An interview with Education and Research Director, Dr Rabia S Khan, at ICE Postgraduate Dental Institute and Hospital, on the future of dental education, reflecting on the impact of COVID-19.
What changes do you see happening in dentistry in general after COVID?
The spread of coronavirus (COVID-19) has posed significant challenges for dentistry and medicine, and dental and medical schools, in all affected countries. Due to the unique characteristics of dental procedures where a large number of droplets and aerosols could be generated, the standard protective measures in daily clinical work are not effective enough to prevent the spread of COVID-19, especially when patients are in the incubation period, are unaware they are infected, or choose to conceal their infection.
Interim guidance on infection prevention and control during health care is recommended when COVID-19 infection is suspected. On the basis of our experience and relevant guidelines and research, dentists should take strict personal protection measures and avoid or minimise operations that can produce droplets or aerosols. The 4-handed technique is beneficial for controlling infection. The use of saliva ejectors with low or high volume can reduce the production of droplets and aerosols. With the increased knowledge of viral features, epidemiological characteristics, clinical spectrum, and treatment, efficient strategies have been taken to prevent, control, and stop the spread of COVID-19. The infection prevention and control strategies that we have adopted are determined by the fact that we are in the centre of COVID-19. We must be constantly aware of infectious threats that may challenge the current infection control regimen, especially in dental practices and schools of dental medicine.
2. How do you think training programmes may change? For example, we have a lot of hands-on elements to our dental courses and the Mentee School.
There are education-related challenges for medical and dental schools, as well as their affiliated hospitals, that are significant. Open communication among students, clinical teachers, and administrative staff would enhance mutual trust and facilitate adequate cooperation. Telecommuting should be recommended for faculty during the indefinite shelter-in-place order. Clear policies and protocols should be conveyed to the faculty, so there is no confusion with regard to expectations and responsibilities.
ICE has taken the lead with regard to recommendations for teaching modalities like online education and other creative teaching methods, connecting faculty and administrators to share ideas and resources to implement in these unusual times.
On the basis of our experience with COVID-19, we provide a few basic recommendations for dental education during an outbreak:
First, during the outbreak period, online lectures, case studies, and problem-based learning tutorials has been adopted to avoid unnecessary aggregation of people and associated risk of infection. Existing smart devices and applications have already made it possible for students to listen to and review lectures whenever and wherever possible. In fact, our students started online learning from March.
Second, we have encouraged students to engage in self-learning, make full use of online resources, and learn about the latest academic developments.
Third, during this period, it is easy for students to be affected by disease-associated fear and pressure, and ICE is also prepared to provide psychological services to those who need them.
The biggest challenge has been to postpone direct patient care, which is a key component of the dental curriculum. No virtual sessions can duplicate the close experience with patients. Faculty and administrations are struggling to balance the need to comply with state and governmental agencies’ recommendations, while keeping students engaged and motivated to continue to learn remotely in this dynamic environment.
3. How will this impact dental education?
The biggest challenge for the administration of dental schools is trying to balance the important task of safeguarding the health of students, faculty, and patients, while keeping track of the changing environment and local or national policies, and at the same time, ensuring that there is continuity in the education of the students.
Telecommuting should be recommended for faculty during the indefinite shelter-in-place order. Clear policies and protocols should be conveyed to the faculty, so there is no confusion with regard to expectations and responsibilities.
With the surge of confirmed COVID-19 cases in the UK and stay-at-home orders implemented, dental schools have had to manage the increasing anxiety among students, faculty, and patients.
Most dental schools in the UK have suspended clinical activities except for dental emergencies, and some are practicing social distancing in their preclinical simulation laboratory activities. For those schools that do not have this option, simulation with mannequins is very difficult to teach online considering the time, manpower, and technology needed for instruction. Virtual reality systems and haptic technology, if already available, are not portable and therefore cannot be used at this time. Each dental school must consider the institutional, operational, teaching, and learning capacity in determining what types of modifications to the educational program would be successful during this time.
Because of indefinite stay-at-home orders in place, school calendars and schedules are affected; licensing exams have been delayed or cancelled. Because of this, the responsibility may fall upon the dental school to certify the competency of the graduating dental students.
It may be crucial to design an assessment that includes the skills, knowledge, aptitude, and behaviour needed to be a competent dentist.
Technology can be very useful but, for many faculty and students, it still involves a learning curve. Since faculty are scrambling to learn and teach online during this emergency, there is no time to evaluate and choose between synchronous and asynchronous online teaching and learning, to relay on students distance education etiquettes and protocols, yet still be flexible enough to deviate from the original plan of content delivery.
4. What measures will ICE be putting in place to maintain student safety yet allow for a maximum learning experience?
Distance education as a solution is the way to move forward. Technology in teaching and learning has been employed when appropriate after adequate training of faculty in remote teaching. The success of e-learning depends on the attitudes and interactive teaching styles of the faculty, as well as on the experience and attitudes of students with regard to technology.
Though there may be challenges in e-learning in dentistry, ICE went for including online courses or elements of e-learning in courses and measure their effectiveness from an organisational, teaching, and learning perspective.
Distance education expectations were made clear to students, and included in the course description with extra points allotted for participation in online seminars, journal clubs, and case based discussions. In choosing the type of educational methodology to be utilised for distance learning, it is important to understand the differences between synchronous and asynchronous teaching. Synchronous teaching is preferred when peer interactions would be beneficial and when critical thinking skills are taught at the level of a novice. Asynchronous teaching could be adopted to facilitate collaborative learning but may need to be moderated by experienced faculty.
Blended learning that has both synchronous and asynchronous elements may be effective for teaching integrated content and its application in clinical scenarios, as in dental emergencies.
Flipped classroom techniques require students to review online modules before participating in seminars. Problem-based learning (PBL) approaches could ensure comprehension of important concepts and build on critical thinking.
Clinical videos that enhance the learning experience has also been created by faculty. Since it can be time-consuming to create these videos, it might be beneficial to share these resources with other schools. Assessment strategies can include formative exams on learning management systems like and summative exams.
Due to the COVID-19 pandemic, most of the schools have suspended clinical care by students except for dental emergencies for active patients that are seen by faculty or residents.
The administration of dental schools could also reassess the existing policies in the clinic and protocols in place for emergencies and learn how to improve them in the event of another emergency in the future.
5. Are there any other risks to worry about?
Multiple agencies, universities, and companies are working diligently to develop faster testing, and better measures for prevention and treatment of COVID-19 infection. Dental schools should focus on re-evaluating and reprioritising their policies and protocols and include a detailed contingency plan in case of future pandemics. This experience should also prompt dental schools to re-evaluate their competency based education, incorporate variations of distance learning permanently in their curricula, invest in haptic technology to improve psychomotor skills and also in faculty training for teaching through technology. Extramural rotations and inter professional education should be strengthened in the curricula to enable dental students to have the ability to make an impact in the community and help during such a crisis.
With the increased knowledge of viral features, epidemiological characteristics, clinical spectrum, and treatment, efficient strategies have been taken to prevent, control, and stop the spread of COVID-19. The infection prevention and control strategies that we have adopted are determined by the fact that we are in the centre of COVID-19. We must be constantly aware of infectious threats that may challenge the current infection control regimen, especially in dental practices and schools of dental medicine.
To fill the gaps and in preparedness of many dental schools for such pandemics in the future, thus minimising disruptions to the training of students and residents.
Contact Dr Rabia S Khan:
(+44) 161 413 8337
Contact our Dental Team:
(+44) 161 413 8330