A former student of Dr Richard Cure’s, Runa Mowla-Copley had the pleasure of interviewing the man himself. Dr Cure is head of Dentistry Studies as well as course and clinical director in orthodontics at the University of Warwick
Firstly, what motivated you to become an orthodontist?
I became increasingly fascinated by the ‘problem solving’ aspect, which required greater understanding of growth and development and the biological processes associated with tooth movement. Also, I felt that orthodontics gave aesthetic treatment options for patients which involved less invasive dentistry, preserving natural tissues.
As Warwick’s head of Dentistry Studies, what do you consider the major challenges facing dental education today and what changes would you recommend?
There is a growing recognition that, whatever our GDC registration status, continuing lifelong education is required and will be the norm as opposed to the exception. Post-registration qualifications will increasingly need to show levels of quality assurance not previously required. In the future, simply turning up for a programme will not be proof of CPD or competence. Courses will need to be fit for purpose and have summative assessments mapped to learning outcomes. These processes will become increasingly subject to scrutiny, as will educators and educational institutions. Also, as the majority of dental care is carried out in primary care, I feel that more dental education should be based in quality assured, primary care practices, overseen and regulated by universities. However, far stricter regulatory control over both educators and delivery sites is required than currently exists.
Congratulations on submitting your PhD – has this changed your outlook on dental education?
Thank you and yes it has. I am embarrassed to admit that, despite being actively involved in dental education, both as an educator and examiner for over 20 years, I had little knowledge of how we actually learn, especially as adults. My PhD is on interprofessional education for the orthodontic team. I believe that more dental education should involve the whole team and in an interprofessional environment. Despite the GDC documenting in 2004 the importance of the dental team, the majority of dental education still does not reflect this. As a profession, in the majority of teaching environments, we do not educate interprofessionally, but hopefully that will change as the benefits are recognised.
What aspects of the Warwick MSc in orthodontics course do you enjoy teaching the most?
Essentially I am still a clinician. Our patients are most important and, as such I enjoy discussing clinical cases the most. However, the intricacy in orthodontics is the understanding of what is happening biologically, so I enjoy discussing this and trying to explain what physiological processes are going on when we apply forces to teeth. Case assessment and diagnosis is critical, plus recognising the need for on-going therapeutic diagnosis throughout treatment, especially when tooth movement is not progressing how we expected it to.
Among your many achievements, what are you proudest of in dentistry?
Seeing other people develop and feeling that I have helped their progression. One of my team once said to me ‘thanks for giving me the opportunity to do this and for believing in me that I could do it.’ It sounds very twee, but that made me feel very humble and proud at the same time.
What do you consider the biggest changes in either the practice or the science of orthodontics? What changes do you think we can expect in the next decade?
I think the biggest changes have been in the orthodontic team, including orthodontic therapists and extended duties orthodontic nurses. Also changes in appliance systems, some good and others less so. In the next decade, the delivery of orthodontic treatment will be increasingly team based, specialist led and with appliance systems focused on light, consistent forces.
Recognising the importance of physiological tooth movement is critical and appliance systems will need to provide more evidence of the forces applied to teeth – as clinicians we are responsible for the treatment we deliver and we should insist on companies providing more evidence on force levels.
There has been a huge surge in short orthodontic courses aimed at GDPs. What advice do you have for dental practitioners interested in orthodontics?
If you do not understand and cannot explain what is happening when you are moving teeth, then you are putting your professional registration at risk. I am very concerned that many courses aimed at GDPs are simply geared to selling products. However, are these companies there to support the GDP when things go wrong? My advice to GDPs is to look for orthodontic education that provides the level of knowledge and qualification that allows them to recognise appropriate cases to treat, understand what they are doing when treating cases, and as such, be able to be supported by their defence society if things do not go according to plan. Look for education that does not simply give a certification of completion of use of a certain appliance system, but one that teaches orthodontics, is not limited to one appliance system and ends with an orthodontic qualification which is of value because it has to be earned.
In your opinion, is there a need to change the way postgraduate dental programs in the UK educate orthodontists?
