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Perceptions of UK secondary care adult dental conscious sedation clinics: a qualitative analysis

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Objective: To explore the purpose of dental conscious sedation provided within UK University-based secondary care dental settings as defined by patients, referrers and providers. Methodology: A qualitative investigation using semi-structured interviews was undertaken. Participants comprised of sedation staff in five UK University-based hospital settings as well as referrers to, and patients attending, one UK University-based hospital setting. Thirty one participants were interviewed in total (9 patients, 9 referrers and 13 sedation providers). Participants were purposively sampled, and included to develop emerging analysis. Transcribed interviews were qualitatively analysed using a constant comparative method which coded responses and grouped codes to identify predominant themes of response. Results: Secondary care conscious sedation clinics were shown to have a variety of both immediate and long-term intended functions for participants. Short-term outcomes were removing anxiety, providing access, and meeting institutional requirements, whilst longer-term intentions were passing on interest and rehabilitation to primary care. Conclusions: Rather than one unified understanding being held by all participants, the meaning of 'conscious sedation' within such clinics varies between and within each group. Despite diverse understandings however, the majority of interpretations are compatible, and this interpretative flexibility allows participants to achieve differing needs simultaneously. Although countries provide conscious sedation differently, it is not unreasonable to expect similar interpretations of its intention. Awareness of interpretations should help both referrers and providers provide patients with appropriate information as well as understand each other groups' aims. Abstract 1. Clinical Lecturer in Restorative Dentistry; 2. Professor in Paediatric Dentistry, Cardiff University School of Dentistry; 3. Senior Lecturer in Medical Education, Wales Deanery (School of Postgraduate Medical and Dental Education) Perceptions of UK secondary care adult dental conscious sedation clinics: a qualitative analysis
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Objective: To explore the purpose of dental conscious sedation provided within UK University-based secondary
care dental settings as defined by patients, referrers and providers.
Methodology: A qualitative investigation using semi-structured interviews was undertaken. Participants comprised
of sedation staff in five UK University-based hospital settings as well as referrers to, and patients attending, one UK
University-based hospital setting. Thirty one participants were interviewed in total (9 patients, 9 referrers and 13
sedation providers). Participants were purposively sampled, and included to develop emerging analysis. Transcribed
interviews were qualitatively analysed using a constant comparative method which coded responses and grouped
codes to identify predominant themes of response.
Results: Secondary care conscious sedation clinics were shown to have a variety of both immediate and long-term
intended functions for participants. Short-term outcomes were removing anxiety, providing access, and meeting
institutional requirements, whilst longer-term intentions were passing on interest and rehabilitation to primary care.
Conclusions: Rather than one unified understanding being held by all participants, the meaning of ‘conscious
sedation’ within such clinics varies between and within each group. Despite diverse understandings however, the
majority of interpretations are compatible, and this interpretative flexibility allows participants to achieve differing needs
simultaneously. Although countries provide conscious sedation differently, it is not unreasonable to expect similar
interpretations of its intention. Awareness of interpretations should help both referrers and providers provide patients
with appropriate information as well as understand each other groups’ aims.
Key words: Conscious sedation, experience,
perception, qualitative
Date Manuscript Received: 15/11/2014
Date Manuscript Accepted: 24/02/2015
Doi: Doi: 10.4483/JDOH_Woolley07
516/1 |Journal of Disability and Oral Health (2015) |
Woolley et al.: Perception of UK secondary care conscious sedation clinics
SM Woolley,1BL Chadwick,2L Pugsley3
Abstract
1. Clinical Lecturer in Restorative Dentistry; 2. Professor in Paediatric Dentistry, Cardiff University School of Dentistry;
3. Senior Lecturer in Medical Education, Wales Deanery (School of Postgraduate Medical and Dental Education)
Perceptions of UK secondary care adult dental
conscious sedation clinics: a qualitative analysis
Introduction
Dental anxiety is present in a signicant proportion of the
world population (Oosterink et al., 2009; Pretty et al., 2011).
Within the United Kingdom (UK), high dental anxiety is
present in approximately 12% of the population (Humphris
et al., 2009; Nuttall et al., 2011). It is associated with
avoidance of dental situations (Mejía et al., 2010; Goodwin
and Pretty, 2011; Nuttall et al., 2011) and 2.7% of the UK
population have not attended a dentist in the past two years
due to dental anxiety (Goodwin and Pretty, 2011). Whilst
some anxious patients engage with dental treatment through
a set of interpersonal strategies which make treatment
possible (Bernson et al., 2011), approximately 5% of patients
that attend primary care settings are classied as anxious
enough to require conscious sedation (Pretty et al., 2011).
