Abstract
Introduction:
A curriculum is the general and immense outline of a training activity. The curriculum design determines student assessment and evaluation of the program, and ultimately defines the framework for each activity in the training period. On the other hand, regarding the importance of training in medical sciences, especially dentistry, the present study was conducted with the aim of “investigating the curriculum of some of the specialized fields of dentistry PhD in Iran and some top faculties of the world”. This project is along with “accountable and justice-centered education” and “moving towards third-generation universities” and the package of “developing and upgrading medical education infrastructure”. These packages further emphasize the implementation of policies number 1 (institutionalization of accountable education approach in the health system) and number 12 (the production and localization of credible scientific evidence to promote high-quality health education [research-based training]).
Methods:
In a descriptive-sectional study, the important components and parameters of the curriculum of ten international and Iranian dentistry PhD faculties were purposefully selected and investigated. The study was conducted in two phases: the first one included a study to find the 10 top dental faculties in the world that have been credible and pioneer in dentistry education, which was conducted in four phases, and the second phase identified and examined different components of the PhD curriculum (objectives and mission, general structure and educational content, duration of the training period and certificates) in each five fields of study in the assigned top ten faculties and Iran.
Results:
Investigation of the intended curriculum characteristics of top 10 out of 50 dental faculties showed that curriculum review was performed in most faculties and curriculums with updated content and structure were used. Likewise, the results of this study have determined that regarding goals and mission, and Iranian universities compared to the credible universities of the world, had more comprehensive goals in all mentioned fields, and would receive a PhD certificate in Iran.
Conclusion:
In most of the studied dental faculties, for prominence in the research field which was emphasized by international academic ranking systems, there were several factors influencing the success of training scope such as the presentation and educational mission of diverse curricula, their rich content and appropriate length of terms.
Keywords:training curriculum, specialty field of orthodontics, specialty field of pediatric dentistry, specialty field of prosthodontics dentistry, specialty field of periodontics, specialty field of oral and maxillofacial surgery, Shanghai ranking, QS ranking.
INTRODUCTION
According to experts in the field of education, the creation of favorable changes in students is the main and ultimate goal of education. Therefore, the provision of appropriate educational programs for educational objectives and principled evaluation and assessment are essential principles (1). Various factors are effective in curriculum desirability, including updated scientific knowledge, compatibility with the needs of community, achieving educational objectives, and ability to implement the curriculum. Therefore, the desirability of the curriculum and its implementation must be constantly revised and evaluated (1). In curriculum revision, scientific methods, including extensive and adaptive review, are used in agreement with similar curriculums in reputable universities (1). Regarding the great volume of information produced in the postmodern period, many challenges have been created for those involved in medical affairs, especially dentists (2, 3). The goal of dental education is not just clinical training, but also forming dentists’ ability to have a holistic view of each patient, improve patient oral health, build team work spirit and focus on patient socio-economic and emotional state (1, 4). Therefore, providing the preventive and therapeutic services for oral diseases is the main goal of dentists’ training in every specialized field of dentistry.
Thus, given the importance of dental curriculum in the community health system and training of vigorous individuals in this field, the new dental curriculum has to provide knowledgeable postgraduates able not only to work in a variety of fields but also to adapt to changes and scientific advances that emerge after their graduation and learn how to face them in self-study programs, which requires a balanced and accurate educational approach (3).
In a study by Zarandi et al, the curriculum of the periodontal field in Iran was compared with accredited American and Canadian faculties of dentistry. The results showed a course-based curriculum in all selected faculties, in which theoretical courses in the stomatology system were provided along with practical courses. Harvard has also been found to continue its academic, research and clinical activity. The length of terms in these universities varies from 45 to 57 months, and two periodontal certificates are awarded to graduates (5). Likewise, Gaffari et al (2011) compared the Iranian general medical curriculum with some of the accredited medical faculties in the world, and found that the studied medical faculties from Australia, America, Europe, Asia and Africa had included the most part of indicators for effective and efficient curricula (Ludvigsson’s indicators) in their curricu- lum.
