The fifteen UNI Projects are located in eight countries. They include fourteen different health occupations, with an average of four to six careers per project. Dentistry is one of these and is included in eleven of the fifteen projects. One of the projects introduced dentistry after its inception, bringing to twelve the total number of projects including dentistry thus far.
The development of health occupations in the health services sector is, in a holistic sense, an orientation for team work, which must be based on the maintenance and strengthening of each profession's individuality. The refinement of each profession's own characteristics is a need that results from its obligation to respond to a social need. In other words, the refinement of uniprofessional education is a prime condition for developing multiprofessional work and teaching within the scope of the UNI Program's Conceptual and Operational Guidelines.
The UNI Projects represent a natural evolution from older projects characterized by teaching-care integration (IDA), which were highly widespread in Latin America in the 70's and 80's. IDA's projects were frequently uniprofessional, and community participation was often just an appendage many times the community was considered an "intervention" in and of itself. Conversely, in the UNI Projects communities are treated as subjects that shape their own destinies, with two invaluable partners: universities and health services.
1. A teaching model must be developed which aims to appropriately shape the dental professional to practice with competence. Dentists should be able to guide the profession to act in response to social needs for better oral health, with practices integrated with those of other health sectors in order to achieve better overall health for the public.
2. A research program must be created, which is complementary to basic and clinical sciences and designed to: support the aforementioned educational purposes, help dental services in areas of quality control, assist communities in embracing individual oral health practices, facilitate the use of dental services at appropriate levels, and encourage cooperation of dental leadership in organizing, implementing and evaluating oral health programs.
1. Educational priorities.
The priorities at the school level will be reviewed in regards to training a general clinical dentist, from the teaching of prevention-oriented practices to those engaging social services.
2. Professional capability.
Teaching of appropriate skills necessary to perform quality professional practice should be incorporated into clinical areas. Student evaluations should be based on individual student performance according to pre-established criteria in diagnosis, treatment planning, and patient care.
3. Active learning.
Theoretical coursework should be de-emphasized in favor of more individual and small group learning methods, especially regarding relevant themes and problems of dental practice.
4. Integration of basic sciences with professional practice.
Presently, horizontal curriculums are not considered to be the best way to teach, nor do they have an educational basis that justifies them. They almost completely separate basic biological sciences from the technical and clinical parts of the profession. The introduction of active learning methods oriented to problem-solving is an important step in any innovative educational process.
5. Preparation of teachers.
Constructive change will be severely limited by insufficient training for teachers in the principles of education. We need a revision of didactic teaching methods based on the acceptance of a group of ideas and social needs which can function as a catalyst for change. Teachers high in the educational hierarchy will have significant influence in the modeling of young teachers to update courses pedagogically without diverging from intended academic plans.
6. Health promotion and disease prevention.
Concerning priorities in dental education, this theme is implicit; nonetheless, it deserves special attention. The five levels of prevention defined by Levell and Clark in the 50's are still widely accepted. Advances in individual and community techniques of prevention have changed the panorama of professional practice within a generation in industrialized countries. These changes pose implications for higher education on the one hand and consumer utilization on the other. Dental graduates must now be readied for practice in the 21st century, with greater ethical sensitivity, knowledge of epidemiology, and training in targeting high risk populations.
7. Expansion of teaching-learning sites.
Dental schools have traditionally been self-sufficient and somewhat isolated from other professions. For the UNI concepts to become reality, schools must become more interactive with other parts of the community. This implies some degree of transition from teaching in a simulation of the real world - the intramural clinic - to teaching in the real world itself. The choice is not limited to one or the other, but rather should include both. Examples of clinical learning sites might include public health work environments such as schools, day care centers, elderly institutions, factories, etc. It is critical to include work experiences in these environments during curricular hours, with adequate supervision to attain specific teaching objectives within allotted time frames.
8. Staff work.
In the past, dentists have been trained for so-called "solo" practice, with one or two assistants. However, dentists of the future will be more likely to participate as members of health teams during the course of their professional careers. In rendering care at the primary or secondary level, they will be working more frequently with physicians, nurses, nutritionists, and other health professionals in integrated work arrangements. Current inadequacies in the training of health professionals for this level of practice are gradually being remedied by plans for increased interprofessional education, especially in Europe. The preparation of undergraduate and graduate health occupations students for this type of staff interaction is an important objective of UNI. Learning must first take place in universities at a theoretical level, by including relevant academic themes such as bioethics, health services organization and management, epidemiology, and health information systems for maximizing cost-effectiveness, etc. However, these emphases must also be incorporated into health services training at the community level. Special care should be taken not to create artificial situations of interprofessional cooperation but, instead, to seek out real- life interactive scenarios, while bearing in mind the ever-present issue of cost.
1. Education research.
This kind of research is essential to establishing the rationale for the changes proposed by UNI. It will include evaluation in areas such as student selection, teaching methods, curriculum modifications, use of information systems to monitor learning , skill-based teaching, and clinical performance including record-keeping and patient communications.
2. Clinical-epidemiological research.
This area should be of particular interest to clinical dentistry because it relates needs of the individual with those of the community. Investigations in this area will always deal with the idea of "denominator" or "target population" as well as the concept of "risk". Additionally, results from treatment and prevention alternatives and the inherent costs and trustworthiness of diagnostic, preventive and curative methods will be of paramount importance. Ultimately, the reduction of disease and cost-effectiveness will measure overall success of the program.
3. Health services research.
This area is essential to foster student learning in a quality service environment, along with a continuous process of self-evaluation and improvement. These investigations will include research projects involving service professionals, teachers, and students, according to the particular problem being studied. It will include evaluations in areas such as:
· Productivity, layout, kinds of equipment, instruments and materials, and work modules involving different combinations of professionals and assistants;
· Cost-effectiveness of services, considering factors such as material shelf-life, application techniques, time studies related to professional work patterns, etc.
· Quality control, including evaluation criteria, minimum competency guidelines, supervision, and methodologies for change
· Information systems for monitoring and evaluation
· Patient satisfaction
4. Community research.
This area will focus on the distinction between a "subject" community and an "object" community, which is an integral concept of the UNI Projects. Luckily, our communities have become intolerant of surveys, questionnaires, and indiscreet door-to-door questioning, much of which is of little to no avail. Worse yet are the promises of services and benefits that are never fulfilled. To the contrary, the focus of investigation proposed in the UNI Program's Conceptual and Operational Guidelines is characterized by participatory community input. It is made in, with and for the community. The learning is collective. Representatives from the involved community, academia, and/or health services search for information that suggests a better approach to the community's problems. It presupposes a commitment among the partners in the investigation and in the necessary actions which follow. In this kind of research, action is often immediate: the research itself is inherently part of the action.
With the participatory approach, surveys addressing oral health values and behaviors are justified. They function as the basis for establishing comprehensive programs involving self-care and professional dental services. One should remember that knowledge of the behavioral aspects of dental health should be ascertained as a reasonable starting point for communications between dental faculty and students. Moreover, it is important to know if humanitarian values and genuine attitudes necessary for community work are genuine to teachers and students, and, if not, what potential exists for internal resolution of such ethical dilemmas.