ieaacai ieacher, Vol. 14, No. 4, 1992
333
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”imeinvolvement in journal reading and a uggested facilitation
W. M.JEFFREY, Dental School, The University, Dundee, DDl 4HN, Scotland
In the field of continuing postgraduate education, the reading of professional irnals is an accepted method of keeping informed in regard to new developments and itemporaT thought on direrent philosophies of treatment. Not only is such reading rlized as being an efJicient educational vehicle, but there is now a growing awareness of actual necessity for any clinician to set aside specific time to the exercise. It is not vays readily apparent, however, how great the time commitment can be, even when reading is limited to selected articles. This paper sets out to indicate in quantiative ws the time that could be expected to be utilized by both general dental practitioners i academic teachers if a thorough and conscientious perusal of the journals were to be dertaken. A practical strategy for facilitating at least part of the problem is put forward the hope of reaching a helpful compromise.
WRY
roduction is an ethical prerequisite in the practice of a caring profession that, after initial
ilification, a member must continue his or her professional education. This is a long 3 belief historically expressed in Maimonides’s daily prayer of a physician which ads “May there never develop in me the notion that my education is complete, but 3 me strength and licence and zeal continually to enlarge my knowledge”. Formal Ignition of this continual need was made implicit in Section 63 of the National 11th Services Act when it was compiled in 1968. More recently, exhortations by the ieral Dental Council have given impetus and encouragement to the general dental Etitioner to make greater efforts to keep his or her professional knowledge in line 3 contemporary thought and technical development. This encouragement to conte professionai education has now taken on a new dimension with the publication of New Contract for dentists. It is clearly stated in this agreement that there is a
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
334
I. W.M. Jef/i.ey
statutory requirement for dental surgeons in dental practice “to keep their professional knowledge and skills up to date through appropriate postgraduate education” and an education allowance to facilitate attendance for at least two sessions per year is awarded to promote this activity. Further support is engendered indirectly by the annual reports put out by the medical defence societies suggesting ways of limiting litigation against their members by reminding them of the necessity of being conversant with up-to-date practices should any defence of treatment be needed. Finally, if further stimulus to the need and justification for continuing education were required, it is only necessary to turn to the report published by the Standing Committee on Postgraduate Medical Education on the new infrastructure for postgraduate medical training to realize how seriously the matter is being taken by those in authority. It is also important to understand the relevance now being attached to the integrated subjects of continuing education and clinical audit. Indeed it is this very relevance which prompts a closer scrutiny of one of the educational tools, i.e. journal reading and is the raison d’etre of the present investigation. There is a variety of methods open to practising dentists to further their education. These include attending courses, given either under the auspices of Section 63 or organized privately, meetings conducted by dental societies, membership of local study groups, visual and oral displays offered by videos or tape/slide productions that have been distributed locally or nationally and finally, by means of the written word either via books or journals. There have been a number of excellent surveys investigating collectively the success or failure of these methods (Awty & Balk, 1975; Kerr Gilbert 1975; Wild, 1989). The main emphasis, however, has been given to the matter of attendance-or nonattendance-at courses. It is perhaps relatively easy to monitor this last particular educational route and to equate it with the interest or apathy of the general practitioner, considering at the same time the appeal of a particular subject and the ability of those presenting it. It is felt, however, that very little investigative attention-at least to any depth-has been paid to the supposedly important part played in the acquisition of knowledge by the literary medium of books or journals. In a recent survey (Scottish Council for Postgraduate Medical Education, 1990), it was made evident that the reading of journals is claimed as a popular means whereby the busy practitioner can keep knowledgeably informed. In another survey (MacGregor, Long & Mercer, 1990) 59% of the respondents rated journals as valuable or very valuable as an updating medium and again the authoritative comment has been made (Pulse, 1990) that “Reading books and journals is probably the best method of keeping up to date”. It is easy to understand why learning in this way is commonly favoured. It can be carried out in domestic surroundings, at moments of convenience or when passing interest is aroused, and does not require any effort from the point of view of travelling to a pre-arranged meeting. Many people confess to a preference for learning in almost monastic seclusion rather than participating in group discussion or seminar procedures where they may run the risk of exposing their ignorance. Reading in isolation suffers, however, from arguable drawbacks taken in the context of the busy practitioner. It demands a high degree of self-discipline. There is a susceptibility to distraction from other competing and less taxing interests. There is no compulsion such as might be incurred by the attendance at some learned society’s meeting where truancy would invite any absence to be noticed. One other negative point has to be made, that selflearning in this way makes the task of monitoring or assessing the reader’s accumula-
I
m e znvolvement in journal reading
335
on of knowledge by any administrative postgraduate authority for whatever purpose
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
f audit, extremely difficult.
