J Dent Educ. 71(9): 1210-1216 2007
© 2007 American Dental Education Association
International Dental Education |
Accreditation of Dental Programs in Australia: A Thematic Analysis of Recommendations, 1996–2004
Gina Arena, B.A. (Hons), M.A., Ph.D.;
Estie Kruger, B.Ch.D., M.Ch.D.;
Marc Tennant, B.D.Sc., Ph.D.
Key words: Australian Dental Council, dental schools, education, accreditation
Submitted for publication 12/08/06;
accepted 05/18/07
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Abstract
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For dental education to continue to grow in Australia, there is a need to understand the effect of new innovations and to reflect on the way the profession as a whole has adapted to the highly innovative environment that is modern dental education. The Australian Dental Council’s (ADC) accreditation activities for undergraduate dental programs is one constant over the last ten years that can be used to provide some insight into the reactions of schools to threats and opportunistic solutions brought about by change. In this study, accreditation reports were analyzed to provide trends in the themes of accreditation findings over the last ten years. The hypothesis was that the themes emanating from the findings of accreditation will reflect changes over time as schools have adapted to the changing higher education environment. A total of 820 recommendations were collated from twenty-one reports. From the recommendations collated, a series of themes were identified; predominant themes included staff, external relationships, funding, structure, documentation, curriculum, and communications. No clear trends in terms of recommendations were noted over the study period, and themes remained fairly consistent over the years. The outcome of the study did not support the hypothesis that changing trends in accreditation recommendations over the last ten years would reflect changes in the environment in which education providers are operating.
Dental education in Australia has faced many challenges over the last ten years.1 These challenges have resulted in adaptations by dental schools to the new environments in which they operate. It is widely acknowledged that the future of dental education remains under threat with rising costs of providing dental education (in particular, the clinical teaching) and reduced overall higher education budgets.1 Dental education in Australia has for some sixty years taken place in five dental schools. In the last five years, one new school has opened, and another couple are planned. All schools are government funded; no fully private dental programs exist in Australia. In total, between 200 and 250 dental students graduate each year and enter a dental work-force of approximately 10,000 practitioners.
It is against this backdrop that innovations in dental education have occurred in a number of universities, and a number of new dental programs have been established. Changes include curriculum restructuring and the introduction of problem-based learning. A number of schools have also moved towards a very high emphasis on community placements in the final year of the program, thus moving students outside the physical bounds of the school environment. For dental education to continue to grow in Australia, there is a need to understand the effect of these innovations and to reflect on the way that the profession as a whole has adapted to the highly innovative environment that is modern dental education.
One constant over the last ten years that can be used to provide some insight into schools’ threats and opportunistic solutions is the Australian Dental Council’s (ADC) accreditation activities for undergraduate dental programs (including dentistry and oral health). This accreditation process has not fundamentally changed over the period, and schools, old and new, have been measured against the guidelines that underpin the process. Accreditation is the public recognition accorded to a dental program that is judged to meet established qualifications and educational standards through periodic evaluations. The maximum period of accreditation is seven years, but the Accreditation Committee recommends a period of accreditation to the ADC based on the assessment team’s recommendation and report. A course is evaluated on the extent to which it accomplishes its stated goals. In dental education, there is diversity, and in this diversity, there is potential strength. The accreditation process, therefore, seeks to maximize potential strengths while ensuring basic expectations for quality dental education are met.
In this study, the publicly available materials of the ADC were analyzed to identify trends in the themes of accreditation findings over the last ten years. It is assumed that the accreditation process will identify strengths (positive comments) and weaknesses (recommendations) related to all aspects of the institution’s professional program. If new innovations and/or change lead to any problems/weaknesses or strengths, it is expected that this will be reflected in the accreditation findings. The hypothesis is thus that the themes emanating from the findings of accreditation will reflect changes over time as schools have adapted to the changing higher education environment.
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Materials and Methods
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The accreditation process is governed by the joint ADC/Dental Council of New Zealand’s Accreditation Committee. The committee advises the council on accreditation policy and procedures. For each assessment of a course, the Accreditation Committee sets up an expert team.2 Teams are made up of members from dental science and clinical disciplines and from a range of dental schools. The accreditation process is conducted within the guidelines of the ADC for the accreditation of dental programs.2 In working terms, the accreditation process involves written submissions addressing the guidelines that are reviewed by a visiting team selected by the ADC. The visiting team can ask for clarification of the documentation, but usually waits until its members attend a two-to-four-day site visit to the school under review. The site visit includes meetings with various key stakeholders, including the local dental community, university executive, and students, as well as the academic staff of the school. Following the visit, the team prepares a report for the ADC that has a sequence of recommendations based on its findings. Recommendations refer to "negative" findings. The school is provided with an opportunity to address errors of fact before the report is finalized. Following ratification of the report by the ADC, the school is then expected to address recommendations and report progress to the ADC on a time-course determined by the visiting team.
