Current challenges in dental education- a scoping review

Abstract

Introduction

This scoping review aimed to review the various challenges facing dental education. Dental education faces multiple institutional, student and faculty-based challenges. Institutional challenges include updating infrastructure resources, recruiting qualified faculty, and implementing administrative policies that enhance dental education. Student-based challenges include implementing teaching/learning strategies that will enable students to acquire adequate knowledge, skill, and logical reasoning to identify and execute evidence-based treatment. Faculty-based challenges include regular updating of the dental curriculum, including recent advances in teaching methodology, and adding elective courses that can enhance the readiness of future dentists to address the evolving oral health needs of the public.

Methodology

The scoping review was conducted using the PRISMA-ScR, focusing on the current challenges in dental education. Articles were identified via searches of Google Scholar, PubMed, Web of Science and Embase for the period 2019 to 2024. Only English language papers detailing challenges in dental education were included. At the culmination of the search protocol, twelve articles were selected for inclusion in this scoping review.

Results

Analysis of these twelve papers identified several themes, which apply to the dental education systems of many, but not all, nations: (1) the correlation between the basic science and clinical phases of the curriculium remains poor; (2) dental students receive inadequate patient care experience to truly develop the competency needed for unsupervised dental practice after graduation; (3) dental students often graduate with inadequate foundational knowledge and clinical experience to provide care for geriatric, specialized pediatric and medically compromised patients, and recieve limited clinical experience in public health settings; (4) dental schools struggle to provide students with training in the technology advancements that are increasingly prevalent in dental practice; (5) difficulties in hiring, training and retaining dentists in faculty positions diminishes the quality of the education experience for students; and (6) an increased number of graduates in some countries struggle to find employment.

Conclusion

A variety of studies and advocacy papers over the past 25 years have identified or described similar challenges facing dental education in many nations of the world. The fact that these challenges persist signals the urgent need for curricular and infrastructure reform to better prepare dental students for the realities of dental practice in the 21st century and to provide an environment that will provide an attractive workplace for dentists who desire to participate in the education of the next generation of dentists.

Introduction

FDI (Fédération Dentaire Internationale) defines basic dental education as “Teaching and learning of dentists to prevent, diagnose and treat oral diseases and meet the dental needs and demands of individual patients and public” [5]. Dental Institutions provide the knowledge and skills required for dentists to practice competently. The training for dentists varies globally [11] This variation in dental training affects graduates’ knowledge and skill levels. Dental education consists of basic sciences, preclinical training and clinical training. The clinical-based training is mandatory, with students doing patient work during their training period on live patients per the requirements set by each dental institution. The dental college bachelor’s degree varies from 4 to 6 years [10]. Various authors reported on the challenges faced by graduating dentists [21, 23]. The challenges reported in their survey indicate that the rapidly expanding dental field requires graduates to update their knowledge constantly. The pandemic experienced recently has exacerbated the problems with mental and financial issues, and many dropped out of the course [8]. Financial debts from the study loans burden them to take up immediate employment, but the lack of employment opportunities in some nations makes it challenging. Understanding the various challenges in dental education aids in enhancing the quality of education and addressing the gaps in dental curriculum and clinical training. Issues such as insufficient faculty or lack of a better learning environment can be assessed. Dental education involves theoretical and practical training. Any problems in the training process can impact the student’s competence and confidence during clinical practice. The evolving dental education with new technologies such as digital dentistry, artificial intelligence and teledentistry require constant updates in the infrastructure. Understanding challenges in dental education helps with new teaching methods and technologies.

Recognizing the various challenges through literature review and cross-sectional studies enables institutions to promote equity, offering scholarships, hybrid learning and inclusion of underrepresented groups. Knowing the shortages and challenges aids institutional policymakers and educational leaders in better resources and implementing development programs. This ensures that future dental professionals are well-equipped and ready to meet the evolving demands of the healthcare system. This article highlights various challenges faced in dental education and summarizes the challenges into the following categories: institutional, faculty, student, financial and patients.

Methodology

This qualitative review aimed to identify and analyze dental education’s various challenges. Understanding the different challenges is crucial for improving the existing educational system to the current practice requirements for better patient satisfaction and safety.

