Recognition of Oral Pathology as a Subject among Dental Undergraduates: Addressing their Concerns

ABSTRACT

Oral and Maxillofacial Pathology is a speciality department of dentistry which deals with identification of diseases affecting oral and maxillofacial regions and investigates the cause, processes and effect of these diseases. Books, internet, lectures have made great progress but there is still a gap between students’ understanding and interest in the subject. The aim of this study was to evaluate and analyse the challenges faced by undergraduate students in understanding oral pathology theory & practical and modify the teaching process accordingly. A descriptive cross-sectional study of 300 BDS third year students was conducted in our college. The results stated that 83% of the participants attended classes, 90% found the topics covered to be useful, 97% reported that the classes were taken to provide an in depth view of the subject, 71% faced difficulties in understanding the topics in theory classes. 46% attended seminars, 68% viewed more than 4 slides on an average in one practical class, and 80% faced difficulties in identifying the slide. Our data concluded, that if certain measures will be taken so as to engage the students’ interests, then this subject would prove to be a much better scope of learning for the budding dentists.

INTRODUCTION

Dentistry is a branch of medicine that focuses on the investigation, diagnosis, and treatment of diseases and disorders of the oral cavity and maxillofacial region.[1] The primary goal of higher/professional education, including dentistry, is to develop student’s abilities and skills so they can become competent graduates.[2] The dentistry course is a 4-year opportunity for dental educators to gradually develop students’ knowledge, skills, and attitudes, in hopes of becoming competent dentists upon graduation.[3]

A class of dental students is not the same and within a class, there may be a difference in the intellectual abilities of students with some students mastering the curriculum more quickly than others.[4] As the students progress through the dental curriculum, knowledge will gradually be acquired in classrooms, seminars, clinics, and interactions.[3] The foundation of dental students is built on their ability to identify pathological diseases under a microscope.[1] This can be achieved by reading books, and dental literature, following the prescribed curriculum. The theoretical and practical grasp of a subject is often referred to as knowledge. Instead of working on it later, it is important to cultivate positive attitudes about dental health promotion while still being a student.[5]

The Oral and Maxillofacial pathology department plays a vital role in training them in this unique and diversified field of dentistry.[3] This field of dentistry identifies and manages diseases affecting oral and maxillofacial regions and investigates the cause, processes, and effects of these diseases.[1] Despite significant advancements in books, the internet, and lectures, there is still a disconnect between students’ understanding and enthusiasm for the subject. There may be a narrower field of practice since students perceive it as a non-technical subject.[3]

This study attempts to analyze the difficulties dental students have learning about oral pathology and solutions to solve these difficulties to provide a supportive atmosphere for aspiring dentists.[3]

MATERIALS AND METHODS

A descriptive cross-sectional study was conducted in the department of Oral & Maxillofacial Pathology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha. The prepared questionnaire was distributed to all the undergraduate students of BDS 3^rd year, 4^th year, and interns of KIDS. The study’s goals were explained to every participant. Each respondent received the questionnaire and was asked to complete it anonymously while providing their email address, age, gender, and year. The total study sample of 300 subjects was divided into 3 groups:-

GROUP 1: 3^rd year BDS students

GROUP 2: 4^th year BDS students

GROUP 3: Interns

The questionnaire was in the form of MCQs and consisted of two to four alternatives and short answer types as well as aimed in such a way that was easy to understand and answer. Two different questionnaire pattern was made, one focused on theory and the other focused on the practice of oral pathology.

RESULTS

The data were recorded in Microsoft excel 2016 and analyzed using IB SPSS Version 25. Individual continuous variable scores were calculated using Descriptive statistics. It was presented in terms of Frequency and Percentages. One Way ANOVA statistic was calculated to compare each group. P Value was kept at < 0.05. The study was conducted among 300 participants; divided into three different groups.

1. Demographic Characteristics of the study population

   The mean age of the study population was 22.60 ± 1.364. Out of 300 participants 212 were female and 87 were male. One participant did not mention the gender.

2. Responses of the students belonging to individual years

   Table 1a describes the theory-related perceptions of the participants as compared between the groups. Regarding the question “Whether attended all classes in Oral Pathology”, the Group 3 students showed the highest attending percentage (83%) in comparison to other groups. Upon comparison, there was a statistically significant difference noticed amongst the group with a P value of 0.009. But in contrast, Group 1 had the highest exposure to oral pathology theory classes with 48% of them attending for 5 to 6 hours. But the difference among the group is not statistically significant. 90% of the students from Group 3 found the topics covered in theory to be very useful. But again there was no statistically significant difference noted amongst the group. So, that signifies that the three groups overall found topics covered in theory to be useful, both in academics and in clinical. In contrast to Group 2, which only claimed that the understanding level was easy, 87% of the students in Group 2 frequently asked the professors to repeat or explain the subject. 47% of Group 1 students expressed a strong level of satisfaction with the staff members’ ability to impart knowledge. The number of lectures was satisfactory to 97% of Group 3 students. Whereas, 97% of Group 3 students agreed with the question “taken to provide an in-depth view of the subject”. 71% of Group 3 students reported having trouble comprehending the concepts covered in theoretical lectures. 69% of Group 2 students agreed that their prime source of knowledge about the topics included all the above i.e., (the Internet, Notes & Textbook). But 67% of students pointed out that they have not attended seminars related to Oral Pathology topics.

