1. Background detail about the initiative
- Title of the initiative described by the case study: Trans-Atlantic Engagement: a Novel Dental Educational Exchange and Opportunities from the Pandemic
- Contributor of the case study: Sara Pittarello – UNICollaboration
- Key informant: Katie Lavender, International Office/ Paula Waterhouse, Dental Sciences – Newcastle University
- Data sources used for the case study:
- Interviews with staff
- Publication: Waterhouse, P., Kowolik, J., Schrader, S. et al. Transatlantic engagement: a novel dental educational exchange. Br Dent J 228, 637–642 (2020). https://doi.org/10.1038/s41415-020-1478-x
- University behind the initiative:
- Initial Exchange: The School of Dental Sciences and The Faculty of Medical Sciences, Newcastle University and The Indiana University School of Dentistry and Office of International Affairs, Indiana University Purdue University, Indiana.
- During Pandemic: The School of Dental Sciences and The Faculty of Medical Sciences, Newcastle University, The School of Dentistry University of Indonesia, The School of Dentistry National University of Fiji
2. Introduction to the case: brief history and goals of the initiative
Newcastle University School of Dental Sciences (NUSDS) and Indiana University School of Dentistry in the United States of America (IUSD) are like-minded institutions committed to civic engagement. Over the last 15 years, both universities have built civic engagement into the dental curricula, however each institution operates within significantly different health care systems.
A dental educational exchange was developed enabling NUSDS and IUSD students to learn alongside each other within dental and community settings in both countries.
The exchange aims to allow students to gain mutual awareness of delivery, access to care and possible barriers facing patients relating to the oral health care systems in England, the State of Indiana and the USA.
Preparations for the exchange began in 2015 and the programme is now in its fourth cycle. Students participate in a unique face-to-face collaborative and interdisciplinary education programme within respective dental schools and community settings. The students’ physical exchange is supported by a series of videoconferences/webinars scheduled before the on-site visits. These videoconferences allow for elements of the programme to be formally co-taught by staff from NUSDS and IUSD and enable staff and students to get to know one another prior to the physical exchange. Students then undertake their own informal peer exchange through their choice of social media platform.
3. Key aspects
At NUSDS, 3rd-year dental students provide oral health education (OHE) to a range of community groups. In later years, students provide continual direct clinical care at local ‘outreach’ primary care dental clinics serving areas of high deprivation.1 To widen further their dental experience, at the end of the 4th year most undergraduates are encouraged to undertake a period of elective studies at home or abroad.
IUSD provides extra-curricular education within local communities and short international service-learning engagements to developing countries2, 3 and has a mandatory program for 2nd-year dental students where they deliver prevention for children in areas of high need both in and around Indianapolis.
Enhancement of the dental curriculum has many forms. It can be achieved by students learning outside the walls of a dental institution, for example providing dental care directly within patients’ residential environments, in community dental clinics, or delivering OHE to community groups. This exchange was enriched by the use of virtual introductory, teaching and preparatory sessions.
Examples of community groups are special schools, residential care homes, day-care centers, asylum seekers’ drop-in centers and facilities for the homeless. These activities provide experiential learning opportunities different to those within a dental hospital setting; often aiming to foster learners’ awareness of social accountability as a healthcare professional.4-6 Dental students provide care for hospital or community-based patients within a healthcare system particular to that country or in the case of the USA, the State. Students, therefore, contextualise dental care in relation to their own country’s system with little insight into alternatives. In Europe, the Erasmus scheme allows a small number of dental students to experience learning in another European university.7 However, a longitudinal clinical dental education exchange between UK and US students had not been undertaken before. To enable such an exchange, close collaboration between dental academics and dental students alongside support from their respective universities was imperative. The logistical challenges were overcome and the exchange is now in its 4th cycle.
The planning and development of the educational exchange and its associated educational research interventions are presented, highlighting key factors in successful trans-Atlantic collaboration.
Development
Following email correspondence and initial agreement from each Head of School, respective staff visited the partner dental school in 2015 to meet key goals. The aims were to:
- Engage each university’s International Office to ensure requirements could be met
- Plan appropriate timing of students’ visits in relation to USA and UK curricula
- Co-design program content and methods of communication
- Co-design methods of evaluating student feedback
Staff working together both during and after these scoping visits aided the production of a ‘Civically Engaged Bilateral Student Exchange Program Document’ in Indiana University (IU) and an ‘International Concept Document’ in Newcastle University (NU) which were submitted to the relevant administrative centers. Approval was granted rapidly due to a pre-existing Memorandum of Understanding (MoU) between the universities. The approved program documents stated aims, learning outcomes, benefits to students and staff, and an outline of the logistics of the overall program.