Research design

This study employed a qualitative approach to explore perspectives concerning dental education challenges. Articles that addressed challenges in dental education were searched using Mesh terms Dental Education or Education Dental AND challenges OR Issues OR Problems OR barriers were used to search databases such as Google Scholar, PubMed, Web of Science and Embase for the last five years of 2019 to 2024. The search yielded a total of 2551 documents. The relevancy of the articles was based on triple screening. Six authors screened the title and abstract to eliminate all articles that did not include issues, problems or challenges in dental education. The second screening was done to exclude the articles based on full-text reading. Four independent reviewers reviewed all the selected articles to check if they met the inclusion criteria. A final total of 12 articles, as per inclusion criteria, were confirmed by three reviewers, from which data were extracted. Only studies in the English language that detailed challenges in dental education were included. Grey literature, conference proceedings, editorials and articles in other languages were excluded. A total of 12 articles were selected. (Fig. 1). The inclusion criteria covered dental education and availability of resources, categorised under institutionally based, faculty-based, student-based, financially based and patient-based educational challenges. By evaluating these criteria, one can gain a deeper understanding of the challenges faced in dental education.

Fig. 1

PRISMA Flow chart

Results

The thematic analysis of these twelve articles produced the roster of dental education challenges that are reported in Fig. 2. These challenges were categorized as institutional-based, student-based, faculty-based, and patient and financial-based. As the financial-based category includes all the other groups, such as institutional overhead cost, student fees and expenses, this was not added to the general classification (Table 1).

Fig. 2

Classification based on challenges in dental education

Table 1 An overview of challenges in Dental Education

Institutionally based challenges

The most common institutional challenges many dental colleges face are a lack of updated infrastructure, resources, clinical facilities and the number of patients attending the clinics required for adequate training. Insufficient faculty resources are a global issue [9]. Inadequate preclinical resources, such as simulator labs and trained faculty, are also common problems at many dental schools. Other institutional challenges include a lack of continuous faculty training through professional development programs that offer workshops and seminars and grant sufficient incentives for research and publications. The majority of institutional-based challenges were inadequacies in resources and training [3, 24].

Faculty-based challenges

Faculty-based challenges include a gap in updating the dental curriculum to the community’s existing needs. The topics in basic sciences and preclinical training sessions must be realigned to gain sufficient knowledge and skills for clinical training; hence, the faculty need to update their knowledge in advanced technology to teach the students. If advanced technology such as CAD CAM and intraoral scanners are not taught in dental colleges, dental graduates will require further self-training to update their skills in newer technologies [2, 13].

The institution’s curriculum committee must design the curriculum to integrate basic sciences with clinical applications [26]. Challenges related to assessment of student performance were identified. For example, rubrics for measuring student performance during case-based learning and in comprehensive interdisciplinary clinics are rarely implemented. When dedicated research time is not allotted to faculty members, it can hinder academic and professional development. Lack of research time diminishes the overall quality of education and research and impacts the progress in their career (Table 1).

Student based challenges

In many nations, the challenges related to students primarily revolve around insufficient opportunities for the volume and diversity of patient care experiences needed to develop readiness for independent and unsupervised dental practice after graduation. In case of limited clinical training, students and patients can experience trauma later on in practice due to the students’s lack of true clinical competence. This often happens when the graduates lack sufficient clinical skills and knowledge of patient ethics, patient safety, practice management, patient diversity and cultural complexities. To address this challenge, several critiques of dental education have recommended expanded community service rotations, internships, rural postings for dental students, and increased use of case-based studies to equip students with diversity and cultural awareness [3, 32]. Improving dental students’ readiness for clinical practice can be accomplished by using dental simulations before patient contact [27]. The stress of going through an undergraduate program, learning and skill acquiring can cause anxiety, depression or mild stress in some students [6]. Student counsellors should consider implementing training programmes on how to cope with stress should be implemented on campuses. Among the challenges, the student-related domain was reported to be more stressful than the institutional and co-faculty-related domains [14].

Financially based challenges

The dental institution fees are relatively high, and students face financial burdens in completing the course [40]. Student scholarships, financial aid, and loan forgiveness for graduates from specific categories will ease stress in graduating dental students. Hybrid learning can be a cost-effective solution to reduce educational fees and overhead costs (Table 1).

