The demands on today’s dental students – and dental educators – are high, but Dean of the Dublin Dental University Hospital Professor Brian O’Connell feels that the future is bright.
From his third-floor office in the Dublin Dental University Hospital (DDUH), Professor Brian O’Connell can see both the green spaces and historic buildings of Trinity College Dublin, of which the Dental School is part, and the buildings and rooftops that represent the wider city, where the 100,000-plus people who seek treatment every year in ‘the Dental Hospital’ are drawn from. It’s a fitting illustration of the dual function of the institution he represents as Dean – where academic considerations meet the day-to-day practicalities of offering excellent dental care to the public. The role of dental education in preparing students primarily to care for people, and to be a crucial part of general healthcare in Ireland, is extremely important to Professor O’Connell, and is a theme we return to several times during our conversation.
A well-rounded education
Unsurprisingly, he praises the calibre of student coming to the School, and is proud of its diversity, with one-third of students coming from non-EU countries.
“I think the graduating students are better than they ever have been. They’ve a better, more rounded education, and are generally well equipped to go out into the world.”
These days, providing that well-rounded education means more than just covering the clinical topics, vital though that is. The need to ensure that graduates have the communication and business management skills to complement their clinical skills is something Professor O’Connell is very conscious of. The Dublin School’s efforts in this regard will include a module on preparing for life after college, and involvement in the GradLink Programme in TCD, which links final-year students with volunteer mentors in the community.
“It’s just a start and something we would like to build on, but you’re constrained by the curriculum – there are so many other things to do.”
The curriculum takes up a massive 5,000 hours, so finding space for everything is an ongoing challenge. Sometimes, the question is not what to include, but what to let go, and the School is currently undertaking a major review.
“We’re looking at every part of [the curriculum], so we can get a better handle on exactly how it maps on to the areas of competence that we’re trying to deliver. For example, you might find that something like prevention, or salivary health, is taught two or three times in different areas, so you might change that to one area, and use that time for something else.”
This is the first time in some years that such an audit has been carried out in the School, but Professor O’Connell says that the staff have taken it on enthusiastically.
“We’re all very aware that there are fewer people now trying to do more. It’s not just that we have more students, but we have more areas to cover; during the recession we had a lot of staff retire early, and most have not been replaced. Everybody wants to make the best use of their time.”
This is the first mention of the dreaded ‘R’ word, and Professor O’Connell is keen to say that while losses during that period were difficult, recruitment is beginning, and there are advantages to the ‘new broom’.
“We’ve lost a lot of institutional memory, but every institution has to go through periods of rebuilding, so there’s a genuine opportunity now to bring in a new generation who will take things forward, hopefully to an even better place.”
Training the team
The student cohort now comprises the dental team of dental nurses, hygienists, clinical dental technologists and orthodontic therapists, and integrating these disciplines is an important element of education here.
“I think this is probably the only place where we train everybody in the dental team together, so we try very much to give everybody an exposure to working in the dental team. It’s something we want to develop for the future.”
He speaks very highly of the enthusiasm and passion of the students in the ‘newer’ disciplines.
“The people involved with some of the newer programmes are amazingly enthusiastic about what they’re doing, maybe because they are the newcomers in a sense. They have a passion for what they do and an excitement that sometimes in dental science we would do well to be reminded of.”
Professor O’Connell sees teamwork as extending beyond the doors of the School, or even the dental practice.
“I would hope that the dentists of the future will be seen more as part of a primary care team for patients and my dream, if I were to have one, would be that the public will view their dentist as someone who is involved in looking after and promoting their health, as well as somebody who can do wonderful things to make your teeth look nice!”
He feels that this is already beginning to happen.
“Anecdotally, I hear that a lot of doctors, since the introduction of free GP care for under sixes, are seeing more children with dental problems, and they don’t know what to do with them. If we had a bit of joined up thinking here [in regard to healthcare policy] and dentists could be seen as part of that health spectrum, I’d be very happy.”
Life after school
Of course, in order to be part of this vision, dentists must first graduate and begin their practice. The vast majority of dental science graduates become general dental practitioners, but a sizable number begin their careers outside Ireland, and this is a source of concern. “We still unfortunately lose too many graduates early on who emigrate. Most of them come back, but it says something about the state of dentistry at the moment that we don’t have enough attractive opportunities for graduates, at least at first.”
