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Aust Endod J 2015; 41: 111–116

ORIGINAL RESEARCH

An overview of the endodontic curriculum in Fiji from

2009 to 2013
Arpana A. Devi, BDS, PGDip1 and Paul V. Abbott, BDS, MDS and FRACDS (ENDO)2
1 Department of Oral Health, Fiji National University, Suva, Fiji
2 School of Dentistry, University of Western Australia, Perth, Western Australia, Australia

Keywords Abstract
block teaching method, dental curriculum,
endodontic. This paper seeks to provide the reader with an overview of the endodontic
curriculum in Fiji from 2009 to 2013. It also intends to inform readers of the
Correspondence changes in endodontic teaching, the learning methods utilised, curriculum
Dr Arpana A Devi, Department of Oral Health,
development, the transition from block teaching to partial block teaching
Fiji National University, Suva, PO Box 9443, Fiji.
combined with longitudinal teaching, and the future plans for the endodontic
Email: arpana_dv@yahoo.com
module.
doi:10.1111/aej.12099

Dental education history in Fiji Fiji’s unique dental curriculum

Dentistry has been taught in Fiji since 1931, whereby
some lectures about dentistry were delivered to medical
students. Dentistry was a part of the medical teaching
program until 1945 when a 2-year clinical dental course
was implemented and students graduated as Assistant
Dental Practitioners. To date, medical students are still
taught how to extract teeth at the College of Medicine,
Nursing and Health Sciences (CMNHS) at the Fiji
National University. This is largely carried out in order to
cater for the smaller islands in Fiji where there is no
access to dental providers for dental care.
The first cohort of students in dental mechanics and
dental nursing graduated in 1955. In 1968, the University
of the South Pacific began teaching dental students in the
first year of their course after which they completed three
years at the Fiji School of Medicine (FSMed). Upon
completion of the four years, they were awarded a
Diploma in Dental Surgery. However, this course was
abolished in 1984 and The University of Adelaide in Aus-
tralia agreed to take two dental students from Fiji per year
into their Bachelor of Dental Surgery degree course.
These students were sponsored by the Government of
Fiji. Then, in 1993, the Bachelor in Dental Surgery
program was re-introduced into FSMed with an innova-
tive curriculum (1).
Fiji has been training dentists for the past 20 years for the
country as well as for other nations within the South
Pacific region. In 1993, a new approach to the training
and education of oral health personnel was introduced at
the then Fiji School of Medicine. Courses of study were
designed to enable students to proceed through a
sequence of educational modules on a career pathway
leading from a dental assistant through other auxiliary
levels (dental technologist, dental hygienist and dental
therapist) and to eventually become a dentist with a
university degree (2).
The courses offered were very unique when compared
to other universities as the education of dentists and the
training of auxiliaries were integrated into the same insti-
tution, the content of the courses was matched to the oral
health-care needs of the public; the pattern of oral dis-
eases and conditions as revealed by a national oral health
survey; and the local cultural, social, demographic and
economic factors affecting oral health in the region. The
scope of the curriculum was broadened to provide appro-
priate knowledge in general as well as oral health. The
uniqueness of this program allowed those in training to
remain on the pathway, to step off it and enter the work-
force at different levels, and then after gaining some
experience, to re-enter the pathway for further training

© 2015 Australian Society of Endodontology 111

Endodontic Curriculum in Fiji
at the next level. Provision was made for progress from
one level to another with full credit for previous training
and experience. Movement back into the mainstream
and upwards from one step to the next was dependent
upon performance and the availability of posts within the
different South Pacific countries, as most of the graduates
work for their home Ministry of Health, or equivalent. A
clearly defined career path was established, which
allowed students to have the flexibility of choosing to
leave in the middle of the overall course with some quali-
fication or to pursue the entire Bachelor’s degree and
graduate as a dentist. Hence, the distinctiveness of this
multi-entry, multi-exit program (3).
