Assessment in postgraduate dental education: an evaluation of strengths and weaknesses

Assessment in postgraduate dental education:an evaluation of strengths and weaknesses

Z S Morris,1 A D Bullock,2 C R Bel®eld,3 S Butter®eld 2 & J W Frame4

Introduction This paper describes a study designed to

evaluate assessment in postgraduate dental education in

England, identifying strengths and weaknesses and fo-

cusing speci®cally on its relevance, consistency and

cost-effectiveness.

Methods A four-phase qualitative method was used: a

mapping of current career paths, assessment policy, and

issues (phase 1); more detailed studies of the practice of

assessment for a range of courses, and the systemic/

management perspective of assessment (i.e. quality

assurance) (phases 2 and 3), and analysis and reporting

(phase 4). Data were analysed from documents, inter-

views, group consultations and observations.

Results and discussion Five key issues may be distilled

from the ®ndings: (i) lack of formal assessment of

general professional training; (ii) trainer variation in

assessment; (iii) the extent to which assessments are

appropriate indicators of later success; (iv) the rela-

tionship between assessment and patient care, and

(v) data to assess the costs of assessment.

Conclusion Current assessment procedures might be

improved if consideration is given to: assessment which

supports an integrated period of general professional

training; training for trainers and inspection procedures

to address variation; more authentic assessments, based

directly on clinical work and grading cases and posts,

and better data on allocation of resources, in particular

clinicians' time given to assessment.

Keywords Cost effectiveness; curriculum; education,

dental, *standards; education, medical, graduate;

educational measurement; Great Britain; professional

competence; reliability and validity.

Medical Education 2001;35:537±543

Introduction

Postgraduate dental education has undergone radical

change in recent years, with profound implications for its

assessment. This is particularly true for specialist training

following the Calman Report.1 The Report of the Chief

Dental Of®cer (CDO)2 in 1995 proposed that higher

specialist training should be shorter, better structured

(`seamless', modular, aims-led), and more ¯exible,

whilst maintaining high standards which would be set by

the competent authority, the General Dental Council

(GDC). The CDO also accepted the introduction of a

new Certi®cate of Completion of Specialist Training

(CCST, as in medicine), consistent with European

Union regulations. It was required that all the CDO's

recommendations (`Calmanization') were applied to all

dental specialties by March 1997. The use of a range of

assessment instruments was encouraged, to re¯ect

changes in the nature of specialist training.1

The CDO's Report2 also made recommendations for

the pre-specialist or general professional training. It

suggested that young dentists should undertake an

initial 2-year period of general professional training in

both primary and secondary care settings, underpin-

ning all career options at the end of it. Although widely

supported,3±5 the proposal has unresolved implications

for assessment.

In short, postgraduate dental education has recently

been subject to considerable critical scrutiny and

modi®cation, involving shortened training courses

structured by prede®ned standards and modularized

(theoretically) to facilitate ¯exible entry and exit, and

choice, offering a combination of experiential learning

with formal didactic teaching, and supported by good

assessment which enables trainee development and

safeguards patients.

1Faculty of Social and Political Sciences, University of Cambridge,

Cambridge, UK2School of Education, University of Birmingham, Birmingham, UK3Teachers College, Columbia University, USA4Regional Postgraduate Dental Of®ce, School of Dentistry, University

of Birmingham, Birmingham, UK

Correspondence: A D Bullock, School of Education, University of Bir-

mingham, Birmingham B15 2TT, UK

Research papers

Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:537±543 537

This paper reports on a study which evaluated the

strengths and weaknesses of the existing assessment

systems. The study concentrated on the assessment of

postgraduate dental training across primary and

secondary care, focusing on relevance, consistency, and

cost-effectiveness as factors essential to `good' assess-

ment. Based on the ®ndings, modi®cations to the

assessment system were suggested. These are consid-

ered in the Discussion, and are explored in more detail

in the ®nal project report.6

Assessment

By assessment we mean: `measuring progress against

de®ned criteria'. Such measurement is important

because it allows judgements to be made about the

effectiveness of training, and the monitoring and

maintenance of standards in training. It supports career

structures and progression, and can provide the public

with information.7 In evaluating assessment, atten-

tion was paid to its relevance, consistency and cost-

effectiveness.

