Structure of Dental Undergraduate Programme

The Faculty of Dentistry provides a four-year undergraduate dental course leading to the Bachelor of Dental Surgery (BDS) degree. The selection of candidates for the course is stringent and those seeking admission require good grades in Chemistry, either Biology or Physics, and a third subject at the Singapore-Cambridge ‘A’ levels General Certificate of Examination. The candidates are also required to have good grades for their General Paper and second language as well as the Scholastic Aptitude Test. There is also a manual dexterity test and an interview for candidates who are short-listed for the course.

The BDS course comprises two pre-clinical and two clinical years. In the pre-clinical years (Year 1 & 2), dental undergraduates share some common core subjects with medical students such as Anatomy, Biochemistry, Physiology, Dental Anatomy & Histology, Pharmacology, Microbiology (including Immunology) and Pathology. This is to ensure dental students acquire the essential basic science knowledge needed for clinical practice. They also receive extensive pre-clinical training in dentistry. The methods of instruction include lectures, tutorials, seminars, laboratory sessions and technique work.

In the clinical years (Year 3 & 4), students manage and treat their own patients under supervision. It is here that they apply the theory and skills acquired previously in the various disciplines. The programme is rigorous with comprehensive didactic and clinical sessions. A multidisciplinary approach to solving problems is emphasised, thus encouraging the undergraduates to integrate and fully understand management and treatment modalities. Courses such as General Practice Management, Behavioural Science and Problem-based Learning (PBL) have been added to the curriculum to prepare the student for the demands of clinical practice upon graduation.

The dental curriculum is competency-based, with emphasis in imparting basic skills essential to the practice of dentistry. The didactic programme teaches relevant knowledge and skills necessary to train a competent general dental practitioner. Clinical competency tests have replaced the schedule-based clinical assessment. A student will sign up for competency tests for different procedures after he or she has adequate exposure to basic clinical competency. This will allow the more clinically-competent students to progress at a faster rate. At the same time, students who may need remedial help can be identified.

Since dental students have to accomplish so much in such limited time, it is important for them to be able to learn effectively and efficiently. They spend many hours taking part in clinics and attending didactic sessions, approximately 40 hours a week in the faculty, and even longer hours in the laboratory after school, preparing for their clinical cases. The aim of this preliminary study was to investigate the students’ perception of the effectiveness of teaching methods, the teaching staff and how they cope with the pressures of their dental education.

Subjects and Methods

During March 2003, a questionnaire was distributed to 48 clinical year students (15 Year 3 and 33 Year 4) who were assured that their responses would be kept anonymous and confidential. This questionnaire assessed, on a 4-point Likert scale, the methods of teaching that they found effective, their methods of learning, the people that support their learning, their time for social activities and how they coped with the pressures of their studies.

Results

A total of 37 students (11 Year 3 and 22 Year 4) completed the questionnaire giving a response rate of 77%.

1. Helpful teaching methods
   
   
   More than 75% of the dental students agreed that mass lectures, tutorials and class lectures were helpful teaching methods in their learning process. A mixed response of agreement was found for group projects/assignments. A high proportion agreed that individual and group laboratory/practical work was helpful. About 85% of the students agreed that PBL was helpful.
   
   
   
   Table 1. Helpful teaching methods
   
   
   
   Figure 1. Helpful teaching methods
   
   
   
   
2. Effective study methods
   
   
   Slightly more than two-thirds of the students found that group study was an effective method in their learning. 94% preferred to study alone. The use of internet was found to be an effective study tool in 85% of the sample. All the dental students in this sample agreed that understanding concepts was important for effective studying. The need to memorise facts was found to be an effective study method in 75% of the students. About one-third of the sample found that studying with music or TV on to be effective. Less than a third of the sample agreed that tape-recorded lectures were effective in their learning.
   
   
   
   
   Table 2. Effective study methods
   
   
   
   
   Figure 2. Effective study methods
   
   
   
   
   
3. People who are helpful in learning process
   
   
   Subject lecturers and tutors were found to be most helpful in the learning process by the dental students. Laboratory technicians were also found to be helpful as reflected by the 82% response rate. Head of department was found to be helpful in 75% of the sample. Classmates (76%) and representatives (67%) were also found to be helpful people. Library staff and administrative personnel played a lesser role in assisting the learning process.
   
   
   
   
   Table 3. People who are helpful in learning process
   
   
   
   Figure 3. People who are helpful in learning process
   
   
   
   
   
4. Spending less time with family and friends
   
   
   About two-thirds of the students agreed that they had less time for family and friends outside university. Slightly more than half of the students agreed that they spent less time with friends of either or both sexes, foreigners in Singapore and people overseas.
   
   
   
   
   Table 4. Spending less time with family and friends
   
   
   
   
   Figure 4. Spending less time with family and friends
   
   
   
   
5. Coping with pressures
   
   
   More than two-thirds of the students coped with pressures of student life by taking part in leisure activities such as sports and movies. Majority of the students preferred to confide in their family and friends when under stress. The students were more likely to confide in their friends outside university than their classmates. The majority of the students (82%) would not confide with the teachers. A minority of the students (30%) would go out for drinks with their friends as a means of stress relief.
   
