| Abstract|| |
The dental education forms the foundation of the professional lives of the dentists. In the context of the student, faculty and the curriculum constitute the main aspects of the dental education. The important perspectives of these three arena are analyzed with plausible suggestions for improvising them. The present technology-savvy "Y generation" has evolving educational needs and has to be provided with more diverse and interactive methodologies for learning and also involving information technology applications. The faculties both in terms of quality and number have profound impact on the outcomes of the dental education. The present dental curriculum needs to be reformed by correcting some inherent concerns and flaws such as inadequate clinical relevance of basic science concepts, lack of comprehensive patient care model for clinical education, and overcrowding of the curriculum. The dental education in India, despite its tremendous growth since the beginning, has some significant issues regarding the quality of dental education mostly in some private dental colleges. The Dental Council of India and the Union Government should be more stringent with reinforcing rules and regulations to assure adequate infrastructure and quality education in all the private dental colleges. More number of job postings for dentists should be created in the government hospitals, and the present inappropriately limited number of postgraduate seats should also be increased to assure the viability of the dental profession in future.
Keywords: Dental curriculum, dental education, dental faculty, dental students, Indian dental education
|How to cite this article:|
Padmapriya T. The perspectives and perceptions of dental education in the West and an overview of dental education in India. J Educ Ethics Dent 2015;5:41-6
|How to cite this URL:|
Padmapriya T. The perspectives and perceptions of dental education in the West and an overview of dental education in India. J Educ Ethics Dent [serial online] 2015 [cited 2020 Mar 30];5:41-6. Available from: http://www.jeed.in/text.asp?2015/5/2/41/188565
| Introduction|| |
The dental education is considered to be a much coveted and a demanding professional field. It requires the students to acquire a diverse collection of skills and related comprehensive theoretical knowledge within the given time span of graduation. Although there are differences in the dental education between the different countries worldwide in terms of educational systems and methods, there are many concurrences regarding the student, faculty, and curriculum perspectives. In this review, we aim to analyze these dimensions of dental education and sketch some practical suggestions that can be considered in improvising the rapidly evolving field of dental education.
Most of the advancements in the field of dental education have been limited to dental schools in developed countries, thus resulting in an expanding division between the well-established schools and those lower economic countries. Efforts are being instituted toward globally accepted competencies and quality standards in dental education. Efforts toward such convergence will also aid in interprofessional communication and exchange of professional views between countries. 
| Perception of Dental Students|| |
It is imperative to know and assess the point of view of students and their preferences toward the dental education in terms of the learning environment, the educational methodologies, and the course curriculum, so as to incorporate compatible changes into these aspects of the dental education to effectively cater to educational requirements of the students to motivate and rejuvenate their interest toward learning.
Analyzing the motives and reasons behind their option of choosing the profession of dentistry shall help in understanding the needs of the dental students, and hence, to improvise the prioritized features of the dental field. The dental students' motives toward dentistry seemed to be toward factors such as the attractive working conditions where they can choose their own working hours unlike the medical doctors, being financially more lucrative and being easier to combine work life with family life. 
In a SWOT analysis done among the students of North American and Canadian dental schools, the students reported that the teaching methods were tedious, being based only on memory recall rather than being problem-based or involving critical thinking abilities. The present generation of students are the internet generation or the so-called Y generation with expectations toward clearly explained training using readily available resources and they also prefer digital modalities such as three-dimensional (3D) dental anatomy software and internet sites with videos and demonstrations for learning their preclinical procedures.  The student's perception toward the dental school environment has not been very positive mainly due to several factors ranging from faculty-student relationship, academic overload, examinations, and grades, etc., Some strategies suggested for intervening this situation include self-assessment opportunities, collaborative learning, and international student exchange programs.  An unique educational program designed for the gen y students in a study conducted at the Harvard School of Dentistry of integrated aspects of team-based and self-directed learning with peer-to-peer teaching minimizing the need for intensive faculty supervision showed that the supposedly weak students performed markedly better toward the end of the program, which highlights that exclusively customized educational plans would effectively stimulate the students toward learning. 