Self-teaching by means of journal reading nevertheless offers to the general dental ractitioner a satisfactory and cost-effective method of acquiring knowledge. There is, )weveryone important problem which must be considered. There has been an almost :ometric progression in the burgeoning growth of the dental literature itself, ranging om the more precise scientific learned journal to the less intellectually heavy but wertheless informative magazine type publications that are offered, some gratuiusly, to the profession. As an indicator of this growth, the Index of Dental Literature 1950 consisted of 176 pages; in 1960, it was 304 pages, whereas in 1989,974 bigger Id more closely typed pages were taken up in the publication of this information. herefore if a sensible usage of this medium is to take place, it is obvious that some ocess of selectivity must be performed. This in itself is time consuming and difficult. lucationists have been aware of this problem and tentative suggestions have already en made to rationalize and facilitate some form of selective procedures (Jewell, 433). It was felt, therefore, that an attempt should be made to evaluate how much time volvement might reasonably be expected if knowledge were to be increased by the ading of currently published literature. In addition, it would be of help to those in thority if some guidance could be given to the possible financial implications and st efficiency involved in the physical reading of journals. It has been recognised in 1 construction of the new dental contract by a monetary figure being equated to the irning associated with the sessional attendance at recognized courses of instruction. it is accepted that postgraduate education is to be encouraged and that the reading of irnals is a suitably convenient way of acquiring such knowledge, it begs the question to the measure of remuneration that could be offered to reward the time so iployed carrying out this function. It was considered worthwhile to look at two )arate sections of the professional spectrum that would use the current literature as a :ans of continuing their education-firstly the general dental practitioner in the nuance of his or her daily clinical duties, with the emphasis perhaps being on the ictical application of new thought, and secondly, the academics, with the obligation both teaching and research responsibilities that their position demands.
:thod ) General dental practitioner
rning firstly to the general dental practitioners, an approach was made to determine ir anticipated reading intentions. Use was made of the journal Current Titles in utistry to provide a source of the necessary information. This is a publication issued nthly in which the contents of other dental journals (but not all-embracing) are exed, thereby allowing a more rapid search of current published work than the more ie-consuming browsing usually carried out in an institutional library demands. Eight ctitioners were invited to take part, the selection of whom gave cause for careful Lsideration. What was being sought fundamentally was the number of articles in the ital literature over a given period a conscientious practitioner would choose to read, en total freedom of time in order to satisfy in his or her mind the requisite of being icationally informed of contemporary dental matters. It was felt, therefore, that a ,ely random selection of general dental practioners, as would have been preferred to vent bias, might not include those who were deemed by their peers to be
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
336
I . W. M . j e p e y
“conscientious”. The purpose of the investigation was to be aimed, after all, at seeking ways of improving the educational standards of dentists. To use as an indicator somebody who rarely opened a journal would give a fallacious base on which to build recommendations. The eight practitioners chosen were engaged in the performance of their dentistry in well-established town practices and were considered by their peers to be sound representatives of their profession. Their ages ranged from 25 to 60 and included principals, associates and assistants in their practice ranking. They were each presented with a copy of the January 1990 edition of Current Titles in Dentistly and asked to indicate those articles which they would wish to read irrespective of the practical uptake of time. An earnest attempt was made to preserve anonymity by having the returned copies unmarked other than the articles selected and in the collation of the results, only the page numbers of the articles were recorded. No attempt was made to relate such variables as the age of the respondent or their prime interest in selecting the articles with the final total of pages involved. Any correlation, indeed, might be the subject of a follow-up investigation, looking particularly, for example, at the relationship between choice of subject and the number of years since qualifying, but for the moment the quest was simply to ascertain the number of pages which was felt by the respondent to benefit their professional knowledge.
(B) Academic dental teacher It would not be inappropriate at this point to consider journal reading with the obligations expected of the academic dentist involved in teaching and research. It is sine qua non that in an academic position of trust, the teacher must be conversant with all that is happening in his or her sphere of interest. In addition, there is a requirement at least to be reasonably well-informed of events and findings in related aspects of the specialty to which he or she may belong. There are three divisions of interest which can immediately be identified: (1) those matters directly concerned with the principal subject being taught, e.g.
conservation, orthodontics, etc; (2) current work pertinent to the field of research in which all academics are expected
to engage but which might not be directly relevant to the subject matter that is being taught, e.g. laser development; (3) matters of general interest which can help to round off the integrated approach to clinical matters, e.g. control of cross-infection, epidemiology of AIDS, etc. It would be advisable at this point to consider a number of the problems associated with an investigation of reading times before any attempt can be made to constrain the different variables which obviously must exist. In any preliminary study such as this, the parameters can only be defined in the broadest terms. In the event of any trend becoming evident, a more exacting protocol could then be planned involving the more classical, methodological restrictions.
Page size Obviously, due to the variation in journal size, there is no standardization with regard to the dimension of printed page or indeed, the type of print employed. Varying parts of a particular article may comprise illustrations or tables which can only add further inexactitude. Regarding size, it would appear, however, that the modern tendency is
Time involvement in journal reading
337
or journals to be larger than they were in the past and that A4 would now seem to be a ommonly employed page measure.