This study showed that the failure of Iranian general medical curriculum to include the desired indicators of an effective curriculum is evident, indicating the necessity of reviewing and modifying the general medical curriculum of the country (6).
Regarding the worldwide integration and globalization phenomena, it seems that there is a reduced difference in quality of academic dentistry institutions and professional quality of dentists and trained educators in the developing countries. The two ideal approaches for globalizing dentistry education in all countries is collaborating, identifying, and confronting shared challenges and experiences as well as available resources, but changes in implementation of dental education worldwide are decreasing. Therefore, some differences in the criteria of dentistry education, both theoretically and clinically, have been established among different countries; this has led to challenges in the development of dental education, and also generally made it difficult to acquire a set of acceptable worldwide standards for a structured and uniform curriculum in all countries (4).
Stronger curricula cause better readiness of specialists in the fields of periodontics, prosthodontics, surgery, orthodontics and pediatrics, which increases their self-esteem while treating patients in their own field related activity. It also reduces the numerous problems with oral health due to specialists’ efficiency. To this end, the study of 50 top universities of the world showed that the first 10 selected in this study had five specialized fields (pediatrics, periodontics, prosthodontics, surgery, and orthodontics), and educational curriculum was revised in all of them along with Iranian universities.
Therefore, we decided to conduct a study aimed at “investigating the curriculum of some specialized fields of dentistry PhD in Iran and some top faculties of the world”, thus providing a basis for revision of the current curriculum in our country.
MATERIALS AND METHODS
This descriptive-sectional study was conducted to compare pediatrics, periodontics, prosthodontics, surgery and orthodontic dentistry curriculum of Iran with that of 10 international accredited universities (New York University, Pennsylvania, South Carolina, North Carolina, Los Angeles, Florida, Harvard, London College, King’s College London, San Francisco) in terms of goals and mission, overall structure and training content, term length and educational certificate provided. This study was conducted by searching and investigating the websites related to dental faculties in Iran and the United States in 2017-2018, and using the national health books to the World Health Organization as a source.
In this study, Google, Altavista, Google Scholar search engines and some related medical education websites, including WFME, IIME AMEE, AAMC and other trustworthy websites of associations and colleges relevant to medical education were used to collect relevant data.
In order to investigate the aforementioned goals, this study was conducted in two phases. The first phase aimed at searching and finding the best dental faculties in the world, and was carried out in four steps, as follows:
1. extracting the list of names of top faculties in Shanghai and QS websites (from 1 to 50);
2. extracting the list of faculties classified as top higher education institutions in both ranking systems, that were providing specialized fields;
3. selecting five of the specialized fields of dentistry (Orthodontics, Pediatric dentistry, Periodontics, oral and maxillofacial surgery) that were similar to Iranian dental curriculum;
4. selecting the final list of studied faculties based on the above list and considering the five specialized fields of pediatric dentistry, orthodontics, prosthodontics dentistry, periodontics, and oral and maxillofacial surgery as well as the availability of information in any way possible and purposefully
The selection of the studied universities was based on the following criteria:
1. pioneering and having a long history of curricular effective and efficient teaching methods;
2. availability of required information on websites or their availability in any possible way.
In the second phase, the identification and investigation of PhD curriculum was evaluated in terms of goals and mission, general structure and training content, length of terms and awarded certificate. To this end, a checklist was firstly provided that included general information such as mission and objectives, length of an entire training term, overall structure and training content, and type of awarded certificate. The results of studying each university were then recorded in the checklist and, in order to achieve the specific goals, they were descriptively analyzed to evaluate the system of postgraduate dentistry courses in each of the top universities of the world and Iran.
RESULTS
The findings provided by investigating the curriculum of the intended fields in the top ten faculties of the world are presented in the table below that summarizes information about goals and mission, structure and content, term length and certificates awarded by these higher education institutions.
