New curriculum revamps dental education and improves student experience

The shift: New curriculum focuses on what graduating dentists need to know

For over a decade, students in the Faculties of Medicine and Dentistry took a joint biomedical curriculum together. But this curriculum—which was primarily geared towards medical students—left dental students wondering what exactly was relevant to their profession. In 2010, the faculty began an extensive assessment of their biomedical curriculum, as part of an accreditation recommendation. They found that only 47 percent of the joint biomedical curriculum was “need to know” (Best et al, 2016). The faculty decided to restructure their entire curriculum, one year at a time. They have increased interactive learning and introduced Progress Portfolios, which include PeerWise assignments and progress surveys that benchmark students’ development related to the expected competencies of a graduating dentist.

The strategies

The team is currently reworking their Doctor of Dental Medicine (DMD) degree program year by year, while considering the entire four-year curriculum. A new first-year curriculum was introduced in the 2015/16 academic year. Among the teaching strategies used are flipping and blending the classroom. More faculty agreed that lengthy lectures weren’t working and wanted to make classtime more meaningful. Students now pre-read assignments and review learning materials during curriculum time that has been specifically allotted for independent study. Faculty then engage students in the classroom with discussions or Clicker quizzes.

More dentally-relevant problem- and case-based learning has also been added so that students can apply their knowledge. By including more oral health-related contexts, the team aims to create a more relevant and engaging experience for students. To gain hands-on experience, students get clinical experience as soon as they start, in the first term of their first year.

The new curriculum also emphasizes collaboration and peer teaching. Through PeerWise, students can generate multiple-choice questions, and then rate and comment on questions submitted by others. “It enhances the students’ learning when they are encouraged to research content to create questions,” explains Leandra Best, associate dean, academic affairs in the Faculty of Dentistry. “An incentive for students to create meaningful, good questions is knowing that these questions might be used in their final exams.” She adds that while it is often difficult for faculty to write multiple-choice questions, they have found some students excel at it.

The progress survey

With these changes, the team agreed there needed to be new and varied forms of measuring learning. “If we’re going to have a new curriculum, we also need to have a new assessment system,” says HsingChi von Bergmann, associate professor in the Faculty of Dentistry.

Professional schools, such as dentistry, focus on a competency-based education. But this type of knowledge can be difficult to assess. To help with this, the team, supported by a Teaching and Learning Enhancement Fund (TLEF) grant, introduced progress surveys. Progress surveys are 200-item online multiple-choice exams given to all four years of DMD students simultaneously twice a year. They map where students are in their preparation to becoming a dentist.

Progress surveys help in “understanding what cognitive knowledge is required in a competent professional,” explains von Bergmann. “Once they’re finished the professional school, what is the knowledge that is required of them for us to say that they are competent?”

To create the progress surveys, faculty members looked at dental competency documents from Canada and the United States. The blueprint for the test was a grid, where the horizontal rows represented different dental areas, and the columns represented the assessment of patients. Where the cells crossed, “we asked the faculty to have a dialogue about what the knowledge could look like,” explains von Bergmann. Faculty members then voted on the competencies they thought were most important for dentists to know. The surveys are independent of curriculum—because it measures end-point learning outcomes, the blueprint does not fluctuate much.

While it is expected that students in their first year will have little cognitive knowledge, they hope students will have 100 percent of this knowledge by their final year.

“The directive is that you don’t need to prepare for it, because it benchmarks your own progress. It’s cognitive knowledge—you know it or you don’t know it,” says von Bergmann. “Once the report card [for the progress survey] is out, [students] can look at their own domains and compare it to the class average.”

The faculty hope this will encourage students who scored lower than average to assess their learning and seek further help in areas they’re struggling with. For the instructors, it can also promote dialogue amongst the curriculum planning committee.

The challenges

The new curriculum is being rolled out one year at a time, with the full four years of renewed curriculum implemented by 2019. This approach helps faculty tweak the curriculum for the next year, based on students’ feedback and experiences. But this also means that some students are still learning through the old curriculum. One challenge has been ensuring those students still see the value in their learning. “Their curriculum is still very rich and very good—it’s just that they’re on a different path to the end point competencies,” explains Best.

The progress survey also presents its own set of challenges. As von Bergmann points out—capturing students’ extent of knowledge is not an easy task within a 200-item survey. And creating new questions can be equally challenging. The team hopes they can alleviate some of this supply issue by crowdsourcing some of the questions, including student-generated questions created in PeerWise.

The impact

The new curriculum was welcomed by students, who provided verbal and written feedback. Students particularly appreciated that they now saw the relevance of everything they were learning from a dental context.

Like with any assessments, students were nervous when the progress surveys were introduced. But, as von Bergmann explains, they began to see it as a self-assessment and self-diagnosis tool—a way to see how their knowledge has grown over time.

“It’s quite interesting for students to see at different times of their learning where they are in relative standing,” says von Bergmann. “I have received emails from students from time to time after report cards were sent out, and the fourth-year students…always say ‘This is really, really helpful, because it gives me a wake up call. I’m going to take the board exam, and I’m not sure I’m ready yet.'”

The board exam, which is a standardized test administered by the National Dental Examining Board of Canada, is a high-stakes exam required for licensure to practice dentistry in Canada. The progress survey, on the other hand, is no-stakes. The faculty hope that taking the progress surveys will help reduce stress and anxiety when students take the board exam.

What’s next

The team will continue to take student feedback into consideration as they work on creating the new third-year of the curriculum. Reflecting on her experiences, Best says that collaboration and consensus building have been essential. She adds that the renewal has also made the faculty more cohesive and aware of the work others are doing. “It’s been an opportunity for faculty to re-evaluate and determine discipline-related benchmarks at the end of each year of the program,” explains Best. “Likewise, students are seeing results of their feedback.”

The team hopes that their work will also showcase the importance of thinking about teaching and learning.

“Education itself is a discipline,” says von Bergmann. “To understand curriculum, to understand teaching, to understand assessment—these all take time.” She hopes that more evidence-based thinking will be brought into curriculum planning. “Education is not soft science. Education can also be scientific.”

The team has received recognition for their work, winning the top prize last summer for their poster presentation at the American Dental Education Association Commission on Change and Innovation in Dental Education. They’re also hoping that the impact of the progress surveys can be scaled up, and are looking to expand it to dental schools throughout Canada.

“It’s been a great opportunity to improve the education for our students,” Best says. “It’s exciting to know that there’s lessons learned that we’ve gone through that might help others as well.”

Resources

Best, L. Walton, J. N., Walker, J., & von Bergmann, HC. (2016). Reaching consensus on essential biomedical science learning objectives in a dental curriculum. Journal of Dental Education, 80(4), 422-429. http://www.jdentaled.org/content/80/4/422.full

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Feature image photo credit: Martin Dee