Khalid S. Al-Fouzan, BDS, MSEd
King Fahad Hospital Riyadh, KSA
 

It has become widely recognized that curriculum planning in any phase of education should begin with research.1,2 This is particularly true in continuing dental education, where the dentist is generally able to select the subject matter, the instructor, and the frequency of his or her participation. No other phase of education is as dependent on the preferences of the learner. Mandatory continuing education may alter this situation slightly, however. At present, irrelevant continuing education offerings that are canceled at the last minute or poorly attended waste time, money, and human resources.

The assessment of needs is an integral part of program planning in continuing education. Ideally, it is both the beginning and the end of a planning process. First, it formulates the learning objectives and then it measures whether the needs have been met through the learning activities. Basically, two types of learning needs can be measured.3 Real need - an existing deficiency in an individual, group, institution, or community. It may or may not be recognized by those who have the need, and it is usually determined at least in part by an objective observer. Felt need - a deficiency perceived by a person, group, or institution. It usually indicates educational preferences and is connected with a high level of motivation. It may or may not be a real or educational need. Felt or perceived needs in dental health care, for example, may best be identified through questionnaires or interviews with the potential course participants, whereas real needs may best be identified through strategies that include objective evaluation, such as audits, testing of performance, and observations of patients. Several studies have used questionnaires to determine perceived needs of dentists regarding continuing education.2,4,8,11   

Bauer and Bush,4 determined those other factors such as tuition, lodging expenses, distance from home, and course length which influenced demand for continuing education courses. Other studies conducted in various regions of the United States and Europe have shown a variety of topic preferences for continuing dental education.3,5-11  Dental office emergencies were the topics most frequently requested by dentists in South Carolina U.S.A and in the Thames region in southeast England.8 Operative dentistry was most requested in North Carolina and New York.7,9 Other top-rated topics have included preventive dentistry, endodontics, and crowns and bridges. 5,6,10  

Dentistry in Saudi Arabia is rapidly developing in quantitative and qualitative care. However, todate there are no published data that specifically deal with the perceived needs of the Saudi Arabian general dental practitioners for continuing education courses (CEC). Such data when available will facilitate efforts through continuing education in dentistry in the Kingdom of Saudi Arabia to upgrade the skills of all dentists regardless of their background. The development of an ongoing validated survey instrument will contribute to the defining of needs of continuing education courses for general dental practitioners in Saudi Arabia, and, by extension, in the Arabian Gulf countries. It is presumed that these other countries may also be interested in starting continuing education courses for their general dental practitioners. The survey instrument will provide information on what a model program for the new age dental technology should be.

A nine-page self-administered questionnaire with a separate covering letter explaining the purpose of the assessment was distributed to 350 dentists who were randomly selected in eight major cities within the Kingdom namely Riyadh, Jeddah, Mecca, Madinah, Tabouk, Dammam, Alkhubar, Aldahran. The needs-assessment questionnaire was developed through review of relevant literature and nationwide continuing dental education programs.2,4-6 It was field tested in a pilot study on a group of dentists in Riyadh, and appropriate revisions were incorporated. The questionnaire was distributed between December 12, 1996 and January 10, 1997.

General dental practitioners in Saudi Arabia were classified into two groups. Group 1: Saudi general dental practitioners who graduated from either of the two dental colleges in the Kingdom, or colleges outside the Kingdom. Group 2: Non-Saudi general dental practitioners from different countries with a variety of undergraduate and graduate learning experiences and expectations.

The survey instrument had two parts. Part I listed seven main questions including demographic data, the background of the individual and other data like learning preference such as the scheduling. Part II listed 60 clinical dentistry topics. For each question, need was rated on a 4-point scale, with one representing "no need" and 4 representing "critical need". Open-ended items were also included. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) and State View computer software.       

