p p l i c a t i o n of the learning. Lower Mainland.  The Lower Mainland i s the area of the province bounded  by Georgia S t r a i t on the west, the 49th p a r a l l e l on the south, the Surrey boundary and P i t t Riveroon the east, and the municipal boundaries of North and West Vancouver on the north. F u l l - t i m e Employment.  For purposes of t h i s study the term f u l l - t i m e  employment i s applied to those employed t h i r t y - t w o hours or more or four days or more a week. Part-time Employment.  Part-time employment i s considered any employment  period l e s s than thirty-two hours or l e s s than four days per week. P r i n c i p a l Type of Employment.  P r i n c i p a l type of employment i s defined as  that form of p r a c t i c e i n which the majority of the h y g i e n i s t s ' work week was spent.  7 PLAN OF THE STUDY The study i s reported i n four chapters.  The f i r s t chapter  contains the i n t r o d u c t i o n , background and statement of the problem, some d e f i n i t i o n s of terms, and the methodology used f o r the study. The second chapter reviews the l i t e r a t u r e r e l a t i v e to the study. Chapter 3 consists of the analysis of the data and i s presented i n two sections: the c h a r a c t e r i s t i c s of the p a r t i c i p a n t s and n o n - p a r t i c i pants and the extent of p a r t i c i p a t i o n .  The summary, conclusions and  i m p l i c a t i o n s f o r the future are included i n Chapter 4.  CHAPTER 2 REVIEW OF THE LITERATURE This study focuses oh the continuing education patterns of dental h y g i e n i s t s .  Published materials from 1940 to the present time  were reviewed to determine the extent of research r e l a t e d to the p a r t i c i p a t i o n of dental h y g i e n i s t s i n continuing education programs. This revealed that l i t t l e had been published about p a r t i c i p a t i o n i n continuing education by dental h y g i e n i s t s .  The reports that were  found generally provided d e s c r i p t i v e information about program content but l i t t l e or no data about p a r t i c i p a n t s . As d e n t i s t r y i s a c l o s e l y r e l a t e d p r o f e s s i o n , a review of published reports of d e n t i s t s i n continuing education was also conducted.  I n a d d i t i o n , continuing  education i n the h e a l t h sciences was reviewed b r i e f l y i n an attempt to discover a d d i t i o n a l relevant information. DEFINITIONS OF CONTINUING EDUCATION The importance of continuing education f o r persons engaged i n a l l professions has been established. his  W i l l i a m McGothlin.(29), i n  comparative study of the professions of a r c h i t e c t u r e , business  a d m i n i s t r a t i o n , engineering, law, medicine, nursing, psychology, s o c i a l work, teacher education and v e t e r i n a r y medicine found that a l l of them expressed the b e l i e f that education i s a l i f e l o n g o b l i g a t i o n i n t h e i r p r o f e s s i o n a l code of p r a c t i c e .  Thus, continuing education has been  8  9 formally accepted as a c e n t r a l value i n most professions, but as Randolph (43) suggested "those who have the b a s i c knowledge and  skill  for r e s t o r i n g and preserving h e a l t h have a greater o b l i g a t i o n than most professions to f u r t h e r t h e i r education and keep abreast of a l l new developments•" In r e f e r r i n g to educational a c t i v i t i e s designed f o r adults, the terms adult education, continuing education, continuous education, l i f e - l o n g l e a r n i n g and l i f e - l o n g education appear to be used i n t e r changeably.  The health science professions appear to prefer the term  "continuing education."  Although the phrase "continuing education" i s  almost s e l f - e x p l a n a t o r y — a process whereby a person continues  his/her  education—many d e f i n i t i o n s have been evolved to s u i t s p e c i f i c purposes. In general adult education, several d e f i n i t i o n s have been expressed such as that found i n a UNESCO Report (47) which defined continuing education as a process whereby: . . . persons no longer attend school on a regular or f u l l time basis undertake sequential and organized a c t i v i t i e s with a conscious i n t e n t i o n to b r i n g i n g about changes i n information, knowledge, understanding or s k i l l , appreciation and a t t i t u d e s or f o r the purpose of i d e n t i f y i n g and s o l v i n g personal or community problems. Another d e f i n i t i o n views continuing education as having three major areas: . . . To educate and re-educate i n the f i e l d of work, to produce an informed worker who w i l l understand the world he l i v e s i n and who w i l l through continuing education achieve growth and personal f u l f i l l m e n t . (17)  10 Many d e f i n i t i o n s r e l a t e s p e c i f i c a l l y to the health sciences. Randolph (42) has suggested that any education which follows prep r o f e s s i o n a l programs of undergraduate study should be termed cont i n u i n g education.  The Kellogg Foundation (12) has described  continuing  education as: . . . a continuing study by adults u t i l i z i n g p e r i o d i c l e a r n ing experiences w i t h i n an u n i v e r s i t y environment and f e a t u r i n g a s p e c i a l l y designed f a c i l i t y . A more precise d e f i n i t i o n of continuing education i n the health  sciences  was created by P o p i e l (39) as: . . . any educational a c t i v i t y f o r the health profession through which opportunities f o r systematic learning are provided. Included i n t h i s d e f i n i t i o n are any planned l e a r n i n g experiences which may range from formal courses, through conferences, conventions, i n s t i t u t e s or workshops, to c l i n i c a l traineeship so long as they are conducted f o r the p r a c t i c i n g p r o f e s s i o n a l and are systematic  learning  activities. Neylan (34) described continuing education as: . . . a moderate degree of o r g a n i z a t i o n , f l e x i b l e , responsible to current l e a r n i n g needs of i n d i v i d u a l s or groups and designed to enable i n d i v i d u a l s to maintain competence and increase e f f e c t i v e ness and e f f i c i e n c y i n present r o l e performance.  11  CONTINUING EDUCATION IN DENTISTRY Dentists have been concerned with the advancement of t h e i r profession and have accepted the challenge of c o n t i n u a l personal and p r o f e s s i o n a l growth.  Recognition of t h i s was f i r s t expressed by  G.V. Black (4) the "Father of D e n t i s t r y , " i n h i s 1907 statement that "the p r o f e s s i o n a l man has no r i g h t to be other than a continuous student." concept.  Since that time the p r o f e s s i o n has continued t o support t h i s One of the objectives c i t e d i n the 1962 Report on Dental  Education of the World Health Organization (15) was the "need f o r cont i n u i n g p r o f e s s i o n a l education throughout  life."  In recent years i n t e r e s t i n continuing education has m u l t i p l i e d considerably, probably as a r e s u l t of pressure exerted by i n d i v i d u a l p r a c t i t i o n e r s and p r o f e s s i o n a l bodies, as w e l l as s o c i e t y at large. In 1964, the H a l l Royal Commission on Health Services (46) recommended "that to help ensure that physicians i n p r a c t i c e maintain t h e i r l e v e l of competence, medical schools inaugurate or expand t h e i r program of continuing medical education . . . "  A s i m i l a r recommendation was  made at the same time w i t h respect to d e n t i s t s . Definitions i n Dentistry In the Report of the American Dental A s s o c i a t i o n Council on Dental Education (22) continuing d e n t a l education was defined as: . . . c o n s i s t i n g of educational a c t i v i t i e s designed to review e x i s t i n g concepts and techniques and to convey information and knowledge on advances i n dental medical sciences.  12 The Council f u r t h e r stated that the o b j e c t i v e of continuing dental education i s to improve and increase the a b i l i t y of the d e n t i s t to d e l i v e r the highest q u a l i t y of dental care p o s s i b l e .  The ultimate  aim of continuing dental education i s increased h e a l t h care f o r the patient.  Continuing education should make i t p o s s i b l e f o r each d e n t i s t  to attune h i s p r a c t i c e to the modern dental knowledge that continuously becomes a v a i l a b l e . Optimal p r o f e s s i o n a l growth ensues through the p a r t i c i p a t i o n of each d e n t i s t i n e f f e c t i v e programs of continuing educat i o n i n a d d i t i o n to h i s own experience and assessment of the l i t e r a t u r e . During the Canadian Dental A s s o c i a t i o n Conference on Continuing Education  (7) held i n September, 1972, several d e f i n i t i o n s of continuing  education were put f o r t h : . . . Any form of education f o r a member of the dental health team f o l l o w i n g a c q u i s i t i o n of the basic q u a l i f i c a t i o n aimed at maintaining and upgrading the q u a l i t y and quantity of dental care delivered t o the p u b l i c . . . . . . the motivation towards t o t a l l e a r n i n g , using a l l the pedogogic techniques a v a i l a b l e (such as courses, conventions, c l i n i c a l t r a i n i n g , l e c t u r e s , seminars). Studies which should enable the members of the dental profession i n c l u d i n g a u x i l i a r y personnel to b e t t e r serve the p u b l i c by maintaining current standards and good dental p r a c t i c e . Emergence of Continuing Dental  Education  Dental educators and other leaders i n the p r o f e s s i o n along with those i n many other professions have agreed that continuous l e a r n i n g i s e s s e n t i a l f o r the maintenance of p r o f e s s i o n a l excellence.  (1, 5, 26)  As Patterson (37) stated i n 1960, "the d e n t i s t or p h y s i c i a n who i s conducting a 1940 type p r a c t i c e i n 1960, i s rendering l i m i t e d service to  13 the p a t i e n t and c o n s t i t u t e s a l i a b i l i t y to h i s profession."  Holroyd  (23)  noted that more frequent change and adjustments must be incorporated i n t o p r a c t i c e i n order to keep abreast of modern p r a c t i c e .  Massler  (30),  i n 1971, r e f e r r e d to the q u a l i t y of p r a c t i c e as being l i k e "horse and buggy d e n t i s t r y i n a jet-age."  Chambers and Hamilton (9) 'observed that  further answers to the problem of "how sought.  best to protect the p u b l i c " be  Randolph (43) acknowledges that while the professions are  becoming i n c r e a s i n g l y aware of the need f o r organized continuing educat i o n , "obsolescence i n knowledge or t e c h n i c a l s k i l l i s a v i o l a t i o n of the t r u s t committed to those who become p r o f e s s i o n a l l y and  legally  q u a l i f i e d to tend the health needs of others." According to Nakamoto and Verner (33), continuing dental educat i o n was a product of the Second World War.  Up to that time there  appeared to have been few attempts to o f f e r s y s t e m a t i c a l l y planned l e a r n i n g opportunities f o r dental p r a c t i t i o n e r s .  The return to c i v i l i a n  l i f e of a l a r g e number of d e n t i s t s a f t e r World War Two,  coupled with  the advance i n a l l the health sciences, f o r c i b l y demonstrated the need for s p e c i f i c programs f o r continuing dental education.  In response, a  s e r i e s of refresher type programs were conducted at several dental schools. In r e c o g n i t i o n of the need f o r more e f f e c t i v e programming a f i r s t conference on continuing dental education was held i n the United States i n 1948 .  At t h i s conference plans were made to organize f u r t h e r conferences  and workshops to study the problems r e l a t e d to the establishment conducting of programs of continuing dental education.  