The New Zealand Dental Services
CHAPTER 9 — The Training of Staff
The Training of Staff
THERE were two types of training required in the Dental Corps, technical and general. The officers and mechanics already had the technical training but, apart from the few who had served in the Territorial Dental Corps before the war, none of them knew anything about military matters, nor was it possible, because of the amount of dental treatment demanding attention, to give them all an immediate and comprehensive course of general training. In the very early days of the war, therefore, much had to be learned by individual observation and inquiry. This was inevitable in a young Corps with its meagre administrative facilities, but it was not intended to allow this haphazard method to continue and definite steps were taken to standardise the work and make every officer and man familiar with his technical and general duties.
Training of Dental Officers
When the men of the Second Echelon went on final leave, a course of instruction was held at the Army School, Trentham, for as many dental officers as could be spared from treating the fortress troops and mobilisation camps' staff. The course was held from 4 to 19 April 1940 and was attended by thirty-two officers, including the seven who were to go overseas with the echelon. It was similar to the courses held in 1938 and 1939 for Territorial officers. The general training included army organisation and administration, military law, squad drill, map-reading, anti-gas training and weapon training. The technical part included lectures and discussions on the care of equipment, procedure for supplies, training of orderlies, the policy of dental treatment in the armed forces and aspects of dentistry particularly applicable to war, such as the treatment of Vincent's stomatitis and injuries to the jaws and face. The DDS and other senior dental officers gave these lectures; one of the lecturers was Lieutenant-Colonel H. P. Pickerill, CBE, NZMC (retired), whose work on maxillo-facial injuries in the 1914–18 War has already been mentioned.
As soon as time permitted the DDS issued a book of ‘Instructions to Officers NZDC’, a copy of which was given to every officer in the Corps in New Zealand. This contained all the information an page 92 officer should require in the administration and organisation of his unit, as well as certain standardisation of dental technique peculiarly applicable to the conditions of work in the armed forces. There was no attempt to influence unduly the individual officer's dental technique, but some standardisation was necessary in the matter of providing stock and equipment sufficient for all purposes everywhere in the Corps. Every officer was expected to be thoroughly conversant with the contents of the book, to keep it up-to-date with any amendments, to produce it on the demand of an inspecting officer and to keep it with him always as his ‘Standing Orders’. The first copies were distributed in 1941 but became so full of amendments that a revised edition was published in 1943 after the Corps organisation had become more stable.
It is extremely difficult in wartime to find time to train dental officers without interfering with their primary function, which is treatment of the troops. This is an added argument in favour of having a trained nucleus in peacetime ready to occupy key appointments on mobilisation for war. For example, it would be useless and dangerous to detach a sub-section from a mobile dental section in charge of a dental officer with no knowledge of map-reading, in a part of the country where all road signs had been removed. Serious attempts were made by the DDS to give each officer as much general training as possible by arranging with the staff officers at the mobilisation camps to give them drill and instruction whenever they could be spared from their dental duties, but these occasions were infrequent.
In 1941 an opportunity occurred to give the Corps some practical experience in the field. During April, May and June, field force exercises were held in each of the three military districts. According to the General Staff memorandum of 24 February, the objects of these exercises were:
To exercise commanders, staffs and leaders in functions of command and duties in the field.
To practise all ranks in field exercises in co-operation with other units, arms and services.
The NZDC took part in these exercises with both these objects as well as a third, which was to provide urgent treatment to the troops in the field. The exercises occupied fourteen days and, in each district, the number of troops involved was in the vicinity of 6000, nearly all belonging to the Territorial Force and therefore not dentally fit.
