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Development of Integrated Curriculum for Basic Dental Hygiene Based on Competencies
J Dent Hyg Sci 2024;24:37-53
Published online March 31, 2024;  https://doi.org/10.17135/jdhs.2024.24.1.37
© 2024 Korean Society of Dental Hygiene Science.

Hye-Young Yoon , Sun-Jung Shin , Bo-Mi Shin , Hyo-Jin Lee , Jin-Sun Choi , and Soo-Myoung Bae

Department of Dental Hygiene, College of Dentistry & Research Institute of Oral Science & Research Institute of Dental Hygiene Science, Gangneung-Wonju National University, Gangneung 25457, Korea
Correspondence to: Soo-Myoung Bae, https://orcid.org/0000-0002-1802-4129
Department of Dental Hygiene, College of Dentistry & Research Institute of Oral Science & Research Institute of Dental Hygiene Science, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea
Tel: +82-33-640-3033, Fax: +82-33-642-6410, E-mail: edelweiss@gwnu.ac.kr
Received February 29, 2024; Revised March 14, 2024; Accepted March 14, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: To train dental hygienists to utilize knowledge in practice, an integrated curriculum based on the competencies of dental hygienists is expanding; however, in the field of basic dental hygiene the curriculum is still fragmented and based on segmented knowledge. This study developed an integrated curriculum based on the competencies of dental hygienists in Anatomy, Histology & Embryology, Physiology, which are subjects for basic dental hygiene that have high linkage and overlap.
Methods: After selecting the learning objectives for the integrated curriculum from those of Anatomy, Histology & Embryology, Physiology, the duties of the dental hygienist in relation to the learning objectives were analyzed. Learning objectives were combined with the duties of a dental hygienist to derive competencies for an integrated curriculum. Referring to the syllabus and learning objectives for each subject, the weekly educational content, learning objectives, and credits of the integrated curriculum were derived. After conducting a Delphi survey to validate the competency and content of the derived integrated curriculum, an integrated curriculum was developed.
Results: By using the first and second Delphi surveys, four competencies were developed for dental hygienists that can be achieved through an integrated basic dental hygiene curriculum. In addition, an integrated curriculum including the courses Anatomy, Histology & Embryology, Physiology, Structure and Function of the Human Body/Head/Neck, and Structure and Function of the Oral Cavity was established.
Conclusion: This study presents a specific example for developing a competency-based integrated curriculum that can be used as a framework to derive a competency-based integrated curriculum among subjects that can be integrated according to the linkage of learning contents and the competencies that can be achieved.
Keywords : Basic subjects, Competency-based education, Curriculum, Dental hygiene, Integrated curriculum
Introduction

1.Background

As modern society enters the 4th Industrial Revolution and changes rapidly, there are many different ways to access knowledge, and cramming education that unilaterally transfers a large amount of knowledge is no longer relevant1). Adapting to a rapidly changing society beyond the acquisition of academic knowledge requires the acquisition of high-level and comprehensive skills, including communication, analytical thinking, problem solving, creative thinking, interpersonal, and self-management skills2). Competency refers to the comprehensive skills required to cope with the needs of society, and competency-based education is applied and emphasized in higher education2). In particular, in university education that trains professionals, competency-based education defines the essential roles of professionals, stipulates the competencies required to perform these roles in practice, organizes curriculum based on these defined competencies, and educates and assesses learners through educational methods necessary to achieve these competencies3).

Dental hygienists are professionals who are responsible for improving the oral health of the public by providing oral health education, preventive dental treatment, dental care cooperation, and management support to local residents and people with dental diseases; thus competency-based education is required for training dental hygienists. Accordingly, to expand competency-based education in dental hygiene education, Bae et al.1) defined the competencies of dental hygienists and proposed 8 core competencies and 52 specific competencies that dental hygienists should achieve by the time of graduation; Kim et al.4) identified standard competencies for dental hygienists at the national level that can be applied in the educational field; and Choi et al.5) introduced a competency evaluation system to analyze student levels of competency achieved by grade and semester.

In competency-based education, the process is organized around integrated and comprehensive problem-recognition and problem-solving skills3). Therefore, Park3) has emphasized utilizing an integrated curriculum of competency-based dental education and suggested establishing competencies that dentists should possess and integrate this knowledge in relation to these competencies. The operation of an integrated curriculum based on the linkage of knowledge allows for an understanding of the totality of knowledge and can broaden the range of practice-focused thinking and strengthen problem-solving and work performance skills6). For this reason, to train healthcare professionals who can utilize and apply knowledge in practice, the operation of integrated subjects is expanding in Medicine, Dentistry, and Nursing, which focus on competency-based education6,7).

