Learning from COVID-19
Exploring emerging innovative learning opportunities for dental postgraduate education and training
This article reflects on the learning that has emerged from the COVID-19 pandemic and highlights the innovative opportunities for postgraduate dental education as a direct consequence of the continuing global challenge on the health and social care sector. We discuss the need to move away from a traditional teaching pedagogy and adopt an adult-learner centred approach, in order to refocus training priorities to meet the changing requirements of the healthcare system.
The global impact of COVID-19 has personally affected everyone. Regardless of the challenges faced, no-one has been left untouched and everyone has had choices taken away. According to the International Association of Universities, more than 1.5 billion students and young people globally have been affected by school and university closures directed related to the pandemic.1 While social media and digitalisation within dentistry prior to COVID-19 was becoming a key influencing factor in the delivery of education and training for undergraduate dentists, this has exponentially increased in response to the pandemic. Teaching has transferred seamlessly into virtual classrooms, conferences delivered remotely, recruitment held via global proctored selection centres and clinical skills training delivered through virtual reality portals. Education has rapidly moved into the age of the ‘Digital Dentist’, which is offering versatility and exciting opportunities for innovating with technology.
When the four UK Chief Dental Officers called for the cessation of routine dental services in March 2020, there was an automatic disruption to education and training. Despite the challenges imposed through suspension of training and the reduction of face-to-face dentistry it became apparent that, as educators, the focus should not solely be on the recommencement of aerosol generating procedures but viewed as a genuine opportunity to redefine training.
COVID-19 has already made a lasting impact on the delivery of dental services but the longer-term changes to the shape of the oral health workforce have yet to be fully determined. It is obvious that the public health implications will drive educational changes for the entire healthcare workforce and dentistry has a unique opportunity to embed the importance of oral health as part of maintaining overall general health. Dental multi-disciplinary teams, with colleagues in health and social care sectors, must develop closer interprofessional working. It is no longer aspirational to simply consider collaborative care, where oral health is included within medical care plans, but it is vital that we start to ensure delivery is across an integrated healthcare system.
This reprioritisation of oral health must be driven by the dental profession, which can use this opportunity to not only reform dental education, but also to reframe expectations of patients and public. It has been highlighted that a well-planned and conducted Interprofessional Education strategy (IPE) can support a “flexible, co-ordinated, complementary, patient centred and cost-effective collaboration in interprofessional teams within a policy-aware understanding of organisational relationships”.2 If IPE is already recognised within the undergraduate health and social care curricula, this is a challenge to dental training, where interprofessional working has yet to be widely integrated. Interprofessional working currently exists within dental teams however the maturity of working relationships across the wider health and social care sector needs careful exploration. This provides opportunities to innovate and offers a vision for future programme development.
The dental professions response throughout the pandemic period however does highlight innovative opportunities and the ability to adapt to adversity. As foundation training was significantly disrupted many trainees were redeployed across the entire health and social care system. There are many published reports of trainee experiences from being deployed into primary, community and secondary care settings where they were able to rapidly and safely utilise existing core competencies into different clinical environments. These ranged from telephone triaging, working in ITU and high dependency units, PPE distribution, hospice care and swabbing centres.
Despite the inevitable anxiety posed by the prospect of re-deployment, trainees proactively supported requests for assistance. These unique volunteering opportunities even extended to COVID-related research where for the full duration of lockdown, several foundation dentists worked alongside a range of medical specialties to collect data from COVID-positive patients. This immersive, interprofessional, educational experience provided insights into hospital working and presented opportunities to develop additional skills such as research methodology, communication and multi-disciplinary working. Clinical skills such as phlebotomy, cannulation, swabbing and medical imaging interpretation was gained and assessed as part of their training programme competencies. Embedding dentists into established medical teams demonstrated how a collaborative approach to delivering patient-centered care provided additional transferrable skills that would benefit their future patients.3 More importantly it has provided an insight into future careers opportunities, both within and outside of dentistry.
As the country faces renewed surge activity, dentistry will inevitably be challenged with further disruption to services and training. With restricted access to patients created by social distancing and reduction in aerosol generating procedures the education and training system must adapt in order to maximise clinical training time. This time, however, the profession will benefit from prior learning and be more prepared to adapt through the rethinking and reshaping within dental education. While patient access will be limited, the emergence of technology and digitalisation through In-situ simulation, haptic technology and virtual reality programme will become an important adjunct for clinical skills acquisition, maintenance and assessment. However, the true learning has been the versatility and resilience of the dental workforce, the ability to integrate across different sectors and clear identification of the reciprocal benefits of dentistry being part of the wider healthcare system. When dentistry is finally re-established, it is hoped the learning from COVID-19 will remain an integral part of future working, which will benefit patients, the profession and interprofessional relationships.