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Cover page of the Journal of Health Sciences


 
 Table of Contents  
MEDICAL EDUCATION
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 130-135

Introducing evidence-based dentistry to undergraduates in the Indian dental curriculum


1 Department of Oral Medicine and Radiology, KLE VK Institute of Dental Sciences, Mysore, India
2 Department of Oral and Maxillofacial Surgery, KLE VK Institute of Dental Sciences, Mysore, India
3 Department of Prosthodontics, JSS Dental College, Mysore, India
4 Department of Pharmaceutical Chemistry, KLE College of Pharmacy, Belgaum, Karnataka, India

Date of Web Publication17-Jan-2016

Correspondence Address:
Vasanti Lagali-Jirge
Department of Oral Medicine and Radiology, KLE VK Institute of Dental Sciences, Belgaum - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.174247

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  Abstract 

The importance of evidence in health care teaching in order to orient the practitioners to the great amount of scientific information, and to support clinical decisions, is well established in health care, including density. The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, and information explosion and the consumer movement associated with advances on the internet. Aim of evidence-based practice is the systematic literature review, which synthesizes the best evidences and provides the basis for clinical practice guidelines.

Keywords: Dental curriculum, dental undergraduates, evidence-based dentistry


How to cite this article:
Lagali-Jirge V, Kadagad P, Sunila B S, Bagewadi A, Maste M, Mali D. Introducing evidence-based dentistry to undergraduates in the Indian dental curriculum. Indian J Health Sci Biomed Res 2015;8:130-5

How to cite this URL:
Lagali-Jirge V, Kadagad P, Sunila B S, Bagewadi A, Maste M, Mali D. Introducing evidence-based dentistry to undergraduates in the Indian dental curriculum. Indian J Health Sci Biomed Res [serial online] 2015 [cited 2019 Dec 13];8:130-5. Available from: http://www.ijournalhs.org/text.asp?2015/8/2/130/174247


  Introduction Top


The importance of evidence in health care teaching in order to orient the practitioners to the great amount of scientific information, and to support clinical decisions, is well-established in health care, including density. The practice of evidence-based medicine is a process of lifelong, self-directed, and problem-based learning which leads to the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues. Nowadays the practice of dentistry is becoming more complex and challenging because of the continually changing dental materials and equipments, an increasingly litigious society, an increase in the emphasis of continuing professional development, and information explosion and the consumer movement associated with advances on the internet. The aim of evidence-based practice is the systematic literature review, which synthesizes the best evidence and provides the basis for clinical practice guidelines. [1]

Systematic reviews are especially important in reducing large quantities of information into manageable portions. They also limit bias and improve accuracy in addressing a question, so that the findings have increased power and precision. [2] Besides that, patients nowadays wish to be informed of various treatment options available to them. [3] This is a relevant issue because patients have information available at their fingertips through the internet [4],[5] and an increasing awareness of consumer protection laws. [6]


  Current Scenario: Problem Identification and General Needs Assessment Top


Currently, there is no evidence-based practice in the curriculum of dental undergraduate students in Indian dental institutions. Students do not seem to have the attitude of critical thinking, self-directed learning or lifelong learning, or the habit of scientific enquiry. This can have repercussions on their future practice which will in turn affect patients, healthcare professionals, educators, and the society. The lack of skills in critical appraisal of literature among students affects the patients who may receive suboptimal care.

Current approach

At present, most dental faculty teaches what they learned as students and learning occurs mostly through didactic lectures. There is no literature on innovations in teaching and learning in dental schools in India. Students are not aware that research translates into clinical patient care. Clinical decisions are mainly based on the experience of the dentist and not always based on evidence. As evidence-based dental care (EBDC) is not a part of the curriculum, there is a possibility that students may learn outdated clinical practices due to which the society is not benefited with newer interventions in dental care. Although numerous workshops are conducted across the country, evidence-based dentistry (EBD) has not been incorporated into the curriculum.

Ideal approach

An ideal approach entails implementing EBD to train future dentists to provide optimal dental care based on evidence so that they will treat patients with predictable outcomes. This approach will provide bridging between science and clinical practice and help in clinical decision making based on research facts and patients will be benefited from care based on evidence.

Key areas of deficient knowledge

The major area of deficient is a lack of knowledge of EBD in practice.

Methods to overcome

  • It requires initial survey to assess course contents
  • Literature review to design EBD program for undergraduates
  • Best practices followed in other institutions
  • In person interviews: Small sample of the population, students, and medical educators.


When is the right time to start?

Evidence-based practice is a process of lifelong, self-directed learning in which providing health care, creates the need for important information about diagnosis, prognosis, treatment, and other clinical and health care issues.

We suggest that the EBD module be developed by faculty experienced in EBD and introduced in the Department of Community Dentistry as a subset of a larger course in clinical epidemiology, to 2 nd year dental students. This will provide them with the fundamental principles of clinical epidemiology and critical appraisal.

