| Abstract|| |
The dental education forms the foundation of professional lives for the dentists with respect to students, faculties, and curriculum which are considered the main aspects of the dental education. The important perspectives of these three arenas should be analyzed with plausible suggestions for improvising them. In order to meet the inevitable increase in demand for training, teaching, and learning, innovative approaches are required and dental academia should be asked to respond. The educational needs can be viewed as a three-dimensional problem, increased breadth across the dental team, vertical integration within and between specialties, and the longitudinal expansion with lifelong learning and continuing professional development. 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. In many countries, the practice of dentistry is only permitted after passing an examination to get dental license for few years. Furthermore, this license should be renewed with essential continuing dental education, which is considered an international trend for reconciling. 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 dental colleges.
Keywords: Clinical practice, continuing dental education, dental curriculum, dental faculty, dental students
|How to cite this article:|
Pereira T. The role of continuing dental education in clinical practice. J Educ Ethics Dent 2017;7:25-9
| Introduction|| |
The dental education is a coveted and a demanding professional field. It requires that students should acquire a diverse collection of skills and related comprehensive theoretical knowledge within the given time span of their graduation years. Although there is a difference in the dental education between different countries worldwide in terms of educational systems and methods, there are many concurrences regarding the student, faculty, and curriculum perspectives.
Mostly advancements in the field of dental education are 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.
Recently, to practice dentistry in most countries all over the world, all doctors are required by law to be registered in councils and to have a license for dental practice. Achieving good dental practice requires doctors to keep their scientific knowledge and skills up to date throughout their work as well as to maintain and improve their clinical performance and attitude.
| A Students' Point of View|| |
It is important that one should know and assess the point of view of students and their preferences toward the dental education in terms of the learning environment 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 (strengths, weaknesses, opportunities and threats) 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 is the internet generation or the so-called “Y” generation with expectations toward clearly explained training using readily available resources, and they also prefer 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 improvising this situation include self-assessment opportunities, collaborative learning, and international student exchange programs.
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 the patients by 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 mean that the students felt that the faculty valued the world outside dentistry and also encouraged extracurricular 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 Point of View|| |
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. 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 that the faculty holds toward their profession will aid in implementing appropriate measures so as to enhance recruitment and retention of the population of faculty.
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 the Continuing Dental Education (CDE) 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.
Ullian and Stritter 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.,
| What Does The Curriculum Say|| |
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 need to be assessed and tailored according to the demands of the changing era of dental profession.
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. Education, on the other hand, produces professionals with a complete understanding of their profession that would liberate them to bring about social and scientific changes in their field.
There always exists a need for reform in the dental curriculum as it has to be in accord with the current disease demographics and changing treatment demands. When the patients' availability becomes 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.
| International Accreditation Standards|| |
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 provide the students with opportunities for research, their participation in research organizations seems very limited.
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
- The curriculum is not sufficiently in par with the current dental science and practice
- Dentistry and medicine are not well linked
- The dental curriculum being overcrowded, hence does not allow room for developing critical thinking skills.
In 2014, the Dubai Health Authority (DHA) was pleased to present the CDE guidelines, which represent a milestone toward fulfilling the DHA strategic objective which is to “ensure quality, stability, and availability of health-care professionals.”
According to the DHA, the strategy guidelines include the following:
- Benefits to the patient
- Patients receive safe, high-quality, and evidence-based service.
Benefits to the professional
- Improves confidence in delivery of professional service
- Promotesand maintains competence to practice
- Improves satisfaction with work role
- Provides structure and support for the health professional and his or her valued goals
- Enhances career opportunities.
Benefits to the organization
- Contributes to meeting the increasing demand for accountability, flexibility, and a skilled and competent workforce
- Improves interprofessional working
- Improves staff motivation and morale
- Contributes to quality assurance.
Exemption from CDE requirements will be granted to the following categories.
- Interns and residents
- Nonpracticing health-care professionals
- Completion of recognized higher education program in the related field (certifications, master or PhD degree, etc.). CDE exemption will be limited to the period of study (e.g., 1-year diploma will exempt the professional from 1-year CDE requirements).
In Pakistan, the CDE has wide-ranging competencies necessary to practice high-quality dentistry, including medical, managerial, ethical, social, and personal skills. According to the Pakistan Medical and Dental Council, specific standards and guidelines were developed for the renewal of license to practice dentistry. According to which, license to practice is given only to those medical/dental practitioners/specialists who have completed at least 5 credit hours/years (for general practitioners) and 10 credit hours/year (for specialists) of training of CDE. These training shall be conducted by recognized Degree Awarding Institute listed on Higher Education Commission website in Islamabad, Pakistan.
Ucer et al. investigated the current trends and status of CDE in implant dentistry (ID) in Europe. In most European countries, previous surveys had shown that newly graduated dentists do not obtain adequate theoretical knowledge, especially the clinical skills in ID through their undergraduate education. Therefore, they must acquire knowledge and develop competencies through further postgraduate learning.
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 American Dental Education 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. stated 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). The second life is an example of three-dimensional technology with simulation-based virtual settings, and 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.
| Dental Education in India|| |
Dental education in India has seen a tremendous growth ever since its beginning when the 1st dental college was started in 1920. At present, there are about 290 dental colleges that are the 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 practitioners 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 under graduation.
