In March 2020, the Harvard School of Dental Medicine went fully remote; all students were sent home, and the Harvard Dental Clinic — where students typically hone their skills working with patients — was shut down except for emergency care.
“We went from a full clinic and then to a hard stop: 100 miles per hour to zero,” said German O. Gallucci, chair of the restorative dentistry and biomaterials sciences department.
With the shutdown, third- and fourth-year dental students — whose curriculum is based on clinical practice and experience — were cut off from seeing patients. While fourth-year students had completed most of their requirements, third-year students in the Class of 2021 faced the challenge of meeting their graduation and competency standards despite reduced clinical availability, according to Sang E. Park, HSDM’s associate dean for dental education.
“I have to say that it was the most challenging class — the Class of 2021 — that I had to be graduating on time in my 20 years of being dental faculty,” Park said.
Despite this, every member of the Class of 2021 graduated on time or early, a feat the school’s dean, William V. Giannobile, credits to faculty members going above and beyond to help students complete their requirements.
“What the faculty did is they ‘sacrificed’ their faculty practice time to open up the clinics to the students,” he said in an October interview. “And then they worked three nights per week, and also on Saturdays, to provide that education.”
Members of the Class of 2021 said in interviews they were initially worried about the sudden discontinuation of their clinical education, but impressed with how the school responded — first, by adapting its curriculum to online for the first few months of the pandemic, and later gradually returning students to clinical practice in person.
“I’m so glad I went to a school like Harvard where, honestly, they cared so much about helping us graduate,” said Ashiana Jivraj, a 2021 HSDM graduate who was a third-year student when she was sent home.
Russell H. Taylor, a lecturer in restorative dentistry and biomaterials sciences, acknowledged that providing remote instruction in a particularly hands-on field such as dentistry was challenging.
“There’s a lot of skills that you need to practice and you need to do under supervision when you’re starting out, because it is a very hands-on and a very visual profession, too,” he said. “There’s a lot of tactile, visual things that you can’t just assign a reading for, necessarily.”
‘Solving a Big Puzzle’
Designing a virtual curriculum that made the best use of students’ and faculty members’ time, while ensuring that students could meet dental competency standards during the shutdown, was “like solving a big puzzle,” according to Park.
“It has offered an opportunity for us to be innovative — ranging from digital learning, reorganization of content delivery, and restructur[ing] of the curricular timeline,” she said.
For the first time, the school introduced teledentistry, in which students helped screen patients, triage, and provide them dental advice virtually, according to Park.
Patient case presentations including grand rounds — in which complex cases are presented to a large audience of dentists and students — and case review seminars also took place virtually, she added.
“Even though they weren’t direct, hands-on clinical experiences for the students, we were trying to really maximize the time that we had to learn remotely,” Park said.
“It cannot replace direct patient care, but it can complement the way that we provide patient care,” she added.
Neil T. Griseto, an instructor in restorative dentistry and biomaterials sciences, said the pandemic allowed the Dental School to re-examine its curriculum and reintroduce prior teaching techniques.
“We used older teaching methods — classical teaching methods for hand skills like waxing — and we reintroduced that in the curriculum,” he said.
Faculty sent instruments to students at home and asked students to record themselves using them. Faculty then assessed students’ performance through self-evaluation and photos, Griseto said.
“Those are the things that I think really benefited me and my education, but maybe that we hadn’t been teaching for some time,” he added. “They had fallen out of favor as methods for teaching.”
Park also noted that the emergent situation brought on by the pandemic allowed for efficient review and revision of the school’s curriculum that would normally have taken a longer time to enact.
“It has offered a chance for us to review the curriculum and the program comprehensively in a very short amount of time,” she said.
Some faculty provided additional research opportunities and study groups to further supplement students’ remote learning experience.
Hiroe B. Ohyama, a professor of restorative dentistry and biomaterials sciences, said she recruited students to conduct research with her during the shutdown and helped them publish their work.
Through the HSDM Aesthetics Society — a co-curricular organization — Taylor said he worked with students to create roughly 20 virtual lectures on topics ranging from basic dental fillings to the proper use of dental equipment.
When Kasey D. Ha, a 2021 HSDM graduate, returned to the Dental School in July 2020, she said she was afraid to go back into the clinic, given that nobody had been vaccinated, and she would have to do procedures up close on unmasked patients.