We have identified the 2 nd year dental undergraduate students for the training course as we intend the training to be part of the basic sciences. As a result of this students will have an insight of EBD well before entering the clinical postings. The entire faculty associated with all the disciplines will be our other group of targeted learners. The targeted learners have no knowledge of EBHC practice and the current performance is based on traditional method and learning style that include didactic lectures, case history, discussions, and patient care wherein clinical decisions in dentistry have been based on the experience of the clinical dentist.

We believe that the undergraduate students are enthusiastic to undergo the module of EBD as it is need of the hour to be proficient in rendering optimum oral care, while the teachers need to be sensitized to meet the demand. Agreement among the teachers is essential regarding the horizontal and vertical integration of EBD skills and clinical dentistry.

Although changes in disease prevalence, technological advances, and the increasing demands of consumers of dental health care for accountability are inducing change within the dental profession there are several barriers in the teaching and practice of EBD. These include insufficient evidence, underdeveloped critical appraisal skills, inadequate time, and poor accessibility to the literature. To obtain subjective information on their attitude and knowledge on EBD in the dental curriculum a questionnaire survey should be conducted for the interns (analyzed by percentage) and focus group discussions (FGDs) with the faculty (2 h during college working period; course director will conduct FGD with faculty of all disciplines in college council hall, analyzed by consensus). A pilot study of this module will be conducted to include a Group of ten interns.


  Broad Educational Goals Top


Our broad educational goal is:

  • To design a module on EBD for Bachelor Dental Surgery (BDS) undergraduates that will enable them to provide optimal evidence-based oral care.


The objectives of this module are focused on three aspects namely the learner, the faculty, and the process of the module. The learner objectives are focused to address the cognitive, psychomotor, and affective aspects of EBD [Table 1].
Table 1: Learner objectives

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A 3 days workshop will be required for the faculty to train them to teach students evidence-based dental practice. Objectives for faculty are described in [Table 2].
Table 2: Faculty objectives

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Process objectives: By the end of the course, 80% or more students should be able to implement the EBD model for delivering patient care for five patients according to standard EBD protocol.

Patient outcome objectives

By the end of the course, the students will be able to plan satisfactory treatment for five case scenarios as per standard treatment plan devised by trainer and two real patients (feedback will be taken from patients).

It is necessary to have all these objectives well-planned so that any possibility of failure is avoided in the course of successful implementation.


  Educational Strategies Top


Studies in evidence-based medicine have shown that introduction of EBD course early in the curriculum enables students to develop EBD skills right from the onset of their clinical training and fosters a desire to practice EBD. [1],[2] The aim of the EBD is not only to introduce EBD to students but integrate and reinforce EBD skills in clinical practice. Hence, we suggest that EBD modules be introduced in the 2 nd year of BDS in the ongoing curriculum of community dentistry. The objective of this module was to introduce students to the concept of EBD including study designs, statistical analysis, and literature search for the evidence and basic research methodology. This module is in the form of active lectures and focuses on experiential learning in terms of literature search and statistical analysis.

  • The second-year 1 st term: 12 h, in the form of active lecture sessions, are allotted in the existing timetable of public health dentistry and topics are given in [Table 3]
  • The second-year 2 nd term: Foundation course for EBD; 15 h are assigned in the clinical sessions of community dentistry and are elaborated in [Table 4].
Table 3: Lecture time table

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Table 4: Practical sessions

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This block is a facilitated learning experience where an entire batch of 15 attends two basic sessions. Subsequently, the batch is divided into a group of five students, and a trained tutor demonstrates EBD skills and guides students later for practice giving them case scenarios. Here the topics chosen are common conditions which the students in 2 nd year BDS can relate to although they are still not exposed to clinical patient care.

The third-year clinical rotation postings in seven departments: We plan two sessions in each clinical rotation posting of 2 h each. Each session is divided into two activities [Table 5].
Table 5: Clinical posting schedule

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The fourth year: In the 4 th year, it is expected that each student should be able to apply the principles of EBD, write a report and present it to the faculty individually. In each clinical rotation, every student should at least present two EBD presentations and apply it to patient care practice.

Resources required for curriculum

Having understood the educational strategy required to address the need for implementation of EBD curriculum for undergraduates we will now have to look into the details of the resources and infrastructure available or required. As there is a pretest questionnaire being conducted before the implementation of the EBD curriculum, we will need interns to answer the pretest questionnaire. Trained faculty is need for smooth implementation process and undergraduate students from II/II, III, and IV BDS year will be a part of the EBD curriculum. After the 3 days workshop, faculty will have to prepare evidence-based standard operating procedures (SOPs) for all types of cases that the undergraduate will have to be familiar with.

Students in the II BDS I term will have lectures pertaining to EBD on various topics mentioned in [Table 3]. A total of 12 h is required to complete the lectures. In the second term, they will be introduced to the foundation course which requires 15 h. The foundation course will be conducted during clinical postings in the Department of Public Health Dentistry. Once the students enter the 3 rd year, they will be posted in various departments where they will undergo training in the application of principles of EBD in case. Facilities that are required are lecture halls, computers, and the internet.

