Harsh tone in dentistry clinic ‘unacceptable and surprising’, says Head of Department

At the Department of Dentistry and Oral Health, where students are trained by clinical instructors and perform dental treatments on patients, students have, according to a study of the study and work environment, experienced comments such as “Are you stupid?”, “You should probably visit a psychologist,” and “I only shout at those who can take it.”

More than one in four students (29 per cent) responded in the survey that they had experienced a harsh tone in the clinic, while one in six (16.7 per cent) generally don’t feel safe in their relationship with their clinical subject instructors.

This is unacceptable, says Siri Beier Jensen, head of the Department of Dentistry and Oral Health. She says the survey results, presented in a report, took her by surprise.

“Yes, I was surprised by them. That’s not how it should be,” she says, commenting on the report’s findings:

“I’m sorry that some dental students – and also some staff members – experience a harsh and disrespectful tone in the clinic. As the report also notes, a harsh tone leads to uncertainty and insecurity, which isn’t conducive to well-being or learning. And that isn’t  how it should be at an educational institution or workplace,” she says.

READ MORE: After reports of a "toxic study environment" at the school of dentistry: more than one in four students have experienced a harsh tone in the clinic

Like the report, Siri Beier Jensen points to several factors that may help explain why problems arise in the clinic. These include the considerable responsibility carried by staff and students, high workload, and a complex learning situation.

“I want to emphasise that regardless of the reason, it’s unacceptable. We need a respectful and caring tone. There must be psychological safety in the learning environment for both students and staff, and that’s what we will now work on,” she says, elaborating on possible causes:

“Clinical training is a very particular kind of situation, with a student treating a patient. You’re new to the profession but must still act as a professional authority in relation to the patient, while also being in a learning situation with an instructor present. This context is therefore very particular, very vulnerable, and very complex for all parties. I’m not saying this to excuse anything. These are conditions we need to examine to see how we can prevent them from fostering poor well-being or a harsh tone,” Siri Beier Jensen says.

“Everyone must be treated with respect”

The report also shows that the harsh tone occurs between staff members. Among employees in the clinic, 8.3 per cent had experienced a harsh or disrespectful tone within the past year. The report states that this is most frequently experienced by dental assistants, who encounter it from dentists towards their profession as a whole and towards the dental students. That shouldn’t happen, Siri Beier Jensen says.

“Regardless of your role here or your professional background, we’re all necessary for delivering education and research, which are our core tasks. Everyone must be treated with respect,” she says.

“We need to move forward”

Siri Beier Jensen has discussed the report with the clinical instructors at the Department of Dentistry and Oral Health.

“I have gone through the report’s conclusions – including examples – and the possible causes. But I have also been very clear: We need to move forward. This isn’t acceptable,” she says.

“The instructors’ own reflections on this particular teaching situation align closely with the report’s conclusions and recommendations. That’s a good starting point for our work going forward – to change the conditions so that they foster a positive and safe environment rather than a harsh one,” Siri Beier Jensen says.

She has also heard the instructors’ perspective on situations where something may be perceived as a harsh tone, even if that was not the intention. The explanation is that, in some cases, the tone may seem harsh but is in fact necessary when the instructor must give clear, direct instructions.

“I fully recognise that there can be difficult situations in which very clear, directive instructions must be given from instructor to student during ongoing patient treatment, and that the student may then perceive it as harsh. There’s no doubt about that. But patient safety must also be considered, so sometimes instructions must be delivered very precisely, and action must be taken quickly,” Siri Beier Jensen says, again stressing that the tone should still be proper and respectful.

Constructive feedback

The report makes a number of recommendations for how the department can address the situation. The department will base its actions on these recommendations, Siri Beier Jensen says.

The management team will prioritise and initiate the recommendations to be developed into action plans. The department is in the process of establishing a broadly represented focus group, with students, staff, and managers. This will include, for example, representatives from the “semester forum”, comprised of two student representatives from each semester of the odontology degree programme as well as representatives from the department forum, the board of studies, and local cooperation committees. Once the focus group has worked on the topics, working groups will be set up to develop concrete action plans and initiatives. Progress will be monitored to see whether changes have occurred. How to measure this will be determined with the help of Falck Healthcare.

Siri Beier Jensen says some things can be changed quickly, while others will require more long-term work. There are both fundamental issues in the clinical environment to be addressed and more isolated problems to be handled.

First and foremost, she highlights the need to work on the feedback culture.

“Both how feedback is given constructively and how it’s received constructively. This is absolutely essential to creating a psychologically safe learning environment where students can also receive constructive criticism – because it’s, of course, also about becoming a good dentist and ensuring that the treatments you carry out are safe for patients,” she says.

Among other things, the department will consider a whistleblower scheme and raising awareness of complaints procedures for students.

“I won’t pre-empt what should be prioritised first, but it’s something we will look at – making sure there’s a simple and clear path for reporting concerns, for both students and staff. And clear guidelines on how such matters will be investigated and followed up. Again, it comes back to psychological safety: It must be done in a way that gives everyone confidence to come forward – preferably as early as possible – and the assurance that there will be no repercussions,” she says.

Almost ten percent experience discrimination

According to the report, 9.6 per cent of students experience discrimination. Most cases relate to ethnicity and health. One example is that a student in the clinic was asked “a question about religious affiliation that seemed out of place in the situation.”

“Overall, I would say that we won’t tolerate discrimination, whether it concerns ethnicity, gender, sexuality, or similar. We will therefore work more on creating awareness and understanding of the issue – when something is discriminatory and when something is perceived as discriminatory,” Siri Beier Jensen says.

The report notes that the survey includes a hypothesis that the failure rate is higher among students with an ethnic background other than Danish, as well as a hypothesis that these students ask fewer questions because asking questions isn’t ssociated with independence. “Both hypotheses could usefully be investigated further,” the report from Falck Healthcare states.

The Department of Dentistry and Oral Health doesn’t record the backgrounds of students or staff, Siri Beier Jensen explains.

“We don’t register students’ or staff members’ backgrounds, so we don’t know whether there are ethnic or cultural differences. We must ensure that no one is discriminated against, and we must work on feedback culture – how it’s given and how it’s received – and there must be a psychologically safe learning environment so that everyone feels able to ask questions regardless of background,” she says.

Most feel safe

Alongside the report’s negative findings, the head of department wants to emphasise that the majority of students feel safe in the clinical setting, and many don’t experience a harsh tone.

“I have also noted that the vast majority of both students and staff say they thrive and feel safe in the clinical environment. That is good, and we must preserve it in our further work. It must be developed and made the reality for everyone,” she says.

“The report shows there’s a strong basis for creating these changes in the department. We must reach a point where we have a positive and safe environment for everyone – students and staff alike – while, of course, continuing to deliver education and research, which are our core tasks,” Siri Beier Jensen says.

It will be safe for students to return to the clinic after the summer break, the head of department assures, again stressing that most respondents said they feel safe.

“My impression is that everyone has been very engaged with this and has become more aware of how things are said and can be perceived. I’m quite certain that everyone has reflected on it. So yes, I believe it’s safe to come back,” she says.

Access to the report

Omnibus has been given access to the report, but parts of it have been redacted. The department states that the redactions are due to GDPR regulations and information that could identify individuals. Staff and students at the department have therefore not seen the report in its entirety.

This text is machine translated and post-edited by Cecillia Jensen