In my view, there should be one treatment standard – the best possible. Education should mirror this. As such, the learning outcomes should be those set by the SAC (Specialist Advisory Committee) in orthodontics. Quality education should be uppermost; there should be more emphasis on who delivers the education and less on where it is delivered. We have to be more flexible and, in my opinion, educate interprofessionally. Educating postgraduates, orthodontic therapists and orthodontic nurses in an interprofessional environment is, in my opinion, a very viable alternative approach for the future.
And where do you see postgraduate dental education heading in the future?
It will be more flexible, increasingly self-funded and quality assured. Summative assessment will be required for CPD; new assessments will be developed which are meaningful and be usable towards further qualifications. Post-registration qualifications will be increasingly sought after, as more and more registrants will recognise that their colleagues are becoming more qualified than they are. The quality will improve as increasing regulatory demands are placed on education providers. An increasing amount of postgraduate education will be delivered on an outreach basis, in quality assured primary care environments. This will need to be highly regulated to maintain and increase standards.
What is the most unusual experience you have had during your orthodontic career?
Hard question to answer. I suppose receiving a referral of a dog! I saw the prospective ‘patient’ and owner, who did not want a vet to be consulted, as having an anterior crossbite would affect the breeding potential. I politely declined the chance to treat! Gaining patient consent would have been interesting though!
What qualities do you think a good clinical teacher should possess?
Recognition that they can learn from students, a willingness to listen and continually evaluate their own beliefs. Good clinical teachers should still be active in clinical practice, be up to date, happy to accept that how they did things five years ago may now be outmoded and be continuing their own education. I feel it is now appropriate for clinical educators to have a formal qualification in medical/
clinical/dental education. Also, an understanding of adult learning. Adult education is increasingly about facilitation and recognising the need to understand different students learn in different ways.
Has the political environment affected your work?
Yes. I think it has affected all of us in dentistry and wider afield too. There is a reduction in state funding for dentistry and an increased patient expectation level. It is the same in dental education. More expectation with less resources. That puts increasing pressure on everyone.
Many clinicians get very excited with the idea of decreasing treatment time by using self-ligated brackets, but after evaluating recent papers, it was found that one cannot treat patients any faster. What are your thoughts on this?
Self-ligation is one of the current major talking points in orthodontics. It divides opinion. I think the main problem is that the wrong questions are being asked and the focus should not just be on comparing mechanical systems. If we carry out, for example, extraction-based treatments with self-ligation mechanics, the cases are unlikely to be finished any quicker. I think there is still much to learn. The focus should be more on the forces applied and whether they are more biologically appropriate. There is a lot of evidence relating to orthodontic forces and the type of resorption which results. I think we may find evidence in the future that self-ligation mechanics allow us to apply lighter forces more consistently to more teeth than other systems and that this is more biologically appropriate.
As course director at Warwick what changes have you made over the years?
Team members have been increasingly integrated into the education process and all the evidence shows that this is beneficial. Also, I have tried to make sessions increasingly interactive and explain the importance of self-direction. Focus in orthodontics is on understanding as opposed to remembering facts. Some people find that hard and still want to revert to a more traditional undergraduate approach where all the information is provided, to read and remember. In depth understanding requires a different approach; harder for students at first but much more rewarding eventually.
Looking back at your career, would you do anything differently?
Hmmm, not sure. It’s always tempting to look back and think it would have been better if…. Some things I may have done earlier, such as my PhD, but I am not sure I would have got as much out of it if I had.
What are your interests outside of work?
Sport. I’m no good at it but love snowboarding. I watch football regularly – I go with a few pals and my kids. Also, I now have two grandchildren, so that’s a new dimension to life!
And finally do you have any pearls of wisdom you can share with our readers?
Wow – not sure I have any, but here goes! Dentistry is a stressful occupation and I think it is important to try and keep fit. Continuing education and further reputable post-registration qualifications will become increasingly important, so choose both wisely.
Most of all, put quality and patient care uppermost and you will be happy and successful in what you do.
For more information on the MSc in orthodontics at warwick visit: www2.warwick.ac.uk/fac/med/study/cpd/dentistry/orthodontics/