gms | German Medical Science

The Bologna Declaration of 1999 expresses commitment to a Europe-wide consolidation of higher education [http://www.bmbf.de/pubRD/bologna_deu.pdf]. This process has been furthered by the subsequent conventions in 2001 in Prague [1] and 2003 in Berlin [2]. Following the Anglo-American system, a consecutive two-part program structure was decided upon for Bachelor’s and Master’s degrees. Problematic is the implementation for subjects, such as Medicine and Dentistry, which culminate in a state examination that already corresponds in value to a Master’s degree. For this reason, only advanced (post-graduate) Master’s degree programs at a specialized level come into question for these subjects. In recent years many such post-graduate training programs in dentistry have come into existence.

The need has its root the structure of dental school. Upon successful completion of the state examination in dentistry, graduates are fully licensed dentists after only five years of regular study and can begin practicing without any further qualifications in dentistry. The only formality required for acceptance by the statutory health insurance system is a two-year period as an assistant in a dental practice. This is very different from medical school, which is followed by training in a specialty lasting five years.

The numerous sub-topics in dentistry can only be imparted as basic information during formal dental studies. In light of the rapidly developing technological possibilities and scientific knowledge, specialized skills and specific expertise are increasingly necessary. At present, specialization is only possible through post-graduate training, such as course series, curricula, and Master’s degree programs.

There are many different models and approaches [3]. Since 2004 the University of Greifswald has offered advanced Master’s programs in dentistry [4], [5]. These programs link theory with practice and allow for study that is not only independent of location, but also enables participants to work simultaneously. Dental Functional Analysis and Therapy is a classic field for advanced training and requires high levels of expertise and interdisciplinary cooperation.

With the Master’s program in Computer-assisted Dental Functional Analysis and Therapy, the University of Greifswald was one of the first universities in Germany to establish a post-graduate program in the field of dentistry.

There is a lack of publications dealing with this issue in the German-speaking countries. Since many years of experience have been gathered in terms of this degree program, its design is described in this paper to serve as an example. The concept presented here refers to a practice-oriented study program for working professionals.

Within the context of interdisciplinary, professional and academic training, the objective of the program is to both impart in-depth knowledge and skills in functional analysis and therapy and enable participants to critically and scientifically assess existing therapeutic methods in regard to routine patient treatment. Also belonging to these main goals are the sharing of information and experiences among colleagues and the development of interdisciplinary modes of thought.

The degree program is distinguished by a focus on both scientific theory and practice that, alongside the acquisition of knowledge, concentrates primarily on acquiring practical skills and gathering experience. The following content has been defined for the study program:

1.

Basic principles and guidelines for dental examination, diagnostics, therapy and monitoring of patients who need to be functionally rehabilitated as part of restorative-prosthetic measures or who show temporomandibular disorders

2.

Indication and documentation of clinical, imaging and instrumental techniques used for functional analysis and biomechanical optimization of occlusion of the stomatognathic system, including therapeutic concepts,

3.

Differential diagnosis of general medical clinical pictures and possibilities for monitoring the progress of dysfunctional symptoms,

4.

Integration of treatments oriented toward functional analysis/therapy into everyday dental practice.

Along with the European directives within the scope of the Bologna Process [1] and the Ministerial Conferences [6], other specific legal requirements define how post-graduate study programs can be set up. Not only must state laws concerning higher education be observed, but also the rules and regulations of the particular university. A fundamental pre-requisite for potential students is the state examination coupled with a valid license to practice medicine or dentistry.

For the study program described here, the following formal rules and regulations needed to be drafted:

• Examination regulations
• Study regulations
• Sample study schedule
• Diploma supplement [7]
• Fee regulations
• Quality management with evaluation and reporting
• Accreditation process
• Provider (instructor responsible for a curricular unit) for off-campus organization

Figure 1 [Fig. 1] illustrates the approval procedure at the state and university levels. In cooperation with a professional scientific association or society, in this case the German Association of functional diagnostics and therapy. (Deutsche Gesellschaft für Funktionsdiagnostik und –therapie), the program content and regulations were drafted by the Center for Dental, Oral and Craniomandibular Sciences and then reviewed and approved by the committees and commissions of the department and the university.

