Passion in evidence

20 March, 2014
 

Derek Richards’ passion for evidence-based dentistry has seen him work not just throughout the UK, but also around the world. And now, as one of the
founders and the current director for the Centre for Evidence-Based Dentistry, he has brought the centre up to Dundee.

Originally from Caerphilly in South Wales, Derek completed his undergraduate studies at Cardiff Dental School, graduating in 1977. After a brief spell in
the community and a job in Bristol doing general duties, he moved into oral surgery and registrar jobs in Nottingham and then Inverness. He then moved back
down south to Oxfordshire, where he took a general practice job in David Cameron’s constituency of Witney.

However, after two and a half years in general practice, Derek decided that this wasn’t the career for him. “I’d probably spent too much time in the
salaried services prior to that, to be honest,” he said. After a short break from dentistry where he took on some locum jobs for friends, an opportunity
came up to go back into the salaried service and he subsequently joined the Oxfordshire Community Dental Service.

This new role provided the opportunity to do some postgraduate training through a bursary scheme and Derek wasted no time in enrolling on the diploma in
public health at the Eastman Dental Institute. Unfortunately, the bursary couldn’t stretch to the full masters so, keen to forge a career in dental public
health, he was advised to do the fellowship and was then successful in applying for a public health post in Berkshire.

It was during his specialty training in dental public health, that his involvement in the growing evidence-based healthcare movement was kindled. Derek’s
lead trainer in Berkshire was the late Alan Lawrence, who was secretary for the specialist society for dental public health. He had just completed a
regional oral health strategy with Muir Gray, who was at that time the regional director of public health in Oxfordshire. Muir, one of the founders of the
Cochrane Collaboration and the national electronic library, had also just brought David Sackett on board to help establish the Centre for Evidence-Based
Medicine in Oxford.

Derek said: “I started on 1 August 1994 and, later that month, I was sitting in the canteen of the John Radcliffe Hospital in Oxford with Muir Gray, David
Sackett and my boss Alan Lawrence talking about evidence-based healthcare. It was at this point that Muir turned to Alan and said: ‘Now you’ve got a
trainee, you can start the centre for evidence-based dentistry’.” And so the Centre for Evidence-Based Dentistry (CEBD) was born.

Derek became involved with the Oxford Critical Appraisal Skills Programme (CASP), spending a lot of time with Amanda Burls, one of the leading lights in
the CASP UK Network, providing

workshops on critical appraisal skills.

It was then decided it was time to run a workshop on evidence-based dentistry to garner support and interest from the profession. This first workshop took
place at Templeton College in Oxford in December 1994 and attracted some big names, including people from the Department of Health, the BDA and
representatives from the Faculty of Dental Surgery, among others.

The two main outcomes from the workshop was a plan for the centre and a journal. A steering committee was put together to start developing a presence for
the centre and discussions took place with Mike Grace, the editor of the BDJ, which was published by Oxford Medical Knowledge. The journal, Evidence-Based
Dentistry, initially came out as a supplement for the BDJ and in 2000 became an independent journal, being indexed on Medline in 2004.

After Derek finished his training, he took over a consultant post in dental public health in Berkshire, working very closely with the Oxford region.
However, due to changes within the Oxford region and the NHS in general, Derek and his wife, who is Scottish, started looking at opportunities to move up
to Scotland. Derek already had links to Scotland through his time in Inverness earlier in his career and working with the Dental Health Services Research
Unit (DHSRU) in Dundee on the development of evidence-based healthcare.

So, in 2003, Derek moved north of the border to take on a part-time role in Forth Valley as consultant in dental public health. He said: “This was
attractive because it meant that I could do my dental public health activity part time and I could develop the evidence-based dentistry element the rest of
the time, so that was quite a nice move.”

His role has changed a bit during the last few years – he now provides dental public health support as part of a network to the five health boards in the
east – Tayside, Forth Valley, Fife, Lothian and Borders. And, following the recent changes in the structure at Dundee Dental School, the opportunity arose
to move the CEBD into the school itself.

Derek explained that the centre has never really had a formal home, apart from the early days when he and a couple of dental public health colleagues
shared an office in Oxford. Instead, it has existed virtually, providing training and workshops around the country and often further afield. He said: “We
have always run workshops and I work quite closely with a colleague from the States, Rick Niederman, who is the director of the Center for Evidence-Based
Dentistry in New York. We’ve also done work with the American Dental Association and other regular courses in the states, the Gulf states, India and some
workshops in New Zealand. More recently, one of our masters students from Oxford has established a centre in Alexandria in Egypt.”

