The education process was conceptualised as a continuum of related experiences that begins during undergraduate education and builds throughout the professional life of a dentist, entailing a set of knowledge, skills, competences and attitudes towards PD to be covered as undergraduate (UG), graduate, postgraduate (PG), or as continuing professional development (CPD) courses.
Undergraduate training and education: current challenges
Undergraduate PD is taught as clinical courses mainly in the fourth and fifth years of a 6-year degree course in Chile. Pre-clinical activities are commonly in the third year, and in the fourth year students start performing clinical procedures on children. Participants agreed that undergraduate PD programmes need to develop general dental practitioners (GDP) who are able to manage the oral health of pre-school children effectively, including prevention, early intervention and treatment of simple issues and more complex cases. It was noted that although some oral health problems (e.g. ECC and DT) might be complex and multifactorial in nature, their prevention and management should be emphasised as part of the UG curriculum.
However, according to participants in the current curriculum, training and education is fragmented, with wide variability and lack of uniformity in the curriculum contents offered by the different dental schools represented in this session. This discussion indicated that, although most dental schools gave special attention to some aspects of cariology, other relevant topics still needed to be addressed. Regarding DT, with the exception of one school that has undergraduate modules (University of Valparaiso, Chile), there was minimal teaching of DT.
Participants agreed that a need exists for greater emphasis on developing patient-oriented models, focussing on the health team to deliver better outcomes. It was also agreed that together with acquiring clinical competencies, dental students should be able to assess children in the context of the family and the community. In particular, participants highlighted the need to incorporate teaching about social determinants of health (i.e., gender, race/ethnic discrimination, etc.), about children’s rights and local laws and practices, and other complementary skills to provide a solid base for advocacy . Advocacy was seen as a most powerful instrument to address social, economic and environmental inequalities. At the same time, social determinants of health and advocacy were perceived as difficult to consider appropriately within the context of an unbalanced biomedical approach.
There was also common agreement that avoiding the duplication of contents within the different oral disciplines would be of great advantage. Participants provided an overview of contents from existing undergraduate programs that could be substantially modified, while still achieving competency and high quality oral health outcomes. This included topics which were considered time consuming, and comprised a significant proportion of undergraduate education (e.g. in maxillofacial surgery, orthodontics, restorative dentistry, and complex oral rehabilitation).
Postgraduate training and education: lack of consensus and accreditation
In regard to specialist training in PD, participants highlighted the increasing offering of courses, with great variability in terms of length, content, and course credits per unit. In most Chilean programs, specialist training takes 2 years, but there are also 1-year programs being offered. Furthermore, none of these programs are at the master’s level, but exist as professional specialization programs. Additionally, the lack of accreditation in Chile for postgraduate paediatric dentistry education programs was noted.
The lack of consensus and accreditation,Footnote 1 and the need to ‘rethink’ the education in this specialty in Chile to incorporate other competencies, in particular, those needed to treat medically complex patients was discussed. Participants agreed that the number of children, adolescents and adults with special needs and chronic conditions has increased over the last few decades. In addition, for participants, it was not unusual that PD treat these patients. The need to expand PG education and to develop postgraduate programs in dental traumatology was also emphasized. One postgraduate program was identified which includes DT modules. The University of Valparaiso offers a postgraduate Diploma in dental trauma, as well as a diploma in cariology and preventive dentistry.
Continuing professional development: standardization of contents
Since the body of health knowledge is constantly expanding, GDPs and specialist dentists need to maintain lifelong learning. The maintenance and further development of competence through continuing professional development were seen as essential for the provision of state-of-the-art, high quality oral health care. Dental practitioners need to confidently manage paediatric problems in the context of evidence-based practice and have prompt access to new developments and information. This would require equipping GDPs and specialists with the skills and abilities to search, select, critically analyse and apply valid and relevant evidence-based information to maintain lifelong learning.
Participants called for an expansion of learning opportunities to maintain or improve GDPs capabilities and confidence in the provision of effective early intervention to prevent dental caries and other oral health problems in infants and toddlers. The general reluctance of GDPs to examine and treat very young children or those with special needs was discussed. According to participants, the quality of undergraduate dental training strongly affects the GDP’s willingness to provide a variety of treatments to children.
CPD courses were also seen as lacking consistency in objectives and content between schools providing CPD. Professional associations also had CPD programs with their own contents. Participants recommended that the provision of CPD courses should also be part of the accreditation of the school. Furthermore, continuing certification is now a mandatory and common practice in many countries. In line with those practices, the group recommended the need for professional registration which includes a mandatory level of CPD points for renewal.
At both level of training (i.e., GDP and specialists), there was consensus that they should be trained to serve as members, leaders and consultants of health/non-health teams. The need to build and maintain working relationships with other discipline workers (e.g., social sciences), to address patients’ needs was emphasised. It was noted that oral conditions, such as ECC and DT, cannot be resolved by one discipline alone, nor by excluding psychological, and social factors. An interdisciplinary approach was seen as essential in addressing the complexity of these conditions and providing and attaining comprehensive health care for the community e community. Integration with teaching and learning disciplines was also highlighted during the discussions. Further, participants noted that, whilst in some dental schools there is a level of integration of PD with other dental disciplines, this was not consistent across the curricula at all schools and faculties.
Disciplines in social sciences (i.e., sociology, anthropology and psychology), nutrition, and audiology were the most commonly mentioned in which dentists required additional training. The expansion of training on how to communicate with pre-school children and work with their families, other health professionals, local leaders, and the wider community (while applying an evidence-based framework to clinical practice) was also mentioned as an area in need of better coverage. Other health-related disciplines mentioned in which dentists required additional training were kinesiology and public health (e.g. epidemiology, health care management, and health care policy).
Further exposure to research methodology and evidence based practice tools and techniques, and critical appraisal needs to be increased to allow the development of enhanced skills in evidence-based practice. This was seen to be as important with respect to advocacy and leadership.