An International Perspective on Curriculum Reform

Curriculum innovation is key for educational organizations to remain current, with dental education being no exception. Similar to evolving technology, are pedagogical practices requiring new perspectives and approaches to promote teaching, deeper learning, and competencies of the modern workforce [1]. As oral health educators aim to innovate, the curriculum reform process holds similar tenets despite varying cultural and environmental differences. This paper aims to review commonalities experienced by four geographically diverse dental schools in Australia, Canada, the United Kingdom, and the United States that have recently undertaken curriculum reform. Individuals involved with leadership of curriculum development at these schools met via zoom over a 3-month period and a total of five times in preparation for a presentation at the Association of Dental Education in Europe (ADEE) Conference in Leuven 2024. The overarching drivers for curriculum innovation, getting started, and maintaining forward movement are described. Strategies used to navigate change and common lessons learned for educators to consider with curriculum reform are outlined. A curriculum is a planned learning journey with interrelated parts including learning goals, content, delivery, resources, and assessments. Curriculum development is a cyclical process that evaluates how a curriculum meets learners and community needs and is intended to adapt to meet those needs [2]. Although the ongoing process of curriculum review enables some adjustments to be made, when major concerns particularly with curriculum coherence sequencing arise, a complete redesign is often needed. Motivators for major curriculum changes can include significant advances in clinical practice, shifting healthcare needs within the community, innovations in best pedagogical practices and /or changes in accreditation, regulatory or licensing body standards. For all four institutions, the majority of these motivators drove the transformation. By its very nature, curriculum reform is a major, complex, and lengthy initiative. Typically, the total time frame from initiation to implementation of curriculum change with moderately complex changes takes from 2 to 4 years, and larger scale efforts 5 to 10 years. A similar timeline was experienced by the four institutions. Curriculum reform introduces risk and uncertainties for constituents, and the cascading changes can be stressful and challenge core norms. For these reasons curriculum reform must begin from a conducive context, integrate high levels of constituent engagement, and be founded upon systematic processes (i.e. policies, curriculum models, project planning) that are transparent to all involved. A well-defined communication plan is paramount for success. All four institutions used a framework similar to the 5-step model of curriculum reform described by Lin et al. [3]. Projects were initiated with establishing a committee that was tailored to include representation across disciplines, contexts for learning (clinical/pre-clinical/didactic), administration, and operations, as well as experts with educational, project and change management experience. Leadership support was secured, and each institute established a clear purpose and vision for their renewal committee. Curriculum mapping initiatives aligned existing content and assessments to relevant professional competencies and accreditation standards. Needs assessment activities explored internal interests (stakeholder surveys and focus groups), external drivers (institutional visits, speakers, and benchmarking processes), and mechanisms to resource the work, including faculty time allocation to fulfill project roles. Purposefully engaging all constituents including faculty, staff, students, and alumni in the early stages of the project, (e.g. in the needs assessment) ensured the drivers for change were understood. With this engagement came interest in each renewal project and a sense of community developed in each institution. Throughout the development, implementation and evaluation phases of curriculum reform, various and purposeful consensus-building strategies such as working groups, workshops, forums, and school-wide meetings occurred. These activities provided key deliverables (e.g. guiding principles, curriculum models, program frameworks, and learning outcomes) and helped continue each renewal project's momentum so that timelines were met. They also provided multiple opportunities for discussion and feedback with constituents. Despite efforts to maintain clear, transparent and rigorous actions, and structures, all institutions described periods where forward momentum stalled, the way forward became murky, designs, or plans were insufficient, or engagement dwindled. The need to trust the process, practice flexibility, and adapt iteratively, while keeping the desired interests in mind was emphasized through countless examples. While the process of curriculum redesign should be democratic, collaborative, and include all relevant constituent perspectives, it was top–down leadership and bottom–up grassroots efforts that sustained forward transformation movement. Successful curriculum change requires a well-structured, systematic approach that considers both institutional objectives and constituents needs [3]. Research shows that alignment between curriculum shifts, and an institution's core mission, goals, and educational philosophy is critical [4]. This alignment enables a sustainable change management process that contributes to an effective experience. Change management begins with understanding all constituents’ perspectives and developing a shared vision. Leaders must create an environment where all participants feel valued and heard, fostering collective ownership in the change process. Strong, consistent communication is essential to keep all constituents informed. A communication plan can provide a framework for engagement throughout the implementation phase [5]. Implementation is a critical phase of a change process and calls for utilizing structured and systematic change management methods for successful outcomes. For one institution, the Kotter's change management (1996) framework provided a structured method through three key phases [6]. First, creating a climate for change through establishing urgency, building guiding coalitions, and forming strategic vision. Second, is engaging and enabling the organization via volunteer recruitment, action enablement, and generating quick wins. Finally, implementing and sustaining change through continued acceleration and institutionalization. While this model has been widely utilized, the organizational culture is not captured and necessitates consideration for an effective strategy towards change. The interconnected nature of the educational institutions demands bidirectional engagement between faculty and administration. Another institution used Palatta's (2018) systems approach which emphasizes implementing change at the interrelated systems level through an “engage and learn” model [7]. This approach recognizes that institutional change process depends on individual change, as highlighted by the ADKAR (Awareness, Desire, Knowledge, Ability, and Reinforcement) Model that defines the outcomes an individual needs to achieve for a change to be successful. When leadership teams ineffectively guide transitions and manage resistance, individuals may lack clear understanding of both why changes are needed and how they will be implemented, causing them to miss the deeper context. The ADKAR Model provides comprehensive frameworks that leadership teams concentrate their efforts on activities that promote individual adaptation, ultimately leading to broader organizational success [8]. Quinonez et al. describes five essential components of a methodical curriculum change management process to ensure effectiveness and sustainability of the change [9]. These include adequate time and resource allocation, clear, well-defined planning, effective collaboration, consideration of institutional culture, and proper resource management. Equally important in the change management process is demonstration of commitment from the institutions leadership that maintains approachability and responsiveness to concerns as they arise [10]. Leadership should establish clear metrics for measuring both implementation progress and success, ensuring alignment of the institution and its transformation goals. Successful organizational change management requires structured frameworks, broad constituents’ engagement, adequate resources, and effective leadership. The key to sustainable change that aligns with organizational values and maintains constituents buy-in lies in clear communication, fostering collaboration, and ensuring all participants feel valued and heard throughout the change process. Although all four dental schools are at differing stages of curriculum reform completion and vary in location, size, program length, accreditation, and licensing requirements, they all encountered similar motivators, challenges and opportunities. The combined “lessons learned” below aim to provide encouragement and some “curriculum therapy” for those considering or navigating major curriculum changes. This paper represents perspectives on oral health professions curriculum reform from schools in four countries, varying in program size, and at various stages of their journey. Yet, the programs experience similar challenges and opportunities that shaped the process and outcomes. Curriculum change can be messy despite the best plan put forth. ​Innovation is sometimes analogous to “leading through a fog” and demands risk and courageous leadership. Establish a strong quality improvement process and don't let perfection be the enemy of good! Our gratitude to our institutions for their support and work towards innovating curricula in dental education. The authors declare no conflict of interest to declare.

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