Predoctoral Curriculum Research Articles

The Impact of Technology Teaching in the Dental Predoctoral Curriculum on Students' Perception of Digital Dentistry.

The goal was to assess dental students' perception of digital technologies after participating in a CAD/CAM exercise for scanning, designing, and manufacturing computer-aided provisional fixed dental restorations. A survey was conducted among second- (pre-D2 and post-D2), first- (D1, negative control), third-, and fourth-year dental students (D3 and D4, positive controls). Only OSU College of Dentistry students who completed the activity and completed the surveys were included. Seven questions were rated, which evaluated changes in knowledge, skill, interest, the importance of technology availability in an office, patients' perception of technology, the importance of having the technology, and the expected frequency of clinics utilizing the technology. Statistical analysis was performed with a significance level of 0.05. A total of 74 pre-D2 and 77 post-D2 questionnaires were completed. Additionally, 63 D1, 43 D3, and 39 D4 participants responded to the survey. Significant differences were found for "knowledge" and "skill" between the pre-D2 and post-D2 and pre-D2 and control groups (p < 0.001). There was a significant difference between the post-D2 participants and all the controls in terms of "interest" (p = 0.0127) and preference for in-practice technology availability (p < 0.05). There were significant results between the post-D2 participants and all the controls regarding the importance of technology availability in an office (p < 0.001) and the expected frequency of clinics utilizing the technology (p = 0.01). No significance was found for "value of technology to patients" and "the importance of having the technology". The presence of technology in practice and in educational academic environments significantly improved students' interest and perception of their knowledge and skill.

Assessment of dental ergonomics among dental students: A retrospective study.

Musculoskeletal (MSK) disorders account for 11%-98% of occupational health issues for dental professionals, with an onset as early as in dental school. Dental ergonomics is among the risk factors; thus, a prompt assessment is crucial in preventing future MSK pain. The aim of this study was to retrospectively assess dental ergonomics of second-year dental students after dedicated lectures were introduced in the predoctoral curriculum. Three cohorts of second-year dental students were evaluated during preclinical activity in July 2019, January 2022, and December 2022 by an Occupational Therapy (OT) faculty and calibrated OT students. Dental ergonomics was assessed with the Rapid Upper Limb Assessment (RULA). Dental student cohorts were compared with one-way analysis of variance (ANOVA). The average RULA final score of 409 participants was 5.1±0.9, with no difference between the three cohorts (p=0.676). The January 2022 cohort scored significantly lower in wrist-arm score than that of 2019 (p=0.001) and December 2022 (p=0.046). Neck and lower limb posture were significantly higher in January 2022 cohort than in 2019 (p=0.001 and 0.013) and December 2022 (p=0.001 and 0.005) cohorts. The December 2022 cohort revealed a medium, high and extremely high risk of developing MSK of 40.2%, 37.1%, and 21.6%, respectively, with no difference between sexes. The risk of developing MSK pain was medium-high in predoctoral dental students and was not related to sex. The overall dental ergonomics required attention and rapid change. Further implementation of varied forms of teaching and monitoring of dental ergonomics from the early years of education is recommended to prevent development of MSK pain at young age and foster better postural habits.

A survey of white spot lesion prevention and resolution in the US dental school curricula.

White spot lesions (WSLs) are opaque white lesions on smooth tooth surfaces as a result of demineralization. Proven methods of prevention and resolution of these lesions are available yet the incidence rate, especially in orthodontic patients, is still high. Perhaps the way dental schools are educating students on the topic is insufficient. The purpose of this study was to determine if and how predoctoral dental students are taught about the prevention and resolution of WSLs. An electronic survey was developed and sent out to each of the 66 accredited dental schools in the United States and Puerto Rico. The survey consisted of 13 questions and inquired about whether the school includes instruction of WSLs in its predoctoral curriculum. If the school indicated instruction WSLs was in the predoctoral curriculum, further questions were asked pertaining to the content and method of the instruction. Demographic data was also gathered from each institution. Twenty-eight of the 66 schools responded for a 42% response rate. Eighty-two percent of schools indicated they were teaching about prevention of WSLs, while 50% indicated they were teaching about resolution, or treatment, of WSLs. The most commonly taught methods were patient education, over-the-counter fluoride mouthrinse, toothpaste, or gel, and high fluoride content toothpaste. The majority of responding dental schools are at least including some instruction of WSLs in the predoctoral curriculum. Many of the known prevention and treatment measures available, however, are not routinely taught.