Relevance concerns the issue of validity, of which there

are three aspects: content and curricular validity, con-

struct validity and predictive validity. Content validity

and curricular validity refer to how far the assessments

re¯ect periods of training. Construct validity relates to

the extent to which an assessment actually measures or

re¯ects the domains (skills, attributes, and types of

knowledge, understanding, or analysis) developed in a

period of training. Predictive validity is here de®ned as

the extent to which the assessments are appropriate

indicators of future success in the ®eld.

Consistency relates to the extent to which standards

are applied uniformly across settings and time. There

are two speci®c elements: comparability and reliability.

Comparability relates to how far the standards of dif-

ferent parts of the assessment system are capable of

comparison and involves the systemic issues of quality

control and inspection. Reliability concerns the extent

to which assessments match when they are carried out

by different assessors or at different times and places.

Cost-effectiveness involves the ef®cient use of

resources, recognizing that resources are scarce and

have alternative uses. It is a relative concept and a

secondary issue to relevance and consistency: irrelevant

and inconsistent assessment will not be cost-effective.

Methods

This qualitative study was conducted in four overlap-

ping phases over a period of one year starting in March

1998. The ®rst phase provided a mapping of the cur-

rent provision of postgraduate dental education and its

assessment in vocational, basic and specialist training

including examinations and inspection visits. Evidence

was obtained from existing data, previous research and

interviews with two postgraduate dental deans and a

representative from the Joint Committee for Specialist

Training in Dentistry (JCSTD). Representatives from

other national bodies were also interviewed later in the

study.

In the second phase a more detailed study of

assessment in practice was undertaken, in order to

explore the ways assessment is experienced by assessors

and trainees. A range of postgraduate training pro-

grammes and placements (in primary and secondary

care, and in general and specialist training) were

selected from the West Midlands Deanery for more

detailed study of the policy and practice of assessment.

Published course curricula and examination syllabi,

and trainee logbooks/portfolios, and other assessments

and records were gathered and analysed. Semistruc-

tured interviews were conducted with trainers and

trainees in the West Midlands Deanery. In secondary

care, this involved ®ve consultants, 13 house of®cers/

senior house of®cers (including those undertaking the

general professional training (GPT) `package'1 ), and 13

specialist registrars. In primary care evaluation meet-

ings with vocational trainees (vocational dental practi-

tioners (VDPs)) were observed, and interviews were

held with those responsible for the GPT package. In

addition, vocational training advisors were consulted at

their national conference, and four were followed up

individually.

In the third phase the systems used to ensure effec-

tive management of assessment, including inspection

procedures, were investigated. Opinion from those key

Key learning points

There is considerable scope for improving current

assessment procedures.

There is a need for assessment to support an

integrated period of general professional training.

Variation, particularly trainer variation, could

be addressed by training for trainers and inspec-

tion procedures.

Links between assessment and patient care could

be strengthened.

Better data are needed on the allocation of

resources to assessment, in particular clinicians'

time.

Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:537±543

Assessment in postgraduate dental education · Z S Morris et al.538

informants identi®ed in phase 1 was sought through

semistructured interview and expert panels, in order to

investigate the current position and potential for

development of the systemic management of assess-

ment. Those consulted included representatives from

the General Dental Council (GDC), Postgraduate

Dental Deans and deans of dental schools, the Royal

College of Surgeons of England, the Hospital Recog-

nition Committee, two Specialist Advisory Committees

(SACs), vocational training advisors, and the Com-

mittee for Vocational Training (CVT).

Analysis relating to the earlier phases was provided in

phase 4, together with the preparation of reports and

recommendations.

Results

Phase 1 provided an overview of postgraduate dental

education, that is, career paths and assessment within

it. Brie¯y, on completion of a BDS, most young den-

tists undertake one year's vocational training within an

approved practice, during which time they keep a

professional development portfolio (PDP). The

experience is signed off at the end of the year by their

Postgraduate Dental Dean, allowing the trainee (VDP)

to enter independent NHS general practice. Others will

undertake a year as a house of®cer or senior house

of®cer, during which time they complete a manual or

logbook. They may choose to take a Membership of the

Faculty of Dental Surgery (MFDS) examination

(secondary care) or the Membership of the Faculty of

General Dental Practitioners (MFGDP) (primary

care). In either order, this experience forms a period of

general professional training. Those wishing to specia-

lize will spend at least one year as a house of®cer/senior

house of®cer and must pass the MFDS examination to

be eligible for specialist registrar training posts.8

Assessment processes used during their specialist

training include the use of logbooks, SAC/JCSTD

structured assessments, record of in-training assess-

ment (RITA) panels, and Membership and Fellowship

examinations. In this study, distinction was made

between the records (RITAs, log books, PDPs) and the

assessments (JCSTD and Membership exams).

