Eur J Dent Educ 2001; 5: 23–30
Printed in Denmark. All rights reserved
Report on the development of
a new dental curriculum at Helsinki
Eero Kerosuo1,2, Juha Ruotoistenmäki2 and Heikki Murtomaa2
1
Faculty of Dentistry, Kuwait University, Kuwait; 2Institute of Dentistry, University of Helsinki, Helsinki, Finland
A review of the dental curriculum was undertaken in Helsinki in
the mid 90s. The objectives of the new curriculum were to re-
inforce the links between basic biomedical and dental sciences
in order to give more emphasis to oral medicine and comprehen-
sive dental care. Furthermore, the curriculum needed to promote
an interdisciplinary approach and encourage students to under-
stand dental diseases in relation to the community at large. A
two-year, topic-based, preclinical curriculum, fully integrated with
medical students, was started. For didactic teaching in the clin-
ical phase, new learning entities were established to promote an
inter-disciplinary approach. For the first time in Finland, objec-
tives were formulated for attitudes and interpersonal skills. Clin-
ical training was conducted in a comprehensive clinic, based on
the team concept, where emphasis was given to proven compet-
ency instead of to the number of procedures performed. The time
spent in the clinic was kept the same as previously (1440 h).
Students’ learning process was assessed with a portfolio. The
majority of students welcomed the comprehensive care clinic,
especially its team concept and treatment planning seminars.
F INNISH DENTAL EDUCATION celebrated its 100th
anniversary in 1992 in the University of Helsinki.
In the same year, the State Council directed that all
dental training in Kuopio be terminated by 1998, and
only research and post-graduate training be con-
tinued in Turku. The total number of dental graduates
per year has decreased from 142 in 1990 to 60 in 1999.
The early training of dentists in Finland has resulted
in one of the highest number of working dentists per
capita (1:1060) in the world with minimal geographi-
cal variation in their distribution. The education of
dentists in Finland follows the EU legislation with
duration of minimum 5 years and recommendations
for clinical proficiencies set by the Advisory Commit-
tee on the Training of Dental Practitioners of Euro-
pean Commission. Since 1974, Finnish dentists have
been able to specialise in oral surgery, orthodontics,
clinical dentistry and in oral public health. Specialist
training programmes involve 3–4 years’ full-time
study in the University with salary.
Copyright C Munksgaard 2001
ISSN 1396-5883
However, feedback seminars after treatment of the patient were
not in favour. As part of the evaluation process, a DENTED visi-
tation took place in Helsinki in March 1999. The results obtained
in the student questionnaire were consistent with the aims of the
undergraduate training and with the present patient treatment
range. In conclusion, the curriculum change enabled the school
to broaden the biomedical aspects by increasing the period of
preclinical studies. Although the extent of these studies was
greater than in the past, and meant postponement of clinical
skills courses by one semester, it did not jeopardise the compet-
ency in clinical dentistry, owing to the effective integration of the
clinical phase teaching.
Key words: schools, dental; dental education; competence, clin-
ical; care, comprehensive dental; educational measurement.
c Munksgaard, 2001
Accepted for publication 27 June 2000
Oral health
Oral health in children and young adolescents has
steadily improved and the number of caries-free
children has increased since the 70s. Today, 12-year-
olds have an average of 1.2 DMF-compared to 6.9 in
1975. Edentulousness has decreased in all age groups.
Whereas in 1970, 23% of the over 15-year-olds were
edentate, the respective number in 1990 was 14%. In
1991, about half of 12–18 year-olds and about 28% of
33-year-olds had healthy gingiva (CPIΩ0). 75% of 30-
year-olds needed periodontal treatment (CPI at least
2) and the need for periodontal treatment increased
with increasing age. These changes in the disease
spectrum lead to the need for curriculum change, as
simple restorative procedures are seldom needed and
preventive measures should be based on present
knowledge (1,2). The future dentist is challenged with
elderly patients keeping their own teeth but de-
manding comprehensive understanding of their
medical problems (3).
23
Kerosuo et al.

Helsinki University
The University of Helsinki, the largest university in
Finland, is among the oldest universities in Europe.