The Implementation of CAD/CAM Technology at Schools of Dentistry: A Short Communication

This short communication aimed to acquire and transmit information about inserting CAD/CAM technology in the dental school’s curriculum to better prepare dental students for new approaches. The CAD/CAM system implementation has occurred slowly in the dental curriculum at universities. In 2012, authors evaluated the use of CEREC, showing an educational tool impacting the cost-effectivity for patients. A similar result was found in 2013, with an appreciation of the marginal fit and esthetic obtained. In 2014, CAD/CAM was incorporated into the predoctoral curriculum at the Indiana University School of Dentistry, showing good or excellent overall learning. In 2017, a CAD/CAM system was implemented at the University of Illinois at Chicago College of Dentistry’s predoctoral implant program, which had an increased preference and proportion of implant restorations made digitally. In 2018, a German dental school used CAD/CAM in the curriculum of prosthetic education, obtaining a clear tendency for the use of this technology. In 2023, pre-doctoral dental students in the U.S.A. received a questionnaire that significantly improved their knowledge and attitude to using this technology; otherwise, student satisfaction was non-significant. In conclusion, integrating CAD/CAM technology into the curriculum has become an essential component of modern dental education.

Incorporating cancer survivorship care in dental education.

Incorporating cancer survivorship care in dental education.

Dental Therapists Can Help Improve Oral Health Equity

"Dental Therapists Can Help Improve Oral Health Equity," takes issue with dental institutions for not promoting dental therapy in their predoctoral curriculum and posits that they fail to meet their responsibility to the communities they advocate for and fall short in achieving equity and access to the profession.

Predoctoral Curriculum Modifications in Caring for Patients With Special Health Care Needs

Recent changes to educational competency standards have been implemented by the Commission on Dental Accreditation (CODA) in preparing dental students to care for patients with special health care needs. A major emphasis includes those patients with intellectual and developmental disabilities. This article offers some broad suggestions to consider when implementing curriculum changes in dental schools.

Perceived Didactic Curricular Effectiveness of In-Person vs. Virtual Formats amongst Fourth-Year Dental Students.

Purpose: The COVID-19 pandemic altered the methodologies of dental education delivery, resulting in both immediate and more enduring changes. To assess student perceptions of learning effectiveness, graduating dental students from the class of 2020 were surveyed to identify student comfort with technology and content retention, individual motivation and mental focus, and access to resources pertaining to an abrupt transition to a virtual learning didactic seminar approach in March 2020. Methods: a voluntary, 18-question electronic survey was distributed to fourth-year dental students prior to graduation to assess perceptions of learning outcomes and preferences of a virtual seminar format relative to previous in-person didactic seminars experienced. Results: 34 of 80 dental students (42.5%) completed the electronic survey. Comfort and retention of concepts through virtual learning were reported ≥ by 91% and 85% of the respondents, respectively. Increased distractions and multitasking were reported with virtual learning in 56% and 71%, respectively. Desires to have all teaching conducted through virtual learning platforms was reported at 21%. Conclusions: the positive student responses obtained when comparing virtual to in-person seminars in the survey assessment demonstrates the long-term potential for such delivery modalities to be intentionally incorporated into an evolving predoctoral curriculum in a hybrid nature.

