The views of European students on the inclusion of research in undergraduate Oral Health Professional curricula

Introduction: The education of Oral Health Professionals (OHPs) is variable across Europe and consequently, there is concern that research skills are not consistently or optimally integrated into European OHP curricula. The aim of this study is to investigate the perspectives of European OHP students regarding the inclusion of research in the undergraduate curriculum. Materials and Methods: A 21-question online survey was administered to dental, dental hygiene, and dental hygiene and therapy students across Europe. Informed consent was obtained from

qualifications (2005/36/EC). 4Although the directive provides overarching guidelines regarding the length and type of training that should be given to dentists, details concerning the content and mode of delivery are open to broad interpretation by dental educators across Europe and decided at a national or local level. 1Training of other oral health professionals such as dental hygienists or therapists (DHTs) is not regulated by a European directive and is often managed nationally by individual regulators. 1,2e Association for Dental Education in Europe (ADEE) has formed a large network of dental educators in Europe and has supported work aiming to harmonise OHP education through taskforces, annual meetings and special interest groups. 1 Through an international task force and consultation, the Graduating European Dentist (GED) curriculum was developed and published in 2017 to provide recommendations for best academic practices in dental education. 5The four current domains of GED are Professionalism, Safe and Effective Clinical Practice, Patient-Centred Care and Dentistry in Society. 5ientific advancements and research in dentistry are essential in driving improvements in patient care.7][8] Due to the variation in OHP education across Europe, there is concern that research is not consistently and optimally integrated into the OHP curricula.Whilst learning outcomes relating to research are included in the current GED curriculum, these are broadly separated across multiple domains.As there is no separate domain within the GED curriculum that focuses on research and explicitly outlines the expected research skills of graduating OHPs, the inclusion of research within the curriculum is open to interpretation by dental educators across Europe.OHP institutions have demonstrated various approaches to including research as part of their curricula ranging from student research clubs, mandatory theses, research projects and research methodology courses and electives. 9,10e to the mutual recognition of qualifications of European graduates in the EU, the mobility of students and OHP professionals across Europe may bring together professionals with different experiences and skills sets. 1 The development of a research domain could help harmonise the teaching and assessment of OHP research skills across Europe.To account for differences in healthcare settings and individual professional expectations, an open curriculum approach could enable a framework that also allows for flexibility and customization to meet the needs of individual learners, institutions and healthcare systems across Europe.In an open curriculum, there are fewer prescribed courses or requirements, and students and institutions have greater freedom to explore various educational pathways. 11 an effort to develop an optimised approach to the inclusion of research in European OHP education, the perspectives of dental, dental hygiene and dental therapy students towards research in the OHP curricula are to be considered in this study.The successful implementation of educational research outcomes relies upon the understanding of how students experience and perceive their studies. 12,13udent feedback related to learning experiences at European OHP institutions can provide valuable insight into enhancing research-related learning experiences in OHP curricula.Students' attitudes towards research inclusion in the OHP curriculum can be gauged to better understand student needs and interest.By understanding the student perspective, relevant student-centred strategies for research inclusion in OHP curricula and improved learning outcomes that help harmonise dental education in Europe can be developed.
The aim of this exploratory study is to investigate the perspectives of European OHP students regarding the inclusion of research in the undergraduate curriculum.The study was initiated by the European Dental Students' Association (EDSA) which serves as the representative body for dental students across the WHO European Region and advocates for their views in national and international forums.Attitudes of European students towards research and its inclusion in the OHP curriculum and their perspective regarding research knowledge, teaching and assessment will be explored.

| ME THODS
The study was conducted under the basic principles and ethical standards of the Declaration of Helsinki.The study was approved by the Ethics Committee of Victor Babeș University of Medicine and Pharmacy Timișoara, Romania (Nr.58/22.12.2021).
An online survey was developed, and after undergoing a pilot stage it was administered to dental, and dental hygiene and therapy (DHT) students.The survey was distributed through peer dissemination by EDSA representatives and national delegates from 33 countries across the WHO European Region.The survey was also disseminated through EDSA's member email list and was advertised in EDSA's newsletter.All communication regarding the survey highlighted that completion of the survey is voluntary, confidential and anonymous.
Survey participants were provided with an information document that outlined the project aims, the methodology, data storage and disposal and any potential risks and how these were mitigated.
All the participants subsequently provided online informed consent for the survey.The survey was open from 12 February 2022 until 15 May 2022.