and  Burket (6), a  leading dental educator, at one such workshop pointed out that the  14 dental schools must have a d e f i n i t e r e s p o n s i b i l i t y i n the area of continuation study, a r e s p o n s i b i l i t y beyond graduate programs. Since these i n i t i a l conferences, conferences,  there have been many discussions,  and workshops concerning the need f o r continuing dental  education, however, there has been l i m i t e d study of the p a r t i c i p a t i o n patterns of d e n t i s t s involved i n continuing education.  Much of what has  been w r i t t e n over the past several years has been opinions and viewpoints and not v a l i d s c i e n t i f i c study. The f i r s t major conference on continuing dental education i n Canada was held i n 1972 (7). Discussion was focussed on the r e l a t i v e r e s p o n s i b i l i t i e s of the profession and i t s p r a c t i t i o n e r s to plan t h e i r own continuing education, and on the machinery f o r deciding the methods and techniques  of i t s  implementation.  Begrie (3), considered that continuing dental education determined the manner by which a standard of care f o r the p u b l i c i s maintained to a required l e v e l .  He stated that i n some instances i t has been necessary  to implement t h i s standard of care by compulsion.  I n the United States,  several states have already enacted l e g i s l a t i o n demanding continuing education as a requirement f o r the r e l i c e n s u r e of d e n t i s t s .  In Canada  Charter (8) reported that the provinces of Manitoba and A l b e r t a have made such demands on t h e i r l i c e n c e d d e n t i s t s and s e v e r a l other are considering s i m i l a r a c t i o n .  provinces  In B r i t i s h Columbia, the Council of the  College of Dental Surgeons of B r i t i s h Columbia have approved r e v i s i o n s to the Dentistry Act which have been submitted ment.  to the p r o v i n c i a l govern-  The r e v i s i o n s allow the College the a u t h o r i t y to require l i c e n c e d  15 personnel to meet continuing education requirements as a c o n d i t i o n of relicencing. P a r t i c i p a t i o n of Dentists i n Continuing Education Although there i s no accurate data a v a i l a b l e about p a r t i c i p a t i o n i n continuing dental education i n general, there i s some data that suggests f a c t o r s which may a f f e c t p a r t i c i p a t i o n . of p r a c t i c e , type of p r a c t i c e , age and income.  These include l o c a t i o n I t was found that i n  the United States only f i f t e e n to twenty-five per cent of the d e n t i s t s r e g u l a r l y attended continuing education courses (33).  Regional surveys  showed a s i m i l a r i t y to t h i s n a t i o n a l f i g u r e (14, 16, 21, 27, 35, 36, 38). Darby's survey (14) further compared the opinions of d e n t i s t s i n the New England and Western s t a t e s .  In both areas 90 per cent of the res-  pondents expressed a w i l l i n g n e s s to p a r t i c i p a t e i n c o n t i n u i n g education but t h e i r p a r t i c i p a t i o n would be subject to i n f l u e n c e by such f a c t o r s as subject matter presented, length of course, t r a v e l distance required and p o r t i o n of the week involved. These factors were f u r t h e r r e i t e r a t e d by P e t i t and 0'Shea's Western New York study (38) as w e l l as K e e v i l ' s study (27) of the U.S. P u b l i c Health Qentists and dental h y g i e n i s t s . The motivating f a c t o r s involved i n gaining attendance i n continuing education courses, as found by Adler ( 2 ) , were mainly i n t e r e s t and  improve-  ment of p r a c t i c e procedures. I t was estimated that during the year, 1970-71, 24 per cent of the licenced d e n t i s t s i n B r i t i s h Columbia attended continuing education courses made a v a i l a b l e through the D i v i s i o n of Continuing Dental Education  16 at The U n i v e r s i t y of B r i t i s h Columbia (48).  In the f o l l o w i n g years there  was a s u b s t a n t i a l increase i n attendance with 47 per cent i n 1971-72, and 51 per cent i n 1972-73 (49, 18).  Since one d e n t i s t could attend  more than one course, the figures were not t r u l y representative of the a c t u a l number of i n d i v i d u a l s p a r t i c i p a t i n g i n courses.  Furthermore  64 per cent of the d e n t i s t s attending these contlinuirig^dental education . courses were from the Lower Mainland (18).  This probably was due to the  f a c t that the courses were held at The U n i v e r s i t y of B r i t i s h Columbia campus or at other l o c a t i o n s i n the Greater Vancouver area and were, therefore, r e l a t i v e l y i n a c c e s s i b l e to a large number of p r a c t i c i n g d e n t i s t s outside the immediate area. CONTINUING EDUCATION IN DENTAL HYGIENE Continuing education f o r dental h y g i e n i s t s has had a l a t e r s t a r t than i n the case of d e n t i s t r y .  The increased knowledge of and emphasis  on prevention and the opening of laws governing dental hygiene p r a c t i c e has stimulated a c t i o n by the h y g i e n i s t s to plan and p a r t i c i p a t e i n cont i n u i n g education. D e f i n i t i o n s of Continuing Education i n Dental Hygiene In reviewing the l i t e r a t u r e there appeared to be only one recorded d e f i n i t i o n a v a i l a b l e which s p e c i f i c a l l y r e l a t e d to continuing education i n dental Hygiene.  This d e f i n i t i o n , fcom the American Dental H y g i e n i s t s '  A s s o c i a t i o n (44), s t a t e d that continuing education i s :  17 The education of the i n d i v i d u a l beyond basic preparation f o r the profession of dental hygiene whose primary goal i s to promote optimal s e r v i c e to the p u b l i c by f o s t e r i n g continued p r o f e s s i o n a l competence. Continuing education includes educational a c t i v i t i e s that up-date, refresh and increase the knowledge and competency of the p r a c t i t i o n e r . Emergence of Continuing Dental Hygiene Education The e a r l i e s t reports of courses s p e c i f i c a l l y designed f o r dental h y g i e n i s t s appeared i n the l i t e r a t u r e i n the e a r l y 1940's (45).  Since  then the number of courses a v a i l a b l e to h y g i e n i s t s has increased at a steady rate and current a c t i v i t i e s are more v a r i e d i n design and content than those of past years.  These range from lectures through seminars  and workshops to c l i n i c a l s i t u a t i o n s f o r the a p p l i c a t i o n and p r a c t i c e of t e c h n i c a l s k i l l s .  Topics are presented both on a short term b a s i s ,  such as the one hour l e c t u r e , and on a long term b a s i s , such as a month long course. The need of dental h y g i e n i s t s to increase knowledge and to keep informed of current research being done to improve techniques of p r a c t i c e by p a r t i c i p a t i n g i n continuing education has been stated often i n recent l i t e r a t u r e (13, 19, 24, 31). hygiene education was  Even as l a t e as 1960,  continuing  s t i l l i n i t s e a r l i e s t stages as the majority of  hygienists were not p a r t i c i p a t i n g i n any formal programs. u n t i l 1968  dental  I t was  not  that the House of Delegates of the American Dental Hygienists'  A s s o c i a t i o n (32) o f f i c i a l l y commited i t s e l f to the concept of  continuing  education i n the statement: To promote continuing education f o r continued improvement of dental hygiene services and the r e t e n t i o n of dental hygienists i n the manpower force.  18 In Canada continuing education o f f e r i n g s f o r dental h y g i e n i s t s have developed more slowly than i n the United States.  The Canadian  Dental Hygienists' A s s o c i a t i o n declared i n i t s o r i g i n a l Code of E t h i c s (10) i n 1967  that:  Every dental h y g i e n i s t has the o b l i g a t i o n to keep h i s knowledge current and s k i l l s freshened by continuing education through out his professional l i f e . This statement was  repeated in;.the amended Code of E t h i c s i n 1972  (11).  Recently the Canadian Dental Hygienists' A s s o c i a t i o n has supported the concept that continuing education i s necessary f o r a l l members and has d i r e c t e d a l l provinces to encourage and promote p a r t i cipation.  The need to e s t a b l i s h guidelines for continuing  f o r dental h y g i e n i s t s has been reported (5). "Continuing E d u c a t i o n — D i r e c t i o n s  '73," was  education  In a d d i t i o n , the theme, selected f o r the n a t i o n a l  convention and the program focussed on the many facets of continuing education from "The  Recognition of Need"; "Choice or Necessity";  "Expanded Functions, What Now?"; through the "Organization and Implementation of programs." A l l p r o v i n c i a l associations appear to recognize the  importance  of continuing education and some provinces are becoming a c t i v e l y i n volved i n the development and promotion of programs.  At the present  time continuing education seems to be a major component of a l l p r o v i n c i a l and l o c a l meetings. Discussions r e l a t i n g to compulsory continuing education as a p r e r e q u i s i t e of dental hygiene r e l i c e n s u r e have been held i n most provinces.  19 At present, however, no province includes compulsory continuing educat i o n f o r r e l i c e n s u r e of a u x i l i a r y personnel under e x i s t i n g or proposed legislation. P a r t i c i p a t i o n of Dental Hygienists i n Continuing Education A 1973 study of p r a c t i c i n g dental h y g i e n i s t s i n Canada revealed that 69 per cent of them attended one or more continuing education a c t i v i t i e s i n the previous year (28).  This study d i d not analyze the  data of p a r t i c i p a t i o n by s p e c i f i c types of courses but i t d i d i n d i c a t e an i n t e r e s t i n p r o f e s s i o n a l enrichment experiences of v a r i e d kinds.  through p r o f e s s i o n a l educational  In the main, h y g i e n i s t s attended  i n the province i n which they resided.  courses  Even w i t h i n that geographical  l i m i t a t i o n , p a r t i c i p a n t s e s s e n t i a l l y represented the more urban communities.  This was a t t r i b u t e d to the predominantly c e n t r a l i z e d and urban  l o c a t i o n s of most of the programs a v a i l a b l e and the p r o h i b i t i v e expense involved i n attending by those l i v i n g on the periphery. Although the r e l a t i o n s h i p between educational achievement and p a r t i c i p a t i o n i n continuing dental hygiene education has not been examined i n the l i t e r a t u r e , the studies of Verner and Newberry (50) as w e l l as those of Johnstone and Rivera (25) showed that the greater the number of years of b a s i c schooling, the greater the l i k e l i h o o d of a person p a r t i c i p a t i n g i n adult education programs.  The majority of dental  h y g i e n i s t s have s i m i l a r educational backgrounds because the entry r e q u i r e ments f o r p r e - p r o f e s s i o n a l education demand a minimum of twelve years of schooling.  20 Continuing Education f o r Dental Hygienists i n B r i t i s h Columbia In B r i t i s h Columbia continuing education programs s p e c i f i c a l l y designed f o r dental h y g i e n i s t s were not a v a i l a b l e u n t i l 1971 (48). P r i o r to that date, opportunities f o r the continuing education f o r dental h y g i e n i s t s were l i m i t e d to the few programs o f f e r e d through the d i v i s i o n s of continuing education of American dental schools, i n p a r t i c u l a r , those i n the neighbouring states o f Washington and Oregon.  Many  p r a c t i t i o n e r s have e n r o l l e d i n c r e d i t and non-credit courses i n educat i o n a l i n s t i t u t i o n s i n subject areas r e l a t i n g to d e n t i s t r y such as those i n the behavioural sciences, b a s i c sciences, and business administration.  Some h y g i e n i s t s i n B r i t i s h Columbia e n r o l l e d i n courses of  study leading towards a baccelauriate degree and a s e l e c t number have pursued a masters degree.  