LEARNING FROM THE PAST

Dental school is a rigorous experience. For some, memories from their time learning dentistry are not happy ones. Over the years, alumni have recounted stories of a militant atmosphere, a competitive spirit and discrimination. This is not exclusive to U of T or even to the field of dentistry; other dental schools and areas of study, especially those in the sciences and health care, have grappled with similar concerns. The calls for change haven’t gone unnoticed. U of T’s Faculty of Dentistry has been taking steps to foster a more inclusive, supportive environment for students, faculty and staff. From then to now, the Faculty has come a long way — and it’s just the beginning.

By Sarah MacFarlane

Although she was a member of the most women-heavy cohort at the Faculty of Dentistry in history up to that point, with a record 19 women out of 128 in the class of 1980, Elizabeth MacSween 8T0 sometimes found her gender a barrier during her education. 

“I remember having my hand up once and watching our demonstrator walk down the aisles, helping the male students,” she says. “Finally, he came over. I said, ‘Sir, I’ve been waiting a lot longer.’ He said, ‘Well, I don’t want to waste my time, and you’re wasting my time being in this Faculty.’” 

That upsetting incident stood in stark contrast to the support she and her female classmates frequently got from the young men in her cohort. But, in addition to that moment, something potentially more damaging to her career happened behind the scenes. A four-person interview panel nearly rejected her application for the DDS program. “Three thought I was a suitable candidate, but the student on the panel wouldn’t pass me. He didn’t feel women belonged in dental school,” she says. 

The third-year student was removed from the panel, and MacSween underwent a second interview — she only learned what had happened after starting the program, when a faculty panelist sought her out to apologize. 

MacSween isn’t alone in her not-so-pleasant memories of certain moments in dental school. While many graduates enjoyed their time as they learned important skills, that’s not been the universal experience. Incidents of mistreatment are an unfortunate but very real part of the Faculty of Dentistry’s history. 

Many dental faculties across the country harbour a similarly blemished history. And those, in turn, resemble what students recall about their treatment in other competitive healthcare programs such as medicine and nursing. 

That was then, and this is now. U of T’s Faculty of Dentistry and many dental schools across the country increasingly prioritize a positive and inclusive student experience. “This is a faculty that recognizes the world’s a different place,” says MacSween, who practises near Ottawa. “They recognize the differences and are trying to anticipate the effects those differences have on the education of future dentists and the delivery of health care.” She is a vocal supporter of her alma mater and its renewed commitment to promoting equity and student well-being. 

“As an alumnus myself, it pains me to hear that some alumni had a negative student experience at the Faculty,” says dean Daniel Haas. “To those who experienced bullying or discrimination here, I am truly sorry. I know an apology can’t undo the past, but please know that we are trying to do better.”

"To those who experienced bullying or discrimination here, I am truly sorry"

But dentistry and other healthcare programs still grapple with finding the right degree of intensity to teach professionals who will one day be responsible for patient health. They need to rout out hidden discrimination in the curriculum and try to make amends for a past that cannot be changed. A better, more accountable future lies ahead. 

DISCRIMINATION ACROSS DISCIPLINES 

Health care and other science-related education programs have long encouraged a competitive mindset that can trigger bad behaviour. A multi-nation study published in 2010 found that, in first year, nearly 35 per cent of dental school students reported being intimidated or badly treated by instructors, while 17 per cent had been bullied or poorly treated by fellow students. 

In 2018, a National Academies of Sciences, Engineering and Medicine survey of multiple U.S. campuses showed the rate of sexual harassment for female students ranged from 20 to 50 per cent, depending on their major and if they were in undergraduate or graduate school. Female medical students were a shocking 220 per cent more likely to experience sexual harassment than students outside of science, engineering and medicine. 

The report suggests that part of the reason the numbers are so high in science-related education is because the risk of sexual harassment increases in male-dominated environments, especially where there is perceived organizational tolerance for harassment. 

In the past, there were few mechanisms in place to resolve student problems. For instance, MacSween filed a complaint about the dismissive demonstrator. She never heard if anything had been done about it — which upset but didn’t surprise her. “It was so much a part of our lives in the ’70s and ’80s, not just in school,” she says. “You saw it in so many parts of your life that it was just one more hurdle,” she says. “It wasn’t terribly unexpected. I think young students nowadays would not put up with that, nor should they.” 