The Principal Dental Officer of each camp dental hospital group was appointed ADDS for the respective field force. Although NZDC war establishments were taken as a basis, he had to make his own appreciation after conferring with the General Staff of the field page 93 force, taking into consideration the composition of the force, the operations planned and the details of the terrain. He had to make all arrangements to provide dental service to the ‘Enemy’ and the ‘Home’ forces, and on the completion of the exercise forward a report to the DDS with recommendations and lessons learned. The exercise to be of any value to the dental officers had to be organised on a skeletal divisional scale, which made the object of providing treatment easy of achievement, but the deployment of dental forces had, to a certain extent, to rely on a conception of larger manoeuvres than actually took place. If this had not been the case there would have been little reason to move the sections or sub-sections, and the value of the exercise would have been lost. For this reason also, there was a certain amount of criticism of dental forces being farther forward than was considered wise, and this was undoubtedly true, but the front was so shallow that in actual warfare the base would have been as far forward as the dental sections would have gone and there would have been no exercise for the NZDC. As it was, by the use of imagination, the organisation had a practice run and the officers had an opportunity to learn something about movement in the field and co-operation with other units.
Training of Dental Mechanics
While recognising the excellent reputation of most of the mechanics employed in the Corps, it cannot be denied that there were some disappointments. There was no qualifying examination in civilian life to guarantee a standard of efficiency and nothing to prevent the half-trained man from claiming the status of expert. As an example, the large advertising dental firms made so many artificial dentures that some of them adopted the chain system in their laboratories, i.e., a man would be trained in one process of the work and might be retained in only that process for some time. This man could claim in all good faith that he had had years of experience in a dental laboratory, whereas in fact he was not capable of constructing an artificial denture in all its phases. Without further training he was useless to the NZDC.
A large number of mechanics were required in the Corps, not only for the large amount of work to be done in New Zealand but to accompany the troops overseas. First-class mechanics were difficult to get and, before the National Service Department took action to prevent it, several were lost to the Corps by having volunteered for service in combatant units. The result was that the Corps in the early part of the war was always short of mechanics. It therefore decided to augment the supply by training some of its own. A few men who were mechanically minded and keen to be trained were selected and classified as dental mechanic's orderlies to work in the prosthetic laboratories of the mobilisation camp dental hospitals.
PDO Papakura Mobilisation Camp to DDS, 9 September 1940:
A course of lectures and demonstrations has been arranged starting tomorrow, 10 September, for mechanic's orderlies. The four at Papakura are showing considerable aptitude for the work and I feel confident that with extra tuition it will not be long before at least two of them will be in a position to be used as junior mechanics.
In six months two of them were so appointed. They were not by any manner of means dental mechanics, but they had a working knowledge of all branches of denture construction as carried out in the army prosthetic laboratories and the opportunity to learn more. Of those trained in this way some fell by the wayside, but others served as dental mechanics in New Zealand and overseas.
This method of training was somewhat haphazard as it was not always possible to get dental officers and senior mechanics willing, or even competent, to act as satisfactory teachers. In 1943, therefore, schools were started for the specific purpose of training mechanics and dental officers appointed to devote their whole time to it. On 1 March 1943, Captains P. B. Sutcliffe and C. H. M. Brander1 and Lieutenant K. P. Tompkins2 became prosthetic officers and instructors at the mobilisation camps at Papakura, Trentham and Burnham respectively. Similar action was taken in the RNZAF when Captain O. M. Paulin was appointed on 18 March to Whenuapai Air Station.
Men and women were given a course of approximately twelve months and then sat an examination. An exception was made for trainees with previous experience who were allowed, on the recommendation of the officer commanding the school, to sit the trade test without completing the syllabus.
The candidate had to get 70 per cent marks in the technical syllabus and produce a certificate from the officer commanding the school as to his readiness for examination before being allowed to sit the test. Those not recommended were either deferred for six months or transferred to other duties as unsuitable and unlikely to qualify. There were two examiners, one being the PDO of the camp dental hospital to which the school was attached and the other was appointed by the DDS.
On passing, the successful candidates were given provisional standing as ‘B’ grade dental mechanics, NZDC, and were sent to other camp dental hospitals for a further three to six months' training. At the end of this probationary period they were given the full status of ‘B’ grade dental mechanics, NZDC, without further examination, providing the report of the officer commanding the prosthetic school was satisfactory.
