Implications of the growth of dental education in India

By influencing the supply of trained human resources, the dental education sector can play a significant role in influencing policy goals of ensuring good quality and equitable access to oral health services in developing countries. Our research goal was to assess quantitatively the size of the Indian dental education sector, its growth over time, and the implications of this growth for equity and quality in oral health care. Information on the location of teaching institutions, the year of establishment, type of ownership, and seat capacity was obtained from government sources, the Dental Council of India, and websites of individual institutions to estimate the growth in the undergraduate dental education sector, including the role of the private sector from 1950 to 2005. Data on location of training capacity and institutions were used to assess the geographical distribution of undergraduate dental education capacity in India. Registration data on dentists, the size of available faculty relative to regulatory requirements, and penalties imposed on offending faculty and education institutions were used to assess the impact of the growing Indian dental education sector on graduate quality and equitable access. Dental colleges and enrollment capacity have grown rapidly over the five decades since 1950, mainly due to a growing private sector. There is regional inequality in the location of dental education schools in India with a bias toward economically better-off regions. The growth in the dental education sector has translated into increased overall access, although accompanied by rising inequality in access and possibly lower quality of dental education.

Tobacco cessation interventions in dental networks: a practice-based evaluation of the impact of education on provider knowledge, referrals, and pharmacotherapy use

Tobacco is a significant risk factor for oral diseases. Dental care providers have the opportunity to inform patients about the risks associated with tobacco use and refer them to tobacco cessation resources. Although dental teams usually ask their patients about their tobacco use, most do not provide tobacco cessation counseling. This project involved four staff-model dental clinics and four contracted network dental clinics. Project goals were to 1) describe current practice patterns of tobacco cessation intervention, 2) increase the use of steps for treatment, known as the 5 As, recommended by the U.S. Public Health Service, 3) increase referrals to a tobacco helpline, and 4) increase use of pharmacotherapy for tobacco dependence treatment. The project included training and program support (e.g., sharing of project data, weekly newsletters, discussion at clinic meetings). Results indicate that this approach to addressing tobacco dependence in a dental clinic setting can effectively change dental provider knowledge and action.

Application of an interactive computer program to manage a problem-based dental curriculum

Managing the change from traditional to problem-based learning (PBL) curricula is complex because PBL employs problem cases as the vehicle for learning. Each problem case covers a wide range of different learning issues across many disciplines and is coordinated by different facilitators drawn from the school's multidisciplinary pool. The objective of this project was to adapt an interactive computer program to manage a problem-based dental curriculum. Through application of a commercial database software--CATs (Curriculum Analysis Tools)--an electronic database for all modules of a five-year problem-based program was developed. This involved inputting basic information on each problem case relating to competencies covered, key words (learning objectives), participating faculty, independent study, and homework assignments, as well as inputting information on contact hours. General reports were generated to provide an overview of the curriculum. In addition, competency, key word, manpower, and clock-hour reports at three levels (individual PBL course component, yearly, and the entire curriculum) were produced. Implications and uses of such reports are discussed. The adaptation of electronic technology for managing dental curricula for use in a PBL curriculum has implications for all those involved in managing new-style PBL dental curricula and those who have concerns about managing the PBL process.

Results of the questionnaire on orthodontic boards

There has been a proliferation of Orthodontic Boards across the world but there is no uniformity in standards, purposes or in the type of examination. In order to promote discussion at the International Orthodontic Congress in Paris in September 2005 a questionnaire was sent out to 80 Orthodontic Societies on the World Federation of Orthodontists list. There was a limited response to the questionnaire but the results are described in this paper. It illustrated that there were mainly two types of Board, mandatory ones that acted to license the Orthodontist in that country on the Specialist register and voluntary ones where the orthodontist demonstrates his excellence. The paper describes the answers to the various questions asked on the purpose, eligibility and type of examination of the Boards. They were also asked about the feasibility of an International Board. This was rejected as an option but an affiliation of Boards was recommended.

