Educational Setting and Rationale for the Geriatric Core Curriculum
In 2015, the division of Gerodontology at the School of Dental Medicine, University of Bern, was established. Meanwhile, a cooperation with the Department of Geriatric Medicine at the University of Bern has been established for specifically educating dental students.
The rationale for a geriatric core curriculum at the University of Bern was based on the clinical and faculty setting offering lecture classes covering all domains of the Swiss curriculum for undergraduate dental students in their final semester before graduation.
Undergraduate students at the School of Dental Medicine, University of Bern, undergo the curriculum as described in the Swiss educational objectives for dental medicine, which has been accredited by the Swiss Federal authorities. The Gerodontology curriculum is embedded as a dedicated course in the series of prosthodontics during the Master of Dent Medicines course. It comprises patient treatment in the scope of the synoptic clinical course taught in conjunction with the Department of Restorative, Preventive, and Pediatric Dentistry and the Department of Periodontology, and encompasses facultative one-on-one instruction in a geriatric hospital and the lecture series for “Gerodontology and Geriatric Aspects” in the second term of the 5th year. This lecture series was designed according to the recommendations of the European College of Gerodontology  and to be similar to courses at the University of Geneva. In Bern, it comprises 28 lecture units and reflects the multidisciplinarity of Gerodontology. Of these 28 lecture units, 8 are specifically dedicated to the geriatric core curriculum Series that is taught by a geriatrician of the Department of Geriatrics at the University of Bern.
Development of the Geriatric Core Curriculum
Curriculum development of the geriatric lecture series began with a review of the current Swiss core curriculum for undergraduate dental students, updated in 2017 by all Swiss dental schools at the Universities of Basel, Bern, Zürich, and Geneva . In this Swiss curriculum, we identified four general knowledge and skill competencies relevant to older adults on which we aimed to elaborate in this new curriculum. Therefore, we focused on learning outcomes numbered 73-76, addressing special needs of elderly patients. The main emphasis of these four general learning outcomes is on systemic diseases, functional impairments, and ethical and juridical issues in elderly patients. In particular, students are expected to take adequate steps for diagnosis, therapy, and prevention with respect to the general situation upon graduation.
Next, the European undergraduate curriculum in geriatric medicine for medical students was consulted to identify overall geriatric domains for undergraduate dental students [10, 11]. The main criterion for selecting domains was clinical relevance for dental practice. We identified eight domains (cognitive impairment and dementia, vision and hearing impairment, malnutrition, gait and balance disorders, pain, polypharmacy, decision-making capacity, and palliative care). Each domain was scheduled for one 45-minute lecture unit.
For constructing our curriculum, we used the “backward design process” as described by Wiggins and McTighe . This process starts with a vision of the desired results, i.e. defining competencies students are expected to achieve prior to their graduation.
Accordingly, in a first step we phrased the learning objectives for each domain based on the taxonomy of Bloom [13, 14]. For each learning objective, the corresponding level of competencies of Bloom that could be achieved was attributed. Six levels of competencies were distinguished: level 1: knowledge, level 2: comprehension, level 3: application, level 4: analysis, level 5: synthesis, level 6: evaluation.
Next, we aligned learning activities within the geriatric lecture series to each learning objective according to the concept of constructive alignment [12, 15]. We decided to use a case-based approach using real patient or clinical practice scenarios to elaborate learning objectives. For each of the eight domains, we developed clinical practice scenarios for dentistry. This case-based pedagogy is in line with Aquifer Geriatrics, a case-based curriculum for medical students emphasizing learning outcomes and competency-based learning [16, 17].
All course material was peer-reviewed by two experienced geriatricians and finalized in consultation with the chair of gerodontology.
Student attitude survey
To assess general attitudes of dental students towards older adults, we included a previously validated German-language translation of the University of California Los Angeles geriatric attitude scale (UCLA-GAS) in the questionnaire [18, 19]. According to this scale, a negative attitude corresponded to an overall UCLA-GAS score of less than 42 points. We distributed the questionnaire before starting the lecture series on geriatrics.
The final dedicated lecture series for geriatrics was implemented in the spring semester of 2019.
Student competencies were evaluated by oral exams at the end of the semester. The testing strategy of the oral exams was aligned to the corresponding learning objectives . We developed a clinical case scenario with standardized questions for each domain . Overall, our bank includes 35 standardized questions. Each student is presented one case-scenario and three questions each.
At the end of the lecture series in April 2019, dental students were asked to fill in a survey to ascertain their satisfaction with the completed geriatric curriculum. The full survey can be found in the appendix. Students were asked to rate each geriatric domain regarding relevance for their future dental practice on a scale of 1 (irrelevant) to 4 (highly relevant). Moreover, students could also provide free comments and identify further domains or questions of interest for improving future geriatric lecture series.
We informed the students that completing the attitude questionnaire and satisfaction survey amounted to consent to an anonymized analysis of their answers for this project.
In accordance with regulations of the Swiss Human Research Act, projects that work with anonymized data sets or anonymized samples do not require authorization. While researchers do work with health-related data of human beings, the data can no longer be assigned to any specific individual. These criteria apply to our study and therefore our study was exempt from formal ethical approval.
Descriptive statistics reporting proportions of categorical data, and means with standard deviations or medians with interquartile ranges for numerical data were used. Student satisfaction was reported as proportions of rating categories (irrelevant, slightly relevant, relevant, and highly relevant). Qualitative comments were organized according to themes. Student attitude was summarized as overall UCLA-GAS (median and interquartile ranges), and subscales (compassion, resource distribution, medical care, social value) thereof.