4anner of reading ’he manner in which an article is read varies considerably. Three categories of perusal lay be suggested: desultory or, as the educationists refer to, skimming. Here, the reader is attracted by the title and the perusal may be no more than a rapid look at the main text-using whatever facility of speed reading the individual possesses, or a cursory glance at any illustrations or tables present, with perhaps a slower and more assimilative reading of the abstract or conclusion; )) normalcy. This form of reading is meant to indicate a rate that would be given, for example, to a leader in a quality newspaper. Sufficient time must be alloted to assimilate and comprehend what the writer is trying to communicate without necessarily mentally debating the theme of the article or the point it is making; :) interpretative. In this case, the specific article is carefully read and “inwardly digested”, perhaps because of a special interest in the methodology of the experimental procedure being employed, or to compare the results being presented with the results of similar investigations currently being used by the reader. Under these circumstances, reading time can be extended to quite considerable lengths, making speculation about time involvement extremely difficult.
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
a)
an attempt to arrive at some quantitative value for the time spent on reading an ticle, an informal study was carried out using members of staff of a teaching hospital. ie age of the reader varied between 25 and 60; the academic ranking ranging from wly appointed lecturer to that of professor. The purpose of the experiment was plained to the reader and an article relevant to his or her teaching discipline was osen in distinction to one relating to a different specialty. This decision was taken in der to conform to the choice of subject that would occur naturally and at the same ne would probably produce a shorter reading exposure time as it was presumed that x c t s of the article would be of a familiar nature and demand less concentrated ;imilation. It was also carefully pointed out to the readers that they were to read it der the terms set out in the category of normalcy, i.e. sufficient to enable the reader comprehend fully what the article was about. The length of the article selected was considered carefully-too short might invite a )re superficial reading style, too long might induce an element of mental fatigue iich might lead to a greater disproportionate time involvement. An article of between 5 pages of A4 was therefore arbitrarily chosen-a length of article commonly found journals. This number of pages included any tables and illustrations within the text. .e exact number of column inches was deliberately not measured as certain aspects, . acknowledgements, are not necessarily read as carefully as other parts of the text i may vary in extent, thereby introducing unnecessary complications. A more listic measurement using quarterly divisions of a page of type was taken. From a total of ten readers, the average time taken per page would appear to be 3 lutes. If this is the case, then it would not be unreasonable to conjecture that an icle of particular interest, e.g. a research paper falling into the interpretative egory, would command a reading time of at least 4 minutes per page.
338
I. W.M . Jeney
As an example of an academic interest that might be examined, the teaching discipline of Conservative Dentistry was chosen. This particular subject obviously includes all operative procedures, as well as those aspects of Materials Science which are applicable to the practice and teaching of Conservative Dentistry. Only those articles published in English were considered and the same journal, Current Titles in Dentistry for the period January 1990 inclusive was examined. Three members of staff were asked for their co-operation in marking the articles they felt they should read, given total freedom of time. The total of pages involved was recorded as well as the number of articles concerned with teaching and research as distinct from those matters of general interest. Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
Results
The number of pages of those articles appearing in the January edition of Current Titles in Dentistry that eight general dental practitioners would choose to read, given freedom of time to do so, are shown in Table I. The numbers are presented in rising order of ascendancy. If a 25% trimmed mean is taken-permissible in such a small survey-a figure of 492.5 pages per practitioner is obtained. TABLE I. Number of pages
General dental practitioners
140
162 423 467 500
580 597 684
Looking now at the academic dentist, the average figure for three teachers of 649 pages taken from the same journal, was recorded as being thought worthy of reading. In addition, the distinction was drawn between those articles germane to teaching and research as distinct from those of general interest, it being presumed that note taking or indexing would be involved in the proper and beneficial usage of the former, so taking a longer time. The average number of such articles number 79. TABLE 11.
Average number of pages selected
Average number of articles requiring note taking
Time taken for note taking 5 mins/paper
Time taken for reading 3 minslpage
Total time involvement
General Dental Practitioners 8
492.5
-
-
24.62 hours
24.62 hours
Academic Teachers 3
649.3
79.0
6.58 hours
32.64 hours
39.04 hours
;lime involvement in journal reading
339
Referring back to the findings of the informal study whereby 3 minutes per page was ound to be a reasonable time allocation, and in consideration of card indexing and/or iote taking where a time allocation of 5 minutes per paper was allowed, it is now iossible to postulate the total time taken by both general dental practitioners and cademic teachers for these exercises. The results are shown in Table I1 and indicate, or general dental practioners, a monthly commitment of 24.62 hours whilst for the cademic, as much as 39.04 hours are required.