Dental anxiety and irregular dental attendance are direct
factors in patients’ referral for treatment with sedation
(Milgrom et al., 2010).
Within the UK, dental conscious sedation is dened as:
[a] technique in which the use of a drug or drugs produces
a state of depression of the central nervous system enabling
treatment to be carried out, but during which verbal
contact with the patient is maintained throughout the
period of sedation…e drugs and techniques used to
provide conscious sedation for dental treatment should
carry a margin of safety wide enough to render loss of
consciousness unlikely (Department of Health, 2000).
A variety of techniques fall within this denition and are
classied as ‘standard / alternative’ (Faculty of Dental Surgery
of e Royal College of Surgeons of England and Royal
College of Anaesthetists, 2007) or ‘basic / advanced’
techniques (Independent Expert Group on Training and
Standards for Sedation in Dentistry, 2011). e provision of
conscious sedation within primary dental care settings has
oen varied (Whiston et al., 1998; Foley 2002; Burke et al.,
2005; Chadwick et al., 2006; Hill et al., 2008). e General
Dental Council currently recommends that all UK dental
graduates should be able to prevent, diagnose and manage
patient anxiety appropriately, eectively and safely(General
Dental Council, 2011) and to achieve this previous guidance
has recommended that dental students should have a sound
theoretical knowledge and some practical experience of basic
dental sedation techniques (General Dental Council, 1997). To
this end conscious sedation is provided, to varying degrees,
within UK university-based secondary care settings (Leitch
and Girdler, 2000; Leitch and Jauhar, 2006). Although
conscious sedation has been extensively examined
pharmacologically, and has regular guidelines and regulatory
documents published, there is limited available research on the
psycho-social impact of conscious sedation. Previous research
with paediatric patients has shown that conscious sedation
may not be interpreted in the same way by both those
providing and those receiving treatment (Averley et al., 2008).
is study aimed to understand the perception of basic
conscious sedation (titrated intravenous midazolam or
inhalation of nitrous oxide and oxygen mix) provided within
secondary care settings, by exploring dierent participants’
understandings of the purpose of such settings. e study
formed part of a larger project exploring the aims, processes
and outcomes of secondary care sedation for dentally-
anxious adults receiving restorative treatment.
Methods
Following the provision of NHS Research Ethics
Committee approval, a qualitative approach was used to
explore participants’ interpretations and experiences of
secondary care conscious sedation (Bower and Scambler,
2007; Stewart et al., 2008). A purposive sample was used to
select participants based upon their usefulness in addressing
the research question (Green and orogood, 2009). irty
one participants took part in the study, comprising of
patients (n=9), referrers (n=9) and GDC-registered dentists
and nurses (n=13). Providing-participants were drawn from
ve UK university-based secondary care dental clinics which
provide conscious sedation for dentally-anxious adult
patients requiring restorative dental care. Patient and referrer
participants were sampled from previous referrals to one of
the sample clinics.
Participants were recruited through a variety of means.
Patient and referrer participants were identied from an
audit of referrals received by one secondary care facility in
the UK. Provider participants were identied through
membership of specialist interest society committees,
presentations at specialist society meetings and publications
within the dental literature. Invitations and standard
information sheets were sent to potential participants along
with a reply / consent form and a freepost reply envelope.
Invitations were also sent to providers via electronic mail
(with appropriate forms included as attachments). e
process was repeated two weeks aer the initial invitation for
non-responders. If respondents agreed to participate, a
mutually-convenient interview time and location was
arranged. All patients invited had experienced at least one
complete course of dental treatment under sedation.
Semi-structured interviews were used to explore
participants’ views regarding conscious sedation provision.
Such an approach allows topics to be explored and reected
upon in an unfettered manner (Gill et al., 2008) so that the
interview is more like a ‘conversation with a purpose’
(Burgess, 1988). A exible interview guide was used to
ensure that topics of interest were covered, whilst allowing
participants to talk around those topics and add others of
interest to them (Figure 1). Interviews lasted between 36 and
137 minutes in duration (average length 56 minutes). ey
were conducted by the rst author (SW), recorded on digital
media and transcribed verbatim before analysis using NVivo
8 soware (QSR International). Participants were
anonymised with codes or pseudonyms for analysis and data
presentation.