In Iranian faculties it was found that the educational curriculum of the above mentioned fields was very comprehensive and extensive in terms of mission and objectives. In periodontology, professional individuals are trained in periodontics, implants, periodontal medicine, plastic surgeries, oral reconstruction and research. The term duration is three years with a PhD certificate in periodontics.
In pediatrics, specialist individuals are trained in the areas of knowledge and ability that enable them to advise children and teenagers in the community how to maintain and improve their oral health and prevent oral diseases; they are also taught how to prevent oral and dental diseases in children, healthy teens or people with special needs, how to diagnose and treat oral problems either in general or under anesthesia for certain children who are not normally in a position to communicate with them, how to conduct research in relation to child oral and dental problems. The educational system of pediatric dentistry is based on terms (semesters). Courses are presented in theoretical, practical, theoretical-practical, and workshop forms in three areas of science (basic, affiliated and specialized), and in most of the basic and affiliated science courses there is a content and simultaneous integration with specialized courses, in a way that assistants start attending courses in the specialized group and department, while basic and affiliated science courses are provided along with specialized courses to deepen and facilitate learning. The term length is three years, with a PhD certificate in pediatrics.
In surgery, specialist individuals are trained in diagnosis of diseases, lesions, injuries, defects and congenital malformation, acquired infectious, traumatic, developmental, benign and malignant neoplastic of soft and hard tissues of the oral and maxillofacial tissue, surgical and non-surgical treatment and mentioned related cases, reconstruction of soft and hard tissues, cosmetic and functional surgeries of the oral and maxillofacial area. The educational system of oral and maxillofacial surgery is annual, and for courses it is based on hours. There are various theoretical, practical, and theoretical and practical courses as well as workshops, which are presented in the form of basic, affiliated and specialized sciences. The term duration is five years, with a PhD certificate in surgery.
In orthodontics, individuals are trained with the aim of identifying and diagnosing complete dental anomalies and multiplicity nature assessment, problems associated with dentofacial anomalies, functional and morphology disorders (oral jaw system), creating a deep understanding of biology science and neuromuscular physiology and occlusion, and the relation with clinical orthodontics, providing the necessary knowledge and skills to present patient’s clinical problem and its documentation, designing the most appropriate evidence-based treatment and applying different preventive and corrective therapies for dentofacial anomalies, building the knowledge and skill to create communication, coordination and providing services in conjunction with other specialized fields for orthosurgery treatments, cleft patients, and syndromes, and forming the ability to evaluate and use new research information in clinical treatments. The educational system of orthodontics is based on terms (semesters) and courses. There are theoretical, practical, theoretical-practical courses and workshops, which are presented in the form of basic, affiliated sciences and specialized courses. Term duration is three years, with a PhD certificate in orthodontics.
Ultimately, in the field of prosthodontics, individuals are trained to recognize stomatognathic devices and their occlusion and diseases, to diagnose and design treatment for reconstruction of intraoral and extraoral lost tissues and temporomandibular joint. The educational system of dental prosthodontics is based on terms (semesters) and courses that are presented as units. Theoretical, practical as well as theoretical-practical courses and workshops are presented in the form of basic and affiliated sciences and specialized courses. Term duration is three years, with a PhD certificate in prosthodontics
DISCUSSION
A comprehensive educational curriculum, which is consistent with the needs of health system, forms the pivotal part of each educational process; therefore, every educational program has to be designed, revised and modified in accordance with the current needs of the community. In educating the community’s human resources, including general dentists who play an important role in the health system of the community, a comprehensive training program that can both respond to the changing needs of the society and train skillful and capable individuals to help the health system in fulfilling its duties, is one of the most important tasks of the educational system (9).
In recent years, experts have presented models to promote health care and change dental education; they have also proposed solutions to enable dental students to pay more attention to patients’ social needs. Therefore, there have been reforms in the content of dental education process, structure and organization.