Table 1a.

Theory-related perception of the participants

	GROUP 1		GROUP 2		GROUP 3		P
	n	%	n	%	n	%
Attended all classes in oral pathology
Yes	64	64.0	71	71.0	83	83.0	0.009*
No	36	36.0	29	29.0	17	17.0
Hours per week do you spend in oral pathology theory classes
0 h	0	0	4	4.0	4	4.0	0.167
1-2 h	16	16.0	30	30.0	23	23.0
3-4 h	36	36.0	46	46.0	47	47.0
5-6 h	48	48.0	20	20.0	26	26.0
Find topics covered in theory useful
Academics	14	14.0	12	12.0	10	10.0	0.097
Both	83	83.0	88	88.0	90	90.0
None of the Above	3	3.0	0	0	0	0
Asked your teachers to repeat or explain the topic again in case of difficulties/doubts
Yes	75	75.0	87	87.0	81	81.0	0.012*
No	25	25.0	13	13.0	19	19.0
Rate the understandability of the topics covered in the class
None	2	2.0	6	6.0	7	7.0	<0.0001*
Easy	75	75.0	81	81.0	63	63.0
Difficult	12	12.0	11	11.0	18	18.0
Not Comprehensive	11	11.0	2	2.0	12	12.0
Teaching skills of your staff members
Unsatisfied	3	3.0	0	0	3	3.0	<0.0001*
Satisfied	45	45.0	44	44.0	64	64.0
Strongly Satisfied	47	47.0	36	36.0	30	30.0
Neutral	5	5.0	20	20.0	3	3.0
Satisfied with the number of lectures taken
Yes	88	88	87	87	97	97	0.028*
No	12	12	13	13	3	3
Taken to provide an in depth view of the subject
Yes	88	88.0	87	87.0	97	97.0	<0.0001*
No	12	12.0	13	13.0	3	3.0
Faced difficulties in understanding the topics in theory classes
Yes	36	36.0	53	53.0	71	71.0	<0.0001*
No	64	64.0	47	47.0	29	29.0
A prime source of knowledge about the topics
Internet	4	4.0	2	2.0	0	0	0.399
Notes	10	10.0	10	10.0	20	20.0
Textbook	22	22.0	19	19.0	20	20.0
All of the above	64	64.0	69	69.0	60	60.0
Attended seminars related to oral pathology topics
Yes	33	33.0	41	41.0	46	46.0	0.168
No	67	67.0	59	59.0	54	54.0

*Statistically significant

Table 1b describes the practical-based perception of participation. Statistically significant differences were noted between the groups for all the related questions. Group 2 reported more than 2 hours of weekly practical class, and Group 2 (94%) reported seeing all slides. Both Groups 2 and 3 told that efforts were made to identify the features on a slide. Participants in Group 3 (68%) saw an average of more than four slides during a practical class. Majorly Group 2 participants read about the topics seen in the slides (71%). The majority of the Group 3 participants faced difficulty in identifying the slide (80%) and there were 97% of Group 2 participants made histological diagrams for each slide.

Table 1b.

Practical-based perception of the participants

	GROUP 1		GROUP 2		GROUP 3		P
	n	%	n	%	n	%
Hours do you spend in practical classes in a week
0 h	23	23.0	8	8.0	7	7.0	0.012*
1 h	20	20.0	25	25.0	37	37.0
2 h	40	40.0	37	37.0	43	43.0
>2 h	17	17.0	30	30.0	13	13.0
Seen all slides shown in practical classes to date
Yes	57	57.0	94	94.0	91	91.0	<0.0001*
No	43	43.0	6	6.0	9	9.0
Make an effort to identify the features seen on a slide
Yes	87	87.0	100	100.0	100	100.0	<0.0001*
No	13	13.0	0	0	0	0
Slides have you seen on an average in one practical class
2 slides	29	29.0	10	10.0	8	8.0	<0.0001*
3 slides	22	22.0	34	34.0	7	7.0
4 slides	23	23.0	39	39.0	17	17.0
>4 slides	26	26.0	17	17.0	68	68.0
Read the topic before you see the slide
Yes	53	53.0	71	71.0	67	67.0	0.021*
No	47	47.0	29	29.0	33	33.0
Faced difficulty in identifying the slide
Yes	63	63.0	75	75.0	80	80.0	0.021*
No	37	37.0	25	25.0	20	20.0
Make a histological diagram for each slide
Yes	77	77.0	97	97.0	96	96.0	<0.0001*
No	23	23.0	3	3.0	4	4.0