Today there are 32,000 students and 2500 academic
and research staff in the University of Helsinki. The
Faculty of Medicine offers two basic degrees: Li-
centiate in Medicine with a yearly intake of 90 stu-
dents and Licentiate in Dentistry with a yearly intake
of 30 students. After graduation, 6 months internship
in the oral health service as an assistant dentist is
compulsory in order to obtain a dental licence.
Due to national economical recession in the early
90s, new strategies by the University Senate in 1994
enabled the faculties to achieve better results with
fewer resources. Within the Medical Faculty, new
goals were set and the faculty decided to implement
a new curriculum in several stages, starting in August
1994 with PBL for preclinical studies as a ‘parallel
track’, based on the Harvard system (4). Only volun-
teer medical students were allowed to enrol for the
new programme. This change was preceded by the
integration of the preclinical curriculum through the-
matic and topic-based teaching (5). As the preclinical
studies were partly common for medical and dental
students, changes also became inevitable in the dental
curriculum. Furthermore, the Faculty Council fo-
TABLE 1. Subjects (entities) and credit hours in European Credit
Transfer System (ECTS) credits in the preclinical studies during the
1st and 2nd year of integrated medical/dental education in the Univer-
sity of Helsinki; the entities are presented in chronological order
Entities Total
hours
Semesters 1 and 2, 1st year
introduction to medical studies 120
introduction to molecular and cellular biology and 200
pharmacology
cell biology and basic tissues 160
from cell to multicellular organism 80
metabolism 200
molecular biology and protein synthesis 160
the musculo-skeletal system 280
interpersonal skills* 60
total 1260
Semesters 3 and 4, 2nd year
interpersonal skills 60
neurobiology 376
circulation, kidneys and respiration 350
the gastro-intestinal system and nutrition 200
endocrinology and the reproductive organs 160
environment, protection and
defence mechanisms of the body 136
final examination of the first (preclinical) stage
total 1282
* The course continues all through the studies.
cussed most of the budget cuts on the dental training
programme. Regardless of the visions of the Institute
of Dentistry, a significant cut in staff numbers was in-
evitable. This created pressure for further planning of
the dental curriculum as a whole, and an urgent need
to reorganise existing resources.
Curriculum revision: objectives
The process of planning a new curriculum was started
in the Institute of Dentistry in 1993 by nominating an
ad hoc committee representing each discipline. The
main objective was to produce a framework for the
curriculum change. Thus, a document – ‘Guidelines
for the Curriculum Change in Dental Undergraduate
Studies’ – was prepared and approved by the Faculty
Council in December 1994 with the following curricu-
lar requirements:
(1) To reinforce the links between basic biomedical
and dental sciences, with emphasis on oral medicine
and comprehensive dental care.
(2) To promote an interdisciplinary approach and
encourage students to understand the dental diseases
in relation to the community at large.
(3) To formulate, for the first time in Finnish dental
education, objectives for the behavioural sciences. The
graduate should possess a positive attitude towards
life-long learning and should have evidence-based
dentistry as the goal and should be able and willing
to promote scientific reasoning. The graduate should
be able to manage patients from all age groups
(healthy or handicapped) with ease and respect, and
should be aware of the ethics of the dental profession.
ECTS
credits
(4) To emphasise interpersonal communication
skills and ability to work in a team both as a member
and as a leader.
6
9 (5) To arrange the clinical training in a comprehen-
sive care setting.
8
(6) To arrange the clinical training in a team-concept
4
9 setting to allow more patient contacts per student and
8 thus ensure willingness to encounter patients with
13
different types of oral health problems in the future.
3
60
Planning process
3
16 Reorganisation of the didactic teaching
15.5 For the biomedical curriculum, a co-ordinator (EK)
9
7
was appointed to re-organise the pre-clinical courses
and extend the integration with the medical studies
6 in order to consolidate the biomedical basis (6). The
3.5
most feasible option was to integrate the dental and
60
medical courses totally (Table 1), although only a few
schools have so far implemented a total integration

24
 New Helsikin curriculum

(5, 7). The only exceptions are the interpersonal skills teaching. It appeared that most teachers would have
courses, where the dental students have a programme preferred their course to be in the last clinical year,
specially planned from the dentist’s point of view. when the students already know ‘the basics of den-
Rather than keeping dental students separate as is tra- tistry’. To start the clinical training as soon as possible,
ditional, the merger grouped the students in alpha- the dental skills laboratory courses were grouped into
betical order so that there are always both medical smaller ‘packages’ alternating with the clinics. Thus,
and dental students in the small study groups, with- the delay in practising the newly-learned skills, which
out the teachers’ awareness. We feel that this is an could have been 6 months in the old model, was
important step on the way to regarding dentistry as avoided, and the students experienced hands-on den-
an equal partner with medicine and not as a ‘little tistry much earlier.
