teaching oral sciences in the rapidly changing society in ... lecture education uofbasel.pdf ·...
TRANSCRIPT
![Page 1: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/1.jpg)
9 Oct 2001 1
Teaching oral sciences in the rapidly changing society
in an age of information
Asbjørn JokstadInstitute of Clinical Dentistry
University of Oslo
![Page 2: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/2.jpg)
2
A rapidly changing society• The production of new knowledge is at
maximum in historical context• Rapid changes of new ideas and
concepts• Information technology has improved
the potential for information transfer to everybody
• Affects us all– Students and teachers– Patients– Researchers
![Page 3: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/3.jpg)
3
Dental journals in circulation
0100200300400500600700800900
1000
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Source: Ulrich’s International Periodicals Directory
N=933
![Page 4: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/4.jpg)
9 Oct 2001 4
Where and by who is new knowledge in oral
sciences created?
![Page 5: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/5.jpg)
5
The clinical practitioners
•Single handed GPs/ specialists in teams; secondary/tertiary care•Great diversity of experience, interest and capacity •Draw on a panoply of experience•Pragmatism: what works - what creates problems
![Page 6: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/6.jpg)
6
The researchers
•Creates “scientific evidence”•Formulation of ideas, hypotheses, study design, data collection•Peer review, internal/external validity, debates within paradigms•Report findings in probabilities, not absolutes
![Page 7: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/7.jpg)
7
The appraisers of evidence for clinical practice
•Epidemiologists, health economists, statisticians, social scientists, and clinicians •Collect, abstract and appraise practice related knowledge•Debates about value and balance between consensus and evidence, rigour of data and application of statistics
![Page 8: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/8.jpg)
8
Developers of local guidelines and protocols
•Local consensus, sometimes on national guidelines •Clinical specialists seeking ways to influence peers
![Page 9: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/9.jpg)
9
Advancement depends on good communication
?
BARRIERS: Ignorance-Defensiveness-Arrogance Different educational backgrounds, evaluation of best practicePressures, priorities, language, preoccupations
![Page 10: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/10.jpg)
9 Oct 2001 10
How will tomorrow’s students and teachers be
affected?
![Page 11: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/11.jpg)
11
The graduate yesterday
Teachers“Curriculum”
Knowledge -base for oral care
![Page 12: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/12.jpg)
12
The graduate today
Teachers“Curriculum”
Advertising- producers- colleagues
Knowledge -base for oral care
![Page 13: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/13.jpg)
13
The graduate tomorrow
Teachers“Curriculum”
Advertising- producers- colleagues
Knowledge -base for oral care
![Page 14: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/14.jpg)
14
• Already from day 1 the oral sciences advances further - how to stay updated?
• Theoretic knowledge at zenith, from now on less time for reading / question of priorities
• No hands-on experience with many procedures common in modern dental clinics
- from where and how can further training be obtained?
The graduate today and tomorrow• Has been taught and can perform many
basic clinical procedures - not necessarily the most modern
![Page 15: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/15.jpg)
15
Solution: Educational strategy
Premise: Difficult politically to expand curriculum and length of study
• Problem based learning PBL• Focus on “why”s instead of “how to”s• Motivate on need for life-long learning• Teach critical appraisal of new information• Prepare how to meet tomorrow’s
knowledgeable patients’ needs and requests
![Page 16: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/16.jpg)
9 Oct 2001 16
How will tomorrow’s clinical practitioners
be affected?
![Page 17: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/17.jpg)
17
Dentists’ environment: An information overload
Meetings/courses
Colleagues
Advertising- producers- colleagues
Dental literature “Vitenskap
”
WWW
Patients & (-groups)
Popular magazines & Media
Dental„science‟700 journals: 25 000 articles/yr
![Page 18: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/18.jpg)
18
More knowledgeable patients:
Patient communication!Wish to remain sound, look healthy…. youngCompetitive health providers
![Page 19: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/19.jpg)
19
We need to consider not only the amount
of information, but alsothe
qualityof this information
![Page 20: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/20.jpg)
20
• An ethical aspect–A strategy for being reasonably
certain that my advises and treatment are the best available to my patients.