For staff involved closely with the program, the opportunity for collaborative curriculum development and educational research were also important goals. Reciprocal visiting lectureships were awarded to the authors by their hosting university, facilitating collaboration.
Objectives for student learning during reciprocal visits
During the reciprocal visits to respective dental schools, students were fully registered within the host university immersing themselves in being dental students within that establishment as much as possible. During the visits, students’ learning objectives were to:
- Gain experience of accommodating, communicating with, and working alongside international dental student colleagues during planned oral health education activities within community group settings such as nurseries, schools, care homes, and refugee agencies.
- Participate in collaborative and interdisciplinary forms of dental education training within NUSDS and IUSD.
- Gain mutual awareness of delivery, access to care and possible barriers facing potential patients relating to the respective oral health care systems in England and the US.
- Improve NUSDS students’ understanding of the US/Indiana State approach for providing oral health care for underserved populations and IUSD students’ understanding of the NHS.
- Increase cultural awareness regarding the dominant and minority cultural groups in Indiana and relate this to Newcastle/northeast England.
- Work alongside each other in delivering oral health care to community groups; comparing and contrasting findings with the ‘Newcastle approach’.
Participants and Timetables
In the USA, dental school entry is at the postgraduate level whereas, in the UK, entry is predominantly accessed at an undergraduate level although opportunities exist for postgraduate application. To align the ages of each cohort as closely as possible, 1st year USA students and 3rd year UK students were recruited. Recruitment of the first cohort of six students in NUSDS involved poster campaigns and publicizing the program in lectures. This was followed by a lunchtime question and answer session for interested students. Applications were competitive and used a specific application form. The lead academics in NUSDS jointly chose the final six participants who were required to make satisfactory progress within the course; measured by the usual processes of student progression. In IUSD six students were also recruited. The lead academics gave a presentation to 1st-year dental students; applicants were asked to write an essay about their interests in international civic engagement. Essays were assessed by the lead academics and the best six were chosen. Only those students with Grade Point Averages greater than 3.5 were accepted.
It was important to recruit students within the first Semester/Term of the new academic year in order to optimise both the communication between the students and their attendance at future educational videoconferences.
To avoid examination or other curricular clashes, the first Indiana student visit to Newcastle was scheduled for mid-May 2016 for 9 days (time permitted by IU for ‘International Trips’). The return visit by Newcastle students to Indianapolis was arranged to take place at the end of these students’ subsequent 4th year (early July 2017). The UK students visited Indianapolis for a 2-week period as part of the standard timetable for 4th-year students to undertake a period of ‘Elective Study’ either at home or abroad. One complete exchange cycle included two academic years. During their visits, each group was enrolled as students of the host university with identity cards, library access and most importantly clinical access within the teaching hospitals and community settings. This also required extensive occupational health clearances. It is required at IUSD that staff accompany students during ‘International Trips’ however, NUSDS staff do not accompany students at any point during ‘Elective Studies’. Student accommodation was organised on campus.
Program Structure
Several live, one-hour video conferencing (webinar) sessions were organised to facilitate student orientation, introductions and wider student learning related to health policy, local demographics and comparison of oral health between the UK and USA. To optimize time differences, these were held at 5 pm (Newcastle) and 1 pm (Indianapolis). The first was a ‘get to know you’ session with staff present only at the start and end as facilitators. The remainder encompassed joint discussions based upon an open-access journal publication comparing the UK and US oral health surveys 8, introduction to a senior Oral Health Educator (DH) based in Newcastle community clinics, discussion of the types of clinical and non-clinical experiences the students would value, and initial induction into the dental hospitals/schools, UK and US student life. To further prepare IUSD students to deliver OHE within community settings they were given access to a ReCap® recording of the OHE induction lecture given in Newcastle as part of the School’s dental outreach course.
All participating staff and students were enrolled onto the IU course networking platform TheCN© which provided a closed group to aid sharing of information, providing a discussion forum outside of timetabled videoconferences. The students formed (independently) a closed group within a separate social media platform. The time and effort from all participants during e-communication prior to the Indiana students’ visit to Newcastle in May 2016 was reflected in the way the students greeted each other when first meeting face-to-face; friendships were already forged. The power of social media cannot be underestimated as a motivational tool for learning!
It was also beneficial to build-in student social events during the weekend before the ‘working week’ because these activities enhanced inter-group collaboration.