Evidence- Based Dentistry: Integration in Predoctoral Curriculum

Scientific evidence is one of the fundamental principles of dental practice. Evidence-Based Dentistry (EBD) integrates the use of the best evidence by taking into consideration the expertise of clinicians and the needs and preferences of patients to inform therapeutic decision-making. Therefore, the practitioner needs to acquire this skill. Considering the constant development of new therapeutics, and technologies and the demand for quality of treatment in contrast to the lack of training in this field, the integration of EBD in the curriculum has become a necessity. Our work aims to define the interest of EBD, to make an inventory but also to highlight the applicability of evidence-based dentistry by focusing on the organizational aspect and the various constraints that can accompany the integration of EBD in the learning of dental students. Materials and methods: A search and review of the literature were conducted to highlight the importance of the acquisition of this skill and its application in the field. Results: The integration of critical thinking and EBD into the undergraduate curriculum prepares graduates to maintain a state-of-the-art evidence-based clinical practice. EBD has the potential to change the future course of oral health education, patient care, reimbursement, research programs, and evidence-based health policy.

A Qualitative Look at Faculty Perspectives on Ergonomics in Dental Education

Due to the high-risk nature of musculoskeletal disorder development in dentistry, ergonomic education and evaluation are needed in predoctoral programs. The purpose of this pilot study is to investigate perceptions of ergonomics within the School of Dentistry (SOD), current ergonomic clinical practices among third- and fourth-year dental students, and dental students' level of knowledge of ergonomics. The study was conducted utilizing an explanatory sequential mixed methods design to collect both quantitative and qualitative data. While the data collection occurred in three phases, this article will primarily focus on Phase III. The three phases of data collection were: Phase I consisted of a questionnaire distributed to all dental students; Phase II consisted of clinical observations of third- and fourth-year dental students' ergonomic postures during patient care, and Phase III consisted of SOD faculty focus groups to determine perceptions of ergonomic education with the predoctoral curriculum. Data revealed three overarching themes: (1) Didactic to clinical disconnect, (2) Elective impacts, and (3) A ready commitment. Phase I yielded a response rate of 84% (n=135). Phase I responses noted that 81.5% (n=110) of the dental students reported experiencing musculoskeletal pain. Ninety-three dental students reported receiving one or two lectures on ergonomics; however, 60% (n=27) failed to implement proper ergonomic postures while caring for patients in the clinical environment during Phase II. Phase III, revealed faculty support of ergonomic evaluation and correction among dental students. The results indicated a need to establish and implement an ergonomic evaluation and corrective program within the SOD

Faculty Positions

Creighton University invites qualified applications for the position of Chair the Department of General Dentistry who will provide vision, leadership, direction, and management of the didactic, pre-clinical and clinical instruction in coordination with the other departments and the School’s pre-doctoral curriculum. This position involves engaging the faculty of the department in teaching, scholarly activity, professional development, and service activities in alignment with the mission and purpose of the department, School and University. The position will need to work well in a collegial environment with other department chairs and leadership of the School to assure that the department is integrated within the School and the University and fosters the continued growth of the school’s team practice model and advances the efficient delivery of the department’s curriculum. The position includes the opportunity for advancement through rank and tenure processes of the University. DDS/DMD degree or equivalent is required along with eligibility for dental licensure in Nebraska. Preferred qualifications include certificate, Master’s or PhD degree in operative or material sciences, or advanced degrees appropriate for academia and the needs of the position.If interested, please apply via this link: http://k.rfer.us/CREIGHTONhrP1TB

Survey of Current Predoctoral Removable Partial Denture Curriculum in the United States

The purpose of this survey was to determine removable partial denture (RPD) framework design concepts, new materials, and digital technology that are currently being taught in the predoctoral RPD curriculums in the U.S. dental schools. A questionnaire including RPD framework design concepts, materials, and digital technology was created on Qualtrics. The link to the questionnaire was distributed by email in May 2018 to U.S. dental schools. Thirty-nine of the sixty-six schools responded, yielding a response rate of 59%. Most schools are utilizing textbooks by McCracken and/or Stewart as their primary reference (90%). Only a few schools teach incisal rest (24%) and intra-coronal retainers (8%) in the clinic. The majority of schools teach three or less clasp assembly variations for distal extension RPD scenarios and utilize altered cast impression techniques only for selective patient scenarios. Half of schools currently utilize digital technology in their RPD curriculum. Although twenty-five schools (69%) indicated that implant-assisted RPD (IARPD) is being taught in the curriculum, only nineteen of them teach IARPDs in the clinic. Half of schools are utilizing non-metal clasp denture (NMCD) in their curriculum; most of these school provide this treatment as immediate/interim partials or long-term interim partials. Many U.S. dental schools are simplifying RPD design concepts and principles that are being taught. More schools are introducing new concepts and materials such as IARPD and NMCDs while incorporating digital technology in their predoctoral RPD curriculum.

