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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.Sc, University 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 this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA August, 1975 In presenting th i s thes is in par t i a l fu l f i lment of the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying of th is thes i s for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of this thes i s fo r f i nanc ia l gain sha l l not be allowed without my writ ten permission. Department of The Univers i ty of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 i ABSTRACT The study reported on the p a r t i c i p a t i o n patterns of dental hygienists 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 hygienists registered and licenced 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 hygienists represented 76.2 per cent of dental hygienists registered and licenced i n B r i t i s h Columbia i n 1973. Eleven variables were selected for study: age, marital status, number of children, years of post-secondary education, year and place of graduation, place of residence, work towards further dental 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 employ-ment. Of these variables only three were found to d i f f e r e n t i a t e between participants 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 into four categories: c l i n i c a l s k i l l s , patient evaluation, dental health education and practice management. The eleven variables were tested against the four course categories to determine whether any of the characteristics influenced p a r t i c i p a t i o n i n the different types of courses. In four instances s i g n i f i c a n t differences were found: age was related to attendance i n c l i n i c a l s k i l l s courses; the number of years of post-secondary education was related 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 i i courses and patient evaluation courses; and marital status was related to p a r t i c i p a t i o n i n practice management courses. The findings of this study indicate that the socio-economic variables 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 for future research con-cerning the role of psychological and other factors influencing p a r t i c i p a t i o n i n continuing education programs. i i i TABLE OF CONTENTS Chapter Page 1 INTRODUCTION 1 THE PROBLEM 3 METHOD 4 Sample 4 Survey Instrument 4 Data Analysis 5 DEFINITION OF TERMS 6 PLAN OF STUDY 7 2 REVIEW OF THE LITERATURE 8 DEFINITIONS OF CONTINUING EDUCATION 8 CONTINUING EDUCATION IN DENTISTRY . 11 / Definitions i n Dentistry 11 Emergence of Continuing Dental Education 12 Par t i c i p a t i o n of Dentists i n Continuing Education . 15 CONTINUING EDUCATION IN DENTALY HYGIENE 16 Definitions of Continuing Education i n Dental Hygiene 16 Emergence of Continuing Dental Hygiene Education . 17 Pa r t i c i p a t i o n of Dental Hygienists i n Continuing Education 19 Continuing Education for Dental Hygienists i n B r i t i s h Columbia 20 SUMMARY 21 i v Chapter Page 3 ANALYSIS OF DATA 22 CHARACTERISTICS OF PARTICIPANTS AND NON-PARTICIPANTS . 22 Age 23 Marital Status 23 Number of Children 25 Place of Residence 25 Year of Graduation 27 Place of Graduation 28 Post-Secondary Education 29 Other Dental Qualifications 31 Non-Dental Qualifications 32 Employment Status 33 Pr 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 Non-Clinical Courses 37 TYPES OF COURSES 37 C l i n i c a l S k i l l s 37 Patient Evaluation 38 Dental Health Education 39 Practice Management 39 Characteristics of Participants 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 43 Marital Status and Practice Management Courses . . . 44 Post-Secondary Education and Patient Evaluation Courses 45 SUMMARY 46 4 SUMMARY, CONCLUSIONS AND IMPLICATIONS . . . 48 SUMMARY 48 CONCLUSIONS . . . 49 Place of Graduation 49 Par t i c i p a t i o n i n Other Areas 50 Prin c i p l e Type of Employment 50 Age 51 Marital Status and Number of Children 52 Place of Residence 52 Year of Graduation 53 Post-Secondary Education 53 IMPLICATIONS 53 Administration 54 Sponsorship . . . 55 F a c i l i t i e s 55 Budget 55 Faculty 55 Curriculum 56 Educational Methodology 58 v i Chapter Page Evaluation 58 AREAS FOR FUTURE RESEARCH 59 IN CONCLUSION 61 REFERENCES 62 APPENDIX 66 v i i LIST OF TABLES Table Page 1 Percentage Dist r i b u t i o n of Participants and Non-Participants by Age 23 2 Percentage Distribution of Participants and Non-Participants by Ma r i t a l Status 24 3 Percentage Dist r i b u t i o n of Participants and Non-Participants by Number of Children . 25 4 Percentage Dist r i b u t i o n of Participants and Non-Participants by Place of Residence 26 5 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Year of Graduation 27 6 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Place of Graduation 28 7 Percentage D i s t r i b u t i o n of Participants and Non-Participants by Number of Years Post-Secondary Education. 30 8 Percentage Dist r i b u t i o n of Participants and Non-Participants by Work Towards Other Dental Qualifications. 31 9 Percentage Dist r i b u t i o n of Participants and Non-Participants by Work Towards Non-Dental Qualifications . 32 10 Percentage D i s t r i b u t i o n of Participants and Non-Participants by Employment Status 33 11 Percentage D i s t r i b u t i o n of Participants and Non-Participants by P r i n c i p a l Type of Employment 35 12 Number of Par!leipants In Each of Four Categories of Continuing Dental Hygiene Education Courses from March 1971 to March 1974 38 13 Summary of Chi-Square Values and Significance Levels for Participant Characteristics by Course Categories . . 41 v i i i Table Page 14 Percentage Dist r i b u t i o n of Participants i n C l i n i c a l S k i l l s Courses and Participants i n Other Courses by Age 42 15 Percentage Di s t r i b u t i o n of Participants i n C l i n i c a l S k i l l s Courses and Participants i n Other Courses by Number of Years of Post-Secondary Education . . . . 43 16 Percentage Dist r i b u t i o n of Participants i n Practice Management Courses and Participants i n Other Courses by M a r i t a l Status 44 17 Percentage Di s t r i b u t i o n of Participants i n Patient Evaluation Courses and Participants i n Other Courses by Number of Years Post-Secondary Education 45 i x LIST OF FIGURES Figure Page 1 Number of Hours of Continuing Dental Hygiene Education by Participants 36 ACKNOWLEDGMENTS Sincere thanks are tendered to the writer's husband, two daughters and one son for graciously allowing the infringement of this paper on th e i r way of l i f e . Special appreciation and thanks go to members of the writer's advisory committee, Dr. Coolie Verner, Dr. Gary Dickinson and Mrs. Joan Voris for t h e i r guidance, encouragement and patience. A debt of thanks i s expressed to Dr. Donald 0. Anderson, head, Division of Health Services Research and Development and his s t a f f , Richard S h i l l i n g t o n , Gordon Muir, Margaret Wertz and Russell Nakonsbey for their 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 of high q u a l i t y health services i s the primary aim of a l l health professions. In recent years increasing concern has been expressed about the a b i l i t i e s of the health professions to maintain and improve the competency of p r a c t i t i o n e r s who are involved i n the delivery of health services. This 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 i n s t i t u t i o n s , governments and, more recently, consumers. There i s evidence that there i s often a gap between the knowledge and s k i l l s attained for graduation and those of 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 t h i s gap tends to increase each year. In addition, i n the health sciences there i s , apparently, a growing need f or a l l p r a c t i t i o n e r s to be constantly r e v i s i n g and updating the various forms of services under-taken. The information explosion combined with increasing pressure from society on health professionals to d e l i v e r better care to more people, make i t imparative to discover more e f f i c i e n t ways to provide continuing education to health professionals. Simply d e l i v e r i n g more of the old w i l l not do. Opportunities which provide for maintenance of competence and a c q u i s i t i o n of new information and s k i l l s must be made av a i l a b l e . 1 2 D e n t i s t r y i s one o f t h e h e a l t h s c i e n c e p r o f e s s i o n s t h a t h a s e x p a n d e d r a p i d l y . Many t y p e s o f c o n t i n u i n g e d u c a t i o n i n d e n t i s t r y i n c l u d e : p o s t g r a d u a t e a n d g r a d u a t e p r o g r a m s o f a y e a r o r m o r e g i v e n a t u n i v e r s i t y o r 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 c o u r s e s o f a f e w d a y s o r w e e k s ; 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 b y v i s i t i n g s p e c i a l i s t s ; s t u d y c l u b a c t i v i t i e s ; j o u r n a l s , r e p r i n t s , t e x t b o o k s ; a u d i o t a p e o r c l o s e d c i r c u i t t e l e v i s i o n p r o g r a m s ; a n d u p g r a d i n g o r r e t r a i n i n g p r o -g r a m s o f v a r i a b l e l e n g t h t o m e e t t h e n e e d s o f i n d i v i d u a l p a r t i c i p a n t s . 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 , o b j e c t i v e s h a v e b e e n i l l - d e f i n e d , a n d p r o g r a m s p o o r l y p l a n n e d a n d c o n d u c t e d . T h e r e i s e v i d e n c e , h o w e v e r , t h a t t h e s i t u a t i o n i s c h a n g i n g . A n s w e r s 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 q u e s t i o n s r e l a t i n g t o t h e a d m i n i s -t r a t i o n , o r g a n i z a t i o n , r e s p o n s i b i l i t y a n d m e t h o d o l o g y o f c o n t i n u i n g e d u c a t i o n f o r d e n t i s t s a n d d e n t a l a u x i l i a r i e s . T h e s e a n s w e r s h o p e -f u l l y w i l l l e a d t o m o r e e f f e c t i v e l e v e l s o f c o m p e t e n c y f o r p r a c t i t i o n e r s a n d h i g h e r q u a l i t y d e n t a l s e r v i c e s f o r t h e p u b l i c . C o n t i n u i n g e d u c a t i o n s p e c i f i c a l l y f o r d e n t a l h y g i e n i s t s s h a r e t h e s e c o n c e r n s . D e n t a l h y g i e n i s t s h a v e b e e n e d u c a t e d a t t h e u n i v e r s i t y o r c o m m u n i t y c o l l e g e l e v e l t o p e r f o r m c l i n i c a l a n d p r e v e n t i v e d e n t i s t r y a n d d e n t a l h e a l t h e d u c a t i o n . T h e y a r e l i c e n c e d t o p r o v i d e d i r e c t c l i n i c a l s e r v i c e s t o p a t i e n t s u n d e r t h e s u p e r v i s i o n o f a d e n t i s t . The 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 b y r e c e n t c h a n g e s i n u t i l i z a t i o n p a t t e r n s a n d t h e d e l e g a t i o n o f a d d i t i o n a l new f u n c t i o n s . 