Dentistry, nursing, and medicine: a comparison of core competencies

Health care, including oral health care and oral health education, is under great stress in the United States. The cost of and access to care, the cost of dental education, and a shortage of educators have led leaders in dental education, organized dentistry, and the public sector to underscore the problem. One of the proposed solutions is to find synergies and new health care and education models by building bridges among the health professions. One potential solution is being implemented at the NYU College of Dentistry (NYUCD). Dentistry and nursing are seemingly unrelated professions, and they are rarely if ever modeled together. That is about to change with the joining together of NYUCD and the Division of Nursing of the NYU Steinhardt School of Education in creating a College of Nursing within the College of Dentistry. This process has not been without controversy. Following the Division of Nursing's request to join NYUCD, and the subsequent announcement of the proposed combination by NYU in December 2004, some members of the dental profession responded by questioning the appropriateness of the merger and the similarity of the two programs. Nevertheless, substantial parallels exist in the education and practice of dentists and nurse practitioners (NP) including basic, social, and some clinical science education, practice models, research synergies, and community service. However, similarities in the core competencies of these professions have not been analyzed formally and in detail. Accordingly, the purpose of this study was to compare the core competencies of nurse practitioner and dental education programs. The results show a surprising overlap of the core competencies of the dental and nursing professions (38 percent partial or total overlap). A similar overlap with medicine also exists, albeit lower (25.4 percent). These results are notable because they demonstrate that the three health professions, independently of one another, developed very similar basic competencies and learning objectives. These data should encourage other health professions programs to seek new collaborative models for education, beyond the current silos of training, and new health care delivery systems as has been strongly recommended by the Institute of Medicine. Such collaborative education redirects health care toward providing truly interdisciplinary comprehensive primary care for patients.

Confronting shibboleths of dental education

Shibboleths are common expressions presented as indisputable truths. When used in educational discussions, they reflect "motherhood and apple pie" viewpoints and tend to bring debate to a halt. Use of shibboleths may precede a desired imposition of "locksteps" in educational programming and are easily perceived as paternalistic by recipients. Nine shibboleths are presented as common beliefs of dental faculty and administrators. Evidence contradicting the veracity of the "obvious truths" is offered. The traditional "splendid isolation" of dentistry contributes to parochialism and belief in false shibboleths. Sound principles of higher and health professions education, student learning, and dental practice apply to dental education as to all health disciplines. Student passivity in dental education is not the best preparation for proficiency in dental practice. The master teacher possesses a repertoire of methodologies specific to meeting defined educational objectives. Active learning experiences bear close resemblances to professional duties and responsibilities and internally motivate future doctors of dental medicine. The difficulty in achieving curricular change leads to curricular entrenchment. Dentistry and dental education should not trade their ethical high ground for the relatively low ethical standards of the business world. Principles of professional ethics should govern relationships between dentists, whether within the dental school workplace or in practice. Suggestions are made on how to confront shibboleths in dental school settings.

A model for widening access into medicine and dentistry: the SAMDA-BL project

OBJECTIVES

To assess whether assistance with and/or advice on the UK Universities & Colleges Admissions Service (UCAS) application process by undergraduate medical and dental students increases the offer rate to applicants from educational institutions situated in areas of socio-economic deprivation for medical and dental courses.

METHODS

A sample of 42 students making 172 applications in 2001 and another sample of 40 students making 158 applications in 2002 from 4 further education and sixth form colleges across East London were entered into the study. Applicants were either offered advice and assistance with writing their personal statement and extra curricular activities, such as work experience (group A) or advice only on the importance of the personal statement and extra curricular activities (group B). Applicants were also assisted with or advised to submit their applications early. All applicants were offered mock interviews. Main outcome measures The number of offers made to applicants by medical and dental schools and the dates of offered interviews.

RESULTS

The total offer rate rose from 9% (preceding 4 years) to 38% (CI 25-51%, P < 0.05) in 2001 and 44% (CI 27-61%, P < 0.05) in 2002, confirming a rising trend in offers to applicants in group A. Applicants who were only advised on the importance of the personal statement and extra curricular activities (group B) showed smaller increases, ranging from 10% to 29% for 2001 and from 28% to 37% for 2002. The dates for the offered interviews were earlier in group A than group B.