Likewise, considering the role of dental faculty students in the five fields of study that were investigated here and their comparison with Iran, it was found that the certificate issued by all explored faculties did not grant graduates a professional role to work in the clinical area. Therefore, the permission to work in clinical practice after completing academic postgraduate education was given only following a period of at least one to four years in which graduates could work under supervision of trainers with teaching roles, which could be followed by practical courses, mostly in educational hospitals, approved by national health services or other community-based services or both, in order to independently obtain a dental professional license to have a clinical activity in the desired field. In Iran also, activities in the clinical field after the completion of the course are monitored and continued.
According to our findings on the status of the general structure and content of the specialized courses in dentistry PhD in Iran and top 10 faculties of the world, in some of the investigated faculties, about 20% of term content and structure was related to theoretical and basic courses, with about 50-65% for clinical courses and about 10-20% for research courses. In Iranian faculties there are theoretical, practical, theoretical-practical courses and workshops that are presented in the form of basic, affiliated, and specialized courses.
The following five specific fields of study in dentistry are discussed separately for the analyzed indicators.
In periodontology, it was determined that the main goals and mission of top ten faculties were to enhance the quality of diagnosis in this study field and success in dentistry activities, to teach scientific techniques for treatment of periodontium diseases and train qualified individuals for the board test, while in the universities of Iran, the main goal was to train qualified specialists in the field of prevention, preservation and promotion of oral and dental health in the fields of periodontal medicine, periodontal plastic surgery, reconstruction of soft and hard tissues of mouth surgery, and implants. Considering these goals, it is clear that treatment is of particular importance in other universities of the world, while prevention is being addressed in addition to treatment in Iranian universities.
In periodontology, the results indicate that in all universities of the world, term duration is three years full time, with most of them awarding a professional graduate degree, but with the difference that, in New York and South Carolina, only a periodontology specialty certificate is awarded, while in Pennsylvania, North Carolina, Los Angeles, Florida, San Francisco and Harvard, a master degree of biology is also awarded in addition to the periodontology specialty certificate.
It is worth noting that in Pennsylvania, in another five-year period, and at Harvard, in another four-year period, a PhD in biology is awarded along with a periodontology specialty certificate. At King’s College London and London College, an advanced master degree is awarded to graduate students in a three- to five-year period, while in universities of Iran, graduates receive a periodontology PhD for a three-year full-time period.
Investigation on pediatrics goals and mission also indicates that the main goal of top ten universities in the world is to prepare students for the board test, to train skilled students in preventive care for infants and children and to educate pediatric dentists with high academic backgrounds. In this context, perhaps one of the more specific goals is related to the University of San Francisco, which includes training of excellent educated professionals who can take the leading responsibility in children’s dentistry academy or private offices and public health, while in the universities of Iran there are more comprehensive goals and missions, including the ability to train health, prevention, diagnosis, treatment and research in children’s oral and dental problems (even children with specific needs). Given that children are the target group in this field, preventive goals are of particular importance, and for this reason they are pursued in both top international universities and Iranian universities.
In pediatric dentistry, in all top ten universities investigated by us, except for King’s College London and London College, the term duration is two years and three years full-time, with awarding a specialty certificate. A master degree in pediatrics is awarded in the two-year full-time King’s College London and three-year part-time London College, a clinical PhD being also awarded in the latter college.
It should be noted that in the universities of Los Angeles, Florida, New York and South Carolina (for a two-year period), only a Pediatric degree is awarded, while in those of South Carolina, North Carolina, San Francisco, and Pennsylvania (for a three-year period), and Harvard (for a two-year period), a pediatric specialty certificate and master degree of biology is awarded.
At Pennsylvania University (for a five-year period), a PhD in biology is also awarded in addition to a pediatric specialty certificate.
