Dental education in Malaysia

Unravelling the impact of dental workforce training and education programmes on policy evolution: a mixed-method study protocol

BACKGROUND

The dental workforce plays a crucial role in delivering quality oral healthcare services, requiring continuous training and education to meet evolving professional demands. Understanding the impact of dental workforce training and education programmes on policy evolution is essential for refining existing policies, implementing evidence-based reforms and ensuring the growth of the dental profession. Therefore, this study protocol aims to assess the influence of dental workforce training and education programmes on policy evolution in Malaysia.

METHODS

A mixed-method research design will be employed, combining quantitative surveys and qualitative interviews. Stakeholder theory and policy change models will form the theoretical framework of the study. Participants from various stakeholder groups will be recruited using purposive sampling. Data collection will involve surveys and one-on-one semi-structured interviews. Descriptive statistics, inferential analysis and thematic analysis will be used to analyse the data. Integration of quantitative and qualitative data will be used to provide a comprehensive understanding of the data.

DISCUSSION

This study will shed light on factors influencing policy decisions related to dental education and workforce development in Malaysia. The findings will inform evidence-based decision-making, guide the enhancement of dental education programmes and improve the quality of oral healthcare services. Challenges related to participant recruitment and data collection should be considered, and the study's unique contribution to the existing body of knowledge in the Malaysian context will be discussed.

Expert consensus on relevant topics for undergraduate paediatric dental curriculum using the fuzzy Delphi method: a new direction for Malaysian dental education

BACKGROUND

Paediatric dentistry is a branch of dental specialty that focuses on dental care for children from infancy through adolescence. However, there is no standardised national undergraduate paediatric dental curriculum in Malaysia. The present study aimed to identify relevant topics for undergraduate paediatric dental curricula and to determine the appropriate cognitive and psychomotor levels for each topic based on the consensus among paediatric dental experts.

METHODS

Potential relevant undergraduate paediatric dentistry topics were initially drafted and revised according to the revised national competency statement. The final draft included 65 topics clustered under 18 domains. A fuzzy Delphi method was used and experts who fulfilled the inclusion criteria were invited to anonymously ranked the importance of relevant topics using a five-point Likert scale and proposed suitable cognitive and psychomotor levels for each topic. Fuzzy evaluation was then performed, and experts were considered to have reached a consensus if the following three conditions were achieved: (a). the difference between the average and expert rating data was ≤ 0.2; (b). the average expert consensus was ˃70%; and (c). the average fuzzy number was ≥ 0.5. Subsequently, the mean ratings were used to determine the cognitive and psychomotor levels.

RESULTS

20 experts participated in the survey. 64 out of 65 paediatric dentistry topics were deemed acceptable. The average fuzzy number ranged from 0.36 to 0.85, while the average Likert score ranged from 3.05 to 5.00. The topic "Dental amalgam" was rejected based on expert consensus since the average fuzzy number was 0.36. The most significant topic was "Pit and fissure sealant", followed by "Preventive advice", "Early childhood caries", "Dental caries in children & adolescent", "Management of dental caries in paediatric patients", and "Consent" which were equally ranked as the second most important topics. According to Bloom's and Simpson's taxonomies, most of the paediatric dentistry topics were rated adequate for undergraduate students at the cognitive level of "Apply" (C3) and a psychomotor level of "Guided response" (P3).

CONCLUSION

The current study successfully identified relevant undergraduate paediatric dentistry topics using the fuzzy Delphi method, which can facilitate future educators to improve existing Malaysian undergraduate paediatric dental curricula.

Identifying relevant topics and their competency levels for dental materials science: a fuzzy Delphi study

BACKGROUND

Dental materials science is an important core course in undergraduate dental programs which integrates foundational concepts of chemical engineering and materials science into clinical dentistry. The present study aimed to identify relevant dental materials science topics for Malaysian undergraduate dental curricula and to determine their appropriate competency levels in terms of cognitive and psychomotor taxonomies.