Where feasible, the relevant details of basic and pre-
clinical disciplines – such as general anatomy, general
physiology, biochemistry, oral anatomy, oral physiology,
general pathology, and diet and nutrition – were incor-
porated into appropriate modules through problem-based
learning rather than through the conventional teacher-
oriented, subject-based didactic teaching. These subjects
were taught mainly in the first and second years of the
course.
Planning of the courses for each level was undertaken
to ensure that the curriculum satisfied the requirements
of defined job descriptions for each level, had a strong
community orientation with emphasis on prevention and
the promotion of oral health, incorporated where feasible
the principles of problem-based learning and included
procedures to ensure the early development of clinical
skills (2).
The objectives and the content (topics covered) for
each teaching module were defined. The objectives were
matched with teaching, learning and assessment and they
were regularly reviewed. Finally, provision was made for
the structure and content of all courses to be subjected to
critical examination and evaluation by students, staff and
external examiners.
With reviews and constant feedback from external
examiners, the major problem that was highlighted
was the lack of human resources for specialist subjects
(e.g. endodontics and periodontics). In order to over-
come this, courses that required specialist personnel for
teaching were organised as ‘block sessions’. These block
sessions were provided over 1 or 2 weeks whereby
invited specialists would come from abroad and teach
the entire curriculum for that subject in this duration of
time. This meant that in order to cover the whole
subject, teaching included didactic, pre-clinical and clini-
cal sessions in the same week(s) and often started at
8.00 a.m. and continued until 9.00 or 10.00 p.m. each
day. Depending upon the courses, assessment was some-
times carried out at the end of the block through a
written examination.
112
A. A. Devi and P. V. Abbott
Block teaching scheduling/intensive teaching format
There are many modes of teaching students a concept.
There has been a continuous change in teaching methods
over the years with recent innovative methods that
include technology aids, peer teaching, independent
learning and more emphasis on the engagement of the
students in the teaching process. The utilisation of these
creative approaches is intended to accommodate indi-
vidual learning styles so that students are able to progress
towards being a deep learner rather than a surface
learner.
To achieve this, the curriculum has to be structured in
such a way that, with the resources available, all the aims
and objectives of the curriculum are met, together with
the requirements of the profession in which the graduates
might engage themselves.
Block teaching involves scheduling classes in a manner
that replaces the traditional 40–50 min class periods. In
this type of teaching schedule, the teaching is done in an
overall shorter period of time but it is conducted intensely
within the short period. Block scheduling is a type of
academic scheduling whereby each student will have a
smaller number of different classes per day but each class
will have longer duration. Some medical schools use
more ‘intensive blocks’, which means that every day for a
set number of weeks only one module or subject is
covered. Therefore, within a period of say 3–4 weeks, a
whole module is focused on and completed rather than
having a course throughout the entire academic year
with only a few (or less) hours per week (4). The
extended class time allocated and modified scheduling
frameworks require a change in instructional practice (5).
Queen reported that a number of methodologies such as
the case method, synaptic and concept attainment are
well-suited to use within a block schedule (6). In terms of
using the extended class period for science instruction,
many articles have been published in science education
journals focusing on creative lesson plans and time usage
within a block schedule (7–15). However, Jenkins et al.
concluded from their study that the teachers in their
survey did not use different instructional methods based
upon whether they were in traditional or block schedules
(16).
Some schools adopt a mixed approach whereby some
modules are taught in blocks and some are taught on a
regular yearlong basis. The current curriculum at Fiji
National University, Department of Oral Health follows
this approach.
There has been much discussion in the literature
regarding the advantages and disadvantages of block
scheduling in a curriculum. Kienholz et al. stated that
block scheduling allowed students to learn material at a
© 2015 Australian Society of Endodontology
A. A. Devi and P. V. Abbott
‘more relaxed, less frenetic pace’ and that it enhanced the
‘environment for learning for both teacher and students’
(17). The Center for Education Reform debated that block
teaching increases scheduling flexibility and is more con-
ducive to team teaching, multidisciplinary classes, labo-
ratories and fieldwork (18). Day et al. commented that
converting to a block schedule resulted in increased
attendance, decreased failure rate and an improved
quality of instruction (11).