Competency-based education in the current dental hygiene curriculum is well established and expanding; however, the integration of subjects has only been implemented in a few dental hygiene fields. Although research is being conducted to integrate courses in clinical dental hygiene and clinical dental hygiene based on competencies and integrated subjects within the field of clinical dental hygiene are being implemented in actual curricula, subjects in the field of basic dental hygiene are still offered subject-centered courses with fragmented knowledge1,8). In dental hygiene education, the basic dental hygiene field is the most fundamental of the specialized knowledge to be dealt with in dental hygiene and provide the foundation for solving clinical problems9). According to study by Lee et al.10), when analyzing the overlapping learning content between courses in the field of basic dental hygiene, overlapping content was found in all courses, and the most overlapping content occurred in the following order: Oral Histology and Oral Physiology, Oral Histology and Tooth Morphology, and Oral Physiology and Oral Anatomy. Despite this overlap in content, the subject-centered curriculum in the current basic dental hygiene makes it difficult to think integrally and limits the development of problem-solving skills10).

The establishment and strengthening of a competency-based curriculum in dental hygiene education requires the introduction of a competency-based integrated curriculum in the field of basic dental hygiene; subjects with linkages and overlaps in knowledge should be prioritized for integration. Among the basic dental hygiene subjects, there is a link between the courses Anatomy, Histology & Embryology, and Physiology because Anatomy is the study of the normal structure of the human body, head and neck, and oral cavity; Histology is the study of the microscopic state of normal structures as part of Anatomy; and Physiology is the study of the normal functioning of the various tissues that make up the human body, head and neck, and oral cavity11).

2.Objectives

Therefore, to enhance competency-based dental hygiene education, this study developed a competency-based integrated curriculum including Anatomy, Histology & Embryology, and Physiology, which are courses with high knowledge linkage and overlap in the field of basic dental hygiene.

Materials and Methods

1.Derivation of competencies for integrated subjects

Referring to the Dental Hygiene Department Learning Objectives published by the Korea Dental Hygienists Association, the learning objectives of the courses Anatomy, Histology & Embryology, and Physiology were listed, and overlapping content was arranged. The arranged learning objectives were then selected as the learning objectives for the integrated subjects12).

After selecting the learning objectives for the integrated subjects, the duties of dental hygienists that could be performed using the learning objectives were analyzed based on the research of Park et al.13). Based on the study by Bae et al.1), the competencies that dental hygienists should achieve from the learning objectives of integrated subjects were identified. The competencies of the integrated subjects were derived by referring to the learning objectives of the integrated curriculum, dental hygienist duties that can be performed through the learning objectives, and dental hygienist competencies that should be achieved through the learning objectives.

2.Derivation of competency-based integrated curriculum

The learning objectives of the integrated curriculum were rearranged based on their correlation with the derived competencies. At this point, competencies with overlap in the listed learning objectives were determined to be covered in the same curriculum and categorized. Two curriculum categories were derived based on the listed learning objectives.

By referring to the learning objectives listed in the two categories for subjects, the syllabus of relevant integrated subjects in dental education in the Republic of Korea, the syllabus of relevant integrated subjects in dental hygiene education in other countries, and Kim’s study11), which presented the required courses and their learning objectives in the dental hygiene curriculum, the learning objectives and weekly learning content for the integrated curriculum were derived. In addition, after checking and summing the hours required to complete each learning content by referring to the syllabus, the credits for the integrated subject, and the year and semester of completion were derived by referring to the prerequisite subject and learning content.

3.Delphi survey on competency-based integrated curriculum

1) Selecting experts for Delphi surveys

A Delphi survey was conducted to assess the validity of the competencies and integrated curriculum derived from this study. The Delphi survey was conducted twice with 15 experts who were full- or part-time professors with teaching experience in the courses Anatomy, Histology & Embryology, or Physiology in dental hygiene departments in Seoul, Gyeonggi-do, Gangwon-do, Gyeongsangbuk-do, Gyeongsangnam-do, Busan, Chungcheongnam-do, and Daegu.

2) Evaluating the validity of competencies for integrated curriculum

The validity evaluation for the competencies of the integrated curriculum was conducted with a questionnaire consisting of closed-ended questions that asked for ratings on a 5-point Likert scale for content validity, clarity, difficulty, and importance, as well as open-ended questions for expert panel comments14-17).

To produce the results, content validity was calculated and compared based on five analysis criteria, including the content validity ratio (CVR), content validity index (CVI), degree of convergence, and degree of agreement18). For CVR, the number of experts was 15, so a CVR value of 0.49 or higher was considered valid15,19). A CVI value of 0.78 or higher was considered valid if the number of experts was 10 or more20). A degree of convergence of 0.5 or less and a degree of agreement of 0.75 or more were interpreted as high agreement and low disagreement on the analysis criteria. Clarity, difficulty, and importance were determined using the mean and standard deviation of the responses, with higher means indicating greater clarity, difficulty, and importance21). The competencies were revised and supplemented based on the results of the analysis criteria and other opinions from experts.

3) Evaluating the relevance of an integrated curriculum

The questionnaire for evaluating curriculum relevance consisted of questions on learning possibility, unity, systematicity, and efficiency, referring to the criteria of integration developed by Kim and Hong22), and questions on quantity and level, which were items suggested in Kang’s study23) for analyzing the adequacy of educational content, were rated on a 5-point Likert scale (Table 1).

