Certainty in Uncertain Times: Dental Education during the COVID-19 Pandemic-A Qualitative Study

The COVID-19 pandemic necessitated a rethinking of teaching methodologies across universities, particularly for practice-oriented fields like dental education. In March 2020, the World Health Organization declared COVID-19 a pandemic, leading to severe social contact restrictions. Dental education, heavily reliant on hands-on patient interaction, faced significant challenges. While many universities transitioned to digital learning, this presented limitations as dental education inherently necessitates practical, in-person training. A survey by the Association of Dental Education in Europe revealed widespread adoption of online tools but highlighted the irreplaceable nature of face-to-face clinical experience. Studies worldwide indicated that the shift to digital learning negatively impacted students' clinical competence and mental health. The Kiel Dental Clinic in Germany, due to relatively low infection rates, implemented strict hygiene and social distancing measures to maintain in-person practical courses, becoming a pioneer in this approach. This study aimed to explore the experiences of both dental students and teaching staff in Kiel regarding certainty and uncertainty during this period, aiming to inform the development of more resilient training concepts.

Existing literature highlights the challenges faced by dental education during the COVID-19 pandemic. Studies from various countries (e.g., the US, Europe, and Jordan) demonstrate the widespread shift to online learning, and while this was sometimes perceived positively, the limitations of a digital-only approach were also noted. These limitations included reduced clinical competence, negative impacts on mental health, and increased stress among dental students. Researchers also found that the abrupt transition to digital platforms affected communication and feedback mechanisms, leading to concerns about the quality of learning. The lack of face-to-face interaction also reduced the students' sense of support and connection with peers and instructors. Prior research emphasizes the importance of social support and clear communication in managing uncertainty and stress during crises. This study builds upon these findings by investigating the specific experiences of German dental students and faculty within a context where in-person practical training was partially maintained under strict safety protocols.

This qualitative study employed semi-structured interviews to gather data from dental students and teaching staff at the dental school in Kiel, Germany. A purposive sample included students from the second, third, fourth, and fifth years and teaching staff from the four departments of the dental clinic. The total sample consisted of 39 students and 19 staff members. Inclusion criteria for students included participation in respective courses, being over 18, and sufficient German language proficiency. For lecturers, the criteria included responsibility for teaching content and implementation, being over 18, and adequate German language skills. Interviews were conducted in person or by telephone, with the interviews audio-recorded and transcribed verbatim. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guided the study's reporting. An interdisciplinary team developed a semi-structured interview guide focused on feelings of certainty and uncertainty during the pandemic. Two female researchers coded the transcripts using ATLAS.ti 8.4 software, employing a deductive-inductive approach. The coding process continued until thematic saturation was reached, ensuring the comprehensive capture of the data. The researchers maintained reflexivity through detailed note-taking and discussions to minimize bias. Ethical approval was obtained from the Ethics Committee of the University of Kiel, and informed consent was secured from all participants.

The study revealed that several factors influenced the feelings of certainty and uncertainty among both students and teaching staff. **Certainty:** Feelings of certainty were enhanced by: * **Adaptation and acclimatization:** Students and staff reported increased certainty as they adapted to online teaching tools and processes. * **Clear communication:** Transparent communication regarding course design and procedures fostered certainty. * **Teaching staff support:** The support and supervision provided by teaching staff were vital for student certainty, particularly during practical courses. * **Availability of resources:** The availability of online presentations and lectures on platforms allowed for repeated access to materials. * **Technical proficiency:** Experience in digital teaching tools and implementation increased teaching staff certainty. **Uncertainty:** Factors contributing to uncertainty included: * **General aspects of the pandemic:** The unpredictable nature of the situation and changing guidelines caused general uncertainty. * **Lack of communication and transparency:** Insufficient communication regarding study policies created insecurity. * **Missed aspects of in-person learning:** The absence of face-to-face interaction, direct feedback, and spontaneous exchanges led to uncertainty. * **Concerns about the pandemic:** Significant anxiety and uncertainty centered on the risk of COVID-19 infection, particularly in the practical clinical setting. This was especially relevant to the ethical implications of asking potentially vulnerable patients to attend in-person sessions. * **Planning and implementation:** Uncertainty existed regarding semester planning, exam design, and the effective implementation of online teaching methodologies. The findings indicated that a transition from uncertainty to certainty often occurred as participants adapted to the new learning environment. However, the initial period was characterized by significant apprehension, especially concerning patient safety and the overall effectiveness of the online instruction.

The findings highlight the impact of clear communication, readily available resources, and teaching staff support on students' sense of certainty during the pandemic. These factors align with existing research emphasizing the importance of social support in mitigating stress and anxiety. However, the limitations inherent in online learning, especially regarding the lack of immediate feedback and non-verbal cues, also emerged. The uncertainty surrounding COVID-19 infection, particularly for practical courses with patient contact, presents a unique challenge for dental education. The study supports the need for improved communication strategies, training in online teaching methods, and robust feedback mechanisms to create a more supportive learning environment during crises. Future research should explore more effective strategies to maintain clinical competence while mitigating health risks during future pandemics. The study also suggests further investigation into the impact of the pandemic on students' mental well-being.

The COVID-19 pandemic significantly challenged dental education, particularly its practical aspects. This study underscores the critical role of clear and transparent communication, training in online teaching, and robust feedback channels in fostering certainty. Addressing these elements is crucial for creating a more resilient dental education system prepared for future uncertainties. Future research could explore the long-term effects of the pandemic on dental students' clinical skills and mental health, and further investigate effective approaches for delivering high-quality dental education in uncertain times.

The study's qualitative design limits the generalizability of the findings. The self-reported nature of the data introduces the potential for recall bias and subjective interpretation. Additionally, the voluntary nature of participation might have introduced a selection bias, attracting participants more inclined to engage with the study's themes. The focus on a single dental school in Germany further restricts the applicability of the findings to other contexts.