Findings are presented here in three sections, relating

to the assessment of vocational training, house of®cer/

senior house of®cer training, and the training of

specialist registrars.

Vocational training

Vocational training is not assessed in any formal sense.

The vocational training year was described as providing

experience in clinical work, for which basic levels of

competence are already assessed by university ®nal

examinations.9 There are no pass/fail criteria as such,

and some respondents suggested that trainees receive

certi®cation based mainly on attendance. There are,

however, three educative elements of the vocational

training year included in this evaluation: the study days,

the PDP and the weekly tutorial hour with the trainer in

general dental practice.

VDPs have provision for 30 full study days during the

vocational training year which represent a substantial

resource commitment within the system. However,

views on the ef®cacy of these days as an opportunity for

ongoing education were varied. They were not linked to

preparation for quali®cations, as the house of®cer/

senior house of®cer study days are linked to the MFDS,

for example.

A range of views on the merits of the PDP were

found (and are reported in other work10±12). The idea

of the PDP as a re¯ective tool was welcomed by some

trainers, but many VDPs found it repetitive, lengthy to

complete and lacking in relevance. As a result many

admitted to `minimal compliance' in maintaining the

document. It was also noted that problems need to be

addressed as they arise rather than to be re¯ected on

some time later. This perhaps suggests a need for more

timely (continuous) formative assessment.

The success of the tutorial hour was dependent upon

the individual trainers who were likely to vary in: (a)

their prior knowledge; (b) their enthusiasm for the

educative role, and (c) their knowledge of the assess-

ment protocols and the instruments to use. It appears

that the tutorials themselves were not always under-

taken seriously or considered to be necessary.

There is also variety between regions, as evidenced in

documents, with regard to the content and format of

study day programmes and the involvement of formal

programme committees to plan and monitor standards.

Nor is there a standard format between regions for

selection of trainers and their training for the role.

Although local and regional ¯exibility can be defended,

issues of consistency should be considered.

Thus, there was considerable variety (or lack of

consistency) between training experiences, and many

trainers acknowledged a need to improve consistency.

This would also be welcomed by trainees.

House of®cer/senior house of®cer training

The formal assessment of house of®cer/senior house

of®cer training is by means of the MFDS examination,

although this is optional. House of®cers/senior house

of®cers now contractually receive half a day per week of

Assessment in postgraduate dental education · Z S Morris et al. 539


formal teaching which focuses on the MFDS syllabus.

This re¯ects the way in which training is becoming

more structured.

During the period of this study, a new national log-

book/manual for house of®cers/senior house of®cers

was introduced, but these were not yet being widely

used in the West Midlands. It is, however, a record and

not an assessment: it records activities undertaken, and

not a statement of quality measured against de®ned

criteria. The role of the house of®cer/senior house

of®cer logbook in career progression is not yet known.

Concerns were expressed by those expected to

implement the national logbook that it was overly

complex and might also meet with trainee resistance.

The clinical experience of house of®cers/senior house

of®cers varies considerably between different hospitals

and specialties making comparison dif®cult. Neverthe-

less, in the West Midlands, logbooks were used with

some success by those on the formal general profes-

sional training programme, for recording experience as

well as for planning future work.

The MFDS exam is in three parts which are related

to à knowledge and understanding of the clinical

practice and science of dentistry suf®cient to enter

formal training in one of the dental specialties'.

Candidates must have passed Parts A and B before they

can take Part C, after a minimum of 20 months in

general professional training. Most house of®cers/

senior house of®cers interviewed considered the MFDS

to be relevant to their house of®cer/senior house of®cer

training, although, the experience gained in the primary

care element of general professional training was not

directly linked to the MFDS, nor were VDPs encour-

aged to prepare for it.

House of®cers/senior house of®cers undertaking

rotating posts felt that assessments of each part of the

rotation were generally unreliable, based on a non-

standard, often verbal report. The house of®cer/senior

house of®cer interviewees understood consultants'

references to be important to career progression but

were unclear about what factors would be highlighted.