Assessment Questions for Integrated Curriculum Relevance

Category Question
Quantity Is the amount of learning in the integrated curriculum appropriate for the credits?
Level Is the content of the integrated curriculum appropriate for the student’s cognitive level
at the time of introduction?
Learning possibility Is the learnability of the integrated curriculum high?
Unity Do the learning topics within the integrated curriculum have unity?
Systematicity Do the learning topics in the integrated curriculum have sequence and continuance?
Efficiency Does the integrated curriculum enable competencies to be achieved more effectively?


To analyze the relevance of the integrated curriculum, the percentage of positive responses and the mean of responses for each assessment question were identified24). The curriculum was revised and supplemented based on the results of the analysis and expert opinions.

After revising the content to reflect the results of the first Delphi survey, a second Delphi survey was conducted with the same experts and evaluation questions as the first Delphi survey to investigate the validity of the revisions made to the first Delphi survey. The results of the second Delphi survey were interpreted and processed in the same way as those of the first Delphi survey, and the competencies and integrated curriculum were derived.

Results

1.Validity for competency

The results of the first expert Delphi survey of the competencies showed that the values for all four content validity analysis criteria (CVR, CVI, degree of convertgence, and degree of agreement) for five of the nine competencies were rated as valid (Table 2). Of the four competencies that satisfied the analysis criteria for content validity, the competency “Can utilize knowledge of the normal structure and function of the head and neck in the dental hygiene assessment and diagnosis process.” was retained, and the other three competencies were modified or deleted in consultation with the researchers, based on other opinions from experts, as follows: The competency “Can utilize knowledge of the normal structure and function of the human body in the dental hygiene assessment and diagnosis process” was revised because there was consensus from multiple experts that the learning content regarding the normal structure of the human body was insufficient. Competencies with the phrase “in the oral cavity” were revised to “oral cavity” due to expert opinion that the phrase should be changed. The competency “Can utilize knowledge of the morphology and characteristics of lost tissue in the oral cavity for patient care and treatment.” was removed because multiple experts opined that it was difficult to achieve using only this integrated curriculum.

Results of Delphi Surveys on Competencies for an Integrated Curriculum

Competency Delphi survey Content validity Clarity Difficulty Importance Agreement to remove
CVR CVI Degree of convergence Degree of agreement
1. Can utilize knowledge of the normal function of the human body in the dental hygiene assessment and diagnosis process. 1st 0.60 0.80 0.5 0.75 4.33±0.72 4.20±0.68 4.33±0.90
2nd 0.47 0.73 0.75 0.63 4.00±0.93 4.20±0.56 4.40±0.91
2. Can utilize knowledge of the normal structure and function of the head and neck in the dental hygiene assessment and diagnosis process. 1st 0.87 0.93 0.5 0.80 4.47±0.52 4.33±0.82 4.73±0.46
2nd 0.73 0.87 0.50 0.80 4.27±0.80 4.40±0.63 4.80±0.41
3. Can utilize knowledge of the normal structure and function of the oral cavity in the dental hygiene assessment and diagnosis process. 1st 0.73 0.87 0.5 0.80 4.67±0.49 4.20±0.68 4.80±0.41
2nd 0.87 0.93 0.25 0.90 4.67±0.49 4.47±0.64 4.93±0.26
4. Can utilize knowledge of anatomical structures on radiographs in dental radiographic examinations. 1st 0.07 0.53 0.75 0.63 4.40±0.74 4.00±0.38 4.53±0.74
2nd 3.87±0.92
5. Can utilize knowledge of pain and paresthesia that occurs in the head and neck and oral cavity in dental hygiene care and treatment. 1st 0.60 0.80 0.25 0.88 4.40±0.63 4.33±0.62 4.47±0.74
2nd 0.60 0.80 0.50 0.75 4.27±0.88 4.33±0.62 4.47±0.64
6. Can utilize knowledge of the morphology and relationships of tissues in the oral cavity to apply materials and instruments. 1st 0.33 0.67 0.5 0.75 3.60±0.91 3.93±0.70 3.93±1.10
2nd 4.53±0.64
7. Can utilize knowledge of the morphology and characteristics of lost tissue in the oral cavity for patient care and treatment. 1st 0.60 0.80 0.25 0.88 4.13±0.74 4.13±0.83 4.47±0.64
2nd 4.20±0.77
8. Can utilize knowledge of the structures in the oral cavity to take impressions and make models. 1st 0.33 0.67 1 0.50 4.33±0.90 3.80±0.56 4.40±0.74
2nd 4.00±0.85
9. Can utilize knowledge of the range of anesthesia-induced paresthesia in patient care and treatment. 1st 0.20 0.60 1 0.50 4.27±0.70 3.93±0.46 4.27±0.80
2nd 3.87±0.83

Values are presented as mean±standard deviation.

CVR: content validity ratio, CVI: content validity index.



Of the nine competencies, the remaining four were removed because neither the CVR nor CVI values were met.

For clarity, with the exception of one competency, all competencies scored 4 or higher, indicating that they were written appropriately in clear and understandable terms.