A POWER STRUGGLE 

While the hierarchies implicit in dental schools foster learning — students in labs and clinics defer to instructors who guide them through the acquisition of dentistry’s skills, while graduate students rely on principal investigators for research direction and funding — these relationships can lead to misuses of power. 

Greg Smith (not his real name) was completing a graduate degree at the Faculty a decade ago when he made a key research discovery. “It was difficult for the principal investigator to let go of this seminal article,” he says, although the two of them had agreed in advance that Smith would be the first author. “It was a challenge, but in the end, I was allowed to be the first author,” he recalls, admitting he had to firmly stand up for himself for this to happen. 

While the power struggle was stressful, the research experience was still a positive one. “I was fortunate to be given an opportunity to be at the University of Toronto at a time when such research was going on. It opened doors,” he says.

Smith says his graduate experience was often grueling, and the school culture at the time encouraged students to think of their teachers as vastly superior to themselves. This led to the sense that any deviation from perfection would be career ending. “You’re so scared of your teachers; you’re working with these people who are like gods, and you’re just a student.” It took some moments of real compassion from individual instructors to end that myth for Smith. “I learned not only about the practice, but also tolerance and keeping the bigger picture in mind.” 

Indeed, in the past, dental schools didn’t always get the balance right between teaching rigour and excellence while preserving students’ self-confidence and mental health. “I hated dental school,” admits Ernest Lam, associate dean of graduate education and graduate program director of the Oral and Maxillofacial Radiology program at U of T. “But now, in retrospect, I understand the method to the madness because I’m on the other side.” 

Lam completed his DMD at the University of British Columbia (UBC) in 1989, and it was only years later when he understood why the program was sometimes tough to bear for a young student. “It’s meant to be hard. After you finish, you could potentially hurt an individual. All of the things that are put in place in dental school to ensure both academic and clinical rigour are there to ensure that the student, when they leave, is a safe and thoughtful practitioner.” 

DENTISTRY’S PIVOT 

Over the last decade or so, healthcare education programs have tried to check their power imbalances and refresh their programs and protocols. But few have had the kind of watershed moment that dentistry in Canada went through starting in December 2014. That’s when screenshots leaked to the press revealed that a group of fourth-year dental students from Dalhousie University had posted sexist, misogynistic and homophobic remarks in a private Facebook group. 

The students were suspended from the teaching clinic for two months and went through a restorative justice process. The school created a task force to investigate the incident, publishing a report in 2015 that examined how the culture within Dalhousie’s Faculty of Dentistry permitted such behaviours. The task force was emphatic, however, that Dalhousie “does not stand in isolation.” The report went on to state: “We must recognize that we all live a sexist, racist, and heterosexist culture to lay the groundwork for change. The status quo is unacceptable.… This incident is an opportunity to confront inequalities and make meaningful change.” 

The task force made recommendations around systemic change that included the need for clear communication of policies and processes to support and protect complainants. Plus, it stated schools should foster a diverse and respectful environment, robust ethics and professionalism education for dental students and strong leadership to encourage a collective commitment to change. 

In order to learn from the findings and recommendations of this task force, in 2015, U of T’s Faculty of Dentistry struck a diversity, inclusivity, collegiality and equity (DICE) committee. It issued a report in 2017, and the working group committee reformed in fall 2020 to further this work. 

Concurrently, many at U of T’s Faculty of Dentistry were already working to improve the dental school experience. The result has been an array of initiatives across the school — and indeed at other dental schools across the country — to better support students, prioritize mental health and root out prejudices. 

One of the priority actions of the strategic plan was to appoint a lead to focus on student engagement, well-being and student life

CHANGES ON THE GROUND 

To identify challenges and strengthen its programs and services, the Faculty has conducted a number of self-assessments, including during the creation of its 2014–19 strategic plan, the 2019–22 update, a 2016 self-study, as well as a 2021 self-study that is currently underway. The 2016 assessment highlighted two objectives for the DDS program: “to continue to attract high-calibre students” and “to continue to improve the experience of our DDS students.” 

