Cross-border collaborative BDS Curriculum Workshop in Lilongwe

Following the National Oral Health Policy Dissemination and Implementation Workshop on 14th and 15th November, the MalDent Project team convened a two-day BDS Curriculum Workshop on 16th and 17th November that included representation from Kamuzu University of Health Sciences (KUHeS), the Copperbelt University (CBU), Zambia, Levy Mwanawasa Medical University (LMMU), Zambia and the University of Glasgow (UofG). As the KUHeS BDS programme, launched in 2019, prepares for its pioneer cohort of students to enter BDS 4 in early 2023, it is time to begin reviewing curriculum content and structure. The CBU is currently undertaking a review of its own programme and LMMU will be accepting its first students into the clinical part of the programme (BDS 3) in 2023. There are many opportunities for joint learning and collaboration between these three organisations, with potential for links with UofG and other international dental education providers.

The first session was chaired by Dr Peter Chimimba, the MalDent Project Lead at KUHeS. After introductory comments, he invited Drs Mchenga, Majambo and Sayela to provide summary overviews of the existing BDS curricula at KUHeS, CBU and LMMU respectively.

Dr Mchenga gave a very full account of the admissions process, the course structure, and the teaching and assessment methods that were employed at KUHeS, together with a summary of the various challenges that the fledgling programme was facing.

Dr James Mchenga providing an overview of the KUHeS BDS curriculum

Dr Majambo followed, and delivered a similarly comprehensive presentation. The BDS course at CBU was the first in Zambia and launched in 2011, graduating its first dentists in 2016. To date, the course has delivered more than 120 dental graduates. The course runs for six years, excluding internship, and the students do not begin their formal dental teaching until the Fourth Year. Dr Majambo also highlighted some of the challenges in course delivery, revealing a number of parallels to those identified by Dr Mchenga

Dr Majambo presenting on behalf of the Copperbelt University

We next heard from Dr Sayela about the new BDS programme at LMMU. Construction of the LMMU building began in 2016, funded by the Zambian Government, with an ambition to resolve the deficit of 50,000 members of the healthcare workforce in the country. The university has five schools (Institute of Basic & Biomedical Sciences, School of Nursing, School of Health Sciences, School of Medicine & Clinical Sciences, and School of Public Health & Environmental Science). The six-year BDS degree programme sits within the School of Medicine & Clinical Sciences and its curriculum was developed in 2020. Formal dental teaching starts in BDS 4 with an average of 30 students per year. However, there is some integration and introduction of dental topics in the earlier years. The first intake of clinical students is due in 2023. As reported in the two earlier presentations, there were challenges in relation to equipment, staffing and costs of dental materials.

Dr Sayela describing the BDS programme at Levy Mwanawasa Medical University

Whilst there were some significant differences between the three BDS curricula, there were also obvious synergies, suggesting that joint working could potentially help to ease some of the challenges being faced individually. These would be examined and discussed in detail the next day.

We had been joined for this session by Dr Emma Thomson, who has been a great friend to the KUHeS BDS programme since its inception. In her previous role as Director of the College of Medicine Education and Training Office, Emma was involved in the first and second BDS curriculum conferences, when the course was being created, and has since provided much behind-the-scenes support. In the new KUHeS structure, Emma is Acting Director of the Teaching and Learning Development Centre and she had kindly agreed to deliver a session on Clinical Assessment.

Dr Thomson introducing her topic for the day

Emma’s talk provided an excellent grounding in assessment across all of the learning domains – knowledge (cognitive), skills (psychomotor) and attitudes (affective) – including specific advice on chair side assessment. The value of feedback, delivered in a constructive and positive manner, was stressed as a way of helping students to be the best they can.

It had been a very full morning, with much food for thought, and following Emma’s lecture we were able to continue our discussions over lunch:

Emma relaxing at lunchtime with members of the MalDent Project team

Before Emma departed to join an on-line meeting in her schedule for that afternoon, we had a group photo.

Replete after lunch and ready for the afternoon session

The afternoon session, chaired by Dr James Mchenga, was devoted to a workshop on Restorative Dentistry teaching in the context of Malawi and Zambia, led by Andrew Paterson and Niall Rogerson from UofG. Despite the infrastructural challenges in Malawi for delivery of dental care, as described during the Oral Health Policy Workshop earlier in the week, the ambition is to train dentists who are ‘globally competent and locally relevant’. Ensuring that curriculum content is appropriate to this aim is very important and Restorative Dentistry is perhaps the clinical discipline which makes such decisions most difficult.

Andrew kicking off the afternoon workshop on Restorative Dentistry teaching

Andrew delivered an excellent presentation which covered all aspects of teaching in Restorative Dentistry, including biodental sciences, pre-clinical skills, laboratory skills, clinical skills and integrated care.

Following the presentation, we enjoyed an informal discussion session:

Andrew facilitating discussions following his lecture

One of the most valuable elements of this workshop was the interaction that took place during refreshment breaks. With colleagues attending from multiple universities, disciplines and career stages, there were rich opportunities for joint learning and establishment of academic links.

By close of play on the first day of the workshop we had all absorbed a lot of information and were ready to return to the hotel for a rest before dinner. As I came out to our trusty bus I caught a cameo view of Niall already seated and ready to go:

Niall in classic ‘Our Man in Havana’ pose!

One of the joys of this week of activities in Malawi was the opportunity to meet four of the six Assistant Lecturers who were able to join us. In order to thank them for their excellent input to the workshops and to acquaint ourselves better, we had invited them to join us for dinner that evening.

Dinner is served in Vincent’s Restaurant – bon appétit!

