A Proposed Curriculum for 5-years BDS Programme in Pakistan and its Comparison with the Curricula Suggested by PMDC and HEC

The dental school curriculum varies from institution to institution and country to country but most colleges and universities follow a general structure that is in the first two years of dentistry course, students spend most of their time studying basic biological & biomedical science. They learn the structure and function of the human body and the diseases that can affect it. Then in next 2 to 3 years (depending upon the course is 4 or 5 year-long) there is a gradual transition towards more clinically oriented subjects.1 The goal is to prepare dental graduates who possess strong knowledge base, right set of skills, and values essential to the practice of safe and ethical dentistry. Moreover, dental curriculum is built around some essential themes that could inculcate attributes such as professionalism, life-long learning and ability to critically evaluate, correlate and synthesize scientific evidence to help the graduate remain current and up-to-date in clinical practice.

In Pakistan, there are 55 recognized dental colleges.2 Presently, the Bachelors of Dental Surgery (BDS) course

is four-years duration.3 Its existing curriculum is devised by the statutory body of the country, Pakistan Medical &

Dental Council (PMDC). However, the institution responsible for other degree awarding courses in the country, Higher Education Commission (HEC) has also placed a 5-year long curriculum on their website for long4, but for various reasons this curriculum has not been made to any use as hardly any institution in the country follows it.

Whether to enforce a 4-years BDS course versus a 5-years programme, is a matter of debate that warrants multiple deliberations. In US and Canada, dentistry is 4-year long course but students there get admission into

dental school when they have already done 16 years of schooling (i.e. a 4 years of graduate university education is the pre-requisite). In UK & Ireland, students can apply for admission into dental colleges with 12 years of high school education. However, they follow a 5-years BDS programme. In simpler words, a dental graduate in UK & Ireland is generally three year younger than his North American counterpart. As medical and dental education in Pakistan and India, follow British system of education, 5 thus it’s imperative to align our BDS curriculum and assessment methodologies with the prototype so that dental graduates trained in Pakistan don’t face challenges when they apply for equivalence or when they go abroad for further education or apply for registration to practice outside Pakistan.

This paper is to critically appraise the PMDC and HEC advised BDS curricula and suggest an alternate curriculum

that is more balanced in terms of subject distribution, assessment and above all contemporary to cater the evolving

needs of the dynamic discipline of dentistry.

CRITICAL ANALYSIS AND PROPOSAL

The shortcomings in the PMDC curriculum (table 1) are: Firstly, it’s a four year curriculum which needs overhauling as the quantum of knowledge in dental sciences have grown so much in last 40 years that it’s not possible to cover the fundamentals of dental sciences in just four

Table 1: Existing curriculum by Pakistan Medical & Dental Council (PMDC)

Ω As per the state regulation, Pakistan Studies, Islamiat/ Ethics examination to be done at the end of first year.

*Source: PMDC website: http://www.pmdc.org.pk/

years. Moreover, the countries from which this four year BDS curriculum was adopted (UK, Ireland and Australia)

have already moved to the five year program in late 90’s. Thus, it’s likely that Pakistan too will follow their foot step

and will move to 5-years BDS programme soon.

Endodontics is entirely missing as a main subject. It should be specifically mentioned annexed to Operative Dentistry. Oral Medicine is being paired with Periodontology, it should have been synched with Oral Pathology instead. No mention of subjects such as Behavioral Sciences, Ethics, Implant Dentistry, Forensic Odontology etc. Although, Pediatric Dentistry has recently been recommended to be established as separate subject but so far only a few institutions have established its departments. The problem in Pediatric Dentistry teaching and assessment is the post graduate programme and availability of trained faculty.6,7

The limitations of the HEC dental curriculum (table 2) are: An unequal distribution of subjects throughout the length of the course. The final year is over burdened with too many subjects. Periodontology is taught in year 3 and then in year 5, skipping year 4 and not mentioned as which year its examination will be carried out. Similarly, Operative Dentistry is being taught in year 3 and 5, skipping year 4. Pediatric Dentistry is being merged with Operative Dentistry whereas Endodontics is absolutely ignored in the list of subjects. Again, year 4 is skipped for Oral Medicine, Oral Diagnosis & Oral Radiology. These three are clustered as one subject and repeated in year 3 and 5 too. Oral Medicine should have been paired with Oral Pathology to make more

Table 2: BDS Curriculum proposed by Higher Education Commission of Pakistan (HEC)

*Source: HEC website: https://hec.gov.pk

sense. Subjects such as Comprehensive Care Dentistry and Special Care Dentistry have been mentioned but there no

specialty residency programs in the country to train faculty in these subjects.