*Statistically significant

DISCUSSION

Regular investigation of the teaching and evaluation techniques is extremely significant in locating the issues and solving them to the core.[6] Various studies enumerate the main factors influencing dentistry students’ future career choices to be financial security, independence, specialization, job happiness, status, and a desire to serve the general public. One of the less popular post-graduate options for undergraduates who have passed the BDS is oral pathology and histology. Although learning this is undoubtedly depressing, if it were possible to make the necessary changes to the way oral pathology training is provided, it would undoubtedly inspire dental graduates to choose this field as their area of expertise.[7] Considering the number of dental colleges, it is apparent that India produces maximum number of Dental Graduates.[3] Knowing and comprehending pathological conditions at the microscopic level forms the solid foundation of a dental graduate. The need for students to get interested in oral pathology is therefore critical. The oral pathology branch is primarily responsible for preparing students for professions in hospitals and universities by equipping them with the skills required to provide direct patient care. To ensure that dental institutions must emphasize it at the undergraduate level.[1]

Through this study we aimed to identify the problems the students have been facing regarding Oral Pathology as a subject in their syllabus. We also incorporated the level of difficulty in understanding the subject as a whole, both theory and practically wise, in a questionnaire form. To help undergraduate students better grasp pathological microscopic slides, the goal of our study was to quantify the challenges or difficulties they encountered. The results showed the percentage of students who were able to grasp the subject and also those students who faced difficulties in doing the same. This study has a 90% response rate and a sufficiently good sample size. Since the students were divided into three batches, each showing varied results. Out of 300 students from the three batches, Group 3 (83%) showed higher attending percentages as compared to the other batches. Group 1 showed the highest exposure to the oral pathology classes with 48% attending for 5-6 hours. Group 3 (90%) confirmed that the topics that were taught to them were useful. Group 2 (87%) mostly asked the faculties to repeat the topics that were difficult to comprehend. Group 2 participants mostly stated their understandability level as easy. 97% of the Group 2 reported that they were mostly satisfied with the teaching skills of the faculties 97% of Group 3 participants said that further lessons were taken to provide them with a thorough understanding of the topic. The majority of members of Group 3 (71%) had issues comprehending the theory lectures. This can be solved by introducing new methods of teaching the chapters in the syllabus such as graphical representations of the difficult portions in any particular chapter, as well as introducing some interactive videos about those chapters. It will instill a certain level of curiosity in the students and this might keep them more focused in the theory classes. Group 3 participants (46%) attended more seminars in comparison to the other two batches.

There was another evaluation done regarding the practical-based perception of the participants. Group 2 reported more than 2 hours of weekly practical class, with 94% of them having seen all the slides. Group 3 participants (68%) viewed more than 4 slides on average in one practical class. Majority of the Group 2 (71%) read about the topics which were shown to them in the slides. Group 3 participants (80%) faced difficulties in identifying the slides and 97% of Group 2 participants made histological diagrams for each slide. The issues of the students in identifying the slides can be resolved by revising them again and again if any particular slide might be causing them difficulty. They can increase the time to spend on each slide and can go through the chapters for a better understanding of the slides and the features seen. Virtual microscopy can be used to enhance the inability of the participants to identify the slides in a very limited time. Digital microscopes (DM) have replaced optical microscopes as a result of recent technological advancements that allow computers to function as microscopes. Digitalization of the slides can improve this issue faced by them. Students can be asked to focus on the slides all by themselves so that they can have a better understanding of the features seen in the slides, which will eventually benefit them in their examinations.[3] Group 2 participants reported having the highest utilization of sources of knowledge like the internet, and textbooks. However, our study discovered two pitfalls during this survey 71% of the students faced difficulties while understanding the topics that were taught in theory classes, and only 67% did not attend any seminars related to oral pathology topics. Therefore, this also draws our attention to the fact that we could introduce visual and creative aids to create interest in the students so that the topics would be easily understood by them. In addition to that, we can also motivate and encourage them to attend seminars or webinars related to this subject to gain more knowledge and deep learning about it.

In this study, the majority of students believed that textbooks were the best source of knowledge. There are still gaps between the students’ grasp and awareness of the topic, although dental students in this study should have a sufficient understanding of it. This can be because students don’t see much practical application for this subject and therefore regard it as non-clinical. Therefore, efforts should be made to maintain a conducive learning atmosphere without compromising the standard of education, and this can only be done through student feedback and curriculum revisions made by institutions.[5] The fact that oral pathology is a unique specialty where research and practice collide is crucial to comprehend. A final histologic diagnosis is made after we, the oral pathologists, have met the patients, seen them clinically, looked into the problem, and evaluated the reason. We thus have the exceptional chance to do research and then use it in clinical practice.[6]

CONCLUSION

The quality of education should not be compromised, and efforts should be made to preserve a supportive environment for learning. This can be achieved by student feedback and curriculum redesign.If simple adjustments are made by incorporating newer technologies like digital microscopes, these obstacles can undoubtedly be solved and the learning environment may be made more engaging and organized for the students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.