brother’, thus reinforcing the motivation of the dental These suggestions were forwarded to the Dental
students. Curriculum Planning committee and finally approved
To revise the clinical curriculum, an ad hoc commit- in the Faculty Council in May 1996.
tee was established. The following objectives were
formulated: (i) To evaluate the contents of the didactic
Implementation of clinical phase studies
teaching in the clinical phase (years 3–5); (ii) to revise
the didactic teaching; (iii) to reorganise clinical train- Roughly half of the 5-year curriculum comprises 9
ing to reinforce the links between theoretical knowl- newly formed entities and clinical training (Fig. 1). In
edge and clinical competence. Finally, the task was to order to synchronise the teaching/learning process,
reduce the clinical curriculum by 25 European Credit for each semester in the clinical phase (years 3–5),
Transfer System (ECTS) credits (8), so as to accom-
modate preclinical subjects without extending the
total of 300 ECTS as the total volume and duration TABLE 2. Inter-disciplinary learning promoted by arranging the sub-
(5 years) of the undergraduate degree is legislated by jects into new learning entities; entity .1 comprising substance from
statute (9). 10 courses/disciplines in the past
To ensure competency and completeness, senior lec- Courses/disciplines under which New integrated courses under the
turers from each discipline were invited to this ad hoc the topics were taught in the new learning entity .1 :
committee to work on a part-time basis for revision of past Growth of the masticatory system
the curriculum. Short-term clinical staff were hired to head and neck anatomy A. head neck anatomy
substitute for the committee members. Consultant tooth morphology B. tooth morphology
oral physiology C. facial growth, development of
economists also served on the committee and in line development of the dentition dentition & masticatory function
with current university practice, students were asked oral pathology D. developmental disorders of the
to nominate their representatives. After identification oral surgery face & teeth
oral radiological diagnostics
of the overlapping of subjects in the existing teaching, cleft lip & palate
the committee made a proposal, whereby the didactic principles of teratology
teaching was reorganised into 9 new entities. These human genetics
covered all aspects of modern dentistry, each forming
an umbrella for several conventional disciplines,
thereby promoting an inter-disciplinary approach
(Table 2). Special emphasis was put on oral medicine TABLE 3. New learning entities in the clinical phase and their teach-
ing load in ECTS credits
and oral public health, each of which was recognised
as an entity in its own right (Table 3). The proposal Title of the entity Total Credits
hours
also outlined the reorganisation of the clinical training
into a comprehensive clinic model (see implemen- 1. growth of the masticatory system 160 6.0
tation). 2. oral diagnostics 216 8.1
3. development guidance of the occlusion 220 8.3
4. stomatognathic physiology 172 6.5
Time schedule 5. reconstruction of bite function 280 10.5
The last step in the planning process was to prepare 6. infectious diseases of the tooth and 856 32.1
periodontium
a timetable for these courses and synchronise them 7. traumatology and diseases of soft and hard 228 8.6
with the clinical training. For this purpose, another ad tissues
hoc committee was nominated, comprising represen- 8. oral medicine 508 19.1
9. oral public health 180 6.8
tatives from newly established entities. Each entity
total 2820 106
was supposed to give its first priority for timing of its

25
Kerosuo et al.
Fig. 1. The new dental curriculum comprising 306 ECTS credits. The
clinical phase didactic teaching (106 ECTS) and clinical training (54
ECTS) contribute more than half (52%) of the 5 year curriculum.
special emphasis is given to selected topics (Table 4).
However, unlike in Malmö (10), these are not discrete
courses, but merely guidelines for arranging both
didactic studies and clinical training. Thus, the num-
ber of hours spent on these topics cannot be stated
exactly.
Clinical training
In a previous curricular change in 1972, when the first
attempt towards comprehensive care was launched,
the departmental model was maintained. This carried
many disadvantages. The aim of the new curriculum
was for the student to visualise the instructor as a role
model performing comprehensive dental care with
competence. This goal can only be achieved in an inte-
grated, comprehensive model where the instructor
need not be a specialist, as the treatment modalities
carried out in the clinics are not on a specialist level.