I n a d d i t i o n , most h y g i e n i s t s hold membership  i n t h e i r n a t i o n a l organization which l i s t s continuing education as one of the b e n e f i t s of membership. Dental h y g i e n i s t s i n B r i t i s h Columbia have had opportunities to attend courses offered f o r members of l o c a l dental s o c i e t i e s and s p e c i a l t y groups throughout the province (40, 41, 42). clubs.  A l s o , some have j o i n e d study  These study clubs have been established i n some areas of the  province and are l e d by those w i t h expertise i n a s p e c i a l i z e d area of p r a c t i c e who share t h e i r t e c h n i c a l s k i l l s and knowledge with t h e i r prof e s s i o n a l peers. In the guidelines f o r study clubs e s t a b l i s h e d by the B r i t i s h Columbia Dental Hygienists' A s s o c i a t i o n (20) the purpose of study clubs has been defined as:  21 A means of continuing education f o r the graduate dental h y g i e n i s t enabling her to increase her c l i n i c a l s k i l l s and keep current i n new dental knowledge i n a group s i t u a t i o n . Since 1971, formal courses s p e c i f i c a l l y designed f o r h y g i e n i s t s have been made a v a i l a b l e through the D i v i s i o n of Continuing Dental Education a t The U n i v e r s i t y of B r i t i s h Columbia w i t h l i a i s o n provided by the B r i t i s h Columbia Dental H y g i e n i s t s ' A s s o c i a t i o n (18, 48, 49).  The  s p e c i f i c dental hygiene t o p i c s included: "Teaching the Dental P a t i e n t , " "Recognition and Control of P e r i o d o n t a l Disease," "Radiography," "Recognition of Oral Lesions," "Prevention and Handling of Emergencies i n the Dental O f f i c e , " " P r i n c i p l e s of Occlusion," "Plaque and Preventive D i e t e t i c s i n the Dental O f f i c e , " " F i n i s h i n g Restorations," and "Adhesives i n Restorative D e n t i s t r y . " SUMMARY The review of the l i t e r a t u r e revealed that there has been l i t t l e published research about p a r t i c i p a t i o n patterns of d e n t i s t s or dental hygienists.  There i s , however, much d i s c u s s i o n concerning the need f o r  more organized programming of continuing d e n t a l education. i n t e r e s t i n and concern f o r continuing education courses  In addition,  specifically  designed f o r both d e n t i s t s and dental h y g i e n i s t s i s most apparent.  CHAPTER 3 ANALYSIS OF DATA In t h i s chapter the f i r s t section describes the socio-economic c h a r a c t e r i s t i c s of p a r t i c i p a n t s and non-participants i n continuing dental hygiene education programs.  The c h a r a c t e r i s t i c s examined include:  age, m a r i t a l s t a t u s , number of c h i l d r e n , place of residence, year and place of graduation, number of years of post-secondary education, work towards other dental and non-dental q u a l i f i c a t i o n s , employment status and p r i n c i p a l type of employment. presented  Some a d d i t i o n a l iiSformation i s  to describe more f u l l y some of the c h a r a c t e r i s t i c s of the  respondents.  In the second section the extent of p a r t i c i p a t i o n by  dental h y g i e n i s t s i s described i n four categories: c l i n i c a l s k i l l s , patient evaluation, dental health education and p r a c t i c e management. The s t a t i s t i c a l l y s i g n i f i c a n t socio-economic c h a r a c t e r i s t i c s of the p a r t i c i p a n t s i n each category are discussed. CHARACTERISTICS OF PARTICIPANTS AND NON-PARTICIPANTS To i n v e s t i g a t e the c h a r a c t e r i s t i c s of p a r t i c i p a n t s and nonp a r t i c i p a n t s i n continuing dental hygiene education courses,  chi-square  analyses was conducted to i d e n t i f y differences i n the d i s t r i b u t i o n s between p a r t i c i p a n t s and non-participants at the .01 l e v e l of s i g n i ficance.  22  23  Age The average age of the respondents was 28 years, w i t h a range from 20 to 54 years of age. A large group of respondents (13.5%) were 23 years of age and another group (12.9%) were 26 years o l d . For purposes of a n a l y s i s , respondents were divided i n t o two age groups: l e s s than 25 and 25 and over (Table 1). TABLE 1 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Age  Less than 25 n %  25 and Over n %  n  Total  %  Participants  63  68.5  49  69.1  112  68.7  Non-Participants  29  31.5  22  30.9  51  31.3  92  100.0  71  100.0  163  100.0  Total  = .01, d.f. = 1, p = .88 not s i g n i f i c a n t Some 56.4 per cent of the respondents were i n the younger group, and the remaining 43.6 per cent were i n the older group.  No s i g n i f i c a n t  d i f f e r e n c e between p a r t i c i p a n t s and non-participants by age was recorded. Thus, age d i d not d i f f e r e n t i a t e between p a r t i c i p a n t s and non-participants. M a r i t a l Status The average number of years that the married respondents had been married was s i x years w i t h the range from 1 to 28 years. A large number (33%) had been married w i t h i n the past four years.  24 For purposes of a n a l y s i s , respondents were divided i n t o three categories: unmarried, married l e s s than f i v e years, and those married f i v e years or more.  Unmarried respondents included those who were  s i n g l e , separated, divorced or widowed, with only three h y g i e n i s t s i n t h i s group separated, divorced or widowed (Table 2 ) . TABLE 2 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by M a r i t a l Status Unmarried  Married l e s s than 5 years n %  Married 5 years or more n %  n  %  Participants  53  73.6  35  68.6  24  Non-Participants  19  26.4  16  31.4  72  100.0  51  100.0  Total  Total n  %  60.0  112  68.7  16  40.0  51  :31.3  40  100.0  163  100.0  X** = 2.22, d.f. = 2, p = .33 not s i g n i f i c a n t A l a r g e majority of the unmarried h y g i e n i s t s , 73.6 per cent, p a r t i cipated i n continuing dental hygiene education courses compared to 60 per cent of those married f i v e years or more and 62.6 per cent of those married l e s s than f i v e years.  The variance recorded between the p a r t i c i p a t i o n of  s i n g l e and married h y g i e n i s t s suggested that unmarried i n d i v i d u a l s were more l i k e l y to be p a r t i c i p a n t s but the d i f f e r e n c e i n d d i s t r i b u t i o n between p a r t i c i p a n t s and non-participants by m a r i t a l status was not s u f f i c i e n t to produce a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e .  25 Number of Children S i x t y - f o u r per cent of the respondents reported that they had c h i l d r e n while 70.2 per cent d i d not (Table 3). TABLE 3 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Number of Children With Children n %  Without Children n %  n  Total %  Participants  25  64.1  87  70.2  112  68.7  Non-Participants  14  35.9  37  29.8  51  31.3  39  100.0  124  163  100.0  Total  X*" = .25, d.f. = 1,  100.0  p = .61 not s i g n i f i c a n t  Of the t o t a l number of respondents, 23.9 per cent reported a t o t a l of 43 c h i l d r e n .  The number of c h i l d r e n by age ranged from 25  four years o l d or l e s s to 13 c h i l d r e n f i v e to fourteen years of age, 4 c h i l d r e n f i f t e e n to nineteen years, and one c h i l d over twenty years of age. Of the preschool age c h i l d r e n four years of age and under, 21 hygienists  (12.9%) had one preschooler while four h y g i e n i s t s  (2.5%)  had two. The number of c h i l d r e n d i d not show a s t a t i s t i c a l l y s i g n i f i c a n t difference i n the d i s t r i b u t i o n of p a r t i c i p a n t s and non-participants  in-  d i c a t i n g that t h i s was not a f a c t o r i n f l u e n c i n g p a r t i c i p a t i o n . Place of Residence For purposes of a n a l y s i s , place of residence was grouped i n t o two categories: Lower Mainland and Other Areas of B r i t i s h Columbia.  The  26 Lower Mainland i s bounded by Georgia S t r a i t on the west, the 49th p a r a l l e l on the south, Surrey boundary and P i t t River on the e a s t , and the munic i p a l boundaries of North and West Vancouver, Lions Bay and Coquitlam on the north.  Of the h y g i e n i s t s responding 74.8 per cent l i v e d i n the  Lower Mainland (Table 4). TABLE 4 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Place of Residence Lower Mainland n %  Other Areas n %  n  Total %  Participants  86  70.5  26  63.4  112  68.7  Non-Participants  36  29.5  15  36.6  51  31.3  122  100.0  41  100.0  163  100.0  Total X  2  = .42, d.f • = 1, p = .52 not s i g n i f i c a n t Of the 25.2 per cent resident i n other areas, 9.8 per cent l i v e d  on Vancouver I s l a n d , 6.7 per cent l i v e d i n the I n t e r i o r and 8.6 per cent resided i n scattered l o c a t i o n s throughout the province.  Of the Lower  Mainland residents 70.5 per cent attended courses w h i l e 29.5 per cent did not attend as compared to 63.4 per cent of those r e s i d i n g out of the Lower Mainland who attended courses and 36.3 per cent who d i d not. The d i s t r i b u t i o n of p a r t i c i p a n t s and non-participants by t h e i r place of residence was not s t a t i s t i c a l l y s i g n i f i c a n t and thus, place of residence was not a f a c t o r i n p a r t i c i p a t i o n .  The 63.4 per cent p a r t i c i p a t i o n rate  of those l i v i n g outside of the Lower Mainland i s an encouraging f i g u r e  27 as most of the courses were held w i t h i n the Lower Mainland. Year of Graduation The average year of graduation of the respondents was w i t h the e a r l i e s t year being 1947.  1968  Seventy-four h y g i e n i s t s (45.6%)  graduated between 1947 and 1969, while 89 hygienists (54.4%) graduated i n 1970 or l a t e r .  This d i f f e r e n c e can be a t t r i b u t e d to the e s t a b l i s h -  ment of the program i n Dental Hygiene at The U n i v e r s i t y of B r i t i s h Columbia and the graduation of the f i r s t c l a s s i n 1970 (Table 5). TABLE 5 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Year of Graduation  1970 or A f t e r n %  Total  Before 1970 n %  n  $  Participants-  60  67.4  52  70.3  112  68.7  Non-Participants  29  32.6  22  39.7  51  31.3  89  100.0  74  100.0  163  100.0  Total X" = .05, 1  d.f. = 1,  p = .81 not s i g n i f i c a n t  Since 1970, twenty students per year have graduated and most of these have remained r e g i s t e r e d and licenced i n the province.  P r i o r to 1970, a l l  B r i t i s h Columbia residents seeking education as h y g i e n i s t s had to go out of the province. In the group graduating since 1970, 67.4 per cent p a r t i c i p a t e d i n continuing education and 32.6 per cent d i d not as compared with 70.3 per  28  cent and 39.7 per cent r e s p e c t i v e l y f o r those who graduated before 1970. There was no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n d i s t r i b u t i o n by year of graduation between the p a r t i c i p a n t s and non-participants i n d i cating that the year of graduation was not a f a c t o r i n f l u e n c i n g p a r t i cipation. Place of Graduation Dental h y g i e n i s t s r e g i s t e r e d and licenced i n B r i t i s h have graduated from many d i f f e r e n t schools.  Columbia  For purposes of a n a l y s i s  the place of graduation was grouped i n t o two categories: Canada and the United States (Table 6). TABLE 6 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Place of Graduation  n  Canada  %  United States n %  n  Total %  Participants  64  62.1  48  80.0  112  68.7  Non-Participants  39  37.9  12  20.0  51  31.3  103  100.0  90  100.0  163  100.0  Total X^ = 4.83 ,  d.f. = 1,  p = .02  significant  Of the t o t a l respondents, 79.1 per cent graduated i n Canada and 20.9 per cent graduated i n the United States. The l a r g e s t group (36.2%) of respondents graduated from The U n i v e r s i t y of B r i t i s h Columbia, while 27.6 per cent graduated from e i t h e r the U n i v e r s i t y of A l b e r t a or the  29 U n i v e r s i t y of Manitoba.  Some 15.3 per cent graduated from e i t h e r the  U n i v e r s i t y of Toronto i n Ontario or Dalhousie U n i v e r s i t y i n Nova S c o t i a . A t o t a l of 20.9 per cent of the respondents received t h e i r t r a i n i n g from educational i n s t i t u t i o n s i n the United States. Sixty-two per cent of the Canadian graduates p a r t i c i p a t e d i n continuing education and 37.9 per cent d i d not as compared w i t h 80 per cent of the American graduates who p a r t i c i p a t e d and 20 per cent who d i d not.  