Decolonising dental educational research: reflections from a white researcher.

While there is an emerging scholarship on decolonising dentistry, the debate about reflexivity, positionality and white privilege in dental educational research and practice is still at a developmental stage. This article aims to contribute to this nascent debate by contemplating the question- is it appropriate, or possible, for a white researcher to undertake decolonisation work in dental education? If so, what would it entail or 'look' like? To answer this important question, the author offers a reflective account of their ethical and epistemological journey with this very question. This journey begins with how I, a white researcher, first became aware of the everyday racism experienced by my racially and ethnically minoritized students, the whiteness of dental educational spaces and how my white privilege and position as a dental educator consciously and unconsciously implicated me in these processes of exclusion and discrimination. While this revelation led to a personal commitment to do better in my practice, both as an educator and a researcher, I continue to struggle with my white ignorance and white fragility as I strive to make my work more inclusive. To illustrate this, I discuss an ethnodrama project on everyday racism that I lead on and how, despite choosing a more democratic research method, hegemonic whiteness continued to make its presence felt through my 'going it alone' method of work. This reflective account reaffirms that regular and routine self-reflection is key to ensuring that racialised inappropriate and damaging assumptions, frameworks of thinking, and ways of working are checked for. However, my praxis won't evolve through critical introspection alone. I need to be open to making mistakes, educating myself about racism and anti-racist practice, asking for help and guidance from my minoritized colleagues and more importantly, committing to working with people from minoritized communities rather than on them.

Dental students' self-reported confidence level in restorative crown and bridge procedures: A UK quantitative study.

INTRODUCTION: Graduating confident students who can flourish and develop in their future career is an important outcome of dental education. The aim of the study was to gain an insight into students' self-reported level of confidence in restorative crown and bridge procedures, highlighting in which stage of the process students have the highest and lowest confidence, depending on the level of supervision required. MATERIALS AND METHODS: Fourth and final year students (n = 85) were invited to complete a 71-item closed questionnaire specific to self-reported confidence based on the level of supervision required in stages of crown and bridge procedures. Clinical activity for each student from their portfolio system was collected. Non-parametric tests, specifically the Mann-Whitney U-test was used to analyse the continuous non-normal data. RESULTS: A response rate of 65% was obtained. Final year students were more confident in crown and bridge procedures than fourth year students. Fourth year students were more confident in bridges, whilst final year students were more confident with crowns. Majority of students expressed "average confidence requiring minimal supervision" in crown and bridge procedures. An association between clinical activity, confidence and year of study was noted. Gender was not strongly associated with confidence. Stages in crown and bridge procedures were noted where students lacked confidence. CONCLUSION: The study highlighted areas in which students were most and least confident in crown and bridge procedures. A positive relationship between clinical activity in crown and bridge procedures and student self-confidence has been noted for both years, though slightly higher in the bridge procedure for fourth year students. We attribute this to the fact that fourth year students had recently completed their bridge competency assessment. Upon graduating, final year students still require supervision and reported average confidence in certain aspects of crown and bridge procedures, namely occlusal, bevel and axial reduction.

When I say everyday racism.

In this 'When I say …' article, the concept of everyday racism is defined and explained as a useful theoretical and methodological tool to evidence the numerous ways in which the climate of medical school can adversely impact the social and educational achievements of ethnic minority students.

Exploring the impact of digital professionalism awareness training on dental undergraduate students.

INTRODUCTION: Since the publication of GDC guidance, there have been small, but rising numbers of Fitness to Practise (FtP) cases made against qualified dentists, relating to the use of social media. Prior to graduation, dental students currently receive training in the appropriate use of social media, but more work is needed to determine the most effective methods do this. The aim of this study is to explore the impact of the digital professionalism awareness training provided at one UK-based institution. MATERIALS AND METHODS: In year 2, a "brown envelope" is compiled using an online publicly available Facebook profile search for every student. All year 2 to 5 dental undergraduate students at one UK dental school who had completed the "brown envelope" were invited to participate in focus groups to examine its impact on behaviour change. A qualitative framework analysis method was applied to the transcripts. RESULTS: Eleven dental undergraduate students participated in two focus groups. All students had experienced the "brown envelope" intervention. Four main themes emerged, including: a clear expression of dental student autonomy and rejection of regulation; that online activity in dentistry is different to medicine; that the intervention is useful and changed online behaviour; and constructive suggestions for improving training. CONCLUSION: The interactive "brown envelope" intervention for digital professionalism awareness training was well received and appeared to result in actionable behavioural change on student profiles (eg alterations in privacy settings or restricting access to their own "friends lists").

Between fairness and fear-Dental undergraduates' attitudes towards objective structured clinical examinations.