Consequently, ‘fully’ specialised colleagues may feel
uncomfortable in instructing students in procedures
beyond their field. In order to maintain an active link
TABLE 4. The special emphasis to be focused in each clinical semester
Semester Special emphasis on
5 theoretical basics, preventive dentistry
6 basic clinical skills
7 diagnostics
8 rehabilitation of masticatory system
9 independent work in the clinic
10 dental profession as a part of the health care system
26
between the academic faculty members and the in-
structors, frequent seminars and training sessions are
organised.
As in Malmö and Aarhus, paedodontics and ortho-
dontics were not included in the comprehensive care
model. In Helsinki, this was for two main reasons.
First, since there was a need to focus orthodontics
more on interceptive and early treatment procedures,
it was essential to integrate it into the teaching of pae-
dodontics. Secondly, as the dental care of children and
adolescents has been to a great extent separated from
that of adults in Finnish society, most of the clinical
instructors in other disciplines lack the experience to
treat children.
Even since the curriculum change of 1972, the time
allocated for clinical training had been 54 ECTS
credits (approximately 1440 h) which falls into the
highest quarter among European schools (11). In spite
of the high pressure caused by the shortage of time
due to the extention of preclinical studies, this figure
was kept constant in the new curriculum.
The training includes diagnosis, treatment plan-
ning and the procedures needed for treatment ac-
cording to the learning goals. The dental students
are rostered with dental hygiene and nursing stu-
dents. Clinical teams consist of 2 dental students
from each clinical year, 2 dental nursing students
and 1–2 dental hygienist students. Students have
different roles in the team depending on their stage
of learning process. Dental students have a 16-week
semester and rotation in all units of the dental clinic
in order to cover all aspects of patient care. Clinical
training is from 8 a.m. to 2 p.m. Time spent in the
clinic per week increases from 2 days in the 3rd
year to 4 days in the 5th year.
Students and their instructors screen adult pa-
tients in a separate unit of admissions, but children
and adolescents enter the comprehensive dental care
units directly. Clinical instructors of the comprehen-
sive dental care unit then choose appropriate cases
for their students in co-operation with a particular
student. The clinical instructor is responsible for the
completion of all the treatment modalities of the pa-
tients.
In the clinical training, emphasis is given to the
proven competency rather than the number of pa-
tients treated or number of procedures performed (12,
13). This approach enables the clinical work to focus
on high-technology procedures. In addition, simula-
tion models are also fully exploited in the clinical
phase of the studies.
Since the beginning of 1997, the clinical training has
been executed in the realm of an administrative unit,

Clinic for Dental and Oral Diseases, which is an inde-
pendent unit to provide teaching facilities for learn-
ing.
Interpersonal skills
Training in interpersonal skills introduces the student
to the role of the dentist and allows early patient con-
tacts. It provides an excellent forum for practising be-
haviour change skills (14), without being anxious of
failing in the manual skills. Interpersonal skills add
up to 11.3 ECTS credits in 5 years, equalling 40 contact
hours per year. The main objectives are: (i) to support
the student’s professional identity, (ii) to develop the
student’s interpersonal skills needed as a dentist, (iii)
to develop the student’s ability in ethical reasoning,
(iv) to develop the student’s understanding of the
dentist’s role as a member and leader of a team, and
(v) to familiarise the student with the use of scientific
knowledge in clinical practice (evidence-based den-
tistry).
The work towards these objectives occurs mainly
in small groups, interviewing persons of different age
groups on their experiences in dental care, with
special emphasis on dental anxiety. Clinical work is
observed in different clinics outside the university.
Students may have their first exposure in real dental
work carrying out simple preventive measures in the
2nd year. Short episodes in dental offices are simu-
lated and played, based on imaginary or clinically ob-
served scenaries. Students take dental histories with
emphasis on oral health habits. At a later stage of the
course, visits are made to health care centres, hospi-
tals, old people’s homes, and institutes for the handi-
TABLE 5. The three levels of competency applied to knowledge, skills and attitudes
Level of competency Applied knowledge
1 knows the basics for this
beginner particular treatment
2 knows the basics for this
independent performer particular treatment and
its relation to
comprehensive care of
the patient
3 able to evaluate causes
skillful performer and consequences;
able to give reasons for
chosen procedures
New Helsikin curriculum
capped as well as to private dental clinics. Project
work in ethics in dentistry, critical reviews of scientific
articles and presentation of a scientific report to the
whole class, are compulsory. By challenging the stu-
dents as early as possible to independent study and
project work, utilising modern information tech-
nology, we believe that the responsibility of the learn-
ing process is given to the students themselves, thus
promoting scientific reasoning and life-long learning.
