How did UK dental schools respond to the COVID-19 pandemic?
In late March 2020, routine dental services were suspended in the UK due to the COVID-19 pandemic. Naturally, this had a huge impact on dental schools which are responsible for educating and training the future dental workforce. Despite these challenging and unprecedented circumstances, dental schools across the UK and Ireland adapted to ensure the successful graduation of final year students and the continued education of other year groups through novel means of teaching and assessment.
Understanding the risk
Initially, dental services were suspended over concerns around the unestablished risk of transmission of COVID-19 within dental settings. Drilling teeth can create airborne particles (known as aerosols) which contain water from the drills dentists use and smaller amounts of patients’ saliva. In the early days of the pandemic, the risk of infection by SARS-CoV-2 posed by the amounts of saliva in these aerosols and the precise dilution of the saliva in clean water used by the drills was yet to be determined. This posed a unique problem for dental education, as dental students are taught how to drill in open-plan, multi-chair clinics – increasing the amount of aerosol produced if all chairs are in action at once.
In response, many dental schools contributed to the production of national guidelines and NHS Covid standard operating procedures. Working together through Dental Schools Council and the Association of Dental Hospitals, guidelines were produced to mitigate the return to open plan clinics. Schools’ rapid research found solutions to allow dental services and teaching to resume in a way which was safe for patients, students, and staff, particularly in the open plan clinic environment. In addition to returning to the clinical environment, many schools also significantly contributed to acute dental care hubs and redeployment within the NHS to support other services.
Innovations in technology
Research from our dental schools also allowed for the creation of a modified design of dental drill to reduce the aerosols produced during dental treatment. Procedures using these ‘micromotor’ drills did not classify as Aerosol Generating Procedures (AGPs) so the use of long gaps between patients (known as fallow time), rules on ventilation and spacing were not as restrictive. This Investing in these drills safely allowed dental services to increase their capacity to provide patient care and train students in a COVID-19 world.
As a result of dental schools’ research findings, AGPs are now carried out in new environments within dental schools. Several schools now uses dedicated pods with a minimum of ten air exchanges per hour (higher than normal environments) and independent climate control. Others measures schools have taken to minimise the risk of spread of COVID-19 include: adding a type of vacuum near patients’ faces to gather droplets during drilling optimised suction for high-speed aspiration; refitting clinics with permanent high-impact acrylic side screens; increasing student supervision ratios so fewer staff are moving between patients and trainees; and providing student-led remote triage for clinically extremely vulnerable patients to avoid unnecessary contact with others.
Dental schools also identified and mitigated against factors which could potentially inhibit the return of students to clinical placements, which are vital to their training as dentists. For example, schools staggered arrival times, moving to 60% capacity for predominantly AGP areas and 80% for non-AGP sessions, and adopted innovative approaches to timetabling. Many schools introduced additional evening sessions to allow students to catch-up on gaining clinical experience, developing a bespoke timetable for each teaching area.
Adapting to new methods of teaching and assessment
Dental education responded to the pandemic by embracing the opportunities offered by online learning. One of the challenges of teaching online can be to create a sense of class engagement. Recognising this, one school made the decision to teach basic suturing skills virtually. Students collected a suture kit prior to their first tutorial and were then timetabled for three remote online sessions, each covering a different suturing technique. Group sizes were limited to eight students to ensure students felt comfortable in sharing their work and asking questions. The feedback of students and demonstrators was so positive that the school has implemented changes in the way they plan to teach suturing skills even after the pandemic.
Many assessments also moved online. For example, a Virtual Objective Structured Clinical Examination (VOSCE) was created so students could meet their course requirements to progress into the next year of study. Not only did this allow for assessment to go ahead in a manner which was safe for both staff and students, it also allowed international students who had returned overseas to participate and complete the assessment. A mock VOSCE took place prior to the actual examination in order to ensure that both candidates and examiners felt comfortable with the technology, alleviating some of the stress on the day. Students fed back that the assessment process was similar to a face-to-face OSCE and was fair, with some even stating a preference for it over the conventional OSCE.
Dental Schools made concerted efforts to ensure that students were exposed to different healthcare settings, even if they could not physically visit them. At one school, cancelled elective modules were replaced with series of web conferences which were designed to allow students to gain insight into different clinical specialities and settings. Students virtually ‘met’ with international, national and local senior colleagues to explore their areas of expertise, allowing them to experience some of the varied opportunities electives would usually offer.
In a time of such challenges, it has been heartening to see the novel and creative ways in which Dental Schools have adjusted to ensure that the future dental workforce continues to be trained to the highest standard and oral healthcare is protected and promoted in local communities. Working hand in hand with Dental Schools Council’s partner organisations, this innovation and hard work allowed for 932 of 962 dental students in England, Wales and Northern Ireland to graduate on time, ready to commence dental foundation training in September. Both staff and students should be congratulated on their adaptability and commitment.