| Inclusion criteria
Undergraduate students enrolled in dentistry or dental hygiene and dental therapy programs at a registered university in the European Region.The WHO definition of the European Region was used which includes "53 countries, covering a vast geographic region from the Atlantic to the Pacific Ocean".

| Exclusion criteria
Undergraduate students studying in non-clinical dental courses (such as doctoral research, dental public health or dental technology), dental assistant students, students of unrelated courses, OHP students enrolled on programmes at institutes not designated as universities, and OHP students from countries outside the WHO definition of Europe.

| Instrument development
The questions of the survey were developed by the authors of this manuscript which consisted of a team of dental students, early career dentists and experienced educators.The questions were developed by identifying important topics and categories of questions that would enable investigation of European OHP students' perspectives regarding the inclusion of research in the undergraduate curriculum.
The questions were divided into categories: demographic information and participant profile (gender, country of origin, university, year of study, prior involvement in research); attitudes towards research in dentistry, research in the OHP curriculum; exposure to research and perspective regarding personal research knowledge, as well as, existing teaching and assessment methods and future needs.The survey contained 21 questions of varied type: demographic questions, Likert scale questions, multiple-choice questions and open-ended questions (Appendix 1).Completion of all questions was required for survey submission.

| Instrument pilot stage
To ensure validity before distribution to the study sample, the survey was first filled out by a sample of dental student representatives from 33 European region countries.Upon completion of the pilot survey, the dental student representatives were asked to leave written feedback so that the survey could be improved prior to the final release.Based on the feedback of the dental student representatives two co-investigators (CS, JF) made minor modifications to the survey.Any disagreements between the two co-investigators were solved by consensus.

| Quantitative data analysis
All Likert-scale statements used a five-point scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree).The categorical data were presented as frequencies and ratios, whilst the scores obtained using the Likert scale represented pseudo-interval data and were shown descriptively as mean, mode and standard deviation.Normal Q-Q plots and formal normality tests (Shapiro-Wilk) indicated significant departures from normality; hence, all statistical comparisons were performed using non-parametric tests.The level of agreement for the following two Likert-scale statements "Knowing how to interpret research is an important skill to have as an OHP" and "Knowing how to conduct research is an important skill to have as an OHP" was compared using related samples Wilcoxon signed rank test.Scores on Likert-scale statements were compared regarding the respondent's exposure to research methodology courses within the dental curriculum (exposed vs. unexposed) using independentsamples Mann-Whitney U test.In analogy, scores on the statement "I feel confident in my abilities to interpret scientific literature about dentistry" were compared regarding prior involvement in scientific activities (involved vs. uninvolved) using independent-samples the Mann-Whitney U test.All the statistical analyses were performed at a significance level of 0.05 using SPSS version 25 (IBM).

| RE SULTS
A total of 841 students responded to the survey, of which 825 were eligible for inclusion.The sample consisted of respondents from 33 countries in the European Region.More than half of the sample was female (69%) and most respondents (93%) had not been involved in research before starting their undergraduate oral health professional studies.Table 1 describes the demographics of the study participants.The results for all Likert questions in the survey are presented in Table 2 and the results of the open-ended questions are presented as word clouds.The modal year of study was the fourth year for dental student participants and the second year for DHT student participants.

| Attitudes towards research skills
There was strong agreement with the statement "keeping up to date with published research is important for delivering effective oral health care as an OHP" among both dental and DHT students (mode = 5).Responses from dental and DHT students showed agreement with the importance of knowing how to conduct (mode = 4) and interpret research (mode = 5) as an OHP (Figure 1).Dental and DHT students showed more agreement with the importance of knowing how to interpret research rather than knowing how to conduct it (p < .001).
Dental students who were exposed to research methodology courses within the dental curriculum were more likely to agree with the importance of knowing how to conduct research as a dentist (p = .026).
Dental and DHT students showed agreement with the statements "I am interested in learning more about research" (mode = 4) and "I would like more training on interpreting scientific literature about dentistry" (mode = 4).Female dental students showed a statistically significant higher agreement to wanting more training on interpreting scientific literature about dentistry than male dental students (p = .007).
Responses were slightly skewed towards an agreement with the statement "I feel confident in my abilities to interpret scientific literature about dentistry" (mode = 4) for both dental and DHT students; Dental students who had involvement in research prior to undergraduate dental studies (p = .015);attendance or involvement with scientific conferences, seminars, or workshops (p = .008);and involvement in research projects in their current dental studies (p < .001)were more likely to show agreement to feeling confident in their abilities to interpret scientific literature about dentistry.Conversely, dental students who reported no exposure to dental research opportunities were more likely to show disagreement (p = .001)with this statement.
DHT students who reported attendance or involvement with scientific conferences, seminars, workshops or research projects were more likely to feel confident about their abilities to interpret scientific literature about dentistry (p = .021).

