Face masks aren’t the only thing standing in the way of some incredible UBC smiles.
For doctor of dental medicine (DMD) students, curricula changes following the onset of the pandemic have limited patient interactions and opportunities for practical experience. These challenges call into question how our future dentists feel about the training that they receive at UBC, as they learn how to make our smiles picture — and Zoom meeting — perfect.
Sinking your teeth into it
Though most UBC students have had to transition to online learning, training to be a dentist is unique in its “strong hands-on component,” according to Dr. Rikki Gottlieb, associate dean of admissions and student affairs at the faculty of dentistry.
Developing hands-on competencies starts in the first year of dental school, with students mostly working on mannequin heads and fake teeth or conducting simple assessments on volunteers. In their second year, students get acquainted with patients, moving on to progressively more patient-oriented work and complex procedures in the upper years.
“[If] you’ve been to a dentist ... you notice that we work with our hands a lot,” said Gottlieb. “And that is something that can’t be trained very well without actually having a mannequin or patient next to you.”
Last spring, provincial health regulations forced the DMD program to halt all in-person student activities for the rest of the academic year. For DMD students like Taylor, whose name has been changed in order to preserve their professional contacts, this meant no longer having access to spaces required to hone future skills.
“We didn’t have any more practice in [the] simulation clinic, which was really scary to think about as dental students,” Taylor said.
“You practice every week to try and improve your hand skills and then the pandemic comes along and you suddenly don’t have that practice anymore.”
To ensure that first-year DMD students met the clinical requirements for being promoted to second year, students were invited back to the university in August 2020 to get caught up.
“We had full days in [the] clinic where we just practiced ... and that was very helpful,” said DMD student Sophia Kim, who is now in her second year.
Since setting up in the clinic can be time consuming, Kim explained that the full days felt more productive than the shorter, intermittent clinic opportunities in the regular school year. Overall, most second-year students that were interviewed felt like they had made up for the clinical experience that was lost at the end of their first year.
But not all opportunities are recoverable. Normally, DMD students can participate in the summer student practitioner program. The program, which is external to UBC, is offered to students in the summer of their third year as an optional opportunity to intern at a local dental practice. Due to COVID-19 restrictions, the program was not offered to students last summer, nor will it be available this year.
Cavity of the situation
With the arrival of the fall 2020 academic term, DMD students continued to face challenges.
Night practices are an optional opportunity for students to come in to the clinic in the evening and further develop hands-on competencies. Last fall, COVID-19 restrictions reduced night practices from two nights a week to one.
“It was doable. I mean, most students came every single time,” said Taylor.
The limited night practices led to some long days, with students sometimes being in class or clinic from 8 a.m. to 5 p.m., and then attending the only night practice slot available until 9 p.m.
“The whole first term we were actually encouraging the dean and faculty to please allow for a second night,” explained Kim. “Especially because when we’re in clinic we have all the [personal protective equipment], so we’re all in scrubs [and] everybody wears a face shield mask. So it’s pretty safe in the clinic, especially because in first-year [the program] drilled infection control.”
Hoping to improve their situation, students embraced the various lines of communication available to them in the DMD program. Gottlieb explained that students are welcome to bring concerns directly to faculty members like herself, but they can also communicate their thoughts to student representatives or to the dean directly through townhall-style meetings.
It was through this communication that students were able to successfully gain an additional time slot for night practices starting in 2021.
“I feel very lucky that they listened to us,” said Kim. “[It] was a big win for everybody.”
For Gottlieb, hearing from the students was crucial to developing an optimal learning environment.
“The students have been amazing in providing feedback ... offering solutions that are just so helpful, because sometimes we don’t have that perspective from the faculty and administration,” she said. “We need to hear from the students and we’re looking for that feedback.”
Gottlieb encouraged students in the DMD program to bring forward their concerns, as the program aims to create an “open culture” that is receptive to student feedback.
“We want to help students [and] we can’t help if we don’t know,” she said.
Drilling it in
Physical distancing restrictions also forced the DMD program to limit the number of students interacting with patients by having students work in pairs.
“You can kind of imagine that effectively cuts our clinical experience in half,” said fourth-year DMD student Kenny Liu. “But it’s not so bad because now we have an assistant.”
Liu explained that pairing up helps keep the space clean, as the student in the assistant position is able to suction, pass tools and reduce possible contamination.
“It’s a little bit of getting used to, but I’m just grateful that we’re able to make something work,” he said.
As fourth-year students were prioritized in the clinic due to their pending graduation, according to Liu, third-year students were left with less experience. Throughout the year, the faculty consulted with students to establish a game plan to optimize learning and get students on par with previous years.
“We look[ed] back and said, ‘How can we make this better for students compared to last year where we had this gap?’ And we didn’t want to repeat that deficit this year,” said Gottlieb.
She explained that the DMD program settled on an extended term, meaning students will gain experience into the summer without being charged additional tuition or fees. The faculty is looking into ways to provide financial support, housing accommodations and other supports to students; so far, they have gotten U-Pass extensions approved for the summer, according to Gottlieb.
Brace(s) for the future
Overall, most DMD students are feeling optimistic about their experiences in spite of the pandemic, even acknowledging the benefits of COVID-19-era learning.
“For infection control, it’s the first thing you learn in dental school ... I think in first year we would spend literally hours every week just sanitizing and wiping things down,” said Taylor.
“As soon as the pandemic hit we were like, ‘Oh, that’s why we do it.’”
Liu said that the pandemic “brought [him] out of [his] shell” as he cultivated his soft skills. He explained that many of the patients seen by the DMD program are seniors, who could benefit from a “sympathetic ear,” and that reassuring patients over the phone while making appointments was good practice for the future.
“I think overall in dentistry … there’s a whole set of skills,” he said. “And I argue it’s actually more important than hand skills – and that’s basically how you treat other people, how you talk to people, how you make them feel when they’re in your chair.
“I think COVID actually gives you a unique challenge to work on your soft skills. ”
But there are some new anxieties that the pandemic has created for DMD students. For second-year student Negar Rezqi Qomi, the economic impact of the pandemic on dental offices and other small businesses highlighted the importance of a business mindset.
“I realized that it’s better for me to learn about the business aspect [of dentistry] as well,” she said. “Dentistry is not just seeing the patient and taking care of them. That’s our main goal, but … if you can’t run a business, then you can’t help your patients. So they kind of go hand in hand.”
To support students in the development of business skills, Gottlieb explained that the DMD program offers management courses in the upper years, as well as the Lunch and Learn program, where speakers discuss the business side of dentistry with students.
Still smiling (nitrous oxide not required)
In terms of mental health and well-being, most of the DMD students interviewed have coped well.
To promote a positive mental health culture, the DMD program sends weekly “Well-being Wednesday” emails containing support resources. Following student feedback about mental health, the program will appoint an embedded counselor to serve the specific needs of students in the DMD program.
DMD students have also joined the ranks of student health care workers who have access to COVID-19 vaccinations, which many students are “super grateful for,” according to Taylor.
The willingness of the DMD program to listen to students during the pandemic was acknowledged by Rezqi Qomi, alongside a deep appreciation for her peers who spoke up in the pursuit of positive change.
“We have great students that push for the good of all,” she said