A survey conducted by Hendricson et al. to analyze the students' perception of mandatory laptop programs using Institutional Readiness for Electronic Curriculum students' questionnaire surprisingly revealed that majority of the students felt that it was not necessary for their course performance though the newcomer seemed to feel more positive attitude about the laptop program than their seniors.  Even though the information technology has innumerable applications, their utility can be implemented in the dental education only if their use is necessarily validated.
The requirement or quota system has an inappropriate emphasis, and therefore, it is a major concern for the students and also a common area of complaint where the students feel compelled to act sometimes unethically toward patients being pressurized by the quota system to complete the required number of clinical cases.  This situation can be avoided and will be of benefit to both the students and patients if the emphasis of clinical training is shifted to the quality of clinical cases from the number of cases.
The student's impression of the faculty's attitude and approach toward them is an important factor that influences the learning atmosphere of the students in the dental school. Henzi et al. found that the breadth of interest was one of the positively identified two highly rated subscales which means that the students felt that the faculty valued the world outside dentistry and also encouraged extra-curricular activities of nondental interest.  Another questionnaire study conducted by Henzi et al. in 2006 involving 655 students from 21 North American dental schools to evaluate their perception about the dental school environment observed that the most positive aspect of the clinical education was the relationship with the faculty. 
| Faculty Perspectives|| |
The success of the education is always largely dependent on the educators, and hence, the dental faculties both in terms of quality and number have a profound impact on the dental education system. An immediate need for more dental faculty has always been mounting so far, which is exaggerated by the disinterest of the graduating dentists who tend to choose practice over academia as it seems to be a more lucrative career. Collaborative efforts by the professional organizations and dental education system are needed to overcome this problem of decreasing number of faculty.  The dental faculty feels that the work environment is the foremost among the criteria influencing the professional satisfaction apart from other factors such as funding for research, private practice opportunities, and scope for professional development. The knowledge of such perceptions the faculty hold toward their profession will aid in implementing appropriate measures so as to enhance recruitment and retention of the population of faculty. 
The Academic Dental Careers Fellowship Program survey on faculty interview by students found that factors such as the intellectual and scientific challenge and basic interest in teaching were the most important influences on their career choice into academics whereas the detriments to academic career choice were the student loan indebtedness and low-income level compared to the private practice and also opinioned that the academic field comprised several positive aspects that include research opportunities and diversity in job and family compatibility.  Contriving such programs will exemplify the broad scope of academic career and encourage the dental students to pursue a career in academics.
Dental science is a rapidly advancing field; hence, there always prevails a constant need for the educators in the field to continuously upgrade their knowledge and teaching skills. It is necessary for the faculty to participate in continuing dental education programs and mentorship activities to be successful teachers.  Faculty mentorship creates motivated, productive, and successful teachers who, in turn, will inspire students, thus resulting in a legacy. It also serves to promote satisfaction among the faculty and by thus creating a congenial and supportive academic environment will also improve the retention of faculty.
Ullian and Stritter have proposed a seven-tier hierarchy of faculty development strategies for effective faculty development. that includes self assessment, participation in teaching improvement courses and mentoring for new faculty etc. ,
| Curriculum|| |
The realm of dental education has advanced tremendously from the beginning many decades ago. It has been contributing to the growth of the dental profession in the ways of technological and scientific progress.  The curriculum that forms the core content of dental education and the methodologies involved in delivering the education as well need to be assessed and tailored according to the demands of the changing era of dental profession for the advantage of its stakeholders, that is, both the students and the patient population whom the dental profession ultimately strives to serve.
Kay argues that the process of education is different from what is called training in the very basic way that training will only result in creating passive people with a tendency to perform in the exact manner they were taught to do. Whereas education produces professionals with a complete understanding of their profession that would liberate them to bring about social and scientifc change in their field. 
There always exists a need for reform in the dental curricula as it has to be in accord with the current disease demographics and changing treatment demands. When the patients' availability become inadequately less to procure competence in certain procedures and the same gets reflected in the dental practice, then such procedures should be shifted from general dental curriculum to curriculum of expanded or newly created specialties. 
