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Dr. John Evans

Editorial: Teaching Dentistry, What Works and What Doesn't

"Human beings, even bright ones, cannot absorb, learn, consume—choose your verb—facts delivered rapid fire, for more than about twenty minutes," Dr. John Evans says. "After that the facts start to bounce off and the efficiency of instruction drops off rapidly."
Several years ago the faculty of the University of Washington revised the pre-doctoral curriculum for three basic reasons. First, the Standards established by the Committee on Dental Accreditation (CODA) changed. It was clear that the old curriculum was inadequate if ADA accreditation was to be maintained. Second, the curriculum was rigid and difficult to change. Parts of it were outdated and in need of revision. Third, methods of teaching were changing all around us and we wanted to modernize our pedagogy. The question became: Where do we start and how do we revise of such a complex system? It was decided that tinkering around the edges would be insufficient and confusing, so, we revised all four years.

Let’s start with this premise: Dental and Medical educators, for years, have recognized that in order to produce clinical experts we must provide our students with a large knowledge base and as much clinical experience as we can. Students spend a lot of time and a lot of money acquiring both. 

The knowledge base consists of many inter-related facts from the biomedical and clinical sciences and is gained through didactic instruction and study. Clinical experience must be acquired through closely supervised patient care. There is no substitute. Simulations have clear and obvious limitations. While there are many clever inventions marketed to simulate clinical care, they can take us only so far. 

Since real, instructive patient care takes time and the participation of an expert dental preceptor, a student and a patient in a fully functional clinical setting it is difficult to accomplish quickly and inexpensively. An instructor to student ratio of about one to four or five is optimal. 

Efficient didactic instruction is, therefore, mandatory if we are to produce safe and effective clinicians in just four years. Our pedagogy must be state of the art. We have bright, motivated students so it is up to the faculty working in an academic institution to provide efficient, comprehensive instruction. The question is then, how do we help students build the required knowledge base in four years?

Didactic instructional efficiency may be defined as the effective and timely transfer of knowledge from instructor to student. It is not efficient to present fact after fact, principal after principal, to students in a large lecture hall and expect those students to collate, memorize and subsequently apply in clinic, what they hear out of context as part of a group of sixty—or a hundred—other students. 

Three elements of modern pedagogy come to mind. First, we know, and any experienced teacher knows, that small group instruction—seminars, if you like—works better than methods that primarily rely on lecture halls filled with many students and one instructor. Even truly gifted teachers have trouble transferring clinically relevant knowledge efficiently to more than 20 students at a time in this traditional setting. The new curriculum at the School of Dentistry was constructed to maximize the use of small group instruction. 

Second, human beings, even bright ones, cannot absorb, learn, consume, memorize—choose your verb—facts delivered rapid fire, for more than about twenty minutes. After that the facts start to bounce off and the efficiency of instruction drops off rapidly. This is an argument for mini (twenty minute)-lectures followed by small group discussion. The new curriculum at the School of Dentistry seeks to take advantage of this method of instruction whenever possible.

Third, the clinical and biomedical sciences are best taught in context. For instance, if we are seeking to teach the pathophysiology and clinical implications of a recent myocardial infarction to a student, is there a better context than in a dental clinic with an expert clinician talking directly with a patient and a student about cardiovascular disease and risks of proceeding with dental care? This is efficient instruction because the student is presented with information in a clinical context and they will think of this patient and this conversation when they treat similar patients in the future. They remember the facts because they file them in their memories in a way that makes them immediately available when they see other heart patients. Because patients are now living longer with heart disease, this aspect of dental care has become quite important.

The clerkship model at the School of Dentistry—the third year of dental school—provides small group, didactic instruction followed immediately by clinical experience, followed the same or the next day by more didactic instruction, etc. This is the most likely explanation for scores in the top 5 percent nationally on part two of the national board examination and a school ranking of third, surpassed only by the University of North Carolina and the University of Michigan. 

Since we cannot rush through or skimp on clinical instruction, we must accept that this component of dental education will take time. And the more time we devote to clinical instruction, the better. We must, therefore, be as efficient as possible in teaching the didactic components of dental education. The external measures available at this time would seem to indicate that we have been successful to a considerable degree. With further refinement, the best in the nation is within reach.
The views expressed in all WSDA publications are those of the individual authors and do not necessarily reflect the official positions or policies of the WSDA.