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 a b r e a s t o f t h e s e c h a n g e s a n d h a v e r e v i s e d c u r r i c u l a a n d c l i n i c a l t e a c h i n g a c c o r d i n g l y , h o w e v e r , many 3 have not. Many practicing hygienists 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 facing the dental hygiene profession include: How can a profession insure optimum quality performance once i t s members have l e f t their formal training 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 probability that p r a c t i c i n g dental hygienists 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 par t i c i p a t i o n of dental hygienists i n continuing education. I t was designed to discover whether or not there i s a difference between those dental hygienists who do participate and those who do not participate i n continuing dental hygiene education programs. In seeking to answer this question the study sought to id e n t i f y the socio-economic characteristics which d i f f e r e n t i a t e participants from non-participants, and to determine i f the choice of course topic was related to any s p e c i f i c characteristics of the participants. Furthermore i t sought to i d e n t i f y some items which might influence p a r t i c i p a t i o n i n continuing education. 4 The variables examined were: age, marital status, number of children, 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 , employ-ment status and p r i n c i p a l type of employment. The course topics were categorized into four groupings: c l i n i c a l s k i l l s , patient evaluation, dental health education and practice management. METHOD Using the register and mailing 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 hygienists registered i n the province along with the licence renewal form. These were mailed on January 10, 1974 to 221 dental hygienists. From this mailing, 158 (71%) replies were received. A second mailing was sent the middle of February which produced t h i r t y additional res-ponses. A t h i r d mailing resulted i n 26 more returns for a t o t a l of 214 responses received and a response rate of 96.8 per cent. No questionnaires were rejected because of incomplete data. Sample After 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 collected 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' Association. The format used for 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 into 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. In addition, the questionnaire was pre-tested on twelve ac t i v e l y employed dental hygienists. Data Analysis The data were transferred to tapes for computer analysis. B i -variate and multi-variate tabulations were made and eleven socio-economic characteristics (the dependent variables) were cross-tabulated against the independent variables; p a r t i c i p a t i o n and non-participation i n continuing dental hygiene education courses. Further tabulations were conducted against the same eleven socio-economic characteristics on those hygienists who participated i n courses. The data processing was done at The University of B r i t i s h Columbia Computing Centre on the LMB System 370, Model 178. The c h i -square test was conducted on a l l cross-tabulations. The significance l e v e l of .10 was used. This was judged to be appropriate for this study as i t was an exploratory study seeking to id e n t i f y needs for future research and approaches to program development. DEFINITION OF TERMS Continuing Education. For purposes of this study the term continuing education i s applied only to short, formal programs offered on 6 a non-credit basis. These courses were offered uni-professionally to dental hygienists as a group, or multi-professionally where the dental hygienists participated with dentists or with 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 refer to those learning experiences that were planned and implemented to achieve behaviourally defined objectives within a given time period. C l i n i c a l . The term c l i n i c a l i s used to describe those courses which included opportunities for c l i n i c a l application of material 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 did not involve direct c l i n i c a l application 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. Full-time Employment. For purposes of this study the term f u l l - t i m e employment i s applied to those employed thirty-two hours or more or four days or more a week. Part-time Employment. Part-time employment i s considered any employment period less than thirty-two hours or less 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 practice i n which the majority of the hygienists' 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 introduction, background and statement of the problem, some de f i n i t i o n s of terms, and the methodology used for 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 characteristics of the participants and non-partici-pants and the extent of p a r t i c i p a t i o n . The summary, conclusions and implications for the future are included i n Chapter 4. CHAPTER 2 REVIEW OF THE LITERATURE This study focuses oh the continuing education patterns of dental hygienists. Published materials from 1940 to the present time were reviewed to determine the extent of research related to the par t i c i p a t i o n of dental hygienists 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 hygienists. The reports that were found generally provided descriptive information about program content but l i t t l e or no data about participants. As dentistry i s a closely related profession, a review of published reports of dentists i n continuing education was also conducted. In addition, continuing education i n the health sciences was reviewed b r i e f l y i n an attempt to discover additional relevant information. DEFINITIONS OF CONTINUING EDUCATION The importance of continuing education for persons engaged i n a l l professions has been established. William McGothlin.(29), i n his comparative study of the professions of architecture, business administration, engineering, law, medicine, nursing, psychology, s o c i a l work, teacher education and veterinary 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 obligation i n th e i r professional code of practice. Thus, continuing education has been 8 9 formally accepted as a central value i n most professions, but as Randolph (43) suggested "those who have the basic knowledge and s k i l l for restoring and preserving health have a greater obligation than most professions to further th e i r education and keep abreast of a l l new developments•" In referring to educational a c t i v i t i e s designed for adults, the terms adult education, continuing education, continuous education, l i f e - l o n g learning 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 self-explanatory—a process whereby a person continues his/her education—many definitions have been evolved to s u i t s p e c i f i c purposes. In general adult education, several definitions 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 intention to bringing about changes i n information, knowledge, understanding or s k i l l , appreciation and attitudes or for the purpose of i d e n t i f y i n g and solving 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 definitions relate 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 pre-professional programs of undergraduate study should be termed con-tinuing education. The Kellogg Foundation (12) has described continuing education as: . . . a continuing study by adults u t i l i z i n g periodic learn-ing experiences within an university environment and featuring a spec 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 Popiel (39) as: . . . any educational a c t i v i t y for the health profession through which opportunities for systematic learning are pro-vided. Included i n this d e f i n i t i o n are any planned learning 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 for the practicing professional and are systematic learning a c t i v i t i e s . Neylan (34) described continuing education as: . . . a moderate degree of organization, f l e x i b l e , responsible to current learning needs of individuals or groups and designed to enable individuals 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 role performance. 11 CONTINUING EDUCATION IN DENTISTRY Dentists have been concerned with the advancement of their profession and have accepted the challenge of continual personal and professional growth. Recognition of this was f i r s t expressed by G.V. Black (4) the "Father of Dentistry," i n his 1907 statement that "the professional man has no right to be other than a continuous student." Since that time the profession has continued to support this concept. One of the objectives cited i n the 1962 Report on Dental Education of the World Health Organization (15) was the "need for con-tinuing professional education throughout l i f e . " In recent years interest i n continuing education has multiplied considerably, probably as a result of pressure exerted by in d i v i d u a l practitioners and professional bodies, as wel l as society at large. In 1964, the H a l l Royal Commission on Health Services (46) recommended "that to help ensure that physicians i n practice 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 simi l a r recommendation was made at the same time with respect to dentists. Definitions i n Dentistry In the Report of the American Dental Association Council on Dental Education (22) continuing dental education was defined as: . . . consisting of educational a c t i v i t i e s designed to review ex 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 further stated that the objective of continuing dental education i s to improve and increase the a b i l i t y of the dentist to deliver the highest quality of dental care possible. The ultimate aim of continuing dental education i s increased health care for the patient. Continuing education should make i t possible for each dentist to attune his practice to the modern dental knowledge that continuously becomes available. Optimal professional growth ensues through the pa r t i c i p a t i o n of each dentist i n effec t i v e programs of continuing educa-tion i n addition to his own experience and assessment of the l i t e r a t u r e . During the Canadian Dental Association Conference on Continuing Education (7) held i n September, 1972, several definitions of continuing education were put forth: . . . Any form of education for a member of the dental health team following acquisition of the basic q u a l i f i c a t i o n aimed at maintaining and upgrading the quality and quantity of dental care delivered to the public . . . . . . the motivation towards t o t a l learning, using a l l the pedogogic techniques available (such as courses, conventions, c l i n i c a l t r a i n i n g , lectures, seminars). Studies which should enable the members of the dental profession including a u x i l i a r y personnel to better serve the public by maintaining current standards and good dental practice. Emergence of Continuing Dental Education Dental educators and other leaders i n the profession along with those i n many other professions have agreed that continuous learning i s essential for the maintenance of professional excellence. (1, 5, 26) As Patterson (37) stated i n 