A colleague pointed to a possible misconception in my previous criticism of IKO’s postgraduate training program “Clinical Dentistry” where I had written,

“Frequent mentioning of a “holistic” and “patient-centered approach” in the Study Plan [of Clinical Dentistry] may indicate that the planning committee had an allegedly novel idea in mind. Hence, treatment should differ from previous, mainly tooth-related, repair. But what the committee probably meant, comprehensive dental care, is not a new concept at all.”

Well, “comprehensive dentistry” as I understand it is, in fact, holistic by definition (meaning considering systemic health in its entirety when addressing oral problems) and, of course, patient-centered.

But the colleague pointed to some brief discussions about a position paper by former institute leader Eriksen et al. of 2008, in which a “patient-centred clinical teaching profile in the undergraduate dental curriculum at the University of Tromsø” is described. He mentioned a  certain “biopsychosocial model” which is described in this particular paper and  which might in fact have been the basis for a certain model of patient-centered teaching at IKO [1].

In their paper, the authors describe the differences between a “traditional specialist-directed treatment to comprehensive, patient-centred care,” as follows,

“The traditional model is characterised by a specialist role model, student-centred instruction, segmented patient care with focus on procedures and numerical requirements. In contrast, the comprehensive care model has a generalist role model with patient-centred education, evaluation and management focus and qualitative requirements applying criteria of competence for student evaluation.”

They further mention various models of physician-patient relationships such as a traditional “authoritarian” (paternalistic), “reflective, learning in action” or “interpretive and deliberative model reflecting increasing concern for the patients’ values and integrity in the treatment planning process,” which may be adopted in teaching/learning process as well but actually depends quite a lot on experience which is completely lacking in undergraduate students.

The paper eventually aims in contrasting three main “designs” of dental students’ clinical training,

1. “The patients are primarily serving the teaching goals of the student clinic. Dental treatment is decided by specialists and performed in a segmented setting primarily based on the detailed needs of the student. The patient acts as a ‘supplier’ of clinical conditions necessary for the student’s record.

2. Comprehensive treatment is emphasized and performed, but the patients may primarily be serving the teaching goals of a specialist-dominated student clinic. Treatment may be completed by clinical instructors or hospital dentists in order to compensate for the lack of sufficient qualifications of the students in order to avoid unnecessary suffering from the side of the patient,

3. The treatment planning is primarily based on the perceived needs as seen from the patients’ perspective and the clinical teaching process is adjusted accordingly.”

So, while patients are considered “suppliers” in the two former designs, the “customer” aspect is emphasized in the latter. The first “design” is, for obvious reasons, considered outdated even by the authors, and denounced accordingly as conforming to a “segregated and highly specialised clinical setting with teaching usually based on the prevailing philosophy of authoritarian professors.” This is the traditional departmental teaching in which “treatment strategies are usually poorly coordinated,” and “the way of ‘using’ the patients may challenge ethical principles for proper clinical conduct.” They rightly conclude that “[t]his teaching regime does not comply with modern principles of comprehensive care and the development of critical thinking skills.” [2]

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