INTRODUCTION: Objective structured clinical examinations (OSCEs) are an established method of assessment for dental undergraduates. There is little published dental education research exploring the views of undergraduates towards OSCEs. AIM: To explore and describe the views of dental undergraduates towards OSCEs. METHOD: A sequential mixed methods design was applied. This included a cross-sectional survey of all 204 dental undergraduates in Years 2, 3 and 4 within a UK dental school using an anonymous self-report online questionnaire (response rate 57%), which was followed by two focus group interviews of n = 10 Year-2 students. RESULTS: Most students gave positive views regarding the OSCE form of assessment. Questionnaire data highlighted that students felt that the OSCE tested their diagnostic, clinical and communication skills, and covered a wide range of skills and disciplines. Students also generally saw them as a useful educational exercise that went beyond testing recall of facts. Most students thought that the OSCEs were "fair" assessments. Negative views focused around student lack of preparation for them, especially in earlier years. Focus group data explored further these concerns but also emphasised the need for more student-centred support pre-OSCE. CONCLUSION: Objective structured clinical examinations can be an anxiety-inspiring form of assessment for students in the early years of the programme. Dental educators need to be more aware of these concerns to develop strategies to increase student preparedness for OSCEs without increasing stress.

The behavioural and social sciences as hidden curriculum in UK dental education: A qualitative study.

INTRODUCTION: The behavioural and social sciences (BeSS) are an integral part of dental curricula, helping students become holistic, patient-centred practitioners. Nevertheless, UK studies document that dental undergraduates struggle to see the relevance of BeSS to their training. Using the concept of hidden curriculum, this study explored dental students’ perceptions of and attitudes towards BeSS in one dental school in the UK. MATERIAL AND METHODS: Six focus groups were conducted with 37 dental students from years 1 to 5. Thematic analysis was conducted revealing five themes: student attitudes towards BeSS, teaching culture, learning culture, curricular issues and student culture. RESULTS: Many students recognised how BeSS contributed to their communication and patient management skills. Nevertheless, the study revealed a dental student cohort who have a strained relationship with BeSS. This negative attitude became more apparent from year 3 onwards, when the clinical phase of studies begins. It was perpetuated and legitimated by the existence of a strong student culture that openly critiqued BeSS among and between student year groups. DISCUSSION AND CONCLUSION(S): In UK dental education there is a hidden curriculum related to BeSS. By underestimating the utility of BeSS, students are failing to recognise the biopsychosocial dimensions relevant to oral health and dental practice. All UK dental schools should review their relationship with BeSS and assess whether they are perpetuating a hidden curriculum about BeSS within their curricula.

Librarian or counsellor?: a pilot study of the experiences of library staff in one healthy reading scheme in Ireland.

BACKGROUND: Book prescription schemes and healthy reading schemes place self-help books in public libraries to assist in the treatment of mild to moderate mental illness. Research has highlighted that library staff play an active role in the success of this initiative. AIMS: To conduct a pilot study of the professional experiences of the library staff of Clare County Healthy Reading scheme as they deal with the therapeutic demands of the reading public. METHOD: A preliminary questionnaire was developed and distributed among the staff members. In total, 12 completed questionnaires were returned and analysed. RESULT: Despite their lack of training and support from statutory mental health services, library staff affirmed their belief in the benefits of healthy reading schemes. Library staff also maintained a clear understanding of their role as gatekeepers but not as therapeutic advisors to the reading public. CONCLUSION: Despite the serious restrictions to mental health services in Clare, library staff did not believe that their role was to 'fill in the gap' in terms of providing mental health assistance to the reading public.

Contemporary dental student professionalism: moving towards a macro-level perspective.

Defining professionalism and developing educational interventions that foster and assess student professionalism are integral to dental education. Nevertheless, conceptual, methodological and pedagogic differences define the academic field, leaving students, educators and the profession itself struggling to make meaningful progress on how best to elicit and monitor dental student professionalism. This article proposes that more progress can be made on this important issue when a contextualised, sociological assessment of dentistry and dental professionalism is undertaken. We contend that identifying some of the socio-cultural demands in UK dental students' lives, and acknowledging how these pressures shape their interactions with the UK dental education system, provides a nuanced and contemporaneous understanding of what it means to be an oral health care professional at a time of social and health care upheaval. Dental educators can use this insight to work towards being more understanding of and responsive to dental student professional development.

Are there more women in the dentist workforce? Using an intersectionality lens to explore the feminization of the dentist workforce in the UK and US.