1960, "the dentist or physician who i s con-ducting a 1940 type practice i n 1960, i s rendering limited service to 13 the patient and constitutes a l i a b i l i t y to his profession." Holroyd (23) noted that more frequent change and adjustments must be incorporated into practice i n order to keep abreast of modern practice. Massler (30), i n 1971, referred to the quality of practice as being l i k e "horse and buggy dentistry i n a jet-age." Chambers and Hamilton (9) 'observed that further answers to the problem of "how best to protect the public" be sought. Randolph (43) acknowledges that while the professions are becoming increasingly aware of the need for organized continuing educa-t i o n , "obsolescence i n knowledge or technical s k i l l i s a v i o l a t i o n of the trust committed to those who become professionally and l e g a l l y q u a l i f i e d to tend the health needs of others." According to Nakamoto and Verner (33), continuing dental educa-t i o n was a product of the Second World War. Up to that time there appeared to have been few attempts to offer systematically planned learning opportunities for dental practitioners. The return to c i v i l i a n l i f e of a large number of dentists after 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 for continuing dental education. In response, a series of refresher type programs were conducted at several dental schools. In recognition of the need for more effec t i v e programming a f i r s t con-ference on continuing dental education was held i n the United States i n 1948 . At this conference plans were made to organize further conferences and workshops to study the problems related to the establishment and conducting of programs of continuing dental education. 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, there have been many discussions, conferences, and workshops concerning the need for continuing dental education, however, there has been limited study of the p a r t i c i p a t i o n patterns of dentists involved i n continuing education. Much of what has been written 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 practitioners to plan t h e i r own continuing education, and on the machinery for 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 for the public 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 this standard of care by compulsion. In 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 for the relicensure of dentists. In Canada Charter (8) reported that the provinces of Manitoba and Alberta have made such demands on thei r licenced dentists and several other provinces are considering similar action. 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 revisions to the Dentistry Act which have been submitted to the p r o v i n c i a l govern-ment. The revisions allow the College the authority to require licenced 15 personnel to meet continuing education requirements as a condition 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 available 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 factors which may affect p a r t i c i p a t i o n . These include location of practice, type of practice, age and income. 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 dentists regularly attended continuing education courses (33). Regional surveys showed a s i m i l a r i t y to this national figure (14, 16, 21, 27, 35, 36, 38). Darby's survey (14) further compared the opinions of dentists i n the New England and Western states. In both areas 90 per cent of the res-pondents expressed a willingness to participate incontinuing education but the i r p a r t i c i p a t i o n would be subject to influence by such factors as subject matter presented, length of course, travel distance required and portion of the week involved. These factors were further reiterated by P e t i t and 0'Shea's Western New York study (38) as w e l l as Keevil's study (27) of the U.S. Public Health Qentists and dental hygienists. The motivating factors involved i n gaining attendance i n continuing education courses, as found by Adler (2), were mainly interest and improve-ment of practice procedures. I t was estimated that during the year, 1970-71, 24 per cent of the licenced dentists i n B r i t i s h Columbia attended continuing education courses made available through the Division of Continuing Dental Education 16 at The University of B r i t i s h Columbia (48). In the following years there was a substantial increase i n attendance with 47 per cent i n 1971-72, and 51 per cent i n 1972-73 (49, 18). Since one dentist could attend more than one course, the figures were not t r u l y representative of the actual number of individuals p a r t i c i p a t i n g i n courses. Furthermore 64 per cent of the dentists attending these contlinuirig^dental education . courses were from the Lower Mainland (18). This probably was due to the fact that the courses were held at The University of B r i t i s h Columbia campus or at other locations i n the Greater Vancouver area and were, therefore, r e l a t i v e l y inaccessible to a large number of practicing dentists outside the immediate area. CONTINUING EDUCATION IN DENTAL HYGIENE Continuing education for dental hygienists has had a l a t e r s t a r t than i n the case of dentistry. The increased knowledge of and emphasis on prevention and the opening of laws governing dental hygiene practice has stimulated action by the hygienists to plan and participate i n con-tinuing education. Definitions 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 available which s p e c i f i c a l l y related to continuing education i n dental Hygiene. This d e f i n i t i o n , fcom the American Dental Hygienists' Association (44), stated that continuing education i s : 17 The education of the i n d i v i d u a l beyond basic preparation for the profession of dental hygiene whose primary goal i s to promote optimal service to the public by fostering continued professional 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 practitioner. 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 for dental hygienists appeared i n the l i t e r a t u r e i n the early 1940's (45). Since then the number of courses available to hygienists has increased at a steady rate and current a c t i v i t i e s are more varied 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 situations for the application and practice of technical s k i l l s . Topics are presented both on a short term basis, such as the one hour lecture, and on a long term basis, such as a month long course. The need of dental hygienists to increase knowledge and to keep informed of current research being done to improve techniques of practice 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). Even as l a t e as 1960, continuing dental hygiene education was 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. I t was not u n t i l 1968 that the House of Delegates of the American Dental Hygienists' Association (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 for continued improvement of dental hygiene services and the retention of dental hygienists i n the manpower force. 18 In Canada continuing education offerings for dental hygienists have developed more slowly than i n the United States. The Canadian Dental Hygienists' Association declared i n i t s o r i g i n a l Code of Ethics (10) i n 1967 that: Every dental hygienist has the obligation to keep his 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 Ethics i n 1972 (11). Recently the Canadian Dental Hygienists' Association has supported the concept that continuing education i s necessary for a l l members and has directed a l l provinces to encourage and promote p a r t i -cipation. The need to establish guidelines for continuing education for dental hygienists has been reported (5). In addition, the theme, "Continuing Education—Directions '73," was selected for the national 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 Imple-mentation 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 ac 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 prerequisite of dental hygiene relicensure have been held i n most provinces. 19 At present, however, no province includes compulsory continuing educa-tion for relicensure of a u x i l i a r y personnel under existing or proposed l e g i s l a t i o n . P a r t i c i p a t i o n of Dental Hygienists i n Continuing Education  A 1973 study of practicing dental hygienists 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 did 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 did indicate an interest i n professional enrichment through professional educational experiences of varied kinds. In the main, hygienists attended courses i n the province i n which they resided. Even within that geographical l i m i t a t i o n , participants e s s e n t i a l l y represented the more urban commun-i t i e s . This was attributed to the predominantly centralized and urban locations of most of the programs available and the prohibitive expense involved i n attending by those l i v i n g on the periphery. Although the relationship between educational achievement and part 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 basic 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 hygienists have sim i l a r educational backgrounds because the entry require-ments for pre-professional education demand a minimum of twelve years of schooling. 20 Continuing Education for 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 for dental hygienists were not available u n t i l 1971 (48). P r i o r to that date, opportunities for the continuing education for dental hygienists were limited to the few programs offered through the divisions of continuing education of American dental schools, i n p a r t i -cular, those i n the neighbouring states of Washington and Oregon. Many practitioners have enrolled i n credit and non-credit courses i n educa-t 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 dentistry such as those i n the behavioural sciences, basic sciences, and business adminis-tr a t i o n . Some hygienists i n B r i t i s h Columbia enrolled i n courses of study leading towards a baccelauriate degree and a select number have pursued a masters degree. In addition, most hygienists hold membership i n their national organization which l i s t s continuing education as one of the benefits of membership. Dental hygienists i n B r i t i s h Columbia have had opportunities to attend courses offered for members of l o c a l dental societies and specialty groups throughout the province (40, 41, 42). Also, some have joined study clubs. These study clubs have been established i n some areas of the province and are led by those with expertise i n a specialized area of practice who share the i r technical s k i l l s and knowledge with t h e i r pro-fessional peers. In the guidelines for study clubs established by the B r i t i s h Columbia Dental Hygienists' Association (20) the purpose of study clubs has been defined as: 21 A means of continuing education for the graduate dental hygienist 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 si t u a t i o n . Since 1971, formal courses s p e c i f i c a l l y designed for hygienists have been made available through the Division of Continuing Dental Education at The University of B r i t i s h Columbia with l i a i s o n provided by the B r i t i s h Columbia Dental Hygienists' Association (18, 48, 49). The sp e c i f i c dental hygiene topics included: "Teaching the Dental Patient," "Recognition and Control of Periodontal Disease," "Radiography," "Recognition of Oral Lesions," "Prevention and Handling of Emergencies i n the Dental Office," "Principles of Occlusion," "Plaque and Preventive Dietetics i n the Dental Office," "Finishing Restorations," and "Adhesives i n Restorative Dentistry." 