Demographic data

Two hundred and ninety-eight of the 350 general dental practitioners surveyed responded. Saudi respondents were 156 (52.4%) while the remaining 142 (47.6%) were from different nationalities. Males who responded were 173 (59%) while the females were 119 (41%). Among the foreign dentists, Egyptians constituted the majority accounting for 60.7%. Most of the Saudi general dental practitioners received their training either at King Saud University (136 [88.8%]), or King Abdullaziz University (15 [9.8%]). Two Saudis received their training in foreign dental schools. The non-Saudi dentists received their dental education in a diverse number of dental schools. Of the non-Saudi respondents, 38% reported that they had their professional training in Cairo University, 22% in Alexandria University, and others (40%) in different universities worldwide.

Although the year of graduation of the respondents ranged from 1963 to 1996, 137 (50%) graduated between 1990 and 1996, 105 (38%) between 1980 and 1989, and the remaing 31(12%) graduated between 1963 and 1979.

In response to the question "Where do you practice dentistry?", 101 (35%) responded "Private clinics". Others were in primary 89 (31%), secondary 28 (10%), and tertiary 71 (24%) care clinics. Regarding the question on "the years of administration if applicable", 33 (11%) responded positively, 39% (13) of whom had at least one year administrative experience. One respondent had nineteen years of administrative experience.

In response to the question "How many continuous education courses did you attend during the last two years?", 80 (31%) attended more than four, while 116 (46%) attended only one or two courses during the preceeding two years as shown in Table 1.

In response to the question " Which day of the week do you prefer to attend a continuous education course?", 96 (33%) preferred Thursday followed by Saturday 78 (26%).

Academic deficiencies data

Almost half of the general practitioners responded "No" or "Little" need to removable prosthodontics course as shown in Table 2. There was quite strong support (150 [53%]) for "Jaw Relation" as it relates to removable prosthodontics with a mean value of 2.57. "Examination and Treatment planing" and "Partial denture design" showed almost equal need, while there was only a minimal need for "Full dentures" and "Impression procedures" with a low mean value of 2.28 and 2.24 respectively, as shown in Table 2.

Table 3 showed the response to Fixed prosthodontics. "Laboratory procedures", "Bridge design", "Porcelain fused to metal restorations", and "Tooth preparation", were reported as needed by more than half of the respondents. "Tissue management"; and "Temporary restoration and cementation" had less interest.  

The third competency area was Operative dentistry (Table 4). "Esthetic consideration in operative dentistry" was viewed as a definite need; as was "Retentive pins in operative dentistry". There was minimal interest among the respondents toward "Biologic aspects of operative procedures" and "Amalgam restorations and tooth preparation" with a very low mean value of 2.39 and 2.22 respectively.

There was overwhelming positive reaction from respondents when asked about their perceived need for "Endodontics" as shown in Table 5. Among the ten subject topics of this competency area "Bleaching of vital and non-vital teeth" rated the highest interest with a mean value of 2.90. On the contrary "Anatomy of the root canal system" attracted minimal need among the respondents with a low mean value of 2.49.      

The fifth competency area listed was "Periodontics" as shown in Table 6. The "Periodontal treatment of medically compromised patients" and "Management of periodontal emergencies" were considered to be of great need with mean values of 2.84 and 2.81 respectively; while minimal need was perceived for "Periodontal instrumentation" with a low mean value of 2.24.

"Pediatric dentistry", the sixth major competency area was perceived as an appropriate subject for continuous education as shown in Table 7. "Nitrous oxide-oxygen inhalation for children" was considered a critically needed course by 70% [200] of the respondents. "Endodontic treatment and traumatic injuries"; "Behavioral management"; and "Prosthetic treatment of children" were considered as needed. "Diagnosis of periodontal disease in children" received a low interest among the respondents with a low mean value of 2.36.