The difference i n d i s t r i b u t i o n of p a r t i c i p a n t s and non-participants  by place of graduation i s s t a t i s t i c a l l y s i g n i f i c a n t and thereby a f a c t o r i n f l u e n c i n g p a r t i c i p a t i o n . IHygienists who graduated from dental hygiene programs i n the United States were more l i k e l y to p a r t i c i p a t e i n continuing dental hygiene education which may suggest that Canadian graduates were not imbued with the concept of continuing education as a necessity or did not develop favourable a t t i t u d e s toward continuing education i n t h e i r undergraduate years. Post-Secondary Education Training f o r dental hygiene generally c o n s i s t s of a two year post-secondary education program leading to a diploma i n dental hygiene. Some programs require one or more years of post-secondary education as a prerequisite.  In a d d i t i o n , some h y g i e n i s t s obtain some e l e c t i v e years  of post-secondary education. Of the respondents, only 4.9 per cent had a degree from u n i v e r s i t y and the remaining 95.1 per cent had only a diploma i n dental hygiene. Many respondents (30.6%) had accumulated one to three years of further  30 post-secondary education i n a d d i t i o n to that required by the two year dental hygiene diploma.  Fourteen h y g i e n i s t s (8.6%), i n d i c a t e d that  they were working toward degree q u a l i f i c a t i o n s .  Of those h y g i e n i s t s  with two or three years post-secondary education and a diploma, 67.3 per cent p a r t i c i p a t e d i n continuing education while 32.7 per cent d i d not (Table 7). TABLE 7 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Number of Years Post-Secondary Education  2-3 Years with Diploma  4 Years or more w i t h Degree or Diploma n %  Total n  %  n  %  Participants  76  67.3  36  72.0  112  68. 7  Non-Participants  37  32.7  14  28.0  51  31. 3  113  100.0  50  100.0  163  100. 0  Total  = .18, d.f. = 1, p = .67  not s i g n i f i c a n t  Among those hygienists w i t h four years or more post-secondary education w i t h e i t h e r a degree or diploma, 72 per cent p a r t i c i p a t e d i n continuing education courses and 28 per cent d i d not.  There was no  s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the d i s t r i b u t i o n of p a r t i c i p a n t s and non-participants by number of years post-secondary education and, therefore, i t d i d not influence p a r t i c i p a t i o n patterns.  31 Other Dental Q u a l i f i c a t i o n s Fourteen of the h y g i e n i s t s indicated that they were continuing to work towards some f u r t h e r academic q u a l i f i c a t i o n s .  These q u a l i f i c a -  tions included a range of course o f f e r i n g s leading to a Baccalaureate Degree.  The courses selected were preparing the p a r t i c i p a n t s to pursue  education or program administration i n dental hygiene.  Several respond-  ents were working towards a Master's Degree and one respondent was attempting to q u a l i f y f o r admission to a d e n t a l program.  Of the  h y g i e n i s t s working towards other d e n t a l q u a l i f i c a t i o n s , 78.6 per cent p a r t i c i p a t e d i n continuing d e n t a l hygiene education courses and 21.4 per cent d i d not i n comparison with 67.8 per cent who were not working  towards  any a d d i t i o n a l dental q u a l i f i c a t i o n but p a r t i c i p a t e d i n continuing educat i o n courses and 32.2 per cent who d i d not p a r t i c i p a t e (Table 8). TABLE 8 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Work Towards Other Dental Q u a l i f i c a t i o n s  n Participants Non-Participants Total X  = invalid.  yes  %  n  11  78.6  101  3  21.4  48  14  100.0  149  no %  n  total %  112  68.7  32.2  51  31.3  100.0  163  100.0  67.8 •  One c e l l contained l e s s than f i v e responses.  32 Non-Dental Q u a l i f i c a t i o n s T h i r t y - f i v e per cent of the t o t a l hygienists were working towards non-dental q u a l i f i c a t i o n s (Table 9).  Respondents working toward non-  dental q u a l i f i c a t i o n s reported a wide range of subject areas of study such as: elementary education, psychology, language,  anthropology,  business administration and s e c r e t a r i a l training i n the academic areas and piano, s a i l i n g mastery and figure skating i n the non-academic areas.  TABLE 9 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Work Towards Non-Dental Q u a l i f i c a t i o n s  total  no  yes n  %  n  %  Participants  45  78.9  67  63.2  112  68.7  Non-Participants  12  21.1  39  36.8  51  31.3  57  100.0  106  100.0  163  100.0  Total X*" = 3.57,  d.f. =1,  p. = .05  n  %  significant  Of the respondents, 78.9 per cent participated i n continuing education courses while 21.1% did not p a r t i c i p a t e .  On the other hand, of the 65  per cent of the t o t a l who were not working towards any non-dental cations, 63.2 per cent did p a r t i c i p a t e i n continuing education and per cent did not.  qualifi36.8  The difference i n d i s t r i b u t i o n of participants and  non-participants by work towards non-dental q u a l i f i c a t i o n s i s s t a t i s t i c a l l y s i g n i f i c a n t and therefore was a factor influencing p a r t i c i p a t i o n .  It  33 i n d i c a t e d that those respondents seeking f u r t h e r education of any type also p a r t i c i p a t e d i n continuing dental hygiene education Employment  courses.  Status  Of the t o t a l number of respondents, 125 or 76.7 per cent were employed f u l l - t i m e while 38 or 23.3 per cent were employed part-time. For purposes of t h i s study f u l l - t i m e employment was defined as employed thirty-two hours or more or four days or more a week and anything l e s s than that amount was considered part-time employment (Table 10). TABLE 10 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by Employment Status  Part-time n %  Full-time n /o  Total n  la  Participants  90  72.0  22  57.9  112  68.7  Non-Participants  35  28.0  16  42.1  51  31.3  125  100.0  38  100.0  163  100.0  d.f. = 1,  p. = .14  Total = 2.08,  not s i g n i f i c a n t  Some 72 per cent of the f u l l - t i m e employed h y g i e n i s t s p a r t i c i p a t e d i n one or more continuing education courses and 28 per cent d i d not as compared to 57^9 per cent of those who worked part-time and p a r t i c i p a t e d and 42.1 per cent who d i d not.  The d i f f e r e n c e i n d i s t r i b u t i o n between  p a r t i c i p a n t s and non-participants by employment status was not s t a t i s t i c a l l y s i g n i f i c a n t but suggests that those employed f u l l - t i m e are more l i k e l y to p a r t i c i p a t e i n continuing education.  34  P r i n c i p a l Type of Employment P r i n c i p a l type of employment was defined as that form of p r a c t i c e i n which the majority of the h y g i e n i s t s ' work week was spent.  The  p r i n c i p a l types of employment, f o r purposes of a n a l y s i s , were divided i n t o two categories. The category " p r i v a t e p r a c t i c e " includes general dental p r a c t i c e and dental s p e c i a l t y p r a c t i c e s , such as orthodontics, p e r i o d o n t i c s and pedodontics. the respondents.  This category contained 88 per cent of  The category "other," employment modes such as dental  a u x i l i a r y education, p u b l i c h e a l t h , school h e a l t h and community agencies were included. Of the 12 per cent of respondents i n t h i s group, 3.7 per cent were i n v o l v e d i n dental hygiene education, 1.2 per cent i n dental a s s i s t i n g education, 5.5 per cent i n p u b l i c h e a l t h and 1.2 per cent i n community agencies. Of the 144 respondents employed i n p r i v a t e p r a c t i c e , 65.9 per cent attended continuing education courses and 34.1 per cent d i d not i n contrast to the 89.4 per cent of those employed i n other areas of p r a c t i c e who p a r t i c i p a t e d i n continuing education courses and the 10.6 per cent who d i d not (Table 11). Hygienists not employed i n p r i v a t e p r a c t i c e p a r t i c i p a t e d more i n continuing education courses.  The d i f f e r e n c e between the d i s t r i b u -  t i o n of p a r t i c i p a n t s and non-participants was s t a t i s t i c a l l y s i g n i f i c a n t and thus p r i n c i p a l type of employment d i d d i f f e r e n t i a t e between p a r t i cipants and non-participants.  35 TABLE 11 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s and Non-Participants by P r i n c i p a l Type of Employment  Private Practice n %  n  Other  n  %  Total %  Participants  95  65.9  17  89.4  112  68.7  Non-Participants  49  34.1  2  10.6  51  31.3  144  100.0  19  100.0  63  100.0  Total X  = 3.29,  d.f. = 1 ,  p = .06  significant  EXTENT OF PARTICIPATION Of the 163 respondents to the survey, 112 (68.7)%)._dental h y g i e n i s t s attended continuing dental hygiene education courses during the three year period from March, 1971 to March,M9 74. /  Certain s p e c i f i c  c h a r a c t e r i s t i c s were examined i n an e f f o r t to analyse the nature and extent of the p a r t i c i p a t i o n i n continuing education by dental h y g i e n i s t s . The non-participants were excluded from t h i s a n a l y s i s . Hours of Attendance In computing the amount of p a r t i c i p a t i o n , a s i n g l e day course was recorded as seven hours.  The average time spent i n attendance was  twenty-eight hours or four days of continuing education over the three year period of study.  The most time recorded was 150 hours reported by  one respondent and the l e a s t was s i x hours.  The l a r g e s t s i n g l e group  p a r t i c i p a t e d 14 to 27 hours while the next group attended 28 to 41 hours (Figure 1).  36  29 28 27 26 25 24 23 22 21 20 19 co 18 17 & 16 T3 15 Tj 14 S 13 * 12 11 10 9 8 7 6 5 4 3 2 1  a  1-13  14-27  28-41  42-55  56-59  •  70-83  84-97  98-111  Number of Hours Figure 1.  Number of Hours of Continuing Dental Hygiene Education by P a r t i c i p a n t s  112 or more  37 Number of Courses Attended The average number of courses attended was two. The l a r g e s t group of h y g i e n i s t s , 16.6 per cent, attended two courses while 14.7 per cent reported p a r t i c i p a t i o n i n one course.  Attendance at ten  courses was reported by two per cent of the respondents. C l i n i c a l and N o i i - C l i n i c a l Courses The p a r t i c i p a n t s were divided i n t o two categories: those who attended a t l e a s t one c l i n i c a l course and those who attended only nonc l i n i c a l courses.  Of the p a r t i c i p a n t s , 61.3 per cent attended a t l e a s t  one c l i n i c a l course while 39.4 per cent attended only n o n - c l i n i c a l courses. TYPES OF COURSES The courses attended were grouped i n t o four categories i n terms of the nature of the educational content. Clinical Skills The c l i n i c a l s k i l l s category contained courses which were r e l a t e d to the performance of c l i n i c a l techniques by the d e n t a l h y g i e n i s t such as p e r i o d o n t i c s , pain and anxiety c o n t r o l , r e s t o r a t i v e d e n t i s t r y , pedodontics, orthodontics, endodontics, prosthodontics, myofunctional therapy and o r a l surgery.  Over two-thirds (70.5%) of the h y g i e n i s t s  p a r t i c i p a t e d i n c l i n i c a l s k i l l s courses (Table 12).  38 TABLE 12 Number of P a r t i c i p a n t s i n Each of Four Categories of Continuing Dental Hygiene Education Courses from March 1971 to March 1974  n  Category  Yes %  n  Total  No  n  %  %  Clinical Skills  79  70.5  33  29. 5  112  100.0  P a t i e n t Evaluation  22  19.6  90  80. 4  112  100.0  Dental Health Education  83  74.1  29  25. 9  112  100.0  P r a c t i c e Management  24  21.4  88  78. 