Identifying the pros and cons

Cardiff University is one example of a school making changes to their undergraduate dental electives, as described by Dr Richard Oliver, Director of the Dental Education Unit at Cardiff University, in his keynote lecture. Cardiff Dental School have changed their curriculum and the elective has become a final year project. As they now have a classified degree, they have placed constraints on the manner of completing the project, defining clear aims and learning objectives.

Although there were initial concerns from the students about the loss of their elective 'holiday' period, and some problems with organisation, the school has found the change has brought many advantages and has generally been well-received. One advantage of the change is that it has allowed the final year project to have clear structure, guidance and assessment criteria. Students have a range of projects that they may undertake suggested by staff, although there is some loss of academic freedom and there is no longer a 'bank' of overseas contacts. However, the School already participates in the Erasmus scheme and so many students do have the opportunity to visit other establishments in Europe.

Much discussion centred on the definition and purpose of electives, including who was responsible for developing and setting up the elective programmes. There was also debate about the difficulties in arranging domestic and overseas electives.

The students' perspective

With a wide variety of elective being undertaken, it is important to consider the students' side of the debate. Students from three different universities gave accounts of their electives, each with a very different experience that illustrated the variety of electives that are on offer.

Selina Takhar, a final year student at the University of Birmingham, undertook her elective in Zambia working for SKIP (Students for Kids International Projects). This is a registered charity that works towards sending healthcare students to help in overseas countries. Selina had been instrumental in setting up the first branch at the University of Birmingham, and was the first dental student to go abroad to help look after communities. The aim of her elective was to visit the district of Kanakantappa in Zambia and work with children in two rural villages, addressing their oral health needs. For Selina, this highlighted the importance of seeing dentistry not as a single entity, but as a factor of general health and wellbeing (Figs 1 and 2).

Figure 1
figure 1

Examining children in different conditions to those in a dental school

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Figure 2
figure 2

Some happy patients who also benefit from a student elective

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The benefits of undertaking a clinical elective in the UK were demonstrated by Michelle Naylor and Lee McMahon. Currently in their final year at Newcastle University Dental School, Michelle and Lee carried out a special care elective within the Community Dental Service at South Tyneside. During their elective they had learnt a great deal about their chosen topic of special care dentistry, including management, communication and treatment issues for this group of patients. The opportunity to learn about this aspect of dentistry had been enjoyed by them both and both wished to continue their interest in special care dentistry when they qualified.

Finally, Shauna Culshaw, a recent graduate from Glasgow University, provided an overview of a research-based elective and described how it helped her with her subsequent career. Her project, entitled A peptide vaccine to protect against dental caries: identification and assessment of immunogenic peptides of glucosyltransferase of mutans streptococci, was undertaken at the Forsyth Center in Boston, USA. She outlined funding opportunities and stressed the advantages of developing research experience and of meeting people that lead to future collaborations, especially for those wishing to take up an academic career. The elective gave her the opportunity to travel and also led to various presentations and publications.

The future of electives

The future of electives in the undergraduate curriculum was the final subject discussed at the workshop, including how to redefine student electives and to agree the best practice features of a successful elective. Where are student electives heading and where do they fit within the wider aims of the dental undergraduate course?

'It is clear that for an elective to be successful, aims should be set and the elective should be assessed formally.'

From the outcome of the discussions, it is clear that for an elective to be successful, aims should be set and the elective should be assessed formally. If the elective has a formal assessment process then it will be seen as important, as the effort of the student will be recognised. Schools reported that there were a variety of assessment methods, which were either formative or summative, but it was agreed that there should be evidence of completion. This assessment could take various forms including a report, poster or presentation after elective completion.

The elective may lead to a publication or assist in the preparation of a CV for a job interview. It also allows the student to gain knowledge of working in different environments. It was strongly felt that electives contribute to wider personal development and so learning outcomes should not be restricted by the curriculum. Electives should retain freedom and openness and 'belong' to the student, not to the staff.

Early support and discussion from school contacts is also important, together with a period of preparation with a fixed deadline. During the elective period, there should be good local supervision (where possible) or contact (support). If students are going to an outside institution then health and safety advice must be followed and a full risk assessment made. There were many suggestions about dissemination, including placing a portfolio of previous electives on the Internet.

Perhaps most importantly, there is strong support for the concept of a student elective period and this opinion is particularly strong among student representatives. The students voiced the opinion that electives should remain part the curriculum and that any changes should be made with student input. One student stated that the elective is the only time in the undergraduate course where there is a chance for students to recharge their batteries. At the end of fourth year there is a tough examination and students need to have a chance to reflect and then get ready for final term.

Conclusions

This timely workshop was highly successful and has already generated some interest.1 The hope is that the momentum of the day will allow those schools still providing an elective scheme to move forward and enhance their student learning experience.