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 dentists or dental hygienists. There i s , however, much discussion concerning the need for more organized programming of continuing dental education. In addition, interest i n and concern for continuing education courses s p e c i f i c a l l y designed for both dentists and dental hygienists i s most apparent. CHAPTER 3 ANALYSIS OF DATA In this chapter the f i r s t section describes the socio-economic characteristics of participants and non-participants i n continuing dental hygiene education programs. The characteristics examined include: age, marital status, number of children, 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. Some additional iiSformation i s presented to describe more f u l l y some of the characteristics of the respondents. In the second section the extent of pa r t i c i p a t i o n by dental hygienists 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 practice 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 characteristics of the participants i n each category are discussed. CHARACTERISTICS OF PARTICIPANTS AND NON-PARTICIPANTS To investigate the characteristics of participants and non-participants 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 distrib u t i o n s between participants 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, with 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 old. For purposes of analysis, respondents were divided into two age groups: less than 25 and 25 and over (Table 1). TABLE 1 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Age Less than 25 n % 25 and Over n % Total n % Participants Non-Participants Total 63 68.5 29 31.5 49 69.1 22 30.9 112 68.7 51 31.3 92 100.0 71 100.0 163 100.0 = .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 difference between participants and non-participants by age was recorded. Thus, age did not d i f f e r e n t i a t e between participants and non-participants. Marital Status The average number of years that the married respondents had been married was s i x years with the range from 1 to 28 years. A large number (33%) had been married within the past four years. 24 For purposes of analysis, respondents were divided into three categories: unmarried, married less than fiv e years, and those married f i v e years or more. Unmarried respondents included those who were single, separated, divorced or widowed, with only three hygienists i n this group separated, divorced or widowed (Table 2). TABLE 2 Percentage D i s t r i b u t i o n of Participants and Non-Participants by Marital Status Unmarried n % Married less than 5 years n % Married 5 years or more n % Total n % Participants Non-Participants Total 53 73.6 19 26.4 35 68.6 16 31.4 24 60.0 16 40.0 112 68.7 51 :31.3 72 100.0 51 100.0 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 large majority of the unmarried hygienists, 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 fiv e years or more and 62.6 per cent of those married less 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 single and married hygienists suggested that unmarried individuals were more l i k e l y to be participants but the difference i n d d i s t r i b u t i o n between participants and non-participants by marital 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 difference. 25 Number of Children Sixty-four per cent of the respondents reported that they had children while 70.2 per cent did not (Table 3). TABLE 3 Percentage Dist r i b u t i o n of Participants and Non-Participants by Number of Children With n Children % Without n Children % n Total % Participants 25 64.1 87 70.2 112 68.7 Non-Participants 14 35.9 37 29.8 51 31.3 Total 39 100.0 124 100.0 163 100.0 X*" = .25, d.f. = 1, 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 children. The number of children by age ranged from 25 four years old or less to 13 children f i v e to fourteen years of age, 4 children 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 children four years of age and under, 21 hygienists (12.9%) had one preschooler while four hygienists (2.5%) had two. The number of children did 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 participants and non-participants i n -dicating that this was not a factor influencing p a r t i c i p a t i o n . Place of Residence For purposes of analysis, place of residence was grouped into 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 east, and the muni-c i p a l boundaries of North and West Vancouver, Lions Bay and Coquitlam on the north. Of the hygienists responding 74.8 per cent l i v e d i n the Lower Mainland (Table 4). TABLE 4 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Place of Residence Lower n Mainland % Other n Areas % n Total % Participants 86 70.5 26 63.4 112 68.7 Non-Participants 36 29.5 15 36.6 51 31.3 Total 122 100.0 41 100.0 163 100.0 X 2 = .42, d.f • = 1, p = .52 not si 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 Island, 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 locations throughout the province. Of the Lower Mainland residents 70.5 per cent attended courses while 29.5 per cent did not attend as compared to 63.4 per cent of those residing out of the Lower Mainland who attended courses and 36.3 per cent who did not. The d i s t r i b u t i o n of participants and non-participants by th 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 factor 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 figure 27 as most of the courses were held within the Lower Mainland. Year of Graduation The average year of graduation of the respondents was 1968 with the e a r l i e s t year being 1947. Seventy-four hygienists (45.6%) graduated between 1947 and 1969, while 89 hygienists (54.4%) graduated i n 1970 or l a t e r . This difference can be attributed to the establish-ment of the program i n Dental Hygiene at The University of B r i t i s h Columbia and the graduation of the f i r s t class i n 1970 (Table 5). TABLE 5 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Year of Graduation 1970 or After n % Before 1970 n % Total n $ Participants-Non-Participants Total 60 67.4 29 32.6 52 70.3 22 39.7 112 68.7 51 31.3 89 100.0 74 100.0 163 100.0 X"1 = .05, 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 registered 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 hygienists had to go out of the province. In the group graduating since 1970, 67.4 per cent participated i n continuing education and 32.6 per cent did not as compared with 70.3 per 28 cent and 39.7 per cent respectively for 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 difference i n d i s t r i b u t i o n by year of graduation between the participants and non-participants i n d i -cating that the year of graduation was not a factor influencing p a r t i -cipation. Place of Graduation Dental hygienists registered and licenced i n B r i t i s h Columbia have graduated from many different schools. For purposes of analysis the place of graduation was grouped into two categories: Canada and the United States (Table 6). TABLE 6 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Place of Graduation Canada n % United n States % n Total % Participants 64 62.1 48 80.0 112 68.7 Non-Participants 39 37.9 12 20.0 51 31.3 Total 103 100.0 90 100.0 163 100.0 X^ = 4.83 , d.f. = 1, p = .02 s i g n i f i c a n t 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 largest group (36.2%) of respondents graduated from The University of B r i t i s h Columbia, while 27.6 per cent graduated from either the University of Alberta or the 29 University of Manitoba. Some 15.3 per cent graduated from either the University of Toronto i n Ontario or Dalhousie University i n Nova Scotia. A t o t a l of 20.9 per cent of the respondents received the 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 participated i n continuing education and 37.9 per cent did not as compared with 80 per cent of the American graduates who participated and 20 per cent who did not. The difference i n d i s t r i b u t i o n of participants 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 factor influencing 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 participate 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 attitudes toward continuing education i n their undergraduate years. Post-Secondary Education Training for dental hygiene generally consists 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 addition, some hygienists obtain some elective years of post-secondary education. Of the respondents, only 4.9 per cent had a degree from university 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 addition to that required by the two year dental hygiene diploma. Fourteen hygienists (8.6%), indicated that they were working toward degree q u a l i f i c a t i o n s . Of those hygienists with two or three years post-secondary education and a diploma, 67.3 per cent participated i n continuing education while 32.7 per cent did not (Table 7). TABLE 7 Percentage Dist r i b u t i o n of Participants and Non-Participants by Number of Years Post-Secondary Education 2-3 Years with Diploma n % 4 Years or more with Degree or Diploma n % n Total % Participants 76 67.3 36 72.0 112 68. 7 Non-Participants 37 32.7 14 28.0 51 31. 3 Total 113 100.0 50 100.0 163 100. 0 = .18, d.f. = 1, p = .67 not s i g n i f i c a n t Among those hygienists with four years or more post-secondary education with either a degree or diploma, 72 per cent participated i n continuing education courses and 28 per cent did 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 difference i n the d i s t r i b u t i o n of participants and non-participants by number of years post-secondary education and, therefore, i t did not influence p a r t i c i p a t i o n patterns. 31 Other Dental Qualifications Fourteen of the hygienists indicated that they were continuing to work towards some further 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 offerings leading to a Baccalaureate Degree. The courses selected were preparing the participants 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 qualify for admission to a dental program. Of the hygienists working towards other dental q u a l i f i c a t i o n s , 78.6 per cent participated i n continuing dental hygiene education courses and 21.4 per cent did not i n comparison with 67.8 per cent who were not working towards any additional dental q u a l i f i c a t i o n but participated i n continuing educa-tion courses and 32.2 per cent who did not participate (Table 8). TABLE 8 Percentage Di s t r i b u t i o n of Participants and Non-Participants by Work Towards Other Dental Qualifications yes n % n no % n t o t a l % Participants 11 78.6 101 67.8 • 112 68.7 Non-Participants 3 21.4 48 32.2 51 31.3 Total 14 100.0 149 100.0 163 100.0 X = i n v a l i d . One c e l l contained less than f i v e responses. 