Background
Health and oral health inequity exists within and across nations including the western world. In England inequities in oral health across all stages of the life course and over different clinical indicators such as dental decay and related quality of life measures still persist. Oral diseases are predominantly preventable, and they share common risk factors with other non-communicable diseases. The biomedical model of care has limitations as it does not take into account or address what predisposes individuals to poor health and makes them sick, these being the social determinants of health. It is well documented that the further down someone is on the socio-economic ladder the worse health outcomes and access to care they will experience. Health professions including dentists and oral health professionals have a social responsibility to fulfil. Morally, oral health professionals not only have a role to play in manage oral diseases clinically but also to advocate for oral health for all and especially the most vulnerable in society.
Social accountability in medical and healthcare education was introduced as a concept in 1995 by the World Health Organisation (WHO). It initially referred to the obligation of the medical schools to direct their education, service and research to address the needs of the communities and nations they have a mandate to serve. This concept has been adopted by various organisations worldwide and the need to produce a socially accountable health care workforce internationally has been highlighted. In the UK, the dental regulator, General Dental Council (GDC), also expects future graduates to demonstrate social accountability. The GDC published the Safe Practitioner Framework which describes the desired behaviours that future graduates are expected to exhibit and the learning outcomes that the dental curriculum should address. According to the framework, under the domain of professionalism, dental graduates should demonstrate professionalism and integrity by behaving ethically, show leadership and social accountability. They should be committed to advocating for oral health, promoting good oral health and understand the importance of sustainable service provision in the population and across communities, and addressing priority health needs for the communities.
Research interest and previous work
The dental and dental therapy and hygiene programmes of study at Peninsula Dental School in Plymouth (UK) are centered around social accountability and integrate community engagement, reflective practice, and interprofessional education within a spiral curriculum.
Clinical skills are also gained mainly within primary care-based community clinics, serving patients who may have diverse and complex needs due to social deprivation. The dentistry undertaken by students in these primary care clinics thus meet the city’s community oral health needs and address the poor dental access that the local population is facing. Complementing this, Peninsula Dental School also delivers innovative community engagement modules referred to as interprofessional engagement (IPE), whereby students are introduced to the concepts of community engagement and social accountability outside of the clinic, through outreach projects and experiential learning. The aim of these modules are to develop students’ societal and community awareness, so they recognise their future role in the healthcare system and wider society. As part of the IPE modules in the first two years of their studies (IPE1 and IPE2), students engage with local community organisations to co-design health improvement projects, critically reflect on their experiences, and gain deeper insight into oral health inequities and the social determinants of health.
As part of my PhD, I am looking at the impact of the IPE module on dental student’s empathy and their views and attitudes towards social accountability. At the earliest stages of my research, I explored the impact of community engagement in healthcare education across high development countries by conducting a mixed methods systematic review. It became apparent at the early stages of the review (title and abstract stage) that the terminology used about community engaged education is diverse and frequently different terms were used interchangeably. In order to address the confusion and frame the systematic review, a typology of community based healthcare education was used, in which community engagement is conceptualised as a form of experiential education which utilises community exposure educational programmes or activities (i.e., students are exposed to the population/community of interest usually in a non-clinical setting) to highlight and address community health care needs.
Community engagement and graduate behaviours
In the British Dental Journal paper, we utilised the knowledge gained by the international systematic review results to map and discuss the potential of incorporation of community engagement within the undergraduate dental curriculum to cultivate the desired behaviours in future dental graduates as these are outlined in the Safe Practitioner Framework, namely: social accountability; ethics and integrity; insights; effective communication; and teamwork and wellbeing of others. In summary community engaged dental education can:
- Deepen students’ sense of social responsibility
- Improve willingness for advocacy
- Help students appreciate the role of social determinants of health
- Improve cultural competence and sensitivity
- Help students appreciate peoples’ stories and lives
- Help students to overcome preconceived ideas, stereotypes and bias
- Help students to reflect on their privilege and become less judgmental
- Improve communication and interpersonal skills
- Help students to build rapport with patients and members of the public
- Enhance empathetic communication
- Improve attitudes towards vulnerable and underserved groups
- Improve teamwork among students
- Help students appreciate the role of other health and social care professions
- Help students to appreciate importance of interprofessional collaboration
Thus, community engaged dental education can plant the seed for future graduates to become drivers for change and advocate for the oral health of those in need. However, we suggest that as well as educating students, health educators may also need training and education on the importance of social factors to avoid perpetuating traditionalist biomedical views in patient care. More significantly, a radical change at policy level and investing in upstream public health approaches is required to allow for social determinants of health to be addressed. Only then, individual oral health professionals will be in a position to effectively manage established oral disease and effectively prevent future disease.
Reference:
Plessas, A., Paisi, M., Ahmed, N. et al. The role of community engaged dental education in producing socially accountable graduates in the context of the General Dental Council's Safe Practitioner Framework. Br Dent J 239, 417–422 (2025). https://doi.org/10.1038/s41415-025-8817-x