According to our findings on goals and mission of the surgery field, those of top ten universities in the world include students’ formation for board test and training for successful oral and maxillofacial surgery as well as training acknowledged specialists for academic clinical, teaching and research activities. In this field, perhaps one of the more specific goals is related to King’s College London, which includes identification of oral diseases, infections and lesions, and external and intraoral prosthesis. The goals and missions of Iranian universities are more comprehensive, including diagnosis of diseases, lesions, injuries, defects and congenital malformation and acquired infectious, traumatic, developmental, benign and malignant neoplastic of soft and hard tissues of the oral and maxillofacial tissue, surgical and non-surgical treatment, reconstruction of soft and hard tissues related to cosmetic and functional surgeries of the oral and maxillofacial area and the ability to study and research in the above fields.
In the field of surgery, the results of our study indicated that in all top universities of the world, except King’s College London and London College (a four-year or six-year period, or both), a maxillofacial specialty certificate with medical certificate is awarded for students in Pennsylvania, North Carolina, Los Angeles, San Francisco and South Carolina universities (a six-year period) and only a medical certificate at Harvard. In New York, Florida and South Carolina universities, only a medical certificate is awarded for four-year and six-year periods.
King’s College London (a two-year full-time) and London College (one year full-time, two-year and three-year part-time periods) grant master degrees. In Iran, graduates are awarded PhD in maxillofacial surgery after completing a full-time period of five years.
According to the investigation on goals and mission of orthodontic field in this study, it has been determined that the main goals and mission of top universities in the world include the development of empowered people, creation of innovative therapeutic methods, preparation for the board test, appropriate training program for taking care of patients, clinical research, preparation of residents for complex craniofacial problems or skeletal abnormalities, enhancement of cosmetic skills in dentistry, management of malocclusion, treatment mechanism and orthodontic appliances. In this regard, one of the more specific goals is related to the University of London and San Francisco, with an evidence-based approach via a program that includes clinical Comparing the Curriculum of Five Specialized Fields of Dentistry in Iran and 10 Top Faculties of the World 36 Maedica A Journal of Clinical Medicine, Volume 14, No. 1, 2019 work, presenting seminars as well as practical and research work. In Iranian universities there are more comprehensive goals and missions that include the identification and diagnosis of complete dental and facial anomalies, creating deep understanding of biology science and neuromuscular physiology and occlusion, use of various therapies for prevention and correction of jawdental abnormalities, necessary knowledge and skills for orthosurgical treatment, presenting research projects in the field of orthodontics. These results indicate that in the orthodontic field, Iranian universities have much more comprehensive goals and missions.
In the field of orthodontics, the results of our study indicate that there is a three-year period for students in all top universities in the world. A master degree is awarded along with an orthodontic specialty certificate in all universities, except King’s College London, London College and New York, and a PhD in biology is also awarded in Harvard in another four-year period and in Pennsylvania in another five-year period. Likewise, at the University of New York, only a specialty certificate is awarded. It should be noted that at King’s College London with a three-year period and at the London College with a two-year period for English students and a three-year period for foreign students, a master degree of orthodontics is granted. In Iran, with a three-year period (six terms), a PhD certificate is awarded to graduates.
Ultimately, considering the obtained findings regarding goals and mission of prosthodontics field, it has been determined that the main objectives and mission of top ten universities of the world include strengthening the scientific infrastructures in all fields related to prosthesis, preparing students for board test, relation with a wide range of prosthesis problems and contemporary treatments. In this area, perhaps one of the more specific goals relates to the University of Los Angeles that trains prosthodontics in two sections, one advanced section aimed to apply dental and articular techniques to prepare graduates as doctors and teachers, and jaw prosthesis section aimed at advanced training for the diagnosis and treatment of jaw abnormalities. One of the more specific goals relates to the University of North Carolina, which includes a complete oral reconstruction and toothlessness treatment, special attention to individuals with syndrome and acquired dental congenital malformation. In Iranian universities, more comprehensive goals and missions are pursued, including full knowledge of the stomatognathic system and occlusion and its related diseases, diagnose ability, treatment plan and reconstruction of intraoral and extra oral lost tissues, temporomandibular joint. These results indicate that the universities of Iran have much more complete goals in prosthodontics.
