The obvious question at this moment is: What will become of the Chapter (soon to become College) of Dental Surgeons, now that the task of postgraduate specialist assessment has been subsumed by the DSACs under MOH? Has it become a redundant – and expensive – society that has outlived its function, and is now defunct?

The Experience of Others

This same question faced the Medical Chapters (and fundamentally the Academy itself) in 2004 when the Medical Specialist Register was formed. It should be noted that, from the start, not all medical specialists were FAMS. This continues today, but the percentage of medical specialists who are Fellows remains at over 85%. There is an element of tradition that contributes to the continued well-being of AMS, but my membership of AMS Council has established firmly in my mind that the major reason for the elevated role that AMS continues to play is its position – in MOH’s view – as a single-point-of-contact honest broker. AMS role in medical specialist education is accelerating, and it is being asked to form committees to evaluate and make recommendations on how postgraduate medical education is to proceed amidst the multiplicity of international schemes and standards, to furnish expert opinions on health issues and so forth.

The Dental Chapter’s position within AMS, the continued recognition of FAMS as the de facto senior specialist qualification in Singapore in medicine and dentistry, and the critical mass of the second largest dental grouping – and largest specialist grouping – after the Singapore Dental Association make this current series of events an opportunity, and not a threat.

It may be a valid criticism to say that the Chapter Committee has been concentrating on the Exit Assessment Criteria to the exclusion of all else for these past three years. For those of us who gave the time, in the Chapter Committee and in the SABs, it is due recognition that our efforts will form the basis of the new DSR assessment regime. Nonetheless, the question remains – what now?

How We Intend to Proceed

Since the current Chapter Committee assumed office in May 2007, we have been paying attention to three issues – Continuing Professional Development, finalising the Exit Assessment to make it fit for purpose and exploring the possibility of introducing Special Needs Dentistry into Singapore.

• CPD/CDE
  This is ongoing and must be shared with other bodies – SDA, CGDP and the RACDS Regional Committee are keen. Those of you who have seen the latest SDA Council letter will know that we intend to collaborate on journal clubs to start this off. SDA’s vision is a little more ambitious than ours, but they recognise the value of a specialist’s perspective and training in the evaluation of the literature and/or clinical techniques. I urge all Fellows to make themselves available to contribute to these journal clubs – it is less onerous than a formal lecture, and may well accrue points towards the re-registration protocol that is being developed. We also intend to run three full-day events throughout the coming year. As you know, there is a move to award distinct specialist CDE points as opposed to general ones. These events will cater to this area, but we will also address more general topics of major interest. As the DSR may tend to polarise the profession, it will be in all our interests to maintain the goodwill we now enjoy amongst all Singaporean dentists and extend every effort to improve relations. Contributing through education is a logical and much needed pathway to this end.
  
  I am also pleased to announce that, after some years of lobbying, MOH has agreed to sponsor a set of Clinical Practice Guidelines addressing “The Management of Edentulism”. This set of evidence-based guidelines serve as recommendations of best practice, as opposed to protocols which are meant to be followed strictly. Nonetheless, as is the practice worldwide, to deviate substantially from these guidelines raises questions regarding the clinicians competence and motivations. This work will be carried forward by a team formed under the auspices of Ministry, and chaired by Dr Chan Siew Luen. We wish them every success as they tackle this broad-ranging and potentially controversial task.
  
  
• Exit Assessment/FAMS
  It is interesting to note that the medicals are still running the FAMS pathway – parallel to non-FAMS entry onto the Medical Specialist Register. Not counting Dental Fellows, there are well over a hundred new Medical Fellows who are inducted every single year – who do not need FAMS to qualify for entry onto the MSR. I do not think it is disrespectful to our medical colleagues, or MOH, to observe in their actions a heightened sense of their role in safeguarding health coupled with a desire for self-regulation and, perhaps, a slight lack of faith in the abilities of non-medicals to make medical judgements. These elements come together in a heady concoction of effort and purpose to set the high ground on standards. So too should it be with us. I am very pleased to note, from discussions with the relevant authorities, that our track record in setting up the Exit Assessment and running it successfully have persuaded them that the wheel does not have to be invented again. I think it will be sensible to let those with experience fulfill their roles, and Chapter looks forward to adopting the DSR assessment process if asked to do so, and if the effort is appropriately resourced.
  
  It does not require insider knowledge to realise that there are economic imperatives and a social agenda feeding into national health initiatives, of which the DSR certainly is one such initiative. What can be seen from other countries’ experience of attempts at inclusiveness and rationalisation is a slow regression of standards, and ultimately patient safety, ironically the prime rationale for establishing such initiatives in the first place. It is my fervent wish – and I know it is yours as well – that our standards do not slip one inch. The FAMS and our control over its implementation are a complementary reference to the DSR, as it is in the medical arena. We must make this known in clear terms to everyone we meet. I have put up a proposal that addresses the specific need for a higher level of training to be applied to institutional consultants who necessarily require additional knowledge and experience in research, management and clinical skills. This may eventually form the basis of a senior Fellowship-level ‘exit’ qualification. The DSAB is currently studying the proposal.
  
  
• Special Needs Dentistry
  Singapore ’s current state is a product of hot-housing, or artificial acceleration. Prescient, focused and well-managed hot-housing, no doubt, but accelerated nonetheless. From a purely clinical standpoint, we have mastered the latest and best techniques available to us but only ad hoc solutions exist to address problems such as: dental management of geriatric oral health, the physically-, cognitively- and behaviourally-challenged, cancer and medically-compromised patients. Over the past two terms, the Chapter has been discussing this ‘hole’ in the provision of dental care in Singapore and in November 2006 we asked Dr Elizabeth Coates to deliver a day-long seminar on Special Needs Dentistry. There are indications that there is some recognition from official quarters this unrepresented area needs to be addressed. AMS is able to, through its medical links from the team approach perspective and from Chapters contacts with ‘wet-fingered’ clinicians like Dr Coates and overseas programmes, contribute meaningfully to any effort in this area.
  
  I am pleased to announce that MOH is keen to seek Chapter’s help in addressing some of these issues. A “Geriatric and Special Needs Focus Group” is to be set up, once again under the auspices of MOH, involving representation from the institutions and Chapter.

What We Need to Do  

I hope it will be apparent by now that Chapter has been working diligently to demonstrate its breadth and range of expertise to the relevant bodies. Although these are not steps which result in very tangible results for our Fellows, they are absolutely vital in preserving the value of the post-nominal letters they worked so hard for, and what it continues to represent for Singapore Dentistry. Now that much of the structural work is established and must be completed, Chapter’s attention will turn to creating value for individual Fellows in clinical and other matters that you feel are relevant to your practice. The aim of the current Chapter Committee is to return as much as possible, if not all, of what it is given of Fellows subscriptions to them. Under the Academy, the current arrangement is for the new College of Dental Surgeons to be given 25% of Dental Fellows subscriptions as a block budget to run educational activities – something we very much intend to do. The process of College formation is in its last stage and we shall shortly have the autonomy to use funds as we wish.

I would very much like to hear from you, and like it even more if you would continue to contribute in the ways I’ve mentioned – starting with CPD, and spreading the word on the relevance of FAMS, and not forgetting support for the Chapters activities. Please write to me at andrewaw@starhub.net.sg or by conventional mail if you prefer. I look forward to any feedback or comments you would care to make.

With best wishes,
Andrew Aw
Chair, Chapter of Dental Surgeons