)iscussion Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
: must be conceded that from the limited number of subjects employed in the survey,
would be presumptive to draw too many firm conclusions from the results obtained. levertheless, certain facts emerge which must be accepted and then rationalized in :tempting to suggest a practical compromise solution to the problem of acquiring ostgraduate knowledge by means of the written word. The first of these facts is that there surely can be no disagreement with the belief iat the continuing education of dental professionals is both necessary and desirable. xondly, there would appear to be a consensus view from the authors of articles msidering this particular problem of continuing education that the reading of :ofessonal journals is a valuable and realistic means of acquiring knowledge. Thirdly, lwever imprecise the present investigation at first may appear, the time commitment whatever degree of journal reading the dentist indulges, whether they be a general .actitioner or academic, is shown to be considerable. If the desires to read all that may : felt worthy of reading were to be satisfied, it can now be seen that in the case of the :neral dental practitioner, as much as 3 working days per month could be taken up. 5th the academic, as might be expected, the figure rises to almost 5 working days per onth. Equally, it would be safe to surmise that these time allowances in the real x l d would be well nigh financially impossible, whether the reader was self-employed salaried. Two further points emerge from this present investigation. When those in authority e considering the continuing education of members of their profession, they must be ade aware of the time commitment-in real terms-that the reading of journals in an ucationally rewarding manner demands. If reliance is to be placed on self-learning the use of journals, then it would not be unreasonable to expect the dentist to be warded, or at least compensated financially in the same way that attendance at a lstgraduate course of instruction is now recompensed. The difficulties inherent in the ministration of such a self-learning scheme, however, would be overwhelming and [practical. If, on the other hand, advantage is to be taken and proper usage made of : immense amount of research work and review articles that are published-and :re is no reason to suppose this flow will diminish in the future-some attempt ould be made to seek an educational pathway that would be both practical and ministratively manageable. One suggestion might be to organize a Section 63 type course where instead of the )re usual pattern of one specific topic being covered, a broadly based resume of :ent articles relevant to all the dental specialties could be presented. Such a collation selected papers could be presented to general dental practitioners by members of Iff selected by each department or specialty of the geographically nearest Dental hool. Such a course would serve five functions. I
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
340
I. W.M. Jefley
(1) It would encourage a more organized and integrated appraisal of the literature by teaching staff of the Dental School including part-time demonstrators at a departmental rather than an individual level. This collation would be seen as a formal teaching duty of lecturers rather than a moral option to be taken up if time permitted. (2) It would present to the general dental practitioners an informative and educational service regarding contemporary developments taken from the broad spectrum of dental research which the busy practitioner might otherwise never find the time to investigate. (3) It would stimulate a more profound reading of papers of particular interest or to attend those courses currently on offer and which deal in more detail with one topic. (4) Such a literature review course would attract Section 63 funding and be eligible for all administrative benefits associated with this classification. (5) It would make general practitioners aware of findings abstracted from a wider selection of the more esoteric journals held by a medical library to which they, the practitioners, might not have easy access.
Conclusion The burgeoning of the dental literature, most of which is refereed work and of considerable educational merit, presents a problem of assimilation and application. It can be safely assumed that its value is unquestionable and its utilization in the field of continuing education is of value to both general dental practitioner and academic teacher. The time commitment involved in its perusal, if the literature is to be used properly, however, is considerable and at present is largely unrecognized by fiscal authorities with no specific remuneration being aimed at its encouragement. Only by a rational and selective approach being made to the matter can the transmission of the educational implications offered by the mass of contemporary published work be used to the best advantage by the profession.
Acknowledgements I would wish to make known my sincere appreciation of the help and advice shown to me in the preparation of this paper by Dr H. Mulholland of the Centre for Medical Education, Dundee. REFERENCES A W , M. 81 BALK, T. (1975) Dental Practitioners, attitudes to postgraduate education in the South East Thames Region, British Den& Journal, 139, pp. 111-1 12. CURRENT TITLES IN DENT~STRY (1990) 3(1). GENERAL DENTALCOUNCIL(1990) Recommendations Concerning the Dental Curriculum. Jm D. (1988) Reading scientific articles or how to cope with the overload, The Practitioner, 232, pp. 720-725.
KBRRGILBERT,R. (1975) An investigation into postgraduate dental education in the Newcastle region, Journal of Dentistry, 3, pp. 73-76. MAGREGOR, A.J., LONG,A.F. & MERCER,P.E. (1990) The conrinuingplofessional development of general dental practitioners in the Yorkshire Region (School of Dentistry, University of Leeds). PULSE(1990) Editorial, Pulse, 50, p. 78.
Time involvement in journal reading SCOlTISH COUNCIL FOR POSTGRADUATE MEDICAL EDUCATION (1990)
341
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
An enquiry into continuing education for General Dental Practitioners. STANDING, COMMITTEEON POSTGRADUATE MEDICAL EDUCATION (1990) A new infrastructure fur posrgraduate medical training and continuing education. WILD, J.R. (1989) A survey of attitudes and non-attendance at dental section 63 courses in South East Scotland, Health Bulletin, 47, pp. 92-94.
