In March 2020, Harvard Dental School is quite far away; All students have been sent home, and Harvard’s dental clinic — where students usually hone their skills in working with patients — has closed except for emergency care.
“We went from a full clinic and then to a tough stop: 100 mph to zero,” said German O. Galucci, chief of dentistry and biomaterial sciences.
With the closure, third- and fourth-year dental students – whose curriculum is based on clinical practice and experience – have been cut off from seeing patients. While fourth-year students completed most of their requirements, third-year students in the class of 2021 faced the challenge of meeting graduation and proficiency standards despite low clinical availability, according to Sang-e Park, associate dean for dental education at HSDM.
“I have to say it was the most challenging class – class of 2021 – that I should have graduated on time in my 20 years of dental school,” Park said.
Despite this, every member of the Class of 2021 graduated on time or early, a feat that the school’s dean, William V. Giannobel, has made for the faculty who go above and beyond to help students complete their requirements.
“What the faculty did was they ‘sacrificed’ faculty training time to open clinics to students,” he said in an October interview. “And after that they worked three nights a week, also on Saturdays, to provide for this education.”
Members of the Class of 2021 said in interviews that they were initially concerned about the abrupt interruption of their clinical education, but were impressed with how the school responded — first, by adapting its curricula online in the first few months of the pandemic, and then gradually returning students to clinical practice in person.
“I am so glad I went to a school like Harvard where, frankly, they cared so much about helping us graduate,” said Ashiyana Jevraj, a 2021 HSDM graduate who was a third-year student when I was sent home.
Taylor, a lecturer in restorative dentistry and biomaterials science, admitted that providing distance education in a particularly practical field such as dentistry has been challenging.
“There are a lot of skills that need to be practiced and need to be done under supervision when you start out, because it is a very practical profession and a very visual profession, too,” he said. “There are a lot of tactile visual things that you can’t just customize a reading to, necessarily.”
Big puzzle solving
Designing a virtual curriculum that makes the most of students and faculty time, while ensuring students meet standards for dental proficiency during lockdown, has been “like solving a big puzzle,” according to Park.
“It has given us the opportunity to be innovative – starting with digital learning, reorganizing content delivery and restructuring[ing] Of the curriculum schedule, she said.
For the first time, the school introduced remote dentistry, where students helped screen and triage patients and advise them about dentistry virtually, according to Park.
She added that patient case presentations including major rounds – where complex cases are presented to a large audience of dentists and students – and case review seminars were held virtually.
“Although they weren’t direct hands-on clinical experiences for students, we were really trying to maximize the time we had to learn remotely,” Park said.
“It cannot replace direct patient care, but it can complement the way we provide patient care,” she added.
Neil T Grescito, an instructor in restorative dentistry and biomaterials science, said the pandemic has allowed the dental school to re-examine its curriculum and reintroduce previous teaching techniques.
“We’ve used old teaching methods – classic teaching methods of hand skills like waxing – and we’ve reintroduced that into the curriculum,” he said.
The faculty sent the tools to the students at home and asked the students to record themselves using them. Gressetto said the college then assessed the students’ performance through self-evaluation and photos.
“These are the things that I think have really benefited me and my education, but maybe we haven’t been studying for some time,” he added. “They have lost their luck as teaching methods.”
Park also noted that the emerging situation brought about by the pandemic allowed for effective revision and revision of the school’s curriculum that would naturally have taken longer to enact.
“It gave us an opportunity to review the curriculum and program comprehensively in a very short period of time,” she said.
Some faculty have offered additional research opportunities and study groups to enhance the distance learning experience for students.
Hiroe B. Ohyama, a professor of restorative dentistry and biomaterial sciences, said she has recruited students to do research with her during the lockdown and has helped them publish their work.
Through the Society for Esthetics HSDM — a cross-curricular organization — Taylor said he has worked with students to create nearly 20 virtual lectures on topics ranging from basic dental fillings to the correct use of dental equipment.
Back to clinic
Ha, a 2021 HSDM graduate, who returned to dental school in July 2020, said she was afraid to go back to the clinic, since no one had been vaccinated, and had to do the procedures closely when exposed. The patients.
