A journey into clinical education in dentistry leads to an epiphany

Cheryl Deslaurier, Arnaldo Perez - 1 May 2020

The journey of exploring alternate approaches to clinical education began over four years ago with the clinical education subgroup. The mandate of this group was to propose a new clinical model to use in the new DDS curriculum. The work led to discussions including questions like: "What does patient-centred care and person-centred care really mean, and is it inclusive of other aspects of dental school operations?" From there, the recently published manuscript titled, "Thinking Ecologically about Clinical Education in Dentistry," was born. Authored by Arnaldo Perez, Jacqueline Green, Sharon Compton, Steven Patterson, and Anthea Senior, this work is a collection of thoughts and perspectives on Clinic Education (CE) approaches in dentistry.

After a thorough review of the literature, the team found that the more common approaches to CE in dentistry (student-, patient-, and person-centred approaches) each had their own biases. They also noted that the conversation on approach to CE was gradually shifting from approach development (establishing guiding principles for CE) to system development (implementing the principles of the chosen CE approach).

They thought that this transition was, at best, premature since existing approaches had been described, but not critically challenged. As highlighted in the paper, developing CE systems informed by limited approaches will not substantially improve CE in academic dental institutions. Their critical appraisal of the current approaches led them to identify three main limitations. First, these approaches focused on the needs and interests of students and/or patients, so the interests of other stakeholders (e.g., instructors, administrators) were not sufficiently considered. Second, they were based on a "priority rationale" where the interests of a single stakeholder (e.g., patients) took precedence over those of others. Lastly, and perhaps more importantly, recent studies showed that prioritizing some interests might lead to neglect others.

As a response to these limitations, they discovered the Eco-centered approach. This approach does not prioritize the interests of a particular stakeholder (e.g., students' educational needs), but considers the interests of all stakeholders in a responsive, holistic, and sustainable manner. Indeed, mutual benefit and sustainability are the two main outcomes expected from the implementation of this new approach. They did not outline a system informed by this approach in the paper but discussed concrete actions that can be undertaken to develop such a system, which may likely be the next step of this project. The Eco-centered approach embraces the principles of multi-level influences and reciprocal causation. The former highlights that complex social systems like CE are better understood if factors at different levels (e.g., personal, interpersonal, organizational) are considered, while the latter stresses that "causality" within theses systems is never linear, but reciprocal in vertical and horizontal directions.

A great deal of the literature on dental education tells the story of the struggles dental schools face to meet their educational, patient care and research aspirations sustainably. Schools are somehow "thinking" ecologically in the pursuit of these interconnected aspirations. Therefore, an approach that articulates what dental schools are trying to do is timely and promising. The Eco-centered approach may be useful not only in dental education but also in other disciplines with similar complex educational systems. Thinking and acting ecologically in health professions education is no longer an option, but a necessity.

Read the article here.