Curriculum structure,content, learning and assessment in European undergraduate dental education – update 2010

This paper presents an updated statement on behalf of the Association for Dental Education in Europe (ADEE) in relation to proposals for undergraduate Curriculum Structure, Content, Learning, Assessment and Student / Staff Exchange for dental education in Europe. A task force was constituted to consider these issues and the two previous, related publications produced by the Association ( 3 and 2007) were revised. The broad European dental community was circulated and contributed to the revisions. The paper was approved at the General Assembly of ADEE, held in Amsterdam in August 2010 and will be updated again in 2015.     

Quality assurance and benchmarking: an approach for European dental schools

This document was written by Task Force 3 of DentEd III, which is a European Union funded Thematic Network working under the auspices of the Association for Dental Education in Europe (ADEE). It provides a guide to assist in the harmonisation of Dental Education Quality Assurance (QA) systems across the European Higher Education Area (EHEA). There is reference to the work, thus far, of DentEd, DentEd Evolves, DentEd III and the ADEE as they strive to assist the convergence of standards in dental education; obviously QA and benchmarking has an important part to play in the European HE response to the Bologna Process. Definitions of Quality, Quality Assurance, Quality Management and Quality Improvement are given and put into the context of dental education. The possible process and framework for Quality Assurance are outlined and some basic guidelines/recommendations suggested. It is recognised that Quality Assurance in Dental Schools has to co-exist as part of established Quality Assurance systems within faculties and universities, and that Schools also may have to comply with existing local or national systems. Perhaps of greatest importance are the 14 'requirements' for the Quality Assurance of Dental Education in Europe. These, together with the document and its appendices, were unanimously supported by the ADEE at its General Assembly in 2006. As there must be more than one road to achieve a convergence or harmonisation standard, a number of appendices are made available on the ADEE website. These provide a series of 'toolkits' from which schools can 'pick and choose' to assist them in developing QA systems appropriate to their own environment. Validated contributions and examples continue to be most welcome from all members of the European dental community for inclusion at this website. It is realised that not all schools will be able to achieve all of these requirements immediately, by definition, successful harmonisation is a process that will take time. At the end of the DentEd III project, ADEE will continue to support the progress of all schools in Europe towards these aims.     

Profile and competences for the graduating European dentist – update 2009

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Helsinki in August 2009. A new taskforce was convened to update the previous document published in 2005. The updated document was then sent to all European Dental Schools, ministries of health, national dental associations and dental specialty associations or societies in Europe. The feedback received was used to improve the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed once again in 5 years time. Feedback to the newly published document is welcomed and all dental educators are encouraged to draw upon the content of the paper to assist them in harmonising the curriculum throughout Europe with the aim of improving the quality of the dental curriculum.     

European core curriculum in cariology for undergraduate dental students

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North-South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.     

British Society for Oral and Maxillofacial Pathology, UK: minimum curriculum in oral pathology

This paper describes a minimum curriculum in oral pathology for undergraduate dental education in the United Kingdom prepared by the Teachers Group of The British Society of Oral and Maxillofacial Pathology. Curricular development in UK dental schools is overseen by the General Dental Council (GDC), the Quality Assurance Agency for Higher Education (QAA) and the European Union. These organisations define the framework for education and learning outcomes but provide little or no detailed guidance on syllabus or curriculum. This recommended minimum curriculum has been drawn up by a consensus process involving teachers of oral pathology from all 13 UK and one Irish dental schools and is cross-referenced to the GDC and QAA published requirements for undergraduate dental education.     

Profile and competences for the European dentist

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Cardiff in September 2004. A task-force drafted the document, which was then sent to all European Dental Schools. Reactions received were used to amend the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed in 5 years time. This paper will be disseminated to ministries of health, national dental associations and dental specialty associations or societies in Europe and these organisations will be asked to offer their comments. This information will be used in the reviewing process to be started in 2007. It is hoped that the availability of this document will assist dental schools in Europe to further harmonize and improve the quality of their curricula.     