METHODS

Potential dental materials science topics were drafted in alignment with the revised national competency statement. The list of topics was further amended after comparing it with those recommended topics in the literature. Fuzzy Delphi method was applied. Experts were selected based on the different inclusion criteria. They ranked the topics using a five-point Likert scale and recommended the appropriate cognitive and psychomotor levels. Next, fuzzy evaluation was performed. Consensus was deemed for a topic to be included if (a) the average expert agreement was ≥ 75%, (b) the d-construct threshold value for each topic was ≤ 0.2 and (c) the average fuzzy number was ≥ 0.5.

RESULTS

Sixty-two experts participated in the study. They accepted 33 out of 36 potential dental materials science topics. The average Likert score and fuzzy number ranged from 3.63 to 4.92 and 0.526 to 0.784, respectively. Furthermore, "Endodontic materials" was ranked as the most significant topic. Meanwhile, many topics required dental students to demonstrate a cognitive level of "Apply" and a psychomotor level of "Guided response". Based on mean scores, "Impression materials" was rated as the most cognitively demanding topic, whilst "Temporary restorative materials" was the most demanding topic for psychomotor taxonomy.

CONCLUSION

The present study has identified relevant dental materials science topics and their appropriate cognitive and psychomotor levels using the Fuzzy Delphi approach. The findings of the present study form the basis for future studies to develop measurable learning outcomes, design corresponding innovative pedagogy and propose assessment criteria for each topic.

Emotional Intelligence, Depression, Stress and Anxiety Amongst Undergraduate Dental Students During the COVID-19 Pandemic

Objectives: This study aimed to measure depression, anxiety and stress (DAS) among undergraduate dental students during the COVID-19 pandemic, identify key contributing factors of stress and explore the association of emotional intelligence to DAS. Methods: A multi-centre, cross-sectional study was conducted across four universities in Malaysia. The study administered a questionnaire consisting of the validated Depression Anxiety Stress Scale (DASS), Dental Environment Stress (DES), Emotional Intelligence Scale (EI) and 10 statements assessing COVID-19 specific potential stressor factors. Results: Participants included 791 students across four universities. Abnormal levels of DAS were identified in 60.6%, 66.8% and 42.6% of the study participants, respectively. "Pressure of performance," "Faculty administration" and "Self-efficacy belief" were the highest rated stressors. On-time graduation was the main COVID-19 specific stressor factor. EI was negatively correlated with DAS scores (p < 0.001). Conclusion: The levels of DAS during COVID-19 pandemic in this population is high. However, participants with higher EI presented with lower DAS suggesting that EI may be a form of coping resource and should be enhanced in this population.

Innovative Pedagogical Strategies in Health Professions Education: Active Learning in Dental Materials Science

Dental materials science education is frequently delivered via traditional didactic lectures in preclinical dental programs. This review aimed to appraise the current evidence on innovative pedagogical strategies in teaching dental materials science courses. English-language articles on teaching methods for dental materials science published between January 1990 to October 2022 were searched in nine online databases (Google Scholar, PubMed, Web of Science [WoS], Science Direct, Cochrane Library, EBSCO, LILACS, Open Grey, and EMBASE) according to PRISMA guidelines. The risk of bias (RoB) was assessed using the Cochrane RoB-2 and ROBIN-I tools, whereas the level of evidence was determined based on the OCEBM guidelines. Only 12 primary studies were included. Two randomized studies (RCTs) were deemed as being of "some concern", and one showed a high risk of bias (RoB). Three non-randomized controlled studies (NRS) demonstrated a moderate RoB, whereas the remaining seven were low. Most studies were ranked at Levels 2 and 3 of evidence. Several innovative pedagogical strategies were identified: flipped classrooms, clinical-based learning, computer-assisted learning, group discussion, microteaching with the BOPPPS (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) model, and game-based learning. The evidence suggested that students generally showed positive perceptions toward these pedagogical strategies. Dental educators should revise their current undergraduate dental materials science curricula and integrate more effective teaching methods.