   
   
   Table 5. Coping with pressures
   
   
   
   
   Figure 5. Coping with pressures
   
   
   
   

Discussion

The teaching methods that dental students found most helpful were lectures and tutorials. These results suggest that the students in this sample had not totally steered away from the influence of the pre-university educational system that is very much a teacher-centred approach rather than student-centred. However, a majority of the students (85%) found Problem-based Learning to be effective in helping them to learn. This finding is indicative of the educational value to the students with the introduction of PBL modules into the dental curriculum to complement the traditional teaching methods. The dental course is compact and rigorous with new clinical and scientific information being introduced daily. Thus it was not surprising to find that the dental students still preferred the top down approach in their learning as it would reduce the time needed to gather and assimilate relevant information at the expense of appreciating the learning process of attaining knowledge.

Group assignment/project was not found to be a teaching method that was as effective as group or individual lab/practical work. This could be due to the fact that dental training is very much a practical course that requires hands-on approach in the learning. It could be speculated that group assignment/projects that were didactic or research in nature were not valued as much as practical training by the students. The assumption made was that the dental students considered group assignments/projects to be a separate entity from PBL when answering the questionnaire. Moreover, there is currently no peer appraisal system in the evaluation of dental students. As such, group assignments/projects that did not have an impact on the overall performance rating would be considered less useful. The nature of dentistry is one that requires independent practical training. Thus it was not surprising to find that teaching methods that require individual ownership of the training and performance to be considered highly useful by dental students.

A majority of the dental students preferred to either study alone or in groups. These findings suggest that both independent and interdependent learning played an important role in the learning process despite the fact that the nature of dental training could be individualistic at most times. The competitive nature of the dental course could also motivate students to study alone. Further investigation will be necessary to determine whether independent or interdependent learning is more effective and constructive during the course of training. A majority of the students found that memorising facts was also a helpful study method. This finding was typical with any medical or dental training whereby certain basic clinical or scientific information must be committed to memory for efficient clinical application. In addition, all students in this survey agreed that understanding concepts was important to help them study. This finding might be reflective of a level of maturity in the thinking of these students. More information will be needed to find out if understanding concepts is able to better assist in memorising factual information at university level of education.

Subject lecturers and tutors were most influential in helping the students to learn. In the present dental curriculum, heads of department are also involved in teaching both didactic and clinical subjects. Lesser teaching contact time could be a possible reason for the perceived lesser attention felt by the students given to them by the heads of department. Two-thirds of the sample agreed that classmates were helpful in the course of learning. This finding reflected the need of interdependent learning among the students. However, which aspect of the learning process dental students need to rely on one another will require further investigation. Laboratory technicians were also found to be helpful by the students. As mentioned previously, a significant part of the dental curriculum consists of practical training that includes laboratory work. Thus this finding validated the importance of having quality dental technicians to assist the students in their learning process. Administrative personnel and library staff had lesser influence on the learning process. However, this finding does not mean that they are not important. It might merely indicate that the students had lesser contact with these people who did not have a clear and immediate educational impact on their learning process.

Dental students generally agreed that they spent less time with family and friends outside dentistry. This was to be expected due to the long hours of the dental course. Staying in student hostels might also contribute to the lesser time spent with family. However, slightly more than half of the students did not find that the educational process had reduced their contact time with friends, presumably within the same course. This finding reflected the close-knit environment unique to the dental course.

Two important finding with regards to how dental students cope with pressures was that 82% of the students would occasionally or seldom/never confide their problems to the teachers and 48% would frequently keep the problems to themselves. These findings could mean that dental teachers were approachable and effective for educational purposes only. Further investigation will be required to determine the perception of dental students towards their teachers’ ability to help them cope with pressures from other aspects of life that may affect their educational performance. In addition, a great proportion of dental students would rather confide their problems to friends unrelated to the dental course. This might be indicative of the highly competitive nature of the local dental undergraduate programme.

One of the limitations of this study was the small sample size. As such, the use of statistical analysis would not be meaningful and appropriate. The sample included only students in the clinical years. A larger sample consisting of both pre-clinical and clinical students is necessary for future studies. However, this study has provided a broad spectrum of potential areas for future educational research in dentistry. Greater refinement of the questionnaires that address specific issues of the dental education is proposed.

Conclusions

The following conclusions could be drawn from this study:

• Lectures and tutorials were preferred teaching methods.
  
  
• PBL was found to be helpful in the learning process.
  
  
• Individual/group, practical/lab work was more helpful than group assignment/project.
  
  
• A majority of the dental students studied in groups or alone.
  
  
• Understanding concepts was unanimously agreed to be helpful in the learning.
  
  
• Subject lecturers and tutors were most helpful in the learning process.
  
  
• Dental students spent less time with family and friends outside dentistry.
  
  
• Dental students rather confide in family/friends than lecturers/classmates.

Dental education is both science and art amalgamated into a rigorous course that requires clinical proficiency and discipline from dental students through both didactic and practical training. The final outcome of the dental course is to produce clinically competent dentists who are independent performers, critical thinkers and long-term learners. A successful dental curriculum will need to address the many facets of the course that will impact the learning process.