Incorporation of research into dental education is very important for the growth of the dental profession, and even though the accreditation standards in the USA and Canada and organizations such as the National Institute of Dental and Craniofacial Research, Age Discrimination in Employment Act (ADEA), and AADR provide the students with opportunities for research, their participation in research organizations seems very limited. The overcrowded curriculum needs to be modified by allowing room for integrating research components into the dental education. 
The National Academy of Sciences, USA, enlists the issues with the curriculum of dentistry as follows: 
- Basic science concepts being only weakly connected with clinical education and experience
- The curriculum is not sufficiently in par with the current dental science and practice
- Many problems prevail in the implementation of comprehensive patient care as a model for clinical education
- Dentistry and medicine are not well linked
- The dental curriculum being overcrowded, hence does not allow room for developing critical thinking skills.
Despite the awareness of various pitfalls and the changes needed in the present curriculum, there exist numerous challenges in its implementation such as conservatism of the faculty and economic limitations related with the implementation of the changes. The ADEA launched the Commission on Change and Innovation in dental education with the purpose of bringing about innovative changes in the education of general dentists and has proposed some important principles such as critical thinking, lifelong learning, and integration of knowledge from research into curriculum. 
Hendricson et al. state that the ability to think critically along with problem-solving skills constitutes the basis of clinical reasoning and judgment, which forms the expertise of a competent dental professional. In addition, learning strategies such as conducting case discussions and reviews and in-class quizzing with immediate feedbacks have been suggested for improving the students' critical thinking ability. 
The strategies and methods employed in the process of delivering the dental education also have to be suitably modified to cater the present tech-savvy generation of dental students. Information and communication technology has a wide spectrum of tools available for use in dental education such as communication tools of social software such as weblogs, compact disks, and digital video disks (DVDs), video conferencing, webcasting, podcasts, and virtual learning environments.  The Second Life is an example of 3D technology with simulation-based virtual settings, it utilizes avatars and role-plays for diagnosis and treatment planning and also has the advantage of providing access to participants from any campus or computer, thus facilitating collaboration of virtual communities of dental professionals from all around the world, providing extensive opportunities in the way of distance education.  A study by Nance et al.  on comparing the performance of students exposed to two different instructional modalities for carving, i.e., computer-assisted instruction (CAI) using DVD technology and traditional laboratory instruction has shown that the CAI has the potential to supplement laboratory instruction as there is a need for repeated demonstration of the technique and it is also an advantageous feature, especially in the time of faculty shortages.
Apart from the curricular content and methods of dental education, also the different strategies employed to evaluate the performance of students can motivate the students toward learning efficiently. In Pinckard et al.'s study in 2012, the performance evaluations of 2 nd year dental students were compared keeping the course content and teaching methods as same while the examination procedure was changed to a format of uncured short answer questions along with correction for guessing scoring. The study results on comparing the student's performances showed a significant improvement. 
Globalizing the competencies for dental practice by the way of promoting common curriculum components would provide more consistent learning experiences for students, and by the way of uniform methods for the assessment of competencies, a more direct comparison of global education systems can be created enabling easier licensure of dental professionals from all across the world. This shall also assure the quality and accessibility of health care to each and entire of the global population. 
| Dental Education: The Indian Scenario|| |
Dental education in India has seen a tremendous growth ever since its beginning when the first dental college was started in 1920. At present, there are about 290 dental colleges that are Dental Council of India (DCI)-recognized in India. The distribution of dental colleges across India is extremely disproportionate, with most of the dental colleges being located in Southern and Western states such as Tamil Nadu, Karnataka, and Maharashtra, hence more dental colleges need to be opened in the areas such as the Northeastern regions that are highly underrepresented, creating more equal opportunities for all the students.  In addition, the freshly graduating dentists mostly set their practice in bigger towns or metropolitan cities resulting in overcrowding of dentists in big towns and cities while the rural areas are scarce of qualified dentists. The government can correct the situation by creating policies and vacancies that can get dentists to serve in the rural areas of India. 