In early 2006, we asked the ADC for copies of all undergraduate accreditation reports for the last ten years. In response to the request and in keeping with its open disclosure policy, the ADC provided reports for 1996 through 2004. All reports were coded, and all references to visiting committee members, their universities, and schools of origin were removed from the reports, thereby blinding the data source for this study. A single researcher not involved in dentistry, but having significant expertise in educational process and public health, reviewed each recommendation and determined the core theme(s) for each recommendation. Using a grounded theory approach,3 Seidel’s4 model of data analysis, which is based on noticing, collecting, and thinking, was utilized. The grounded theory approach is based on noticing things in the data and assigning "codes" to them based on a topic or theme. This breaks the data into fragments, and the codes assigned to the data act as sorting and collection devices. In addition, data were collected as to which of the ADC’s twenty guidelines each recommendation was under, and this was related to themes. All data from the thematic analysis were transcribed and collated using Excel (2003).
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Results
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A total of twenty-one reports were provided for the ten-year period, and a total of 820 recommendations were collated. In the first year analyzed (1996), a total of five reports were provided. This was followed by one report in 2000, five reports in 2001, five reports in 2002, and five reports in 2004. To ensure anonymity, the 2000 report was clustered with the 2001 reports. The average number of recommendations per report was thirty-nine.
Recommendations were very broad-ranging; some typical examples are provided in Table 1
. Recommendations were made on the basis of twenty guidelines, which are outlined in Table 2. Of the total of 820 recommendations, the average number of recommendations per guideline was forty-five. No comments regarding guidelines 18 and 19 were made. Guideline 8 (the curriculum) had significantly more recommendations (n=169, 20 percent) than any other guideline (Table 2).
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Table 2. Average number of recommendations per report for each guideline, 1996–2004 (absolute numbers in parentheses)
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From the recommendations collated, a series of themes were identified, and these formed the basis of the thematic analysis. It is noted that, as each report was analyzed, a number of additional themes were found that brought the total number of themes to 103 at the completion of the data collection phase. Those themes that attracted fewer than ten recommendations over the study period were excluded. A total of twenty-six themes remained (Table 3). Predominant themes included staff, external relationships, funding, structure, documentation, curriculum, and communications. The theme on staffing issues included frequent recommendations about staff shortages, excessive workloads, limited research, and lack of reflective and educational development time available to staff. These staff issues were consistent in most reports. External relationship issues referred to school relationships and agreements with various stakeholders, including health departments and hospitals, colleges, outplacement agencies, government services, dental boards, the dental association, and the community. The theme referring to communications included recommendations on paths of communication, remote sites communication, and communication between staff and students, between staff in different disciplines, between faculties, and between schools and hospitals. The documentation theme referred mainly to documentation in general regarding the accreditation process. The curriculum theme referred to all aspects of the curriculum, including documentation, monitoring, changes, new curricula, and coordination of the curriculum. This theme was also very prevalent in all reports. The average number of recommendations per report (by theme) is shown in Figure 1. The twenty-six themes in Figure 1 are listed in Table 3. Not all themes attracted recommendations in all years. Recommendations regarding theme 9 (external relationships) and theme 23 (staff) were high. Some themes like theme 1 (assessment) have shown a decrease in recommendations over the years, whilst themes 15 (organization), 16 (outcomes), and 23 (staff) have increased numbers of recommendations over the years.
The twenty-six themes were grouped into six clusters based on some commonality between them. For example, all the themes in cluster 1 relate to management or administration issues, all the themes in cluster 2 relate to educational and curriculum issues, etc. (Table 4). Each cluster had between two and twelve themes. The cluster regarding educational and curriculum trends had the most themes, which is to be expected as the guideline regarding the curriculum had the majority of recommendations.
The total number of themes (all 103) was attributed to one of the six clusters; the distribution of these themes is shown in Table 5. The majority of themes (n=41, 40 percent) were in the educational and curriculum cluster. The total number of recommendations per cluster are also shown, and most (n=301, 38 percent) were in the educational and curriculum cluster. There were no trends over time regarding the clusters. A trend over time would imply that the number of recommendations per cluster would either increase or decrease at a substantial gradient over time.
