The Dental Curriculum: Is It Relevant to Dental Practice? WilliamA. Welker,DDS,AdSD* Does the undergraduate dental curriculum devote the appropriate amount of time to those areas of dentistry that are relevant to today’s general dental practice? In a survey of dentists who graduated between 1980 and 1985, it was determined that they felt curriculum offerings in orthodontics, research, endodontics. periodontics, oral surgery, fixed prosthodontics, and occlusion had not been extensive enough. However, graduates also reported that their educational experiences in biochemistry, dental laboratory procedures, gross anatomy, microbiology, and occlusion were too extensive. J Prosthod 1147-50. Copyright 0 7992 by the American College of Prosthodontists. INDEX WORDS: dental curriculum, relevance, education, dental practice
A
lthough there are dental educators who fcel the dental curriculum would be better used to develop highcr intellectual skills, such as critical analyses and evaluation,l the mastery of those skills should haw bccn the purpose of the predental curriculum. In the final analysis, the purpose of the dental curriculum is for the dental student to learn how to practice dentistry competently. Much learning is by experience, but it takes place in different forins and in varying degrees of richness and depth. How a person learns is affected by many things. Learning is strengthenedwhen associated with pleasant, satisfyjng feelings but weakencd when associated with unpleasant feelings. Those things most often repeated are best remcmbcred. Thus, the teacher must provide upportunities for the student to practice or repeat what he or she is learning. A person learns when they are ready to learn, and they do not learn if they haw no reason to do so. If outside responsibilities,interests, or worries weigh too h e a d y on the student’s mind, if their schedule is overcrowded, or if their personal problems seem unsolvable, they may have little interest in learning.’ An cxpcricnce that challenges the learner, requires in\d7ement with feelings, thoughts, recall of past experiences, and physical activity, is more effec-
*.hsariote ProJ;;csor,Co[ltx~of Dentis@ The Ohio Stafe Liiiicmrip, ColumhiLc,, OH. Address re,tnint requests to: $$’A.Wdker: DDS. MSD. College Dentisty, 305 W 12thh e . Columbus, OH43210.
OJ‘
CopyjCht Q 1992 the American College ofProsthodontists I Ot;?-94iXl9a 0101-0O09$5.0010
tive than an experience in which the student simply commits something to memory. Overlearning, that is, the practice of a skill beyond the point of initial correct performance, has several bencfits; it promotes transfer of learning; increases confidence; cements skill; allows quicker detection and corrcction of errurs; and helps adaptation to altered environments.3 Yet, because of today’s knowledge explosion, the dental curriculum tends to be so extensive that students have no time to overlearn but just to memorize. In 1983, Cotmore et al+determincd that a significant number of practitioners felt that their training in removable partial prosthodontics was inadequate. Cotmore et al’concluded that it would be interesting to know if the practitioners also felt that their training was weak in other disciplines of dentistry as well. Today’s curriculum committees are often challenged to add new material to the curriculum in the areas of orthodontics, oral biology, interpersonal relationships, insurance proccdurcs, and business managcment. Mosl of the time these additions must be made without removing any ofthe existing material or extending thc time required to complete the curriculum. h4any of these new additions are subjects that are for the benefit of the system (dentist). We must not lose sight of the patient’s need. Dental cducational systems and thc health care delivery they spawn, must be based on the needs of the patient rather than the needs of the ~ y s t e m . ~ More and more evidence is available that there is a significant differcncc bctwcen what dcntists are taught in dcntal school and the senice they deliver in
Journal ofPrarthodontzrs, Voi I , XOI (Septtniber). 1992:pp 47-50
47
48
Is Cum‘culurn Relenant t o Practice a WilliamA. WeleMrer
practice?,’ Is this a function of their dental education or ofthe “system”? The dental curriculum places great stress on the student, perhaps it is the most intense in professional education. These stresses arc partially due to lack of time to do academic ~7ork,the perfectionism demanded in dental courses, noncooperation of patients, and inability of the student to secure clinic space when they wish it. Because of the stressfd curriculum, students face many ethical dilemmas which impact on moral standards, humanitarianism, benevolence, and principled learning.* The students know that they must complete their requirements with an educational system whose curriculum seems to place road blocks in their path. The result is that a great number of students feel it is the dental school courses that teach them to use short-cut techniques and do onlywhat is necessary to get by. This is more than likely an effect of the hidden curriculum than of the established one. Nevertheless, the students form habits that are near impossible to overcome when they begin to practice. It is difficult, if not impossible, for dental faculty to delete material that is already in the curriculum. One of the reasons is that the faculty tend to give things equal importance whether or not they deserve it. This is true because faculties, as a group, focus their attention on too broad an area, such as, “Is knowing the Krebs cycle as important as knowing how to do a complete crown preparation when practicing clinical dentistry?” To decide to remove something from the curriculum is an awesome responsibility, because you are determining the future knowledge ofdental practitioners. When making such decisions, curriculum committees need all of the pertinent information available. It is enlightening for dental schools to survey their graduates in general practice periodically, not only to detcrmine what comprises that “general practice” but also to gather suggestions for changes in dental education.g The purpose of this survey was to (1) determine if the 1980 through 1985 Ohio State University graduates felt that any of their dental education was too extensive or not extensive enough and (2) determine their opinions as to how well they were prepared to practice dentistry.