32 Non-Dental Qualifications Thirty-five per cent of the total hygienists were working towards non-dental qualifications (Table 9). Respondents working toward non-dental qualifications reported a wide range of subject areas of study such as: elementary education, psychology, language, anthropology, business administration and secretarial training in the academic areas and piano, sailing mastery and figure skating in the non-academic areas. TABLE 9 Percentage Dist r i b u t i o n of Participants and Non-Participants by Work Towards Non-Dental Qualifications n yes % n no % n total % Participants 45 78.9 67 63.2 112 68.7 Non-Participants 12 21.1 39 36.8 51 31.3 Total 57 100.0 106 100.0 163 100.0 X*" = 3.57, d.f. =1, p. = .05 significant Of the respondents, 78.9 per cent participated in continuing education courses while 21.1% did not participate. On the other hand, of the 65 per cent of the total who were not working towards any non-dental q u a l i f i -cations, 63.2 per cent did participate in continuing education and 36.8 per cent did not. The difference i n distribution of participants and non-participants by work towards non-dental qualifications i s s t a t i s t i c a l l y significant and therefore was a factor influencing participation. It 33 indicated that those respondents seeking further education of any type also participated i n continuing dental hygiene education courses. Employment 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 this 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 less than that amount was considered part-time employment (Table 10). TABLE 10 Percentage Dist r i b u t i o n of Participants and Non-Participants by Employment Status Full-time n /o Part-time n % Total n la Participants Non-Participants Total 90 72.0 35 28.0 22 57.9 16 42.1 112 68.7 51 31.3 125 100.0 38 100.0 163 100.0 = 2.08, d.f. = 1, p. = .14 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 hygienists participated i n one or more continuing education courses and 28 per cent did not as compared to 57^9 per cent of those who worked part-time and participated and 42.1 per cent who did not. The difference i n d i s t r i b u t i o n between participants 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 fu l l - t i m e are more l i k e l y to participate 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 practice i n which the majority of the hygienists' work week was spent. The p r i n c i p a l types of employment, for purposes of analysis, were divided into two categories. The category "private practice" includes general dental practice and dental specialty practices, such as orthodontics, periodontics and pedodontics. This category contained 88 per cent of the respondents. The category "other," employment modes such as dental a u x i l i a r y education, public health, school health and community agencies were included. Of the 12 per cent of respondents i n th i s group, 3.7 per cent were involved 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 public health and 1.2 per cent i n community agencies. Of the 144 respondents employed i n private practice, 65.9 per cent attended continuing education courses and 34.1 per cent did not i n contrast to the 89.4 per cent of those employed i n other areas of practice who participated i n continuing education courses and the 10.6 per cent who did not (Table 11). Hygienists not employed i n private practice participated more i n continuing education courses. The difference between the d i s t r i b u -tion of participants 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 did 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 Di s t r i b u t i o n of Participants and Non-Participants by P r i n c i p a l Type of Employment Private n Practice % 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 Total 144 100.0 19 100.0 63 100.0 X = 3.29, d.f. =1, p = .06 s i g n i f i c a n t EXTENT OF PARTICIPATION Of the 163 respondents to the survey, 112 (68.7)%)._dental hygienists 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 characteristics 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 hygienists. The non-participants were excluded from t h i s analysis. Hours of Attendance In computing the amount of p a r t i c i p a t i o n , a single 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 least was s i x hours. The largest single group participated 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 a 17 & 16 T3 15 Tj 14 S 13 * 12 11 10 9 8 7 6 5 4 3 2 1 1-13 14-27 • 28-41 42-55 56-59 70-83 Number of Hours 84-97 98-111 112 or more Figure 1. Number of Hours of Continuing Dental Hygiene Education by Participants 37 Number of Courses Attended The average number of courses attended was two. The largest group of hygienists, 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 Noii-Clinical Courses The participants were divided into two categories: those who attended at least one c l i n i c a l course and those who attended only non-c l i n i c a l courses. Of the participants, 61.3 per cent attended at least 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 into four categories i n terms of the nature of the educational content. C l i n i c a l S k i l l s The c l i n i c a l s k i l l s category contained courses which were related to the performance of c l i n i c a l techniques by the dental hygienist such as periodontics, pain and anxiety control, restorative dentistry, pedodontics, orthodontics, endodontics, prosthodontics, myofunctional therapy and oral surgery. Over two-thirds (70.5%) of the hygienists participated i n c l i n i c a l s k i l l s courses (Table 12). 38 TABLE 12 Number of Participants i n Each of Four Categories of Continuing Dental Hygiene Education Courses from March 1971 to March 1974 Yes No Total Category n % n % n % C l i n i c a l S k i l l s 79 70.5 33 29. 5 112 100.0 Patient Evaluation 22 19.6 90 80. 4 112 100.0 Dental Health Education 83 74.1 29 25. 9 112 100.0 Practice Management 24 21.4 88 78. 6 112 100.0 Total* 208 204 * Individuals participated i n more than one category of courses. Patient Evaluation The patient evaluation category included a broad spectrum of courses related to general and s p e c i f i c o r a l conditions of patients including subject matter concerned with medical and.dental hist 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 interpretation, recording of dental and periodontal findings and supplementary diagnostic aids such as ora l photographs, blood pressure, impressions, study casts, cytology smears and pulp testing. Only 19.6 per cent of the hygienists participated i n patient evaluation courses. 39 Dental Health Education Dental health education encompassed a range of courses related to preventive dentistry. Included i n th i s area were courses related to the o r a l health status of the patient and the maintenance of optimal o r a l health. Specific courses covered subject matter r e l a t i n g to patient ins t r u c t i o n i n areas such as toothbrushing, f l o s s i n g , supplementary aids, fluoride therapy and n u t r i t i o n and dietary counselling. Courses related to the behavioural sciences such as psychology, communication and be-haviour modification were also 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 learning, learning methodology and materials or devices used to enhance learning situations were included. Of the hygienists who participated, 74.1 per cent attended courses concerned with dental health education. Practice Management The practice management category included a range of courses concerned with o f f i c e management, dental economics and practice adminis-tr a t i o n . Of the participants, 21.4 per cent attended practice management courses. The hygienists involved i n continuing education courses p a r t i c i -pated primarily i n courses concerned with direct services to the patient. The c l i n i c a l s k i l l s and dental health education areasshad the majority of hygienists' p a r t i c i p a t i o n . Hygienists appeared to have a high interest i n maintaining effective patient contact. The 74.1 per cent figure re-f l e c t i n g hygienists' involvement i n courses r e l a t i n g to preventive dentistry 40 that i s , dental health education, appeared to correlate to the thrust of dentistry toward a prevention oriented philosophy rather than tre 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 dentistry continuing education courses throughout the province offered ample opportunity for p a r t i c i p a t i o n by dental hygienists. Continuing education courses i n a l l four groupings were a v a i l -able to dental hygienists during the period studied with at least f i v e courses per year made available through the Division of Continuing Dental Education at The University of B r i t i s h Columbia. These courses were held i n the Lower Mainland. The Universities 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 hygienists from B r i t i s h Columbia. In addition, programs of varying topics were available through the p r o v i n c i a l and l o c a l professional organizations and neighbouring state associations. Characteristics of Participants Eleven socio-economic variables were tabulated against the four course categories to determine whether any participant characteristics influenced p a r t i c i p a t i o n i n different types of courses. Significant differences were found with respect to four of the variables studied (Table 13). 