CONCLUSIONS

Undergraduate students can help applicants to medical and dental schools from socio-economically deprived areas submit earlier, improved UCAS applications and provide interview practice, all of which are associated with a higher offer rate. Applicants benefit from advice on activities such as work experience, community work and personal interests, but assistance in organising such activities increases the offer rate more. The study was conducted during a period of time when there was an increase in the number of medical school places available. Therefore, more research is needed to confirm that such assistance can increase applicants' offer rates elsewhere, particularly applications from students who traditionally would not apply for medicine or dentistry.

An investigation of the acceptability of undergraduate supervision by Senior House Officers and General Professional Trainees

AIM

This study assessed whether Senior House Officers (SHO)/General Professional Trainees (GPT) are, or would be, comfortable supervising clinical undergraduates, whether they find this to be a valuable experience within their training programme, and whether undergraduates are or would be comfortable with SHO/GPTs supervising them.

METHOD

Questionnaires were distributed to fourth and final year students at Glasgow and Dundee Dental Schools and fourth year students at Newcastle Dental School. Questionnaires were also distributed to SHO/GPTs at Glasgow Dental Hospital and School and Edinburgh Dental Institute.

RESULTS

Seventy-nine per cent of respondent SHO/GPTs were currently not involved in the supervision of undergraduates within their present rotation, 65% of whom stated that they would value the experience of this within their training. Of those involved in supervision, 83% found the experience valuable. Forty-four per cent of students were unsure or not comfortable with SHO/GPTs supervising within an oral surgery department and approximately the same in other departments. Twenty-eight per cent of respondents felt that university lecturers should be the main trainer.

CONCLUSION

SHO/GPTs value supervising undergraduates as part of their training experience. More than half of students are comfortable with SHO/GPTs supervising them. Both groups suggest that SHO/GPTs should receive some form of training in teaching prior to supervising undergraduates.

[Odontology in Spain: towards the integration to the European high education space]

The European Higher Education Space (EHES) is a project to harmonize all the European University systems in order that all of them will posses a homogeneous structure of undergraduate, graduate and post graduate studies. The time period established to implement this project is year 2010. The present paper describes the establishment of a new career degree model in Spain, the degree in Dentistry that started twenty years ago. Also it has been stated the number of the present Departments and Schools, the access system to Public University Schools of Spain, the evaluation system, and which are the new mechanisms incorporated in the Spanish University system to implement this integration to the EHEE. This is the moment to design the new master guidelines to obtain homogeneous career degrees that may imply more accessibility and mobility of students and professionals.

Enhancing ethical behavior: views of students, administrators, and faculty

In an article published in the April 2004 issue of the Journal of Dental Education, Dr. Charles Bertolami proposed that our ethics curricula don't work due to the limitations of didactic education. He suggested that ethics should be taught as a "precurriculum" course prior to entering dental school and that the dental school ethics course should be elective and consist of small groups of students who are guided to introspection to understand their true self-interest. He argued that "enlightened" self-interest is the best means to motivate students to behave ethically. Our article was stimulated by Bertolami's contentions. Six essays are presented that offer perspectives on the issue of professional ethics and ethics instruction from the viewpoints of students, administrators, and faculty at one dental school. The student essays support the difference between teaching about ethics and changing behavior and discuss the pressures to cheat in dental school. Bertolami's proposition regarding the role of self-interest in ethical decision making is examined. The final essays discuss the ways that ethics curricula and dental schools can encourage students to internalize the values of dentistry. They conclude that while some of Bertolami's propositions may have merit, many do not seem to accomplish the desired goals of inculcating ethics or enhancing ethical behavior in dental students, and they encourage further discussion of ethical instruction.

Why our ethics curricula do work

The purpose of this article is to respond to Dr. Charles Bertolami's article "Why Our Ethics Curricula Don't Work" in the April 2004 issue of the Journal of Dental Education. This article analyzes the arguments put forth by Bertolami and challenges his assumptions and conclusions. Several examples are given of the ways in which our current ethics curricula do, in fact, work.