333
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
”imeinvolvement in journal reading and a uggested facilitation
W. M.JEFFREY, Dental School, The University, Dundee, DDl 4HN, Scotland
In the field of continuing postgraduate education, the reading of professional irnals is an accepted method of keeping informed in regard to new developments and itemporaT thought on direrent philosophies of treatment. Not only is such reading rlized as being an efJicient educational vehicle, but there is now a growing awareness of actual necessity for any clinician to set aside specific time to the exercise. It is not vays readily apparent, however, how great the time commitment can be, even when reading is limited to selected articles. This paper sets out to indicate in quantiative ws the time that could be expected to be utilized by both general dental practitioners i academic teachers if a thorough and conscientious perusal of the journals were to be dertaken. A practical strategy for facilitating at least part of the problem is put forward the hope of reaching a helpful compromise.
WRY
roduction is an ethical prerequisite in the practice of a caring profession that, after initial
ilification, a member must continue his or her professional education. This is a long 3 belief historically expressed in Maimonides’s daily prayer of a physician which ads “May there never develop in me the notion that my education is complete, but 3 me strength and licence and zeal continually to enlarge my knowledge”. Formal Ignition of this continual need was made implicit in Section 63 of the National 11th Services Act when it was compiled in 1968. More recently, exhortations by the ieral Dental Council have given impetus and encouragement to the general dental Etitioner to make greater efforts to keep his or her professional knowledge in line 3 contemporary thought and technical development. This encouragement to conte professionai education has now taken on a new dimension with the publication of New Contract for dentists. It is clearly stated in this agreement that there is a
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
334
I. W.M. Jef/i.ey
statutory requirement for dental surgeons in dental practice “to keep their professional knowledge and skills up to date through appropriate postgraduate education” and an education allowance to facilitate attendance for at least two sessions per year is awarded to promote this activity. Further support is engendered indirectly by the annual reports put out by the medical defence societies suggesting ways of limiting litigation against their members by reminding them of the necessity of being conversant with up-to-date practices should any defence of treatment be needed. Finally, if further stimulus to the need and justification for continuing education were required, it is only necessary to turn to the report published by the Standing Committee on Postgraduate Medical Education on the new infrastructure for postgraduate medical training to realize how seriously the matter is being taken by those in authority. It is also important to understand the relevance now being attached to the integrated subjects of continuing education and clinical audit. Indeed it is this very relevance which prompts a closer scrutiny of one of the educational tools, i.e. journal reading and is the raison d’etre of the present investigation. There is a variety of methods open to practising dentists to further their education. These include attending courses, given either under the auspices of Section 63 or organized privately, meetings conducted by dental societies, membership of local study groups, visual and oral displays offered by videos or tape/slide productions that have been distributed locally or nationally and finally, by means of the written word either via books or journals. There have been a number of excellent surveys investigating collectively the success or failure of these methods (Awty & Balk, 1975; Kerr Gilbert 1975; Wild, 1989). The main emphasis, however, has been given to the matter of attendance-or nonattendance-at courses. It is perhaps relatively easy to monitor this last particular educational route and to equate it with the interest or apathy of the general practitioner, considering at the same time the appeal of a particular subject and the ability of those presenting it. It is felt, however, that very little investigative attention-at least to any depth-has been paid to the supposedly important part played in the acquisition of knowledge by the literary medium of books or journals. In a recent survey (Scottish Council for Postgraduate Medical Education, 1990), it was made evident that the reading of journals is claimed as a popular means whereby the busy practitioner can keep knowledgeably informed. In another survey (MacGregor, Long & Mercer, 1990) 59% of the respondents rated journals as valuable or very valuable as an updating medium and again the authoritative comment has been made (Pulse, 1990) that “Reading books and journals is probably the best method of keeping up to date”. It is easy to understand why learning in this way is commonly favoured. It can be carried out in domestic surroundings, at moments of convenience or when passing interest is aroused, and does not require any effort from the point of view of travelling to a pre-arranged meeting. Many people confess to a preference for learning in almost monastic seclusion rather than participating in group discussion or seminar procedures where they may run the risk of exposing their ignorance. Reading in isolation suffers, however, from arguable drawbacks taken in the context of the busy practitioner. It demands a high degree of self-discipline. There is a susceptibility to distraction from other competing and less taxing interests. There is no compulsion such as might be incurred by the attendance at some learned society’s meeting where truancy would invite any absence to be noticed. One other negative point has to be made, that selflearning in this way makes the task of monitoring or assessing the reader’s accumula-
I
m e znvolvement in journal reading
335
on of knowledge by any administrative postgraduate authority for whatever purpose
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
f audit, extremely difficult.