Demographic data

Analysis of the demographic data reveals that most of the general dental practitioners in the Kingdom are recent graduates who already may have learned newer developments and procedures during their dental education. Thirty one percent had attended more than four continuing education courses during the previous two years, while about forty six percent had attended either one or two continuing education courses during the previous two years. In U.S.A., prior to World War II, perceived need by dentists for continuing education was little, but as the need for continuing education became more apparent, especially to the dental practitioners, dental societies, study clubs, and dental schools began offering continuing education courses.12,13 Continuing education was voluntary14 until Minnesota became the first state to implement a continuing education requirement for licensure renewal in 1969. Now, continuing education requirements are mandated by many state dental societies and dental boards.7,14 In order to improve effectiveness and efficiency in the provision of dental care among the general dental practitioners in the Kingdom of Saudi Arabia, continuing education opportunities should be permitted and actively promoted by institutions employing dentists. Mandatory continuing education as a requirement for relicensure should be considered. The results also suggest that dentists prefer courses to be offered on either weekends or shortly after weekends. Block et al5 also found a preference for one-day programs that were held on Friday or Saturday. Hamilton et al10 in their study described a preference for weekday evenings on Friday or Saturday. Overall, such preferences indicated a desire to minimize disruption of the work routine.

Priority ranking by content

Table 10 lists the top ten items identified most often by the general dental practitioners as "greatly" or "critically" needed. Eight of the ten items are related to orthodontics, and oral and maxillofacial surgery. All the four topics in the competency area of orthodontics showed critical need among the general dental practioners. Based on this, continuing education planners in the Kingdom should concentrate in these competency areas as they relate to clinical dentistry. Results also showed that there was high interest expressed by the general dental practitioners in clinical dentistry topics, such as "endodontic treatment and traumatic injuries", "behavioral management", "treatment of traumatized teeth", "bleaching of vital and non-vital teeth", "periodontal treatment of medically compromised patients" and "management of periodontal emergencies".

The ten items mentioned least often in needs score are listed in Table 11. Four of them relate to removable prosthodontics.

Recent literature assessing the need of continuing education is limited.3,9,15-17 Four of the most recent surveys were conducted between 1981 and 1984,3,15-17 while another was completed over a decade ago.9 Despite differences in topic content and analytical methods, results from these surveys showed that there are differences in preferences along the following categories: generalists and specialists, experience level, age, urban and rural dentists,  solo and group practitioners.3,9,17  The relatively low interest may be related to the following factors: (1) dentists may delegate some of these procedures and therefore may send auxiliaries to the programs rather than attend themselves; (2) dentists may believe they already have a good grasp of such fundamentals as cavity design and manipulation of amalgam alloy; (3) practitioners may believe it inappropriate to try to acquire a large, specialized body of knowledge through traditional continuing education courses 

Priority ranking of the eight competency areas as it relate to Part-I

Orthodontics, oral and maxillofacial surgery, and pediatric dentistry received the most enthusiastic support while operative dentistry and removable prosthodontics received the lowest interest.  Factors such as level of dental education, years of experience, and participation in the continuing education courses could potentially influence these perceived needs for educational topics. Further research efforts should be directed toward identifying these factors. To ensure that the special dental needs of the community being served are met, and to address the educational needs of the general dentists, CE program planners, at all levels of Dental Health Care team, must give consideration to the differences in perceived needs that exist between the various groups cited in this study. In addition, these perceived needs should be reassessed on a regular basis. Even though this study was designed for general dental practitioners in Saudi Arabia, the questionnaire, the methods of analysis, and the results, with modification and refinement can be readily converted for use and application in government, public, or private dental organizations.

The author would like to express his gratitude to Prof. Marwan Abou-Rass, Chairman, Department of Endodontics, University of Southern California, School of Dentistry, for his help and advise in the questionnaire design and for his contribution and guidance. Special thanks is extended to Dr. Nasser Al-Zaid, Dr. Abdullgani Al-Quadi, Dr. Ghazi Holdar, Dr. Khalid Omar, Dr. Akeel Al-Akeel, and Dr. Khaled Al-Hussein in distributing and collecting the questionnaires. Finally, my gratitude to Prof. Hezekiah Adeyemi Mosadomi, for his help in the preparation of this paper.

Address reprint requests to:

Dr. Khalid S. Al Fouzan
King Fahad National Guard Hospital, Dental Dept. 1243
PO Box 22490, Riyadh 11426, KSA