Reforming dental health professions education: a white paper

The oral health education system is in need of major reform! This is especially apparent in university-based education for the health professions. So-called preclinical as well as clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and patient/population desires and expectations, changing health system expectations, evolving interdisciplinary expertise and practice requirements, new scientific discoveries and scientific information, focus on quality improvement, and/or integration of emerging technologies. Moreover, university-based "dental education" is the most costly professional degree education within the entire university portfolio, and dental student accumulated debt is increasing each year well beyond national inflation estimates. Today, we have an enormous opportunity to explore major reforms in health professional education. Through the Santa Fe "process" of open and candid engagements and discussions (see www.santafegroup.org), we advance an argument as well as a national strategy that can enable major reforms in the oral health education system. We further suggest that major revisions can result in an outcome-based education system that prepares oral health professionals to meet both the needs of patients/families/communities and the requirements of a changing health system.

The dental curriculum at North American dental institutions in 2002-03: a survey of current structure, recent innovations, and planned changes

This study examined the current format of curricula at North American dental schools, determined curriculum evaluation strategies, and identified recently implemented changes as well as planned future innovations. The academic affairs deans of sixty-four North American dental schools received an email survey in August 2002; a second, follow-up survey was sent to nonresponders in February 2003. Online responses were collected and analyzed using SurveyTracker software. The final response rate was 87 percent, with forty-eight U.S. schools and eight Canadian schools responding. Respondents were asked to select descriptive statements about the general organization of their curricula and the degree to which problem-based learning (PBL), case-reinforced learning (CRL), curricular integration, and community-based clinical treatment experiences were incorporated. They were also requested to identify strategies employed to evaluate the curriculum and to report recently completed and desired future curriculum modifications. In regard to desired future curriculum innovations, respondents identified why they were considering curriculum changes and identified resources needed to implement the planned changes. Sixty-six percent of those who responded defined their current curriculum organization as primarily discipline-based with a few interdisciplinary courses. Nearly 60 percent of schools reported that they used PBL and CRL in specific courses or for components of certain courses, but only 5 percent of the respondents indicated that all of their courses used PBL. Regarding integration of major sections of the curriculum, only 7 percent reported that their entire curriculum was organized around themes of interrelated topics. Sixty-four percent reported that their curriculum had required community-based clinical treatment experiences for students. The most frequent innovations in the past three years were increased use of computer and web-based learning (86 percent), creation of patient care experiences early in the curriculum (84 percent), enhancement of competency evaluation methods (84 percent), and curriculum decompression (79 percent). These items plus increased community-based care were the most frequently identified future curricular innovations. There were virtually no differences between the responses of Canadian and U.S. dental schools. The results of this study help to broadly characterize dental curricula at North American dental institutions and identify curriculum modifications anticipated by the academic dean respondents.

Academy: strengthening the educational mission in academic health centers

A dental school in the modern academic health center often finds that its traditional mission of educating dentists has become more complex as a result of the increased emphasis placed on research and patient care. Although health care education clearly benefits from a rich environment including research and patient care, faculty often find themselves conflicted about their roles in the complex mix of activities in the health center. In order to support faculty in their educational activities, several schools have formed organizational structures with the specific purpose of providing financial and developmental assistance. This article describes a model for an organizational structure within the Harvard School of Dental Medicine designed to promote educational excellence and then describes two academies dedicated to promoting teaching quality at Harvard Medical School and at the University of California at San Francisco.

Dentocase - open-source education management system in dentistry

Since 2001, an interdisciplinary project on multimedia education in medicine has been sponsored by the Federal Ministry of Education and Research at the Charité. One part of the project is on dentistry. In the light of the results of a survey of dental students, an Internet-based education management system was created using open-source back-end systems. It supports four didactic levels for editing documentation of patient treatments. Each level corresponds to the learning abilities of the students. The patient documentation is organized to simulate the working methods of a physician or dentist. The system was tested for the first time by students in the summer semester of 2003 and has been used since the winter semester of 2003 as part of the curriculum.

