New curriculum in dentistry for Tanzania: competency-based education for patient and population health (2008-2011)

Opportunities and Challenges for Implementation of Harmonized Competence-Based Curricula in Medicine and Nursing Programmes in Tanzania: Experiences of Biomedical Sciences' Stakeholders

Background

In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.

Methods

We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.

Results

From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.

Conclusion

The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions' capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.

Huế dental students' use and perception of an online dental learning platform: A pilot study

PURPOSE/OBJECTIVES

Online educational materials are growing in use, and dental students worldwide can benefit from higher quality and more accessible online supplemental resources. This study was created to evaluate the learning resources non-English speaking dental students desire and to pilot My Dental Key (MDK), an English, evidence-based, online dental educational platform.

METHODS

Third to sixth year dental students at the Huế University of Medicine and Pharmacy were asked to pilot MDK over a 5-week period and were invited to answer three surveys throughout the study. A preliminary survey was given to gauge the participants' (n = 209) preferences regarding the use of English-based dental educational resources. Participants (n = 58) completed a presurvey prior to accessing MDK. After the 5-week period, participants (n = 38) were given a postsurvey to evaluate the platform's effectiveness as a supplemental educational resource.

RESULTS

Overall, we found that: (1) students desire credible online supplemental resources in addition to current resources provided by their school, (2) the multimodal content that MDK provides is a strength that bridges language barriers (3) participants perceived that the content on MDK would help them in class and when treating patients.

CONCLUSIONS

Improving the quality of online supplemental dental resources will have the capability to progress the current educational landscape, and further resources should be created to best serve the global dental community.

Development of a Competency-Based Curriculum for undergraduate education in Pediatric Dentistry: A systematic approach

The changing paradigm of dental education in India has led its way to the development of Competency-Based Curriculum (CBC). This article describes the process of developing CBC in the specialty of Pediatric Dentistry under the initiative of Dental Council of India. Rationale behind CBC development is to bring uniform system of education for improving oral health outcomes of the society in long term. The process of CBC development was a collaborative teamwork, planned meticulously with predefined outline, tasks and timelines. Workflow involved identification of curricular content, defining program goals, outlining competencies, assigning them domains / levels of clinical competence, priority, educational strategies, assessment practices, integration and numbers needed for certification in selected competencies. Early clinical exposure was introduced in CBC. The final content was validated and submitted to the Council. CBC output can be summarized as competencies with fair share of all domains, levels, prioritization and integration. It is characterized by flexibility for choosing educational strategies and assessment practices. It opens up ways for global competition. However, it still has some inherent weaknesses like diverging learning paths, time constraints and number chasing. CBC can further have more academic flexibility and develop toward an outcome-based approach. Faculty preparedness and acceptability shall be the biggest challenges in CBC implementation besides resources' availability, support from leadership and acceptability from our primary stakeholders, our learners. CBC is the beginning of evidence-based delivery of education in dentistry. An effective implementation of CBC in current form would result in increased numbers of competent oral healthcare professionals for the society.

Using mobile multimedia platforms in teaching dental diagnosis

OBJECTIVE

Mobile Multimedia Platforms (MMPs) are prolific tools that can be used by individuals and corporations to share content. However, few studies have shown the effectiveness of MMPs as educational tools. Through this study, we aimed to evaluate the effectiveness of MMPs in improving basic dental diagnostic skills. In addition, we captured student feedback on the use of MMPs in a dental curriculum.

METHOD

In this voluntary interventional study on 89 senior dental students, we created pilot learning modules through an MMP called Instagram Stories to teach dental diagnosis. We evaluated the efficacy of the modules through diagnostic tests that were given to dental students who were close to graduating.

RESULTS

The students showed a significant increase in diagnostic test scores from 49% to 73% (p < 0.05) after the use of an MMP. Furthermore, the students' feedback on the MMP indicated that most students found it easy and enjoyable to use.

CONCLUSION

Our study data show that MMPs may be used to improve training in basic dental diagnostic skills and can serve as an adjunct teaching tool. Moreover, MMP modules can potentially enrich professional education in developing countries where access to educational resources is limited.