As with vocational training and specialist registrar

training, there was believed to be considerable variation

between training experiences more generally. Both

trainers and trainees thought that the actual level,

nature and quality of consultant input varied by

individual, the trainee and the unit.

Respondents at the national level felt that the role of

the trainers in assessment could be more structured,

and therefore consistent, but were aware of intervening

factors: few were trained for their educational and

assessment role; nor were they paid or allowed time for

it. Trainers of specialist registrars also noted an increase

in the time spent àssessing' as a result of more struc-

tured training, and many of these would also have had

responsibility for house of®cers/senior house of®cers.

Inspection bodies have a role in maintaining stan-

dards of training and reducing variations. Members of

the Hospital Recognition Committee (HRC) felt ef®-

cacy was limited by the size of the task (it inspects

approximately 780 house of®cer/senior house of®cer

posts in the UK), the fact that inspections varied by

inspectors, who were not trained in inspection and, as

one member put it, by the `smoke, camou¯age and

fresh paint' applied by the unit undergoing inspection.

Inspection covers practical matters (accommodation)

in addition to training and educational issues.

General professional training

There was widespread support for the notion of general

professional training in both primary and secondary

care settings. One purpose is to allow more informed

career choice. The view was also expressed that trainees

with clear career goals should not be obliged to

undertake training in both primary and secondary care

settings as it merely serves to extend the period they

spend in training.

Many trainers supported the notion of a common

examination for general professional training, rather

than the current reciprocity between Part A of the

MFDS and Part 1 of the MFGDP. This is partly on

principle: a common examination articulates well with

the concept of general professional training. In practice,

many trainees were against the notion of reciprocity as

the two examinations have different purposes. The

MFDS was generally seen as being of higher status and

providing greater ¯exibility.

Assessment of specialist registrars

Trainees need an MFDS or èquivalent' to enter spe-

cialist training. Entry to specialist training is compet-

itive, and there is a serious bottleneck in some

specialties (orthodontics and restorative dentistry were

given as the worst examples). In recruitment, therefore,

additional strengths are sought. These include more

experience, experience of speci®c specialist areas, and

sometimes publications in refereed journals. Some

specialist registrars also held Masters degrees, but

trainers were concerned lest this should become the

norm. However, given the competitive nature of career

progression it is not clear how this situation could be

avoided.

On the whole the 13 respondents considered assess-

ment (however interpreted) to be relevant to the



training and to career progression. Whilst the logbook

records quanti®ed experience, in some specialties it may

also contribute to the ®nal college exam. There appeared

to be a good match between the content of specialist

training and JCSTD/SAC assessments which feed into

the RITA process and require trainers to make quality

judgements. However, some concern was expressed that

the RITA referral process was not used enough.

Variation is also an issue in the assessment of spe-

cialist registrars. Few trainees considered that training

would be comparable between posts, but they did not

feel this to be a problem. As with house of®cer/senior

house of®cer training, the completion of logbooks var-

ies by departments; consultants vary in attitude and

aptitude, and assessment methods and procedures vary

by post and by individual trainers and the time available

to them. The relationship between trainer and trainee is

an intense one, which some thought could lead to a

weakening of the prospects for informal and non-

threatening appraisal. Some respondents also consid-

ered the reference process to be inconsistent.

Inspection at this level by a Specialist Advisory

Committee (SAC) was considered to be robust and

effective. The number of inspections required is

manageable, and believed to be rigorous. SACs do

withdraw approval of training posts. Consistency is

enhanced through the SAC Chairs' membership of the

JCSTD.

Discussion

Although there is evidence of good practice in the

assessment in postgraduate dental education, there are

clearly some problems with current approaches. Here

we take three aspects of training, that is, vocational,

house of®cer/senior house of®cer and specialist registrar

training, and consider them in terms of our three

evaluative concepts of relevance, consistency and cost-

effectiveness. It should be noted that there is no formal

assessment of the vocational training year, and very

little of house of®cer/senior house of®cer training, and

this has rami®cations through each of our evaluative

concepts. The assessment during general professional

training (vocational training and house of®cer/senior

house of®cer) may or may not have content, construct

or predictive validity, but information from which to

make judgements is sparse owing to the informal

arrangements associated with this assessment.