Why our ethics curricula don't work

The impact our ethics curricula have on students seems marginal at best. Students take the ethics courses we offer and pass the tests we give, but no one's behavior changes as a result. We fundamentally see ourselves teaching about ethics, which is slightly different than teaching ethics--and expecting behavior to change as a result of what is taught. The premise of this article is that our ethics courses are inadequate in content and form to the extent that they do not cultivate an introspective orientation to professional life. In some cases they amount to little more than a study of various state dental practice acts or the Code of Ethics of the American Dental Association. Three specific weaknesses are identified in a typical ethics curriculum: 1) failure to recognize that more education is not the answer to everything; 2) ethics is boring; and 3) course content is qualitatively inadequate because it does not foster an introspective basis for true behavioral change. A fourth element, an innovation, is directed to this third weakness and entails implementing a precurriculum very early in the dental educational experience to address the disconnect between knowledge and action.

Physical and psychosocial stress exposures in US dental schools: the need for expanded ergonomics training

Dental students train in an environment similar to dentists in private practice. The literature reveals that physical and psychosocial stressors in dental schools are associated with adverse health outcomes. While dental educators have provided resources to address psychosocial factors and ergonomics training at the didactic level, the reinforcement of biomechanics at the clinic level has been overlooked. In this article the authors introduce a descriptive analysis of an ergonomics awareness program that expands the ergonomic training by including an assessment of the physical work performed by dental students in the clinic environment.

The work covenant: a management strategy for department chairs and program directors

Learning contracts have been used in adult education to ensure a positive and successful learning process. By means of a learning contract, the instructor can support the learner in a manner that best suits the learner's individual requirements. Like the learning environment, the workplace finds individuals with varying skill sets, areas of interest, and degrees of motivation. Understanding and applying the skills of the worker to appropriate tasks and interests have important ramifications for how workers perceive their jobs and the ultimate effectiveness of the organization. Studies show that the quality of the work environment is critical for the job satisfaction and retention of employees in the public and private sector as well as for the dental academician. Recent literature on faculty development has focused on adapting business-based motivation, mentoring, and performance counseling strategies to the academic setting. By leading and managing faculty development through the use of such strategies, the quality of the work environment can be improved. This article briefly summarizes the commonality between retention strategies and learning contracts within a human resource context and provides a model document that can be used by chairs and program directors to organize and focus their faculty development efforts.

Preserving the pipeline: a model dental curriculum for research non-intensive institutions

Current advanced degree and research training programs no longer attract adequate numbers of students. The present system of dental education severely limits the appeal of these programs due to overcrowded curricula and clinical components that operate in an environment segregated from the academic/research enterprise. To make research-oriented education/training programs more accessible and increase the number of interested students, the culture of dental schools and dental education must change. Programs for future dental researchers and academicians must be supported by curricula that foster an appreciation of research/discovery, an interest in academic/research careers, and the application of biomedical/clinical advances to practice. The Marquette University School of Dentistry has designed a comprehensive new curriculum that supports student research and scholarly activity throughout all four years of dental education. The curriculum minimizes discipline-based courses and is structured into interdisciplinary content tracks that integrate biomedical, behavioral, and clinical sciences while emphasizing the application of science to patient care. A specific research/scholarly track represents dedicated didactic time that exposes all dental students to material not traditionally included in dental curricula. This track includes mentored research/scholarly experiences at local and national sites that are individually structured for each student. Customized student schedules facilitate participation in these experiences without hardship or penalty. This curriculum structure may serve as a model for research non-intensive institutions seeking to increase student interest in academic and research careers.

Audacious leadership

Three leaders in dentistry are presented as case studies. G.V. Black played a leading role in moving dentistry from a trade to a profession. William J. Gies helped lay the scientific foundation for dentistry. Arthur A. Dugoni has emphasized the human dimension of the profession and built relationships among key constituencies. What these audacious leaders share in common is an expansive vision of dentistry that transcended the confusions of the times and the energy and personal skills to enlist the cooperation of diverse groups in achieving these larger views.

Leadership in research: organizing genius

Science has become complex. Its success is increasingly becoming a matter of collaboration based on established infrastructures and professional norms in response to environmental challenges. Leadership in such situations means organizing the genius inherent in great groups. Three examples--the Manhattan Project, mapping the human genome, and rapidly understanding the nature of the SARS virus--are analyzed, showing a trend away from the individual scientist to a model based on simultaneous competition and collaboration.

