Dental public health education in Egypt: a cross-sectional survey | BMC Medical Education

This is the first study to address DPH education in BDS programs in Egyptian dental schools. In the Egyptian dental schools, DPH education focused mostly on disease determinants, prevention, needs assessment, epidemiology of oral diseases and principles of research design. DPH was generally taught as lectures and seminars in senior years by a median of three academics who were pediatric dentistry academics in most cases with courses developed according to international guidelines. Minimal focus was given to teaching through community outreach activities. Students’ assessment was mainly based on written exams, and a minority of dental schools used case presentations. Healthcare systems, workforce issues and planning for health were not included in the DPH curricula in many dental schools, and if included, the least time was allocated for them.

The present study, based on the international model [9], has its strengths and limitations. The strength was that the survey and questionnaire topics were based on a comprehensive European DPH education survey [9]. However, there were limitations. First, the response rate was modest, partly due to the recent increase in the number of newly opened dental schools in the country. These new schools may not have reached the stage when DPH is taught. Thus, these schools may have declined to respond since they have no DPH education experience to report. When data from established dental schools are analyzed, the response rate becomes much higher. Second, another potential source of limitation is the degree to which the respondent was aware of how DPH was taught. There is a possibility of over or underestimating the time allocated to each topic because of this. However, we ensured that responses were collected only from academics with official posts who were authorized to report on the programs.

The study showed that teaching DPH in Egyptian dental schools focused on oral epidemiology, prevention, and research design. This differs from the emphasis laid in American schools [21] on social and healthcare systems, cultural competency, and oral health promotion. Our findings also disagree with the recommendations of the American Academy of Public Health Dentistry [22] which focus on teaching health disparities, surveillance, global oral health, racism in the healthcare system, the impact of poverty on oral health, the role of tobacco and nutrition in oral health as well as the integration of evidence-based dentistry into multiple DPH topics. By contrast, European dental schools [9] focus on population health, health promotion, planning of health promotion measures while the Nordic dental schools [23] emphasize the teaching of healthcare systems and global oral health development. These differences in topics reflect the national healthcare systems, political structures, priorities, and approaches. For example, cultural competency is relevant to the multi-ethnic American society where subpopulation groups from different cultures seek care and healthcare professionals need to be able to interact with them appropriately [24]. This competency may be less relevant in countries with different population profiles such as in Egypt. Also, preparing graduates to conduct surveillance activities will not be practical if the healthcare system at the country level, as in Egypt, does not have an oral health surveillance system.

The study showed that the percentage of pediatric dentistry academics teaching DPH was greater than DPH academics. This may be partly explained by the development of dental postgraduate degrees in Egyptian universities. Several universities award a combined master’s degree in Pediatric and Preventive Dentistry while only a few universities award a PhD in DPH. Thus, the opportunities for specialization in DPH are limited resulting in reduced availability of DPH specialists [25].

The present study showed that teaching DPH in Egyptian dental schools was traditional, and mainly lecture-based. This method, although cost effective, has limited impact on knowledge acquisition [26] and minimal potential for developing practical or cognitive skills. By contrast, evidence-based [27] and problem-based [28] methods of teaching promote critical thinking skills and lifelong and independent learning in students. More immersive methods based on real life experiences are available, too. For example, a study from Peru [29] showed that a competency-based curriculum was utilized, in which students train in low-income urban and rural communities. This exposed the students to challenges that were present in the community, thus building their capacities at an early stage of their careers. Community-based training increases the chances of developing solutions to problems that have better fit to the community needs and resources as opposed to learning through lectures that rely on educational resources generally produced in higher income countries with different oral health challenges and care systems [30]. Another advantage of community-based learning is utilizing the Ministry of Health public clinics where students can train on delivering primary healthcare services, thus reducing the need for campus-based training facilities, which is a great advantage considering the large class size observed in this study.

The study also showed that traditional student assessment methods, such as written examinations, were mostly used in Egyptian dental schools. Alternative methods such as community outreach activities help students apply the skills they learn [31] and contribute to covering the community needs. This method of assessment fits with community-based learning, aligns with the concepts of DPH and builds links for multi sectoral partnership between stakeholders in higher education, health, and social services as well as non-governmental organizations, thus developing students’ advocacy and community involvement skills. In a middle-income country such as Egypt, these skills are important for healthcare professionals including dentists [32]. It is also important to prepare dental educators for these methods of teaching and assessment by first training the educators since these skills are usually not part of the specialty training that they receive.

DPH curriculum in most Egyptian dental schools was based on international guidelines for DPH education. These guidelines need to be updated in view of the recent developments in the field of oral health at a global level. The World Health Assembly [33] emphasized the need to merge oral healthcare with the noncommunicable diseases (NCDs) agenda and transition from curative to preventive care under the umbrella of universal health coverage (UHC). The WHO also recently included dental products such as fluoride, glass ionomer cement, and silver diamine fluoride in the List of Essential Medicines for Children [34] and, together with the International Dental Federation, is pushing for amalgam phase-down [35]. Provision of oral healthcare for digital natives is another priority with increasing importance, especially post the COVID-19 pandemic. Even at a national level, new developments in health conditions and health policies call for a revision of healthcare workforce training strategies. Egypt is progressing towards UHC and implementing the Social Health Insurance Act to increase citizens’ access to healthcare services without financial hardships [36]. Also, the WHO statistics [36] show that 84% of the mortality in Egypt is related to NCDs which are interlinked with oral health. National priorities should include the control of risk factors shared between oral diseases and NCDs such as tobacco, which is used by 22% of adult Egyptians [37]. These developments clearly show that traditional oral healthcare models need to be replaced by new strategies with changes reflected in educational curricula. A new philosophy is needed to guide the restructuring of DPH education in Egyptian dental schools.

This study presents a comprehensive overview about DPH undergraduate education in Egyptian dental schools. It shows the need for information regarding DPH education in postgraduate studies. Also, the scarcity of data about curricula to train healthcare workers in DPH outside western countries calls for more studies in the Middle East and Africa. The need for the modernization and standardization of DPH teaching is clear especially with increasing mobilization of healthcare providers nowadays [7]. Educators, practitioners and policy makers need to establish a set of DPH skills and competencies to be developed in BDS programs in Egypt in addition to ensuring that DPH education is a core component of BDS programs.