With speakers from across four continents, the Faculty of Dentistry RCSI’s ‘Back to school’ event provided a global insight into how dental education adjusted to the COVID-19 era

Over the summer, the Faculty of Dentistry, RCSI, led an international debate on the future of dental education, hosting a webinar Back to School in the time of COVID-19: an international perspective, which attracted more than 600 participants from all over the world. The speakers were Deans or Directors of Education from 10 Dental Schools from Ireland, Hong Kong, New Zealand, Australia, Canada, the UK, USA, UAE, Italy and Holland, which provided a global insight into how dental schools are rising to the unprecedented challenges as a result of COVID-19. It was chaired by Professor Albert Leung, Dean of the Faculty of Dentistry, RCSI, and Professor of Dental Education at the Eastman Dental Institute at University College London. “The faculty was founded in 1963, with the core mission of advancing the science, art and practice of dentistry by promoting education, study and research,” said Professor Leung. “With this in mind, the faculty has brought together important leaders, movers and shakers in the dental education world from Europe, North America, Asia and Australasia to discuss the many challenges COVID-19 presents, not least in the dental schools.” Professor Cathal Kelly, chief executive of the Royal College, added: “The education and training of students of dentistry, at both undergraduate and postgraduate levels, has been significantly disrupted. There’s a lot of confusion, concern and, as yet, many unanswered questions about the future safe practice of dentistry and the delivery of dental education in this new normal. We don’t have all the answers yet. The aim of this webinar is to bring together friends of the faculty of dentistry at RCSI and leading national and international opinion leaders in dental education, to share information and advice on practices they’re adopting in their own schools — and hopefully we can all learn from each other.There is a great Irish expression, Ní neart go cur le chéile, roughly translated as: ‘There’s no strength without unity’. Hopefully by sharing information and opening dialogue across international borders, we will all emerge stronger and able to face the challenges of the current crisis.”

Hopefully by sharing information and opening dialogue across international borders, we will all emerge stronger and able to face the challenges of the current crisis

Professor Cathal Kelly, royal college

Chris Tredwin, Professor of Restorative Dentistry, head of the UK’s Peninsula Dental School and the incoming chair of the Dental Schools Council UK and Ireland, spoke of the challenges the school faced in June as the resumption of practice began in the UK. The focus was on staff and students — minimising risk and putting safety first -— patients’ clinical needs and vulnerabilities, aerosol generating procedures (AGPs), access to buildings, and increasing simulation facilities. From the beginning, the school switched to an online teaching platform but, over the course of the summer, moved to blended learning. It established clear operating procedures for AGPs and non-AGPs, carried out risk assessments for staff and students, and prioritised patients according to their treatment plan. Tredwin cited the FGDP (UK) and College of General Dentistry’s “comprehensive and useful” guidance on the implications of COVID-19 for the safe management of general dental practice. AGPs, following a clear scope of practice, had been feasible in single surgeries; open plan clinics presented obvious challenges with the use of fast handpieces, using three-in-one – both air and water at the same time – and ultrasonic scaling. The approach had been to instead use slow handpieces, surgical handpieces, and use the three-in-one separately; air only or water only. In periodontology, evidence showed that hand scaling could be as equally effective as ultrasonic, “and therefore we moved to hand scaling only”. 

Patterns of air flow, exchange and filtering were explored, along with the positioning of different types of clinics to minimise aerosol travel. Access to, and movement around, buildings had been reviewed and changed to reduce the risk of infection. Learning through the use of simulation has been increased but, where possible, it is augmented by in-person supervised practice. Telephone consultations and virtual clinics were developed. Tredwin added that ongoing research into issues such as aerosol spread was also a key area of activity.

Alastair Sloan, Professor of Tissue Engineering and Dental Biology and Head of Melbourne Dental School, said that as soon as lockdown was imposed in March, he tasked his colleagues and staff with planning for a return. “We left in a rush,” he said. “I wanted our return to be organised.” As planning got under way, student placements were a priority; to reintroduce them as soon as was safe, appropriate and possible. They had to comply with the prevailing national, state and local guidelines. Similarly, a phased reintroduction of workplace simulation was planned. As much didactic teaching was brought to the front of the year as possible.

Students worked from a document charting their safe return, including traditional simulation activities that were complemented by new skills in terms of personal protective equipment (PPE) and cross-infection protocols. The school building was zoned, students only attended when timetabled and they were temperature tested on entry, and PPE was available at all times. A handbook and video were created for students. Student and staff mental wellbeing – avoiding ‘burnout’ – was a priority. The school also worked closely with placement providers. The whole process, however, was a “moving piece,” said Sloan, referring to a second spike in cases that Australia experienced in July.