Four-Handed Technique in Dental Education: Integrative Review

Background: Since the 1970s, the World Health Organization has defined four-handed dentistry as a simplified method with defined tasks within the work team. It has been mainly implemented in clinics and universities in Brazil, the United States, Spain, and Chile. The comprehensive adult dental clinic (Sixth semester) and the pediatric dental clinic (Seventh and Eighth semesters) of the pre-doctoral dental program at El Bosque University’ Dental School (Bogotá, Colombia) use this method. However, theory on four-handed dentistry has not been included in the curriculum yet. Purpose: To explore and describe the influence of the four-handed method in the training of general dentists in order to justify its inclusion in the predoctoral curriculum. Methods: A search of articles was carried out until June 2020. Full-text selected articles were analyzed, and findings related to this study’s purpose were included in the review. Results: 13 articles were chosen. Findings are organized in three thematic axes: background and general aspects of the technique, benefits of the technique in the training of general dentists, and description of the four-handed care model as an exercise in the pediatric dental clinics, also called Growth and Development clinics, at El Bosque University. Conclusions: Patient care using a four-handed method can contribute to the development of soft skills, critical thinking, problem solving through collaborative work, and promoting meaningful learning in students.

"I don't think the problem's the student…I think it's us": Engaging faculty in curriculum innovation.

The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Developing a curriculum blueprint and taxonomy: Process, progress, and pivots.

Curriculum transformations represent opportunities to innovate; however, there are few examples to inform this process. In 2018, the University of North Carolina at Chapel Hill (UNC) Adams School of Dentistry began to transform the predoctoral curriculum to improve content integration, enhance team-based experiences, and develop leaders. Part of this experience has been crafting a conceptual curriculum guide or "blueprint" that outlines a vision for the design process and ensures the transformation achieves its goals. We describe how we created the UNC Blueprint for our revised curriculum, which defines who our graduates are, what they know, and what they can do. This approach has led us to develop a mapping taxonomy to ensure the student outcomes are appropriately aligned with content, instruction, and assessment throughout the curriculum. Last, we encourage others to be agile in their approach, create a common language among their teams, and frequently engage faculty to facilitate the process.

Peri-implant disease education and diagnosis in the pre-doctoral curriculum.

The purpose of this study was to assess how pre-doctoral periodontal programs in the United States of America are educating their dental students regarding the management of peri-implant diseases and secondarily, to determine if a current standard of teaching exists. Electronic surveys were distributed to pre-doctoral program directors across 57 dental schools in the United States via a secure online survey system. The survey consisted of 19 questions pertaining to curriculum structure involving didactic and clinical management of peri-implant diseases. A total of 25 program directors (44%) responded, and data were analyzed using descriptive statistics. The results indicated a lack of standardization of pre-doctoral didactic and clinical curriculum among dental schools. Data pooled from 25 pre-doctoral periodontal programs in the United States show that there is currently no standardization in the dental school curriculum related to the didactic and clinical management of peri-implant diseases. The development of standardized content is recommended to assist program directors in assessing and enhancing educational experiences for dental students on the management of peri-implant diseases.

Implementing an online OSCE during the COVID-19 pandemic.