Patient based challenges

The students must be knowledgeable enough to understand the level of patient expectations, patient fears, and habits. Challenges regarding patients’ diverse socioeconomic backgrounds, cultural variations, knowledge of chronic health issues, and adherence to treatment plans require knowledge, emotional intelligence, communication skills, and empathy. Faculty mentorship and support systems as team dynamics are necessary for helping students overcome these obstacles for future clinical practice. Miscommunication due to language barriers can lead to misunderstandings about procedures, cost of treatment or care instructions. Patients may misinterpret or not fully understand the importance of treatments or hygiene practices. Patients may not fully disclose their medical history, which can lead to complications or contraindications during treatment (Table 1).

Educational challenges

The main focus of educational challenges lies in the lack of stimulatory preclinical training and the acquisition of adequate clinical and community-based training [3]. The majority of colleges lack training in specialized areas such as geriatrics, paediatrics, compromised cases and community-based training (Table 2) [16, 28, 29, 38]. The lack of infrastructure in many colleges could be due to the tremendous financial burden on the institutions. A modified dental curriculum closing all the evidence-based gaps in dental education is required [24]. Another area that the educators recommended was that critical thinking should be added to dental education [35]. Sleep medicine awareness and analysis was also a suggested elective course for dental students, as orthodontists and prosthodontists fabricate various sleep apnoea appliances [30]. A.I. technology ethics should be added to the dental curriculum to create awareness among students for scientific integrity and a stringent peer review process [19]. Present challenges must be tackled at institutional, student and patient levels with modifications in clinical training methods and dental curriculum [33, 36]. Dentistry taught in college differs from what is practised in private clinics regarding the use of the latest technology adopted in the clinics. Fresh graduates are stressed and anxious about applying advanced technology in practice for which they have not been trained.

Table 2 Studies included with issues mentioned in dental training

Discussion

The various challenges faced in dental education differ from one region to another. These challenges vary based on the available healthcare infrastructure, cultural values, and economic and educational resources. Many colleges in the U.K. and USA have these pre counselling sessions. Students select dentistry as their professional choice as they can be self-employed and decide their working hours [39]. Students must be made aware of the prospects in their earlier undergraduate years [20]. Effective career counselling should be included in the undergraduate curriculum to improve the confidence level of the students to face the future [12]. Guidance allows the student to decide on the options they have after graduating. The highly rated career challenge perceived by dentistry students today is to obtain a job either in the government or the private sector. However, it may take quite a long time for new graduates to acquire finances, get approvals from regulatory authorities, and get appropriate buildings and staff. The solutions to many of the challenges, such as lack of knowledge in practice management and lack of expertise in geriatric or diverse patient case management, can be solved by adding the particular component to the curriculum [21, 34]. To manage these challenges, dentists can employ various strategies, such as establishing trust, taking a detailed medical history, behaviour management techniques, treatment planning and decision-making. By recognizing and addressing these patient factors, dentists can better navigate the challenges of providing effective and compassionate care, avoiding litigation issues, and enhancing patient safety [1].

Adding more elective subjects such as practice management, equipment maintenance, geriatric dentistry, orofacial pain, and sleep dentistry have all been suggested by experts for increasing the knowledge of graduates in a rapidly growing dental field [7, 15, 17, 22]. The evidence indicates that community postings can improve rural communities’ treatment facilities, reducing unmet needs [4]. The policies on licencing for dental training institutions have shown an accelerating trend towards accepting changes by incorporating new technologies and materials [18]. Most dental institutions globally have not converted from conventional dentistry to adhesive and digital dentistry [37]. When a fresh graduate enters the private practice following digital dentistry, he learns an entirely new concept from what he learned in the dental institution. This lacuna from what was taught to what is practised presently in private centres can cause stress and anxiety in dental graduates [31]. Apart from knowledge, skill, and training, other challenges include the ratio of patients needing treatment to the turnover of graduates per year. In some countries, there are excess dental graduates; in others, there are fewer [25].

Conclusions

The 21st century has brought many advances to the dental profession regarding knowledge, which has doubled daily. Advancements happened in technically supported skills along with computer-aided design and machining. Capabilities have expanded along with increased accessibility. Along with these, challenges also get generated, which the professionals must overcome. This review addresses many of these challenges along with its evolution. The challenges in dental education need a multifaceted approach involving curriculum and faculty development changes, implementing new technologies, and ensuring knowledge, clinical skills, aptitude, and reasoning in clinical decision-making. Community and rural postings also boast the students’ cultural competence. Implementing solutions for all the challenges reviewed in the article can enhance undergraduates’ dental education and better prepare them to meet modern dental practice demands.