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Articulation of the Basic Sciences with Clinical Activities in UNI Projects


Dr. Carlos GigouxDirector of the Oral Pathology Reference Institute, University of Chile Santiago, Chile
The articulation of basic sciences with clinical activities represents an important and challenging component of the UNI Projects. Some of the variables to be considered are discussed in the following, along with possibilities for further study of each.

Teaching Basic Sciences

There are several modalities of teaching basic sciences, which are related to the curricular design, horizontal or diagonal, or to the organization of by thematic units, particularly useful when teaching problem-solving. In reality, this method is used least frequently because it often requires complex organizational arrangements in developing curriculums. The so-called "diagonal" approaches are more common, in which professional coursework and activities are included in the first year of study. Unfortunately, basic science disciplines are rarely integrated with clinical courses in either formal or informal arrangements. Nonetheless, it is hoped that basic science academicians will understand the relevance of these subjects to dentistry, stay abreast of the literature and increasingly strive to integrate teaching with the clinical sciences to the fullest extent possible.

Another important factor relates to who is teaching basic sciences. On some occasions, these courses are taught by dentists that are faculty members in the Dental School; on others, they may be taught by either dentists or non-dentists from distinctly different schools which can be rather far removed from clinical health care fields.

>Health Services Characteristics

Coordination between universities and health services is integral to the success of the UNI Projects. Unfortunately, the disarticulation between basic sciences and clinical activities often seen in academic settings tends to prevail in community and health services environments as well. Whether or not dental offices are physically joined with other health facilities, dental care is generally provided with little interaction among health professionals. Dental practice typically follows a routine which is in part designed to meet a variety of administrative requirements.

In some cases, dentists are associated with hospital staffs and have opportunities for interaction with physicians, nurses, etc. from other services. Unfortunately, these situations represent a minority and often depend on circumstances of personality rather than quality in design. Thus, generally speaking, basic science disciplines are not well integrated with dentistry, which effectively limits the quality and scope of dental practice in the primary care setting.

Possibilities for Increasing Articulation between Basic and Clinical Sciences in the UNI Projects.

Considering the characteristics of present dental curricula, the integration of basic sciences is somewhat precarious. Accordingly, it seems convenient to explore other possibilities for change in modes of dental practice, especially in the community. While some aspects might potentially interfere with reaching the proposed UNI objectives, on the other hand, there is certainly much to be gained from shaping students for new professional roles. Specific advantages would include:

1. Orientation of the basic sciences toward dental problems.

2. Incorporating biological theory into dental practice.

3. Developing and applying diagnostic or lab procedures in the dental clinic.

4. Motivating basic science teachers for increased interaction with the practice of dentistry.

5. Interaction of dental staff with other health professionals, through multi-disciplinary analysis of clinical problems.

6. Increasing the knowledge base of dental professionals.

Possible disadvantages might include the following:

1. Increased potential for disagreement among professionals which might interfere with clinical outcomes.

2. Diversion of human resources from basic sciences.

3. Underutilization of lab procedures which facilitate accuracy in diagnosis and increase in operations cost.

Levels for Articulating the Basic Sciences in the UNI Projects

The articulation of basic sciences in the programmed activities of the UNI Projects could be done in several ways with varying degrees of complexity. It is important to consider the characteristics of each participating institution and to assess the chances for program success before making a decision. Strategically, it is preferable to establish attainable objectives which, once reached, may be easily extended. Increased articulation of the basic sciences could be achieved at one of the following levels:

1. Integration of basic sciences in all curriculum activities;

2. Incorporation of basic sciences teachers in the development of clinical activities in community settings;

3. Application of basic sciences concepts in planning, with input from basic sciences faculty.

Areas for Involvement of Basic Sciences in the Dental Practice of UNI Projects

Regardless of the level selected, there are some actions that may be universally applied to clinical care. It is important to work with motivated professionals, students and personnel to establish a level of conviction necessary for professional creativity within the practical limits of dentistry. To achieve this, the proficiency of professional staff must be increased, especially in regards to integration with other health professionals. This creates a common knowledge of the scope of participating disciplines and associated jargons. In so doing, greater proximity and coordination of activities can be achieved. Some of these possible areas for involvement are:

1. Training for dental services staff members committed to the UNI Project;

2. Training academic clinicians in basic sciences;

3. Informing basic science teachers about clinical problems;

4. Reinforcement of basic clinical concepts for students through continuing education, audiovisual media, manuals, etc., especially in relation to community care.

5. Development of thematic units related to dentistry which are of interest to and appropriate for discussion by health services staff at different levels. Meetings should be attended by physicians, nurses, dentists, etc. and should occur regularly or as needed. Pain management, for example, is an area which is suitable for integration between the basic and clinical sciences.

6. Increased collaboration in comprehensive diagnosis, considering socioeconomic, biological, and related factors, utilizing appropriate clinical records to facilitate quality in obtaining patient histories and treatment planning. Ideally, this process should be coordinated with the patient's medical evaluation, and should include relevant information concerning unusual conditions of the oral cavity and early manifestations of systemic disease. This record is also important in the caring for healthy individuals, children, pregnant women, etc.

7. Developing research studies concerning community problems, by using or applying basic science methodologies, (e.g. determining fluoride levels or bacteriological counts in water supplies, caloric content of dietary foods, etc.)

8. Application of basic sciences knowledge for the improvement of the practice of preventive dentistry; for example, development of laboratory diagnostic methods for office use, etc.

9. Strengthening infection control measures through the increased understanding of their scientific foundations;

10. Planning and promotion of simple self-care health practices based on clinic and basic knowledge of the disease. Epidemiological studies should be conducted to determine community risk factors for diseases and to estimate their frequency through self-assessments of oral health.

Projection for Future Articulation of Basic and Clinical sciences

This process should not be considered as an academic exercise but, rather, as an opportunity for real change in modes of dental practice beyond the time frame of the UNI Projects. For dentistry to be better integrated in health services, tangible measures must be adopted to meet the specific health needs of each community. In addition, it is imperative that dental schools develop curriculums to be consistent with health needs and services outside the university environment. Dialogue among health professionals should be equally realistic, based on common problems and the due respect for each other. The experiences of each profession can contribute significantly to the search for ways of increasing multidisciplinary interaction. Furthermore, the basic sciences are shared among health professions and thus provide additional elements for enhanced integration.


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