Problem-based learning is suitable for the curriculum of “Sleep disorders and disease” for students in dentistry

Abstract

The maintenance of good-quality sleep under adequate circadian rhythm during the night is important. A large body of evidence indicates that sleep disorders can induce several diseases, including metabolic syndrome and cardiovascular diseases. Understanding the fundamental physiological regulation of the sleep cycle and the pathophysiology of sleep medicine are thus important for clinicians as well as the general public. Among several sleep disorder-related diseases, accurate diagnosis and appropriate application of methods to treat obstructive sleep apnea syndrome and bruxism have been established for patients and healthcare workers in dentistry. 1–3 Oral appliance therapy has been reimbursable from governmental insurance in Japan since 2004. However, whether most dentists understand the pathophysiological condition of obstructive sleep apnea and hypopnea based on fundamental knowledge about the normal physiological features of sleep remains unclear. Dentists have made significant efforts to study the diagnosis of and therapy for obstructive sleep apnea and hypopnea syndrome by attending postgraduate training courses throughout their careers as clinicians. Dentists themselves suspect that the dental education curriculum focused on learning the normal physiology of sleep might be lacking before pathophysiological knowledge about sleep disorder-related diseases is obtained. At the Nagasaki University Faculty of Dentistry, we have introduced a new curriculum that focuses on “sleep disorders and disease” for fifth-year students before attending the start of clinical exercises in 2006. During the first year, in 2006, we used a curriculum that comprised six 90-min didactic lectures without using any other effective teaching methods used in other lectures. In 2010, we developed a curriculum using a problem-based learning (PBL) teaching method with a single scenario combined with several lectures. To understand the problems of current curriculum needing to be improved, from 2007 to 2013, we conducted a questionnaire survey asking students about several aspects related to the lecture content of “Sleep disorders and disease.” The questionnaire data show high percentages (>80%) for the validity both of the lecture for “Sleep disorders and disease” and of receiving practical training. Interest in clinical training, such as making an intraoral device, and evaluation of individual sleep cycles tended to show a gradual increase, with 71% of respondents in 2013 stating that “This training is absolutely necessary.” Sixty percent of students recognized the significance of PBL learning, selecting the answer of “Should absolutely undertake this learning.” The results in this study indicate that learning by PBL in combination with six didactic lectures was suitable for undergraduate students studying various aspects of sleep. The type of scenario will be improved for future curricula, because 26% of students replied “Several types of scenarios are needed.” The description of the questionnaire indicates that students desire both to positively adopt practice and training and to access more in-depth knowledge about obstructive sleep apnea. Providing updated guidelines on oral appliances (published by JSSR 30 September 2013) and indicating the possible physiological modulation of interactions between respiration and swallowing caused by modern orthodontic treatment and sleep surgery might be important. In addition, the risk of upper airway obstruction associated with sedative status during dental treatment should be recognized by