A survey of local anaesthesia education in European dental schools

Objective: A survey of European dental schools was conducted in 2006 to determine the curricular structure, techniques and materials used in local anaesthesia teaching to dental students. Materials and methods: A questionnaire was designed to collect information about local anaesthesia education. The questionnaires were sent to the Dean of each dental school in Europe and Israel; 49 returned the completed survey, resulting in a response rate of 18.4%. Results: Results from this survey show that dental schools are managing local anaesthesia education in different ways. At most schools, theoretical teaching begins during the first half of the third year (41%), half a year before the practical instruction (43%). In 37% of the dental schools, students use non‐human objects to practice before they inject an anaesthetic in humans. The first injection in humans, usually a fellow student (61%), is mostly supervised by an oral and maxillofacial surgeon (65%). The number of injections under supervision usually depends on the individual capabilities of the student (41%). Ten per cent of the schools need permission of a medical ethics committee for the practical instruction on fellow students. All dental curricula include teaching of mandibular block anaesthesia. The majority also include instruction of infiltration anaesthesia of the upper (98%) and lower (92%) jaws in addition to infra‐orbital block anaesthesia (57%). Although 82% of the schools are satisfied with the current curriculum with regard to local anaesthesia, 43% are planning changes, frequently the introduction of preclinical training models. Conclusion: Local anaesthesia teaching programmes show considerable variation across the surveyed European dental schools.     

Predoctoral implant dentistry curriculum survey: European dental schools

PURPOSE: In 2002 a survey of European dental schools was conducted. The purpose of the survey was to determine the curricular structure, teaching philosophies and materials used in predoctoral implant dentistry courses. MATERIALS AND METHODS: Fifty-six European dental schools were randomly selected from the Association for Dental Education in Europe representing 33 countries. A questionnaire was mailed to the predoctoral implant dentistry director/chairperson of the selected European dental schools. Of these, 40 schools returned the completed survey, resulting in a response rate of 71%. The mean, median and range of responses were computed where applicable. RESULTS: The results from this survey show that 80% of the responding schools required a course in implant dentistry. Between 1997 and 1999 over a third of responding schools (36%) incorporated a predoctoral implant dentistry course into their curriculum. Eighty-seven per cent of the schools have some prosthodontists teaching the course. Thirty-seven per cent of schools are offering a laboratory course in conjunction with the implant course. Sixty-three per cent of the schools are not restoring implant cases at the predoctoral level. However, 68% of schools reported students are required to be present during implant surgery. Ten per cent of schools require that the implant-related laboratory work be completed by the students. CONCLUSIONS: Predoctoral implant dentistry educational programmes vary from school to school. Yet a large percentage of schools agree on certain topics, including the importance of including implant education in predoctoral dental programmes.     

Teaching of all-ceramic restorations in central European dental schools: a survey

The teaching of all-ceramic restorations in Central European dental schools in the mid 1990s has been surveyed. Based on a 65% response, the findings indicate that the majority of undergraduate (pre-doctoral) students receive instruction in all-ceramic restorations with >75% gaining clinical experience in the use of such restorations prior to graduation. When clinical experience was not received, formal instruction, either in the regular curriculum or in elective studies was generally available. All the schools, with one exception, anticipated that the importance of teaching all-ceramic restorations would increase or at least stay the same. In general, the findings were similar to those reported in studies of the teaching of all-ceramic restorations in North America, Scandinavia, and the UK and Ireland, especially in relation to luting systems, contraindications and finishing instrumentation. However, clinical requirements for all-ceramic restorations in Central European dental schools were more common than in dental schools in North America, Scandinavia and the UK and Ireland.     

Curriculum content, structure and ECTS for European dental schools. Part II: methods of learning and teaching, assessment procedures and performance criteria

This paper presents a brief context of dental undergraduate curricular structure and content and lays out the Association for Dental Education in Europe's views on requirements and recommendations for learning, teaching and assessment procedures/performance.     