Lindsay was critical of block scheduling in all areas of
study, highlighting that block scheduling may not work
for all subjects that require daily exposures such as math-
ematics, foreign languages and music (19). He debated
that block scheduling resulted in gaps in knowledge when
there was no regular reinforcement of the subject matter.
The other disadvantage highlighted was that students
who are absent for even just 1 day of a block miss a
considerable amount of material from that subject since 1
day involves 8 h of teaching, which is equivalent to four
weeks of a 2 h week−1 subject.
The Center for Education Reform reported that there
was no evidence that block scheduling led to more mean-
ingful teaching innovations that resulted in higher
student achievement (18). In many cases, longer class
periods result in meeting fewer times per week, and the
overall result is less total class time (20). The use of
instructional practices better suited for traditional sched-
ules and the disuse of instructional practices better suited
to block-type schedules are reasons offered for why block
scheduling plans have not produced enhancement in
student achievement (21).
Other discussions in the literature have focused on
variations in the frequency of particular teaching formats
used in different scheduling plans, and whether or not
block students were better prepared for future academic
achievement than their peers in traditional schedules
(22–24).
In medical education, the practical component aspect is
equally critical to the theoretical components. Hauer et al.
conducted a study to compare a traditional block struc-
ture to a longitudinal integrated structure in a medical
course to see the influence it can have on the students’
clinical learning program (25). They showed that the
students in the longitudinal integrated program consis-
tently developed into a doctor role with patients. The
high level of integration of longitudinal integrated stu-
dents into care systems and their deeper relationships
with their preceptors and patients enhanced their moti-
vation and feelings of competence to provide patient-
centred care (25).
Veal highlighted that teachers reported not only ben-
efits but also challenges and trade-offs when attempting
to improve classroom practice (26). He reported that
© 2015 Australian Society of Endodontology
Endodontic Curriculum in Fiji
classes meeting on a block schedule had 22% less in-class
time. Hence, they utilised lectures to cover the modules
in a more efficient manner and emphasised how this
quickened pace affected students with varied levels of
ability.
There are only a few large-scale studies published on
the effects of scheduling format. Rice et al. looked at the
effect of block scheduling on achievement in mathematics
and found that students taking part in block scheduled
courses performed below those in traditional classes (27).
Larger studies in schools and on different subjects have
concluded that student achievement increased with the
introduction of block scheduling (28–30). However, the
authors also noted no differences between the percent-
ages of students passing science courses from the two
scheduling formats. There has not been any convincing
evidence that a change to block scheduling leads to
greater understanding or achievement by students. None
of the studies mentioned assessed outcomes of participa-
tion in a block schedule over an extended period of time
(28–30).
The study by Salvaterra et al. indicated that students
felt individual teachers played a much greater role in their
preparation (positively or negatively) than did the sched-
uling format (5). Zepeda et al. reported that the overall
perceptions of block scheduling were positive among the
majority of studies they reviewed, but the effect of a block
schedule on student achievement was mixed, with nearly
equal numbers of reports of positive and negative effects
(31).
Endodontic block teaching schedule –
past and present
Educators, administrators and students all strive to find a
schedule that allows for greater retention of knowledge,
provides for adequate time and produces high academic
achievement across all subject areas. The endodontic
block in Fiji has been trying to achieve these aims since
the BDS curriculum was established in 1993 and the first
endodontic block was conducted in 1997 by one of the
authors (PA), a specialist Endodontist and an academic
from Australia. This block has been conducted by the
same person almost every year since then and reports
have been submitted about each visit to Fiji for the
purpose of teaching endodontics.
