Commentary

CommentaryComment on the paper: Can biomedical science be made relevant in dental

education? A North American perspective by B. Baum

Accepted for publication 31 August 2002

In this thought-provoking article, Bruce Baum puts the

view that the major advances occurring in biomedical

sciences are not being reflected in changes in dental

education needed to prepare today’s students for a

future in practice that will rely heavily on biological

therapies. Baum bemoans the lack of emphasis on

reading scientific literature and developing critical

thinking skills in many dental curricula. He argues that

a major reason why biomedical science has not been

made more relevant in dental education is that science

and scientific inquiry are under-valued by most dental

school administrators, faculty members and practising

dentists. Three examples are given to support this view:

the amount of time devoted to clinical training in dental

curricula; the style of licensing examinations in North

America; and the nature of fee schedules in practice.

Whilst acknowledging that no single approach can be

expected to overcome the problem, five directions

likely to be beneficial are outlined: faculty develop-

ment; promotion of critical thinking skills; patient-

based discussions; reading the scientific literature;

and practical training of students in internal medicine.

Baum concludes his essay by offering dental educators

and practising dentists a choice – to embrace change or

to retain the status quo and become irrelevant.

This article addresses a very important issue in dental

education that should generate considerable discussion

and debate. Although Baum draws his examples

mainly from the North American scene, the topic is

of relevance globally.

I agree entirely with Baum that biomedical sciences

and scientific thinking must underpin dental education

and practice, but all too often they are not presented

effectively in present curricula. However, there are

many examples where we (dentistry) have made great

advances by applying knowledge from the biomedical

sciences. For example, our whole approach to dealing

with early carious lesions has changed in the past

10 years or so, as our understanding of surface chem-

istry, including the concepts of demineralisation and

remineralisation, has grown. The developments in

adhesive restorations and implant materials have come

from advances in the fields of biomaterials and bio-

compatibility. These developments and discoveries

may not have been as dramatic as some in medicine,

e.g. gene therapy, but they have been highly effective

and beneficial to the community.

I believe we need to be more positive about these

‘successes’ and highlight them more in our curricula,

emphasising how they represent application of knowl-

edge in the biomedical sciences that has now become

part of everyday dental practice. We then need to instil

a sense of excitement in our students about these dis-

coveries that dental researchers have made. Too often

the biomedical sciences and the advances that flow

from them are taught and described in isolation from

clinical dental practice. Often the teachers of biomedical

sciences are not dentists and the topics are taught and

assessed in isolation from the dental context. Little

wonder that our students often only see the biomedical

science subjects as hurdles that they need to overcome

before they can move on to the real thing – clinical

practice!

My feeling on reading Baum’s article was that he has

tended to focus on ‘biomolecular’ science when refer-

ring to ‘biomedical science’. I would have preferred a

broader concept that included the full range of biome-

dical disciplines. I also sensed a tendency for the author

to focus on therapies by the dentist rather than empow-

erment of individuals to take charge of their own oral

health. We are all aware that the most common dental

diseases, caries and periodontal diseases, are both pre-

ventable and that their prevention need not necessarily

rely on hi-tech remedies. This leads to another point

that I feel should be emphasised – the need to take a

global view of oral health and oral care. We need to

Eur J Dent Educ 2003; 7: 56–59Printed in Denmark. All rights reserved

56

appreciate and understand the great variation in need

and access to oral healthcare of communities around

the world, when considering issues of dental education

and practice.

The five directions Baum proposes, to make biome-

dical sciences more relevant in dental education, are all

important. I agree wholeheartedly about the need to

facilitate change through further training and educa-

tion of faculty members. Our plans and aspirations to

develop and present balanced and relevant dental

curricula may be foiled by an inability of the entire

faculty to project a consistent educational approach.

While this may occasionally be due to deliberate

attempts by some disaffected individuals to undermine

programmes, in most cases it is due to a lack of under-

standing by staff of a school’s educational goals, or of

how they can be achieved in practice. This is particu-

larly an issue in schools where large numbers of prac-

tising dentists act as part-time clinical tutors.

I would stress the need to develop an overall educa-

tional philosophy in any dental curriculum and to

integrate and co-ordinate biomedical topics with clin-

ical practice throughout. As long as biomedical science

subjects are taught and assessed in isolation from the

practice of dentistry, with most examples of application

to practice coming from the medical sphere, students,

staff and practising clinicians will struggle to see their

relevance.

As Baum points out, student-centred educational

approaches, such as problem-based learning (PBL),

seem to provide one way of making the biomedical

sciences more relevant to dental students. By using

carefully designed, clinically realistic scenarios, stu-

dents are stimulated to develop an understanding of

those aspects of the biomedical sciences that are rele-

vant to dentistry. The PBL process also requires stu-

dents to work logically and critically through scenarios,

interpreting information, identifying issues and pro-

blems, generating hypotheses and identifying relevant

learning issues. They are then expected to research the

learning issues, using a range of resource materials, and

to critically evaluate the sources they have accessed and

their own learning. By stimulating students to recog-

nise what they ‘need to know’, I believe the PBL

approach offers a powerful means of emphasising

the importance of biomedical science to the practice

of dentistry.

A challenge that educators in PBL programmes still

face, however, is determining how best these

approaches can be transferred to, and implemented

in, the clinic. Of course, the potential advantages of

PBL or other student-centred approaches are unlikely

to be realised unless the forms of assessment that are

used match our desired learning outcomes. Baum has

raised this issue in relation to the North American

licensing exams and, while it may not be easy to change

this system, we should all be able to develop assess-

ment approaches in our curricula that encourage cri-

tical thinking and reading of the scientific literature. All

too often our assessment methods reward rote learning

and recall of facts, without requiring students to

demonstrate understanding or higher-order cognitive

skills.