Relevance (content, construct or predictive validity)

The way the PDP is actually used in vocational training

renders its validity unveri®able. Most formal assess-

ments (logbooks, and examinations) were considered

relevant to training and to progression (content and

predictive validity). However, there were some issues

concerning construct validity. For example, the MFDS

does not identify a `good pair of hands', considered

essential to clinical practice, nor do current assessments

re¯ect performance needs, for instance the ability to

work under pressure. The national logbook for house

of®cers/senior house of®cers might be viewed as a step

towards agreement on what should be assessed during

this training; however it would need to be developed

further for this role and used more formatively, to

identify strengths, weaknesses, and gaps in training.

Specialist training shows a better match between

training and assessment (content validity), than the two

elements of general professional training: the curri-

culum is broadly and clearly de®ned (enabling con-

struct validity in assessment), and trainers are asked to

make quality statements about trainees.

There is both reason and scope to make assessments

within postgraduate dental education more authentic,

i.e. based directly on clinical work relevant to patient

care. A larger part of the assessment could, for ex-

ample, be based on real patient treatment histories over

a longer period and could include some assessment of

patient progress and recovery time. This would also

provide a more reliable signal of clinical competence,

that is enhance predictive validity. Other methods for

consideration might include the use of objective

structured clinical examinations,12 standardized

patients, and computer-based examinations, or simu-

lations for example. The Membership in General

Dental Surgery (MGDS), a continuing rather than

initial professional development quali®cation, open to

dentists with 5 years' experience, provides an example

of innovative assessment which includes a practice

visitation and examination of two cases with the patient

present. The Fellowship of the Faculty of General

Dental Practitioners (FFGDP) is a further advanced

quali®cation available to general dental practitioners

which, in addition to the use of patients in the assess-

ment, includes two other innovations worth noting.

The ®rst is the use of videorecording to demonstrate

interpersonal skills. The second is the requirement to

present audit, and more particularly, patient satisfac-

tion survey data.

Education quali®cations signal that workers have

the necessary skills (assuming the that assessment is

`relevant' or has `predictive validity'), and assessment is

the means by which there is a formal articulation

between training and career progression. Several issues

emerge from this. Trainees need clari®cation about the

career paths open to them from various quali®cations.



The current duplication of quali®cations or taking of

irrelevant examinations is not cost-effective. References

provided for the trainee provide a mechanism which

may ease or limit progression, and yet trainees are

largely ignorant of what matters. Moreover, some of the

trainers interviewed doubted the objective value of

references. This may provide further reason for national

agreement and guidance on what should be assessed.

A national agreement would also support ¯exibility.

A modular credit accumulation model would facilitate

more effectively movement between general practice

and specialist training at all career stages, than current

assessment systems.2

Consistency (comparability and reliability)

Variation, particularly that associated with trainers,

affects the consistency of assessment and, for the sys-

tem to be regarded as fair with standards being applied

equally, this issue should be addressed. Variation may

not negatively affect the relevance of the programmes,

but will render judgements made about individuals

unreliable. Variation in assessment could be addressed

through more formalized, standard periods of training;

the training of trainers (and inspectors), and the

development of more robust moderation and inspection

procedures. Speci®cally in vocational training, one

approach would be to develop the existing CVT

Guidelines further. A standardized system would sup-

port the competency assessment,13,14 the development

of which many vocational training advisors regarded as

inevitable. Such assessment methodology is being

developed, mainly in undergraduate dentistry, and its

feasibility and acceptability needs greater exploration. It

is also an approach which might serve to make the

length of training more ¯exible as it supports openness

within a structured assessment.15 However, as GDPs

play a greater role in the training of newly quali®ed

dentists their role as educational facilitators needs

supporting.

Cost-effectiveness

It is important that assessment systems offer value for

money and this can be interpreted broadly as à concern

for ef®cient resource usage'. If assessment is not

undertaken ef®ciently, then it is not likely to be cost-

effective. This de®nition prompts a number of resource

issues.

One way of ensuring optimal resource use in

assessment has already been discussed, that is,

strengthening the link between what is taught and the

amount and content of what is assessed (i.e. ensuring

content validity). Establishing the optimal volume of

assessment is also fundamental, but is not straight-

forward.

