The holistic approach in dental education has multiple advantages, through this philosophy of teaching, all aspects associated with disease are taken into account when diagnosing and implementing treatment. This is one reason why this approach has been universally embraced. On the other hand, this pathway allows students to gain management skills and decision-making aptitudes in a problem-based learning approach. Another strength point is the student’s exposure to real life situations which they will encounter in their future career [12]. This methodology also has been shown to increase student confidence in clinical reasoning, problem solving and creativeness [7] which reflects positively on their performance and relationship with their patients [14].
From another aspect, competencies designed by experts, are necessary skills that represent the backbone to guide the development of curriculum content, student assessment and accreditation. Similarly, competency-based education has been suggested to improve, critical thinking and autonomy [8], while embracing knowledge and confidence as well. Nevertheless, the holistic approach in dental education cannot always be practiced in its full conception due to inherent institutional constraints. Our current curriculum may be described as a hybrid one, since it includes competencies related to operative, endodontics and fixed prosthodontic subspecialties, as well as comprehensive care treatments performed in a multidisciplinary line.
For such an approach to succeed all aspect of educational environment must be well contemplated and properly planned. Therefore, to identify the difficulties associated with the implication of this model and for the purpose of adopting improvement methodologies, we gathered students input at the end of the scholastic year. As primary stakeholder, their perception of the quality of education and feedback is valuable [15]. When asked about the struggles encountered, the students referred to patients’ commitment, time and staff related issues as impeding the true benefit of comprehensive based education. From one view, the contributing role of teaching staff is of utmost importance for the success of educational programs [16], however, the variability in educational experience or differences in methods of teaching [17] might have afflicted the aspired result. To overcome this matter, we set regular rotations to establish some sense of consistency and to allow students to be exposed to different learning experiences [18]. A true calibration of teachers must also be provided, so that students can make the best out of this experience. Furthermore, assigning mentors to small group of students might prove efficient for the purpose of sustainability of treatment planning and student achievement as has been shown by other studies [18]. As for the second statement regarding lack of time, this might be overcome by reducing number of secondary competencies and allowing our students to designate more time, knowledge and efforts for the treatment of comprehensive cases. One study in University of Bergen, revealed that the holistic approach did not improve student’s satisfaction with teaching [10]. Their student comments were related to the teaching staff numbers, commitment as well as lack of calibration regarding evaluation strategies.
In this study we can expect that a true appreciation and judgement of this teaching method was achieved by our students. The reason is that the student sample who answered the questionnaire were exposed to both educational teaching models. In fourth year, their curriculum consisted of a competency and requirement-based course. In fifth year additionally to the former, students were asked to perform management of comprehensive cases, which encompassed integrated disciplines such as periodontics, endodontics and prosthodontics. Nevertheless, it would be speculative to assume that the comprehensive case treatments resulted in a positive impact on students from every aspect. In our study, not all students seemed certain of the benefit of this teaching method. As simple as it may seem, selection of cases is primordial for success. Research has linked multiple attributes to the effectiveness of clinical cases such as relevance, realism, engaging and possessing challenging topics [3]. Our student cases were widely diverse from simple operative work, single crown placement or single rooted endodontic treatment, to more complex cases with fixed bridges and multi-rooted endodontic treatments.
At the end of the scholastic year when students were asked to present and discuss their cases, we noticed perceptible improvement in their communication skills. Moreover, majority of our students agreed that this approach resulted in more diverse clinical exposure and enhanced their intellectual skills. This positive impact on the achievements of intended learning outcomes was reinforced by the fact that students were motivated in every step of the treatment and spend time analyzing and perfecting their management. A similar survey performed by the University of Tennessee following a transition from a departmental model to a comprehensive model, revealed that their students had a clear preference for the comprehensive care model yet only half them thought that this model was less stressful [18], which was also noticed in our students feedback.
It makes intuitive sense that students would feel more confident in the tasks they have practiced frequently or when being supervised [19]. However, one question that is constantly raised is whether the perceived need for assistance is justified or not. Most of our students are accustomed to working in an instructor-based environment. Our results demonstrated that students felt less confidence during comprehensive case management than when performing supervised tasks. This is somehow comprehendible since students probably feel great responsibility and have a constant motif to achieve the highest standards of treatment for their cases, especially that they are asked at the end of the year to present their final work in front of a jury of staff members. Building up students’ self-esteem should be one of the primordial outcomes to develop [20]. Contemporary evidence has shown that different teaching methods such as outreach experience can have a positive effect on student confidence [21].
As witnessed in many other schools, the delivery of modern evidence-based approaches is not without challenges [21]. Nonetheless, dental schools should be active in reviewing and modifying their curricula [12]. Hence, from our belief that traditional teaching methods are outdated and lacking attributes necessary for student development our philosophy was to establish, even if partly speaking, a new curriculum that is outcome based and encourages integrated learning in a stress-free environment where students feel that they belong [22]. Although our school is located in the capital, recruitment of the “right patient at the right time for the right student”, as simple as it might seem, is not evident. Demographics and referral protocols with the augmenting number of students make it a difficult process. Yet, within the capacity and feasibility of our institute, future trends in curricular change and innovation are warranted. In order to sustain a contemporary model of teaching, case scenario discussions to enrich students critical thinking might form a useful adjunct. In addition, interdisciplinary education revolving around themes and not specific points would be highly advantageous.
We acknowledge the fact that surveys are capable of measuring perception of benefit from students’ aspect but are inadequate for assessing actual skill acquisition and further studies related to student productivity when using this educational system are indispensable. Another restriction is that our study reported the students’ perception for one discipline which was restorative dentistry. This approach once adopted in other dental disciplines might demonstrate different outcomes. Furthermore, our system was not a pure comprehensive model as it is more of a hybrid system where competencies and requirement are still existing.