I particularly like Baum’s suggestion that dental

educators should explore further the possibilities of

adopting variations of the patient-based discussions

or ‘rounds’ used commonly in medicine. Dental stu-

dents spend considerable time in the clinic, carrying out

treatments for their patients, but often without oppor-

tunities to share experiences with their peers. All too

often their focus is on individual teeth rather than the

patient as a whole. We need to achieve a balance

between providing students with opportunities to

develop their clinical skills, and being able to partici-

pate in groups, where the reasons for adopting a parti-

cular approach can be discussed and the outcomes for

the patient reviewed in the light of current knowledge.

While I agree with Baum that dental students need a

sound education in general (internal) medicine, I am

not convinced that they all need clinical training in this

discipline, e.g. in recording blood pressures or listening

to hearts beat. I think the context of the experience is the

most important issue here. I do not believe it is parti-

cularly valuable educationally to have dental students

trailing around hospital wards behind groups of med-

ical students, with a registrar in the lead doing his/her

rounds. However, if programmes can be developed

where dental students are exposed to a hospital envir-

onment in which they interact with other health profes-

sionals and see a broad range of medically

compromised patients with dental problems, for whom

they need to devise management plans, then great

benefits can accrue.

It is probably true that the biomedical sciences are

under-valued in dental education, but I am not con-

vinced that this is entirely the fault of dental school

administrators and faculty. The financial squeeze to

which most dental schools have been subjected has

meant that biomedical topics or courses are increas-

ingly being taught by staff from medical or science

departments whose educational approaches and enthu-

siasm for dentistry might not match our own. Although

there may be advantages potentially from greater inte-

gration of medical and dental curricula, I strongly

believe that moves in this direction need to be the result

of a balanced two-way process aimed at benefiting

Commentary

57

students of both professions and maintaining the spe-

cific practice context.

For many years, Bruce Baum has been a strong and

effective advocate of the need for dental education and

practice to be based on a solid scientific foundation.

Given the rapid advances occurring in the field of

biomedical science, we, as dental educators, need to

take up his challenge and design curricula that inspire

our students and build a commitment to practising a

biologically based style of dentistry that is informed by

critical evaluation of the scientific literature.

Professor Grant TownsendDental School,

University of Adelaide,

South Australia 5005

Author’s response to Professor Townsend

I am most grateful for Professor Townsend’s extre-

mely kind comments on my essay. Overall, we share

many common viewpoints on dental education,

although we differ some on details and emphasis.

He is quite correct in stating that I write from a more

biomolecular perspective than general biomedical one.

However, that is the area of biomedical science in

which I work, and know, and thus the only one in

which I feel any competency. Nonetheless, my sense is

that the situations described from my biomolecular

perspective are not very different for other biomedical

sciences.

In his commentary, Professor Townsend has raised

several substantive issues that I was either unable to

address adequately or not at all in my essay. Each of

these is important for readers to consider. With one

exception, I tend to agree generally with the points he

has raised. For example, I completely agree with his

point that there are many instances of dentistry making

significant clinical advances by applying biomedical

science knowledge. Indeed, and reciprocally, I would

add to this that there are also many areas where dental

scientists/oral biologists have played leading roles in

understanding major general biomedical science issues,

e.g., microbial attachment and mucosal immunity, to

name just two. We certainly should take a ‘‘communal

pride’’ in such significant accomplishments.

Professor Townsend also correctly writes that tea-

chers of biomedical science may not convey this kind of

information, along with the associated excitement and

the scientific interest that it could generate, to dental

students. In addition to the limited enthusiasm that

external basic science teaching faculty may bring to

dental students, which he notes, I have long felt that one

of the major parties at fault in not making biology

relevant in clinical dentistry is the oral biology com-

munity, of which I am a member. Thus, Professor

Townsend is correct in noting that blame for the current

irrelevance of biomedical science in dental education is

not entirely due to administrators. Clearly, to make

biomedical science relevant in dental education many

types of individuals must work synergistically. How-

ever, because of their prominence and influence, I feel

senior administrative leaders must assume greater

responsibility. They need to provide critical pedagogi-

cal and intellectual guidance in addition to fiscal leader-

ship.

Professor Townsend observes that my essay is pro-

vider-oriented and neglects patient empowerment

issues. I agree fully with him that patients have a

considerable role in maintenance of their oral as well

as general health. However, I tried to make my essay as

focused as possible, so as not to dilute my principal

message, and I appreciate his raising this deficiency.

Similarly, I share his global considerations, despite my

writing from a North American perspective. I did

attempt to address this important point, but too subtly,

in my arguments for the necessity of dentists to have

good critical thinking skills regardless of the wealth or

scientific stature of their society.

The one substantive issue upon which Professor

Townsend and I differ is the need for dental students

to have traditional internal medicine rotations during

their pre-doctoral training. However, there is no right

or wrong viewpoint here, just two opinions lacking

adequate supporting data. Hopefully, various dental

schools will try different approaches to expose students

to practical training in medicine, ranging from his

more focused, dental disease-related suggestion to

my much broader one. If these options are treated as

pedagogical experiments, and appropriate outcomes

are measured, then in the future, useful pathways for

training dental students in medicine should be defined.

In his commentary, Professor Townsend also urges

dental educators to develop student assessment meth-

ods throughout the curriculum that are indicative

58

Townsend

of the desired educational goals. I am in complete

agreement.

In conclusion, I wish to thank Professor Townsend for

his wise words. By raising several important issues, he

has enhanced my efforts to call attention to the need for

biomedical science relevancy in dental education, and

in doing so given the Journal’s readers a good deal

more to consider. He and his colleagues in Adelaide

continue to contribute much to advancing dental edu-

cation. I am most appreciative.

Bruce BaumBethesda, MA USA

Response

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