The John Kelly Award for UDL in Further & Higher Education 2024 - Implementing Universal Design for Learning (UDL) in Dental Education: A Commitment to Inclusive, Student-Centred Teaching

Introduction

This article explores the systematic implementation of Universal Design for Learning (UDL) principles in dental education, particularly within the hands-on practical sessions of a 5-credit module covering the Dental Morphology, Histology and Embryology at University College Cork (UCC). The main goal for restructuring the module was to create an inclusive and accessible learning environment that meets the diverse needs of students from various backgrounds, abilities, and learning preferences. This was achieved by redesigning teaching methods, materials, and assessments to align with the UDL guidelines. Students played a crucial role as co-researchers, ensuring their feedback was integrated at every step. These efforts were closely tied to the broader goals of Academic Integrity and Connected Curriculum at UCC, ensuring research-led educational experience and alignment with institutional values.

Dental Anatomy Education

The word dental student has changed over the last few years and now includes not only students undertaking a bachelor dental science degree but also students working towards dental hygiene, dental therapy or dental nursing qualifications. These students will perform oral examination, dental scaling, restorations and even minor surgical procedures on patients in the early years of their career. Anatomical knowledge especially related to tooth anatomy is, therefore an important component of early training to ensure safe clinical practice (Bakr et al, 2016).

Learning tooth morphology or the anatomy of the tooth requires visualization, understanding of the 3D features of the various teeth, and knowledge of their dynamic interactions with each other. Dental students need detailed tooth morphology knowledge to aid in identifying the teeth and then reproducing and replacing lost tooth structure.

Traditional methods of teaching tooth morphology include studying extracted or plastic teeth, clinical photographs, drawing teeth, carving teeth on soap or wax. These activities reinforce the development of psychomotor skills that can later be implemented and utilized in the clinical setting to restore the morphology of the tooth. While students are often eager to learn this taught module, its application is not until the later clinical years, thus creating a gap between the learning and the application of the knowledge which has been termed as ‘decontextualized technique learning’ (Obrez et al, 2011; Magne, 2015).

Although the conventional teaching methods are effective, they often fall short in addressing the diverse learning needs of modern students. Integrating the Universal Design for Learning (UDL) principles and innovative technologies can help dental anatomy education become more inclusive, engaging, and impactful (Ciolfi et al, 2024).

Challenges in Teaching Dental Anatomy and Understanding the Learner Profile

One persistent challenge noted in teaching dental anatomy is the limited availability of good quality extracted human teeth for practical sessions and student learning. This shortage hinders students' ability to visualize and understand complex anatomical structures, a critical skill for their future careers. Moreover, anatomy as a subject demands’ strong visualization skills, which traditional methods do not always adequately support and is especially challenging for those with learning disabilities or other unique learning needs.

The current student cohort in the dental anatomy course includes 60-70 individuals, including students from a 5-year bachelor's program in Dentistry and those from a diploma program in dental hygiene. The dental hygiene program predominantly consists of women, including several mature students with families and children. In contrast, the dental program has a more balanced gender distribution, primarily composed of younger undergraduate students, along with a smaller proportion of mature learners. Additionally, the dental program reflects greater diversity in ethnic and cultural backgrounds.

This diverse profile underscores the need for including new teaching strategies that cater to varied backgrounds, learning preferences and allows students to learn at a time and in a way that suits their personal circumstances.

Redesigning the Module

For redesigning the module, the following steps were undertaken.

Goal Setting and Planning: Laying the Foundations for Inclusivity and Student Partnership

The first phase of UDL implementation involved setting clear goals that aligned with the UDL framework while emphasizing student involvement as co-researchers. The aim was to offer multiple means of representation, expression, and engagement, fostering inclusivity. The redesign was informed by UDL checkpoints and the collaborative input of students, whose experiences and insights helped shape the teaching methods and materials. By involving students as partners in the development and refinement process, their voices were central to the pedagogical choices made.

Selection of Methods and Materials: Survey of Dental Anatomy Educators in the UK and Ireland

The first step of this redesign was a survey of dental educators across the UK and Ireland to assess best practices for teaching tooth morphology. To gather this information, a survey was conducted from dental educators across the UK and Ireland. The survey provided a comprehensive list of the teaching tools used in dental education. This information was invaluable and served as the foundation for the redesign (Lone et al, 2018).

Assessment of Student Needs

Students' feedback was collected to gain deeper insights into the diverse learning preferences and abilities represented within the learner group, ensuring alignment with UDL principles. (Vagg et al, 2020).

Based on the educator survey, assessment of student needs and the UDL guidelines, we then proceeded to select appropriate methods and materials to support diverse learning preferences and abilities. This included incorporating multiple means of representation, action and expression, and engagement into the teaching practices.

Implementation of UDL Strategies: Flexible, Multi-Modal Learning with Integrity and Engagement

Once the framework was established, UDL strategies were implemented to offer a flexible and inclusive learning experience. Course content, activities, and assessments were redesigned to provide choice, flexibility, and accessibility. For the lectures, the format of the lectures was changed to make it more engaging for the students and include images of teeth first, followed by textual information, providing varied representation and engagement entry points. More teaching resources like extracted teeth, high-quality sets of plastic permanent and deciduous teeth were sourced. This allowed the inclusion of multiple learning stations for the practical sessions, allowing students to engage with plastic teeth, extracted teeth, and a 3D tooth morphology quiz (Lone et al, 2019), rotating between different resources in small groups. This system catered to diverse learning preferences and promoted peer collaboration and inter-professional learning between dental and dental hygiene students. The rotation model facilitated student engagement with staff and provided means for direct feedback, ensuring a dynamic and interactive learning environment.

