Abstract
Background & Objective: Educational promotion requires improved designing and enhancement of the quality of education. The present study aimed to compare the oral and maxillofacial medicine course in the undergraduate dental curriculum of Iran and some other countries.
Material & Methods: In this descriptive comparative study, some dental schools were selected from the United States, Canada, Australia, and Switzerland (one from each country) according to the Quacquarelli Symonds (QS) ranking. All topics related to oral tissue and systemic diseases with oral manifestations were extracted from the content of the courses offered in the respective dental schools. Additionally, all mentioned topics were gathered from nationwide curricula of dental schools in Iran and the UK. The collected data were analyzed based on Bereday’s comparative method in the following four steps: description, interpretation, juxtaposition, and comparison.
Results: The collected data from each curriculum (description) were analyzed (interpretation), tabulated (juxtaposition), and compared (comparison) to find the similarities and differences. The highest similarity was found in sequence of offered courses between Iran and Pennsylvania dental schools. Differences were mainly related to the sequence of chapter titles in different courses and method of instruction. The Australia’s Queensland dental school had the highest difference with Iran’s curriculum since it does not offer an independent course on oral medicine. Additionally, Iran and Australia’s Queensland dental schools do not have a free discussion course on clinical scenarios.
Conclusion: The method of instruction and diversity of the taught topics are responsible for the differences in educational curricula of different countries regarding the oral medicine course.
Introduction
In the past decade, oral health as an integral part of general health has come under the spotlight (1). It is estimated that 90% of the world’s population suffer from different forms of oral conditions throughout their life, and oral diseases impose a high burden on healthcare systems worldwide (2). Dental educational curricula should be able to comprehensively obviate the needs and meet the expectations of dentists and communities. Dental education is a complex field consisting of clinical and theoretical instructions offered in dental schools. It also emphasizes acquiring the essential skills to efficiently communicate with patients (3). Oral and maxillofacial medicine is a field of dental science that concerns the oral soft tissue, salivary glands, and neurological and musculoskeletal tissues in this region (4). Dental clinicians learn the required medical and surgical skills and have an ideal position to provide primary preventive care. The primary manifestations of many diseases are first detected by dentists. Consequently, their knowledge in this respect can play a fundamental role in the early detection and diagnosis of many diseases (5). Moreover, oral manifestations of systemic diseases should not be overlooked. Many systemic conditions, such as diabetes mellitus have oral presentations, and some other systemic diseases, such as hypertension may affect or contraindicate some dental procedures (6). Basirat et al. evaluated the diagnostic skills of senior dental students of Guilan University of Medical Sciences regarding common oral diseases and reported their poor diagnostic skills in this respect. Thus, the adoption and implementation of novel educational techniques and enhanced communication and cooperation of dental school and medical school instructors are recommended to achieve the educational goals (7). Borhan-Mojabi et al. evaluated the degree of knowledge on oral cancer among general practitioners and dentists in Qazvin province of Iran and reported that the level of knowledge in both groups was inadequate (8).
To promote the educational curricula, an assessment of educational programs was scheduled. Additionally, the quality of each designed and implemented program should be assessed. One ideal approach for globalization and promotion of dental education in different countries is the interaction of different dental schools to find the common challenges, share the experiences and brainstorm (9). Considering all the above, the present study aimed to compare the course of oral and maxillofacial medicine offered in the undergraduate dental curriculum in Iran and some selected countries worldwide.
Materials & Methods
Design and setting(s)
This descriptive comparative study was conducted in 2020 after obtaining ethical approval from Guilan University of Medical Sciences.
Participants and sampling
For the selection of dental schools, of 10 dental schools with the highest ranking in QS ranking in 2021, high- ranked universities that met all the inclusion criteria were selected from countries that are more popular among Iranian dentists. Accordingly, the educational curricula of dental schools in Iran, dental schools of the United Kingdom (defined by the general dental council (GDC), the quality assurance agency (QAA) for higher education and ADEE), Pennsylvania University in the United States, Western University in Canada, Queensland University of Australia, and Zürich University of Switzerland were evaluated. The educational curriculum for a particular field of science may be the same nationwide and in all universities of a country or may be different according to the policies of each university. In Iran and the UK, the dental curriculum is the same in all universities nationwide, and dental schools can only apply minor changes in the mode of offering the courses depending on their infrastructure.
Tools/Instruments
This study assessed the undergraduate dental curricula of dental schools by preparing checklists and tabulated data. Universities whose adequate information regarding their curriculum was not available were not included.
Data collection methods
Information on the curricula was obtained by visiting the website of the respective universities and also by using the relevant studies. The educational dental curriculum of Iran was obtained through the Education Department of Dental School, Guilan University of Medical Sciences. All topics related to the oral mucosa, salivary glands, nervous system, musculoskeletal tissues and their related diseases, and systemic conditions with oral manifestations were extracted from the curricula. For this purpose, the contents of all courses of dental curricula were evaluated.
Data analysis
The extracted data was analyzed according to Bereday’s comparative method in education through the following four steps: description and data collection, interpretation, juxtaposition, and comparison (10). In the description and data collection step, the available information and evidence was collected and transcribed. In the interpretation step, the collected data from each curriculum was analyzed. The comparative approach was started by the juxtaposition step. In this step, the data extracted from the curricula was tabulated and the similarities and differences were classified and juxtapositioned. In the comparison step, the details of similarities and differences were evaluated and compared to respond to the question of the study.
Results
The main results of the present study are reported in Appendix1 regarding practical courses, Appendix 2 concerning the topics about systemic diseases, and Appendix 3 regarding the topics related to oral diseases. These tables were designed based on educational, practical, and theoretical topics.