Data collection and analysis occurred concurrently,
allowing early data and analyses to be compared and
explored with later interviews. A form of constant
comparative method was chosen, following the principles of
grounded theory analysis (Strauss and Corbin, 1998;
Atkinson et al., 2003; Charmaz, 2006). Data were examined
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Woolley et al.: Perception of UK secondary care conscious sedation clinics
Clinic conceptualisation: What thoughts come to you when you think of this clinic? ; How would you describe this clinic to someone else?
Patients’ perceived attitudes: What do you think patients want? ; Can you describe a typical patient for me?; What do you think patients would
say if asked how they could improve the clinic?
Purpose of the clinic: What would be a “successful outcome” for the clinic?
Pressures/demands are on the clinic: Who do you feel affects what you do?
Staff attitudes: Can you describe your colleagues for me?
Figure 1: Provider interview topic guide
out of context (line-by-line, as paragraphs and as whole
answers), and given descriptive labels (codes) which
summarised them. Such codes were then linked and
integrated into more abstract concepts (Strauss and Corbin,
1998; Charmaz, 2006). Data collection continued until no
further data added to the analysis, which occurred at 31
interviews within this study.
Results and Discussion
irty one participants were interviewed to gain an
understanding of their perception of secondary care sedation
provision. e accounts demonstrate that the provision of
secondary care conscious sedation is not an action with one
universally agreed interpretation of purpose, but that
patients, referrers and providers all give secondary care
sedation their own short and long-term agenda.
As one participant noted,
I think sedation is a very loose topic and I think that people
that actually operate within sedation have a very tight
concept of what it should be in the dental environment. But
I think that people who perhaps work in other areas…might
perceive it as something slightly dierent, and the general
public might perceive it as something slightly dierent as
well. [Provider 12]
Reecting the longitudinal nature of medical treatment,
two main temporal themes emerged from the data, each
containing sub-themes. Immediate demands that
participants place upon sedation treatment were noted, along
with longer-term hidden agenda of the clinicians involved
with secondary care sedation clinics:
1. Dealing with the Present (removing anxiety; providing
access; and meeting institutional requirements);
2. Changing the Future (passing on; and rehabilitating).
In this paper, themes and sub-themes have been discussed
alongside illustrative quotations to support the discussion.
Such data were representative of views expressed by others
within the participants’ sub-group (patient, referrer or
provider).
Dealing with the present
e main purpose of sedation clinics reported by
participants was to deal with their immediate needs
(Figure 2). For patients this was to facilitate access to
tolerable dental care. By achieving this, clinics also met their
own needs as educational settings, and referrers met their
obligations to address their patients’ requirements through
referral (General Dental Council, 2013b).
Removing anxiety
Sedation is a way of meeting patients’ immediate needs to
overcome their experienced fear so that they can be treated.
[Sedation] is good! Because I’m not going to be in this
terrible state; and frightened, and my heart pounding, so
that is good… So this is what I think with sedation- “Oh
thank God they’re going to do something for me!” [Grace]
[for] lots of very anxious people [you are] able to make a
big dierence to them very quickly. To make them feel
comfortable about what was going on…you can have
patients who are obviously very upset: tearful and unable to
sit in the dental chair, or behave in any rational fashion
towards dental treatment, and they can go from that, to
actually having the courage to come in and be sedated and
have their treatment done. [Provider 2]
Sedation clinics rst and foremost oer a chemical tool to
alleviate patients’ fear. Sedation is something to make
treatment tolerable, and by removing this burden of anxiety
it can make a rapid and ‘big dierence’ to patients so that
they are able to have treatment. However sedation has more
meaning than a simple anxiolytic to help patients cooperate
and behave rationally. Some patients discussed sedation as a
way of removing total awareness or active participation in
the treatment.
