Overhauling the RCSEd dental exams

In education, assessment-driven learning is often stated as an unavoidable truth. It is also frequently postulated that most people plan their learning based on their perception of the assessment method. There is, however, much more to the relationship between learning and assessment. As a Royal College charged with being an ‘Awarding Body’ by the UK General Dental Council, we are entrusted to undertake our role appropriately. 

Having been a candidate, an examiner, an examination assessor and, as Dean, having responsibility for leading the Faculty of Dental Surgery through the overhaul of our existing examination portfolio and the development of the new Dental Diploma Examinations, I have been reminded of our Faculty’s accountability in relation to individual careers and, more broadly, patient safety. 

A significant proportion of RCSEd resource is dedicated to delivering exams. The processes for standard setting, blueprinting, examiner training and calibration, psychometrics for both exam questions and examiners go on in the background along with question banking and quality management. This, along with the countless hours our examiners spend writing questions, does not go unnoticed. The dedication involved in each of these processes provides quality assurance and reassurance for candidates, regulators and populations across the globe, who recognise the high value of an RCSEd qualification. Running summative exams is by no means cheap, and it is often a surprise to candidates and examiners when they discover that across the Royal Colleges, dental postgraduate exams struggle to break even.

Changes and developments 

Last September, I wrote about the new Dental Specialty Fellowship Examinations (DSFE) in relation to the high standards we uphold in the RCSEd, noting that updates would follow as developments unfold. Six months later, I can provide a further update in relation to a number of other changes and developments taking place within our College.

After a long gestation period, the revised General Dental Council dental specialty curricula came into play in September 2024 and this has been the catalyst for the examination changes. The Faculty of Dental Surgery is working hard – in collaboration with the Royal College of Surgeons of England (RCSEng), the Royal College of Physicians and Surgeons of Glasgow (RCPSG) and the Royal College of Surgeons in Ireland (RCSI) – to develop all of the documentation and processes for the new single summative assessment for the 10 dental specialties we deliver. These are dental public health, endodontics, orthodontics, oral medicine, oral surgery, paediatric dentistry, periodontics, prosthodontics, restorative dentistry and special care dentistry. Summative assessments for the Additional Dental Specialties (Dental and Maxillofacial Radiology, and Oral and Maxillofacial Pathology/Oral Microbiology) will continue to be delivered by the Royal College of Radiologists and the Royal College of Pathologists, respectively. 

The new DSFE assessments for the 10 dental specialties we examine will go live in 2026 with the existing mono-collegiate, bi-collegiate, tri-collegiate and quad-collegiate examinations coming to a close in 2027. This change has been signalled along with many other decisions on the dedicated intercollegiate website (dsfe.org.uk). All important items of information will continue to be posted as they become available. I would encourage everyone to use this resource on an ongoing basis.

Confidence in the format 

In relation to assessment design, it is not by accident that the examinations for all of the dental specialties (including the Additional Dental Specialties) will be similar, with two parts to each exam. Excluding Dental Public Health, the remaining nine specialties will use single best answers for part one and structured clinical orals for part two, with the content being bespoke to each specialty. Due to the nature of Dental Public Health, the assessment strategy will be different and will involve a combination of short answer questions to assess skills and critical appraisal (Part A) and three types of structured orals (project-based, unseen case and management). The broad agreement in examination format will be reassuring to all stakeholders across the globe but, more importantly, for patients and populations who can have confidence in the similarity in the pedagogical level and format across the dental specialties. 

At this point, it will not have escaped any reader that all of the information above relates to summative assessment. At the same time as the surgical Royal Colleges are developing the new suite of DSFE, the four College Deans have made it clear to COPDEND (the UK Committee of Postgraduate Dental Deans and Directors) and the subsidiary short-life working group, the Dental Curriculum Advisory Group, that we expect the good work and leadership qualities shown by the Colleges in relation to summative assessment to be mirrored by the development of a formative assessment strategy for each dental specialty. Trainees and trainers can be reassured that the existing formative assessment strategies can continue to be used until the new versions are in place and the College Deans will hold COPDEND to account until the formative assessment strategies have been published.