6  112  100.0  Total*  208  204  * I n d i v i d u a l s p a r t i c i p a t e d i n more than one category of courses. Patient Evaluation The p a t i e n t evaluation category included a broad spectrum of courses r e l a t e d to general and s p e c i f i c o r a l conditions of p a t i e n t s i n c l u d i n g subject matter concerned w i t h medical and.dental h i s t o r y , head, neck and o r a l examination, mandibular a r t i c u l a t i o n , radiographs and radiographic i n t e r p r e t a t i o n , recording of dental and p e r i o d o n t a l f i n d i n g s and supplementary  diagnostic aids such as o r a l photographs, blood pressure,  impressions, study c a s t s , cytology smears and pulp t e s t i n g .  Only 19.6  per cent of the h y g i e n i s t s p a r t i c i p a t e d i n p a t i e n t evaluation courses.  39 Dental Health Education Dental health education encompassed a range of courses r e l a t e d to preventive d e n t i s t r y .  Included i n t h i s area were courses r e l a t e d  to the o r a l health status of the p a t i e n t and the maintenance of optimal o r a l health.  S p e c i f i c courses covered subject matter r e l a t i n g to patient  i n s t r u c t i o n i n areas such as toothbrushing,  f l o s s i n g , supplementary a i d s ,  f l u o r i d e therapy and n u t r i t i o n and d i e t a r y c o u n s e l l i n g .  Courses r e l a t e d  to the behavioural sciences such as psychology, communication and behaviour m o d i f i c a t i o n were a l s o included i n t h i s category.  In addition,  courses r e l a t i n g to general education topics such as adult and c h i l d l e a r n i n g , l e a r n i n g methodology and materials or devices used to enhance l e a r n i n g s i t u a t i o n s were included.  Of the h y g i e n i s t s who p a r t i c i p a t e d ,  74.1 per cent attended courses concerned with dental health  education.  P r a c t i c e Management The p r a c t i c e management category included a range of courses concerned with o f f i c e management, dental economics and p r a c t i c e administration.  Of the p a r t i c i p a n t s , 21.4 per cent attended p r a c t i c e management  courses. The h y g i e n i s t s involved i n continuing education courses p a r t i c i pated p r i m a r i l y i n courses concerned with d i r e c t services to the p a t i e n t . The c l i n i c a l s k i l l s and dental health education areasshad the majority of h y g i e n i s t s ' p a r t i c i p a t i o n . Hygienists appeared to have a high i n t e r e s t i n maintaining e f f e c t i v e patient contact.  The 74.1 per cent f i g u r e r e -  f l e c t i n g h y g i e n i s t s ' involvement i n courses r e l a t i n g to preventive d e n t i s t r y  40 that i s , dental health education, appeared to c o r r e l a t e to the thrust of d e n t i s t r y toward a prevention oriented philosophy rather than t r e a t ment oriented.  Also the a v a i l a b i l i t y and a s s e s s i b i l i t y of preventive  d e n t i s t r y continuing education courses throughout the province offered ample opportunity f o r p a r t i c i p a t i o n by dental h y g i e n i s t s . Continuing education courses i n a l l four groupings were a v a i l able to dental h y g i e n i s t s during the period studied with at l e a s t f i v e courses per year made a v a i l a b l e through the D i v i s i o n of Continuing Education at The U n i v e r s i t y of B r i t i s h Columbia. held i n the Lower Mainland.  Dental  These courses were  The U n i v e r s i t i e s of Washington and Oregon  also offered extensive l i s t i n g s of continuing dental education courses and encouraged p a r t i c i p a t i o n of dental h y g i e n i s t s from B r i t i s h Columbia. In a d d i t i o n , programs of varying topics were a v a i l a b l e through the p r o v i n c i a l and l o c a l p r o f e s s i o n a l organizations and neighbouring  state  associations. C h a r a c t e r i s t i c s of P a r t i c i p a n t s Eleven socio-economic v a r i a b l e s were tabulated against the four course categories to determine whether any p a r t i c i p a n t c h a r a c t e r i s t i c s influenced p a r t i c i p a t i o n i n d i f f e r e n t types of courses.  Significant  differences were found w i t h respect to four of the v a r i a b l e s studied (Table 13).  41  TABLE 13 Summary of Chi-Square Values and S i g n i f i c a n c e Levels f o r P a r t i c i p a n t C h a r a c t e r i s t i c s by Course Categories  Characteristic  Clinical Skills  Patient Evaluation  Dental Health Education  Practice Management  .00  .01  .00  2.94  3.73  .19  4.95*  Children  .19  .68  .25  .01  Place of Residence  .81  2.16  .40  .00  Year of Graduation  2.52  .02  .00  .57  Place of Graduation  1.98  .00  1.63  1.06  Years - Post-Secondary Education  4.71*  3.05*  1.70  .01  Further Dental Qualification  1.47  1.14  .22  .01  Non-Dental Q u a l i f i c a tions  1.36  1.67  .26  .00  Employment Status  .26  .24  .01  .21  P r i n c i p a l Type of Employment  .76  .59  .29  .01  Age  4.47*  M a r i t a l Status  * where p < .10  42 Age and C l i n i c a l S k i l l s  Courses  Seventy-nine p a r t i c i p a n t s (70.5 per cent) p a r t i c i p a t e d i n c l i n i c a l s k i l l s courses.  A majority, 79.4 per cent, who p a r t i c i p a t e d were l e s s  than twenty-five years of age as compared to 59.2 per cent who were twenty-five years of age or over (Table 14). TABLE 14 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n C l i n i c a l Courses and P a r t i c i p a n t s i n Other Courses by Age  25 years or over n %  Skills  Total n %  Less than 25 years n %  Participants i n Clinical Skills  29  59.2  50  79.4  79  70.5  Participants i n Other Courses  20  40.8  13  20.6  33  29.5  49  100.0  63  100.0  112  100.0  Total X  2  = 4.47,  d.f. = 1,  p = .03  The p a r t i c i p a n t s i n c l i n i c a l s k i l l s courses who were most l i k e l y to be the more recent graduates because they were younger, p a r t i c i p a t e d to a greater degree than d i d those who were older and therefore, more l i k e l y to have graduated e a r l i e r .  I t may be that newer graduates f e e l  a need f o r more advanced t r a i n i n g i n c l i n i c a l s k i l l s than do older graduates who have already established t h e i r pattern of c l i n i c a l p r a c t i c e skills.  Many hygienists do recognize that t h e i r educational  preparation  was not adequate f o r the expanded p r a c t i c e demands occurring i n dental  43 hygiene.  In a d d i t i o n , younger graduates may be more oriented towards  higher l e a r n i n g leading them to p a r t i c i p a t e more. Post-Secondary Education and C l i n i c a l S k i l l s Courses A s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n the d i s t r i b u t i o n of p a r t i c i p a n t s i n c l i n i c a l s k i l l s and p a r t i c i p a n t s i n other courses was recorded concerning the number of years of post-secondary education (Table 15). TABLE 15 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n C l i n i c a l S k i l l s Courses and P a r t i c i p a n t s i n Other Courses by Number of Years of Post-Secondary Education  2 to 3 Years w i t h Diploma  4 Years or more w i t h Diploma or Degree n %  n  %  55.6  79  70.5  16  44.4  33  29.5  36  100.0  112  100.0  n  %  Participants i n Clinical Skills  59  77.6  20  Participants i n Other Courses  17  22.4  76  100.0  Total X  2  = 4.71, d.f. ==1,  Total  p == .03  A majority of h y g i e n i s t s , 63.2 per cent, graduated w i t h a basic dental hygiene diploma, that i s , two to three years of post-secondary education.  Seventy-eight per cent of those h y g i e n i s t s p a r t i c i p a t e d i n  c l i n i c a l s k i l l s courses while 55.6 per cent of those h y g i e n i s t s with four  44  years or more post-secondary education p a r t i c i p a t e d i n c l i n i c a l s k i l l s courses.  I t appears that those hygienists a c t i v e l y involved i n f u r t h e r  education and those with a d d i t i o n a l education are more apt to be i n volved i n other areas than c l i n i c a l p r a c t i c e and are l e s s l i k e l y to p a r t i c i p a t e i n c l i n i c a l s k i l l s courses.  Other academic and p r o f e s s i o n a l  i n t e r e s t s a t t r i b u t e to the lessened p a r t i c i p a t i o n . M a r i t a l Status and P r a c t i c e Management Courses Of the p a r t i c i p a n t s i n a l l categories of courses, 21.4 per cent part i c i p a t e d i n p r a c t i c e management courses.  In analysing the p a r t i c i p a n t s i n  the area of p r a c t i c e management courses, 18.9 per cent of the s i n g l e group p a r t i c i p a t e d as compared with 14.3 per cent of those married l e s s than f i v e years and 37.5 per cent married f i v e years or more (Table 16). TABLE 16 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n P r a c t i c e Management Courses and P a r t i c i p a n t s i n Other Courses by M a r i t a l Status Single  Married l e s s than 5 years n %  Married 5 years or more n 7o  Total n  %  n  %  Participants i n P r a c t i c e Management  10  18.9  5  14.3  9  37.5  24  21.4  Participants i n Other Courses  43  81.1  30  85.7  15  62.5  88  78.6  53  100.0  35  100.0  24  100.0  112  100.0  Total X  2  = 4.95, d.f. = 2 ,  p = .08  45 This l a t t e r group was the most widely v a r i a n t f o r the t o t a l and l e d to a s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e i n d i s t r i b u t i o n of p r a c t i c e management course p a r t i c i p a t i o n .  Although t h i s f i n d i n g i s d i f f i c u l t to  explain i t may be that experience as a home manager leads to greater i n t e r e s t i n p r a c t i c e management, hence the greater p a r t i c i p a t i o n i n these types of courses by those who had been married longer. Post-Secondary Education and Patient E v a l u a t i o n Courses Of the p a r t i c i p a n t s i n a l l the four categories of courses, 19.6 per cent attended patient e v a l u a t i o n courses (Table 17). TABLE 17 Percentage D i s t r i b u t i o n of P a r t i c i p a n t s i n P a t i e n t E v a l u a t i o n Courses and P a r t i c i p a n t s i n Other Courses by Number of Years Post-Secondary Education  3 Years w i t h Diploma  4 Years or More w i t h Diploma or Degree % n  Total  n  %  Participants i n Patient Evaluation  11  14.5  11  30.6  22  19.6  Participants i n Other Courses  65  85.5  25  69.4  90  80.4  76  100.0  36  100.0  112  100.0  o  Total X  2  = 3.05,  n  %  d.f. = 1, p = .08  Fourteen p o i n t f i v e per cent of those w i t h two or three years post-secondary education and a diploma p a r t i c i p a t e d i n patient e v a l u a t i o n courses as  46  compared w i t h  30.6 per cent  more p o s t - s e c o n d a r y The  of  t h e h y g i e n i s t s who h a d f o u r  e d u c a t i o n who p a r t i c i p a t e d  under  study.  There was,  i n t h e d i s t r i b u t i o n by and p a r t i c i p a t i o n of  however,  in patient  p a r t i c i p a t i o n by  e d u c a t i o n was a t v a r i a n c e w i t h clinical  skills  courses.  e d u c a t i o n have a g r e a t e r ening t h e i r scope of interested  that  those w i t h a higher  courses.  the p a t t e r n  concern for  only  l e v e l of  performance  of  d u r i n g the  of post-secondary  o r more y e a r s  may b e t h a t  i n performing  routine  four  The h i g h e r of  observed  those w i t h  a higher  technical skills.  patient  difference education the  level  level  and f o r  It  in  of  broad-  e d u c a t i o n may may a l s o  a r e i n employment  evaluation  period  for participation  those w i t h l e s s  education  courses  post-secondary  the o v e r a l l p a t i e n t  p r a c t i c e whereas  more  involving  It  years  evaluation  those w i t h  offered  evaluation  a statistically significant  t h e number o f  or  i n s i m i l a r courses.  o v e r a l l l e v e l of p a r t i c i p a t i o n i n p a t i e n t  was l i m i t e d b e c a u s e f e w s u c h c o u r s e s w e r e  years  be  be  situations  tasks.  SUMMARY I n summary in  those  the q u e s t i o n of whether  or not  d e n t a l h y g i e n i s t s who do p a r t i c i p a t e  there  is a  a n d t h o s e who do n o t  t i c i p a t e i n c o n t i n u i n g e d u c a t i o n c o u r s e s c a n be a n s w e r e d a s Graduates  of  d e n t a l hygiene programs  more l i k e l y t o p a r t i c i p a t e  difference  i n the U n i t e d  i n continuing education  par-  follows: States  courses than  are those  f r o m Canadam C Hygienists non-dental courses.  