Self-teaching by means of journal reading nevertheless offers to the general dental ractitioner a satisfactory and cost-effective method of acquiring knowledge. There is, )weveryone important problem which must be considered. There has been an almost :ometric progression in the burgeoning growth of the dental literature itself, ranging om the more precise scientific learned journal to the less intellectually heavy but wertheless informative magazine type publications that are offered, some gratuiusly, to the profession. As an indicator of this growth, the Index of Dental Literature 1950 consisted of 176 pages; in 1960, it was 304 pages, whereas in 1989,974 bigger Id more closely typed pages were taken up in the publication of this information. herefore if a sensible usage of this medium is to take place, it is obvious that some ocess of selectivity must be performed. This in itself is time consuming and difficult. lucationists have been aware of this problem and tentative suggestions have already en made to rationalize and facilitate some form of selective procedures (Jewell, 433). It was felt, therefore, that an attempt should be made to evaluate how much time volvement might reasonably be expected if knowledge were to be increased by the ading of currently published literature. In addition, it would be of help to those in thority if some guidance could be given to the possible financial implications and st efficiency involved in the physical reading of journals. It has been recognised in 1 construction of the new dental contract by a monetary figure being equated to the irning associated with the sessional attendance at recognized courses of instruction. it is accepted that postgraduate education is to be encouraged and that the reading of irnals is a suitably convenient way of acquiring such knowledge, it begs the question to the measure of remuneration that could be offered to reward the time so iployed carrying out this function. It was considered worthwhile to look at two )arate sections of the professional spectrum that would use the current literature as a :ans of continuing their education-firstly the general dental practitioner in the nuance of his or her daily clinical duties, with the emphasis perhaps being on the ictical application of new thought, and secondly, the academics, with the obligation both teaching and research responsibilities that their position demands.
:thod ) General dental practitioner
rning firstly to the general dental practitioners, an approach was made to determine ir anticipated reading intentions. Use was made of the journal Current Titles in utistry to provide a source of the necessary information. This is a publication issued nthly in which the contents of other dental journals (but not all-embracing) are exed, thereby allowing a more rapid search of current published work than the more ie-consuming browsing usually carried out in an institutional library demands. Eight ctitioners were invited to take part, the selection of whom gave cause for careful Lsideration. What was being sought fundamentally was the number of articles in the ital literature over a given period a conscientious practitioner would choose to read, en total freedom of time in order to satisfy in his or her mind the requisite of being icationally informed of contemporary dental matters. It was felt, therefore, that a ,ely random selection of general dental practioners, as would have been preferred to vent bias, might not include those who were deemed by their peers to be
Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
336
I . W. M . j e p e y
“conscientious”. The purpose of the investigation was to be aimed, after all, at seeking ways of improving the educational standards of dentists. To use as an indicator somebody who rarely opened a journal would give a fallacious base on which to build recommendations. The eight practitioners chosen were engaged in the performance of their dentistry in well-established town practices and were considered by their peers to be sound representatives of their profession. Their ages ranged from 25 to 60 and included principals, associates and assistants in their practice ranking. They were each presented with a copy of the January 1990 edition of Current Titles in Dentistly and asked to indicate those articles which they would wish to read irrespective of the practical uptake of time. An earnest attempt was made to preserve anonymity by having the returned copies unmarked other than the articles selected and in the collation of the results, only the page numbers of the articles were recorded. No attempt was made to relate such variables as the age of the respondent or their prime interest in selecting the articles with the final total of pages involved. Any correlation, indeed, might be the subject of a follow-up investigation, looking particularly, for example, at the relationship between choice of subject and the number of years since qualifying, but for the moment the quest was simply to ascertain the number of pages which was felt by the respondent to benefit their professional knowledge.
(B) Academic dental teacher It would not be inappropriate at this point to consider journal reading with the obligations expected of the academic dentist involved in teaching and research. It is sine qua non that in an academic position of trust, the teacher must be conversant with all that is happening in his or her sphere of interest. In addition, there is a requirement at least to be reasonably well-informed of events and findings in related aspects of the specialty to which he or she may belong. There are three divisions of interest which can immediately be identified: (1) those matters directly concerned with the principal subject being taught, e.g.
conservation, orthodontics, etc; (2) current work pertinent to the field of research in which all academics are expected
to engage but which might not be directly relevant to the subject matter that is being taught, e.g. laser development; (3) matters of general interest which can help to round off the integrated approach to clinical matters, e.g. control of cross-infection, epidemiology of AIDS, etc. It would be advisable at this point to consider a number of the problems associated with an investigation of reading times before any attempt can be made to constrain the different variables which obviously must exist. In any preliminary study such as this, the parameters can only be defined in the broadest terms. In the event of any trend becoming evident, a more exacting protocol could then be planned involving the more classical, methodological restrictions.
Page size Obviously, due to the variation in journal size, there is no standardization with regard to the dimension of printed page or indeed, the type of print employed. Varying parts of a particular article may comprise illustrations or tables which can only add further inexactitude. Regarding size, it would appear, however, that the modern tendency is
Time involvement in journal reading
337
or journals to be larger than they were in the past and that A4 would now seem to be a ommonly employed page measure.
