As the pandemic has changed the way dentists practice, it also has changed how dental schools are teaching their students. Staggered schedules, increased simulations, and virtual lectures all have become standard parts of the curriculum as schools figure out how they can provide an effective education while ensuring the safety of their faculties, students, and patients.
The University of Michigan School of Dentistry, ranked the best dental school in the United States by Quacquarelli Symonds and the best in the world by the Academic Ranking of World Universities, moved quickly to launch remote teaching when the president of the university and the governor of the state both mandated shutdowns of all clinics and classes in March.
“The university said all teaching needed to be remote, and that was on Thursday or Friday. By Monday, we had to change, which was obviously a very short time to do that,” said Carlos González-Cabezas, DDS, MSD, PhD, associate dean for academic affairs and the Richard Christiansen Collegiate Professor of Oral and Craniofacial Global Initiatives.
The university immediately provided resources to help faculty develop online versions of their courses. For example, synchronous lectures happened online in real time so students could engage in questions and discussions, while asynchronous lectures were posted and archived so students could watch them on their own schedule.
Also, the university began training faculty in new methods for conducting secure yet accurate assessments of student performance. Many of these techniques involved moving away from traditional multiple choice questions and toward questions involving more critical thinking. Constant communication between faculty and the administration was key as well.
“That was one of the silver linings. We met weekly, the faculty, and discussed what was working well or not. Now we have a great resource with videos on how to do things yourself that the faculty is using heavily for many things, because the change was profound—how you design a syllabus, how you teach, how you design the order of the lectures,” said González-Cabezas.
These changes enabled the school to finish the remaining few weeks in its 2019-2020 academic year. As restrictions were lifted later in the spring, though, the school pivoted to bring back hands-on work in the preclinic with new infection control protocols.
“We were able to open the preclinic with half of the class at a time and using PPE (personal protective equipment),” González-Cabezas said. “Basically leaving an empty bench between the students, which meant that we had to double the number of sessions that we had to do. We had to extend the number of sessions to evenings and sometimes to Saturdays too.”
The school’s clinic reopened later in the spring and began seeing patients with emergency and urgent cases again as well, though chairs were limited.
“One, we honestly didn’t know very well which safety protocols we had to have. We were all learning. Two, we were very limited in PPE because it had to be CDC-approved, and the hospitals were pretty much stockpiling it,” González-Cabezas said.
By July, things began to improve. The school expanded the number of clinical sessions and started doing rotations again. The PPE shortages got better. And while the clinics continued to use only about half of its chairs, it also began conducting airflow analysis to see how it could best prevent virus transmissions between chairs. And to fill in the gaps in clinical learning, the school ramped up its collaborative discussions too.
“We created clinical study clubs. We had faculty coaches with groups of about 12 students, and they started to meet regularly about three or four times per week to discuss actual patients, from diagnosis to treatment planning and interpretation of data, radiographs, and photographs,” González-Cabezas said.
Plus, the school paid for a subscription to Speer Education to compensate for the reduced number of clinical experiences. According to González-Cabezas, the additional material was well received by the students. Overall, there has been a tradeoff between breadth and depth of the cases that the students have seen.
“They have done fewer repetitions of one treatment, because obviously they have seen fewer patients than the previous class at the same stage. However, they have had deeper discussions about how to do things and why. At the end, I don’t know which one is better. Ask me again five years after graduation,” González-Cabezas said.
Morale On Campus
Yet González-Cabezas also noted that students seem to be more productive. There is a better student-to-faculty ratio, he said, with more one-on-one teaching. Students also are more focused because they know they can’t waste any time, he added. In fact, students can be found practicing between 7:30 and 11 pm, without much chit-chat between them.
“They’re just very focused. They’re down to business, because they know they have fewer chances,” González-Cabezas said.
As the state of Michigan moves into tougher lockdowns with the latest virus surge, though, the work remains difficult.
“The faculty can tell you they are tired. The increased number of sessions, and teaching remotely, is a challenge. It’s been already quite a few months, so people are getting tired. But it’s been an amazing, overwhelming response of support from both the faculty and the students,” he said.
“The students participate right now in all the decisions we make, how we make changes about these crazy schedules that we have. They’re all part of the decision making. We discuss how to do it better, how to do remote teaching better. They understand they are being partners with us, which has been really refreshing,” he said.
“And faculty, honestly, both part-time and full-time, they’re working harder than ever, almost with no complaints,” he said.
The school has a psychologist on staff to provide support, and it encourages its students and faculty alike to seek help. Also, the school facilitates frequent discussions where people can basically vent and talk about things beyond the pandemic, such as the civil unrest affecting the nation this summer.
“There were many issues, and we’re doing a good job in that regard,” González-Cabezas said.
González-Cabezas expects many of the changes that the school instituted to navigate the pandemic to remain once the crisis is over and things return to normal—or settle into a new normal.
“Some of the remote teaching will stay. I do think now we’re getting to a better place from a pedagogy perspective in the design of courses, syllabi, and learning goals than we were before because we were forced to look at these very carefully, and I think those things will stay,” he said.
Administrative routines will change as well. For example, in-person department meetings before the pandemic typically saw about 50% attendance. Since they’ve moved to a virtual format, attendance is now at least 75%, González-Cabezas said. Also, faculty who need to write grant proposals, papers, or similar work will be doing that work from home.
“People will feel more comfortable to stay at home than in the past,” he said.
Of course, González-Cabezas said, all of these changes were the result of a team effort and the work of his predecessor, Diane Hoelscher, DDS, MS, who managed the effects of the pandemic before he assumed his position on July 1.
“We responded very well for keeping safety as the primary goal and being able to carry out our mission, which was a very difficult balance,” he said. “And we’re still navigating that. The safety of our students, faculty, staff, and our patients is the number one priority. How to do that without stopping the school has been a challenge, but I think we’ve done reasonably well.”