Difficulty scores ranged from 3.8 to 4.33, with the highest for “Can utilize knowledge of the normal structure and function of the head and neck in the dental hygiene assessment and diagnosis process” and “Can utilize knowledge of pain and paresthesia that occurs in the head and neck and oral cavity for patient care and treatment,” and the lowest for “Can utilize knowledge of the structures in the oral cavity to take impressions and make models.”

In importance, with the exception of one competency, all competencies scored 4 or higher, with the highest for “Can utilize knowledge of the normal structure and function of the oral cavity in the dental hygiene assessment and diagnosis process.”

In the second Delphi survey, competencies that were retained and modified were re-evaluated with the same evaluation questions as in the first Delphi survey, and for competencies that were deleted, agreement with the deletion was confirmed with the evaluation question “Is the deletion of this competency appropriate?”

Of the four competencies that were retained and revised, three were confirmed as valid because the values for all analysis criteria (CVR, CVI, degree of convergence, and degree of agreement) for content validity were met. The revised competency, “Can utilize knowledge of the normal function of the human body in the dental hygiene assessment and diagnosis process.” was not met for any of the analysis criteria for content validity. Several experts commented on the lack of relevant learning objectives for this competency.

For clarity, all four competencies were scored 4 or higher and all competencies were evaluated as clearly described.

The difficulty and importance scores were also above 4 for all competencies, and “Can utilize knowledge of the normal structure and function of the oral cavity in the dental hygiene assessment and diagnosis process” was the highest in difficulty and importance.

When the means and standard deviations were confirmed for the five deleted competencies, the mean was greater than 3.8 (Table 2). These competencies were finally removed based on the value of the agreement to remove them and other expert opinions that the competencies were not achievable through this integrated curriculum alone.

2.Validity for the integrated curriculum

This study derived two integrated curricula. In the first Delphi survey, the integrated curriculum Structure and Function of the Human Body & Head and Neck had a positive response rate of less than 75% and a mean of less than 4 for all assessment questions, except for the unity question (Table 3). In particular, for the quantity question, all experts commented on the following: “There is a lot of learning content compared to credits” and “There are not enough credits to complete the learning content.”

Results of Delphi Surveys forIntegrated Curriculum

Integrated curriculum Delphi survey Quantity Level Learning possibility Unity Systematicity Efficiency
% Mean % Mean % Mean % Mean % Mean % Mean
1. Structure and Function of the Human Body & Head and Neck 1st 20.0 2.60 60.0 3.47 66.7 3.53 93.3 4.40 73.3 3.93 66.7 3.87
2nd 60.0 3.80 86.7 4.13 80.0 3.93 93.3 4.53 80.0 4.07 80.0 4.00
2. Structure and Function of the Oral Cavity 1st 33.3 2.87 73.3 3.73 80.0 3.93 100. 4.53 80.0 4.13 80.0 4.13
2nd 53.3 3.73 100. 4.33 80.0 4.00 86.7 4.47 73.3 4.00 80.0 4.27

%: positive response rate.



For the integrated curriculum of Structure and Function of the Oral Cavity, the values for systematicity, unity, and efficiency indicated validity. However, the quantity question had a 33.3% positive response rate and a mean of 2.87, with comments such as “There is a lot of learning content” and “Not enough credits.”

The second Delphi survey was conducted on the revised integrated curriculum using the same evaluation questions as the first Delphi survey. For the integrated curriculum Structure and Function of the Human Body & Head and Neck, the values of all the assessment questions increased. Nonetheless, for quantity, the percentage of positive responses was less than 75%, the mean was less than 4, and the mean for learning possibility was less than 4.

For the Structure and Function of the Oral Cavity, all the assessment questions increased in value, with the exception of systematicity and unity. Although the value increased in quantity, the percentage of positive responses was less than 75% and the mean was less than 4. Systematicity showed a positive response rate of less than 75%.

3.Competency-based integrated curriculum

After the first and second Delphi surveys, through a process of revisions to the draft of competencies and integrated curriculum, a final competency-based integrated curriculum was developed (Table 47).

Course Outlines for Structure and Function of the Human Body & Head and Neck Curriculum Developed in This Study

Course outline
Year/semester 1/2
Credit (Lecture-Lab) 4 (4-0)
Competency 1. Can utilize knowledge of the normal function of the human body in the dental hygiene assessment
and diagnosis process.
2. Can utilize knowledge of the normal structure and function of the head and neck in the
dental hygiene assessment and diagnosis process.
3. Can utilize knowledge of pain and paresthesia that occurs in the head and neck and oral cavity
in dental hygiene care and treatment.
Learning purpose Based on the knowledge of the normal structure and components of the human body and head
and neck, with a clear understanding of the normal function of each organ in the human body
and the relationships between them, abnormal structural and functional changes in the human
body and head and neck can be identified and their causes, including birth defects, can be
evaluated in an integrated approach.
Prerequisite subject Biology, Chemistry

Learning Contents for Structure and Function of the Human Body & Head and Neck Curriculum Developed in This Study

