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

In March 2020, the WHO declared COVID-19 a pandemic, leading to significant social distancing measures that required rethinking university teaching, especially in practice-oriented programs like dentistry. While many institutions shifted to a digital semester in 2020, dental education cannot be entirely digital due to essential early and ongoing patient contact that develops clinical competencies. In northern Germany, the Kiel Dental Clinic implemented comprehensive hygiene and distancing measures and, under special provision, resumed in-person practical courses with patients in May 2020 while theoretical courses remained online. Prior studies indicated relief at the continuation of education digitally, but also concerns about loss of clinical competence and negative mental health impacts among dental students. This study aimed to assess aspects of certainty and uncertainty during dental education amid COVID-19 at the Kiel dental school, incorporating perspectives of students and teaching staff.

Early pandemic surveys reported widespread adoption of online tools in dental education (e.g., 90% used online pedagogical software, 72% live/streamed videos, 48% additional online materials). While digital formats maintained continuity, literature highlights limitations for practice-based competencies and concerns about loss of clinical proficiency when in-person patient contact is suspended. Multiple studies reported negative mental health effects among dental students during the pandemic, including increased stress and loneliness, with social support acting as a protective factor. The absence of face-to-face non-verbal cues and immediate feedback in online settings may reduce communication effectiveness and learning outcomes. Risk of COVID-19 infection was a key driver for digital transitions, yet also raised ethical and safety concerns for any continued patient-based activities.

Design: Qualitative interview study adhering to COREQ guidelines. Participants: Purposive sample of dental students and teaching staff at the dental school in Kiel, Germany. Students were drawn from different training stages corresponding to specialist semesters (simulation courses in the 4th and 6th semesters; clinical treatment courses in the 7th–10th semesters, with the 8th and 10th as exemplars). Target sample: approximately 10 students per each of four specialist semesters and 19 lecturers (departmental lecturers and directors) with consideration of theoretical saturation. Inclusion criteria: students—enrolled in the respective subject, >18 years, sufficient German; lecturers—responsible for teaching content and implementation in one of four departments, >18 years, sufficient German. Setting and data collection: Recruitment occurred via video-conference courses (students) and personal presentations (lecturers). Interviews were conducted between June and August 2020, either in person or by telephone, by two experienced female researchers (K.H., dental practitioner; K.G., health services researcher). Standardized procedures ensured consistency (predefined guide, documentation of time, field notes, issues). A semi-structured interview guide developed by an interdisciplinary team focused on two topics: feelings of certainty and feelings of uncertainty during COVID-19 teaching; it was pilot-tested with a student and a lecturer. Interviews averaged about 31 minutes for both groups. Data analysis: Interviews were audio-recorded, fully transcribed, anonymized, and analyzed using qualitative content analysis (ATLAS.ti 8.4). A deductive-inductive approach was used: initial categories developed from the guide were refined and expanded inductively during analysis. Two researchers (K.H., K.G.) independently coded transcripts, discussing until consensus; saturation was considered reached when no new data emerged. Reflexivity was supported through interviewer notes on thoughts and reactions. Ethics: Approved by the Ethics Committee of the University of Kiel (D509/20); informed consent obtained, including permission to publish anonymized quotes.

- Sample: 58 interviews (39 students, 19 teaching staff). Average interview duration ~31 minutes for both groups. - Certainty themes: - Own experiences: Acclimatization and routine in the new teaching situation (especially using online tools) increased feelings of certainty. - Stabilizing aspects: Clear communication about course design; visible support and supervision from teaching staff (including during practical courses); regular online meetings (e.g., Zoom); availability of recorded presentations and materials on online platforms; staff confidence with technical implementation. - Uncertainty themes: - General aspects: Rapidly changing facts and evolving regulations created uncertainty for both students and staff; anxiety was common; concerns about acceptance and feasibility of hygiene and distancing measures in practical courses. - Missing aspects: Loss of peer contact and reduced opportunities for real-time interaction; lack of direct feedback in online teaching; absence of an immediate contact person during online learning; unclear/insufficient information policies; difficulty in semester planning under uncertainty. - Concerns: Risk of COVID-19 infection, particularly in patient-contact practical courses (some suggested patient testing to increase safety); ethical ambivalence about inviting high-risk patients; questions about whether all curriculum content could be effectively delivered digitally; technical challenges with online platforms; some concern about completing the semester, although most believed it would proceed.

The study shows a progression from uncertainty to certainty as students and staff adapted to pandemic-era dental education. Clear, transparent communication and accessible teaching materials fostered certainty, aligning with prior studies. Conversely, non-transparent information flow and the loss of immediate, non-verbal feedback in online settings heightened uncertainty and may impair learning effectiveness. Social support from teaching staff served as a stabilizing factor, potentially mitigating emotional loneliness and stress associated with social distancing. Major concerns centered on infection risk and completing practical components; however, with rigorous hygiene concepts and resumed patient-based courses, uncertainty diminished over time. The findings underscore the need for sustainable training approaches that strengthen technical competencies for digital delivery and support mental health to enhance resilience in uncertain contexts.

The COVID-19 pandemic challenged dental education, particularly practical, patient-based courses. Certainty can be bolstered by clear, transparent communication, accessible online materials, and training in online teaching methods. To reduce uncertainty, institutions should establish effective channels for communication, information exchange, and feedback. The study offers empirical insights into how students and teaching staff experienced certainty and uncertainty, informing future resilient teaching strategies.

- Qualitative design limits generalizability; findings reflect experiences at one dental school. - Reliance on self-reported data precludes verification of accuracy. - Voluntary participation may have introduced positive selection bias, potentially over-representing individuals more open to discussing the topics.