Student Reflections, Feedback and Dissemination
Student involvement and feedback are essential to curriculum development and quality assurance. Post-exchange, Newcastle students are required to provide an Elective Report to the Head of School which includes key areas of reflection upon personal learning outcomes.
IUSD students are required to complete a reflective journal based upon personal learning goals and observations; these respective activities are maintained as essential feedback.
Additionally, to aid development of visits to NUSDS by IUSD students, they were invited to complete reflective clinical logs during each clinical session or OHE visit. These helped future timetabling in the UK. All students and key staff were involved in a series of focus groups.
References
Waterhouse P, Maguire A, Tabari D, Hind V, Lloyd J. The development of a primary dental care outreach course. Eur J Dent Ed 2008; 12: 8-16. DOI: 10.1111/j.1600-0579.2007.00464.x.
Yoder K. A Framework for Service-Learning in Dental Education. J Dent Ed 2006; 70: 115-123.
Hood J. Service-Learning in Dental Education: Meeting Needs and Challenges. J Dent Ed 2009; 73: 454-463.
Dharamsi S, Espinoza N, Cramer C, Amin M, Bainbridge L, Poole G. Nurturing social responsibility through community service learning: Lessons learned from a pilot project. Med Teach 2010; 32: 905-911. DOI: 10.3109/01421590903434169.
Thistlethwaite J, Kidd M, Hudson JN. Moving more of the medical school curriculum into the community. The Clin Teach 2007; 4: 232–237.
Ross M. Editorial; Learning in and out of hospital. The Clin Teach 2017; 14: 83–84.
Manogue M, McLoughlin J, Christersson C, Delap E, Lindh C, Schoonheim-Klein M, Plasschaert A. Curriculum structure, content, learning and assessment in European undergraduate dental education – update 2010. Eur J Dent Ed 2011; 15:33–141. DOI:10.1111/j.1600-0579.2011.00699.x.
Guarnizo-Herreño C, Tsakos G, Sheiham A, Marmot M, Kawachi I, Watt R. Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys. Br Med J 2015; 351: h6543. DOI: 10.1136/bmj.h6543.
4. Lessons Learnt and Transferability Opportunities
Including for example engagement, challenges, successes, anticipated problems and opportunities, mechanisms for integration, and accreditation:
Students from both sides of the Atlantic have presented reflections and experiences verbally and via posters at the university or national level and have been key players in recruiting the next cohorts of potential exchange students.
Notable Pre-COVID challenges included managing time differences for synchronous videoconferencing and technical issues, such as the availability of sufficient video-conference-enabled teaching spaces and presence of technical support staff, particularly outside of conventional teaching hours. From March 23rd, 2020 NUSDS closed its physical doors and staff and students worked from home. The availability of virtual/online communication applications such as Zoom and Microsoft Teams were increased and training was provided rapidly.
In line with both Universities’ regulations, no student travel was permitted and sadly the exchange was temporarily suspended. No elective travel was undertaken in 2020. An opportunity was seized for further development of NUSDS elective program along a virtual/online route. The elective lead contacted counterparts in Indiana, Indonesia and Fiji resulting in the co-development of a wholly ‘virtual elective’ pilot. Indiana were unable to commit due to pandemic pressures, however, volunteer undergraduates from NUSDS, University of Indonesia Dental School and University of Fiji Dental School formed diverse small groups tasked with working together on a self-chosen dental project, using their preferred method(s) of virtual communication tools.
Their projects culminated in virtual group presentations to various university staff and their peers; the overall winner was a hard-hitting film made by 3 students on how COVID had affected them as dental students in different parts of the world. Students wrote a reflective journal/log throughout their virtual communications highlighting challenges and successes. These reflections were submitted to the electives lead in NUSDS aid quality assurance and further evolution of the program. It was advantageous to have an overarching, lead university in the pilot (NU); organisation and communications were aided greatly by local administrative support provided by NUSDS and a shared Microsoft Team’s Group based within NU. IUSD wish to join next year and expressions of interest in joining have been received from Dundee University Dental School.
From the perspective of returning to the in-person exchange, both universities continue to support the engagement. NUSDS is currently exploring enhancing the University’s goal of ‘Widening Participation’ (WP) by pursuing recurrent bursary–type funding awards to ensure access to this international exchange conforms to the School’s ethos around equality, diversity and inclusion. The virtual elective pilot was a great success and will continue beyond the pandemic as another type of elective experience, again being advantageous to WP and inclusivity.