Moreover, the Ministry of Education had to approve the study program based on the state laws governing higher education. Two further basic requirements demanded by the university and the state government are that the program have no effect on the university’s enrollment capacities and that it be self-financing.

The formalities listed here not only take into account the requirements placed at the university level, which can vary by state in Germany concerning the details, but also the basic provisions of the Bologna Process that apply across Europe. In principle, the design presented here can be applied to new study programs, as shown by the successful initiation of other study programs [4], [5], [http://www.medizin.uni-greifswald.de/dental/master/].

The Master of Science in Dental Functional Analysis and Therapy is designed to last two and half years. Almost two years are intended for contact teaching and a further eight months for writing the thesis. In justified cases, extensions may be granted upon application to the examination committee.

The Master’s program has the following features:

• Extra occupational
• Modularized
• Oriented toward theory and practice
• Post-graduate
• Independent of campus
• Financed through tuition fee
• European (Bologna-conform, accredited)

Particular importance was given to modularization regarding the organization of content. The modules are self-contained curricular units consisting of practice-oriented contact teaching (usually 2-3 days) and an extensive homework assignment (see Figure 2 [Fig. 2]). The modules are sequenced as basic, core, and advanced units and build systematically upon each other. Each module is combined with workplace learning. The interdisciplinary patient case planning module, which has larger coverage regarding preparation and presentation of patient cases, poses an exception to this (see Figure 3 [Fig. 3]).

ECTS points (European credit point system) are given for each successfully completed module [8]. For the Erasmus program, the University of Greifswald has defined one ECTS point as equal to 30 hours. This forms the basis for the calculation of the ECTS points in the Master’s degree programs.

To attain a Master of Science, 62 ECTS points are required. These are computed as follows:

• 2 ECTS points per contact module (15 hours of contact teaching and 45 hours of homework)
• 6 ECTS points for the user training module
• 1 ECTS point for academic conference attendance
• 22 ECTS points for writing a thesis paper
• 1 ECTS point for the colloquium

In addition, continuing education points are given by the professional dental boards for successful completion of the modules. For each module, a test is administered and the patient case report and workplace learning (application of the acquired knowledge and skills to the student’s daily practice, including homework) are evaluated by the module provider and a second examiner from the university. At the end there is a test of the composite knowledge in the colloquium and an evaluation of the thesis by two independent experts. The thesis is an academic paper (minimum of 50 pages) dealing with an issue in dental functional analysis. In terms of topic, these generally focus on pilot studies or comparative, methodical reports regarding treatment procedures in dental practice.

Coordination of the administrative responsibilities is undertaken by a continuing education office for master programs, which also functions as a registrar’s office. The basic duties of the education office are academic advising, coordination, verification of student registration documents, administration of the website, monitoring and documenting student performance in the individual modules, and organization of the examination module. In regard to quality management, the education office arranges for the evaluation of the modules and the alumni activities. In coordination with the individual professional associations, instructors responsible for teaching specific modules are selected (module providers); content design, organization of off-campus sessions, and marketing are also attended to.

The university assumes administrative tasks, such as financial management, legal counsel, and review of the study and examination rules and other documents, QM evaluation and feedback procedures for the individual semesters. An appropriate amount of overhead for this is provided for in the schedule of student tuition and fees.

The office’s staffing needs arise from the number of participants in the individual cohorts of a study program and are calculated to be a minimum of around 10 hours per week per cohort /study program. Since multiple cohorts and different study programs are currently being administered simultaneously, there are at present multiple employees in flexible part-time positions working in the continuing education office for master programs. One cohort comprises between nine and 15 participants for the study program discussed here. For the study programs in Dental Aesthetics and Function and in Dental Prosthetics, there are currently 20 to 30 participants in each cohort.

The study program is subject to an accreditation procedure which ensures external evaluation [6]. Independently of the university, a review of the educational objectives, the staff and facilities, as well as an evaluation of the program are conducted at regular intervals by an accreditation agency.

Based on the recommendations of the first accreditation procedure, the program design was modified a number of times. For example, after the first year, the original 21 contact modules were reduced to 17. The focus of the content was placed more strongly on scientific topics due to the heavy concentration on practice-related aspects. As a result of re-accreditation (2012) and the Cultural Ministers’ Decision in 2010 [9], individual modules are to be combined into larger module units of at least five ECTS points. To satisfy these requirements, appropriate restructuring of all the current Master’s programs is presently taking place.