One of the priority actions of the strategic plan was to appoint a lead to focus on student engagement, well-being and student life. Another early priority was the formation of a working group on professionalism. More recent working groups have been formed to develop wellness initiatives for students, staff and faculty. 

Upon approval of the strategic plan in May 2014, dean Haas asked longtime clinical instructor and former program director of the Comprehensive Care program Richard Rayman 7T0 to take on the new role of director of student life in addition to his role as assistant professor. Charged with listening to students and finding ways to make programs more attentive to learners’ needs, Rayman’s efforts have triggered numerous changes. 

“Dr. Rayman organized small group meetings with every single student to encourage feedback and discussion in a supportive atmosphere,” recalls Caroline Conway 1T8, who practises in Ottawa. She felt the positive shift in the culture at the Faculty during her time there. A key component of that, she says, was feeling like student feedback was encouraged and taken into consideration. 

As former Dental Students’ Society (DSS) president, Conway also saw an increase in student outreach committees through the DSS. The wellness initiatives were particularly well-received, she says. “I remember a dedicated group of students setting out healthy snacks once a week for everyone, which they went and purchased themselves with funding from the DSS. Little things made a big difference.” 

Increasingly, the Faculty has embedded representatives from the DSS into its advisory groups, so students now meaningfully contribute to the alumni association board, academic committee and faculty council. As well, the DSS has become more active than ever, running peer support and mentorship programs, the Dental Pride Alliance and the Women in Dentistry group.

Lam has observed an increase in services available to students, both within the Faculty of Dentistry and across U of T. “There were no accessibility services or mental health support services when I was a student at UBC. There are many programs today that never existed 35 years ago, which I think is great.” The University has also published numerous policies related to research that protect students. 

Meanwhile, many curriculum and program changes to better support learning have come from individual Faculty members. “I’ve tried to tailor my educational program because I know the students are inundated with information,” says Lam. For instance, program delivery for radiology and pathology has been combined in third year, which helps students. He’s received positive feedback around these kinds of changes, but he stresses the need for more students to provide feedback, such as through course evaluations, to help faculty members identify what’s working and what isn’t. 

MacSween, who has been serving as a facilitator for an online ethics and professionalism course — which didn’t exist when she was a student — notes that such courses make a difference. “It’s been a huge shift,” she says. “It used to be expected that you would understand what being professional was, whereas now they teach it to help students navigate different ethical problems. The students take it seriously; they’re amazing in their responses.” 

Many of Canada’s other dental schools have also worked hard to adjust their programs to better serve students, including streamlining programs and making sure that those working in hospitals no longer do back-to-back shifts, which is better for their physical and mental health and also reduces medical errors. 

A NEW ATMOSPHERE 

Changes small and large to dental school have led to more students finishing their degrees with positive memories of their educational experience. Conway, who now serves as a clinical instructor at the Faculty, is part of a newer generation of graduates who have benefited from — and contributed to — a more empathetic program. “It was fantastic. I look back on it very fondly. I feel lucky to have been involved in a lot of faculty goings-on and really miss everyone I met through those channels.” 

DSS president Fady Barsoum, who is in his final year of the DDS, has enjoyed dental school so far. “The school has been very involved with creating a diverse community and offering support, and extracurricular activities have given me a rich experience,” he says. 

"we’re committed to continuing to take steps to enhance the student experience, prioritize professionalism and foster a diverse and inclusive environment through strengthened services and supports"

Barsoum’s objective for this academic year is to focus on fostering relationships and building community. “I want to preserve the traditions that made the dental school experience a great one and continue improving the culture in the school. The goal is to show the new generation of students how the dental experience should be.” 

There is a lot of work still to be done in dental education to achieve necessary change and improvements. “It’s not perfect, and we still have a long way to go, but we’re committed to continuing to take steps to enhance the student experience, prioritize professionalism and foster a diverse and inclusive environment through strengthened services and supports. This will always be a work in progress,” says Haas. 

Such efforts will take time and more voices at the table to highlight where more change is needed. But for now, the Faculty and other dental schools hope to keep bettering themselves, and keep graduating students who take away not just great clinical skills, but as many memories as possible of a respectful, meaningful education. 

Illustration by Hanna Barczyk

Interested in more stories? Read the PDF edition of the U of T Dentistry Magazine Summer/Fall 2021 Issue