Teaching and assessment of implant dentistry in undergraduate and postgraduate education: a European consensus

This paper constitutes a summary of the consensus documents agreed at the First European Workshop on Implant Dentistry University Education held in Prague on 19–22 June 2008. Implant dentistry is becoming increasingly important treatment alternative for the restoration of missing teeth, as patients expectations and demands increase. Furthermore, implant related complications such as peri-implantitis are presenting more frequently in the dental surgery. This consensus paper recommends that implant dentistry should be an integral part of the undergraduate curriculum. Whilst few schools will achieve student competence in the surgical placement of implants this should not preclude the inclusion of the fundamental principles of implant dentistry in the undergraduate curriculum such as the evidence base for their use, indications and contraindications and treatment of the complications that may arise. The consensus paper sets out the rationale for the introduction of implant dentistry in the dental curriculum and the knowledge base for an undergraduate programme in the subject. It lists the competencies that might be sought without expectations of surgical placement of implants at this stage and the assessment methods that might be employed. The paper also addresses the competencies and educational pathways for postgraduate education in implant dentistry.     

Undergraduate training in the European Union Convergence or divergence?

A survey of dental schools in the European Union was carried out for two main reasons. Firstly to promote the exchange of information in respect of curriculum objectives in the different countries and secondly to ascertain the differences in the interpretation of the 1978 EU sectoral directives for dental education and training. Out of 127 schools, only 30 responded, yet the information provided is of considerable importance. It demonstrates wide divergence in the interpretation of the 1978 Directives and methods of assessment of clinical competence. There is a considerable difference throughout Europe in hours devoted to the various subjects included in the Dental Directives. There is little evidence of convergence in methods of assessment or quality assurance. The survey demonstrates the difference in resources, levels of staff, availability of clinical training places, output in research and patient treatments throughout the European Union. The results question the effectiveness of the 1978 Dental Directives in promoting convergence of standards. As there is free movement of dentists throughout the European Union, it is concluded that a different approach may be necessary to ensure that all European Union dental graduates achieve comparable standards in their education and training.     

A survey on undergraduate implant dentistry education in Europe

Introduction:  The aim of the survey was to assess the status of implant dentistry education and addressed various aspects related to competence level, practical implementation and barriers for further development in the field.
Materials and methods:  An e-mail survey was performed amongst 73 opinion leaders from 18 European countries invited to the Association for Dental Education in Europe (ADEE) workshop on implant dentistry.
Results:  Forty-nine surveys were returned (67%) and it was found that theoretical and pre-clinical courses to an average of 36 h are given to undergraduates; 70% reported that students assist or treat patients with prosthetics; 53% reported that students assist with surgery and only 5% is operating patients. In 23% of the schools optional undergraduate courses are available and 90% offer postgraduate training. Barriers for including prosthetics and surgery are lack of time, funding or staff. Partial restorations, including surgery, in the posterior regions may be provided by dentists after attendance at additional courses but complex treatments should be limited to specialists.
Conclusion:  This survey confirms that implant dentistry is part of the undergraduate curriculum, albeit with a disparity in time. Whereas implant dentistry is an important part of clinical practice, coverage in the curriculum is limited and when compared with 10 years ago, even stagnating. Priorities within the curriculum should be evaluated depending on demands and treatment needs of the population. To optimise education, learning guidelines should be developed, based on the expected competencies for practicing dentists. Undergraduate education may start the process that must continue through all levels of education, including the postgraduate level.     

Nine years of DentEd--a global perspective on dental education

This paper describes the three successive and successful DentEd projects, funded by the European Union, that established a productive thematic network which identified common content within the dental curriculum. It then developed an agreed professional profile, with a defined set of competences and a modular curriculum for all new dental graduates based on the European Credit Transfer System and trends in learning and assessment. The three phases took nine years to complete. Phase one investigated all aspects of dental undergraduate education and included over 30 visits to different dental schools by teams of dental educators. Phase two built on this work and included further visits to dental schools. Phase three refined the competency framework that had been developed in phase two and culminated in a global dental conference which finalised position papers on all aspects of dental education. The work and recommendations of the ICT in dental education group are considered in detail in the paper. The projects provided the stimulus for a number of European and international collaborations, including the web-based International Federation of Dental Education and Associations (IFDEA) Knowledge Centre and the International Virtual Dental School (IVIDENT), both of which aim to make increasingly sophisticated ICT-based educational material available worldwide and to promote international understanding.     

