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12 FALL FALL 12“The opportunity to dive into clinical dentistry earlier than previous years isa welcomed change that benefits us due to the time it takes to develop properpsychomotor and clinical skills.” – Jordan Sanders, second-year DMD studentBiomedical Sciences—AssessingWhat Dentists Need to KnowBest gathered together feedback that had beencollected over the years from both studentsand instructors. The common concern fromstudents was that they didn’t understand theneed for all the medical information andwondered why it took so long for them to learntechnical dentistry skills. From faculty andtutors the chief concern was not having enoughtime for what they wanted to accomplish.Possibly the strongest catalyst for re-examiningthe breadth and depth of medical content camefrom the Faculty’s last accreditation review in2010, which suggested that the medical coursecontent that is not relevant to dentistry bereduced. Since students wanted to do dentistry,to learn the tools of the trade, while faculty andtutors are challenged with the lack of time toteach it, doing an evaluation of the medicalcourses as suggested by the accreditation reviewwas an obvious next step.Best and a team of faculty members received aUBC Teaching and Learning Enhancement Fund(TLEF) grant to conduct a one-year study toidentify the foundational biomedical scienceslearning objectives required for new graduates ofthe UBC Dentistry program. A panel of fourthyearUBC dental students and faculty (dentalspecialists, general dentists, basic scientists) wassurveyed, using the Delphi method (Rand Project1959) for decision-making. The aim was to reacha 75 percent consensus among panelistsregarding each of the 13 year one and two medicalcourses reviewed.From the 81 learning objectives in the medicalreproduction course, there was a 95 percentconsensus that 76 out of 81 learning objectiveswere not relevant to the practice of dentistry,while four learning objectives were “need toknow,” leaving one objective where consensuscould not be reached. Best says: “We readilyidentified that the medical reproductioncourse stood out to be further scrutinized anddetermined that 106 hours of medicalreproduction content could be reduced to 17relevant to the practice of dentistry.”Removing students from this 106-hourmedical course and covering what dentistsneed to know of reproduction in 17 hoursopened up 89 hours in the second-yearcurriculum timetable. Best’s next task was tospearhead a revision of the entire second year.Medical Science and ClinicalSkills: A Balancing ActAt UBC, significant efforts have been made toimprove the correlation of biomedical sciences toclinical dental practice. The Faculty of Dentistryprovides dentistry-related components used inbiomedical science courses, such as problembasedlearning scenarios that include dentaltriggers. The introduction of the Dental AppliedLearning Experiences (case-based learning)in the longitudinal dentistry course furtherstrengthens connections to dentistry.Additionally, Dentistry faculty members teach inMedicine’s head and neck anatomy laboratory,and the medical anatomist is present in thedental clinic; both encourage students to link thebiomedical science to the practice of dentistry.Clinical skills training for dental studentsactually starts in year one with theIntroduction to Clinical Dentistry (DENT 410)course, including supervised simulated patientexperiences among students and volunteers.(Supervised patient treatment with actualpatients starts in the second year.) It wasn’t thatstudents were learning only medicine-relatedinformation and not receiving clinical dentistrytraining in the first two years, but rather theissue was one of balance and distribution.Best explains: “At UBC, dental students learnthe medical management of disease before thesurgical management. If students receivedpsychomotor skills/operative dentistrytraining, a major module in year two, too early(such as in the first year), there is a risk thatstudents will focus on the hand drill to thedetriment of the medical management ofdisease. But the reverse can also happen:delaying it too long can be frustrating for thedental students, and concentrating it too muchmay be stressful and doesn’t allow enoughrepetitious practise.”Six years ago, psychomotor skills/operativedentistry training was taught at the end of yeartwo in an intense month often referred to asBoot Camp. Students were introduced to thehandpiece, started to learn how to positionthemselves ergonomically, and in just fourweeks they had to accomplish a number ofskill sets so that they could move on into thirdyear. “That was an intensive time,” Bestremembers. “They needed more time topractise, to enjoy developing the skill sets andto become more confident.”In 2007, the Faculty was able to move thePsychomotor Skills/Operative (DENT 420PSO) module forward for a January start. Withthe time freed up in 2012 by greatly reducingthe reproduction content and now deliveringthe 17 hours over several modules in the DENT420 Introduction to Diagnostice Sciencesmodule, the Psychomotor Skills/Operativemodule has been moved to the beginning ofsecond year (in late August)—a monumentalchange. But that is not all that changed.Revising the Whole SecondYear: The Domino EffectRemoving the medical reproduction course fromthe second-year DMD program caused a chainreaction of additional improvements. Guidedby a commitment to collaboration, and withthe approval of the Faculty’s CurriculumEffectiveness Teaching Committee, Best spentmany hours consulting broadly with herAcademic Advisor Team, faculty and students.One identified goal was to start clinical skillstraining sooner to increase practice repetition.