nature  pursuing further  q u a l i f i c a t i o n s of  either a dental  p a r t i c i p a t e more i n c o n t i n u i n g d e n t a l h y g i e n e  or  education  47 Hygienists not employed i n p r i v a t e p r a c t i c e , but employed i n dental a u x i l i a r y education, p u b l i c or school health and community agencies p a r t i c i p a t e more i n continuing education  courses.  P a r t i c i p a n t s i n c l i n i c a l s k i l l s courses are more l i k e l y to be under twenty-five years of age and have two to three years of postsecondary education which includes a diploma i n dental hygiene.  They  also are not l i k e l y to be working towards any f u r t h e r dental q u a l i f i cations. At variance w i t h the p a t t e r n seen i n the c l i n i c a l s k i l l s courses, the p a r t i c i p a n t s i n p a t i e n t evaluation courses are more l i k e l y to have had at l e a s t four years of post-secondary education which includes e i t h e r a diploma or degree i n dental hygiene. P a r t i c i p a n t s involved i n p r a c t i c e management courses are more l i k e l y to be married f o r at l e a s t f i v e years.  CHAPTER 4 SUMMARY, CONCLUSIONS AND IMPLICATIONS This study focused on the socio-economic determinants of p a r t i c i p a t i o n by dental hygienists i n continuing p r o f e s s i o n a l education and includes demographic, s o c i a l and p r o f e s s i o n a l v a r i a b l e s i n the analysis. SUMMARY A review of the l i t e r a t u r e revealed that there have been no published studies o f p a r t i c i p a t i o n of dental h y g i e n i s t s i n continuing education programs and as a r e s u l t there i s a lack of e m p i r i c a l data to guide planners and organizers of such programs. The study surveyed 163 dental h y g i e n i s t s r e g i s t e r e d and l i c e n c e d with the College of Dental Surgeons of B r i t i s h Columbia i n 1973 who were resident and employed i n the Province a t the time of the study. These 163 h y g i e n i s t s represented 76.2 per cent of the employed dental h y g i e n i s t s r e g i s t e r e d and licenced i n B r i t i s h Columbia i n 1973. Eleven v a r i a b l e s were selected f o r study: age, m a r i t a l s t a t u s , number of c h i l d r e n , years of post-secondary education, year and place of graduation, place of residence, work towards f u r t h e r dental or nondental q u a l i f i c a t i o n s , employment status and p r i n c i p a l type of employment. Of these v a r i a b l e s only three were found to d i f f e r e n t i a t e between p a r t i cipants and non-participants  i n c l u d i n g place of graduation, work towards 48  49 non-dental  q u a l i f i c a t i o n s and p r i n c i p a l type o f employment.  The courses attended were grouped i n t o f o u r c a t e g o r i e s : c l i n i c a l s k i l l s , p a t i e n t e v a l u a t i o n , d e n t a l h e a l t h e d u c a t i o n and p r a c t i c e management. to  The e l e v e n v a r i a b l e s were t e s t e d a g a i n s t the f o u r course c a t e g o r i e s  determine whether any of the c h a r a c t e r i s t i c s i n f l u e n c e d p a r t i c i p a t i o n  i n the d i f f e r e n t  types o f c o u r s e s .  d i f f e r e n c e s were found:  In four instances s i g n i f i c a n t  age was r e l a t e d to attendance  c o u r s e s ; the number o f years o f post-secondary participation i n clinical skills  courses  in clinical  skills  e d u c a t i o n was r e l a t e d to  and p a t i e n t e v a l u a t i o n c o u r s e s ;  and m a r i t i a l s t a t u s was r e l a t e d to p a r t i c i p a t i o n i n p r a c t i c e  management  courses.  CONCLUSIONS  With r e s p e c t to the major v a r i a b l e s o f concern  i n this  study,  o b s e r v a t i o n s a r e o f f e r e d a c c o r d i n g to the s i g n i f i c a n t v a r i a b l e s : p l a c e of  g r a d u a t i o n , p a r t i c i p a t i o n i n o t h e r areas  (non-dental  qualifications)  and p r i n c i p a l type o f employment; and to s e v e r a l o f the o t h e r v a r i a b l e s c o n s i d e r e d : age, m a r i t a l s t a t u s , number o f c h i l d r e n , p l a c e o f r e s i d e n c e , y e a r of g r a d u a t i o n and number of y e a r s of post-secondary  education.  P l a c e of Graduation The  study i n d i c a t e d t h a t the m i l i e u i n which the d e n t a l h y g i e n i s t  was t r a i n e d appeared t o e x e r t a s t r o n g i n f l u e n c e on p a r t i c i p a t i o n i n continuing education courses.  D e n t a l hygiene  graduates  the U n i t e d S t a t e s p a r t i c i p a t e d more than those graduated  from s c h o o l s i n from s c h o o l s  50  Canada.  This suggests that Canadian schools f a i l to develop p o s i t i v e  a t t i t u d e s toward continuing education and that they should perhaps modify t h e i r undergraduate curriculums accordingly. Students should be made aware that graduation i s only a beginning step and that the educational process must continue throughout t h e i r p r o f e s s i o n a l careers regardless of type of employment. P a r t i c i p a t i o n i n Other Areas Those respondents who sought f u r t h e r education of any type also p a r t i c i p a t e d i n continuing education courses designed s p e c i f i c a l l y for dental hygienists.  This momentum created by attendance at any form  of continuing education a c t i v i t y appears to be c a r r i e d over i n t o the p r o f e s s i o n a l area.  This suggests that h y g i e n i s t s a c t i v e l y involved  i n i n t e r e s t areas other than d e n t i s t r y are also aware of the developments and changes w i t h i n t h e i r p r o f e s s i o n r e q u i r i n g p a r t i c i p a t i o n i n continuing education. P r i n c i p a l Type of Employment Those h y g i e n i s t s who attended courses were employed predominately on a f u l l - t i m e monthly s a l a r y b a s i s .  The f u l l - t i m e p o s i t i o n s encompassed  a l l employment s i t u a t i o n s whether they were f o r a s i n g l e employer, a group of employers i n one dental o f f i c e , i n s t i t u t i o n or agency, or f o r more than one employer i n more than one d e n t a l o f f i c e , i n s t i t u t i o n or agency. I t was found that these f u l l - t i m e employed h y g i e n i s t s were generally encouraged by t h e i r employers to attend continuing education  51  courses e i t h e r by some f i n a n c i a l inducements such as no l o s s of pay during an absence from work i n order to attend a course and/or payment of t u i t i o n fees f o r the course. In B r i t i s h Columbia, agencies such as the Department of Dental Services, and i n s t i t u t i o n s , such as The U n i v e r s i t y of B r i t i s h Columbia Program of Dental Hygiene, have l e d the way i n encouraging employees to attend continuing education courses.  Incentives such as time a l l o t t e d  to attend courses, t r a v e l expenses and reduced course r e g i s t r a t i o n fees have stimulated i n t e r e s t i n p a r t i c i p a t i o n i n programs.  P r i v a t e dental  p r a c t i t i o n e r s have recently f e l t a pressure to o f f e r t h e i r employees both f i n a n c i a l inducement and time f o r p a r t i c i p a t i o n i n continuing education programs. Age Age was not r e l a t e d s p e c i f i c a l l y to p a r t i c i p a t i o n i n . continuing dental hygiene education but i t was r e l a t e d to p a r t i c i p a t i o n i n s p e c i f i c course o f f e r i n g s . Younger h y g i e n i s t s attended more courses concerned with c l i n i c a l s k i l l s which may i n d i c a t e that many of the younger hygienis are more aware of the ever-changing scene i n d e n t i s t r y and dental hygiene The younger and the more recent graduates who are assuming more respons i b i l i t y w i t h i n the dental profession and are adopting more advanced s k i l l s are becoming the one dental a u x i l i a r y responsible f o r the preventive aspect of patient care.  These h y g i e n i s t s , therefore, f e e l a  stronger need f o r continuing education to keep themselves current.  52  M a r i t a l Status and Number of Children Neither m a r i t a l status nor the number of c h i l d r e n showed any s t a t i s t i c a l l y s i g n i f i c a n t r e l a t i o n s h i p to p a r t i c i p a t i o n i n t h i s study and i t seems that these f a c t o r s may not be of important  consideration  i n the development of continuing education programs f o r h y g i e n i s t s . Yet, i n d i s c u s s i o n with h y g i e n i s t s , the demands of home r e s p o n s i b i l i t i e s are often c i t e d as deterents to p a r t i c i p a t i o n i n courses.  I n s p i t e of  what the data i n d i c a t e d , some a t t e n t i o n might be given t o the p r o v i s i o n of day-care services f o r those h y g i e n i s t s w i t h young c h i l d r e n .  This  could be e s p e c i a l l y important when courses are o f f e r e d outside of normal employment hours. A p o s s i b i l i t y to e x p l a i n the inconsistency between the s t a t i s t i c s c o l l e c t e d and the comments of the respondents i s that the r a t i o n a l e of " a t t e n t i o n to home r e s p o n s i b i l i t i e s " i s an excuse h i d i n g unstated reasons f o r f a i l u r e to p a r t i c i p a t e such as l a c k of enthusiasm and i n t e r e s t i n maintaining competency and/or upgrading or l a c k of awareness of the need f o r continuing  education.  Place of Residence The review of: the l i t e r a t u r e revealed! that attendance at continuing educabJjon'.dc'O.urs'.eSL foniden'ti S'tsdwas:iinfluenced'.ebyrtheEp\roximity of the course ;  to the l o c a t i o n o f p r a c t i c e o r residence of the p a r t i c i p a n t . A survey of B r i t i s h Columbia d e n t i s t s showed that the large majority of dental course r e g i s t r a n t s were from the Lower Mainland and attended courses o f f e r e d on the Lower Mainland.  The assumption that dental h y g i e n i s t s  53  would f o l l o w t h i s pattern was not borne out by the data which revealed that the place of residence was not a s t a t i s t i c a l l y s i g n i f i c a n t f a c t o r . In view of the contradictory r e s u l t s and the f a c t that there has been much pressure brought to bear on the continuing dental hygiene programming to b r i n g courses to areas of the province other than the Lower Mainland t h i s f i n d i n g requires f u r t h e r research. Year of Graduation As with the c h a r a c t e r i s t i c s of age and place of residence,  the  year of graduation was not s i g n i f i c a n t l y r e l a t e d to p a r t i c i p a t i o n of dental h y g i e n i s t s i n continuing  education.  Post-Secondary Education The number of years of post-secondary education was not r e l a t e d to p a r t i c i p a t i o n i n continuing education as the number of years of post-secondary education was s i m i l a r f o r most h y g i e n i s t s who p a r t i c i p a t e d i n the study. IMPLICATIONS Change has been so r a p i d i n the f i e l d of d e n t i s t r y that c o n t i n uing education has become an urgent p r i o r i t y , both of a major concern to the profession and a challenge to the p r a c t i t i o n e r r . of dental hygiene these changes have also been apparent.  In the p r a c t i c e Every h y g i e n i s t  should keep abreast of new developments i n the changing patterns of dental hygiene p r a c t i c e and the d e l i v e r y of dental care.  Because addi-  t i o n a l functions are being delegated i n c r e a s i n g l y to the h y g i e n i s t ,  54 continuing education has become a necessity.  Dental h y g i e n i s t s  who  return to the work force a f t e r an absence of a few years require updating and re-educating i n dental hygiene. Increased involvement i n continuing education as a l i f e - l o n g r e s p o n s i b i l i t y of the profession has accompanied t h i s rapid change i n dental technology.  