41 TABLE 13 Summary of Chi-Square Values and Significance Levels for Participant Characteristics by Course Categories Characteristic C l i n i c a l S k i l l s Patient Evaluation Dental Health Education Practice Management Age 4.47* .00 .01 .00 Marital Status 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 Q u a l i f i c a t i o n 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 * where p < .10 42 Age and C l i n i c a l S k i l l s Courses Seventy-nine participants (70.5 per cent) participated i n c l i n i c a l s k i l l s courses. A majority, 79.4 per cent, who participated were less 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 Participants i n C l i n i c a l S k i l l s Courses and Participants i n Other Courses by Age 25 years n or over % Less n than 25 years % Total n % Participants i n C l i n i c a l S k i l l s 29 59.2 50 79.4 79 70.5 Participants i n Other Courses 20 40.8 13 20.6 33 29.5 Total 49 100.0 63 100.0 112 100.0 X 2 = 4.47, d.f. = 1, p = .03 The participants 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, participated to a greater degree than did 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 for 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 practice s k i l l s . Many hygienists do recognize that their educational preparation was not adequate for the expanded practice demands occurring i n dental 43 hygiene. In addition, younger graduates may be more oriented towards higher learning leading them to participate 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 difference i n the d i s t r i b u t i o n of participants i n c l i n i c a l s k i l l s and participants i n other courses was recorded concerning the number of years of post-secondary education (Table 15). TABLE 15 Percentage Dist r i b u t i o n of Participants i n C l i n i c a l S k i l l s Courses and Participants i n Other Courses by Number of Years of Post-Secondary Education 2 to 3 Years with Diploma n % 4 Years or more with Diploma or Degree n % n Total % Participants i n C l i n i c a l S k i l l s 59 77.6 20 55.6 79 70.5 Participants i n Other Courses 17 22.4 16 44.4 33 29.5 Total 76 100.0 36 100.0 112 100.0 X 2 = 4.71, d.f. = = 1, p == .03 A majority of hygienists, 63.2 per cent, graduated with a basic dental hygiene diploma, that i s , two to three years of post-secondary education. Seventy-eight per cent of those hygienists participated i n c l i n i c a l s k i l l s courses while 55.6 per cent of those hygienists with four 44 years or more post-secondary education participated i n c l i n i c a l s k i l l s courses. I t appears that those hygienists actively involved i n further education and those with additional education are more apt to be i n -volved i n other areas than c l i n i c a l practice and are less l i k e l y to participate i n c l i n i c a l s k i l l s courses. Other academic and professional interests attribute 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 Practice Management Courses Of the participants i n a l l categories of courses, 21.4 per cent par-tic i p a t e d i n practice management courses. In analysing the participants i n the area of practice management courses, 18.9 per cent of the single group participated as compared with 14.3 per cent of those married less than five 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 Participants i n Practice Management Courses and Participants i n Other Courses by Ma r i t a l Status Single n % Married less than 5 years n % Married 5 years or more n 7o Total n % Participants i n Practice Manage-ment Participants i n Other Courses 10 18.9 43 81.1 5 14.3 30 85.7 9 37.5 15 62.5 24 21.4 88 78.6 Total 53 100.0 35 100.0 24 100.0 112 100.0 X 2 = 4.95, d.f. =2, p = .08 45 This l a t t e r group was the most widely variant for the t o t a l and led 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 difference i n d i s t r i b u t i o n of practice management course p a r t i c i p a t i o n . Although this finding 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 interest i n practice 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 Evaluation Courses Of the participants i n a l l the four categories of courses, 19.6 per cent attended patient evaluation courses (Table 17). TABLE 17 Percentage Di s t r i b u t i o n of Participants i n Patient Evaluation Courses and Participants i n Other Courses by Number of Years Post-Secondary Education 3 Years with 4 Years or More Total Diploma with Diploma or Degree n % n % n % Participants i n 22 19.6 Patient Evaluation 11 14.5 11 30.6 Participants i n 90 80.4 Other Courses 65 85.5 25 69.4 o Total 76 100.0 36 100.0 112 100.0 X 2 = 3.05, d.f. = 1, p = .08 Fourteen point f i v e per cent of those with two or three years post-secondary education and a diploma participated i n patient evaluation courses as 46 c o m p a r e d w i t h 3 0 . 6 p e r c e n t o f t h e h y g i e n i s t s who h a d f o u r y e a r s o r m o r e p o s t - s e c o n d a r y e d u c a t i o n who p a r t i c i p a t e d i n s i m i l a r c o u r s e s . T h e o v e r a l l l e v e l o f p a r t i c i p a t i o n i n p a t i e n t e v a l u a t i o n c o u r s e s w a s 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 o f f e r e d d u r i n g t h e p e r i o d u n d e r s t u d y . T h e r e w a s , h o w e v e r , 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 t h e d i s t r i b u t i o n b y t h e n u m b e r o f y e a r s o f p o s t - s e c o n d a r y e d u c a t i o n a n d p a r t i c i p a t i o n i n p a t i e n t e v a l u a t i o n c o u r s e s . The h i g h e r t h e l e v e l o f p a r t i c i p a t i o n b y t h o s e w i t h f o u r o r more y e a r s o f p o s t - s e c o n d a r y e d u c a t i o n was a t v a r i a n c e w i t h t h e p a t t e r n o b s e r v e d f o r 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 c o u r s e s . I t may b e t h a t t h o s e w i t h a h i g h e r l e v e l o f e d u c a t i o n h a v e a g r e a t e r c o n c e r n f o r t h e o v e r a l l p a t i e n t a n d f o r b r o a d -e n i n g t h e i r s c o p e o f p r a c t i c e w h e r e a s t h o s e w i t h l e s s e d u c a t i o n may be more i n t e r e s t e d i n p e r f o r m i n g o n l y t e c h n i c a l s k i l l s . I t may a l s o b e t h a t t h o s e w i t h a h i g h e r l e v e l o f e d u c a t i o n a r e i n e m p l o y m e n t s i t u a t i o n s i n v o l v i n g r o u t i n e p e r f o r m a n c e o f p a t i e n t e v a l u a t i o n t a s k s . SUMMARY I n summary t h e q u e s t i o n o f w h e t h e r o r n o t t h e r e i s a d i f f e r e n c e i n t h o s e 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 a n d t h o s e who do n o t p a r -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 b e a n s w e r e d a s f o l l o w s : G r a d u a t e s o f d e n t a l h y g i e n e p r o g r a m s i n t h e U n i t e d S t a t e s a r e m o r e l i k e l y t o p a r 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 t h a n t h o s e f r o m Canadam C H y g i e n i s t s p u r s u i n g f u r t h e r q u a l i f i c a t i o n s o f e i t h e r a d e n t a l o r n o n - d e n t a l n a t u r e 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 e d u c a t i o n c o u r s e s . 47 Hygienists not employed i n private practice, but employed i n dental a u x i l i a r y education, public or school health and community agencies participate more i n continuing education courses. Participants 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 post-secondary education which includes a diploma i n dental hygiene. They also are not l i k e l y to be working towards any further dental q u a l i f i -cations. At variance with the pattern seen i n the c l i n i c a l s k i l l s courses, the participants i n patient evaluation courses are more l i k e l y to have had at least four years of post-secondary education which includes either a diploma or degree i n dental hygiene. Participants involved i n practice management courses are more l i k e l y to be married for at least f i v e years. CHAPTER 4 SUMMARY, CONCLUSIONS AND IMPLICATIONS This study focused on the socio-economic determinants of par t i c i p a t i o n by dental hygienists i n continuing professional education and includes demographic, s o c i a l and professional variables 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 of pa r t i c i p a t i o n of dental hygienists i n continuing education programs and as a result there i s a lack of empirical data to guide planners and organizers of such programs. The study surveyed 163 dental hygienists registered and licenced 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 hygienists represented 76.2 per cent of the employed dental hygienists registered and licenced i n B r i t i s h Columbia i n 1973. Eleven variables were selected for study: age, marital status, number of children, years of post-secondary education, year and place of graduation, place of residence, work towards further dental 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. Of these variables 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 including 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 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 , patient evaluation, dental health education and pr a c t i c e manage-ment. The eleven variables 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 post-secondary 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 courses and patient evaluation courses; and m a r i t i a l status 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 respect to the major va r i a b l e s of concern i n t h i s study, observations are offered according to the s i g n i f i c a n t v a r i a b l e s : place of graduation, p a r t i c i p a t i o n i n other areas (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; and to several of the other variables considered: age, m a r i t a l status, number of c h i l d r e n , place of residence, year of graduation and number of years of post-secondary education. Place of Graduation The study indicated that the m i l i e u i n which the dental hygienist was trained appeared to exert a strong influence on p a r t i c i p a t i o n i n continuing education courses. Dental hygiene graduates from schools i n the United States p a r t i c i p a t e d more than those graduated from schools 50 Canada. This suggests that Canadian schools f a i l to develop positive attitudes toward continuing education and that they should perhaps modify the 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 the i r professional careers regardless of type of employment. Pa r t i c i p a t i o n i n Other Areas Those respondents who sought further education of any type also participated 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 carried over into the professional area. This suggests that hygienists ac t i v e l y involved i n interest areas other than dentistry are also aware of the develop-ments and changes within t h e i r profession requiring 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 hygienists who attended courses were employed predominately on a f u l l - t i m e monthly salary basis. The fu l l - t i m e positions encompassed a l l employment situations whether they were for a single 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 for more than one employer i n more than one dental 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 hygienists were generally encouraged by their employers to attend continuing education 51 courses either by some f i n a n c i a l inducements such as no loss 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 for 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 University of B r i t i s h Columbia Program of Dental Hygiene, have led 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 re g i s t r a t i o n fees have stimulated interest i n p a r t i c i p a t i o n i n programs. Private dental practitioners have recently f e l t a pressure to offer the i r employees both f i n a n c i a l inducement and time for p a r t i c i p a t i o n i n continuing education programs. Age Age was not related 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 related 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 offerings. Younger hygienists attended more courses concerned with c l i n i c a l s k i l l s which may indicate that many of the younger hygienis are more aware of the ever-changing scene i n dentistry and dental hygiene The younger and the more recent graduates who are assuming more respon-s i b i l i t y within 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 for the pre-ventive aspect of patient care. These hygienists, therefore, f e e l a stronger need for continuing education to keep themselves current. 