There was one danger in the scheme of which the DDS was fully aware. After the 1914–18 War, dental mechanics who had served page 95 with His Majesty's Forces were given the opportunity by the Government, in the face of expert advice to the contrary, to qualify and register as dentists by a shorter and less arduous route than that of the customary dental degree or certificate. This precedent was used as a lever to persuade the Government to take similar action in this war. Certain mechanics in the NZDC in New Zealand and the Middle East were misguided enough to avoid the usual channels of communication and write direct to two Cabinet ministers on the subject. Their unorthodox approach was unfortunate for their cause, as it invited disciplinary reprisals, alienated any sympathy their officers might have had for them and sharpened the inevitable refusal. The Corps, while urgently needing mechanics and willing to train them as such, did not intend to allow them to make similar mistakes through lack of a proper understanding of the limitation of their qualifications.
A statement to the press from the annual conference of the New Zealand Dental Association held in Dunedin in September 1946, although made for the purpose of informing the public of the dangers contained in a petition to Parliament from dental mechanics seeking the right to practise prosthetic dentistry without proper training, so aptly sums up the situation that it is quoted here:
The construction of dentures for the replacement of the natural teeth demands an intricate knowledge of many basic medical and dental subjects other than technical procedures and we wish to correct any public misunderstanding which may exist regarding the capability of anyone other than a fully-qualified dental surgeon to undertake the work.
The scheme of training appeared to be satisfactory, but unfortunately it was started so late in the war that by the time the first trainees gained their full status as ‘B’ grade mechanics, there were signs of a general retrenchment and the fledglings were never tested in full flight. Judging by the comprehensive nature of the course and the interest shown in it, the scheme was of sufficient value to recommend its adoption early in a future war. Even with the advances made and being made in preventive dentistry, it is difficult to visualise a force of New Zealand troops with less than half wearing artificial dentures of some kind.
Training of Dental Orderlies
The men and women engaged as dental orderlies were selected more for their intelligence and general suitability than for their previous knowledge of dental work. Their training as dental assistants was primarily in the hands of the officers of the Corps, who varied in their capabilities as teachers and, in the very early part of the war, were in military knowledge little more than a page ahead of their pupils. With the advent of the officer's vade-mecum page 96 in 1941 there was a standardisation of training, but before that each officer taught his orderly the fundamentals of chairside assistance, care and sterilisation of instruments, mixing of amalgam and cements and recording of examinations and treatment according to his own ideas on the subjects. Training in military matters was in the hands of the Principal Dental Officers or officers commanding sections, as also was the training in specialist branches such as administration, clerical or stores NCOs. It was not the best type of training but it was all that could be done at the time, and many excellent orderlies were produced by these methods.
It was not until 1942 that a scheme was submitted whereby WAAFs were trained and examined for trade testing to classify them as Group ‘D’ (dental). A syllabus was prepared and lectures and practical tuition were given by the officers commanding the dental sections at the various Air Force stations. By this time the officers were better equipped to teach and knew much more of service procedure and Corps organisation. Trade testing was held twice a year or at the discretion of the DDS, the first taking place three months after the inauguration of the scheme. There were two main subjects:
Clerical duties and accounting for stores.
There was a written paper of one hour's duration and a quarter-hour oral examination in each subject. General capabilities were the subject of a report from the officer commanding the section to the DDS, and this was considered with the examination results. Examinations were conducted from Air Headquarters, Wellington, by arrangement with the DDS, who had control of all classification of WAAF dental personnel. The oral examinations were held on the RNZAF station. On completion of the examination the WAAFs were classified:
Group IV: WA2—Written and oral, 50 per cent in each subject.
Group IV: WA1—Written and oral, 60 per cent in each subject.
This reclassification carried an increase in pay as ‘Qualified Personnel’. This produced more highly trained assistants than the haphazard methods of the past had done.
The RNZAF was the only service to adopt this trade testing for dental orderlies, and judging by its success, it is reasonable to suggest its adoption by the other services. The tuition can be given without interfering with normal routine and should take little organisation to set it in motion. It entails extra hours of work, but the officer is repaid by more efficient orderlies and the orderly has the incentive of more pay and added interest in the subject. A sine qua non is a nucleus of officers capable of teaching and this, to begin with, would have to come from those holding commissions in the Regular Forces or the Territorial Force.