Derek also became involved in another world-leading centre in the form of the Scottish Dental Clinical Effectiveness Programme (SDCEP) as a special advisor
when he moved up to Scotland. He said: “The programme is probably unique because, up until the Americans started producing evidence-based guidance, it was
the only solely dental programme. So it was a nice opportunity for me at the time.”

And, just as SDCEP aims to distil research, evidence, guidelines and legislation so that it is more accessible for dental professionals, one of the key
aims of the CEBD is to help the dental team make clinical decisions based on the best available evidence. A vital part of this is enabling them to find the
most valid and up-to-date evidence in the first place on which they can base their treatment decisions.

Derek explained: “Good research is difficult to do and it is also difficult to present and present well. So, even if the research has been done well
initially, sometimes it is not written up well, or not written up in a format that people can easily understand. Certainly not your average practitioner,
whether that is a medical practitioner, a dental practitioner or a nurse practitioner.

“Getting the evidence from the researcher to the patient, where it can do most good, is the biggest challenge. There is a long way between the two and a
lot of it is about understanding the research in the first place.

“One of the key barriers for most clinicians is that issue of time. Practitioners are very busy and they can’t keep up to date with all the latest research
all the time. And a lot of what is published isn’t directly relevant to clinical practice.”

Sifting through the mountains of literature that is published every day is no easy task and once you have found something that is of relevance to your
field, it might not be relevant to clinical practice for five or 10 years. Derek said: “Newspapers can pose significant problems as well. They usually give
details of the research breakthroughs the day they are published and it is often 10, 15 or 20 years before they are in clinical practice. This generates
pressure at the practitioner/patient interface because they have seen these things in the Daily Mail and it might be 20 years before it ever comes to
pass.”

So, finding what is relevant and finding out quickly is vital. Derek said: “Having an ability to decide whether a paper is good or not, at a relatively
rapid run through, is a key skill. Increasingly, it is coming in at a post-graduate level into examinations and with the new changes with the GDC
curriculum it is increasingly coming in to the undergraduate curriculum.

“But there is still an awful lot of change to go through and it will be good few years before we have got people coming out of dental schools and out of
post-graduate qualifications who are completely confident about reading papers.”

Now that the centre has moved up to Dundee, Derek has started developing a masters programme in evidence-based healthcare that he hopes to be able to
advertise later this year. He said: “The feedback that we have had for people who have done the similar programme in Oxford is that if they have an
interest in research, it has given them an awful lot of confidence in their own ability to read and understand papers, and their ability to keep up to
date. In fact, we have had several PhDs doing the programme saying that they wished they had all this training when they were doing their PhDs.”

As well as his evidence-based dentistry commitments and public health role, Derek has for some time been involved with the ScottishDental.org website, a
portal for dental information for practitioner and patients. The site, Derek explained, came about following frustrations at not being able to find
relevant dental information online and, following discussions with Ray Watkins, the chief dental officer at the time, funding was secured. The website is
run by Derek and Doug Badenoch. Doug used to work for the Centre for Evidence-based Mental Health in Oxford and is also one of the men behind the
NationalElfService.net

He has persuaded Derek to get involved with the Dental Elf side of the project – at http://www.thedentalelf.net and on social media, http://www.facebook.com/thedentalelf
and on Twitter @TheDentalElf. The project aims to provide another way for dental professionals to keep up to date with reliable dental health research,
policy and guidance. Derek said: “It’s another tool or avenue for disseminating good quality information out to practitioners. So we put together a simple
summary of the latest information that is relevant to practice and put it on a website and link through social media.”

Looking to the future, Derek, who turns 60 this year, says he will continue to carry on with the CEBD and his public health role as long as he is still
enjoying it, something that he insists is showing no sign of tailing off. And, it is his desire to establish the centre on an ongoing and permanent basis
that is driving him just now. He said: “There are a lot of people who are interested in evidence-based dentistry and participating in evidence-based
activities, but maintaining a centre for the future is what I really want to achieve so that it continues.

“Because, despite the fact that it is now in the undergraduate curriculum, there is still the need for a lead, I think, and to maintain that lead.

“It was the first centre of it’s type in the world, so maintaining a UK lead is important. The Cochrane Collaboration was established at a meeting in
Oxford, and the world has probably looked to the UK for a lead in evidence-based healthcare for a number of years now and it would be nice to maintain that
presence within the evidence-based healthcare fraternity.”

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