Hong Kong government responds to dental internship amendments

In response to the concerns expressed by individual Legislative Council (LegCo) members and attendees of the deputation session of the Bills Committee on the Dentists Registration (Amendment) Bill 2024, the Hong Kong government further issued a press release on 21 May over the background and proposal on requiring local dental undergraduates to undergo a one-year internship after their graduation. 

The proposed internship arrangement aims to enhance the clinical experience of local dental graduates through on-job training, to address the concerns raised by the Dental Council of Hong Kong (DCHK) on multiple occasions over the severe lack of clinical experience among the graduates of the Bachelor of Dental Surgery (BDS) programme of the University of Hong Kong (HKU) in its accreditation exercises. This serves to uphold the standard of dental services in Hong Kong and safeguard the wellbeing of patients.

(Image: HKU Faculty of Dentistry/ Facebook)

The DCHK is a statutory body established under the Dentists Registration Ordinance, which is responsible for handling dentists registration, conducting licensing examinations, and maintaining the ethics, professional standards and discipline of the dental profession. In particular, the DCHK may, pursuant to section 8 of the Ordinance, specify in the Schedule any recognised dental undergraduate programme offered by local universities. Graduates of such recognised programmes are exempted from taking the licensing examination and allowed to become registered dentists direct. At present, the HKU BDS programme is listed as a recognised programme. The DCHK regularly conducts accreditation exercises on the HKU BDS programme to ensure that such graduates can meet the required professional standards.

Since 2012, the DCHK has been conducting an accreditation exercise of the HKU BDS programme every five years. The accreditation exercise is assisted by a visiting team comprising experienced local dentists and overseas experts, who would conduct on-site visits to the HKU Faculty of Dentistry and exchange views with the faculty’s management, teaching staff and students to review the programme on various aspects. After each accreditation exercise, the DCHK examines the visiting team’s findings and issues an accreditation report to the faculty.

The DCHK issued two accreditation reports in 2014 and 2019 respectively. In the first accreditation report, it was revealed that the faculty could not provide complete records for monitoring the training of BDS students’ clinical skills and failed to supplement any quantitative account which was acceptable to the DCHK. As for the second accreditation exercise, the DCHK observed that the faculty would need to enhance the training of clinical skills and clinical experience of local BDS students. Consequently, the DCHK maintained its recognition to the HKU BDS programme only on the condition that the faculty would ensure proper implementation of its relevant recommendations and submit annual reports on the follow-up measures.

In November 2022, the government was informed by the DCHK that the third accreditation exercise was being conducted. However, based on the information submitted by the Faculty, the DCHK found that the faculty’s implementation of the DCHK’s recommendations in the previous two accreditation exercises was far from satisfactory.

According to the press release, the implementation of clinical training in the curriculum was significantly inadequate in particular, and the clinical experience in performing dental procedures varied greatly among local dental graduates. The faculty was also unable to provide any evidence showing that all graduates had completed the required number of clinical practice cases for all essential dental procedures. Moreover, records presented by the faculty even showed that clinical experience of some students were severely inadequate, with individual students having zero actual experience in performing certain dental procedures.

The DCHK advised the Government again in February 2023 that the aforementioned situation revealed the structural problems of the clinical training offered in the HKU BDS programme. As the issue on insufficient clinical experience among graduates had yet to be ameliorated, the DCHK would seriously consider whether it would still be appropriate to continue accepting the HKU BDS programme as a recognised programme in the schedule to the ordinance. Should the programme be removed from that Schedule, all local dental graduates would have to pass the licensing examination conducted by the DCHK, and those who fail to do so would not be able to become registered dentists.

Proposed dental internship arrangement

Hong Kong dental internship
A screengrab of the Bills Committee on Dentists Registration (Amendment) Bill 2024 meeting in the Legislative Council Complex on 6 May (Image: Legislative Council of HKSAR/ YouTube)

The government had been exploring to amend the ordinance in 2022, with a view to creating new pathways for the admission of non-locally trained dentists and addressing the industry’s call for enhancing the professional standards of dentists.

In the light of the views raised by the DCHK and the profession on the need to enhance the clinical experience of dental graduates, the Health Bureau released a consultation document to stakeholders in February 2023 and proposed to introduce a provisional registration system akin to the arrangement for medical practitioners.

This would enable local dental graduates in Hong Kong to undergo a one-year internship under provisional registration for gaining more clinical experience before full registration. As for non-locally trained dentists who sat and passed the licensing examination of the DCHK, they will be required to undergo a period of assessment to familiarise themselves with the local practice as previously suggested by the industry.

During the consultation period, the government met with various stakeholders, such as the DCHK, dental professional bodies, partners of the Government’s dental service programmes, teaching staff and students of the HKU Faculty of Dentistry, associations and training institutions for ancillary dental workers, the Hospital Authority and patients’ groups respectively, to canvass their views on the legislative amendments.