• A practical aspect–A strategy for solving clinical
problems on a daily basis.
Solution: Integrate evidence-based clinical practice
![Page 21: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/21.jpg)
9 Oct 2001 21
Where to find evidence based
dentistry resources?
![Page 22: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/22.jpg)
22
FDI World Dental Federation
![Page 23: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/23.jpg)
23
FDI World Dental Federation
![Page 24: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/24.jpg)
24
Online secondary publication - EBD:
![Page 25: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/25.jpg)
9 Oct 2001 25
How will tomorrow’s clinical
researchers be affected?
![Page 26: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/26.jpg)
26
Several commercial companies are active, with Gore, Guidor, and Calcitek being the biggest actors.
![Page 27: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/27.jpg)
27
GTR Attachment gain -traditional reviews
• Compared to open flap debridement = 2.7mmLaurell L, Gottlow J, Zybutz M, Persson R. Treatment of intrabony defects by different surgical procedures. A literature review. J Periodontology 1998;69:303-313
• Compared to open flap debridement = 1.6mmCortellini P, Tonetti M. Focus on intrabony defects: guided tissue
regeneration. Periodontology 2000 2000;22:104-132.
Incorporation of uncontrolled and unblinded studies
Unclear selection criteria for studiesInclusion of studies of short duration
![Page 28: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/28.jpg)
28
GTR Attachment gain - systematic reviews
• A small benefit is apparent • Results of clinical trials are not consistent • Technically demanding treatment• Local biological factors uncertain
– e.g. “critical size”, endotoxin remnants, etc. Jokstad. Norwegian Periodontal Society. Oslo, Nov 1999.Needleman et al. Cochrane Library 2001;3.
• Compared to open flap debridement = 1.1mm(Needleman et al. Cochrane Library 2001;3)
![Page 29: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/29.jpg)
29
Solution: Attention to methodologicalrigorousness of primary and secondary research
CONSORT statement Good Clinical Practice for trials-
75/318/EEC ISO TC194 Biological evaluation of
medical devices CEN TC055 Clinical investigation
standards Cochrane collaboration guidelines
![Page 30: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/30.jpg)
30
Example 1: Diagnostics
Rapid developments of emerging technologies–e.g. caries diagnosis
![Page 31: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/31.jpg)
31
Caries diagnosis Traditional techniques
VisualTactileRadiological
Recently developed technologies Digital radiography - expert systemsLaser fluorescenceElectrical conductivity (EC)Fibre optic (FOTI)
Emerging technologiesQuantitative laser-light induced fluorescenceUltrasonographyAlternating current impedance spectroscopy
![Page 32: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/32.jpg)
32
Example 1: Diagnostics
• Rapid developments of emerging technologies–e.g. caries diagnosis
• Danger of blinding by technology• Validation in appropriate settings
and populations?
![Page 33: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/33.jpg)
33
Example 2: Therapy
• Only small improvements can be anticipated
• Adequate study design, sample sizes and settings
• Need for RCTs, power calculations, international cooperation and multi-centre studies
![Page 34: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/34.jpg)
34
A rapidly changing societyThe dentist have always had to cope with
patient anxiety…pain…hope...priorities... motivation…gratefulness…anger…worry… despair…pathology…education...esteem… uncertainty…vanity…distress…restoration…submission…inflammation…aggression…values…resentment…appreciation...fear
• Today: Add: informed patients• Adapt or resign• Survival of the fittest informed
![Page 35: Teaching oral sciences in the rapidly changing society in ... Lecture Education UofBasel.pdf · 09/10/2001 · Teaching oral sciences in the rapidly changing society in an age of](https://reader036.vdocuments.us/reader036/viewer/2022071013/5fcb46a48f1db90aad1bdd3c/html5/thumbnails/35.jpg)
9 Oct 2001 35
Thank you for your
kind attention