Continuing education programs designed f o r the  dental hygienist has been a hodgepodge of endeavour.  I t i s apparent  that the number of continuing education programs w i l l increase g r e a t l y i n the next few years and that e f f e c t i v e mechanisms f o r developing evaluating these programs must be developed.  and  There i s a need f o r  s p e c i f i c guidelines to a s s i s t persons involvediinddesirgning-programs to improve the q u a l i t y of e x i s t i n g programs.  and  Such guidelines might  include the f o l l o w i n g c r i t e r i a : Adminis t r a t i o n Proper administration i s e s s e n t i a l f o r the conduct of an e f f e c t i v e continuing education program.  Within the province there must  be an administrating organization which has c o n t r o l with respect to maintaining up-to-date p r o f e s s i o n a l r e g i s t r a t i o n l i s t s , assignments of c r e d i t s for courses upon the i n s t i g a t i o n of mandatory continuing education f o r r e l i c e n s u r e , and formation of the o v e r - a l l long range plan f o r continuing dental hygiene education.  The  administration  should have as i t s goal an education program of high q u a l i t y and which meets the demonstrated needs of the profession.  one  55 Sponsorship The sponsoring agency of a continuing education program must assume the r e s p o n s i b i l i t y f o r organizing, administering, p u b l i c i z i n g , and presenting the program.  The sponsoring agency should assume a l l  l i a b i l i t y f o r the conduct and q u a l i t y of the program.  Institutions  such as f a c i l i t i e s of d e n t i s t r y and community colleges which have dental hygiene programs must be encouraged to sponsor continuing educat i o n programs.  Co-sponsbrship by p r o f e s s i o n a l s o c i e t i e s must also be  encouraged. Facilities Adequate f a c i l i t i e s are e s s e n t i a l f o r both e f f e c t i v e continuing education programs and f o r proper p a t i e n t care when c l i n i c a l are being performed.  procedures  Therefore, f a c i l i t i e s s e l e c t e d should be appro-  p r i a t e f o r the k i n d of educational methodology being employed.  Appro-  p r i a t e f a c i l i t i e s can be found i n such l o c a t i o n s as dental/dental hygiene schools, community c o l l e g e s , h o s p i t a l s and p r i v a t e dental o f f i c e s and clinics. Budget P r o f i t should not be the primary o b j e c t i v e of continuing education sponsors.  I f p r o f i t s are r e a l i z e d , sponsoring agencies should u t i l i z e  these funds f o r the enhancement of t h e i r continuing education program. Faculty Faculty and resource personnel should be q u a l i f i e d to present the m a t e r i a l s e l e c t e d . The primary c r i t e r i a f o r s e l e c t i n g i n s t r u c t o r s  56 or c l i n i c i a n s should include teaching s k i l l , e x p e r t i s e i n the area being covered, and high e t h i c a l standards.  C l i n i c a l m a t e r i a l should be  substantiated by s c i e n t i f i c research as a part of the presentation. For too long the d e n t i s t has defined the h y g i e n i s t s ' r o l e while h y g i e n i s t s have been r e l u c t a n t to seek out and/or recognize e x p e r t i s e amongst t h e i r own colleagues.  I f h y g i e n i s t s are to apply the knowledge  and s k i l l s gained through continuing education programs, e f f o r t s must be made to help them apply the m a t e r i a l to t h e i r r o l e s and employment . setting. When a team approach to dental care i s presented, e f f o r t s should be made to have members of concerned, r e l a t e d d i s c i p l i n e s on the program.  represented  Increasing the number of continuing education programs  planned, presented and attended by representatives from dental or any relevant health d i s c i p l i n e may be one way to f o s t e r the dental health team approach t o dental care. Curriculum Program content should be concerned with the improvement of dental care.  While the o v e r a l l goal of the health professions i s to  meet the consumer's health care needs, the s p e c i f i c purpose of continuing education f o r dental h y g i e n i s t s must focus on the " d e n t a l " component. A v a l i d c r i t i c i s m of the kinds of programs offered by the dental educational i n s t i t u t i o n s and p r o f e s s i o n a l organizations i s that the content i s what the program planners think the learner needs; he may need i t , but u s a l l y he i s only receptive to a f e l t need, that i s one that has been i d e n t i f i e d by the l e a r n e r , himself.  57 Programs should be planned, based on the expressed needs of p o t e n t i a l p a r t i c i p a n t s as w e l l as on needs i d e n t i f i e d by employers, employees, supervisors, and anyone dealing with the dental hygiene profession.  Although i t i s recognized  that l e a r n i n g i s f a c i l i t a t e d  when the learner has a part to play i n i d e n t i f y i n g h i s needs, there are needs which are p r e c i p i t a t e d by new  developments i n the f i e l d  may not be known to the p o t e n t i a l learner.  Programs must be  and  devised  to include the involvement of the learner and a l l necessary i n s t r u c t i o n to encompass new concepts and s k i l l s . Thoughtful planning alsommeanst"fchatttheccourse~content should  be  based on the demonstrated needs of the h y g i e n i s t s of each region as w e l l as on advances i n d e n t i s t r y .  The means of a s c e r t a i n i n g the needs  of dental h y g i e n i s t s should include questionnaires, pre-course t e s t s , self-assessment  t e s t s , p r o f i c i e n c y t e s t s or some form of peer review.  Program topics of i n t e r e s t and use to dental h y g i e n i s t s i n a l l employment s i t u a t i o n s should be selected.  Program planners must con-  s i d e r the diverse needs of h y g i e n i s t s i n a v a r i e t y of c l i n i c a l f u n c t i o n a l areas of dental care s e t t i n g s . populated -aceas must not be overlooked  and  Dental h y g i e n i s t s i n sparsely  i n the planning.  I t i s con-  ceivable that other means than short courses, such as independent l e a r n i n g packages can be implemented. Program t o p i c s should include consideration f o r the needs of the consumer, i n s i g h t i n t o dental care p r a c t i c e s and a perspective of the changing r o l e of the dental hygienist as a member of the dental team.  58  A statement of s p e c i f i c objectives should be formulated during the e a r l y stages of planning.  Such objectives should include: changes  i n the a t t i t u d e and approach of the learner to the s o l u t i o n of dental problems; presentation of new knowledge i n s p e c i f i c areas; i n t r o d u c t i o n to and mastery of s p e c i f i c s k i l l s and techniques; and the a l t e r a t i o n i n the habits of the learner.  Without an i n i t i a l statement of s p e c i f i c  objectives f o r each program, i t i s d i f f i c u l t , i f not impossible, to axcertain i n any meaningful way  that such o b j e c t i v e s have been met.  Educational Methodology Continuing  education program planners should be cognizant of  the increasing v a r i e t y of educational techniques and devices a v a i l a b l e . Such media as programmed i n s t r u c t i o n , s l i d e - t a p e presentations  and  closed c i r c u i t t e l e v i s i o n are i n i n c r e a s i n g use. Programmers should incorporate techniques of i n s t r u c t i o n which a c t i v e l y employ the learner i n the l e a r n i n g experience and not use to any great amount the techniques which j u s t involve passive p a r t i c i p a t i o n by the learner. Self-assessment mechanisms, f o r example pre-course entrance t e s t i n g , have become an i n t e g r a l part of educational methodology both as a d i r e c t l e a r n i n g t o o l and as a stimulus to further continuing education.  A t t e n t i o n should be centered on the development and p r o v i s i o n of  self-assessment tools f o r h y g i e n i s t s . Evaluation The value of continuing education programs w i l l be enhanced i f methods of evaluating the effectiveness of courses are developed and  59  utilized.  I t i s b e n e f i c i a l to the program planner and the p a r t i c i p a n t  to conduct evaluation of course content, i n s t r u c t o r effectiveness and "take-home" behaviour of the learner which he e x h i b i t s when he returns to h i s dental care s e t t i n g .  Information regarding the e f f e c t i v e n e s s  of the program and the p r o v i s i o n of feedback from the p a r t i c i p a n t s i s necessary for adequate evaluation of a program. t i o n , a t t e n t i o n should be directed to determining  As part of evaluathe health care needs  of the community as w e l l as the educational needs of the p a r t i c i p a n t s . Study of each program and the achievements of i t s p a r t i c i p a n t s should be made on a continuing basis by the sponsor. AREAS FOR FUTURE RESEARCH This study has demonstrated that r e l a t i v e l y few of the characteri s t i c s studied appear to have influenced the attendance patterns of dental h y g i e n i s t s i n continuing dental hygiene education programs.  This  i n d i c a t e s a need f o r more d e t a i l e d research and a n a l y s i s i n t o continuing education f o r dental h y g i e n i s t s . 1.  Among other things:  There i s a need to d i f f e r e n t i a t e and evaluate programs designed to meet the needs of recent graduates from those f o r h y g i e n i s t s returning to the work force a f t e r an absence.  2.  I t i s necessary to analyse the needs of the dental hygiene p r a c t i t i o n e r i n l i g h t of the changes i n the d e n t i s t r y acts and make required amendments, as the l e g i s l a t i o n a f f e c t s the requirements of p r a c t i c e as d i s t i n c t from the a n a l y s i s of needs of the i n d i v i d u a l p r a c t i t i o n e r determining p r o f i c i e n c y or competency l e v e l .  h i s own  60 3.  I t i s necessary to conduct research on the underlying reasons f o r the f a i l u r e to p a r t i c i p a t e of h y g i e n i s t s employed i n p r i v a t e p r a c t i c e .  4.  Current programs of continuing education should be evaluated i n terms of content, method and amount of l e a r n i n g accomplished, as w e l l as i n terms of t h e f r adequacy i n meeting the current and future needs of the p r o f e s s i o n .  5.  Further research on p a r t i c i p a n t s i s required i n order to determine ways to increase p a r t i c i p a t i o n . of course a s s e s s i b i l i t y ?  Is there a problem  Is i t necessary.to expand the  continuing education o f f e r i n g s , employ d i f f e r e n t methods and media f o r d e l i v e r y and expand f a c u l t y and s t a f f involved i n the production of these programs?  Since the majority of  working h y g i e n i s t s are under the age of 30 are continuing education programs designed with t h i s i n mind? 6.  There i s a need to study the other segment of the dental hygiene population, the unemployed h y g i e n i s t .  How best can  t h i s h y g i e n i s t be encouraged to return to the work force on a f u l l - t i m e , part-time or casual basis? 7.  I t i s necessary to study the e f f e c t of the  implementation  of mandatory continuing education f o r r e l i c e n s u r e on p a r t i c i pation and l e a r n i n g patterns i n comparison to those patterns of voluntary continuing education.  Would only those w i t h  the desire to l e a r n only b e n e f i t from mandatory education? Would those without the d e s i r e to l e a r n when exposed to  61  knowledge and new s k i l l s through forced p a r t i c i p a t i o n acquire knowledge and s k i l l s ? IN  CONCLUSION  Health professions must expand e x i s t i n g l e v e l s of knowledge and s k i l l s to j u s t i f y t h e i r continued existence.  Major r e v i s i o n s i n  the s t r u c t u r e and d e l i v e r y of h e a l t h services and i n the requirements for education and t r a i n i n g of h e a l t h p r o f e s s i o n s l are occurring.  