Dentistry in 4D
Dundee University has taken what it believes to be the most radical step in modernising the way dental students learn
At its heart, the curriculum integrates clinical science with clinical practice. That means, at Dundee, a dental student will carry out clinical practice from week one; that’s huge.” Dr Andrew Mason, Clinical Senior Lecturer at Dundee University’s School of Dentistry, is explaining its new curriculum. Relatively new, that is; the first students to embark on it are entering their second year and the second cohort of first years started last month.
Mason emphasises that students don’t practise on patients in week one, but every Friday afternoon in first year they are on a clinic. “It makes them feel like a dentist, it’s what they want to do,” he said. “So, by the end of the first module, up to Christmas, one of the key endpoints is the ability to carry out a simple dental and oral examination and to take a history from a ‘patient’.
The curriculum integrates clinical science with clinical practice … at Dundee, a dental student will carry out clinical practice from week one; that’s huge
Dr Andrew Mason
“And we have structured the learning around that endpoint. What do you need to know to examine the mouth? You need to know what it looks like. You need to know what’s underneath the surface, and to be able to chart the dentition; identify what’s present and what’s missing. To take a history you need to understand the information the patient might give you, and to know something of cardiovascular disease and respiratory disease. And we use spiral teaching, where a student learns more about a subject each time the topic is reviewed or encountered.”
With the existing five-year curriculum, the first two years are largely about science; anatomy, physiology and biochemistry, oral biology, cell biology, microbiology, pathology, and dental materials. Towards the end of the second year, there is an introduction to clinical skills – in preparation for entering the clinical phase of the curriculum in the third year. “It has been a very successful curriculum, producing good graduates throughout,” notes Mason.
The new programme, however, reflects both changes in what the General Dental Council (GDC) expects from a curriculum and a wider recognition of how pre-university education generally has changed in the past 30 years.
“I came to Dundee in 1985,” said Mason. “The education system today is quite different to what it was then, but we hadn’t made changes in higher education to reflect this.
“One of the issues with the curriculum prior to 2018 was the content and how it was structured, and the other was how the learning was delivered and what the students did,” he said. “It is a good course, no question, and well taught – but it is lecture driven. Students learn important anatomy and physiology in the first year which is very relevant to clinical practice, but out of a clinical context. They are examined and progress. But when they come to use that knowledge in the third, fourth, and fifth years it might not be as fresh in the mind.”
In addition, observed Mason, the GDC wants dental students to be lifelong learners, “team workers, problem solvers, ethical lifelong learners – and we were concerned that a lecture-based course wasn’t supporting that ambition.” Change did not happen overnight; it’s a challenging process, said Mason. The curriculum review began in 2011, restructuring in 2013, and in 2016 – preparations for its roll-out. The ability to assess information and make changes in practice based on evidence, as well as management, mentoring, and communication skills; they are all to the fore.
“In my day, the dentist was the team,” laughs Mason, “nowadays, the team is much broader than that and possesses a much wider range
The new programme has been dubbed ‘4D’; Dentistry @ Dundee, Driven by Discovery. “We are supporting students to discover for themselves and be motivated, self-directed learners. It’s not a curriculum where the student is just a passive sponge,” said Mason. “Traditionally, the curriculum was driven by the medical curriculum. When I was a student, we shared the physiology class with the medics. In terms of the physiology of the heart and circulation, we were getting the same as the medics. Do dentists need to know as much?
“So, some things we have taken out, where they are perceived to be not as relevant to a practising dentist and there have been some things that have been strengthened. We want students to see the wood for the trees. The aim of current curriculum is to identify what a student needs to know, and what skills they need. We looked at relevance and we made sure all the foundation science is clearly linked to clinical practice. We are integrating clinical science with the practice. For example, we link physiology to disease and clinical presentation, rather than doing it at separate stages.”
From week one, students are introduced to the clinical environment. They learn about cross-infection control, about posture and how to position themselves, and learn to take a patient history. Once they have passed their assessments, in the second half of the first year some of the clinical sessions will involve seeing patients and developing clinical skills, such as hand instrumentation, scaling, and rotary instrumentation. “It might sound radical, but it’s what our colleagues in hygiene and therapy have done for years,” said Mason. “But we are careful to make sure students are able to properly apply their skills and are tested before they move to the
“In terms of the element of discovery, with lectures students are passive. We want students to have drive and a passion to learn, to develop skills so we have reduced lecture component. We are trying to make each class one where a student will engage. We’re using the term iClass, for interactive class, instead of a lecture. Rather than me standing up and talking about occlusion, we steer the students on the need to classify occlusion and they research it.
“We have a new facility here which is an integrated learning suite designed for group-based learning and with screens to which they can connect their devices. We set them tasks and they get used to researching, assessing, and presenting. There are team-based learning sessions where students have a series of cases that they explore throughout the year, supported by practical and clinical activity, culminating in a presentation or a poster.”
An overarching theme of students’ time at Dundee is ‘transition’. “We have three transitions,” explains Mason. “From school to university life. In the past, we didn’t do that great; we’re much better now on wellbeing. The second transition is into clinical practice. And the third is from dental school into the real world.
“So, for the first two or three weeks we discuss what it means to be a dentist – rather than membrane physiology! What the dental team is about, what’s your role, what does it mean to be a professional, to be a lifelong learner? We get them to use the learning resources from day one. And resilience; the importance of looking after themselves.
“The transition into clinical practice is smoother and more logical. Previously, it was two years non-clinical and then – bang! Every day in the clinic, and that could be stressful for students; speak to a patient, give anaesthetic, drill tooth, fill it – and then be in a fit state to talk to the patient afterwards.
“Now, as I have said, we roll skills out gradually. Get them used to the clinical environment. Next, some patient work alongside lab work, for example managing caries. Then simple restorative work, and so on. Finally, the transition into vocational training with the clinical and life skills they need, clinical practice, and experience of the dental practice environment.
“I think we have taken a radical step, perhaps the most radical in the UK.”