Leadership: a new look, a new time, and established leadership

The executive director of the American Dental Association characterizes leadership as involving inspiration, vision, and hope in the service of change. The need is great and the opportunities of numerous. Leadership has been built at the ADA through identifying a shared set of core values and through a billion dollar national Campaign for Dental Education. Although the future of the profession is bright, the outstanding leadership challenges include: increasing access, the cost and faculty shortages in dental education, globalization, emerging biotechnology, licensure, increasing the public's perceived value of oral health, and workforce matters.

A new school's perspective on clinical curriculum

The new predoctoral dental education program at the University of Nevada, Las Vegas, officially began on August 26, 2002. Key concepts identified as foundations for the UNLV clinical curriculum model include Student Active Integrated Learning (SAIL), the need to actively link oral health to systemic health, a sophisticated practice management model, a focus on culturally sensitive statewide outreach, establishing a strong biomedical research base, and development of future faculty. The predoctoral program will be comprised of five general practices. Students from each of the four academic years will be assigned to a practice group; each student will be expected to provide patient care within the scope of his or her current training.

Developing a group practice comprehensive care education curriculum

In fall 2002 the University of Illinois at Chicago College of Dentistry implemented a Group Practice Comprehensive Care Clinical Education Curriculum. The primary responsibility for patient care has shifted in this comprehensive care curriculum from the students to the faculty and staff. Students have a primary responsibility for learning. This competency-based education curriculum utilizes a variety of student evaluation methods including self-evaluation, OSCE, and portfolio to verify competence. Formative evaluation methods are utilized in daily assessment of student performance. On-time graduation rates have increased from 60-70 percent to 96 percent, and regional board first-time pass rates have been maintained at 90+ percent. Overall predoctoral clinical productivity in the first full year of the program has increased by over 300,000 dollars.

Predoctoral clinical curriculum models at U.S. and Canadian dental schools

In fall 2002, the ADEA Section on Comprehensive Care and General Dentistry conducted a survey of the predoctoral clinical curriculum models at sixty-four North American dental schools. Fifty-eight percent of the schools reported that most patient care is provided in a comprehensive care clinic setting, 22 percent reported that most patient care is provided in discipline-specific settings, and 20 percent reported a hybrid of comprehensive care and discipline-specific settings. While ten Primarily Discipline-Based (PD) schools have instituted new Primarily Comprehensive Care (PCC) or Hybrid clinical curricula since 1997, one PCC school has converted to a Hybrid model, and one PCC school has converted to a PD model. PCC curriculum models were frequently associated with the following institutional factors: more densely populated metropolitan areas; private institutional sponsorship; location within a university medical center; larger class size; and more students enrolled in advanced training at the school. Curriculum factors frequently associated with PCC models included the following: increased use of simulation technology: higher proportion of clinical/teaching track faculty; higher proportion of part-time faculty; higher proportion of generalist faculty; same faculty supervising both treatment planning and patient treatment; and use of competency exams as the main requirement for completion of the curriculum.

Developing high-quality educational software

The development of effective educational software requires a systematic process executed by a skilled development team. This article describes the core skills required of the development team members for the six phases of successful educational software development. During analysis, the foundation of product development is laid including defining the audience and program goals, determining hardware and software constraints, identifying content resources, and developing management tools. The design phase creates the specifications that describe the user interface, the sequence of events, and the details of the content to be displayed. During development, the pieces of the educational program are assembled. Graphics and other media are created, video and audio scripts written and recorded, the program code created, and support documentation produced. Extensive testing by the development team (alpha testing) and with students (beta testing) is conducted. Carefully planned implementation is most likely to result in a flawless delivery of the educational software and maintenance ensures up-to-date content and software. Due to the importance of the sixth phase, evaluation, we have written a companion article on it that follows this one. The development of a CD-ROM product is described including the development team, a detailed description of the development phases, and the lessons learned from the project.