These  r e v i s i o n s increase the r e s p o n s i b i l i t i e s of the h e a l t h s e r v i c e d i s c i p l i n e s . Professions must prepare t h e i r members f o r changing and expanding r o l e s . Dental hygiene must continue to recognize p o t e n t i a l changes i n the d e l i v e r y of o r a l health care, look beyond i t s t r a d i t i o n a l r o l e , and s y s t e m a t i c a l l y up-grade, renew and expand current l e v e l s of knowledge and s k i l l s .  The development of comprehensive educational plans must  be encouraged to provide a systematic and co-ordinated approach to meeting the continuing education needs of dental h y g i e n i s t s .  REFERENCES 1.  Adelson, D.S. "Continuing Educational Programs—Their Place i n D e n t i s t r y , " New York State Dental J o u r n a l . December, 1964. 439-440.  2.  A d l e r , N. "Survey on Continuing Education," Journal of the C a l i f o r n i a Dental A s s o c i a t i o n . 45:132-136, F a l l , 1969.  3.  Beagrie, George S. "Throughout L i f e : The Need f o r Continuing Education, Journal of the Canadian Dental A s s o c i a t i o n . 40: 434-438, June, 1974.  4.  Black, G.V. " L i m i t a t i o n s of Dental Education," American Dental Journal. 6:690-703, 1907.  5.  Brown, V i r g i l . "Why Continuing Education i n D e n t i s t r y , " B u l l e t i n of the Academy of General D e n t i s t r y . September, 1964, 42.  6.  Burket, L.W. " R e s p o n s i b i l i t y of Dental Educational I n s t i t u t i o n s for O f f e r i n g Continuing Education Programs," Journal of Dental Education. 28:324-328, September, 1964.  7.  Canadian Dental A s s o c i a t i o n Conference on Continuing Education. Canadian Dental A s s o c i a t i o n , Council on Education, Toronto, 1972.  8.  Charter, Diane. "Status of Continuing Education," Journal of the Canadian Dental A s s o c i a t i o n , 40:430-433, June, 1974.  9.  Chambers, David W. and Douglas L. Hamilton. "Continuing Dental Education: Reasonable Answers to Unreasonable Questions," Journal of the American Dental A s s o c i a t i o n . 90:116-120, January, 1975.  10.  C o n s t i t u t i o n and By-Laws. The Canadian Dental H y g i e n i s t s ' A s s o c i a t i o n . Adopted May, 1967. (amended ."i: -' 1*5  11.  C o n s t i t u t i o n and By-Laws. The Canadian Dental H y g i e n i s t s ' A s s o c i a t i o n . Adopted May, 1967, amended June, 1972.  12.  Continuing Education—an evolving form of adult education. Foundation. Sequoia Press, 1958.  13.  Cosaboom, M.E. "This Greater Need f o r Continuing Education," Journal of the American Dental H y g i e n i s t s ' A s s o c i a t i o n . 46: 267-272, July-August, 1972. 62  Kellogg  63 14.  Darby, D.W. "The Dentist and Continuing E d u c a t i o n — A t t i t u d e s and Motivations," Journal of the American College of D e n t i s t s , 36: 164-170, J u l y , 1969.  15.  Dental Education Technical Report, Series 244, WHO  16.  DiBiaggio, J.A. "Continuing Education at the U n i v e r s i t y of Kentucky: Report of a Seven Year Experience," Journal of the American Dental A s s o c i a t i o n . 78:1007-1009, May, 1969.  17.  Drasek, S.J. et a l . (eds). Expanding H o r i z o n s — C o n t i n u i n g Education. North Washington Press, 1965, p. 7-9.  18.  Fourth Annual Report, Continuing Dental Education. The U n i v e r s i t y of B r i t i s h Columbia, Faculty of D e n t i s t r y , Health Sciences Centre. 1972-73.  19.  Gandy, M.K. "Continuing Education," J o u r n a l of the American Dental Hygienists' A s s o c i a t i o n . 45:9-11, January-February, 1971.  20.  General Information on Study Clubs f o r Dental H y g i e n i s t s . B r i t i s h Columbia Dental H y g i e n i s t s ' A s s o c i a t i o n and the Greater Vancouver Dental H y g i e n i s t s ' Society. May, 1974 (Mimeographed).  21.  Gray, S.B., R.M. O'Shea and W.A. Jordan. "Some C h a r a c t e r i s t i c s of Minnesota D i s t r i c t D e n t i s t s , " North West Dentistry . 45:299-303, November-December, 1966.  22.  Guidelines f o r Continuing E d u c a t i o n — A P o l i c y Report. Council on Dental Education, American Dental Association—House of Delegates, Chicago, November, 1974.  23.  Holroyd, S.V. "The Need f o r Continuing Education i n D e n t i s t r y , " Journal of the American College of D e n t i s t s 28(3):187-192, September, 1961.  Geneva, 1962.  ;  24.  Hulbush, L. "Continuous Learning," Journal of the American Dental Hygienists' A s s o c i a t i o n , 43:180, September-October, 1969.  25.  Johnstone, John W.C. and Ramonmcfa.Rivera. Volunteers f o r Learning. Chicago: A l d i n e P u b l i s h i n g Company, 1965.  26.  Kanterman, R. "The Case of Continuing Education," The Dental Studentjis Magazine. November, 1966, 152.  27.  K e e v i l , J.M. "Public Health D e n t i s t s and Dental Hygienists Express an I n t e r e s t i n Continuing Education," Journal of P u b l i c Health D e n t i s t r y , 39:92-94, Spring, 1970.  64 28.  K l i n e , Carol and K a r i n Sipko. "CDHA Manpower and U t i l i z a t i o n Survey Results," The Canadian Dental H y g i e n i s t . 8:29-31, Summer, 1974.  29.  McGothlin, W i l l i a m J . Patterns of P r o f e s s i o n a l Education. York: G.P. Putnam's Sons, 1960, pp. 21.  30.  Massler, M. "Re-examination f o r Competence of Teachers," Journal of Dental Education. 35:57-58, January, 1971.  31.  Mescher, K. "The Role of Dental A u x i l i a r i e s i n Continuing Educat i o n , " Journal of the American Dental H y g i e n i s t s ' A s s o c i a t i o n . 46:50-51, January-February, 1972.  32.  Minutes of the House o f Delegates, American Dental H y g i e n i s t s ' A s s o c i a t i o n , 1968. (Mimeographed)  33.  Nakamoto, June and Coolie Verner. Continuing Education i n D e n t i s t r y : A Review o f North American L i t e r a t u r e 1960-1970. Vancouver: Adult Education Research Centre and D i v i s i o n of Continuing Education i n the Health Sciences, The U n i v e r s i t y of B r i t i s h Columbia, 1972.  34.  Neylan, Margaret S. "Continuing Education," The Canadian Dental Hygienist . 7:10-13, F a l l , 1973.  35.  0'Shea, R.M. and S. Black. "Short Courses f o r D e n t i s t s : Some Survey Results," Journal of the American College of D e n t i s t s . 32:32-41, January, 1965.  36.  0'Shea, R.M., S.B. Gray and B. Treiman. "Taking Refresher Courses: Some Related Factors," Journal of the American College of D e n t i s t s. 32:320-331, October, 1965.  37.  Patterson, W. "Continuing Education: A Challenge to the P r o f e s s i o n , " Journal of the American College of D e n t i s t s , 28:3-26, March, 1960.  38.  P e t i t , E. and R.M. 0'Shea. " P a r t i c i p a t i o n i n Continuing Education i n Western New York: Some Survey R e s u l t s , " N.Y. State Dental Journal. 37(8):485-9, October, 1971.  39.  P o p e i l , E. "The Role of the U n i v e r s i t y i n Continuing Education f o r Nurses," Paper presented at the U n i v e r s i t y of Texas - M.D. Anderson and Tumour I n s t i t u t e , Houston, Texas.  40.  Program.  Prince George and D i s t r i c t Dental S o c i e t y , 1972-1973.  41.  Program.  Vancouver and D i s t r i c t Dental S o c i e t y , 1972-1973.  42.  Program.  Vancouver and D i s t r i c t Dental S o c i e t y , 1973-1974.  New  65  43.  Randolph K.V. "Baselines and R e s p o n s i b i l i t i e s i n Continuing Educat i o n a l E f f o r t s , " Journal of the American College of D e n t i s t s . 30:283-288, December, 1963.  44.  Report of the Committee on Continuing Education. Hygienists' A s s o c i a t i o n . February, 1973.  45.  "Report of the Educational Committee, 1940," J o u r n a l of the American Dental H y g i e n i s t s ' A s s o c i a t i o n , 15(2):86-90, A p r i l , 1941.  46.  Report of the Royal Commission on Health Services. Queen's P r i n t e r , Ottawa, volume 1, 1964.  47/  Retrospective I n t e r n a t i o n a l Survey of Adult Education - A Report. P a r i s , UNESCO, 1972.  48.  Second Annual Report, Continuing Dental Education. The U n i v e r s i t y of B r i t i s h Columbia, Faculty of D e n t i s t r y , Health Sciences Centre, 1970-71.  49.  Third Annual Report, Continuing Dental Education. The U n i v e r s i t y of B r i t i s h Columbia, Faculty of D e n t i s t r y , Health Sciences Centre, 1971-72.  50.  Verner, Coolie and John S. Newberry. pation," A o ^ i l J ^ J ^  51.  V o r i s , Joan S. Guest E d i t o r i a l . The Canadian Dental Hygienist. Spring, 1973, v o l 7 no. 1, p. 3.  American Dental  "The Nature of Adult P a r t i c i Summer, 1958.  66 The B r i t i s h Columbia Dental Hygienists" A s s o c i a t i o n requests every Dental H y g i e n i s t (whether p r a c t i c i n g o r not) i n the province o f B r i t i s h Columbia t o complete a l l s e c t i o n s o f t h i s application. Miss Mrs. Mr. Dr.  Surname  Given names  Maiden name [ ] single [ ] married [ ] widowed, divorced, I f p r e s e n t l y married: date o f marriage Month  M a r i t a l Status: Home: Apt.No.  S t r e e t No. and name  C i t y , Town  Postal code  Province Home Telephone No. Can.  Year  Occupation o f spouse  S o c i a l Insurance No.  Do you have c h i l d r e n l i v i n g at home? [ ] [ ] yes no I f yes, i n d i c a t e number of c h i l d r e n i n f o l l o w i n g age groups  Birthdate: Month  separated  Year  Birthplace: C i t y , Town, Province, Country Where d i d you l i v e the longest your f i r s t 18 years? City,  Town,  Province,  period  during  . .  4  Country  X  e a r s  *  u  n  d  e  r  15  5-14 years  -!9 /ears 20 years & over  Pre Dental Hygiene Education: no. o f years u n i v e r s i t y / c o l l e g e pre-dental hygiene Basic Dental Hygiene Education: [ ] diploma/certificate [ ] bachelor's degree program program Year completed college/university A d d i t i o n a l U n i v e r s i t y Q u a l i f i c a t i o n s Completed:  degree/'diploma/'certificate  university/college  prov/state  year  completed  year  completed  Other Q u a l i f i c a t i o n s (diplomas, c e r t i f i c a t e s ) :  Name of qualification  area of study  granted  by  Are you c u r r e n t l y working towards other q u a l i f i c a t i o n s ? I f yes, s p e c i f y area o f study and where:  I  I f no, have you ever worked towards other q u a l i f i c a t i o n s ? I f yes, s p e c i f y area o f study and where:  I  prov/state  [ .] yes  [ ] no  [ ] yes  [ ] no  1  T  • •  Have you p a r t i c i p a t e d i n Continuing Dental/Dental Hygiene Education Courses i n the past 3 y r s ? I f yes,  \  specify:  Title  [ ]  Where  yes  Where  no  Number of hours  Have you completed Courses i n any o'.her i n t e r e s t areas i n the past 3 years. I f yes, s p e c i f y : ,  Title  [ ]  [* ] yes  Number of hours  Please  turn over  [ J~ no  E M P L  number of weeks worked i n past dental hygiene 12 month p e r i o d ] f u l l time (4 or more days) ] part time [ ] 3 days [ ] 2 days [ ] 1 day ] casual f u l l time, s p e c i f y : ] 1 dental o f f i c e [ ] other s e t t i n g , s p e c i f y j 2 or more dental o f f i c e s [ ] combination of a n y / a l l categories  [  ]  employed i n [ [ [ i f employed [ [  [  ]  employed i n other than dental hygiene date commenced present  D A T A  area  month [  ]  not employed.  0  Y M E N T  specify  employment:  When were you  year  l a s t employed as a dental h y g i e n i s t  Do you plan to return to dental hygiene?  [ ] yes  [  month ] no  year  i f yes, when? i f no, why not? Present  Employer(s):  Name  no.of  addresscity/town  Type of P r i n c i p a l Employment (check only [ ] general p r a c t i c e [ ] specialty practice specify [ ] dental a u x i l i a r y education  hrs/week  date aorrmenoed  one): [ ] school h e a l t h [ ] community agency [ ] other specify  specify [ ] public health P as t Emp1oyment:  Type  where  ~fuUl time/part  time  dates of employment  period  L i s t P r o f e s s i o n a l C o n t r i b u t i o n s ( i . e . , p o s i t i o n s held i n p r o f e s s i o n a l o r g a n i z a t i o n s , prese.ita t i o n s such as t a b l e c l i n i c s , papers, i n s t r u c t i n g i n continuing education courses).  COMPLETE AND RETURN WITH LICENCE RENEWAL TO: College o f Dental Surgeons of B.C. #325 - 925 West Georgia Street Vancouver, B.C. V6C 1R7  See reverse  side  

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