“That we did,” Best says, “and we achieved anothergoal in second year: to expose students to evenmore kinds of clinical activity that helps themunderstand why they are learning certain contentin the curriculum. When you learn theory, it’smore meaningful to the learner if there areopportunities to apply it right away. Therefore,we sought opportunities for students to applytheir knowledge.”With the Psychomotor Skills/Operative (DENT420 PSO) module underway a full four monthsearlier in second year, some of the skills sets thathad been taught early in the third year havenow been moved into second year, includingthe analysis of cephalograms component of theorthodontics module. And because second yearis composed of integrated modules, pediatricdentistry and orthodontics were naturallyblended and the module changed fromIntroduction to Pediatric Dentistry toIntroduction to the Child Patient (DENT 420ICP), which covers the introductions to bothorthodontics and pediatric dentistry.The second-year Introduction to Prosthodontics(DENT 420 IPROS) module now starts earlierin the year, while the patient care associatedwith the Professionalism and CommunityService (DENT 420 PACS) module comes later.This means that second-year students will havegreater skills sets, so can do more out in thecommunity. With the DENT 420 IPROSmodule under their belt, they will be able tofabricate a set of complete dentures for a patient.Introductory prosthodontics implant sessionsfrom third year are now also integrated into thesecond-year prosthodontic module.The instrumentation component ofperiodontics—from the beginning of thirdyear—was also repositioned into second year.This filled a gap that has existed in theapplication of periodontal skills offeredbetween first year and third year. “We alwaysknew we needed to find time for students tocontinue to practise skills they started to learnin first year and continue to practice in secondyear and beyond—we needed to bridge a gapin second year, and now we have improved it,”Best says. “We needed this kind of opportunityto enrich the second-year curriculum.”What Do the Students Think?And how is second year so far? Best says, “It’sgoing great!” The feedback she’s getting fromsecond-year students is that they are reallyenjoying the clinical dentistry. “Students areexcited, because they feel like they are indental school.”“Amazing,” says second-year student JordanSanders. “The opportunity to dive into clinicaldentistry earlier than previous years is awelcomed change that benefits us due to thetime it takes to develop proper psychomotorand clinical skills.” While acknowledging thatthe workload might be heavier, Sanders says heloves the hands-on dental experience.Likewise, classmate Carmen Hansford is a bigfan of the recent curriculum changes: “Workingon our psychomotor skills and learning clinicalarmamentarium earlier in our educationprovides more balance between the clinicalaspect of dentistry and the biomedical sciencesof medical school in the first two years.”These high appraisals come as no surpriseto Best. When she presented a template ofthe “new” second year to senior students, theywere very enthusiastic—they saw that theirfeedback over the years had been addressed.This enthusiasm spread quickly amongstudents in all years.The Dynamism of CurriculumAs one of the four UBC Dentistry facultymembers who serves on the American DentalEducation Association Commission on Changeand Innovation Liaison (ADEA CCI), Best isfamiliar with curricula at other dental schools.“We’ve learned that UBC is seen as progressive,and other schools are striving to make changeslike we’ve done here in recent years.”And more change there will be. The surveyusing the Delphi method generated a bumpercrop of data that will inform future curriculumrenewal. Removing the medical reproductioncourse was just the beginning. “We are planningand moving quickly. The Faculty of Medicinecurriculum is changing significantly, and it maybe that Dentistry is integrated with the medicalprogram for only a year and a half. It would bea fabulous thing to use the second half of thesecond year solely for the dentistry-specificcurriculum. It could happen by 2014,” she says.The dedication of many people and theirwillingness to collaborate to improve thelearning experiences for the dental students isthe core behind this recent successful change.For Best, the joy of working with curriculum isthat it is dynamic, not stagnant. Hence, facultyneed to continue to develop it for theenhancement and ongoing relevancy of theteaching and learning experience for bothfaculty and students.Top: Dr. Karen Gardner (C), clinical associate professor, reviewsa procedure performed on a mannequin head by second-yearstudents Jordan Sanders (L) and Carmen Handsford.PHOTOS BY MARTIN DEE24 UBC DENTISTRY IMPRESSIONSUBC DENTISTRY IMPRESSIONS 25