52 M a r i t a l Status and Number of Children Neither marital status nor the number of children 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 relationship to p a r t i c i p a t i o n i n this study and i t seems that these factors may not be of important consideration i n the development of continuing education programs for hygienists. Yet, i n discussion with hygienists, the demands of home r e s p o n s i b i l i t i e s are often cited as deterents to pa r t i c i p a t i o n i n courses. In spite of what the data indicated, some attention might be given to the provision of day-care services for those hygienists with young children. This could be especially important when courses are offered outside of normal employment hours. A p o s s i b i l i t y to explain the inconsistency between the s t a t i s t i c s collected and the comments of the respondents i s that the rationale of "attention to home r e s p o n s i b i l i t i e s " i s an excuse hiding unstated reasons for f a i l u r e to participate such as lack of enthusiasm and interest i n maintaining competency and/or upgrading or lack of awareness of the need for 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 location of practice or residence of the participant. A survey of B r i t i s h Columbia dentists showed that the large majority of dental course registrants were from the Lower Mainland and attended courses offered on the Lower Mainland. The assumption that dental hygienists 53 would follow 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 factor. In view of the contradictory results and the fact that there has been much pressure brought to bear on the continuing dental hygiene pro-gramming to bring courses to areas of the province other than the Lower Mainland t h i s finding requires further research. Year of Graduation As with the characteristics 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 related to p a r t i c i p a t i o n of dental hygienists i n continuing education. Post-Secondary Education The number of years of post-secondary education was not related 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 for most hygienists who participated i n the study. IMPLICATIONS Change has been so rapid i n the f i e l d of dentistry that contin-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 . In the practice of dental hygiene these changes have also been apparent. Every hygienist should keep abreast of new developments i n the changing patterns of dental hygiene practice and the delivery of dental care. Because addi-t i o n a l functions are being delegated increasingly to the hygienist, 54 continuing education has become a necessity. Dental hygienists who return to the work force after an absence of a few years require up-dating 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 this rapid change i n dental technology. Continuing education programs designed for 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 greatly i n the next few years and that effective mechanisms for developing and evaluating these programs must be developed. There i s a need for s p e c i f i c guidelines to a s s i s t persons involvediinddesirgning-programs and to improve the quality of existing programs. Such guidelines might include the following c r i t e r i a : Adminis t r a t i o n Proper administration i s essential for the conduct of an effective continuing education program. Within the province there must be an administrating organization which has control with respect to maintaining up-to-date professional r e g i s t r a t i o n l i s t s , assignments of credits for courses upon the i n s t i g a t i o n of mandatory continuing education for relicensure, and formation of the o v e r - a l l long range plan for continuing dental hygiene education. The administration should have as i t s goal an education program of high quality and one which meets the demonstrated needs of the profession. 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 for 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 for the conduct and quality of the program. Institutions such as f a c i l i t i e s of dentistry and community colleges which have dental hygiene programs must be encouraged to sponsor continuing educa-tion programs. Co-sponsbrship by professional societies must also be encouraged. F a c i l i t i e s Adequate f a c i l i t i e s are essential for both e f f e c t i v e continuing education programs and for proper patient care when c l i n i c a l procedures are being performed. Therefore, f a c i l i t i e s selected should be appro-pria t e for the kind of educational methodology being employed. Appro-priate f a c i l i t i e s can be found i n such locations as dental/dental hygiene schools, community colleges, hospitals and private dental offices and c l i n i c s . Budget P r o f i t should not be the primary objective 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 for 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 material selected. The primary c r i t e r i a for selecting instructors 56 or c l i n i c i a n s should include teaching s k i l l , expertise i n the area being covered, and high e t h i c a l standards. C l i n i c a l material 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 dentist has defined the hygienists' role while hygienists have been reluctant to seek out and/or recognize expertise amongst th e i r own colleagues. I f hygienists are to apply the knowledge and s k i l l s gained through continuing education programs, ef f o r t s must be made to help them apply the material to t h e i r roles and employment . setting. When a team approach to dental care i s presented, efforts should be made to have members of concerned, related d i s c i p l i n e s represented on the program. 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 foster the dental health team approach to dental care. Curriculum Program content should be concerned with the improvement of dental care. While the overall 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 for dental hygienists must focus on the "dental" 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 professional organizations i s that the content i s what the program planners think the learner needs; he may need i t , but us 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 learner, himself. 57 Programs should be planned, based on the expressed needs of potential participants 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 learning 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 his needs, there are needs which are precipitated by new developments i n the f i e l d and may not be known to the potential learner. Programs must be devised to include the involvement of the learner and a l l necessary instruc-tion 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 hygienists of each region as w e l l as on advances i n dentistry. The means of ascertaining the needs of dental hygienists should include questionnaires, pre-course test s , self-assessment tests, proficiency tests or some form of peer review. Program topics of interest and use to dental hygienists i n a l l employment situations should be selected. Program planners must con-sider the diverse needs of hygienists i n a variety of c l i n i c a l and functional areas of dental care settings. Dental hygienists i n sparsely populated -aceas must not be overlooked i n the planning. I t i s con-ceivable that other means than short courses, such as independent learning packages can be implemented. Program topics should include consideration for the needs of the consumer, insight into dental care practices and a perspective of the changing role 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 early stages of planning. Such objectives should include: changes i n the attitude and approach of the learner to the solution of dental problems; presentation of new knowledge i n s p e c i f i c areas; introduction 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 for 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 objectives have been met. Educational Methodology Continuing education program planners should be cognizant of the increasing variety of educational techniques and devices available. Such media as programmed i n s t r u c t i o n , slide-tape presentations and closed c i r c u i t t e l e v i s i o n are i n increasing use. Programmers should incorporate techniques of i n s t r u c t i o n which actively employ the learner i n the learning experience and not use to any great amount the techniques which just involve passive p a r t i c i p a t i o n by the learner. Self-assessment mechanisms, for example pre-course entrance testing, have become an i n t e g r a l part of educational methodology both as a direct learning tool and as a stimulus to further continuing educa-tio n . Attention should be centered on the development and provision of self-assessment tools for hygienists. 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 u t i l i z e d . I t i s b e n e f i c i a l to the program planner and the participant to conduct evaluation of course content, instructor effectiveness and "take-home" behaviour of the learner which he exhibits when he returns to his dental care setting. Information regarding the effectiveness of the program and the provision of feedback from the participants i s necessary for adequate evaluation of a program. As part of evalua-t i o n , attention should be directed to determining the health care needs of the community as wel l as the educational needs of the participants. Study of each program and the achievements of i t s participants 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 character-i s t i c s studied appear to have influenced the attendance patterns of dental hygienists i n continuing dental hygiene education programs. This indicates a need for more detailed research and analysis into continuing education for dental hygienists. Among other things: 1. 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 for hygienists returning to the work force after an absence. 2 . I t i s necessary to analyse the needs of the dental hygiene practi t i o n e r i n l i g h t of the changes i n the dentistry acts and make required amendments, as the l e g i s l a t i o n affects the requirements of practice as d i s t i n c t from the analysis of needs of the in d i v i d u a l practitioner determining his own proficiency or competency l e v e l . 60 3. I t i s necessary to conduct research on the underlying reasons for the f a i l u r e to participate of hygienists employed i n private practice. 4. Current programs of continuing education should be evaluated i n terms of content, method and amount of learning accomplished, as well as i n terms of thefr adequacy i n meeting the current and future needs of the profession. 