4anner of reading ’he manner in which an article is read varies considerably. Three categories of perusal lay be suggested: desultory or, as the educationists refer to, skimming. Here, the reader is attracted by the title and the perusal may be no more than a rapid look at the main text-using whatever facility of speed reading the individual possesses, or a cursory glance at any illustrations or tables present, with perhaps a slower and more assimilative reading of the abstract or conclusion; )) normalcy. This form of reading is meant to indicate a rate that would be given, for example, to a leader in a quality newspaper. Sufficient time must be alloted to assimilate and comprehend what the writer is trying to communicate without necessarily mentally debating the theme of the article or the point it is making; :) interpretative. In this case, the specific article is carefully read and “inwardly digested”, perhaps because of a special interest in the methodology of the experimental procedure being employed, or to compare the results being presented with the results of similar investigations currently being used by the reader. Under these circumstances, reading time can be extended to quite considerable lengths, making speculation about time involvement extremely difficult.
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a)
an attempt to arrive at some quantitative value for the time spent on reading an ticle, an informal study was carried out using members of staff of a teaching hospital. ie age of the reader varied between 25 and 60; the academic ranking ranging from wly appointed lecturer to that of professor. The purpose of the experiment was plained to the reader and an article relevant to his or her teaching discipline was osen in distinction to one relating to a different specialty. This decision was taken in der to conform to the choice of subject that would occur naturally and at the same ne would probably produce a shorter reading exposure time as it was presumed that x c t s of the article would be of a familiar nature and demand less concentrated ;imilation. It was also carefully pointed out to the readers that they were to read it der the terms set out in the category of normalcy, i.e. sufficient to enable the reader comprehend fully what the article was about. The length of the article selected was considered carefully-too short might invite a )re superficial reading style, too long might induce an element of mental fatigue iich might lead to a greater disproportionate time involvement. An article of between 5 pages of A4 was therefore arbitrarily chosen-a length of article commonly found journals. This number of pages included any tables and illustrations within the text. .e exact number of column inches was deliberately not measured as certain aspects, . acknowledgements, are not necessarily read as carefully as other parts of the text i may vary in extent, thereby introducing unnecessary complications. A more listic measurement using quarterly divisions of a page of type was taken. From a total of ten readers, the average time taken per page would appear to be 3 lutes. If this is the case, then it would not be unreasonable to conjecture that an icle of particular interest, e.g. a research paper falling into the interpretative egory, would command a reading time of at least 4 minutes per page.
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I. W.M . Jeney
As an example of an academic interest that might be examined, the teaching discipline of Conservative Dentistry was chosen. This particular subject obviously includes all operative procedures, as well as those aspects of Materials Science which are applicable to the practice and teaching of Conservative Dentistry. Only those articles published in English were considered and the same journal, Current Titles in Dentistry for the period January 1990 inclusive was examined. Three members of staff were asked for their co-operation in marking the articles they felt they should read, given total freedom of time. The total of pages involved was recorded as well as the number of articles concerned with teaching and research as distinct from those matters of general interest. Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
Results
The number of pages of those articles appearing in the January edition of Current Titles in Dentistry that eight general dental practitioners would choose to read, given freedom of time to do so, are shown in Table I. The numbers are presented in rising order of ascendancy. If a 25% trimmed mean is taken-permissible in such a small survey-a figure of 492.5 pages per practitioner is obtained. TABLE I. Number of pages
General dental practitioners
140
162 423 467 500
580 597 684
Looking now at the academic dentist, the average figure for three teachers of 649 pages taken from the same journal, was recorded as being thought worthy of reading. In addition, the distinction was drawn between those articles germane to teaching and research as distinct from those of general interest, it being presumed that note taking or indexing would be involved in the proper and beneficial usage of the former, so taking a longer time. The average number of such articles number 79. TABLE 11.
Average number of pages selected
Average number of articles requiring note taking
Time taken for note taking 5 mins/paper
Time taken for reading 3 minslpage
Total time involvement
General Dental Practitioners 8
492.5
-
-
24.62 hours
24.62 hours
Academic Teachers 3
649.3
79.0
6.58 hours
32.64 hours
39.04 hours
;lime involvement in journal reading
339
Referring back to the findings of the informal study whereby 3 minutes per page was ound to be a reasonable time allocation, and in consideration of card indexing and/or iote taking where a time allocation of 5 minutes per paper was allowed, it is now iossible to postulate the total time taken by both general dental practitioners and cademic teachers for these exercises. The results are shown in Table I1 and indicate, or general dental practioners, a monthly commitment of 24.62 hours whilst for the cademic, as much as 39.04 hours are required.
)iscussion Med Teach Downloaded from informahealthcare.com by University of Newcastle on 01/08/15 For personal use only.
