PubMed · 10358607
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B Beech. Missing lessons in skills training.. https://pubmed.ncbi.nlm.nih.gov/10358607/
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The object of this study was to assess the value of dental radiographs for the purposes of personal identification in the absence of tooth restorations. 198 periapical and bitewing radio graphs were taken of teeth contained in 22 dry skulls obtained from the skull collection of the Royal College of Surgeons of Edinburgh. Each selected view was taken three times: by a scientist, a dentist and a dental radiographer. Each operator independently positioned the films, selected the exposure times and positioned the cone of the X-ray machine. Three groups comprising forensic odontologists, dental vocational trainees and dental trainee hygienists attempted to match the randomly mixed radiographs into sets of three. Success rates for matching radio graphs ranged from 63.6 to 100%. The average for forensic odontologists was 93.3%, vocational trainees 85.2% and hygienists 89.7%. Where forensic odontologists had both formal training and experience, or extensive experience without formal training, the success rate was 100%. Where there was formal training but little experience the success rate was lower. Participants believed that root morphology and alignment had been the greatest aid to matching and not crown morphology. The depth of knowledge of the viewer correlated poorly with the number of correct results, although the forensic odontologists achieved the highest success rate. Formal training, although highly desirable, is no substitute for practical experience. Root morphology and alignment were cited most frequently as facilitating matching.
The development and maintenance of expertise in any domain requires extensive, sustained practice of the necessary skills. However, the quantity of time spent is not the only factor in achieving expertise; the quality of this time is at least as important. The development and maintenance of expertise requires extensive time dedicated specifically to the improvement of skills, an activity termed deliberate practise. Unfortunately, determining how to engage in this deliberate practise is not obvious for tasks such as diagnosis, which involve high stakes and are predominantly cognitive nature. Reflection on and adaptation of one's cognitive processes is important; this could be supplanted by seeking out the opportunity to engage in trial and error in low risk environments such as simulators. Regardless, most individuals tend to favour well-entrenched activities and avoid practise. This may be due to lack of awareness of deficiencies in performance. However, it may also be due to the individual's conception of the nature of expertise. Although expertise requires experience, experience alone is insufficient. Rather, the development of expertise is critically dependent on the individual making the most of that experience. As a result, motivational factors are fundamental to the development of expertise. Overcoming deficiencies in self-monitoring is not a sufficient remedy. It is also necessary is that clinicians form an attitude toward work that includes continual re-investment in improvement.
The number of assessments of incapacity for work has increased to such an extent in the Netherlands (450,000 per year, of which 150,000 are first assessments) that experiments are now being undertaken to employ non-physicians for these assessments. There is no shortage of insurance physicians however: the number available is underestimated as many of these have resigned their regular jobs to perform the same activities on a freelance or second basis. A problem is certainly that these physicians are hindered by an exceedingly bureaucratic system in which e.g. patients are summoned by the administrative section to be reassessed who have already resumed working. Non-physicians may assist in the assessments, but in most cases there is a relation between psychic, somatic and social factors, which requires the generalist physician's eye. The main problem is that government regulations lead to a steady growth in the number of (re)assessments required. A possible but onorthodox solution is proposed which involves medical certification of incapacity for work. This may discourage long-term absenteeism and at the same time it may draw the physician's attention to the existence of an industrial health care problem.