Materials and Methods Those surveyed were the graduates of the years 1980, 1981,1983,1984, and 1985. There was no graduating class in 1982 because ofthe change from the %year to the 4-year curriculum. This change affected only the length ofbetween quarter breaks and not curriculum content or tinie. The respondents were asked to answer the followingquestions by checking the appropriate box. Question 1 (Tablc 1) was “Pertaining to the arcas listed how well did your dental education prepare you for your practice today?” (Answers included v e r y ~ e l ladequately; ; poorly; and not at all). Question 2 (Table 2) was “For what you do now, rate your dental cducation in, ie, biochemistry, complete dentures, etc.” (Answers included too extensive; about right; and not extensive enough). Question 3 asked for general information including the year of graduation, location of practice, advanced education completed. For further understanding ofthe form of the questions see Tables I and 2. The survey was first administcred to graduates enrolled in various programs. This was done to evaluate the instrument’s understandability and ease of completion. Next, a pilot study was conducted. By surveying randomly selected members of each class, we determined, among other things, that at least 118 graduates should be included in the final sample. Using random numbers, 13.8 graduates of the 1980 through 1985 classes were selected as the
Table 1. Percentage of Responses to Question No. 1
Biochemistry Complete dentures Dental laboratory prtxredures Endodontics Fixed prosthodont ics Gross anatomy AMicrdiolo~q Occlusion Operative dentistry Oral surgcry Oral pathology Orthodontics Pedodontics Periodon tics Removable partial dentures Research
12 44
72 50
49 29 34 40 8 19 41 31 34 6 13 14
47 53 59 57 74 54 56 57 62 19 71 66
34 1
59 18
All values dcnotr perccntagr.
8 5
8 1
4
0 0 0
18
7 1 12
25 3 12 4 57 16 19
7 35
2 6 2 0 0 0 18
0 1
0 46
49
Septembm 1992, L’olume I , Number 1
Table 2. Percmtaee of Responses to Question No. 2 Tw
Biochemistry Complete dentures Dental laboratory procedures Endodontics Fixed prosthodontics Gross anatomy Microbiology Occlusion Operative dentistry Oral surgery Oral pathology Orthodontics Pedodontics Periodontics Removable partial dentures
Research
Extensiue
About Right
29 6
69 85
23 3 5
74 53 66
19 18 17 7 0
73
IVOt Exlcnviue
Enough
2 Y
3
,w 29
68
8 14
54
29
88 70
30
5
2
81
4 7 5
21 73 53
2 5
81
17
47
48
17 75 20 112
sample population. The survey was mailed to them with a stamped, addrassed envelope. Four weeks after the first mailing, a followup mailing was done. One hundred and eight, or 80% of the sample, returned the completed survey. The responses were collected, tabulated, and interpreted.