I assumed I’d be sleeping it’s as simple as that, I thought Id
be sleeping or appear to be sleeping. I won’t see anything;
hear anything; I’ll just wake up and it’ll be all over…. that
sort of lack of participating or knowledge of participating,
that did make me feel a lot more easier. [Olivia]
is confusion about sedation being a form of sleep
reects similar expectations reported by paediatric sedation
patients and their families (Averley et al., 2008). Anxious
patients feel ambivalence between engaging and avoidance
(Abrahamsson et al., 2002b). e ‘vicious cycle’ (Armeld et
al., 2007) of avoidance, deterioration, health eects and
716/1 |Journal of Disability and Oral Health (2015) |
Woolley et al.: Perception of UK secondary care conscious sedation clinics
Figure 2: Short-term needs of participants engaging with secondary care
sedation clinics
GDC /
Dental Schools
Anxious
patients
Primary Dental
Care Referrers
Sedation
Clinics
Need to provide a
complete syllabus
Need to have dental
treatment and
overcome anxiety
Need to provide
treatment for anxious
patients
Improve
oral
health
Educate
students
Treat patients on
referrers’ behalf
traumatic emergency treatment is inverted within sedation
clinics. ere patients seek to reconcile this engage / avoid
tension by engaging in an avoidant manner, so that ‘lack of
participating’ leads to health improvement rather than
deterioration. Whilst sedated dentistry is by denition a
conscious process, patients seek to engage without
awareness.
Providing access
Whilst sedation clinics meet patients’ immediate needs to
make treatment tolerable, they also meet primary care
practitioners’ needs to provide access to treatment for their
patients.
[Sedation providers] pick up the pieces that I can’t manage.
at sounds awful, but they get all the worst bits then, the
patients that are dicult to treat, that because of their
apprehension about dental treatment may come in with
grotty mouths, complicated treatment…[J]ust like any other
specialist clinic, you’d hope to take a group of patients that
couldn’t be treated in any other way and provide treatment.
[Referrer 2]
[Here patients] get dentistry done that they can’t get done
elsewhere…my bottom line is that because we are a
secondary care service somebody has to treat these patients
and I think if we can’t, well I don’t know who can! So we
are a bit of the end stop. [Provider 13]
Oering sedation encourages engagement rather than
complete avoidance (Goodwin et al., 2012). However
conscious sedation in primary care is limited by availability
and remuneration (Wright and Batchelor, 2002; Burke et al.,
2005; Chadwick et al., 2006; Hill et al., 2008;). Sedation
clinics therefore provide access to treatment for patients who
otherwise would not be able to receive dental care in a
primary care setting.
Meeting institutional requirements
In addition to providing anxiety-free access to dental
services, the clinics studied were also educational sites within
University dental hospitals. As such they give dental students
experience of treating anxious patients and training in
conscious sedation. ese functions are a consequence of the
General Dental Council’s (GDC) previous guidelines for
dental schools’ educational curricula, requiring experience
and familiarity with conscious sedation procedures through
exposure to sedation teaching (General Dental Council,
2002). e combination of this policy drive following the
publication of A Conscious Decision (Department of Health,
2000) and the Dental Sedation Teachers Group’s guidance on
the minimum experience expected for ‘competent’ dental
graduates (Dental Sedation Teachers Group, 2000) provided
the impetus for sedation provision within the dierent clinics.
e First 5 Years was dictating to the University that the
students had to have this activity. And of course at that
time, because we are now looking at kind of late 1990s,
2000, there was this panic…within dental schools that they
had got to have these students being produced who had
done 20 IV cases,10 RA cases, you know the DSTG
document ‘e Competent Graduate’. And everyone was
running around thinking “how the hell are we going to do
this?” [Provider 11]
In addition [to meeting a patient need], the clinic would
teach undergraduates as our school had already been pulled
up a few times by the GDC for not teaching sedation.
[Provider 8]
Not all clinics started as a response to this policy change.
Nonetheless, they are accountable to the GDC via their host
universities (who are unable to train dentists without
experience and teaching) in addition to attending patients
unable to access care elsewhere. Providing clinicians felt that
‘real life’ exposure to clinical sedation was an important
educational tool, providing opportunities for experiential
learning.
[Students] see what conscious sedation is rst hand, up
close and personal. ey get to actually do some sedation,
so it is not just a question of them watching it happen. You
could watch a video couldn’t you? But you won’t get the feel
for what is actually happening to the patient! So they get
that perception of a patient who is coming in, they actually
see and can almost smell the fear, coming in and having the
treatment done and away they go. And that is a very
powerful powerful [sic] tool in my opinion- actually to see it
and witness it. [Provider 11]
Similarly patients understood the importance of giving
students sedation experience.
It’s important for them to know about sedation…to know
every aspect of dentistry, it’s part of their job. [Eve]
Although students ideally gain sucient experience to
make them procient graduates, the myriad demands on
curricula to meet GDC requirements meant that providers
felt the pragmatic educational aim of the clinic was to
provide introductory knowledge.