Each student keeps a study logbook during the in-
terpersonal skills studies. This course guides the stu-
dent to develop and improve professional knowledge
and self-respect, in relation to each student’s own
background and level of personal skills.
Assessing learning process
Preclinical courses are assessed by a written examina-
tion after each of the 12 entities. The students are re-
quired to pass all preclinical courses in order to enter
the clinical phase. The format of these exams consists
of multiple choice questions (MCQ) and short essay-
type questions. Students’ representatives from the
clinical phase of the studies along with the clinical
instructors take part in the planning of the preclinical
final examination. Although traditional written ex-
amination is the most widely used method of assess-
ment, other approaches have been developed to guide
the students’ learning process. Currently, teaching in
the clinical phase is organised according to the enti-
ties, but the final examinations are so far organised by
each discipline. Exams are not necessarily conducted
at the very end of the courses so as to give students
a better chance for feedback and improvement. This
Skills Attitudes and
communication
needs help to perform minimal communication
relevant treatment skills, but still takes the
patient into account;
able to give instructions
to patients
able to perform relevant able to understand
treatment independently treatment also from the
patient’s point of view
able to perform relevant able to discuss several
treatment independently aspects of treatment;
in a reasonable time respects feed back
given by patient;
able to maintain
professional rôle
27
Kerosuo et al.
means a combination of assessment methods includ-
ing both summative and formative aspects. More for-
mative ways are introduced while supporting factors
throughout the student’s learning process are empha-
sised. For this particular reason, the progress test is
being implemented during the clinical phase as part
of the continuous assessment starting in the year 2000.
The test is a modification of the progress test intro-
duced in Maastricht University. The test is taken twice
a year and is mandatory for all students. The results
are only used to monitor individual progress in re-
lation to the candidate’s previous scores and then
compared with fellow students, but not to award
grades.
The progress in one’s ability to perform clinical
treatment procedures is assessed with a portfolio. The
three different dimensions are: (i) duration of clinical
training; (ii) quota of clinical procedures to be com-
pleted; (iii) comprehensive treatment. The student
demonstrates his/her ability to perform clinical work
in every phase of treatment, including documenta-
tion. The performance is self-assessed and then
marked by the clinical instructor as described earlier
in the Malmö model (10, 15). In this context, the stu-
dent’s attitude, knowledge and clinical skills are as-
sessed. Students are expected to reach the level of an
independent performer on a scale modified from that
used in Dundee (13) (Table 5). These overall descrip-
tions are the guidelines for discussions. Short 15–30
min group sessions on treatment planning and im-
plementation precede and follow daily clinical work
in addition to a possible personal feedback to the stu-
dent. More thorough one-on-one feedback sessions
are arranged once per semester. The student and the
teacher compare and discuss their results of the evalu-
ation and, accordingly, set new objectives for the stu-
dent.
Evaluation of the new comprehensive
model for clinical training
Questionnaires
In spring 1998, 2 years after the implementation of
the comprehensive clinic, a questionnaire was
handed out to the final year students. These stu-
dents were exposed to both the old and the new
curriculum. The questionnaire was completed by
74% of the students. More than 2/3 of the respon-
dents felt that the team concept was better than the
old individual approach and that the facilities were
more readily accessible. More than 1/2 the class felt
that the instructors were more readily available and
28
1
/3 found that the overall competence of the teacher
was better in the new model compared to the old
model. The seminars on treatment planning before
seeing the patient were arranged regularly for most
of the students, and more than 1/3 found them very
important. None of the students considered the sem-
inars on treatment planning a waste of time,
whereas the feedback seminars (immediately after
the clinical session) were considered not much use
and were only occasionally arranged. We found this
result disturbing, as in the Malmö model, the post-
treatment seminars (1 h) comprise an essential part
of the learning process (15). Our result may indicate
that still too much emphasis is being placed on the
manual skills, at the cost of a holistic view (4, 10).