Renewal of the clinical-phase dental curriculum to promote better learning at the University of Oulu

The degree awarded to a dentist in Finland is Licentiate of Dentistry, and it takes 5 years to achieve it. The old curriculum at the Institute of Dentistry, University of Oulu, Finland, was based on the departmental division, and there was minimal integration between the disciplines. According to student feedback, the old curriculum was overloaded. The amount of contact teaching was up to 40 h per week throughout the academic year. Based on the workload regulation model launched at the University of Oulu, the actual workload of students for three clinical years was found to exceed the confirmed curriculum (40 study weeks per year for 3 years, representing 180 European Credit Transfer System (ECTS) credits) by 68 ECTS credits (representing 45.3 study weeks). Because of the heavy workload, students did not have time actively to deepen their scientific reasoning. To tackle this problem and to maintain the high academic standards, the Institute of Dentistry, University of Oulu, Finland, decided to change the dental curriculum. The properties and qualities of the competent dentist were listed and arranged in the corners of an octagonal to provide the model of the key dental competencies. Based on this, a thorough core analysis of the courses was carried out by the departments. The new curriculum consists of 10 broader integrative entities, so called dental teaching strands (DTSs), wherein the teaching given by the different departments has been combined. The effort was successful. We managed to remove overlap in the substance of the courses to reduce the students' actual workload by about 45 ECTS credits (representing 30 study weeks and 1200 h of studying) and to promote better scientific reasoning and learning results. The authentic learning and comprehensive patient care comprise the core of the clinical practice.     

Comparison of undergraduate endodontic teaching programmes in the United Kingdom and in some dental schools in Europe and the United States

The pattern of teaching root canal therapy within dental schools of the UK was determined and compared with that carried out within several dental schools in Europe and the USA. Although it appeared that 'teachers of endodontics' in the UK were advocating techniques adopted elsewhere, it was clear that, within the dental undergraduate curriculum as a whole, the teaching of root canal therapy was given a lower priority than that in some schools in Europe and the USA. Recommendations to remedy this unsatisfactory position are provided.     

Undergraduate endodontic teaching in the United Kingdom: an update

Anecdotal evidence and scientific surveys suggest that the quality of root canal treatment within the General Dental Services is often less than ideal. Six years ago, it was reported that endodontic teaching in the United Kingdom was given a low priority and that the time devoted to the laboratory practice of root canal treatment should be increased. In the following year, the European Endodontic Society (ESE) published guidelines for the teaching of Endodontology and made recommendations as to what should be included in the undergraduate curriculum. Shortly afterwards, the ESE published quality guidelines for endodontic treatment. The aim of this project was to determine the current pattern of undergraduate endodontic teaching within the dental schools of the UK. Data were gathered by questionnaire from all 14 undergraduate dental schools and supplemented with further detailed enquiries where necessary. The results were compared with that reported following an identical survey carried out previously. Although the ESE curriculum guidelines for endodontic teaching provide an overall framework for teaching, the results of this study confirmed that a number of topics were either not included or were covered only briefly. However, the average time devoted to the preclinical instruction of root canal treatment in the first clinical year had increased from 14 to 24 h, with additional time provided in subsequent years by the majority of schools. In most instances, staff teaching endodontology in the UK have no specialist training.     

Invited commentary: issues with assessing competence in undergraduate dental education

Competence of practising dentists is an issue that is being addressed in both the undergraduate and postgraduate environment in dental education. The Association of Dental Education in Europe has opened the debate further with guidelines for qualifying dentists in Europe. This puts further pressure on dental schools to produce graduates who are transparently competent. This invited commentary examines the differing concepts of competence and how they might be assessed in the undergraduate dental curriculum.     

Geriatric dentistry education in European dental schools

As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools. No data are available concerning whether or not geriatric dentistry is taught in the 58% non-responding schools.