We are teaching them how sedation works and getting them
experience, but we are not making them competent…I don’t
think you can make your undergrads competent at
sedation, certainly not with the level of sedation they get
here. [Provider 7]
Such views reect a survey of sedation teaching
conducted over a decade previously (Leitch and Girdler,
2000). Recognising that they cannot realistically give
sucient exposure to develop competency and condence,
providers feel that in the short-term they can provide an
understanding of the sedation process and develop holistic
clinicians with a bigger picture of how to treat dentally
anxious patients.
Sedation clinics simultaneously cater to the immediate needs
of anxious patients, referring GDPs and their host Universities.
Whilst providers are primarily concerned with dealing with the
present service and educational needs of patients and students
8|Journal of Disability and Oral Health (2015) |16/1
Woolley et al.: Perception of UK secondary care conscious sedation clinics
respectively, by doing so they also have the potential to
inuence both groups’ future dental trajectories.
Changing the future
e secondary purpose of clinics reported by some
participants was to deal with longer-term behaviour.
Providers aimed to encourage patients’ rehabilitation to
primary dental care and also hoped to inuence graduates
future career interests.
Passing on
e educational intention of clinicians working within the
clinics involved a long-term inspirational component. In
addition to fullling curricular requirements, treating
clinicians hoped to encourage undergraduates to develop an
interest in conscious sedation.
If sedation isn’t taught to dental students it seems shrouded
in mystery and creates a fear of it. e training removes the
perennial ignorance of sedation. It doesn’t provide
competence, but sparks an interest so they can develop
further aer graduating…I want them to understand
appropriate referral and also to trigger an interest in
sedation so they train further aer graduating. [Provider 8]
Participants spoke of ‘sparking an interest’ not only in
conscious sedation, but in the management of anxious
patients generally. By spending time on the clinics,
undergraduates see the challenges and rewards of treating
anxious patients with and without conscious sedation before
they develop other interests. Sedation teaching therefore has
an institutional obligation, but this is facilitated by clinicians
personal motivations and beliefs that an interest in anxiety
management is worthwhile and important to develop in the
next generation of dentists.
Rehabilitating
In the same way that sedation clinics meet
undergraduates’ immediate educational needs whilst seeking
to stimulate long-term change in their interests, referring
and providing clinicians also expressed a secondary ideal of
long-term change in their patients’ feelings about dentistry.
ey saw sedation as a way of easing patients into primary
care dental treatment aer breaking the vicious avoidance
cycle by providing initial access to dentistry.
[e clinic] is there to help them have their treatment, but
the eventual aim should be that they can gradually have
treatment in the [primary care] surgery with local
anaesthetic. [Referrer 6]
[A] gold standard would be to think that by the end of the
treatment that you have acclimatised your patient to accept
dental treatment by anyone anywhere, so that the patient is
rehabilitated. [Provider 12]
Once patients have got over the initial barrier that their
fear created to engaging with any form of dentistry, clinicians
felt that the aim of treatment should be for patients to realise
that dentistry was not as bad or as overwhelming as they
originally believed. By gradually adapting their sedation
needs and developing psychological insight, patients could
then learn to accept dentistry without sedation (Royal College
of Anaesthetists, 1999). Although this rehabilitation is an
ideal, it was not necessarily seen as achievable by providers.
I would like to see the majority of our patients being able to
wean themselves o sedation and having their treatment
carried out in a conventional manner. For some of our
patients that’s what will happen, but it might not happen in
one course of treatment. at might be several years down
the line, because it isn’t always about dentistry it’s
sometimes about other aspects of things of what’s going on
in peoples lives. [Provider 4]
is view reects previous research which showed that
though there were dierences noted in the long-term eects
of dierent sedation modalities and behavioural
intervention, some patients did not change their anxiety or
attendance pattern regardless of intervention (Aartman et al.,
2000). Dental anxiety may be the outworking of other
psychological processes (Freeman, 1998), and rehabilitation
may therefore require psychological rather than
pharmacological treatment. Although the quality of evidence
for studies evaluating such treatment has been considered
weak, the ecacy of behavioural interventions over control
situations such as conscious sedation has been demonstrated
(Wide Boman et al., 2013).
Conclusions
is qualitative study explored participants’ views regarding
conscious sedation provided within secondary care settings.