The educational curricula of Iran, Pennsylvania University of the United States, and Zürich University of Switzerland allocate some time for dental students to attend hospitals and closely observe the process of dental diagnosis, treatment planning, and dental treatment of hospitalized patients. In addition, the dental curricula of Queensland University of Australia and Zürich University of Switzerland practically instruct the treatment of patients with special needs, such as disabled individuals.
Interpretation of paraclinical tests is also included in the dental curricula of Iran, the United Kingdom, Canada (Western University), and the United States (Pennsylvania University). Furthermore, pains of the head and neck region, detection of their origin, and prescription of analgesic medications are included in all curricula. However, in Australia (Queensland University), greater emphasis is placed on medications, and a specific topic regarding pain does not exist.
A noteworthy issue is that all topics evaluated in this study are separately taught in practical and theoretical courses for pediatric patients in all selected countries, which emphasizes the significance of adequate knowledge and expertise in the field of pediatric dentistry.
The temporomandibular joint (TMJ) is an important part of the head and neck region, which can have a wide range of pathologies. Topics related to TMJ diseases and their treatment are comprehensively included in the dental curricula of Iran, the United Kingdom, Canada (Western University), the United States (Pennsylvania University), and Switzerland (Zürich University). It should be noted that among the evaluated curricula, Iran and Switzerland (Zürich University) more extensively addressed the topic of TMJ disorders.
Moreover, it should be mentioned that dental students in Iran, Canada (Western University), the United States (Pennsylvania University), and Australia (Queensland University) spend some time on comprehensive treatment of patients, which includes examination, diagnosis, and treatment planning for oral diseases as an important part of oral medicine course.
Discussion
This study aimed to compare the course of oral and maxillofacial medicine offered in the undergraduate educational curriculum in Iran and some selected countries worldwide.
A comparison of the content of the curricula revealed that all curricula covered topics related to oral soft tissue diseases, salivary gland diseases, and neurological, musculoskeletal, and systemic conditions with oral manifestations. Additionally, all curricula contained theoretical and practical courses regarding the aforementioned topics. In other words, dental students had to acquire theoretical information regarding oral diseases and also had to acquire adequate experience and skills in the management of patients. However, it should be noted that some differences existed among the evaluated curricula as well. In the UK (4) and Western, Pennsylvania, and Zürich universities some time is allocated to free discussion regarding diagnosis and treatment planning of patients. In free discussion classes, the clinical photographs and radiographs of patients, the pathology report and paraclinical test results, and other information regarding the diagnosis of each lesion are provided to dental students, and the cases and clinical scenarios are discussed. Eventually, the final diagnosis is made, and the most appropriate treatment plan is designed. However, it appears that in Iran, dental students spend more time on clinical examination of patients. The drawback of this mode and the lack of free discussion classes is that dental students are less likely to encounter complicated or rare cases during their dental education and examination of patients in the university dental clinic. However, some complicated cases are discussed in the free discussion classes, and different clinical scenarios are presented and discussed by all students. In the Queensland University of Australia, unlike other dental schools evaluated in this study, the educational courses are not entirely focused on a specific topic, and dental education is problem-based. For example, diagnosis of oral diseases and periodontal diseases, tooth extraction, and restoration of caries are all performed simultaneously in theoretical and clinical courses. Accordingly, dental students are familiarized with patient management in private dental offices. For example, the difference between dental practice course IIIA and IVA is that dental students who take the course IIIA treat dental patients with simple general needs while those taking the course IVA treat patients with complex dental needs, medically compromised patients, and disabled individuals with dental needs. Furthermore, in Australia, the association of the teaching of gerodontology- related topics with restorative dentistry, oral medicine, special needs, and preventive dentistry is reported by Shigli et al. (17).
Other differences included the treatment of patients with special needs or disabled individuals since Queensland and Zürich Universities have included clinical management of such patients in their curricula. Also, these topics are included in theoretical courses in dental curricula of Western and Pennsylvania universities. It appears that these topics have been neglected in Iran, and they are only taught professionally for managing pediatric patients. Moreover, it should be noted that some structural determinants (e.g., environmental, political, social, and economic issues), intermediate determinants (social position and conditions), and proximal determinants (behavioral and biological factors) may play a role in the development of oral and non-communicable diseases and their types, and instruction of these topics may be modified based on the existing priorities and current conditions in different geographical locations (18).
Conclusion
Considering the selected curricula, their contents, and the educational systems of the respective countries, it may be concluded that all the evaluated dental curricula covered topics related to oral soft tissue diseases, salivary gland diseases, and neurological, musculoskeletal, and systemic diseases with oral manifestations, and their significance has been well emphasized. What differentiates between the curricula is the method of instruction and the diversity of the topics covered in the curricula. It should be noted that the curricula cannot be judged only by their content. The practice and performance of dentists in the target population can also reflect the quality of dental education in the respective country. Accordingly, the curricula should be tailored and naturalized according to the specific requirements of each country. For example, since some diseases are more prevalent in the Iranian communities, further attention should be paid to their instruction, and such topics should be repeatedly discussed to be borne in mind.
Ethical considerations
This study was obtaining ethical approval from Guilan University of Medical Sciences (Approval ID: IR.GUMS.REC.1400.101).
Artificial intelligence utilization for article writing
No
Acknowledgments
The authors would like to thank the Medical Education Research Center of Guilan University of Medical Sciences.
Conflict of interest statement
The authors have no conflicts of interest to disclose.
Author contributions
All authors participated in the process of planning and conducting the present study and approved the final manuscript.
Supporting resources
There is no supporting resources including grants, equipments or any other financial resources that supported this manuscript.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.