“It was really scary at first, I’ll be honest, to be back in the clinic,” she said. “The patient is sitting right in front of you without a mask and you’re immersed in that for a few hours, so it was really scary.”
Taylor said the initial comeback was “very stressful” for the faculty, too.
“Early on, there was an article in the New York Times that talked about dentistry and hygiene being the most vulnerable of all professions because we’re basically sitting there in a patient’s mouth,” he said. “People were really on edge. We had a really strict protocol for personal protective equipment. We were testing a lot.”
The school provided students with embroidered face shields, gowns and eye protection, and made sure they sanitized their N-95s after each use, Ha said.
Griseto noted that the school was stockpiling N-95 masks beginning in February 2020, and he predicted that the epidemic would increase and that personal protective equipment would run out.
“Because we are small, we had enough PPE to keep the place going,” he said.
The school also changed all the filters in the building and implemented additional equipment like vacuum cleaners and aerosol cleaners, according to Gressetto.
“When I look back now, there were some things we did that were probably not necessary,” he said. “But the measures that we took were very successful in the end, because we had no transmission. As far as I know, we still do not have any documented transmission of Covid-19 in the building.”
According to public health guidelines, the dental clinic is also operating at 50 percent capacity through May 2021.
This helped protect patients — in normal times, patients are only separated by a four- to five-foot wall — but also forced students to prioritize the limited time they have to exercise in the clinic, Ha said.
“Even though we weren’t in the clinic very often, I think that made the experience of each clinic even more important to us,” she said. “Because we knew time was so limited, it made us so efficient in everything we were doing.”
Ohiyama, the professor, said she also noticed that students were more focused in the clinic because they knew they had cut back on training time.
“They were very focused. I think the mentality was different from the student side and from the college as well – this is the only time we have to teach, and vice versa, like a student[’s perspective]It was the only time I could come and rehearse.”
Passion and flexibility
Despite sudden changes to HSDM syllabuses and clinical trials, every student in pre-doctoral and advanced graduate programs in the 2020 and 2021 classes has graduated on time, according to Park.
“Not only that, for the DMD program – this is a pre-doctoral program – we have a 100 percent pass rate – first-time pass rate – for the National Dental Council exam,” Park added.
Students and faculty alike credit the one-on-one mentorship and collaboration that has been fostered within the Dental School during the pandemic to ensure the continuity of student education.
Jevraj, a 2021 HSDM alumnus, said the faculty – especially the full-time professors – “really stood out” in providing support and guidance “day and night”.
“There was a professor who I remember putting his daughter to bed, and he called the phone,” Jevraj said. “He would sit on his balcony not to wake his son, just so we could talk about the cases, but also how we would meet all the prosthodontics requirements and how he would help the fourth- and third-year graduates.”
Aram Kim, professor of restorative dentistry and biomaterials science, said she and other faculty are constantly available to provide students with academic and emotional support on an individual basis.
“This was a very stressful time, and with so many meetings that were virtual and so much virtual content, there was so much loss of human contact,” Kim said. “We have a weekly check-in with the students to hear what their needs are, what they have to say, how we can get through this together, how we can help them maximize our situation, and how we can best help them prepare for the next step.”
“I totally commend all of our students for their passion and flexibility, because I can’t imagine myself going to dental school during a pandemic,” she added.
Ha said the pandemic has strengthened relationships and teamwork within the student body. She noted that the students at the school – the youngest at Harvard – are already holding together, but the pandemic has brought them together in a common struggle to graduate.
“Given the difficult Covid situation and limited capacity, because we are a very narrow group, everyone was willing to help each other,” Ha said. “People are willing to share materials, lab time, clinic time – I think it was really important to have such a tight group in order to help every other graduate.”
Daniel M. Roescher, a 2021 HSDM graduate, said he believes the school has implemented necessary changes to the curriculum and clinical trials in order to maintain the quality of education.
“I feel like we’ve done the right dental education that we set out to do — I think that’s pretty cool,” said Roystacher. “I think this speaks to the resilience of our class as a whole, as well as the school’s efforts.”
—The author can be contacted, Ariel H. Kim at firstname.lastname@example.org.
— Staff writer Anjeli R. Macaranas can be reached at email@example.com.