Participants’ interpretations of conscious sedation clinics
varied, demonstrating both the exibility of such clinics and
also the potential for incompatible interpretations to occur.
Other countries dene and provide conscious sedation
dierently to the UK, and within the UK sedation is also
provided within other settings such as primary care general
practice and the community dental service. However, it is not
unreasonable to expect similar interpretations of sedation
provision especially regarding the short term / rehabilitation
denitions. Consequently the ndings of this research may also
be transferable to sedation provision within dierent settings.
Further studies undertaken within dierent settings are needed
to explore and conrm this transferability. Providing
participants were either dentists or nurses. As appropriately
trained hygienists and therapists are able to provide inhalation
sedation within the UK (General Dental Council, 2013a),
identication of such providers, and their views on sedation,
would also be a useful area of further research.
Participants described short term objectives of increasing
access, and thereby achieving dental care, whilst simultaneously
meeting the institutional objectives of the host institution to
provide conscious sedation training to dental undergraduates.
Such interpretations are generally compatible as both sides get
what they need whilst dierences do not prevent each group
from achieving their priorities. However, clinicians also
expressed longer-term intentions of encouraging rehabilitation
916/1 |Journal of Disability and Oral Health (2015) |
Woolley et al.: Perception of UK secondary care conscious sedation clinics
and developing students’ professional interest. Although some
dentally anxious patients are able to attend dental care settings
by using a variety of coping strategies (Bernson et al., 2011),
there is a proven link between anxiety and avoidance (Mejía et
al., 2010). Framing conscious sedation treatment as a long-
term aid to rehabilitation may therefore be incompatible with
patients’ perceptions of secondary care sedation as being a
sporadic short-term way of tolerably meeting their immediate
dental needs.
Although A Conscious Decision (Department of Health,
2000) came into force within the UK almost a decade and a
half ago, eectively removing dental general anaesthesia (DGA)
from primary care settings within the UK, it is perhaps
unsurprising that patients still equate sedation with sleep given
the history of DGA and various cultural images we have of
upset or traumatised characters being sedated by attending
physicians. Such confusion has also been attributed to
practices’ descriptions of intravenous sedation as ‘sleep’ or
‘twilight’ dentistry (Dental Fear Central, 2014). Whilst this
confusion may occur for patients regardless of any information
provided, it could also be due to the quality of information
provided. In order to minimise conicting messages, the
information provided to patients should be clear and
consistent. Sedation clinics should provide clear referral criteria
which set out minimum information provision requirements.
Clear information should to be given by referring clinicians to
ensure patients fully understand the purpose and nature of
their referral for sedation (Averley et al., 2008). In addition, it
might be benecial for an information leaet to be sent by
sedation clinics prior to initial assessment appointments which
clearly sets out the nature of conscious sedation treatment.
is research provides an insight into perceptions of
secondary care conscious sedation. Secondary care settings
treat on a short-term referral basis so do not develop long-
term relationships between clinicians and patients in a way
that primary care settings have the potential for. Whilst
qualitative studies have explored anxious patients’ views of
dentistry, dental anxiety and treatment (Abrahamsson et al.,
2001; Abrahamsson et al., 2002a; Abrahamsson et al., 2002b;
Averley et al., 2008; Milgrom et al., 2010), further research is
required to explore patients’ experiences of sedation in
primary care settings and to examine students
interpretations of the sedation teaching they receive.
Acknowledgements
e authors would like to thank all the participants who
generously gave their time and expressed their views and
experiences. ey would like to thank Dr. Rob Evans for his
advice in the conduction of this study and the preparation of
this paper. is research was funded by Cardi University as
part of a higher degree undertaken by the rst author.
10 |Journal of Disability and Oral Health (2015) |16/1
Woolley et al.: Perception of UK secondary care conscious sedation clinics
Address for correspondence:
Dr. S M Woolley
School of Dentistry, College of Biomedical and Life Sciences,
Cardi University, Heath Park, Cardi CF14 4XY, UK
WoolleySM@cardi.ac.uk
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... 20,21 Previous examination of CS education seldom employed qualitative research methods, as studies have been survey-based, 6,9 or focussed on patients or qualified healthcare professionals. [22][23][24][25][26][27] One useful qualitative research method is personal semistructured reflective logs. 21,28,29 The GDC require dental professionals to engage with reflective practice to enhance their clinical practice and professionalism. ...
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