In prosthodontics, the results of our study indicate that in all top universities of the world there is a period of full-time three-year and after completing it, in all explored universities, except King’s College London and London College, a prosthodontics specialty certificate is awarded; at the University of New York only a single specialty certificate is awarded, at the universities of San Francisco, Pennsylvania, North Carolina, Florida and Harvard a master degree is awarded in addition to the specialty certificate, and in South Carolina a Bachelor degree in Biomaterials is awarded in addition to the specialty certificate. However, at Harvard by passing another four-year period, graduates are awarded a PhD in Biology. The University of Los Angeles awards a hospital and dental faculty specialty certificate with a one-year full-time jaw prosthodontics and also an advanced three-year part-time course. It is worth mentioning that King’s College London, with a period of three and four years, and London College University, with a period of two and three years, awards an Advanced Master degree in Prosthodontics, whereas in Iran, graduates are awarded a PhD by completing a three-year full-time period.
The complex and changing world of today requires dynamic training in various sciences, especially dentistry, which meets the needs and expectations of dentists and community in a comprehensive and inclusive manner. The quality of programs has to meet the general needs of society in dentistry services. Therefore, the curriculum of specialized dentistry should also have a content that meets the needs of the modern world.
In conclusion, the following academic and global processes are needed in order to unify the educational systems:
1. Establishing a World Dental Foundation to license and standardize the training systems of dentistry around the world;
2. The activity and cooperation of this foundation with training institutions of dentistry and training qualified individuals from all over the world for the examination and authorization of dental faculties in each country. It should be noted that these postgraduates should be selected from all countries and should be trained under the supervision of the World Health Organization (WHO).
3. Developing a set of globally known training standards to train dental students and the use of international standard terminology to facilitate scheduling an appropriate and identical curriculum that can lead to design standard curriculums of dental faculties. This unification, in its turn, will also produce favorable results.
4. Improving oral health worldwide
5. More classes of the communities will benefit of standard dental services
6. Providing job security and appropriate income for dentists in all countries
7. Considering the complete and comprehensive curriculum in Iran, the obstacles of its implementation should be found.
8. Reducing the curriculum bounce that is known as obesity of the curriculum.
CONCLUSIONS
In our efforts to adapt to modern world trends, we considered it necessary to look at the curriculum of five specialized fields in ten top universities of the world in terms of content, general structure of the curriculum, goal and mission, length of study period and awarded certificate, in order to investigate its concordance with the curriculum of Iran, make an evolution in the educational system as well as accountable and justice-centered education; we have also intended to make the differences between training systems more clear, which could help us not only to identify the shortcomings and objections of the curriculum but also to seek for solutions.
Considering the obtained results, it may be concluded that the curriculum of medical universities in Iran, in most of the cited cases, compared to most of the top universities in the world, while having been designed with a more comprehensive prospect; therefore, in case of actualizing these goals, specialized graduates could enter university and work environment.
Conflicts of interest: none declared.
Financial support: none declared.
Contributor Information
Fatemeh DABAGHI-TABRIZ, Department of Operative and Esthetic Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Mahdi RAHBAR, Department of Operative and Esthetic Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Mohammad-Hossein SOMI, Liver and Gastroenterology Diseases Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Ali TAGHIZADIEH, Tuberculosis and Lung Disease Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Jalal HANAEE, School of Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran.
Reza GHAFFARI, Medical education research center, Tabriz University of Medical Sciences, Tabriz, Iran.
Ali-Hossein DEHGHANI, Department of Periodontics, Faculty of Dentistry, Islamic Azad University of Medical Sciences, Tabriz, Iran.
Parvin PARTOVI, Private Practice, Tabriz, Iran.
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