| Research in the OHP curriculum
Dental and DHT students had neutral opinions to the statements "My dental program has made me more enthusiastic about research" (mode = 3) and "I feel that my dental curriculum provides me with enough training regarding research" (mode = 3).
For both dental and DHT students, there was disagreement with the statement "My OHP program provides clear guidance on how to get involved with extracurricular (outside of the normal programme) research activities" (mode = 2) (Figure 2).

| Perspective regarding research skills, teaching and assessment
The qualitative data were presented using word clouds.Responses the responses of students were largely positive (86%), showed support for the initiative and would value a collaborative approach to developing the curriculum (Figure 3).Students suggested that any future open curricula should consider the challenging nature of dental education and the limited time with the curriculum (Figure 6).

| DISCUSS ION
This study shows that OHP students recognise the importance of research skills for their future careers and value the inclusion of research in the OHP curricula.These results are similar to a survey study that found that US dental students' response to research integration in the dental curricula was largely positive. 16[19][20] TA B L E 1 Demographics of the study participants.Future studies are recommended that include the perspectives of dental educators and that report on regional, local and professional differences.Previous analyses have found word clouds to be a potentially unreliable method of data presentation, particularly for the identification of main themes and contextualization of findings.

Gender
However, in this initial exploratory study, the word clouds simply display the words and phrases that were most often used by students to respond to open-ended essay questions.Given the objectives and scope of the study, there was no effort to contextualise these Two co-investigators were involved with the qualitative analysis (CS, IL).Qualitative analysis was required for the open-ended questions "What do you think dental students should know about research before they graduate", "How do you think research skills should be taught", "How do you think research skills should be assessed?"and "What are your thoughts on an open curriculum for research in OHP education and do you have any suggestions?".A content analysis of the grounded theory approach was carried out manually for word and phrase frequency.14,15Any disagreements were resolved by consensus between the co-investigators.The software WordA rt.com was used to develop word clouds for the open-ended questions "What do you think dental students should know about research before they graduate", "How do you think research skills should be taught", "How do you think research skills should be assessed?".Word clouds have been incorporated to represent a corpus of the linguistics used by students in their responses as a crude way of displaying common words.

Figure 3 .
Figure 3.The answers of students were centred on knowing how to find reliable sources, interpret, understand and apply research to patient care in daily clinical settings.Responses expressed by students on how they think research skills should be taught and assessed are reported in Figures 4 and 5. Students indicated that research skills should be taught through discussion groups, workshops, projects, seminars and practical activities.Students expressed that final theses, exams, presentations, essays and critical appraisals were appropriate methods for the assessment of research skills.When asked about their thoughts on an open curriculum for research in Oral Health Professional Education, Some of the limitations of the current study include the differences in various educational models in the European Region and the lack of statistical power in the sample size of survey participants.

F 3 F I G U R E 4 F I G U R E 5 F I G U R E 6
responses.As the first European-scale survey of OHP students' perception towards research inclusions in the OHP curriculum, the Word cloud of responses to the question of what OHP students should know about research before they graduate.Word cloud of responses expressed by students on how they think research skills should be taught.Word cloud of responses expressed by students on how they think research skills should be assessed.Sentiments expressed by students on an open curriculum for research in Oral Health Professional Education.
16000579, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/eje.12917by Welsh Assembly Government, Wiley Online Library on [07/05/2023].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/eje.12917by Welsh Assembly Government, Wiley Online Library on [07/05/2023].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License Mean and mode for Likert Scale Questions.
to teaching and assessment across Europe.To account for regional differences in healthcare settings and individual professional expectations of students, an open curriculum model would the OHP curriculum.Based on the student's responses, research curricula should aim to enable OHP students to effectively interpret research, find reliable sources and apply research to daily clinical practice.Students' answers varied on how research skills should be taught and assessed but common themes included: projects, practical work, presentations, exams, final theses, and critical appraisal exercises.
Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/eje.12917by Welsh Assembly Government, Wiley Online Library on [07/05/2023].See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions)on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License