The food was obviously a highlight of the event …

… but there was also an opportunity to establish some informal mentoring for the Assistant Lecturers. Don, who is specialising in Dental Public Health, sat next to Lorna whilst Yusuf, who is specialising in Prosthodontics, sat with Andrew. As a result, both Lorna and Andrew have agreed to become external mentors for the period of Don’s and Yusuf’s specialist training. Similar external mentoring arrangements will be set up for the remaining Assistant Lecturers.

Mentors in action!

The next morning, while we were waiting for the bus, Niall spotted that one of the events scheduled in the hotel for later that day was a ‘Coca-Cola Malawi Meeting’. Lorna Macpherson, one of the UofG team, was due to deliver a lecture on the importance of preventive dentistry as a component of the BDS curriculum during our workshop, so this was an excellent photo-opportunity in real-time!

Coca-Cola and oral health – an unhappy alliance!

On arrival at Duncan’s Lodge, we launched into the morning session, which was chaired by Dr Majambo. I had agreed to lead a workshop on identifying collaborations between the parties present that could help to overcome some of the challenges in BDS course delivery identified on the previous day.

Facilitating discussions on opportunities for collaboration in BDS curriculum delivery between the schools

We structured the conversation around five initial themes, but by the end of the session that list had grown to seven:

In all of the areas listed above it was possible to identify practical, feasible and often relatively inexpensive ways in which we could all support each other to develop and deliver the three respective BDS curricula.

The morning finished with an excellent lecture by Lorna exploring the relationship and tensions between the need for teaching of preventive dentistry against a traditional historic emphasis in dental schools on operative procedures (curative dentistry).

Lorna introducing the subject matter of her lecture

Having described the preventive focus of the WHO document Promoting Oral Health in Africa and the aspirations of the 2021 World Health Assembly, Oral Health Resolution Lorna examined how these should be reflected in BDS curricula:

Lorna describing the need for integration of preventive and curative approaches in the curriculum

Upstream and downstream interventions, the concepts of Universal Health Coverage, the Basic Package of Oral Care, and the Common Risk Factor approach to prevention of Non Communicable Diseases (including common oral diseases) were all covered.

Lorna outlining upstream, midstream and downstream interventions

Lorna’s final slide tied the whole subject of the BDS curriculum back to the content of the National Oral Health Policy, since it would be the young dental graduates who would be playing a major role in policy implementation. Prevention of oral and dental disease is a corner-stone of the recently launched policy, hence its importance in the undergraduate programme.

Linking undergraduate dental education with Oral Health Policy implementation

Following Lorna’s talk we broke for lunch, when we were joined by the BDS 3 students from KUHeS. They enjoyed eating with us before attending the afternoon session.

The BDS 3 students sharing lunch with us

The afternoon proceedings were chaired by Dr Sayela, who welcomed the BDS students before introducing Andrew and myself to lead the first session.

Dr Sayela welcoming everyone to the afternoon session

The purpose of this first session was to consider innovative ways in which the capacity to deliver oral and dental care in Malawi could be augmented in the short- to medium-term and how undergraduate dental education could prepare students for playing a leadership role upon graduation.

Andrew beginning the session on integrated workforce possibilities

In his presentation, Andrew described the task shifting model that has been used in Tanzania for many years by the charity Bridge2Aid, through which Clinical Officers in very rural environments are taught to deliver emergency dentistry, including uncomplicated dental extractions. Plans are underway to pilot this model in Malawi to train Medical Assistants in a similar fashion. The task shifting approach is approved by the WHO as a mechanism to improve access to care in situations where there are severe shortages of trained workforce, a condition that is certainly fulfilled currently in relation to delivery of emergency dental care in rural Malawi. However, the concept triggered a vigorous discussion, as it had earlier in the week during the Oral Health Policy workshop, and the outcome of the pilot programme will be important to the acceptance and possible adoption of the model in Malawi.

Andrew describing the ‘task shifting’ model

The final event of the workshop was entitled ‘The Student’s Voice’ and was an open discussion with the BDS 3 students about their experience of the course. It was hosted by Dr James Mchenga in his role as Head of the BDS degree course at KUHeS:

James spoke of the importance of the students as the future dental workforce in Malawi and how critical it was that they were equipped to take forward the activities required to implement the National Oral Health Policy:

However, he also made the point that the staff team cares passionately about the welfare of the students – something that was very evident just from watching the minute-to-minute interactions between James and this pioneer group of students under his tutelage.

The open discussion provided some valuable feedback…

Questions and comments from the BDS 3 students to the staff

… and the Student President, Patrick Moses, concluded the session with a very well delivered short speech.

Patrick Moses, the President of the Dental Student Society, addressing the delegates

The workshop concluded with a summary of the activities of the past two days and a note of thanks to all involved. Once again, Annie Mwapasa and Madalitso Kaphamtengo had organised everything perfectly.

We also told the students how much we were looking forward to spending time with them on the following day at the Dental Department in Kamuzu Central Hospital, for delivery of some teaching as part of the MalDent Project Flying Faculty programme. That story will be told in the next post.

On reflection, the overwhelming memory of this two day workshop is of the passion and dedication of those entrusted with teaching the future young dentists of Malawi and Zambia. Dental education is an expensive enterprise, requiring clinical staff, complex equipment and a ready supply of dental materials, all of which are challenging to deliver reliably in low resource environments. Nevertheless, there was a palpable determination to provide the best possible opportunities for the students and to care for their welfare, particularly at this time as the cost of living crisis is impacting so significantly. It is well summed up in the following quote:

One looks back with appreciation to the brilliant teachers, but with gratitude to those who touched our human feelings. The curriculum is so much necessary raw material, but warmth is the vital element for the growing plant and for the soul of the child.

Carl Jung

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