The predictive utility of computer-simulated exercises for preclinical technique performance

The objective of this research was to determine if a computerized simulated dental exercise predicts students' subsequent performance in preclinical technique courses. Twenty-nine first-year dental students voluntarily participated in the investigation prior to their first experience with a dental handpiece. These students prepared an ideal Class I amalgam on an ivorine mandibular first molar tooth after viewing ten-minute videotaped instructions. Students completed the Class I amalgam on a computerized dental treatment simulator (SIM). All participants' SIM scores were correlated with sub-test scores of the Dental Admission Test (DAT), predental overall grade point average (GPA), predental Biology/Chemistry/Physics grade point average (BCP), and grades from the first two preclinical laboratory technique courses (Lab 1 and Lab 2). The results showed a significant correlation between the simulator scores and DAT sub-test scores of Academic Average and Total Science, as well as Lab 1 scores. Based on these results, the simulator appears to be a good measure of general cognitive ability, including cognitive ability required to complete uncomplicated preclinical exercises.

Developing a medical humanities concentration in the medical curriculum at the University of Rochester School of Medicine and Dentistry, Rochester, New York, USA

To the author's knowledge, the University of Rochester School of Medicine and Dentistry is the only medical school in the United States that offers a concentration or minor in medical humanities for medical students. This article presents how the author first thought of offering a concentration in medical humanities and explains the educational elements students must satisfy. In 1998, the university underwent a major curriculum revision, dubbed the "double-helix" curriculum because of its goal of intertwining basic science and clinical medicine over all four years of medical school. As course director of the Medical Humanities Seminars for more than ten years, the author saw this change as an opportunity to expand the humanities curriculum. The number of sessions and courses offered in the first two years doubled as part of the transition to the new curriculum. In addition, the author proposed to the medical school curriculum steering committee to approve a concentration in clinical ethics and humanities. The concentration option motivates students to continue to pursue their humanistic interests in the third and fourth years of medical school. About 25% of the student body has signed up in the first two years the concentration has been available.

[The history of dental technology instruction and its leading scholars at the Budapest university]

The preconditions for university level education on odontotechnology was first set in 1900 with the establishment of the first Odontotechnological Laboratory in the Dental Institute of the Medical Faculty. The first head of the laboratory and the lecturer of the subject was Dr. Lajos Hattyassy who obtained a senior lecturer (private docent) position in the faculty. Both the technical and personal preconditions substantially improved with the opening of the new clinic of Stomatology in 1909. The dental residents could provide comprehensive prothodontic treatment in the dental lab with its 18 working place and also in the auxiliary practical units. They were supervised by dental specialist and assisted by laboratory technicians. The senior lecturer of the subject was Dr. Henrik Salamon the internationally well know dental researcher. During the mid 20's Dr. Dénes Máthé succeeded him, who also became the director of the whole dental clinic. It was him, who introduced the systematic curriculum in odontotechnology. After World War II according to the requirements of the new health insurance system the independent dental training program started in 1952 besides the traditional stomatologist training. The old dental laboratory could not meet the requirements imposed by the large number of dental students. The new teaching laboratory was organized by Dr. Imre Földvári. This new teaching laboratory made room for the teaching of dental materials and metallurgy, odontotechnology and the phantom head training on operative dentistry and prosthodontics. The technical level of the lab was continuously improved. Dr. Imre Földvári was succeeded by Dr. György Huszár. The previously independent dental subject were first merged and later incorporated into the subject of prosthodontics. In the practical training several modern devices, mimicries and articulators were used. Lately Dr. György Götz succeeded Dr. Huszár, and the subjects of dental materials, odontotechnology and phantom head prosthodontics became again independent dental subjects. With the total refurbishment of the teaching laboratory it became one of the most up to date dental teaching laboratories of Europe. The structure and the curriculum of these newly established dental subjects have also changed and upgraded. The international connections has recently improved and many dental students came from all over the world to study dentistry. Recently for a very short period of time Dr. Pál Tóth jr. was the head of this teaching unit of the Dental Faculty.