Results Ninety-two percent of the graduates are in the private practice of dentistry, 70% of those are in the state, while the rest are in 18 other states or the armed forces. Twenty-five percent of them have completed, or are enrolled in, dental specialty programs: 7% in general practice residencies; 6% in orthodontics; 5% in oral surgery; 3% in periodontics; 2% in endodontics;l% in oral pathology and 1% in prosthodontics. The results shorn7 that the graduates feel thcir education had not been thoroughly extensive in orthodontics, 75%;research, 48%; endodontics, 44%; periodontics, 42%; oral surgery, 30%; fixed prosthodontics and occlusion each 29%. In the area of complete dentures, 94% of graduates indicated they were trained very well or adequately and 85% indicated the amount (length) of that training was about right. Almost all (97%) graduates indicated that they were trained very well or adequately in operative
dentistry with 88% saying the length of their training was about right. Ninety-three percent said they were trained adequately to v e q well in removable partial dentures, with 81% saying the lengthwas about right, and 17% indicated it was not extensive enough. Those areas where the graduates felt their training had been too extensive were: biochemistry, 29%; dental laboratory procedures, 23%; gross anatomy, 19%;microbiology, 18%; and occlusion, 17%. Although they were not asked, several graduates wrote comments on the return sheet. The following is a composite ofthose commcnts. 1. “Our dental education did not contain information on how to run a business, that is, hiring, firing, accounting, banking information, types of billing, computers.” 2. “Biochemistry, too much, useless, not enough real world examples, used very little in practice.” 3. “Research, did I need any? I don’t do it! I am not sure of the need for a student to du research.” 4. “Dental lab, laboratory procedures must be stressed. Dentists who wish their dentures, fixed partial dentures, and removable partial dentures to be successful must often be willing to perform some of the dental lab procedures themselves. Farming out all lab work usually yields mountings of poor quality, bad occlusion.. . .” 5. “Gross Anatomy, less whole body would be fine. Used very little in practice.’’ 6. “Orthodontics, my education has been adequate due to the good access to good specialists in my area. More information on diagnosis and minor tooth movement may have been helpful.” 7. “h,licrobiology, was somewhat too extensive. Is used very little in practice.” 8. “Occlusion, not practical enough for general practice. Not extensive enough in areas of clinical importance.” 9. “Complete Dentures, needed to be more for general practice. Not practical enough.” IU. “Pharmacology, not extensive enough, prepared mc poorly for practice.”
Discussion The results differ from thosc of Cotmore et a14 in that most graduates felt they received adequate to very good training in removable partial denturas. We also answcred their question as to how graduates felt
50
IVzlliam A. Welker
4 Curnculuni Releuant to l’ractm
about their training in the other areas of dentistry. Those areas where training could have been more extensive were orthodontics, research, endodontics, periodontics, oral surgery, fixed prosthodontics, occlusion, and in the area of “running the business” part of a denial practice. As a whole, graduates feel that their dcntal education prepared them to practicc dentistry as they do today, although theywere better prepared in some areas than in others. It is interesting that in their unsolicited comments, the graduates indicated that biochemistry, research, gross anatomy, and microbiolo
A
lthough there are dental educators who fcel the dental curriculum would be better used to develop highcr intellectual skills, such as critical analyses and evaluation,l the mastery of those skills should haw bccn the purpose of the predental curriculum. In the final analysis, the purpose of the dental curriculum is for the dental student to learn how to practice dentistry competently. Much learning is by experience, but it takes place in different forins and in varying degrees of richness and depth. How a person learns is affected by many things. Learning is strengthenedwhen associated with pleasant, satisfyjng feelings but weakencd when associated with unpleasant feelings. Those things most often repeated are best remcmbcred. Thus, the teacher must provide upportunities for the student to practice or repeat what he or she is learning. A person learns when they are ready to learn, and they do not learn if they haw no reason to do so. If outside responsibilities,interests, or worries weigh too h e a d y on the student’s mind, if their schedule is overcrowded, or if their personal problems seem unsolvable, they may have little interest in learning.’ An cxpcricnce that challenges the learner, requires in\d7ement with feelings, thoughts, recall of past experiences, and physical activity, is more effec-
*.hsariote ProJ;;csor,Co[ltx~of Dentis@ The Ohio Stafe Liiiicmrip, ColumhiLc,, OH. Address re,tnint requests to: $$’A.Wdker: DDS. MSD. College Dentisty, 305 W 12thh e . Columbus, OH43210.