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 PhD, 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 PhD-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 finds the current teaching methods monotonous and prefers 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.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Divaris K, Barlow PJ, Chendea SA, Cheong WS, Dounis A, Dragan IF, et al.
The academic environment: The students' perspective. Eur J Dent Educ 2008;12 Suppl 1:120-30.
The Statutory Regulatory and Registration Authority for Medical and Dental Education and Practitioners for Pakistan: Pakistan Medical and Dental Council (PM and DC) Guidelines for Continuing Medical Education (CME)/Continuing Dental Education (CDE); 2012.
Kristensen BT, Netterstrom I, Kayser L. Dental students' motivation and the context of learning. Eur J Dent Educ 2009;13:10-4.
Henzi D, Davis E, Jasinevicius R, Hendricson W. In the students' own words: What are the strengths and weaknesses of the dental school curriculum? J Dent Educ 2007;71:632-45.
Henzi D, Davis E, Jasinevicius R, Hendricson W, Cintron L, Isaacs M. Appraisal of the dental school learning environment: The students' view. J Dent Educ 2005;69:1137-47.
Henzi D, Davis E, Jasinevicius R, Hendricson W. North American dental students' perspectives about their clinical education. J Dent Educ 2006;70:361-77.
Livingston HM, Dellinger TM, Hyde JC, Holder R. The aging and diminishing dental faculty. J Dent Educ 2004;68:345-54.
Shepherd KR, Nihill P, Botto RW, McCarthy MW. Factors influencing pursuit and satisfaction of academic dentistry careers: Perceptions of new dental educators. J Dent Educ 2001;65:841-8.
Schrubbe KF. Mentorship: A critical component for professional growth and academic success. J Dent Educ 2004;68:324-8.
Hendricson WD, Anderson E, Andrieu SC, Chadwick DG, Cole JR, George MC, et al.
Does faculty development enhance teaching effectiveness? J Dent Educ 2007;71:1513-33.
Ullian JA, Stritter FT. Types of faculty development programs. Fam Med 1997;29:237-41.
Field MJ. Institute of Medicine, Committee on the Future of Dental Education. Editor Dental Education at the Crossroads: Challenges and Change. Washington, DC: National Academy Press; 1995. Available from: http://www.nap.edu/catalog/4925.html
. [Last accessed on 2018 Jan 12].
Kay E. Dental education-shaping the future. Br Dent J 2014;216:447-8.
Bertolami CN. Rationalizing the dental curriculum in light of current disease prevalence and patient demand for treatment: Form vs. Content. J Dent Educ 2001;65:725-35.
Emrick JJ, Gullard A. Integrating research into dental student training: A global necessity. J Dent Res 2013;92:1053-5.
Dubai Health Authority, Health Authority Abu Dhabi and Ministry of Health-UAE: Continuing Professional Development (CPD), Guideline, Health Regulation Department; 2014.
Ucer TC, Botticelli D, Stavropoulos A, Mattheos N. Current trends and status of continuing professional development in implant dentistry in Europe. Eur J Dent Educ 2014;18 Suppl 1:52-9.
Haden NK, Andrieu SC, Chadwick DG, Chmar JE, Cole JR, George MC, et al.
The dental education environment. J Dent Educ 2006;70:1265-70.
Hendricson WD, Andrieu SC, Chadwick DG, Chmar JE, Cole JR, George MC, et al.
Educational strategies associated with development of problem-solving, critical thinking, and self-directed learning. J Dent Educ 2006;70:925-36.
Feeney L, Reynolds PA, Eaton KA, Harper J. A description of the new technologies used in transforming dental education. Br Dent J 2008;204:19-28.
Phillips J, Berge ZL. Second life for dental education. J Dent Educ 2009;73:1260-4.
Nance ET, Lanning SK, Gunsolley JC. Dental anatomy carving computer-assisted instruction program: An assessment of student performance and perceptions. J Dent Educ 2009;73:972-9.
Schwartz B, Bhan A. Professionalism and challenges in dental education in India. Indian J Med Ethics 2005;2:119-20.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68:28-33.
Elangovan S, Allareddy V, Singh F, Taneja P, Karimbux N. Indian dental education in the new millennium: Challenges and opportunities. J Dent Educ 2010;74:1011-6.
Rao LN, Hegde MN, Hegde P, Shetty C. Comparison of dental curriculum in India versus developed countries. NUJHS 2014;4:121-4.
Comptroller and Auditor General Report No. 14 of Year 2012-13 on Dental Council of India. Available from: http://www.saiindia.gov.in//
.[Last accessed on 2018 Jan 12].
Jain H, Agarwal A. Current scenario and crisis facing dental college graduates in India. J Clin Diagn Res 2012;6:1-4.
Sivapathasundharam B. Dental education in India. Indian J Dent Res 2007;18:93. [Full text]
Dr. Treville Pereira
Department of Oral and Maxillofacial Pathology and Microbiology, School of Dentistry, D. Y. Patil University, Sector 7, Nerul, Navi Mumbai - 400 706, Maharashtra
Source of Support: None, Conflict of Interest: None