: must be conceded that from the limited number of subjects employed in the survey,
would be presumptive to draw too many firm conclusions from the results obtained. levertheless, certain facts emerge which must be accepted and then rationalized in :tempting to suggest a practical compromise solution to the problem of acquiring ostgraduate knowledge by means of the written word. The first of these facts is that there surely can be no disagreement with the belief iat the continuing education of dental professionals is both necessary and desirable. xondly, there would appear to be a consensus view from the authors of articles msidering this particular problem of continuing education that the reading of :ofessonal journals is a valuable and realistic means of acquiring knowledge. Thirdly, lwever imprecise the present investigation at first may appear, the time commitment whatever degree of journal reading the dentist indulges, whether they be a general .actitioner or academic, is shown to be considerable. If the desires to read all that may : felt worthy of reading were to be satisfied, it can now be seen that in the case of the :neral dental practitioner, as much as 3 working days per month could be taken up. 5th the academic, as might be expected, the figure rises to almost 5 working days per onth. Equally, it would be safe to surmise that these time allowances in the real x l d would be well nigh financially impossible, whether the reader was self-employed salaried. Two further points emerge from this present investigation. When those in authority e considering the continuing education of members of their profession, they must be ade aware of the time commitment-in real terms-that the reading of journals in an ucationally rewarding manner demands. If reliance is to be placed on self-learning the use of journals, then it would not be unreasonable to expect the dentist to be warded, or at least compensated financially in the same way that attendance at a lstgraduate course of instruction is now recompensed. The difficulties inherent in the ministration of such a self-learning scheme, however, would be overwhelming and [practical. If, on the other hand, advantage is to be taken and proper usage made of : immense amount of research work and review articles that are published-and :re is no reason to suppose this flow will diminish in the future-some attempt ould be made to seek an educational pathway that would be both practical and ministratively manageable. One suggestion might be to organize a Section 63 type course where instead of the )re usual pattern of one specific topic being covered, a broadly based resume of :ent articles relevant to all the dental specialties could be presented. Such a collation selected papers could be presented to general dental practitioners by members of Iff selected by each department or specialty of the geographically nearest Dental hool. Such a course would serve five functions. I
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I. W.M. Jefley
(1) It would encourage a more organized and integrated appraisal of the literature by teaching staff of the Dental School including part-time demonstrators at a departmental rather than an individual level. This collation would be seen as a formal teaching duty of lecturers rather than a moral option to be taken up if time permitted. (2) It would present to the general dental practitioners an informative and educational service regarding contemporary developments taken from the broad spectrum of dental research which the busy practitioner might otherwise never find the time to investigate. (3) It would stimulate a more profound reading of papers of particular interest or to attend those courses currently on offer and which deal in more detail with one topic. (4) Such a literature review course would attract Section 63 funding and be eligible for all administrative benefits associated with this classification. (5) It would make general practitioners aware of findings abstracted from a wider selection of the more esoteric journals held by a medical library to which they, the practitioners, might not have easy access.
Conclusion The burgeoning of the dental literature, most of which is refereed work and of considerable educational merit, presents a problem of assimilation and application. It can be safely assumed that its value is unquestionable and its utilization in the field of continuing education is of value to both general dental practitioner and academic teacher. The time commitment involved in its perusal, if the literature is to be used properly, however, is considerable and at present is largely unrecognized by fiscal authorities with no specific remuneration being aimed at its encouragement. Only by a rational and selective approach being made to the matter can the transmission of the educational implications offered by the mass of contemporary published work be used to the best advantage by the profession.
Acknowledgements I would wish to make known my sincere appreciation of the help and advice shown to me in the preparation of this paper by Dr H. Mulholland of the Centre for Medical Education, Dundee. REFERENCES A W , M. 81 BALK, T. (1975) Dental Practitioners, attitudes to postgraduate education in the South East Thames Region, British Den& Journal, 139, pp. 111-1 12. CURRENT TITLES IN DENT~STRY (1990) 3(1). GENERAL DENTALCOUNCIL(1990) Recommendations Concerning the Dental Curriculum. Jm D. (1988) Reading scientific articles or how to cope with the overload, The Practitioner, 232, pp. 720-725.
KBRRGILBERT,R. (1975) An investigation into postgraduate dental education in the Newcastle region, Journal of Dentistry, 3, pp. 73-76. MAGREGOR, A.J., LONG,A.F. & MERCER,P.E. (1990) The conrinuingplofessional development of general dental practitioners in the Yorkshire Region (School of Dentistry, University of Leeds). PULSE(1990) Editorial, Pulse, 50, p. 78.
Time involvement in journal reading SCOlTISH COUNCIL FOR POSTGRADUATE MEDICAL EDUCATION (1990)
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An enquiry into continuing education for General Dental Practitioners. STANDING, COMMITTEEON POSTGRADUATE MEDICAL EDUCATION (1990) A new infrastructure fur posrgraduate medical training and continuing education. WILD, J.R. (1989) A survey of attitudes and non-attendance at dental section 63 courses in South East Scotland, Health Bulletin, 47, pp. 92-94.