Corrado Paganelli, Dean of the Dental School at the Universita Degli Studi Di Brescia in Italy, and Chair of the Forum of European Deans and Heads of Departments, noted that neither the Italian Government nor the country’s health authorities ordered a shutdown of dental practice; only that it be limited to emergencies. The ability to practice was limited, however, because of the diversion of PPE to hospitals and the school itself became a facility for the treatment of dental emergencies. When students returned home in February, said Paganelli, the school’s thinking turned to the structural changes that would be needed in the future.

“We think that international collaboration is needed,” he said. “It has been clear for many years how technology enhanced learning can be part of the solution, such as this initiative – and I really would like to thank again the Royal College of Surgeons.”

Our take-home lessons have been collaboration, working together not
only within our faculty but the university at large, as well as other dental schools in Canada and North America”

Mary MacDougall, University of British Columbia

Mary MacDougall, Dean of the Faculty of Dentistry at the University of British Columbia, Canada, spoke of its transition to remote working and online learning.

“Initially, we called together a rapid response leadership team comprising individuals overseeing our clinical facilities, educational programmes, and student admissions, both in the DMD and dental hygiene programme, graduate programmes, as well as department heads.

The Dean added: “We reached out, through the Association of Canadian Dental Faculties, to collaborate and mitigate the impact that closure of academic programmes would have on our students. We also collaborated with the American Dental Education Association, and all the US dental schools. We developed a plan outlining clinical safety operation protocols, following Ministry of Health guidelines. “We also resumed research, which was halted with the Faculty working remotely. Finally, we transitioned to our educational resumption plans. This involved bringing students back through simulation exercises, followed by, ultimately, patient care. Our facilities were never fully closed; we did operate an emergency clinic for our patients, facilitated by faculty members who were volunteers.” 

“In June, we were able to resume our clinics, initially for our graduate students, and also our research activities with a capacity of about 33 per cent. In August, we [brought] back a cohort of our DMT and dental hygiene students from years one, two and three, and they will come in through simulation to finish their competencies for the 2019-20 academic year and be assessed for promotion. If they are successful, they will then begin the next year of their academic programmes in the fall. That education model is going to be a blended one, so all of our didactic courses will be online, with simulation experiences face-to-face on our campus. We will then transition the students to patient care, learning from the experiences we’ve had with our graduate programmes.

“What we found in this process was that it is absolutely essential to have support not only for our students, but also for faculty members. We found hrough town hall experiences that students have some challenges with online learning. There have been issues with computer resources and internet signals and our students have really experienced significant financial hardships based on the loss of some of their employment over the summer. This has really drained their mindfulness, causing stress and anxiety.

“Communication has been critical to inform the students of the situation on campus and to engage them in the process. These same critical areas we find also in our Faculty; the online transition has been harder for some Our take-home lessons have been collaboration, working together not only within our faculty but the university at large, as well as other dental schools in Canada and North America. I’m working to mitigate some of the adversities that our faculty, staff and students are facing and to really exude a level of kindness to one another, and the Minister of Health, Dr Bonnie Henry has been very vocal about being safe and being kind to one another during this pandemic.”

Back in Ireland, the RCSI’s first priority was to devise an alternative plan for examinations that were due to take place. The faculty conducts more than 1,000 postgraduate assessments each year, with candidates from all over the world, so considerable effort went into ensuring that formats and learning outcomes could be adapted, while complying with regulatory standards, and without undermining standards. A fortnight in, with help from the College’s Faculty of Medicine, the first remote examination took place. It was conducted 3,000 miles away in Qatar, with exam and examiners based in Scotland and Ireland using local proctoring. Video monitoring, via Zoom, meant that the RCSI could see those in Qatar. The candidates practised social distancing and wore masks, while trainers were located in different rooms. It was the first postgraduate exam to be conducted in such a way by the RCSI. Since those first exams, the Faculty has been refining its approach. “In the first exams, there were many moving parts and a lot of things could go wrong,” said Professor Leung. “They didn’t go wrong, but there was a huge amount of effort involved to make sure of that. We have made modifications to our initial approach so that there are now fewer moving parts, fewer things can go wrong, and the candidate’s experience can be improved”.

The College’s lectures have also moved online, and are recorded in the lecturer’s home, edited and uploaded within 24 hours. For the future, Prof Leung foresees a mixture of face-to-face and online education becoming the norm, at least in the short to medium term. “There are certain values of face-to-face teaching and assessment. A patient is an individual. Ultimately, can you treat an individual well? If you can, how do you actually do that? Can we test candidates in this particular environment in a way that is close to what they practice? I’m contacting the software providers to see whether or how some aspect of these online examinations can be more interactive, in which clinical scenarios can be tested online. I don’t know whether it will happen or not, but we’re trying”.

He is full of praise for his colleagues around the world: “I am very grateful for the splendid work that they have done. We have been very lucky in that the Faculty Board and other colleagues have huge amounts of expertise in different arenas and different parts of the world. The feedback from candidates was very useful as well. They pointed out things that we didn’t notice, and we made changes accordingly”.