OJ‘
CopyjCht Q 1992 the American College ofProsthodontists I Ot;?-94iXl9a 0101-0O09$5.0010
tive than an experience in which the student simply commits something to memory. Overlearning, that is, the practice of a skill beyond the point of initial correct performance, has several bencfits; it promotes transfer of learning; increases confidence; cements skill; allows quicker detection and corrcction of errurs; and helps adaptation to altered environments.3 Yet, because of today’s knowledge explosion, the dental curriculum tends to be so extensive that students have no time to overlearn but just to memorize. In 1983, Cotmore et al+determincd that a significant number of practitioners felt that their training in removable partial prosthodontics was inadequate. Cotmore et al’concluded that it would be interesting to know if the practitioners also felt that their training was weak in other disciplines of dentistry as well. Today’s curriculum committees are often challenged to add new material to the curriculum in the areas of orthodontics, oral biology, interpersonal relationships, insurance proccdurcs, and business managcment. Mosl of the time these additions must be made without removing any ofthe existing material or extending thc time required to complete the curriculum. h4any of these new additions are subjects that are for the benefit of the system (dentist). We must not lose sight of the patient’s need. Dental cducational systems and thc health care delivery they spawn, must be based on the needs of the patient rather than the needs of the ~ y s t e m . ~ More and more evidence is available that there is a significant differcncc bctwcen what dcntists are taught in dcntal school and the senice they deliver in
Journal ofPrarthodontzrs, Voi I , XOI (Septtniber). 1992:pp 47-50
47
48
Is Cum‘culurn Relenant t o Practice a WilliamA. WeleMrer
practice?,’ Is this a function of their dental education or ofthe “system”? The dental curriculum places great stress on the student, perhaps it is the most intense in professional education. These stresses arc partially due to lack of time to do academic ~7ork,the perfectionism demanded in dental courses, noncooperation of patients, and inability of the student to secure clinic space when they wish it. Because of the stressfd curriculum, students face many ethical dilemmas which impact on moral standards, humanitarianism, benevolence, and principled learning.* The students know that they must complete their requirements with an educational system whose curriculum seems to place road blocks in their path. The result is that a great number of students feel it is the dental school courses that teach them to use short-cut techniques and do onlywhat is necessary to get by. This is more than likely an effect of the hidden curriculum than of the established one. Nevertheless, the students form habits that are near impossible to overcome when they begin to practice. It is difficult, if not impossible, for dental faculty to delete material that is already in the curriculum. One of the reasons is that the faculty tend to give things equal importance whether or not they deserve it. This is true because faculties, as a group, focus their attention on too broad an area, such as, “Is knowing the Krebs cycle as important as knowing how to do a complete crown preparation when practicing clinical dentistry?” To decide to remove something from the curriculum is an awesome responsibility, because you are determining the future knowledge ofdental practitioners. When making such decisions, curriculum committees need all of the pertinent information available. It is enlightening for dental schools to survey their graduates in general practice periodically, not only to detcrmine what comprises that “general practice” but also to gather suggestions for changes in dental education.g The purpose of this survey was to (1) determine if the 1980 through 1985 Ohio State University graduates felt that any of their dental education was too extensive or not extensive enough and (2) determine their opinions as to how well they were prepared to practice dentistry.
Materials and Methods Those surveyed were the graduates of the years 1980, 1981,1983,1984, and 1985. There was no graduating class in 1982 because ofthe change from the %year to the 4-year curriculum. This change affected only the length ofbetween quarter breaks and not curriculum content or tinie. The respondents were asked to answer the followingquestions by checking the appropriate box. Question 1 (Tablc 1) was “Pertaining to the arcas listed how well did your dental education prepare you for your practice today?” (Answers included v e r y ~ e l ladequately; ; poorly; and not at all). Question 2 (Table 2) was “For what you do now, rate your dental cducation in, ie, biochemistry, complete dentures, etc.” (Answers included too extensive; about right; and not extensive enough). Question 3 asked for general information including the year of graduation, location of practice, advanced education completed. For further understanding ofthe form of the questions see Tables I and 2. The survey was first administcred to graduates enrolled in various programs. This was done to evaluate the instrument’s understandability and ease of completion. Next, a pilot study was conducted. By surveying randomly selected members of each class, we determined, among other things, that at least 118 graduates should be included in the final sample. Using random numbers, 13.8 graduates of the 1980 through 1985 classes were selected as the
Table 1. Percentage of Responses to Question No. 1
Biochemistry Complete dentures Dental laboratory prtxredures Endodontics Fixed prosthodont ics Gross anatomy AMicrdiolo~q Occlusion Operative dentistry Oral surgcry Oral pathology Orthodontics Pedodontics Periodon tics Removable partial dentures Research
12 44
72 50
49 29 34 40 8 19 41 31 34 6 13 14
47 53 59 57 74 54 56 57 62 19 71 66
34 1
59 18
All values dcnotr perccntagr.