Due to the COVID-19 pandemic, most dental schools in the United States ceased all in-person activities.1 Lessons learned from past outbreaks demonstrated the need for new applications of information technology to appropriately educate students.2 Objective Structured Clinical Examinations (OSCEs) are assessments that measure clinical competence by physically rotating students through multiple stations. At each station, the student demonstrates competence through oral or technical examinations for a specified amount of time.3 OSCEs are conducted at Harvard School of Dental Medicine (HSDM) throughout the predoctoral curriculum. During the pandemic, lectures and case presentations were able to be transitioned into e-learning through platforms like Zoom (Zoom Video Communications, San Jose, CA).4 However, because students must be physically rotated, it was challenging to convert OSCEs to an online form. There was an evident need to creatively restructure the OSCE to reduce curriculum disruptions. With careful planning, successful online OSCEs were administered. The Zoom platform was selected due to examiner and student familiarity and the “breakout room”5 feature, which allows private minisessions (one-on-one) between host-selected participants. One Zoom link with 21 pre-assigned breakout rooms was created. There were 2 examiners for each of 10 disciplines, plus 1 “rest station” (Figure 1). Within a discipline, 1 examiner was designated as “Red” and the other as “Green.” Thirty-four students were equally split into 2 sessions; within each session, students were assigned to Red or Green group. A clinical case was disseminated to each student session 1 hour before the start times. For standardization, examiner calibration sessions were conducted 1 month and 1 week prior. A pre-OSCE run-through was performed with examiners and students. The Zoom host placed examiners in breakout rooms prior to student entry. Students were asked to sign in with their full names, leaving cameras and microphones continually on to promote academic integrity. Once all students assigned to a session had joined, they were placed into their first breakout rooms by the Zoom host. Six minutes were allotted per station for oral examinations based on the clinical case that students were given. When the allotted time had passed, students were moved to the next room of the appropriate color (e.g., Red Ortho to Red Peds). One-minute warnings were broadcasted to each room before a move. Examiners graded students on Qualtrics (Qualtrics, Provo, UT) or on hard copy. Feedback from students and examiners was obtained (Table 1). Notably, most students thought the online OSCE was similarly successful to traditional OSCEs, and all student respondents felt they were able to fully showcase their knowledge. Half of student respondents thought that even future OSCEs should be performed online. Examiners also felt the OSCEs ran well overall. Several examiners commented that pre-OSCE measures like calibrations and run-throughs were integral. There were only a few problems related to technical difficulties (Table 1). Recommendations from our experiences are listed in Table 2. Considering the overall success of the online OSCE and positive feedback from students and examiners/staff, there may be value in moving traditionally in-person assessments online, even post-pandemic. We thank the HSDM Class of 2021 and contributing faculty and examiners for their participation in and flexibility with the online OSCE. We also thank Adrien Doherty and Chad Bergeron for their assistance in creating the OSCE and helping it run smoothly.

Development, implementation, and early results of a 4-year interprofessional education curriculum.

This article seeks to outline the implementation of a longitudinal interprofessional education (IPE) program in the predoctoral curriculum at a U.S. dental school. The challenges of implementing the curriculum in a complex environment are reviewed, and an overview of the 4-year curriculum is offered, including exposure, immersion, and clinical readiness components. Results of developmental evaluations are reviewed. Respondents to surveys regarding the capstone case conference experiences overwhelmingly suggest the conferences were educationally rewarding as well as enriching for each of the health professions represented. While response was limited, alumni surveys also indicate satisfaction with the IPE experience. A discussion of challenges and suggestions regarding successful implementation and expansion of IPE programs from didactic to clinical settings are also included.

Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model.

The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

Pre-doctoral special healthcare needs education: Lost in a crowded curriculum.

We explored academicians' experiences with pre-doctoral special healthcare needs (SHCN) education using one-on-one interviews with academic leaders. We assessed their personal experience with SHCN, the current state of SHCN education at their institution, and their opinions about SHCN education in the pre-doctoral curriculum. Interviews were transcribed verbatim and analyzed using a qualitative descriptive framework to identify emerging themes. Twelve faculty members were interviewed from 10 institutions. All participants acknowledged that the bulk of their training and experience treating patients with SHCN occurred during residency. Participants identified inconsistent pre-doctoral SHCN curricular experiences attributed to time constraints imposed by an increasingly crowded curriculum. Questions remain regarding the place of SHCN education in future pre-doctoral curricula, as well as how to create sustainable systems and programs for dental graduates to gain this experience.