Week Content topic Learning goal Week Content topic Learning goal
1 Subject Introduction: Properties of the human body ㆍCan understand the subject. 11 Blood vessels comprising the human circulatory system and head and neck ㆍCan explain properties of blood vessels and lymphatic vessels.
ㆍCan explain properties of cells, tissues, and organs. ㆍCan explain the heart.
ㆍCan explain properties of living organisms. ㆍCan explain the blood circulation as systemic circulation and pulmonary circulation.
ㆍCan explain homeostasis in living organism. ㆍCan explain the components and functions of blood.
2 Cells and Tissues in the Human Body: Epithelial and connective tissues ㆍCan explain types and functions of cell organelles. ㆍCan explain structure and function of red blood cells.
ㆍCan explain process of mitosis in cells. ㆍCan explain types and functions of white blood cells.
ㆍCan explain intracellular metabolic processes. ㆍCan explain the mechanism of blood coagulation.
ㆍCan explain structure and function of cell membranes. ㆍCan explain the automaticity of the heart.
ㆍCan explain cellular material transport. ㆍCan explain the blood pressure.
ㆍCan explain properties of epithelial tissue.
ㆍCan explain properties of connective tissue.
3 Bones comprising the head and neck ㆍCan distinguish the skull and facial bones. 12 Functions of human body: Respiration, Metabolism, Digestion ㆍCan explain the terms related to respiration.
ㆍCan explain properties of cartilage tissue. ㆍCan explain structure and function of the respiratory system.
ㆍCan explain structure and properties of bone tissue. ㆍCan explain the ventilation mechanism.
ㆍCan explain functions of bones. ㆍCan explain the gas exchange between alveoli and tissues.
ㆍCan explain the terminology related to bone surface structures. ㆍCan explain the transport of oxygen and carbon dioxide in the blood.
ㆍCan enumerate the individual bone comprising the skull. ㆍCan explain the relationship between energy metabolism and body temperature.
ㆍCan enumerate types and quantities of the skull. ㆍCan explain the concept of metabolic rate and the conditions of basal metabolic rate.
ㆍCan enumerate types and quantities of facial bones. ㆍCan explain the mechanism of thermoregulation.
ㆍCan explain structures observed in the mandible. ㆍCan explain the components and actions of gastric juice.
ㆍCan explain change in mandibular angle with age. ㆍCan explain the components and actions of pancreatic juice.
ㆍCan explain position of the incisive foramen and mental foramen with age. ㆍCan explain the components and actions of bile.
4 Bones comprising the head and neck ㆍCan explain structures observed in the maxilla. ㆍCan explain the function of the small intestine.
ㆍCan explain structure and function of maxillary sinuses. ㆍCan explain the function of the large intestine.
ㆍCan explain structures observed in the palatine bone.
ㆍCan explain structures observed in the sphenoid bone.
ㆍCan explain structures and surrounding muscles in the temporal bone.
ㆍCan explain structures observed in the zygomatic bone.
ㆍCan explain structures observed in the parietal bone.
5 Bones comprising the head and neck ㆍCan explain the sutures present in the skull. 13 Functions of the human body: Excretion, Internal secretion ㆍCan explain structure and function of the kidneys.
ㆍCan enumerate the individual bone involved in orbital formation. ㆍCan explain process of urine production in the kidneys.
ㆍCan explain the blood vessels and nerves passing through the superior and inferior orbital fissures. ㆍCan explain the micturition reflex.
ㆍCan explain the structure of the ethmoid sinus. ㆍCan explain the internal secretion
ㆍCan explain the paranasal cavity. ㆍCan distinguish the location and type of endocrine glands.
ㆍCan distinguish the cranial fossa. ㆍCan explain the physiological actions of pituitary hormones.
ㆍCan explain the types of fontanelles. ㆍCan explain the physiological actions of thyroid hormones and related disorders.
ㆍCan explain position and closure time of fontanelles. ㆍCan explain the physiological actions of parathyroid hormones and related disorders.
6 Muscles comprising the head and neck ㆍCan explain properties of facial muscles and masticatory muscles. ㆍCan explain the physiological actions of adrenal medulla hormones and related disorders.
ㆍCan enumerate types of facial muscles. ㆍCan explain the physiological actions of adrenal cortex hormones and related disorders.
ㆍCan explain actions of the orbicularis oris and buccinator muscles. ㆍCan explain the physiological actions of pancreas hormones and related disorders.
ㆍCan explain functions of the temporal muscle.
ㆍCan explain functions of the masseter muscle.
ㆍCan explain the functions of the internal and external pterygoid muscles.
7 Muscles comprising the head and neck ㆍCan explain actions of the major muscles comprising the neck. 14 Human Embryology and Reproductive Physiology ㆍCan explain the anatomical structures of the male genitalia.
ㆍCan explain the actions of the medial and lateral pterygoid muscle. ㆍCan explain the anatomical structures of the female genitalia.
ㆍCan explain the actions of the sternocleidomastoid muscle. ㆍCan explain male and female hormones.
ㆍCan explain the actions of the platysma muscle. ㆍCan explain the process of fertilization and implantation.
ㆍCan explain structure of muscle tissue. ㆍCan explain formation process of bilaminar embryonic disc.
ㆍCan explain forms and functions of muscles. ㆍCan explain formation process of trilaminar embryonic disc.
ㆍCan explain the mechanisms of contraction and relaxation in skeletal muscles. ㆍCan explain developmental processes the ectoderm and the ectodermal organs.
8 Midterm ㆍCan explain developmental processes of mesoderm.
ㆍCan explain mesoderm and endoderm organs.
9 Nerves comprising the head and neck ㆍCan enumerate perceptual, motor, and mixed nerves among the12 pairs of cranial nerves. 15 Finals
ㆍCan explain the nerves that contain parasympathetic nerve fibers among the 12 pairs of cranial nerves.
ㆍCan explain composition of the nervous system.
ㆍCan explain structure and function of neuron.
ㆍCan explain the mechanisms of excitation transmission between nerves and muscles.
ㆍCan explain types and functions of the autonomic nervous system.
ㆍCan distinguish types of reflex activities.
ㆍCan explain types and functions of the central nervous system.
ㆍCan distinguish types and sensory receptors of mechanical senses.
10 Blood vessels comprising the human circulatory system and head and neck ㆍCan explain the route from the heart to the carotid artery.
ㆍCan enumerate the branches of the external carotid artery that distribute to the face and oral cavity.
ㆍCan explain the distribution area of the lingual artery.
ㆍCan explain the distribution area of the facial artery.
ㆍCan explain the distribution area of the maxillary artery.
ㆍCan explain the arteries that distribute to the masticatory muscles.
ㆍCan explain the veins that distribute to the face and oral cavity.
ㆍCan enumerate types of lymph nodes of the head and neck.