In this paper, we seek to understand feminization of the dentist workforce moving beyond previous research that has looked at gender in isolation. We contend that little consideration has been given to how gender interacts with other important social identities such as race/ethnicity to influence the opportunities and barriers that female dentists encounter during their dental career. We argue that the scholarly debate about the feminization of the dentistry has not acknowledged the intersectionality of women's lives. Intersectionality describes how multiple social identities (such as race/ethnicity, gender, and class) overlap and interact to inform outcomes, creating disadvantages and/or privileges. Our thesis is that the increasing feminization of the dentist workforce is complicated and paradoxical, creating both opportunities for women and gender imbalances and blockages within the profession. To support our thesis, we critically reviewed the literature on feminization and analysed UK and US workforce data. While the female dentist workforce in both the UK and the US has increased significantly over the past decade, the growth in the number of female dentists was not equal across all racial/ethnic groups. The largest increase in the number of female dentists was among White and Asian women. Viewing the feminization of the dentist workforce through an intersectionality lens exposes the multiple and complex experiences of women, as well as the power dynamics in dentistry. Feminization in dentistry demonstrates the importance of presence, privilege, and power. Based on our assessment of the dentist workforce, dentistry may be less inclusive, despite being perceived as more diverse. Further research should explore how power and privilege may operate in dentistry. Dentistry should embrace intersectionality to provide an inclusive evaluation of equity in the workforce.

Developing a person-centred approach in dentistry beyond NHS recall intervals: a commentary.

Person-centred care (PCC) is acknowledged as a fundamental dimension of quality within health care and provides significant benefits for patients and clinicians. Models of PCC have primarily been developed from the medical literature, with limited consideration of their application within dentistry. The Personalised Care Institute was established to deliver education and training on PCC and is working with the Office of the Chief Dental Officer for England to develop resources on shared decision-making (SDM) to promote tailored recall intervals.This paper seeks to promote the value of PCC and SDM in delivering high-quality care but cautions against the use of generic models or training in view of the potential differences which may exist within dentistry, particularly general dental practice. The authors highlight the need to develop materials and training which are appropriate, contextualised and relevant to dentistry. The capacity and desire to deliver PCC is strongly influenced by the healthcare system which is in operation. The current units of dental activity (UDA) system operating in England would appear to act as a barrier to the delivery of PCC. Unless significant and rapid changes are introduced to the NHS Contract, UDA targets will continue to take precedence over PCC, SDM and tailored recall intervals.

The 'leaky' BAME pipeline in UK dentistry.

Introduction There are growing calls for dentistry to debate, critique and analyse the role and place of racism in the profession. This article supports this debate and considers whether people from Black, Asian and Minority Ethnic (BAME) backgrounds experience barriers to progressing in the profession.Aims To create a BAME 'pipeline' model illustrating how ethnicity shapes the composition of the dental profession in the UK.Material and methods Publicly available datasets from UK higher education agencies and professional dental associations were identified, examined and collated to create a BAME pipeline model.Results Registrants from the BAME category do not share similar experiences within the dental profession compared to white registrants. The experiences of British Asian people appear to be more favourable, vis-à-vis access to dental schools and progression to the General Dental Council register, compared to Black British people and other UK minority ethnic groups. Black British registrants experience blockages at all stages of their career progression, most notably when accessing dental schools, with only 2% commencing dental studies. All BAME groups 'leak' out of the dental pipeline at clinical academia. There are insufficient data to ascertain whether there are additional 'leaks' at the career specialisation stage.Discussion and conclusion The UK BAME dental pipeline is a leaky one and is in need of urgent action and repair.

Professionalism and dental education: in search of a shared understanding.

Professionalism has profound historical origins; however, the current health care environment in the UK dental sphere is changing, which presents new professional dilemmas that require continued learning and debate. Professionalism is a key aspect of the education of dental students and the lifelong learning and development of dental practitioners. However, 'being' professional can be challenging because while it is recognised as a social good, there is much debate on what professionalism means and how best it can be learned and assessed. Since 2017, the UK Council for the Dental Teachers of Professionalism, consisting of educators from UK dental schools and dental therapy hygiene institutions, has been exploring and debating the role and place of professionalism, as well as sharing challenges and good practice within UK dental education. This paper includes a narrative overview of current thinking in the academic literature on professionalism to consider the use of a shared understanding of professionalism to facilitate conversations between various stakeholders.

Social media use, professional behaviors online, and perceptions toward e-professionalism among dental students.

