Curriculum structure: principles and strategy

This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry ('shortened dental' or 'accelerated') courses and to postgraduate degree planning and higher education certificate or diploma courses for other dental care professionals (auxiliaries). The report may have a European bias as progress is made to converge and enhance educational standards in 29 countries with different educational approaches - a microcosm of global collaboration.

Developing explanatory models of health inequalities in childhood dental caries

OBJECTIVE

Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities.

DESIGN

Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care.

SUBJECTS

Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week.

RESULTS

Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90).

CONCLUSIONS

Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

International comparisons of health inequalities in childhood dental caries

OBJECTIVE

To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora.

PARTICIPANTS

The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth.

OUTCOME MEASURES

Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled.

RESULTS

2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries.

CONCLUSIONS

Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.

Barriers to the treatment of childhood caries perceived by dentists working in different countries

OBJECTIVE

To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care.

BASIC RESEARCH DESIGN

The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied.

PARTICIPANTS

Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site.

RESULTS

2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children.

CONCLUSIONS

The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups

OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries.

CLINICAL SETTING

Nurseries, health centres and dental clinics in 17 countries.

PARTICIPANTS

2822 children aged 3 to 4 years and their parents.

MAIN OUTCOME MEASURES

Dental examination of children and questionnaire to parents.

RESULTS

Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group.

CONCLUSIONS

This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

5.1 The demography of oral diseases, future challenges and the implications for dental education

This Section considered the immense challenges presented by the changing demography of populations (in particular, cross-boundary flow), changing oral and dental disease trends. It also considered the difficulties of gathering data on such information. It then considered how these challenges may affect the education of the dental team in the future. The Section considered the concept of the 'global village' as a representation of the changing world demography. We were at pains to recognize that our role was in considering both emerging and established market economies. In fact, a major part of the Section's activities concentrated on the development of the professional ethic of social responsibility - represented at the local, regional, national and international levels. We considered a finite group of oral and dental diseases, namely dental caries, periodontal diseases, oral cancer and cranio-facial disorders. In addition, we chose to comment on systemic diseases influenced by oral diseases, oral diseases influenced by systemic diseases and iatrogenic diseases (including prion disorders and cross-infection control issues). The Section recognized the profound difference between needs and demands in the provision of oral and dental health care. We considered the concept of best practices within our working remit and named these as: * the gathering of valid data on health trends; * uniformity in the measurement of disease and diagnostic parameters; * the identification of a core curriculum which best addresses an increased awareness of changing demography; and * a multidisciplinary approach to education and research in the context of global collaboration. The Section recognized the enormous potential for global networking with the explosion of information and communication technology. We investigated the requirements in converging towards higher global standards, while accepting and appreciating important regional and continental differences. To this end, the Section has put forward a number of important recommendations and realistic goals.