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Getting to grips with equine dentistry

by
01 December 2011, at 12:00am

GRAHAM DUNCANSON also attended a BEVA course on dentistry – in a dual role – and explains that attendance at CPD meetings does not necessarily equate with learning

THE level of learning by a delegate depends not only on the delegate but also on the CPD provider. The organiser of the course, the lecturers, the demonstrators, the facilities and the notes are all vital to enhance the delegate’s learning. I was in the happy position at the two-day British Equine Veterinary Association “Modern Equine Dentistry Course” for veterinary surgeons held on 14th and 15th of October at Langford, of being a learner and a demonstrator. BEVA has a very good track record for providing excellent CPD. This is particularly evident with this annual modern equine dentistry course. Modern is definitely the correct adjective as this course is continually updated. I can vouch for that having lectured at the first course for equine dentistry to be held at Bristol in the summer of 1996. For a Bristol graduate it is very reassuring to arrive this October to find massive building work in progress. Bristol is an ideal venue with very good facilities for the delegates. Henry Tremaine is a top course organiser, having learnt the ropes from the legendary Paddy Dixon many years ago. There are rumours that Paddy will not be organising the advanced course in 2012 so we all hope that Henry will take on this task. There is a serious amount of work involved but hopefully Henry will be able to allocate the time required. Henry was not only the organiser but also the main lecturer, covering a very wide area of dentistry from anatomy, radiography to surgery. He gave us excellent lectures with good notes. The other three lecturers took us through all the other aspects of equine dentistry which we required to make it a very balanced course. The only sad omission was the absence of Nicole Du Toit who is now working back in her home country, South Africa. She would have provided a useful lecture on donkey’s teeth. However, delegates who want to learn more about donkeys can hopefully attend the full day’s course on this species planned for 12th January run by Vetswest. Although there was no specific lecture on health and safety aspects of equine dentistry, this subject was covered in many of the lectures. My one concern is the fact that 50% of the lecturers are suffering damage to their shoulders as a direct result of the repetitive strain of equine dentistry. This is unacceptable for not only younger members of the profession but also for more experienced colleagues. 

Preventing injury

I am sure the use of sedation helps to prevent injury and all the lecturers and the delegates agreed that 100% sedation must be the ultimate goal when treating a horse’s teeth. This, however, is not the only answer. I am not alone in thinking that motorised dentistry may well remove some of the repetitive strain but might also bring on other more insidious injuries. BEVA council is well aware of the problems but solutions are not obvious. The delegates and lecturers broke off the course on Saturday morning  to watch the rugby world cup. It is a real concern that veterinary surgeons carrying out full-time equine dentistry may have a working life expectancy as short as international rugby players. I
count myself very lucky to be still carrying out equine dentistry at 67. That does not stop me worrying about the younger generations of veterinary surgeons. The afternoon sessions were practical and this is how the BEVA dentistry course differs from most other equine CPD meetings. It is in this practical element where I switch from being a learner to being a teacher. Do I? In reality I learn and can reflect on what each group of five practitioners tells me. Each of the six groups spends an hour with me discussing the oral examination of a horse, making a plan for the dental procedures to be carried out, and then the delegates as a group do the dentistry. These are privately-owned horses so a full dental chart is completed. We discuss the full range of sedation options. It is amazing how these differ between clinicians. All the regimes in the main seem equally as effective. The only consistent feature is the examination of the horse, particularly the heart before the
sedation is given. Gone are the days of didactic teaching. This is group learning at its best. I am sure all the delegates learn from these sessions by the large number of e-mails I receive after the
course. I am confident that the learning of the delegates is only the tip of the iceberg. By the way the delegates talk and my own experience in our practice in Norfolk, the delegates will be taking
home their learning to their colleagues. It is vital that even if only one member of the practice in the main carries out equine dentistry, that the practice has a unified approach to the work.
When I analysed all the dental charts over a 10-year period from Westover for my fellowship, it was very apparent that in 1998 I carried out the vast majority of the dental procedures. However, in 2007 the distribution of charts was much more equal between the five of us. Could this be a reason why I haven’t got damaged shoulders? It is difficult to analyse why small group learning is successful. Naturally the practical element of actually performing a task lends itself to being memorable. However, I do not agree with the argument that doing such and such a task is like riding a bicycle. Many tasks do remain in my memory like manually pregnancy diagnosing cows or castrating colts, even after months of not performing them. Is it a numbers thing? Reflecting on
such tasks is difficult as I cannot recall how many I had performed
before they were second nature to me. I can reflect on other tasks, e.g. sectioning the median patella ligament in equines
with upward fixation of the patella. I think it took me five or six before I was 100% happy with the procedure. Looking at other professions might be helpful. When the RAF teaches a pilot to fly a fixed wing aircraft, most of the best pilots go solo within four to six hours.

Profession’s problem

If a trainee has not gone solo within 12 hours, that person is told that a flying career is not open to him (or her). It took me eleven-and-a-half hours to go solo. Can I reflect that I am a slow learner or have got poor hand/eye co-ordination? The veterinary profession has a problem. Should individuals or practices be asked to document their success rates for certain surgical procedures or even all surgical procedures? Or should individuals or practices just have to show evidence that they are carrying out clinical  audits or show that they have standard operating procedures in place to monitor their success rates? The RCVS practice tier scheme goes some way to do this. The professional development phase (PDP) quite rightly does not require candidates to give their success rates, only to show that they have satisfied their mentor that they are competent. Certainly attendance at the “New Graduate Dentistry Course” run by Pete Ramzan at Newmarket with the help of the BEVA Trust, must count highly when completing the PDP. To sum up, the BEVA modern equine dentistry course creates a marvellous opportunity for reflective learning and serves as a model for other CPD. It is hoped that equine practitioners will not be plagued with injuries as a result of their work with horses’ mouths. Equally, I hope that no equine practitioners will be injured in the Equine SKI-PD planned for 8th to 12th January 2012 at Ischgl in Austria which Henry Tremaine is organising.