Current assessment methods draw heavily on the

time of clinicians, both trainers and trainees. Yet such

clinicians are highly skilled and highly paid, and have a

high òpportunity cost'. Furthermore, their individual

performance varies. Therefore some consideration

might be given to redistributing the burden of assess-

ment. One approach might be to utilize physical

resources more, such as computerized methods, or to

use only those consultants with particular aptitude in

training and assessment.

There is also an issue concerning the number of

agencies which devise, implement and inspect training,

with each task absorbing resources. More standardized

large-scale (national) assessments would reduce costs.

Cooperative arrangements might be sought to reduce

the number of assessor agencies and the duplication of

effort (and in so doing, improve reliability).

Comment must be made about the paucity of data

and infrequent application of cost-effectiveness tests. In

order to improve resource use, it is essential that

monitoring, evaluation and inspection systems collect

costs and outcomes data and that individual agents

work within a system where ef®ciency and cost-effect-

iveness are encouraged.

Conclusion

In summary, ®ve key issues may be distilled from the

®ndings: (i) assessment of general professional training;

(ii) trainer variation in assessment; (iii) the extent to

which assessments are appropriate indicators of later

success; (iv) the relationship between assessment and

patient care, and (v) data to assess the costs of assess-

ment.

Vocational training is not assessed in any formal

sense, which makes it dif®cult to evaluate. The same is

true of house of®cer/senior house of®cer training. There

is a need for assessment to support an integrated period

of general professional training.

Specialist training, which has undergone consider-

able review recently, shows more relevance, but there

remain issues about its consistency, speci®cally con-

cerning reliability, and cost-effectiveness. Value for

money, that is, ensuring the ef®cient allocation of

resources, in particular, clinicians' time, requires

more data than are currently accessible.

There is considerable evidence of trainer commitment

to the principle of better assessment of more structured,

¯exible training, and some evidence of particular meas-

ures to achieve this aim. However, such aspirations are



currently undermined by the `considerable confusion'8

within the system, perhaps as a result of the evolu-

tionary nature of the changes. There is a need to

overcome variation, particularly trainer variation in

assessment, by training for trainers and for inspection

procedures.

Links between assessment and patient care could be

strengthened. More authentic assessments, based

directly on clinical work, may contribute to improve-

ments in patient care, and grading cases and posts may

improve the robustness of the system. However, there is

a danger that attempts to make assessment more closely

related to working contexts and more patient-focused

(relevant) will produce additional problems in consis-

tency unless underpinned by a strong, coherent and

explicit assessment framework.

Acknowledgements

The project team is grateful for the ®nancial support of

the Department of Health through the Post-registration

Medical and Dental Education Research Initiative. The

views and opinions expressed are the authors' and do

not necessarily re¯ect those of the Department of

Health. Valued critical comment was provided by

Mr Ken Eaton at the National Centre for Continuing

Professional Education of Dentists, 4th Floor, 123

Gray's Inn Road, London, WC1X 8TZ. We acknow-

ledge the support of all those who gave us access to

their meetings and allowed us to interview them

including, trainees, trainers, Postgraduate Dental

Deans and representatives from other local and

national bodies.

Contributors3

The authors are members of the Centre for Research in

Medical and Dental Education (CRMDE), based in

the School of Education, University of Birmingham.

Zoe Morris, BSc PhD, is a Research fellow at the

Faculty of Social and Political Sciences, University of

Cambridge. She was the Research Associate on this

project. Alison Bullock, BA PhD PGCE, is a Senior

Research Fellow in the School of Education, University

of Birmingham. She was a co-investigator. Clive

Bell®eld, BA MA PhD, based at Teachers College,

Columbia University, USA, was a co-investigator. His

main interest is in the cost-effectiveness of programmes

of training. Sue Butter®eld, BA PGCE PhD Dip Psych

BSc, was co-investigator. She has a special interest in

assessment. John Frame, BDS FDS MSc PhD, was the

principal investigator. He is Professor of Oral Surgery

and the Regional Director of Postgraduate Dental

Education, School of Dentistry, University of Bir-

mingham.

Funding4

Financial support was provided by the Department of

Health through the Post-registration Medical and

Dental Education Research Initiative.

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9Received 11 May 2000; editorial comments to authors 22 June 2000;

accepted for publication 27 July 2000



Documents

Assessment in postgraduate dental education: an evaluation of strengths and weaknesses