Dental Council and the wider Faculty have not only been busy with the developments in DSFE. In parallel, the Faculty has been working with the Governance and Membership and Ceremonial Teams as well as College Office Bearers and the College Senior Leadership Team in developing proposals to recognise recent holders of dental specialty membership examinations at the level of Fellowship. This is entirely appropriate as in many medical Royal Colleges, Fellowship is awarded to those on specialist lists. This proposal has involved an extensive piece of work. Approval in principle was given by Dental Council, Office Bearers and College Council earlier in 2024, with the detailed proposals for conversion being approved by Dental Council in December, which was ratified by College Council in January this year. 

I am delighted to announce through Surgeons’ News that all holders of a dental specialty membership examination since January 2020 will be eligible to convert their existing specialty membership to Fellowship and become a Fellow of the Faculty of Dental Surgery. While the Fellowship subscription is higher than that for Membership, those taking advantage will be able to celebrate becoming a Fellow at an additional Diploma Ceremony and receive their new diploma certificate highlighting their professional recognition through Fellowship post-nominals. They will be eligible to apply for a wider range of fellowships, awards, prizes, lectureships, research awards, professorships and will have the opportunity to undertake more senior roles in the College reserved for Fellows. The conversion process will be managed in steps to minimise delays for diploma ceremonies and the Membership Team will be in contact with each member as the process unfolds.

Colleges working together 

Readers may wonder why January 2020 was decided as the threshold date. This was decided by all four Colleges because a Fellowship Without Examination process already exists in each College. RCSEd has an established process for Fellowship and Membership in Dental Surgery without Examination. If you have held a dental specialty membership qualification for five years or more, I encourage you to ‘upgrade’ to Fellowship, In doing so, you will attend a further Diploma Ceremony and receive an additional diploma certificate. 

Turning to other matters, 2024 was the silver Jubilee for the MFDS examination. While candidate numbers have been lower in recent years, the Royal Colleges came together in 2024 to discuss the future for MFDS. We currently deliver MFDS in conjunction with RCPSG as a bi-collegiate examination – RCSEng delivers its own version of the MFDS and the Irish College has a subtly different MFD examination. Following extensive discussion at the RCSEd/RCPSG Bi-Collegiate MFDS Management Board and RCSEd Dental Council, initial discussions with RCSEng in relation to developing a tri-collegiate MFDS examination have been very positive. RCSI has decided it would prefer to continue to run its standalone MFD examination due to its international appeal. Therefore, from 2026 onwards, MFDS will become a tri-collegiate examination with similar standards, governance and finance arrangements as the DSFE. I am also pleased to inform the Faculty through Surgeons’ News that the exam will be aimed at Dental Core Trainee levels 2 and 3 rather than being based on the curriculum for Dental Foundation Programme Training. Furthermore, an early decision has been taken to change the focus of MFDS from communication with actors to a broader assessment of non-technical skills, with some stations involving direct interaction with the examiners rather than all stations involving actors. As part of these discussions, the RCSEd expertise in the field of delivery and assessment of non-technical skills has been noted and we have been asked to share some of our heritage in light of this. Due to the desire for non-technical skills to have been summatively assessed on entry to specialty training, MFDS will become a requirement to sit the new DSFE from 2026, and the latter exams will no longer contain communication sections.

The next steps 

Finally, 2025 will see the next stages of the College Governance Review following the annual general meeting in November. The College laws will undergo a significant overhaul with the majority relating to the Faculty of Dental Surgery moving over to new Dental Regulations later in 2025. The reason for this is to allow a degree of agility in updating governance relating to the Faculty as time goes on, without needing to seek Privy Council approval for even the most minor change. While governance is perhaps not the most headline-grabbing topic, it is of considerable importance for the effective and efficient running of the Faculty within the College. There is much work to do in this area and, as the year unfolds, we will communicate the key changes to all within the Faculty.

It is my hope that you found this article of value and, as ever, please feel free to get in contact with me at dental@rcsed.ac.uk.