The strengths of the curriculum (table 3) proposed in this paper are: Its more balanced in terms of subject distribution, assessment and above all contemporary as it has subjects such as ethics, behavioral sciences, implant dentistry to cater the evolving needs of dentistry. However,

Table 3: Distribution of subjects in the 5-year long BDS course proposed in this paper

Ω As per the state regulation, Pakistan Studies, Islamiat/ Ethics examination to be done at the end of first year.

there is a question that there are lack of subject expert teachers in few of these disciplines, especially the newly proposed ones. For this, a solution has been proposed for identifying suitable subject teacher and the best alternate while keeping the circumstances of Pakistan dental academia in context. The first two years are preclinical years where student journals can be used for the formative assessment of the student. The third year is a blend of basic and clinical sciences whereas years 4 & 5 will be clinical years focused entirely on dental subjects. In addition to summative

Table 4: Allocation of faculty in subject of expertise and cross-subject allocation

*The alternate teaching faculty would a make shift (short term arrangement) for next 5 years only, once the number of adequate subjects specialist are available, this practice will be permanently stopped

assessment at the year-end, student log book in each subject could be used as an evidence of competence gained and

formative assessment throughout year.

Although a number of deliberations have been made by subject experts and dental educationists at the 1st Pioneer

Conference on Dental Education held at the Dental Institute of the Liaquat University of Medical & Health Sciences (LUMHS) Hyderabad, Pakistan on 14-15 November 2014 and at Pakistan Pioneer National Seminar on Dental Education organized by LUMHS held at Governor House Sindh (Pakistan) on 20 February 2015. The outcome of

such deliberations have yet to be translated into actions.

In conclusion, the limitations of PMDC and HEC templates have been appraised above. However, comparing the two

curricula, it seems that PMDC version is more practical compared to what HEC has suggested. In essence, the curriculum proposed here is a modified version of PMDC’s existing curriculum. Only fifth year is added, new subjects relevant to international and local practice needs are incorporated and existing subjects are redistributed.

CONFLICT OF INTEREST

None

FUNDING

None

REFERENCES

1. American Dental Education Association. Dental school curriculum. https://www.adea.org/GoDental/Future_Dentists/Dental_School_ Curriculum.aspx [accessed 29 June, 2020].
2. Pakistan Medical & Dental Council. Recognized dental college in Pakistan. http://www.pmdc.org.pk/recognizeddentalcollegesinpakistan/ tabid/167/default.aspx [accessed 29 July 2020].
3. Pakistan Medical & Dental Council and Higher Education Commission Islamabad Pakistan. Curriculum of BDS. Published 2003. Available at: http://www.pmdc.org.pk/ LinkClick. aspx?fileticket=06HF%2Blta1uc%3D accessed 29 July 2020].
4. Higher Education Commission Islamabad Pakistan. . Curriculum of bachelor of dental surgery (BDS). Five years programme -Revised 2011. https://hec.gov.pk/english/services/universities/RevisedCurricula/Documents/2010-2011/Draft-BDS-2011.pdf [accessed 29 July, 2020].
5. Khan FR. Similarities and differences in specialty training of Conservative Dentistry and Endodontics (India), Operative Dentistry (Pakistan) and Restorative Dentistry- Endodontics (United Kingdom). J Pak Med Assoc. 2020;70:320-3. https://doi.org/10.5455/JPMA.2934
6. Khan FR, Mahmud S, Rahman M. Pediatric dentistry training for dentists in Pakistan. J Pak Dent Assoc. 2013; 22:03-8.
7. Khan FR, Mahmud S, Rahman M. The need of paediatric dentistry specialists in Pakistan. J Coll Physicians Surg Pak. 2013;23:305-7. PMID: 23552549.