In addition, an internal evaluation of each module is done by each program participant. The evaluations include questions about organization and content. Other significant aspects concern teaching quality in terms of the module provider’s professional, didactic, and communication skills and the participants’ subjective assessment regarding their own learning success.

On the basis of these results, adjustments are made to the curricular sequencing in respect to scheduling as well as modifications of the homework assignments regarding meaningful integration into daily practice. Based on the evaluation in justified cases, the teaching of a module in the next academic year is coordinated anew between the module provider and the study program director.

The evaluation results are presented to the staff of the university’s Integrated Quality Assurance (Integriertes Qualitätssicherungss-System-IQS)), which then performs an assessment and, if needed, issues recommendations for change. Furthermore, this information is included in the annual quality report and is published university-wide.

Alongside the module evaluation by the students, graduates also have regular opportunity to report on their experiences and progress in using their acquired knowledge and skills. The alumni initiative serves this particular purpose. The alumni association, Continuum Zahnmedizin Alma Mater Greifswald e.V., was founded in 2011 by the graduates of the Master’s programs. An important function of this association is to inform the university about professional development following graduation from the Master’s program. The annual alumni reunions and the alumni association provide the opportunity to receive feedback. The results of these alumni evaluations are included in the quality development process, as are the results of the module evaluations.

In cooperation with the alumni association, an anonymous graduate survey was conducted of the program’s first four cohorts.

The focus was on questions about benefits regarding students’ continuing professional career and development in terms of practice, improvement in understanding interrelated concepts in dentistry, ability and willingness to engage in scholarly work, and organizational aspects of the study program. In response to the question, which advantages came with the Master’s program in respect to dental practice, the graduates indicated a uniform consensus that this represented a specialization resulting to increased confidence in handling challenging patient cases. The Master’s degree improves relations with colleagues and results in a higher level of recognition. Above all, the broadening of their dental/medical knowledge and the more complex perspective gained through increased insight into related medical fields were evaluated positively.

Another question inquired about how colleagues and referring practitioners perceived the acquired expertise. In answer to this, those surveyed reported an increase in referrals of patients to be diagnosed or treated for functional issues. Since this involves an academic study program, a question was asked about the level of willingness to engage in scientific work after completing the program. Although this is difficult to integrate into daily work schedules, several graduates have written academic articles in the time since graduation. The ability to recognize new scientific methods and to incorporate them into daily practice is not only valued, but also applied.

Our experiences show that continuing education in the form of a Master’s degree program has proven its worth. Undergoing revision almost annually, the program began its sixth year at the end of 2013. To date, a total of around 60 participants have earned a Master’s degree.

The program represents a specialization that leads to increased confidence when faced with difficult patient cases. The participants are exposed to the diverse aspects and issues in functional analysis and receive assistance while discovering their own approach to practical application. The exchange and sharing of experiences with other colleagues was ranked as being extremely important. In general, the time required of the participants could be managed alongside daily work schedules. This can be seen in that the majority of Master’s theses are completed within the time allotted by the degree program.

In contrast to the field of medicine, there have been no notable changes in the tableau of dental specialties for many decades. The reasons may vary, but in most cases they lie in the difficulty of reconciling the often very heterogeneous interests of the professional dental boards. For dentists who, despite this, wish to receive separate certification for their specialty and expertise, the alternative option is a post-graduate Master’s degree. These training programs respond to the urgent need for accredited, quality-assured degrees in specialties that have become necessary and at the same time offer universities opportunities to bundle their own concentrations in research and teaching into post-graduate, tuition-generating programs. In dentistry, the post-graduate Master’s degrees have virtually developed so as to have a status comparable to that of the conventional specialty training in dentistry. A classic win-win situation has resulted and has without a doubt the potential to last not only over the long term, but also to effect sustained change in continuing professional education and training.

With almost annual modification, the program began its sixth academic year in 2013; re-accreditation has been successful in the meantime. Aspects that have proven valuable have been retained and the weaknesses, which were identified by various quality assurance measures, have been remedied with new methods and approaches [10].

The authors declare that they have no competing interests.