The initial visit to Fiji was for a 2-week block teaching
program in February 1997. There were two main aims of
this visit. The first was to develop the undergraduate
endodontic curriculum at the newly established School of
Oral Health in Suva, Fiji. Whilst there, a series of lectures
were presented to the second, third, fourth and fifth year
dental students. The fifth year students also completed a
pre-clinical laboratory endodontic technique course,
113
Endodontic Curriculum in Fiji
observed clinical treatment demonstrations by the visit-
ing specialist Endodontist, and commenced endodontic
treatment on their own patients. Following this visit,
the local academic staff continued the endodontic course
and supervised the clinical treatment of patients by
students in order to increase their clinical experience
prior to graduation. The second aim of this original visit
was to provide the teaching material and to train the
local staff so that they could present the lectures and
conduct the practical and clinical courses over the
following years.
The next visit occurred in 2002 when the same spe-
cialist Endodontist returned to Fiji in order to review the
progress of the endodontic course and to update or revise
it where required. Also, the local staff member who had
presented the course from 1998 to 2001 left the school at
the end of 2001 and therefore there was no dedicated
staff member available to continue teaching this subject
throughout each year. The 2002 program was presented
as a 1-week course of lectures and pre-clinical laboratory
exercises. An examination paper and model answers
were provided for the local staff to administer and grade
the papers.
In 2004, another 1-week visit was arranged. A series of
lectures were presented as well as a pre-clinical program
in endodontics. A general dental practitioner from Perth,
who also teaches at the University of Western Australia
on a part-time basis, also visited and helped to deliver this
program.
Similar lecture and pre-clinical courses were presented
in 2005 (over 8 working days), 2006, 2007 and 2008 with
the latter three blocks being for 1 week (5 working days)
each. Extra teaching assistance was provided by another
specialist Endodontist from Australia for these courses.
One of the early recommendations to the school in Fiji
that arose from the block teaching courses was that it
would be highly desirable to have a permanent staff
member with advanced training and endodontic exper-
tise working on a full-time basis in order to provide the
ongoing teaching of the subject and to provide consistent
clinical supervision. The lack of consistency in clinical
teaching was one of the disadvantages noted with the
block teaching system using visiting teachers. Fortu-
nately, in 2008, a local dentist (co-author, AD) was able to
spend the academic year undertaking a Graduate
Diploma in Dental Studies at the School of Dentistry of
The University of Western Australia. This full-time course
included didactic, clinical and research work and it was
supervised by the same Endodontist (PA) who visits
Fiji. Other visiting endodontists, who teach at the school,
and senior clinical staff in other specialty disciplines and
in general dentistry were also available for advice and
assistance.
114
A. A. Devi and P. V. Abbott
Following this, the 2009 block teaching in Fiji was
modified to a new format as the Fiji school employed AD
as a lecturer. She was therefore available to assist with the
block teaching program. She was also able to deliver the
majority of the basic lectures in endodontics and arrange
the pre-clinical endodontic technique course prior to the
block teaching visit. This meant that the visiting lecturer
was able to cover the more advanced theoretical topics
and provide some clinical teaching to the fourth year
dental students. In addition to this work with the under-
graduate students, the visiting lecturer was able to
conduct a workshop for staff and interested dentists in
Suva. The main purpose of the workshop was to educate
staff and dentists so they could continue to teach the
same philosophy and techniques as that promoted to the
undergraduate dental students. In particular, the extra
time available for lectures meant that the topic of Dental
Traumatology could be covered in more detail and a
number of other topics could also be covered with the
students.
The visits in 2010 and 2011 followed the same format
as the 2009 visit, with the exception that one clinical
session involved the fifth year students. The remainder of
the time was spent with the fourth year students present-
ing lectures and with one clinical session. Some time was
also devoted to meeting with staff and students to discuss
research projects in endodontics. Some of these projects
had been performed during the previous year by the fifth
year students and/or staff, whilst the fourth year projects
were still largely being planned. The projects from the
previous year were being analysed and written up with
the aim of submitting them to refereed dental journals for
their consideration for publication.
The 2012 visit followed a similar format and activities
as the 2011 visit, although the fourth year students had
two clinical sessions with the visiting endodontist.
Further modifications were made for the 2013 visit also to
include two clinical sessions with both the fourth and the
fifth year students (32).