5. Further research on participants i s required i n order to determine ways to increase p a r t i c i p a t i o n . Is there a problem of course a s s e s s i b i l i t y ? Is i t necessary.to expand the continuing education offerings, employ dif f e r e n t methods and media for delivery and expand faculty and s t a f f involved i n the production of these programs? Since the majority of working hygienists are under the age of 30 are continuing education programs designed with this i n mind? 6. There i s a need to study the other segment of the dental hygiene population, the unemployed hygienist. How best can this hygienist 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 effect of the implementation of mandatory continuing education for relicensure on p a r t i c i -pation and learning patterns i n comparison to those patterns of voluntary continuing education. Would only those with the desire to learn only benefit from mandatory education? Would those without the desire to learn 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 ? I N CONCLUSION Health professions must expand ex i s t i n g levels of knowledge and s k i l l s to j u s t i f y their continued existence. Major revisions i n the structure and delivery of health services and i n the requirements for education and tr a i n i n g of health professionsl are occurring. These revisions increase the r e s p o n s i b i l i t i e s of the health service d i s c i p l i n e s . Professions must prepare thei r members for changing and expanding roles. Dental hygiene must continue to recognize potential changes i n the delivery 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 systematically up-grade, renew and expand current levels 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 hygienists. REFERENCES 1. Adelson, D.S. "Continuing Educational Programs—Their Place i n Dentistry," New York State Dental Journal. December, 1964. 439-440. 2. Adler, N. "Survey on Continuing Education," Journal of the C a l i f o r n i a Dental Association. 45:132-136, F a l l , 1969. 3. Beagrie, George S. "Throughout L i f e : The Need for Continuing Education, Journal of the Canadian Dental Association. 40: 434-438, June, 1974. 4. Black, G.V. "Limitations of Dental Education," American Dental Journal. 6:690-703, 1907. 5. Brown, V i r g i l . "Why Continuing Education i n Dentistry," B u l l e t i n of the Academy of General Dentistry. September, 1964, 42. 6. Burket, L.W. "Responsibility of Dental Educational Institutions for Offering Continuing Education Programs," Journal of Dental  Education. 28:324-328, September, 1964. 7. Canadian Dental Association Conference on Continuing Education. Canadian Dental Association, Council on Education, Toronto, 1972. Charter, Diane. "Status of Continuing Education," Journal of the  Canadian Dental Association, 40:430-433, June, 1974. Chambers, David W. and Douglas L. Hamilton. "Continuing Dental Education: Reasonable Answers to Unreasonable Questions," Journal of the American Dental Association. 90:116-120, January, 1975. Constitution and By-Laws. The Canadian Dental Hygienists' Association. Adopted May, 1967. (amended ."i: -' 1*5 Constitution and By-Laws. The Canadian Dental Hygienists' Association. Adopted May, 1967, amended June, 1972. Continuing Education—an evolving form of adult education. Kellogg Foundation. Sequoia Press, 1958. Cosaboom, M.E. "This Greater Need for Continuing Education," Journal of the American Dental Hygienists' Association. 46: 267-272, July-August, 1972. 8. 9. 10. 11. 12. 13. 62 63 14. Darby, D.W. "The Dentist and Continuing Education—Attitudes and Motivations," Journal of the American College of Dentists, 36: 164-170, July, 1969. 15. Dental Education Technical Report, Series 244, WHO Geneva, 1962. 16. DiBiaggio, J.A. "Continuing Education at the University of Kentucky: Report of a Seven Year Experience," Journal of the  American Dental Association. 78:1007-1009, May, 1969. 17. Drasek, S.J. et a l . (eds). Expanding Horizons—Continuing Education. North Washington Press, 1965, p. 7-9. 18. Fourth Annual Report, Continuing Dental Education. The University of B r i t i s h Columbia, Faculty of Dentistry, Health Sciences Centre. 1972-73. 19. Gandy, M.K. "Continuing Education," Journal of the American Dental Hygienists' Association. 45:9-11, January-February, 1971. 20. General Information on Study Clubs for Dental Hygienists. B r i t i s h Columbia Dental Hygienists' Association and the Greater Vancouver Dental Hygienists' Society. May, 1974 (Mimeographed). 21. Gray, S.B., R.M. O'Shea and W.A. Jordan. "Some Characteristics of Minnesota D i s t r i c t Dentists," North West Dentistry. 45:299-303, November-December, 1966. 22. Guidelines for Continuing Education—A Policy Report. Council on Dental Education, American Dental Association—House of Delegates, Chicago, November, 1974. 23. Holroyd, S.V. "The Need for Continuing Education i n Dentistry," Journal of the American College of Dentists ; 28(3):187-192, September, 1961. 24. Hulbush, L. "Continuous Learning," Journal of the American Dental Hygienists' Association, 43:180, September-October, 1969. 25. Johnstone, John W.C. and Ramonmcfa.Rivera. Volunteers for Learning. Chicago: Aldine Publishing Company, 1965. 26. Kanterman, R. "The Case of Continuing Education," The Dental Studentjis Magazine. November, 1966, 152. 27. Keevil, J.M. "Public Health Dentists and Dental Hygienists Express an Interest i n Continuing Education," Journal of Public Health  Dentistry, 39:92-94, Spring, 1970. 64 28. K l i n e , Carol and Karin Sipko. "CDHA Manpower and U t i l i z a t i o n Survey Results," The Canadian Dental Hygienist. 8:29-31, Summer, 1974. 29. McGothlin, William J. Patterns of Professional Education. New York: G.P. Putnam's Sons, 1960, pp. 21. 30. Massler, M. "Re-examination for 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 Educa-t i o n , " Journal of the American Dental Hygienists' Association. 46:50-51, January-February, 1972. 32. Minutes of the House of Delegates, American Dental Hygienists' Association, 1968. (Mimeographed) 33. Nakamoto, June and Coolie Verner. Continuing Education i n Dentistry: A Review of North American Literature 1960-1970. Vancouver: Adult Education Research Centre and Division of Continuing Education i n the Health Sciences, The University 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 for Dentists: Some Survey Results," Journal of the American College of Dentists. 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  Dentists. 32:320-331, October, 1965. 37. Patterson, W. "Continuing Education: A Challenge to the Profession," Journal of the American College of Dentists, 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 Results," N.Y. State Dental  Journal. 37(8):485-9, October, 1971. 39. Popeil, E. "The Role of the University i n Continuing Education for Nurses," Paper presented at the University of Texas - M.D. Ander-son 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 Society, 1972-1973. 41. Program. Vancouver and D i s t r i c t Dental Society, 1972-1973. 42. Program. Vancouver and D i s t r i c t Dental Society, 1973-1974. 65 43. Randolph K.V. "Baselines and Responsibilities i n Continuing Educa-t i o n a l E f f o r t s , " Journal of the American College of Dentists. 30:283-288, December, 1963. 44. Report of the Committee on Continuing Education. American Dental Hygienists' Association. February, 1973. 45. "Report of the Educational Committee, 1940," Journal of the American Dental Hygienists' Association, 15(2):86-90, A p r i l , 1941. 46. Report of the Royal Commission on Health Services. Queen's Pr i n t e r , Ottawa, volume 1, 1964. 47/ Retrospective International Survey of Adult Education - A Report. P a r i s , UNESCO, 1972. 48. Second Annual Report, Continuing Dental Education. The University of B r i t i s h Columbia, Faculty of Dentistry, Health Sciences Centre, 1970-71. 49. Third Annual Report, Continuing Dental Education. The University of B r i t i s h Columbia, Faculty of Dentistry, Health Sciences Centre, 1971-72. 50. Verner, Coolie and John S. Newberry. "The Nature of Adult P a r t i c i -pation," Ao^ilJ^J^ Summer, 1958. 51. Voris, 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. 66 The B r i t i s h Columbia Dental Hygienists" Association requests every Dental Hygienist (whether practicing or not) in the province of B r i t i s h Columbia to complete a l l sections of this application. Miss Mrs. Surname Given names Maiden name Mr. Marital Status: [ ] single Dr. Home: Apt.No. Street No. and name [ ] married [ ] widowed, divorced, separated City, Town Postal code If presently married: date of marriage Province Month Year Home Telephone No. Can. Social Insurance No. Occupation of spouse Birthdate: Do you have children l i v i n g at home? [ ] [ ] yes no If yes, indicate number of children i n following Month Year Birthplace: age groups City, Town, Province, Country Where did you l i v e the longest period during your f i r s t 18 years? . . 4 X e a r s * u n d e r 1 5-!9 /ears City, Town, Province, Country 5-14 years 20 years & over Pre Dental Hygiene Education: no. of years university/college pre-dental hygiene Basic Dental Hygiene Education: [ ] diploma/certificate [ ] bachelor's degree program program Year completed college/university Additional University Qualifications Completed:  degree/'diploma/'certificate university/college prov/state year completed Other Qualifications (diplomas, c e r t i f i c a t e s ) :  Name of qualification area of study granted by prov/state year completed Are you currently working towards other qualifications? [ .] [ ] If yes, specify area of study and where: yes no I 1 If no, have you ever worked towards other qualifications? [ ] [ ] If yes, specify area of study and where: yes no I • T Have you participated in Continuing Dental/Dental Hygiene Education Courses i n the past 3 yrs? \ [ ] [ ] I f yes, specify: yes no  Title Where Number of hours Have you completed Courses in any o'.her interest areas in the past 3 years. [* ] [ J~ If yes, specify: , yes no Title Where Number of hours Please turn over E M P L 0 Y M E N T D A T A [ ] employed i n dental hygiene [ ] f u l l time (4 or more days) number of weeks worked in past 12 month period [ ] part time [ ] 3 days [ ] 2 days [ ] 1 day [ ] casual i f employed f u l l time, specify: [ ] 1 dental o f f i c e [ ] other setting, specify [ j 2 or more dental offices [ ] combination of any/all categories [ ] employed in other than dental hygiene date commenced present employment: specify area month year [ ] not employed. When were you last employed as a dental hygienist month Do you plan to return to dental hygiene? [ ] [ ] yes no year i f yes, when? i f no, why not? Present Employer(s): date aorrmenoed Name addresscity/town no.of hrs/week Type of Princi p a l Employment (check only one): [ ] general practice [ ] school health [ ] specialty practice [ ] community agency specify [ ] dental auxi l i a r y education [ ] other specify [ ] public health specify P as t Emp1oyment: Type where ~fuUl time/part time dates of employment period L i s t Professional Contributions ( i . e . , positions held in professional organizations, prese.ita tions such as table c l i n i c s , papers, instructing in continuing education courses). COMPLETE AND RETURN WITH LICENCE RENEWAL TO: College of Dental Surgeons of B.C. #325 - 925 West Georgia Street Vancouver, B.C. V6C 1R7 See reverse side 

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