The vast majority of stakeholders agreed in principle the idea of introducing an internship/period of assessment. The DCHK concurred in their reply to the Government in April 2023 that there were imminent needs to kick-start the internship arrangement, while HKU also expressed support in the same month for the implementation of the proposal. Both parties subsequently set up a task force with the Department of Health (DH) to discuss the specific implementation details, with the involvement of an existing BDS student representative. 

Subsequently, the DCHK issued an accreditation report to the Faculty in June 2023 which maintained the status of the HKU BDS programme only on a conditional basis.

In briefing the LegCo Panel on Health Services on the consultation results in July 2023, the Government indicated that in recent years the dental profession has suggested from time to time the need to explore ways to enhance the clinical experience of local dental graduates or non-locally trained dentists in real-life setting. This serves to ensure that they are not only equipped with professional knowledge but also sound practical skills and professional attitude as required for making clinical judgment under different situations and handling the work of a practising dentist in an effective manner. The implementation of the proposed dental internship and period of assessment can effectively address the appeal of the dental profession, including the DCHK, for enhancing the clinical experience of dentists who newly joined the profession.

Under the arrangement of internship/period of assessment, dental interns will work in rotation at various service units under the guidance of experienced dentists. The scope of work includes the School Dental Care Service, emergency dental services, hospital dental service (such as oral maxillofacial surgery and specialist dental service clinics), community special dental service (such as outreach services for the elderly at residential care homes and dental services targeting persons with intellectual disability), as well as general dental services (such as government dental clinic services). 

Having gathered the views of BDS students, the DH will, subject to the availability of posts, strive to provide local dental graduates with the opportunities to undergo internship in the dental specialties of their choice. This will further enrich their exposure before pursuing specialty training in future. The internship arrangement will also allow local dental graduates to independently handle unscreened local patients with different clinical conditions, and collaborate with local dentists and other professionals in performing tasks. All these cannot be emulated by normal teaching settings nor practices on dental procedures under instructors’ clinical supervision, thereby allowing local dental graduates to get better prepared for their future practice and professional development. Dental interns will be appointed as dentists under contractual terms at a salary level comparable to medical interns. The specific salary level will be 50% of the Master Pay Scale Point 30 for civil servants, HK$34,470 per month in financial year 2023-24, which ensures that regular adjustments can be made in light of the economic conditions in Hong Kong.

Response to concerns on Hong Kong dental internship arrangement

Hong Kong dental internship
(Image: HKU Faculty of Dentistry/ Facebook)

The above internship arrangement is designed for Hong Kong dental graduates, as in the long-established practice for medical graduates. With reference to the experience of medical interns, cases requiring extension of internship/period of assessment are extremely rare (only about 1%), and there is no record of any case for termination of internship/period of assessment in the past five years.

The government emphasised that local dental graduates are to be treated under the bill as registered dentists when they are undergoing the internship. The internship arrangement is by no means an extension of the BDS programme, and it is infeasible to replace the internship with schoolwork.

The DCHK has provided a written reply to LegCo that it is inappropriate to allow BDS students, who are still in the learning and practising process without having yet fully mastered various clinical skills for dental treatment, to prematurely undergo internship as registered dentists and independently perform various dental procedures on patients. It is of no benefit to both students and patients.

The government also considered that it is impractical to require students to undergo internship on a full-time basis while studying an undergraduate programme at the same time. As for the content and duration of the BDS programme, as well as whether and how it should be adjusted in light of the internship arrangement, is a matter of the university. The DCHK will continue to conduct its accreditation work.

The government undertook to provide internship opportunities for all dental graduates of the HKU BDS programme, and will spare no efforts in assisting every graduate to complete the internship with a view to providing quality dental services to the community. Based on the ongoing legislative progress of the Bill, the internship requirement will, at the earliest, apply to local dental graduates in class of 2025 and thereafter, while the arrangement for period of assessment will apply to non-locally trained dentists who have sat and passed the licensing examination administered by the DCHK with the exact date hinging on the examination schedule.

The Secretary for Health, Professor Lo Chung-mau, emphasised: “The Government attached great importance to the training and regulation of the professional standard of dentists in Hong Kong, as well as the prospect of local BDS students. Regardless of the manpower supply of dentists, we are committed to investing additional resources to arrange internship placement for local dental graduates, thereby promoting their professional development to offer better services to the public.” 

 “I have noticed that some LegCo members plan to propose amendments to the internship arrangement. The Health Bureau never shies away from upholding the quality of healthcare services in Hong Kong. We propose to introduce the internship arrangement as soon as possible, which is crucial to maintaining the professional standards and reputation of dentistry in Hong Kong. More importantly, it is central to safeguarding the wellbeing of our citizens.”

 “The early implementation of internship arrangement is a matter of public interest, and also a matter of imminence. As a responsible government, we should proactively enhance the standard of our dentists to keep up with the times, rather than taking remedial measures only after incidents concerning patients’ safety arise. I strongly appeal to LegCo Members and the industry to recognise the importance of the proposed internship arrangement and render support for its early implementation.”

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