OBJECTIVES: This study aimed to assess self-reported social media use, professional behaviors online, and perceptions on e-professionalism while using social media among dental students in two Southeast Asian universities. METHODS: This cross-sectional study involved clinical dental students at University of Malaya (UM), Malaysia (n = 150) and Airlangga University (AU), Indonesia (n = 150). A questionnaire was distributed using Google Form via WhatsApp network. Data were analyzed using descriptive, Chi-square, and Wilcoxon rank-sum tests. RESULTS: All students responded (n = 300) and reported as active social media users. Majority spent ≥ 1 h a day on social media and checked their social media > 6 times a day. Most commonly used social media accounts were Instagram (UM: 92.7%, AU: 95.3%) and Facebook (UM: 94.7%, AU: 59.3%). A small proportion of UM and AU students admitted to posting clinical photographs, patient records, and comments about patients on social media. UM students had significantly better scores in terms of their professionalism behaviors on maintaining the integrity of the profession compared to AU students (p < 0.001). Meanwhile AU students had better scores than UM students on behaviors related to upholding colleagues' professional image on social media (p = 0.421). Most students in UM and AU shared similar positive perceptions toward online professionalism behavior statements. Majority reported concerns over unprofessional posts online. CONCLUSION: Self-reported behaviors online sometimes contradict with students' perceptions and concerns about being unprofessional online. There is a need for clearer educational guidelines on how to instill e-professionalism values and behaviors among dental students.

COVID-19 presents an opportunity for dental teams to become ready for person-centred care.

Two publications that recently appeared in the British Dental Journal mooted the position that dentistry may not be ready for person-centred care. This commentary takes up this discussion and agrees that while person-centred care is essential to dentistry, it is not without its challenges. Drawing on the multidisciplinary expertise of its authors (two sociologists, one psychologist and a dentist), the nature of these challenges is interrogated further. It also identifies opportunities for change on this position from within the literature, as well as by clinical practice. We present evidence to suggest that the current pandemic has shown that dental teams are capable of rising to a challenge and adapting to change. In this light, we propose that the pandemic presents dental teams with an opportunity to be even more person-centred.

Taking responsibility for the tooth: A semiotic and thematic analysis of oral health and disease in the TV show 'Embarrassing Bodies'.

Oral health and dentistry are seldom the subject of medical reality TV. This study investigates whether the dental segments within the British medical reality show, 'Embarrassing Bodies', may contribute to the anthropological understanding of oral health and social status, through semiotic and thematic analysis. This methodology involves close examination of both the visual and narrative themes within the programme. The show presents mouths afflicted by oral disease as traumascapes, the framing of which provides voyeuristic appeal. The portrayal of dental disease as negatively affecting human flourishing through shame and the inhibition of intimacy was common across the analysed cases. The key themes of intimacy and social distance; discipline, blame and personal responsibility; carnography; disciplining gaze and authority; and redemption and rebirth were identified through analysis. The cases also present a strong correlation between a lack of personal responsibility and the development of dental disease within the wider context of social class, with the dentist as a disciplining authority, enforcing professional and societal norms.

Are dentists considering a career in orthodontic clinical academia? A qualitative study into the factors influencing a career in orthodontics.

Introduction Dental clinical academics are essential members of the dental workforce with roles in teaching, research and scholarship. There is currently a national shortage of UK dental clinical academics, with difficulties recruiting to all grades. In addition, there is evidence of gender inequality within academia, with segregation at a horizontal and vertical level.Aim To investigate the factors that influence a career in orthodontic clinical academia and highlight ways to improve recruitment and retention.Method A qualitative research study utilising focus groups. Purposive sampling was carried out to recruit participants at different stages of an orthodontic career. A total of eight face-to-face focus groups were conducted with 26 participants. Focus groups were split by gender and career stage. An inductive thematic analysis was used to generate themes.Results Three major themes were generated: academic career options, motivations and barriers to pursuing a clinical academic career.Conclusion This paper sheds light on the current factors affecting a career in orthodontic clinical academia. Worryingly, most dentists do not strive for an academic career and the barriers to pursuing this career option are discussed. Ways of addressing the issues facing recruitment and retention of individuals to orthodontic clinical academia are suggested.

Why UK dental education should take a greater interest in the behavioural and social sciences.

Recent moves by public health academics and social scientists for increased recognition of the behavioural and social sciences (BeSS) in medical education in the UK have put the role and place of the BeSS in dental education back on the curricular agenda. Behavioural and social sciences have been a component of the UK dental curriculum since 1990 but, to our knowledge, have only been reviewed once, in 1999. The aim of this article is to reignite a discussion about the role and place of BeSS in dental education in the UK. It reiterates the benefits of BeSS to dental education and dentistry in general, while remaining cognisant of the implicit and explicit barriers that can conspire to side-line their contribution to dental education. This paper concludes by making renewed calls for more integration of BeSS into the dental undergraduate curriculum as well as sectoral recognition for its contribution to the advancement of dental education and the professional development of dentists.