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Introduction: A Global Congress in Dental Education

Diarmuid Shanley¹ and Anders Nattestad²

¹Trinity College, Dublin 2, Ireland; ² University of Copenhagen, Denmark

The DentEdEvolves Thematic Network Project was funded by the European Union's Directorate for Education and Culture. It expanded to involve participation from North America and a growing number from other continents in a Global Congress in Dental Education. Phase One of this was held in Prague in March 2001 and this Supplement carries the 18 Working Section Reports from that Congress. The project was strongly supported by the American Dental Education Association (ADEA), the Association for Dental Education in Europe (ADEE) and the International Federation of Dental Education Associations (IFDEA). In addition to EU funding it was also supported by the participating universities and five founding corporate sponsors. The participation in Prague comprised 240 individuals from all continents representing 160 dental or stomatological schools as well as representatives of the funding corporate bodies. Another 300 individuals had access to an interactive website and could observe progress. The emphasis in Phase One was predominantly on systems in Europe and North America. It is anticipated that, by the time of the final phase of the Global Congress, planned to be held in Washington, DC, in 2004, there will be greater representation from the East as well as the Southern Hemisphere, with special concerns for representation from those countries with emerging economies. An interim meeting of this project was held in Singapore in April 2002 that was attended by 135 people from 31 countries, primarily from South-east Asia.

Phase One was not intended to solve the great challenges facing dental and stomatological education throughout the world. Rather it set out to identify common challenges, share experiences and promote the pooling of intellectual resources. First, it was hoped to understand better the real challenges and secondly to begin to address them. This group cannot influence the fundamental geopolitical determinants of ill health or the inequities of opportunities but it should offer a platform that will identify the significance of these factors in this era of globalization. There is no suggestion that the representation was sufficient to elucidate the full range of issues, therefore the reports should be read as consensus documents of a collection of dental educators. Nevertheless, the participants in Phase One of the Global Congress in Prague were a significant group of peers with established international reputations in dental scholarship, all of whom are leaders in their own schools and mostly deans. It was therefore a cohort of international leaders with considerable influence on national and international dental education. Phase One gained the opinions of this group of leaders in dental education, first through an interactive website, and then by meeting in a small group face-to-face in Prague. This was followed by a further period of consensus development on the 18 Working Section Reports and their recommendations using the interactive website http://www.dented.org/dentedevolves.php3. All Working Sections were asked to be realistic in their recommendations and to confine them to what each group could themselves achieve within their own resources; a request that was sometimes overlooked by those with more ambitious aspirations.

There is a great diversity in the methods, standards and outcomes of dental education systems throughout the world. Serious differences were chronicled in the recent DentEd Report in respect of the content and process of education as well as competences gained by dental and stomatological students in Europe. Even in countries where structured accreditation systems apply, serious deficiencies in educational methods may be masked. At the same time many dental schools and stomatological institutes, working under the most difficult circumstances and resource limitations, produce talented graduates whose priorities in patient care may be significantly different to those graduating from schools in countries with well-developed economies. Unfortunately it is also the case that many dental and stomatological students complete their education and training without reaching levels of competence that would assure the public that newly graduating dentists are able to carry out safely the independent practice of primary dental care. Obviously many national competent authorities and legislators skilfully and assiduously turn a blind eye to this reality. As a consequence, patients in many countries may be exposed to treatments that are without a scientific evidence-base. Some are deleterious to oral health and a smaller but more significant group of procedures constitute a serious risk to the patient's general health; some being even life-threatening. Despite this there is freedom of movement of dentists throughout the European Union and even in those countries with ostensible controls the individual institutional assurance of quality and standards can be difficult to sustain.

It would be difficult to suggest an acceptable set of standards for Europe, not to mention global standards. At this time it seems better to use peer influence to promote higher standards in whatever circumstances the training institution finds itself. Dental schools are not simply vocational institutions of student training, they also play a significant role as a university discipline dedicated to pursuing knowledge through research, learning and discovery. The infrastructure and strategic development plans are of far greater significance in the long term than isolated clinical or laboratory issues. The most advanced and the least well-developed schools must learn from each other; it is by no means a one-way process. Traditional technological approaches to dental education must give greater expression to the psychosocial imperatives of health care whilst adapting to new and rapidly emerging research findings. These are paralleled with breathtaking developments in information and communications technology (ICT) that will either change dentistry as we know it today or else restrict care to an elective service for a very limited minority; that global minority probably the least in need of care. In the final analysis research and applied research offer the only hope of improving global oral health. However, there is serious concern that scientific progress is not applied efficiently in the profession and especially in dental practice which may be too wedded to an attitude that prefers to maintain a status quo.

Whatever the circumstances, all educators must focus on what the graduate needs for optimum performance and lifelong self-development through active learning while being accountable to the society they must serve as ethical practitioners. Increasing emphasis is now placed on student learning and acquisition of competences according to the region of the world in which they live. The process of learning therefore assumes greater importance as ICT facilitates more and more access to scientific information and a better-informed society demands the most appropriate forms of evidence-based health care.

The Global Congress in Dental Education sought to focus the considerable knowledge and experience of established international dental educators on such issues and through the pooling of these intellectual resources to promote convergence towards higher standards in dental education. Prague was selected because it reflected an historical centre of education, culture and an environment conducive to analysis and open debate. It is hoped that this publication will help to increase awareness of best practices in dental education and encourage a more understanding and educated approach when we seek to compare standards between regions and cultures.

The outcome of this Global Congress will be measured by the quality of the 18 Working Section Reports that follow. It will be more difficult to analyse the level of better understanding. The reports represent expert analyses of the fundamental influences on dental education and training. It may help identify shared developments that might be applied on a global basis. Hopefully, the actual process will have made the case that collaboration is a powerful instrument in promoting higher standards and will help a greater proportion of the world's population to find more equitable access to health care. We all share a global society where currently one-sixth does not have access to clean water, two-thirds are undernourished and 10% are on the verge of starvation. Perspective is important.