The need for radical change
Paul Allison on training future oral healthcare professionals
It is time to reposition oral health as a crucial part of an integrated healthcare system, and educators believe that improving the training of the next generation of oral health professionals is the key to do so. Despite being a branch of medicine, the dental profession has developed somewhat separately from the medical profession. Increasing evidence suggests that an integrated healthcare system, which involves a high degree of collaboration among healthcare professionals with different specialities, will enable holistic improvements to patient care. Accordingly, the current focus among many dental educators is improving the quality of dental professional training, which in turn, will ease the integration of dentists’ contributions into current healthcare systems.
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“Despite being a branch of medicine, the dental profession has developed somewhat separately from the medical profession”
In light of these exciting innovations in dental healthcare education, the Keppel Health Review invited professor Paul Allison—a former dean of the Faculty of Dentistry* and a current professor at McGill University in Montreal—to speak on the challenges of training future oral health professionals.
Allison completed his dental training at University College London (UCL) in the 1980s. He subsequently discovered his passion for dental public health and pursued relevant master's, again at UCL, and then doctoral studies in Montreal, Canada. After becoming a faculty member at McGill University, one of Allison’s main research interests was and remains patient-based measures in health. His work centres around ensuring that patient perspectives are an equally important component in clinical assessment to those of clinicians. This passion was expanded when Allison was offered a deanship at McGill, becoming directly involved in the management and administration of educational training programmes. The role offered him a radically new perspective on the value of education in improving oral healthcare services for patients and practitioners alike.
Dental healthcare education follows an apprenticeship model. Practising professionals and academics are both involved in training and mentorship: a novice professional is accompanied by an experienced professional as the trainee practises. Training health professionals within the profession enables them to become competent in practising a wide range of licensed acts while simultaneously applying the latest research on topics related to patients’ health needs and expectations for care.
The apprenticeship model offers many benefits to dental students. However, practising professionals and full-time academics teaching them tend to have different backgrounds, approaches, and priorities. Full-time academics, such as Allison, are experts in their field. They are knowledgeable on the latest developments in, for instance, public health and can provide solid training on the theoretical background of healthcare. Yet academics have often not practised dentistry for many years, and their teaching may not necessarily reflect the reality of work performed in an everyday dental practice. On the other hand, the practising dentists that students work with may not be aware of the latest research and evidence. The training that these dentists provide is solidly grounded in great experience and is heavily influenced by their personal knowledge and practice but may not be supported by the newest evidence. It can therefore be difficult for dental students to integrate training from both practising professionals and full-time academics when they provide different, and sometimes conflicting, advice. Experienced practitioners tend to have a stronger influence on students’ future dental practises because of their strong mentoring role. Consequently, this apprenticeship model of learning, which in many ways provides adequate preparation, could perpetuate historic patterns of practise and become a barrier to introducing new approaches supported by the latest medical and public health evidence.
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This is where Allison’s managerial and academic views on the education system are instrumental: healthcare professional training programmes, he says, should have a stronger emphasis on preventative measures to promote maintenance of health rather than dependence on treatment. Given his public health vantage point, he believes that all health professions need to include an understanding of population-wide and patient-centred needs. It is through adjusting this combination of academic and practical training that will improve the quality of dental education, and better prepare dentists for integration into the healthcare system and community.
But Allison is aware that this is easier said than done. To achieve integration, radical change is needed. It remains that oral healthcare professionals primarily work separately from other health professionals. In Canada, family doctors refer patients to different specialists to receive specialised services. Dentists are not included in this process as they are not part of the Canadian universal health coverage system, and most dentists across the world work in private offices separate from healthcare clinics and hospitals. For dentists to contribute to a more integrated healthcare system, structural changes to both training and practice are essential.
Allison has now turned his attention to addressing these system-wide innovations. After completing his two terms as dean, Allison relinquished his administrative tasks to return to an academic post as a professor. He has since been involved with national and international research projects that aim to improve the delivery of oral healthcare in Canada and the world. These projects include being a co-author of a two-part Series by The Lancet on oral health, which outlines the global public health importance of oral diseases and the need for radically different policies addressing global oral health problems. The authors of the Series are collaborating with the World Health Organization (WHO) to support the creation of a WHO oral health strategy, bringing oral diseases into the work on all non-communicable diseases and supporting the integration of dental care into universal health coverage. The work of Allison and his colleagues promises real changes and advances in the way in which oral health needs are understood and acted upon. This includes improving training of health professionals to address these needs from both a preventative and therapeutic perspective.
“The work of Allison and his colleagues promises real changes and advances in the way in which oral health needs are understood and acted upon”
When asked about his views on the future oral healthcare workforce, Allison admits that he is an optimist. He recognises that there are concerted international efforts from the WHO, The Lancet Commission on Oral Health, and the FDI World Dental Federation. In Canada, access to oral healthcare has made it on the national political agenda. In recent years, oral health has been a topic discussed by various Canadian political parties. There is now a real movement among several provincial and national political parties to integrate dental care into Canada’s general healthcare system. At the same time, Allison is a realist and pragmatist who believes that radical changes in oral healthcare rely on support from within the dental profession and from the public. He is encouraged by the enthusiasm for change shown by many of his students, and he hopes that these efforts will be maintained by future professionals in the imperative work to integrate oral health into global healthcare systems. It is time to act now—the 2030 goal for universal healthcare coverage is approaching fast.
* Now renamed the Faculty of Dental Medicine & Oral Health Sciences, as of January 1 2022.