Course Outlines for Structure and Function of the Oral Cavity Curriculum Developed in This Study

Course outline
Year/semester 2/1
Credit (Lecture-Lab) 4 (4-0)
Competency 1. Can utilize knowledge of the normal structure and function of the oral cavity in the dental hygiene
assessment and diagnosis process.
2. Can utilize knowledge of pain and paresthesia that occurs in the head and neck and oral cavity in
dental hygiene care and treatment.
Learning purpose Based on the knowledge of the normal structure and components of the oral cavity,
with a clear understanding of the normal function of each organ in the oral cavity and the
relationships between them, abnormal structural and functional changes in the oral cavity
can be identified and their causes, including birth defects, can be evaluated in an integrated approach.
Prerequisite subject Biology, Chemistry, Structure and Function of the Human Body and Head and Neck

Learning Contents for Structure and Function of the Oral Cavity Curriculum Developed in This Study

Week Content topic Learning goal Week Content topic Learning goal
1 Subject Introduction: Structure of the Oral cavity ㆍCan understand the subject. 9 Tissues composing the Oral cavity: Salivary glands ㆍCan explain structure and types of salivary glands.
ㆍCan enumerate the components of the oral cavity. ㆍCan explain functions of saliva.
ㆍCan distinguish the oral cavity. ㆍCan explain composition and properties of saliva.
2 Nerves comprising the oral cavity ㆍCan explain the branches and accessory ganglia branching from the trigeminal ganglion. ㆍCan explain the neural control of the salivary glands.
ㆍCan explain the components and major branches of the maxillary nerve. ㆍCan explain the mechanism of secretion of saliva.
ㆍCan explain the components and major branches of the mandibular nerve. ㆍCan explain diseases associated with saliva.
ㆍCan explain the components and functions of the facial nerve. ㆍCan explain considerations for taking maxillary and mandibular intraoral radiographs.
ㆍCan explain the ganglia associated with the facial nerve. ㆍCan explain normal anatomical structures found on intraoral radiographs.
ㆍCan explain the major branches of the facial nerve. ㆍCan distinguish abnormal anatomical structures found on oral radiographs.
3 Nerves comprising the oral cavity ㆍCan explain the components and functions of the glossopharyngeal nerve. 10 Embryology of the mouth and teeth ㆍCan explain the processes forming the face.
ㆍCan explain the ganglia associated with the cranial nerve. ㆍCan explain formation of the lips.
ㆍCan explain the components and functions of the vagus nerve. ㆍCan explain formation of the nose.
ㆍCan explain the components and distribution of the lingual nerve. ㆍCan explain formation of the palate.
ㆍCan explain the distribution of the ansa cervicalis. ㆍCan explain causes of cleft lip and cleft palate.
ㆍCan explain features of Bud stage, Cap stage, and Bell stage.
ㆍCan explain the stage-specific features of dental hard tissue deposition and maturation.
4 Tissues composing the Oral cavity: Tooth ㆍCan explain properties of enamel. 11 Embryology of the mouth and teeth ㆍCan explain formation of enamel and dentin.
ㆍCan explain formation and direction of enamel rods. ㆍCan explain ameloblast and odontoblasts.
ㆍCan explain the growth lines of enamel. ㆍCan explain formation of root
ㆍCan explain properties of dentinocemental junction. ㆍCan explain Hertwig’s epithelial root sheath and epithelial rests of Malassez.
ㆍCan explain the structures found in enamel. ㆍCan explain formation of cementum, periodontal ligament, and alveolar bone.
ㆍCan explain properties of dentin. ㆍCan explain process of tooth eruption.
ㆍCan explain properties of dentin tubules.
ㆍCan explain the structures observed in dentin.
ㆍCan explain the types of dentin.
ㆍCan explain the neural control and the process of sensory transmission of dentin.
5 Tissues composing the Oral cavity: Tooth ㆍCan explain functions and features of the dental pulp. 12 Functions of the Oral cavity: Mastication ㆍCan define a temporomandibular joint.
ㆍCan explain the cells present in the dental pulp. ㆍCan explain structure and features of the temporomandibular joint.
ㆍCan explain the vascular and nerve distribution of the dental pulp. ㆍCan explain the basic and functional motions of the mandible.
ㆍCan explain the physiological actions of the dental pulp. ㆍCan explain the terminology related to occlusion.
ㆍCan explain the chemical composition of the hard tissues of the tooth. ㆍCan explain types and features of mandibular reflexes.
ㆍCan explain the physical properties of the hard tissues of the tooth. ㆍCan explain actions of the masticatory muscles.