Enhancing the dental histology curriculum using computer technology

The predominant difference between the histology offered to dental students and that taken by other health care professionals is the emphasis placed on the oral tissues. The oral histology component of the dental curriculum is commonly handled in one of three ways, all delivering far more detailed information than the often less than one hour that a typical medical histology course spends on the oral cavity and its component tissues. Overall, three general curricular styles can be defined: 1) dental histology is taught by medical or dental faculty as a separate course, the oral histology component being a separate course taught by either faculty group; 2) medical and dental students take histology together in a single class with the oral histology component taught separately by faculty from either college; and 3) both basic and oral histology is taught within a single semester, the format used at the University of Kentucky College of Dentistry. The oral histology topics are similar in all of the course formats, regardless of whether they occur as a stand-alone course or are merged with basic histology. The main portion of this paper will describe a self-study, non-microscope-based laboratory experience designed to complement this fused topic course. Self-study labs using digital media are becoming more popular across both medical and dental histology curricula, specifically with the oral histology component where the histological skills for preparing these tissues are rapidly disappearing from many schools. This paper describes a typical syllabus for a fused course, outlining the topics for basic and oral histology, and demonstrates how the laboratory portion has been enhanced using digital technology.

U.S. predoctoral education in pediatric dentistry: its impact on access to dental care

This study sought to identify faculty, organization, patient pool, and procedures taught in predoctoral pediatric dentistry programs using a questionnaire sent to all fifty-five U.S. dental schools in 2001. Forty-eight (87 percent) programs reported an average of 3.9 full-time and 2.1 part-time FTE faculty, resulting in a mean faculty to student ratio of 1:6.4. One-third employ general dentists to teach pediatric dentistry, and 36 percent report fewer faculty than five years ago. Two-thirds were stand-alone departments. Over half (55 percent) reported increases in patient pools, but also a lack of patients with restorative needs. Half of the programs supplemented school-based pools with special populations, and two-thirds sent students on external rotations, most often to treat high-caries children. Those not using external rotations cited lack of faculty. Accepted patients averaged about four years, with only 6 percent of the pool under three years. Low-income or Medicaid-covered children accounted for 88 percent of school patient pools. Half of the schools felt the pool inadequate to meet competencies, attributable to lack of patients' restorative needs or inadequate intake numbers. Fewer than half of the programs (48 percent) provided hands-on experience with disabled patients, and one-third afforded every student with this experience. Pediatric dentistry was mentioned in fewer than half of the competency documents. Results suggest that U.S. pediatric dentistry predoctoral programs have faculty and patient pool limitations that affect competency achievement and adversely affect training and practice.

Perspectives on dental education in the Nordic countries

The object of this review is to discuss the state of dental education and describe current developments at dental schools in the Nordic countries. The main focus is the undergraduate dental education; however, the postgraduate system will also be addressed. The curriculum model for undergraduate dental education in the Nordic countries is based upon the odontological tradition. The influence of biomedicine on dental education is increasing at present due to scientific and medico-technological developments and the altered disease profiles of oral and systemic diseases. These circumstances create new possibilities for dental education, but at the same time they raise some problems. In the long-term, the strong biomedical influence on dental education will be an advantage to future dentists' function and tasks in health care systems in the Nordic countries. In the short term, it may result in an identity crisis for dental schools, students, and our profession, as we experience the evolution from the traditional odontological curriculum model to one significantly influenced by ongoing changes in the biomedical field. Continuing professional education and advanced training in clinical specialties are likely to play important roles in this evolution.

The study of temporomandibular disorders and orofacial pain from the perspective of the predoctoral dental curriculum

This paper addresses questions 2 to 6 posed in the charge to the conference to discuss the study of temporomandibular disorders (TMD) and orofacial pain from the perspective of the predoctoral dental curriculum. This paper lends itself to an additional query: how much diagnostic and therapeutic skill relative to TMD and orofacial pain should a new graduate possess and demonstrate to be deemed competent in accordance with the definition of competence of the American Dental Association's Commission on Dental Accreditation? Although much of the content of this and the accompanying articles from the conference pertain to the TMD and orofacial pain curricula of dental schools in North America, most of what is presented here is universal to the teaching of the subject matter; therefore, it could be applied to educational institutions in other parts of the world. Indeed, an international survey relative to the teaching of TMD and orofacial pain would be of interest and value to dental schools worldwide.