In the new model, only 12% of the students experi-
enced problems in finding a vacant dental chair,
whereas that had been the case for the majority in
the old model. Thus, the time allocated for clinical
studies was more effectively used.
In the new model, in orthodontics, emphasis has
been given to screening, diagnosis, treatment plan-
ning and follow-up of the patients. The new team
concept has allowed each student to visualise more
clinical (and video-recorded) cases compared to the
individual approach, where students were respon-
sible for only their own patients. More than 2/3 of
the students favoured the new model and found the
load of teaching in orthodontics to be appropriate in
relation to the whole dental curriculum.
DENTED visitation
Dental educational standards vary widely across
Europe and convergence is best promoted through
exchanges (SOCRATES) and voluntary school visi-
tations organised by DENTED (16–18). As part of
the evaluation process, a DENTED visitation took
place in Helsinki in March 1999. The visit was
fruitful and the Institute received several recom-
mendations to improve the undergraduate pro-
gramme.
The DENTED questionnaire on clinical compet-
encies, covering all fields of clinical dentistry was
distributed to the final-year students. The vast ma-
jority of the students (90%) felt themselves well ex-
perienced or competent in all disciplines except
oral surgery (periapical surgery and removal of a
buried root) and prosthodontics (preparing a three-
unit adhesive-resin-bonded bridge). These results
are consistent with the aims of the undergraduate
training and with the present patient treatment
panorama.

Concluding remarks
The Institute of Dentistry has undergone major
change over the years. Only lately has emphasis been
placed on learning. It is hoped that the revised cur-
riculum reported here will facilitate the education of
dentists who can better serve the needs of an individ-
ual patient and the community today and in the fu-
ture. The improvements emphasised a learning-
centred approach, developed skills and attitudes, in-
cluded evaluation by competence, and promoted life-
long learning skills so as to facilitate the future main-
tenance of competence and scientific thinking. A cur-
riculum revision is a continuous process with on-go-
ing evaluation. In this paper, we describe how it was
possible to broaden the biomedical basis by integrat-
ing the preclinical studies with those of the medical
students. Although the extent of these studies was
greater than in the past, and meant postponement of
clinical skills courses, it did not jeopardise the com-
petency in clinical dentistry, owing to the effective in-
tegration of the clinical phase teaching.
However, major changes in Helsinki are still to be
seen. In September 1999, all preclinical teaching in the
Medical Faculty started as a hybrid PBL programme.
In the coming years, this will be a challenge for
further reinforcing the links between the preclinical
and clinical subjects by following the encouraging
examples reported recently in the dental schools of
Malmö, Singapore and Dublin (10, 19, 20).
Since the beginning of 2000, the administration and
management of the Clinic for Dental and Oral Dis-
eases has been changed dramatically. The Clinic has
always been a vital part of the Institute of Dentistry
in the University, under the Ministry of Education,
and its functions have been mainly financed by the
fees of self-paying patients. Starting from the begin-
ning of the new millennium, patients needed for
undergraduate education will be provided by the
Health Care Centre of the city of Helsinki under the
Public Health Act. The University Central Hospital
under the Special Care Act provides patients for stu-
dents in specialist training. All patients pay only a
nominal fee set by the Government. The University
Central Hospital then administers all clinical activities
related to dental undergraduate and postgraduate
training. Some teachers and supporting staff have
been transferred from the present clinic to the new
organisations. The remaining staff will carry out their
academic responsibilities, research and teaching. The
major changes will obviously affect all areas and ac-
tivities and the outcome on academic dentistry is yet
to be seen. The changes will provide ideal working
New Helsikin curriculum
conditions for clinical dental education and for inte-
gration of all the fields of medicine.
Acknowledgements
We wish to express our gratitude to all Faculty mem-
bers and students at the Institute of Dentistry, whose
co-operation and enthusiasm made this curriculum
change possible. We also want to thank all those en-
couraging Faculty members in the Faculty of Medi-
cine, who have devoted their time to the re-organis-
ation of preclinical studies. Finally, our thanks go to
Dr. Bobby Joseph, Kuwait University, for many fruit-
ful discussions and suggestions during the prepara-
tion of the manuscript.
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