8 5
8 1
4
0 0 0
18
7 1 12
25 3 12 4 57 16 19
7 35
2 6 2 0 0 0 18
0 1
0 46
49
Septembm 1992, L’olume I , Number 1
Table 2. Percmtaee of Responses to Question No. 2 Tw
Biochemistry Complete dentures Dental laboratory procedures Endodontics Fixed prosthodontics Gross anatomy Microbiology Occlusion Operative dentistry Oral surgery Oral pathology Orthodontics Pedodontics Periodontics Removable partial dentures
Research
Extensiue
About Right
29 6
69 85
23 3 5
74 53 66
19 18 17 7 0
73
IVOt Exlcnviue
Enough
2 Y
3
,w 29
68
8 14
54
29
88 70
30
5
2
81
4 7 5
21 73 53
2 5
81
17
47
48
17 75 20 112
sample population. The survey was mailed to them with a stamped, addrassed envelope. Four weeks after the first mailing, a followup mailing was done. One hundred and eight, or 80% of the sample, returned the completed survey. The responses were collected, tabulated, and interpreted.
Results Ninety-two percent of the graduates are in the private practice of dentistry, 70% of those are in the state, while the rest are in 18 other states or the armed forces. Twenty-five percent of them have completed, or are enrolled in, dental specialty programs: 7% in general practice residencies; 6% in orthodontics; 5% in oral surgery; 3% in periodontics; 2% in endodontics;l% in oral pathology and 1% in prosthodontics. The results shorn7 that the graduates feel thcir education had not been thoroughly extensive in orthodontics, 75%;research, 48%; endodontics, 44%; periodontics, 42%; oral surgery, 30%; fixed prosthodontics and occlusion each 29%. In the area of complete dentures, 94% of graduates indicated they were trained very well or adequately and 85% indicated the amount (length) of that training was about right. Almost all (97%) graduates indicated that they were trained very well or adequately in operative
dentistry with 88% saying the length of their training was about right. Ninety-three percent said they were trained adequately to v e q well in removable partial dentures, with 81% saying the lengthwas about right, and 17% indicated it was not extensive enough. Those areas where the graduates felt their training had been too extensive were: biochemistry, 29%; dental laboratory procedures, 23%; gross anatomy, 19%;microbiology, 18%; and occlusion, 17%. Although they were not asked, several graduates wrote comments on the return sheet. The following is a composite ofthose commcnts. 1. “Our dental education did not contain information on how to run a business, that is, hiring, firing, accounting, banking information, types of billing, computers.” 2. “Biochemistry, too much, useless, not enough real world examples, used very little in practice.” 3. “Research, did I need any? I don’t do it! I am not sure of the need for a student to du research.” 4. “Dental lab, laboratory procedures must be stressed. Dentists who wish their dentures, fixed partial dentures, and removable partial dentures to be successful must often be willing to perform some of the dental lab procedures themselves. Farming out all lab work usually yields mountings of poor quality, bad occlusion.. . .” 5. “Gross Anatomy, less whole body would be fine. Used very little in practice.’’ 6. “Orthodontics, my education has been adequate due to the good access to good specialists in my area. More information on diagnosis and minor tooth movement may have been helpful.” 7. “h,licrobiology, was somewhat too extensive. Is used very little in practice.” 8. “Occlusion, not practical enough for general practice. Not extensive enough in areas of clinical importance.” 9. “Complete Dentures, needed to be more for general practice. Not practical enough.” IU. “Pharmacology, not extensive enough, prepared mc poorly for practice.”
Discussion The results differ from thosc of Cotmore et a14 in that most graduates felt they received adequate to very good training in removable partial denturas. We also answcred their question as to how graduates felt
50
IVzlliam A. Welker
4 Curnculuni Releuant to l’ractm
about their training in the other areas of dentistry. Those areas where training could have been more extensive were orthodontics, research, endodontics, periodontics, oral surgery, fixed prosthodontics, occlusion, and in the area of “running the business” part of a denial practice. As a whole, graduates feel that their dcntal education prepared them to practicc dentistry as they do today, although theywere better prepared in some areas than in others. It is interesting that in their unsolicited comments, the graduates indicated that biochemistry, research, gross anatomy, and microbiolo