A Case Study Optimizing Human Resources in Rwanda's First Dental School: Three Innovative Management Tools

Harvard School of Dental Medicine, University of Maryland School of Dentistry, and the University of Rwanda (UR) are collaborating to create Rwanda's first School of Dentistry as part of the Human Resources for Health (HRH) Rwanda initiative that aims to strengthen the health care system of Rwanda. The HRH oral health team developed three management tools to measure progress in systems-strengthening efforts: 1) the road map is an operations plan for the entire dental school and facilitates delivery of the curriculum and management of human and material resources; 2) each HRH U.S. faculty member develops a work plan with targeted deliverables for his or her rotation, which is facilitated with biweekly flash reports that measure progress and keep the faculty member focused on his or her specific deliverables; and 3) the redesigned HRH twinning model, changed from twinning of an HRH faculty member with a single Rwandan faculty member to twinning with multiple Rwandan faculty members based on shared academic interests and goals, has improved efficiency, heightened engagement of the UR dental faculty, and increased the impact of HRH U.S. faculty members. These new tools enable the team to measure its progress toward the collaborative's goals and understand the successes and challenges in moving toward the planned targets. The tools have been valuable instruments in fostering discussion around priorities and deployment of resources as well as in developing strong relationships, enabling two-way exchange of knowledge, and promoting sustainability.

Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries

OBJECTIVES

The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs).

METHODS

The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted.

FINDINGS

Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries.

DISCUSSION AND CONCLUSION

Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.

Integrating a primary oral health care approach in the dental curriculum: a Tanzanian experience

This paper is based on a conference presentation made during the inauguration of the Faculty of Dentistry, Kuwait University, as a World Health Organization Collaborating Centre for Primary Oral Health Care (POHC) on November 27-28, 2012. The aim of this paper is to review how the POHC approach has been integrated into the dental curriculum, sharing the Tanzanian experience as a case presentation from a developing country. The burden of oral diseases worldwide is high, and the current oral health workforce is inadequate to meet the challenges. Curative oral health care is very costly and not accessible to the poor and minorities. To tackle the problem, the POHC approach rooted in primary health care that emphasizes equity, community involvement, prevention, appropriate technology and a multi-sectorial approach was developed and has been operating for more than 3 decades now. Execution of a comprehensive POHC requires a trained oral health workforce mix with essential competencies. For this case study, a literature search was done using the search engines subscribed to by the library of Muhimbili University of Health and Allied Sciences, including PubMed, Cochrane, ScienceDirect and Scopus, Wiley-Blackwell Interscience, Sage and the Health InterNetwork Access to Research Initiative (HINARI) that gives access to Scirus and Google Scholar. Challenges are discussed with an emphasis more on addressing the common risk factors and determinants of oral health. Integration of the POHC approach in the dental curriculum for training a competent workforce is crucial in attaining better oral health. Resources are still a major challenge, and the impact of the POHC approach in the curriculum is yet to be evaluated.

Partnering on education for health: Muhimbili University of Health and Allied Sciences and the University of California San Francisco

In 2005, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania and the University of California San Francisco (UCSF) in the United States joined to form a partnership across all the schools in our institutions. Although our goal is to address the health workforce crisis in Tanzania, we have gained much as institutions. We review the work undertaken and point out how this education partnership differs from many research collaborations. Important characteristics include: (i) activities grew out of MUHAS's institutional needs, but also benefit UCSF; (ii) working across professions changed the discourse from 'medical education' to 'health professions education'; (iii) challenged by gaps in our respective health-care systems, both institutions chose a new focus, interprofessional team work; (iv) despite being so differently resourced, MUHAS and UCSF seek strategies to address growing class sizes; and (v) we involved a wider range of people - faculty, administrators, students, and residents - at both institutions than is usually the case with research. This partnership has convinced us to exhort other academic leaders in the health arena to seek opportunities together to enlighten and enliven our educational enterprises.