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Discussion
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The essential purpose of the accreditation process is to provide a professional judgment of the quality of a school’s oral health program(s) and to encourage continued improvement. Accreditation concerns itself with both quality assurance and quality enhancement. The accreditation guidelines require that curricula are responsive to the health needs both of individual citizens and of communities.2 Dentists must be able to care for an individual patient in illness, assist with dental health education of the community, be judicious in the use of dental health resources, and work with a wide range of dental health professionals and other agents.2
Over the last ten years, there have been more than twenty such accreditation processes and subsequent reports related to oral health programs in Australia. From the analysis, it is clear that some of the guidelines consistently attracted far more recommendations than others. Guidelines regarding curriculum attracted most comments. Predominant themes regarding the curriculum included the content and structure of the curriculum, methodology and organization of course content delivery, and specific programs. It also included themes regarding course outcomes, evaluation, and assessment, as well as educational value. Other guidelines that attracted substantial recommendations included course administration and budget; physical facilities and resources; staff and staff development; student assessment and examination; and interface with hospital/government services. No clear trends in terms of recommendations were noted over the study period, and these themes remained fairly consistent over the years. The substantial recommendations regarding guidelines on curriculum and staff and staff development might relate partly to shifts in priorities of dental schools over the last decades, where dental schools are now trying to balance their educational, research, patient care, and community commitments. This problem was highlighted and emphasized by Howell and Karimbux,5 who refer to U.S. dental schools where the traditional mission of educating dentists has become more and more complex as a result of the increased emphasis placed on research and patient care. Although health care education clearly benefits from a rich environment including research and patient care, faculty often find themselves conflicted about their roles in the complex mix of activities.5 These same problems are also experienced by Australian dental schools.
Although several changes occurred and innovations were introduced in dental education during this time, accreditation reports did not reflect any new problems (or different weaknesses) from before. Previous research indicated that some of the obstacles to reform or introduction of innovations include dormant leadership, lack of expertise in curriculum planning, inadequate financial resources, lack of management skills, and the mindset of the faculty.6 International experience also indicates that attempts to increase efficiency and productivity within the educational system inevitably increase faculty workload. For change and innovation to occur in dental education, faculty knowledge, skills, attitudes, and values must also change.7 The outcome of this study did not support the hypothesis that changing trends in accreditation recommendations over the last ten years would reflect changes in the environment in which education providers are operating. Clearly, there is significant further opportunity to undertake detailed research on process outcomes from the dataset developed for this study in order to identify opportunities for further quality improvement.
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Acknowledgments
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The authors would like to thank Dr. Ross King, CEO of the Australian Dental Council, for his provision of the reports.
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Footnotes
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Dr. Arena is Lecturer in Medical Education, Education Centre; Dr. Kruger is Research Fellow, Centre for Rural and Remote Oral Health; and Dr. Tennant is Associate Professor and Director, Centre for Rural and Remote Oral Health—all at the Faculty of Medicine, Dentistry, and Health Sciences, University of Western Australia. Direct correspondence and requests for reprints to Dr. Estie Kruger, Centre for Rural and Remote Oral Health, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia; 61-8-9346-7248 phone; 61-8-9346-7237 fax; ekruger{at}crroh.uwa.edu.au.
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REFERENCES
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- Tennant M, McGeachie JK. Australian dental schools: moving towards the 21st century. Aust Dent J 1999; 44(4):238–42.[Medline]
- Australian Dental Council. Major activities. At: www.dentalcouncil.net.au/adcmajoractivities.htmal. Accessed: October 20, 2006.
- Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine, 1967. At: http://books.google.com/books?id=tSi7KiOHkpYC&pg=PA1&lpg=PP13&dq=glaser+bg&sig=24Ivxo8-TUBzp1dJoEf-Mbong7A. Accessed: November 12, 2006.
- Seidel J, Kelle U. Different functions of coding in the analysis of textual data. In: Kelle U, ed. Computer-aided qualitative data analysis: theory, methods, and practice. London: Sage, 1995.
- Howell TH, Karimbux NY. Academy: strengthening the educational mission in academic health centers. J Dent Educ 2004; 68(8):845–50.[Abstract/Free Full Text]
- Huang C, Bian Z, Tai B, Fan M, Chiu-Yin K. Dental education in Wuhan, China: challenges and changes. J Dent Educ 2006; 71(2):304–11.
- Haden NK, Andrieu SC, Chadwick DG, Chmar JE, Cole JR, George MC, et al. The dental education environment. J Dent Educ 2006; 70(12):1265–70.[Abstract/Free Full Text]
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Abstract
Materials and Methods