Assessments following block scheduling
The major assessments in the block schedule from 1997
to 2011 were:
• Pre-clinical laboratory work 40%.
• End of block written examination 60%.
• Both forms of assessment had a pass mark of 50%.
In 2011, the school had a major review of its entire
curriculum and an external facilitator was hired to review
the curriculum outlines, including the endodontic cur-
riculum. At the same time, the school decided to intro-
duce competency-based assessment, and hence, this was
incorporated as one of the major assessments for the
students. The module assessment thus changed to that
© 2015 Australian Society of Endodontology
A. A. Devi and P. V. Abbott
outlined below. In addition, the endodontic course
extended over two years so students could be constantly
engaged in activities to ensure they master the concepts
and procedures required in the theory and clinical prac-
tice of endodontics.
The assessments with a pass mark of 50% each were:
2011
Semester 1 (Year 4 BDS)
• Pre-clinical laboratory work 15%.
• End of block written examination 40%.
Semester 2
• Assignment 2: 5% (Practical application through
models or essays).
Semester 3 (Year 5 BDS).
• Reflective writing for clinical cases 6% (contributing
towards General Dental Practice).
Semester 4
• Competency assessment (Year 5).
• Clinical work (6 cases) 40%.
Future endodontic teaching in Fiji
The 2004 Fiji National Oral Health Survey was published
in 2007 and depicts the current disease burden. Dental
caries is very prevalent among the Fijian people, with
88.3% of 6 year olds having dental caries, of which
85.2% were still active and not treated. In the permanent
dentitions of older age groups, the percentage of those
affected by caries rose from 52.3% among 12 year olds to
67.5%, 98.1% and 99.5% among 15–19, 35–44 and
55–64 year olds, respectively (33).
These survey results highlight that the caries burden is
very high in the Fijian communities. Therefore, given
that one of the treatment options for caries is root canal
treatment, the school as the teaching institution needs to
prepare students to provide root canal treatment as an
option. However, in order to provide such education, it is
essential to have the appropriate academic staff available
on a full-time basis.
The ideal academic person for the school is someone
with at least a specialty degree in endodontics who can
develop postgraduate courses in this specialty field. Such
courses could be in the form of continuing professional
development courses for dentists who wish to improve
their knowledge and clinical skills, or they could be more
formal university-based higher level Graduate Diploma
or Master’s degree level courses for dentists to become
specialist Endodontists.
Outcomes and the way forward
The literature on block teaching is quiet polarised. Hence,
the perception that the block teaching model is suitable
© 2015 Australian Society of Endodontology
Endodontic Curriculum in Fiji
for teaching in a developing country such as Fiji, where
the educational institution does not have the human
resources to teach specialty subjects, needs to be evalu-
ated. Currently, there has been no evaluation of the
program in terms of teaching and learning outcomes
since the program was introduced. There has been anec-
dotal evidence from alumni that this teaching method
was beneficial to them to some extent. However, the
major disadvantage of teaching in this manner was
re-emphasised by graduates, whereby some subjects
taught by block sessions did not have the reinforcing
through regular work using information that had been
imparted in the block teaching sessions. This sometimes
led graduates to not feel confident in carrying out these
procedures as they felt there was a gap in their knowledge
and clinical experience.
Evaluation is widely acknowledged as a powerful
means of improving the quality of education and hence
the way forward for any institution. Evaluation is univer-
sally accepted as an integral part of teaching and learning.
It is one of the basic components of any curriculum and
plays a pivotal role in determining what learners learn
and what teacher’s teach (34).
The next step for the school is to evaluate the block
teaching method as used in the Department of Oral
Health by the block conveners, both local and interna-
tional. This will indicate whether there is a need to
change the program structure drastically or whether
improvements can be made to the existing structure. The
block teaching model is an interesting model, and if
evaluation shows it is working, then other Universities
could utilise it in the absence of appropriately trained
full-time academics.
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© 2015 Australian Society of Endodontology