The theoretical quality of dental courses in India is of adequate standards being comparable to the quality of dental courses in the USA, and the students are mandated to read textbooks by leading international authors whereas in most dental schools, there are no strict weekly seminars, case presentations, or journal clubs to present treatment planning concepts at the undergraduate level, so the undergraduate students also should be actively engaged in case discussions and seminars for developing analytical and logical reasoning.  Many clinical procedures that are so commonly done in dental clinics such as crown and bridge and root canal treatment for multirooted teeth are not trained well in the undergraduate level. Even after completing the course of BDS, the students are not confident enough to be able to perform such procedures on their own and they will have to seek to train under experienced dental practioners or undergo specialty training courses privately to achieve some degree of proficiency in even doing many such routinely done dental procedures. The curriculum should be necessarily improvised by inclusion of such commonly practiced dental procedures into the agenda of the undergraduation. Newer treatment procedures that are becoming rapidly commonplace in dentistry such as laser dental treatments and dental implants should also be considered for inclusion in curriculum at the undergraduate level to enhance the competency of the graduating dentists.
The faculty requirement in India includes only the master's program in a dental specialty without any requisite for any intense research training or a Ph.D, so most faculty members do neither pursue research nor they encourage students into research, hence the Government of India and DCI should take measures to encourage the dental faculty to procure Ph.D level training and scholarships for getting training abroad.  The dental education in India can be improvised to global standards by comparing with the curriculum and teaching methodologies in the developed Western countries such as the USA and UK like the intercalated degree option, wherein the students choose elective subjects of their interest to be studied in more depth that may be clinically relevant such as psychology, health-care management, or traditional subjects such as biochemistry. The students at the end of their course may also be provided with an opportunity of traveling to institutions in other parts of the country or even abroad for academic purpose. 
At present, among the 290 dental colleges, only forty colleges are government run and the rest are private colleges. The DCI is the only statuary body governing and regulating the dental colleges, but some states in India have not taken any action to derecognize some of the ill-equipped dental colleges in spite of the negative recommendations from the DCI, so some dental colleges that are unapproved by the DCI due to poor infrastructure or facilities have continued to be functional. ,
The career prospects of dentists have been facing a serious bottleneck due to unfair proportion of the number of undergraduates passing out yearly in relation to the number of postgraduate seats.  The postgraduation seats are both limited in number and highly expensive, hence the prospects of postgraduation are very much beyond the scope of many dental graduates. Many of the dental schools do not offer job opportunities for dental graduates with only a bachelor's degree in dental surgery. Even the few dental graduates who manage getting placements in private clinics and hospitals only get a meager pay. The Indian government has the capacity to improve the situation for dental graduates by increasing the number of dental postings for dentists in the government hospitals as there is always demand for more dentists just as for doctors in such a country of ever-increasing population. In the present internet era, the general public are even more aware than before the existence of different specializations in the dental field and prefer a postgraduate dentist for their treatment needs. It is of utmost necessary that the number of MDS seats should be increased, otherwise it will only continue to make way for dentists to take up jobs in unrelated fields to thrive. 
| Conclusion|| |
The students, the faculty, and the curriculum being the most important perspectives of the dental education, it is mandatory to address and amend the drawbacks in these aspects for the success of dental education. The present generation of students find the current teaching methods monotonous and prefer more interactive learning using information technologies such as the internet and teaching software. Adequacy in terms of both quantity and quality of the teachers is essential. Mentoring and other faculty development programs serve in upgrading the knowledge and teaching skills of the faculty. The present dental curriculum has some inherent flaws such as overcrowding of patients and inadequate relevance to clinical practice. The curriculum should also be reformed with placing adequate emphasis on research and components of critical thinking and problem-based learning. The dental education in the Indian scenario has been exponentially growing, especially in terms of number of dental colleges, but the postgraduate seats will have to be increased in a fair proportion to the undergraduate seats, and more job postings for dentists need to be created in the government sector. Inclusion of best practices from Western dental education system such as implementation of in-depth study of elective subjects related or within dentistry, etc., into our Indian dental curriculum which will also help in upgrading our dental education to international standards.
I would like to express my thanks and sincere gratitude to Dr. Sivapathasundaram for his invaluable guidance and constructive comments in improving the article and thanks to Dr. B. Kavitha for her suggestions and support toward contriving the article.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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