ㆍCan explain the physiological actions of the hard tissues of the tooth. ㆍCan explain function of mastication.
ㆍCan explain the metabolism of the minerals comprising the tooth. ㆍCan explain functions of the lips, cheeks, and tongue.
ㆍCan explain vitamin deficiencies in teeth. ㆍCan compare occlusal and masticatory forces.
ㆍCan explain the role of hormones in tooth formation.
ㆍCan explain the dentin-pulp complex.
6 Tissues composing the Oral cavity: Periodontal tissue ㆍCan explain properties of cementum. 13 Functions of the Oral cavity: Sensory ㆍCan explain types and functions of sensory receptors in the oral region.
ㆍCan explain the growth lines of cementum. ㆍCan explain sensory of teeth.
ㆍCan explain properties of dentinocemental junction. ㆍCan explain sensory of the oral mucosa.
ㆍCan explain primary and secondary cementum. ㆍCan explain types of tastes.
ㆍCan explain function of cementum. ㆍCan explain distribution of taste buds.
ㆍCan explain the cells present in the periodontal ligament. ㆍCan explain chemical structures involved in taste.
ㆍCan explain properties of the main fibers of the periodontal ligament. ㆍCan explain taste tracts.
ㆍCan explain function of periodontal ligaments. ㆍCan explain the olfactory receptors and structures.
ㆍCan explain properties of alveolar bone. ㆍCan enumerate anesthetic sites of the maxillary and mandibular nerves.
ㆍCan explain alveolar bone proper and supporting alveolar bone.
ㆍCan explain function of alveolar bone.
7 Tissues composing the oral cavity: Soft tissues, palate ㆍCan explain the histologic features of the oral mucosa. 14 Functions of the Oral cavity: Swallowing and vocalization ㆍCan explain the swallowing process.
ㆍCan explain the tooth-gingival junction. ㆍCan explain causes and symptoms of vomiting.
ㆍCan explain properties of free gingiva and attached gingiva. ㆍCan explain causes of halitosis.
ㆍCan explain structure and function of the gingival sulcus. ㆍCan explain features and disorders of mouth breathing.
ㆍCan explain function of the gingiva. ㆍCan explain structure of phonatory organ.
ㆍCan explain types and characteristics of tongue papillae. ㆍCan explain formation of speech sounds.
ㆍCan explain function of the extrinsic and intrinsic lingual muscles. ㆍCan explain dysphonia.
ㆍCan explain the neural control of the tongue. ㆍCan explain changes in the mandible following tooth extraction.
ㆍCan explain function of the tongue. ㆍCan explain the anatomical structures that must be considered when making dentures.
ㆍCan explain the soft and hard palate.
ㆍCan explain the neural control of the soft palate.
8 Midterm 15 Finals

Discussion

1.Interpretation

This study developed competencies for dental hygienists that can be achieved from Anatomy, Histology & Embryology, and Physiology courses in the field of basic dental hygiene, and developed an integrated curriculum based on these competencies. As a result, four competencies and two integrated curricula were established.

Of the four competencies developed, for the competency “Can utilize knowledge of the normal function of the human body in the dental hygiene assessment and diagnosis process,” the values of some assessment questions did not meet the standard criteria for validity. However, since Anatomy, Histology & Embryology, and Physiology are courses that study the human body, and Physiology in particular addresses the normal function of the various tissues or cells that make up the human body, competency was determined to be closely related to the characteristics of the subject itself and was finally derived in consultation with the researchers11). The experts who disagreed with the content of the competency suggested a lack of relevant learning objectives as a reason; therefore, it was determined that the learning objectives needed to be supplemented rather than the competency. The remaining three competencies were derived in a form whose validity was agreed upon by all the experts during the first and second Delphi surveys.

The clarity, difficulty, and importance scores were above 4 for all four competencies, suggesting that the competencies developed in this study were well expressed in clear terms and with important content. Since the competency “Can utilize knowledge of the normal structure and function of the oral cavity in the dental hygiene assessment and diagnosis process” had the highest level of difficulty, an integrated subject to achieve this competency, Structure and Function of the Oral Cavity, may be assigned after the Structure and Function of the Human Body and Head & Neck integrated subject in the curriculum sequence16).