COVID-19 and a Call to Adapt Dental Education

Introduction: COVID-19 has harmed the economic, academic, and clinical pursuits of dental educational institutions and dental students. As dental associations, health agencies, and regulatory bodies around the globe announced the need for social distancing and stricter safety measures, some dental schools worldwide have been adapting to accommodate for such changes.

Methods: This review attempts to provide a general picture of the early responses of some dental schools worldwide to the COVID-19 crisis and identify some of the regulations that influenced dental schools' initial decisions. An analytical approach was used to assess changes to dental school curriculums in didactic (academic/non-clinical) and clinical education, examinations, administration, and dental school research. The assessment was based on a web-based search of a variety of online global references including research articles, reviews, letters, press releases, and surveys regarding the early effect of covid-19 on dental education at some dental institutions in the U.S, Europe, and Asia from late February to early July of 2020. The review also offered further recommendations to dental school administrators regarding the future of dental education during the early stages of a pandemic.

Conclusions: Innovations in technology and blended educational methodologies will continue to influence how certain dental schools around the world adapt to the changes caused by COVID-19 and better prepare dental education institutions for potential future public health disruptions.

Clinical significance: Dental schools will need to adapt their education system to improve didactic, preclinical, clinical, administrative, and research components of dental education in response to the changes caused by COVID-19 and future pandemics.

Developing consensus in identifying challenges of undergraduate orthodontic education in Malaysian public universities using e-Delphi

AIM

The aim of the study was to seek consensus, identify and explore the challenges facing undergraduate orthodontic education and propose equitable solutions for overcoming the challenges amongst Malaysian public university dental schools.

METHODS

An iterative e-Delphi technique was employed as the method for gathering consensus on a range of topics found pertinent to affect orthodontic teaching and learning established through literature review. A total of ten expert panellists were recruited through a targeted invitation to the orthodontists from Malaysian public universities offering undergraduate dental education. The e-Delphi comprised of three rounds of anonymous e-survey. The consensus was sought for two open-ended and two closed-ended questions.

RESULTS

The response rates for all the three rounds were 100 per cent. The total number of questions responded by the participants in all the three rounds was forty-four. Round one achieved consensus on two closed-ended questions. Round two achieved a consensus on twenty-eight out of thirty-four (82.35%) questions with round three achieving a consensus on four out of six (66.66%) questions. A 70% consensus was considered as the minimum level of agreement for all the rounds. In total, consensus and agreement were achieved on two closed-ended questions and twenty-nine items from the open-ended questions.

CONCLUSION

The study was able to identify a range of issues affecting undergraduate orthodontic education with a good level of consensus using the e-Delphi technique highlighting the need for curriculum refinement. The study has, in addition, proposed tangible methods to enable such a change.

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries

OBJECTIVES

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs).

METHODS

The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted.

FINDINGS

Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries.

DISCUSSION AND CONCLUSION

Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Predictors of academic performance of first year dental undergraduates in Sri Lanka: a re-evaluation following curriculum changes

The dentistry course in Sri Lanka is conducted in English, a second language for its students. A decade ago, English language proficiency was the key factor in predicting the academic performance of first year dental undergraduates. Since then, changes have been introduced to the teaching programme and examination format to minimise the effect of language proficiency on their performance. This study aimed at re-evaluating the factors influencing academic performance in a similar academic cohort. A total of 306 first year students in five consecutive academic years ranging in age from 20 to 24 years (77% of the total number registered, 36.3% men) were recruited, and a questionnaire was used to collect data regarding demographics, previous academic ability and perceived levels of difficulty of the first year course, English language and its sub-skills. Performances of the English language test and cumulative GPA of the first year course were used as objective indicators of language competency and academic performance respectively. The data were analysed using SPSS 11.5. Hierarchical Regression Analysis revealed that English language proficiency, gender and previous academic ability were the significant predictors of GPA. Students who received a lower GPA perceived English as considerably more difficult compared to the academic course itself; however, students who obtained a higher GPA perceived the opposite. Students' language competency remains the major predictor of academic performance, although previous academic ability and gender emerge as significant predictors. The perceived difficulty, however, of the dental course and of studying in English may also be predictors of student academic performance.