Funds

Any new development will incur some costs. Additional funds will be required to conduct a workshop for faculty development. The faculty will need an orientation course for 3 days. During this time, funds are also required to pay the resource persons and for stationery during the workshop. Incentives for teachers involved in EBD training for students would be a good way to motivate the faculty.


  Internal and External Support Top


Based on past history pertaining to curricular changes and the extent of preparation that went into introducing them one can predict the amount of support and success that can be expected from faculty and the administrators.

Administration structure:

  • Meetings will be arranged; circulars regarding schedule and content will be sent to inform all the concerned
  • Arrangement for orientation course for faculty
  • Evidence-based SOP will be prepared by faculty who are trained.


Barriers

It would not be unreasonable to expect some attitudinal barriers from faculty and students initially. However, with proper orientation one can expect to overcome this initial hurdle. Another initial difficulty would be additional curricular time to incorporate EBD into existing timetable by the Department of Public Health Dentistry in II BDS.

Plans to introduce

EBD will be introduced to a group of ten students and feedback will be taken at the end of the module. Based on the program evaluation changes can be made and the full implementation can take place when the next new batch of II BDS students joins classes. The learning that has occurred in the 2 nd year will be reinforced in respective clinical departments in the 3 and 4 years.

At this point, we feel that the process is feasible and will be successful.

Evaluation and feedback

In any program, the purpose of evaluation is to appraise and the shortcomings. The main goal of the evaluation of our EBD program is of EBDC in order to deliver the optimal oral health care to the patient. The users of this curriculum are undergraduates, faculty, and curriculum developers (program director and institution dean). The following resources will be required for evaluation. Questionnaire: Pretest and posttest of 30 min duration. The course director will devise and support staff will administer the questionnaire. Printer and papers are required for the preparation of questionnaire. We have certain critical evaluation questions for which we are seeking answers. They are:

  • Is the concept of EBDC clear to undergraduates?
  • Is the intended EBDC rendered by undergraduates?
  • What are the difficulties encountered by undergraduates in delivering such care?
  • What are the difficulties faced by faculty and in the clinical set up while training undergraduates to deliver EBDC?
  • Are the patients satisfied with the treatment rendered?


Evaluation design

  • Pre- and post-tests for UGs
  • Clinical audit by faculty
  • Group discussion of faculty members involved and reflective observation
  • Feedback questionnaires to patients after completion of treatment in the local language.


Measurement methods: Pre- and post-questionnaire methods are used for measurement which is congruent. Measurement methods are feasible to administer and are reliable and valid.

Ethical issues: Informed consent will be collected from the patients before administering care routine.

Data collection: Course director is responsible for data collection. Questionnaires, clinical audit, group discussions, and reflective observation use minimal resources and provide sample data.

Data analysis: At the end of the session percentage for pre- and post-test will be assessed, and no statistical analysis is required.

Revisiting and revising the goals:

Goal of this curriculum are:

  • To ensure that objectives are being met
  • To conduct pretest on intern in the old curriculum and posttest at the end of each clinical posting after the introduction of EBHC.


Course director and faculty will submit evaluation report to the Dean.

Dissemination: Outcome of this curriculum must be shared in academic inputs like presentations and publications so that other institutions can learn from them.


  Conclusion Top


Evidence based dental care is a process of lifelong, self directed, and problem based learning. The current curriculum does not address this. We therefore need to introduce EBD in our curriculum to train them to be better professionals who are competent at delivering optimum care. As health professionals we need to inculcate a habit of scientific enquiry which will develop with practice from the undergraduate level. In this article we have outlined a curriculum plan for the implementation of Evidence based dental care for undergraduates so that it can serve as a guide for development of an EBD curriculum. We also welcome suggestions from readers and experts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Srinivasan M, Weiner M, Breitfeld P, Brahmi F, Dickerson K, Weiner G. Early introduction of an evidence based medicine course to preclinical medical students. J Gen Intern Med 2002;17:58-65.  Back to cited text no. 1
    
2.
Werb SB, Matear DW. Implementing evidence-based practice in undergraduate teaching clinics: a systematic review and recommendations. J Dent Educ 2004;68:995-1003.  Back to cited text no. 2
    
3.
Tamim HM, Ferwana M, Al-Banyan E, Al-Alwan I, Hajeer AH. Integration of evidence based medicine into a medical curriculum. Med Educ Online (Ser Online) 2009;14:15.  Back to cited text no. 3
    
4.
Azarpazhooh A, Mayhall JT, Leake JL. Introducing dental students to evidence based decisions in dental care. J Dent Educ 2008;1:87-109 .  Back to cited text no. 4
    
5.
Ballini A, Capodiferro S, Toia M, Cantore S, Favia G, De Frenza G, et al. Evidence-Based Dentistry: What′s New? Int J Med Sci 2007;4:174-8.  Back to cited text no. 5
    
6.
Fletcher RW, Fletcher SW. Clinical Epidemiology: The Essentials. 4 th ed., Ch. 12. Philadelphia: Lippincott Williams and Wilkins; 2005.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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