The COVID-19 pandemic introduced challenges but also inspired innovative solutions. With the shift to online learning, free digital scans of teeth were sourced and uploaded to the Canvas, UCC’s Learning Management System (LMS). Alongside these scans, 2D flashcards, lecture recordings, and comprehensive notes were provided, ensuring students had access to a wide array of resources (Lone et al, 2021). These digital tools have since become a permanent feature of the module, based on overwhelmingly positive student feedback, providing ongoing flexibility in the learning process.

Every week the dental students can access the Canvas LMS page displaying multiple entry points to the material. Each week students are presented with lecture notes, lecture video recordings, an interactive dental notation grid linked to 3D models for permanent dentition (University of Dundee SketchFab models), and another grid linked to flash cards for permanent dentition.  While lecture notes and recordings were released in a timetabled fashion, students had continued access to previous material and learning tools, allowing self-pacing of learning.

 Fig 1. Canvas LMS page displaying multiple entry points to the material: an interactive dental notation grid (left side) linking to 3D models for permanent dentition and to 2D flash cards for the same tooth.

Blended and Innovative Teaching Tools Introduced to the Dental Students

Students these days are using Virtual Reality (VR) for gaming and also educational content. In line with the UDL principles and to keep the dental students informed about the latest innovative technologies available for teaching anatomy, anatomy tools available on VR and Mixed Reality (MR) headsets were also introduced to these students allowing them to engage with these haptic and engaging educational tools (Banjar et al., 2023).

Students as Co-Researchers: Shaping an Evolving Curriculum

Throughout this redesign process, dental students were not only learners but also co-researchers, contributing to ongoing evaluations of teaching methods and materials. They participated in action research, providing feedback that directly influenced the module’s redesign. For example, based on their suggestions, the use of extracted teeth in practical sessions was improved, and digital tools for self-assessment were enhanced, including the creation of a 3D tooth morphology quiz. This collaboration ensured that students were active participants in shaping their learning experience, aligning with the UCC’s Connected Curriculum principles, where students engage in research activities and contribute to knowledge creation.

Maintaining Academic Integrity: Ethical and Collaborative Learning

Throughout the redesign process, academic integrity was rigorously maintained. All materials, including scanned teeth and plastic models, were ethically sourced with the appropriate permissions. This focus on integrity also extended to assessments, where diverse forms of evaluation, including mock spot exams and self-assessment tools, were designed to ensure fairness and rigor. Peer feedback and self-assessment further reinforced these values, promoting a culture of academic honesty and collaboration.

Monitoring Progress and Reflection: Continuous Improvement through Student Feedback

Student progress and engagement were continuously monitored to assess the effectiveness of UDL strategies. Feedback was collected through surveys, classroom observations, and performance evaluations, allowing for real-time adjustments. Students' involvement as co-researchers in the feedback process ensured that the curriculum remained adaptive to their evolving needs. This continuous loop of reflection and improvement was critical in refining teaching methods and ensuring the curriculum stayed relevant and engaging. The results of these efforts, along with comparative student performance data, have been published in peer-reviewed journals such as the European Journal of Dental Education and Journal of Dental Education.

UDL and Dental Education Beyond the Classroom: Community Engagement

Efforts to extend UDL principles in Anatomy education beyond the classroom have been notable again with the help of the students. Events like UCC's open day and World Anatomy Day, as well as initiatives with primary school students using VR headsets, showcase the versatility of these methods. Additionally, participation in the Creative Schools Initiative and the Cork Lifelong Learning Festival highlights the applicability of UDL in Anatomy learning across different age groups and sectors with students as collaborators.

Lessons Learned and the Way Forward

By systematically applying UDL principles in teaching, a learning environment that is inclusive, engaging, and responsive to the needs of all students has been created. The involvement of students as co-researchers, the integration of their feedback, and the emphasis on academic integrity have been central to this process. This approach has fostered deeper student engagement, improved learning outcomes, and established a research-driven, student-centred curriculum ensuring all students thrive in an equitable learning environment. Through ongoing collaboration, reflection, and refinement, there is a continued commitment to achieving excellence in inclusive dental education.

By embracing these innovative approaches, dental anatomy education can continue to evolve, fostering a generation of skilled, adaptable, and inclusive professionals.

Impact of UDL Implementation and Success Metrics

UDL principles have been pivotal in transforming the dental students' learning experience. For instance, the redesigned Canvas LMS page offers multiple entry points to the material, enabling self-paced learning. Students have continuous access to previous materials, promoting revision and mastery. The effectiveness of these methods is evident in improved examination scores, as illustrated by a bar chart tracking class averages over several academic years (Lone et al, 2024).

This module redesign has also led to multiple scientific poster and paper publications for several students, including an undergraduate dental student, two master's students and a PhD student.