After the first Delphi survey, based on the values and expert opinions of the assessment questions, the competencies that required an understanding of the subjects, such as Morphology, Pathology, and Clinical Dentistry in addition to the courses Anatomy, Histology & Embryology, and Physiology, were removed. However, as with basic medicine, in order to ensure that basic dental hygiene education is applied in clinical practice and can lead to research, it is recommended that integration between basic dental hygiene subjects as well as integration with clinical dentistry or clinical dental hygiene related to basic dental hygiene is necessary25).

In the relevance evaluation of the integrated curriculum, the results for quantity did not meet the criteria for validity until the second Delphi survey. There were differing opinions among the experts regarding the 4 credits. Some experts agreed that the credits were adequate, whereas others commented that 4 credits were insufficient because there were contents that were not in the existing learning objectives that should be addressed additionally and importantly in this integrated curriculum. Another expert stated that credits were insufficient because the courses Biology and Chemistry, which were presented as prerequisite subjects, were not separately organized as one subject in the overall curriculum and should be handled in this integrated curriculum. These opinions can only be addressed if the standardization of the dental hygiene curriculum and improvement of learning objectives are prioritized.

2.Key results and comparison

The competency-based integrated curriculum provides a link between the curriculum and the actual role by describing the competencies of dental hygienists and enables integrated thinking to solve problems in real situations; thus, it is a necessary curriculum for the training of dental hygienists in the current era that requires various new roles26).

Understanding and solving patient problems requires integrated thinking based on the linkage of knowledge in basic dental hygiene; however, the basic dental hygiene curriculum is still fragmented with specialized subjects, similar to the dental curriculum9). In addition, previous studies have shown that the basic dental hygiene curriculum is less relevant to the competencies of dental hygienists than the total of 13 courses and 450 hours, and the need to reorganize the basic dental hygiene curriculum to increase the relevance of competencies and reduce the hours of operation were also presented27). An integrated curriculum can reduce unnecessary repetition of overlapping content and the number of credits and hours required and is expected to result in efficient utilization of credits and hours for the basic dental hygiene curriculum26). In addition, the low correlation with dental hygienist competencies can be improved by extracting basic dental hygiene knowledge and developing competencies related to the duties of a dental hygienist27). Therefore, this study was a specific example for the development of an integrated curriculum that solves these problems and strengthens the relevance of dental hygienist competencies.

3.Suggestion

Although not shown in the study results, the presence or absence of the courses Biology and Chemistry in the dental hygiene curriculum varied among universities. Similarly, a study that identified the dental hygiene curriculum at 10 universities in the Republic of Korea found that the same course was offered under various titles, and the lecture form and practice were not unified28). Learning objectives, which are used as a standard for organizing the educational content of courses and applying for the national examination, have not been revised since 201712). Since standardization within dental hygiene education is a priority for the development and implementation of a successful integrated curriculum, it is necessary to develop a standardized curriculum that considers school systems (colleges and universities) and the latest learning content in the future.

Consideration is also needed regarding the form of operations. In basic medicine, experimental practice is indispensable for acquisition of basic medical knowledge because it can develop the ability to obtain objective research results and foster accurate judgment and effective application as a doctor. Studies have suggested that it is necessary to diversify and strengthen the practice content in the basic dental hygiene curriculum to increase the overall perception and satisfaction of the basic dental hygiene curriculum9,25). Therefore, it is necessary to develop practical content that enables operations along with the acquisition of knowledge in limited credits.

Since an integrated curriculum is student-centered and aims to strengthen problem-solving skills, it may require the introduction of student-participatory teaching methods such as problem-based learning25). There should be a change in student-participatory teaching methods for the basic dental hygiene curriculum because students can then indirectly experience clinical applications of the knowledge for basic dental hygiene29-31).

4.Limitations

The competency-based integrated curriculum for basic dental hygiene developed in this study has the limitation of not achieving consensus among all experts on some of the assessment questions.

Acknowledgements

None.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This article was exempted from the Institutional Bioethics Committee of Gangneung-Wonju National University (GWNU IRB-2021-38).

Author contributions

Conceptualization: Hye-Young Yoon and Soo-Myoung Bae. Data acquisition: Hye-Young Yoon, Sun-Jung Shin, Bo-Mi Shin, Hyo-Jin Lee, Jin-Sun Choi, and Soo-Myoung Bae. Formal analysis: Hye-Young Yoon, Sun-Jung Shin, Bo-Mi Shin, Hyo-Jin Lee, Jin-Sun Choi, and Soo-Myoung Bae. Supervision: Soo-Myoung Bae. Writing–original draft: Hye-Young Yoon and Soo-Myoung Bae. Writing–review & editing: Hye-Young Yoon, Sun-Jung Shin, Bo-Mi Shin, Hyo-Jin Lee, Jin-Sun Choi, and Soo-Myoung Bae.

Funding

This study was supported by 2021 Academic Research Support Program in Gangneung-Wonju National University.

Data availability

Please contact the corresponding author for data availability.

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