“It was really scary at first, I’ll be honest, to go back to clinic,” she said. “The patient is sitting right in front of you without a mask on and you’re just immersed in that for a few hours, so it was really scary.”
Taylor said the initial return was “very stressful” for faculty as well.
“Early on, there was a New York Times article talking about how dentistry and hygiene was the most at-risk of all professions because essentially we sit there aerosolized in a patient’s mouth,” he said. “People were really on edge. We had really strict PPE protocol. We were being tested very frequently.”
The school provided students with embroidered face shields, gowns, and eye protection, and made sure they were sterilizing their N-95s after each use, Ha said.
Griseto noted that the school had been stockpiling N-95 masks starting in February 2020, anticipating the pandemic would ramp up and personal protective equipment would run out.
“Because we’re small, we had enough PPE to keep the place going,” he said.
The school also changed all the filters in the building and implemented additional equipment like vacuums and aerosol scavenging devices, according to Griseto.
“When I look back on it now, there were some things that we did that probably weren’t necessary,” he said. “But the measures that we took were ultimately very successful, because we didn’t have any transmissions. As far as I’m aware, we still don’t have any documented transmission of Covid-19 in the building.”
In accordance with the public health guidelines, the Dental Clinic also operated at 50 percent capacity through May 2021.
Ha said this helped protect patients — in normal times, patients are only separated by a four- to five-foot wall — but also forced students to prioritize the limited time they had to practice in the clinic.
“Even though we weren’t in clinic as often, I think it made each clinic experience more important to us,” she said. “Because we knew that we were so limited in time, it made us very efficient with everything that we were doing.”
Ohyama, the professor, said she also noticed students were more focused in clinic because they knew they had reduced time to practice.
“They were very focused. I think the mindset was different from the students’ side and from the faculty also — this is the only time we have to teach, and the other way, like a student[’s perspective], this was the only time I can come and practice,” she said.
Despite the abrupt changes to HSDM’s curriculum and clinical experiences, every student in the predoctoral and the advanced graduate programs in the Classes of 2020 and 2021 graduated on time, according to Park.
“Not only that, for the DMD program — that’s our predoctoral program — we’ve had a 100 percent pass rate — first time pass rate — for the National Board Dental Examination,” Park added.
Students and faculty alike credited the individualized mentorship and collaboration promoted within the Dental School during the pandemic for ensuring students’ continuity of education.
Jivraj, one of the 2021 HSDM graduates, said faculty — especially full-time professors — “just truly stood up” in providing support and guidance “day and night.”
“There was a professor who I remember had put down his daughter to go to bed, and he got on the phone,” Jivraj said. “He was sitting on his porch so that he wouldn’t wake up his kid, just so that we could talk about cases, but also how we were going to meet all of our prosthodontic requirements and how he was going to help the fourth- and third-years graduates.”
Aram Kim, a professor of restorative dentistry and biomaterials sciences, said she and other faculty members were constantly available to provide students with both academic and emotional support on an individual basis.
“This was a very stressful time, and with a lot of meetings being virtual and a lot of content being virtual, there was a lot of loss of human connection,” Kim said. “We have a weekly check-in with the students to listen to their needs, and what they have to say, how we can get through this together, how we can help them maximize our situation, how we can better help them get ready for the next step.”
“I absolutely commend all of our students for their passion and resilience, because I cannot imagine myself getting through dental school during a pandemic,” she added.
The pandemic also strengthened relations and teamwork within the student body, Ha said. She noted that students in the school — which is Harvard’s smallest — are already tight-knit, but the pandemic brought them together in a shared struggle toward graduating.
“Given the difficult Covid situation and limited capacity, because we’re such a tight cohort, everyone was willing to help each other out,” Ha said. “People are willing to share materials, lab time, clinic time — I think it was really important for us to have such a tight cohort in order to all help each other graduate.”
Daniel M. Roistacher, a 2021 HSDM graduate, said he believed the school implemented necessary changes to the curriculum and clinical experiences in order to maintain quality instruction.
“I feel like we’ve achieved the proper dental education that we set out to achieve — I think that’s quite remarkable,” Roistacher said. “I think that speaks to the resilience of our class as a whole, as well as the efforts of the school.”
—Staff writer Ariel H. Kim can be reached at [email protected]
—Staff writer Anjeli R. Macaranas can be reached at [email protected]