Thursday, March 7, 2019

What is wrong with the the continuing education point system as a mandatory requirement for registration.

Let me be very clear. Continuing education is a necessity for professional upgradation and public safety. So when I ask "what is wrong..." it is immediately construed as being negative. No! But the system must be implemented in a rationale and beneficial manner causing the least inconvenience to those involved. The issues that require review include
1. The CME/ CDE is not a requirement for registration as a dentist according to the Dentist Act. While there is a gazetted regulation making it mandatory, it cannot be legally binding as the Dentist Act 1948 ( along with amendments) which lays down the criteria for registration as a dentist in India does not have such a requirement. If challenged in a court of law the Act will prevail over the regulation. Therefore the Act will need to be amended to make the CDE points binding.
2. The cost of earning CDE points is very high, at the present. To earn 20 points a year a person will need to spend an amount that is not affordable by a newly minted dentist, thousands of whom do not even have a job. Medical doctors need to earn only 30 hours in 5 years whereas dentists require 100 hours in 5 years ( the calculation of credit per educational hour is of course more stringent for medical doctors). The Dental Council of India or the State Dental Council should therefore offer free programmes to help practitioners, if it is to be made mandatory. At a time when webinars and  online learning and even assessment is possible at a very minimal cost, the necessity to travel and attend costly programmes must be eliminated. Online attendance can even be monitored better. The current system of points for attendance at conferences is a farce with most attendees standing around in corridors and foyers when lectures are delivered to near empty halls. The Kerala state IDA has just announced a free state CDE in Oral Surgery. As one of the speakers, I have waived all reimbursements for travel and stay, which is normally extended for outstation lecturers. I am sure that several senior experts and teachers are willing to do so. If the IDA, a private association, can do it, then the Government statutory bodies should be able to do so with government subsidies. It is after all meant to provide public safety.
3. Some categories of professionals are exempt from continuing education. This seems to be scripted to benefit selected segments. Let me deal with each of these exemptions.
A. Section 8.1 says all dentists above 65 are exempt from CDE. I should be celebrating the exemption because I will be 65 in 5 years and therefore exempt when the first evaluation takes place. But no! If the principle of CDE is based on the ethics of being currently updated there is no rationale in exempting a 65 year old, unless he is not practising, in which case he has no need for those points anyway. How does a 65 year old become safe for practice without CDE when a 55 or 60 year old is deemed unsafe if not updated. It is purely arbitrary.
B. Section 8.2 exempts all MDS staff with 15 years experience and currently teaching post graduate students. This is quite ridiculous as the CDE points is for the sake of safe practice of dentistry. Not just one specialty. The exemption is acceptable if these professors are not practising, as in central or state government institutions which do not permit private practice ( e.g. AIIMS, JIPMER or states like Kerala Government etc). It is even applicable to specialists who only practice their specialty, which is difficult to determine in the absence of a specialty register. However it is unfair to exempt teaching dentists who practice general dentistry after their college commitments. Thousands do so and they mostly do general practice outside of their specialty. For example, how can a professor of oral pathology be provided exemption of CDE points when he/she does endodontics, orthodontics or oral surgery in his/ her private practice. The whole notion is facetious and poorly thought out.
C. Section 8.5 says that if one is 'seriously' sick, it is necessary to get a certificate from a Government doctor. It means if one has a CABG it is not enough to get it from your private cardiac surgeon or hospital. You need a certificate from a joint director of health service or some person.Why? Because Government doctors are honest!!!
There are several other issues. Can a person working abroad retain his/her registration. If so how? Are foreign CDE programmes accredited. What will happen if you don't fulfil the CDE point requirement? Will your registration be cancelled? Since one requires 20 points minimum a year, does it mean one can be considered as ineligible in the first year itself?  How do you get your registration back? 
Does the DCI need to go back to the drafting table?!!!