There has been much discussion about the lack of a vocational scheme for graduating dentists, and it’s worth asking if this is a reason for the high emigration rates, but for Professor O’Connell it’s not so simple.
“I think that’s part of it, but a lot of people go to places where there isn’t a vocational scheme. I think that having some sort of transition to practice after graduating would be useful. That’s where I would really like to see the business training and mentoring, in a supervised year where people could have support. They do it in other professions, such as law, accounting and so on: you’re in the workplace but you’re still completing part of your training. I think something like that could be more suitable to the Irish situation.”
He acknowledges that graduates now are entering a very different business environment, and a different regulatory environment, than existed heretofore, and this presents particular challenges for them, and for the educators who prepare them. He is all too aware that students see their ambitions and future prospects very differently to their predecessors’.
“A lot of dentists are looking at a model, be it a company or a multiple, that takes care of the business side, so they can focus on the dentistry. For some people that’s very attractive. There’s no one size fits all anymore.”
There is also the small matter of rapidly advancing technological change, and the need to adequately prepare students for that. Indeed, on the day of our interview, the School was taking delivery of its second digital system, and there are plans to introduce a digital workflow over the next couple of years.
“Hopefully in five years’ time almost everything will be scanned and digitised in the same way that 10 years ago we were still doing film radiographs and now everything is done electronically. You have to try to give people enough of the old skills that they can get out in the workplace, but also at least an insight into the new skills so they can adapt when they graduate.”
There are, of course, huge costs associated with these innovations.
“We need everything and we need lots of everything! That’s part of the challenge of running an institution like this. We’re constantly struggling for funding from our different funding bases.”
Where to now?
The DDUH, as stated earlier, is engaged in a process of rebuilding, not unlike dental practice in the community, and Professor O’Connell is aware of the parallels. “We’ve managed, like many other places, to do more with less and people have been fantastic and have found new ways of working and so on. But in the last six months there’s definitely a sense that we’re looking more forward than back.” “I do sense also that practices are getting busier again. Patients have always been aware of their oral health but are now maybe a little more confident of spending their discretionary income on it.”
So if he got a blank cheque tomorrow, what would be the priorities?
“We would focus on keeping the curriculum up to date, making sure we have the skills in place to deliver across the board.”
He is confident about the young people that the DDUH is sending out into the world, and has strong views on what makes a good dentist.
“A good dentist I think is somebody who is professional – they put the patient’s interest first, and they’re genuinely interested in helping people. The rest is small stuff! If dentists engage with people, I think they will serve the public extremely well. Our students are extremely bright, extremely capable and want to do a great job. I think you can have faith that they’ll look after us.”
Specialty training and CPD
The School runs an impressive range of specialty training programmes – in oral surgery, orthodontics, paediatric dentistry, prosthodontics and periodontics, among others. These three-year taught doctoral degrees are a big part of the School’s offering, and have measurable benefits, as Professor O’Connell explains.
“Firstly, it generates a lot of research because all of those students do a thesis. Secondly, in contrast to the undergraduates, most of the postgraduates stay in Ireland and teach, and they are among the best teachers that we have.”
The School also has a refreshingly modern and collaborative approach to CPD. “We haven’t emphasised it quite so much in recent years because, quite honestly, a lot of other groups – the IDA, the RCSI, the IFPDC – are providing excellent continuing education, particularly of a less formal type. So we made a conscious decision not to try to compete in that space and to focus on things that we are good at, for example running hands-on courses.”
Research and rankings
On the research front, the School continues to perform strongly in terms of publications and citations. This is vital in these days of international rankings, which place enormous pressure on institutions. Characteristically, Professor O’Connell sees the positives.
“I think in general our dental education is very good and stands up to anywhere in Europe, but of course what rankings measure is mainly research output, so smaller schools will always tend not to do as well. But we’re very flexible – we can change things and be responsive to the needs of the students, which is something you don’t always see in bigger systems.”
“One of our strategic priorities over the next four or five years is to increase the momentum in regard to research, to replace some of what we lost and get the ball rolling again.”
The Dublin School has traditionally performed strongly in areas like microbiology, dental materials, and quality of life and special care. Professor O’Connell hopes that an upcoming staff retreat, where research priorities will be reviewed, will help to set the agenda for the next five years.
Journalist and sub-editor with Think Media