Expert consensus on relevant topics for undergraduate paediatric dental curriculum using the fuzzy Delphi method: a new direction for Malaysian dental education

Two paediatric dental specialists who are full-time senior faculty members from two different dental schools in Malaysia (Universiti Malaya and Universiti Sains Malaysia) and a private paediatric dental specialist were brought together to form a focus group. They contributed to the development of the first draft of relevant paediatric dentistry topics for the undergraduate dental curriculum by compiling the existing undergraduate dental curricula in each Malaysian dental school through discussion with the heads of department, followed by analysing and comparing them to the revised national competence statement published in 2021. Subsequently, a tentative list of pertinent topics was developed. For the literature review, three databases (Google Scholar, PubMed, and Science Direct) with keywords of “undergraduate paediatric dentistry”, “paediatric dental education”, and “paediatric dental curriculum” were used. The initial list of relevant topics was then modified repeatedly until all three members reached a consensus. The final draft included a list of 65 important topics under 18 specific domains (Restoration in paediatric dentistry; Preventive dentistry in children; Minimal Intervention Dentistry (MID); Dental caries in paediatric patients; Growth and development; Basic behaviour guidance techniques; advanced behaviour guidance technique; Examination and diagnosis in paediatric dentistry; Pulp therapy in primary teeth & immature teeth; First permanent molar; Interceptive orthodontics; Tooth eruption and exfoliation; Trauma in paediatric dentistry; Orofacial soft tissue lesion in paediatric patients; Special care in paediatric patients; Tooth extraction in paediatric patients; Dental materials in paediatric dentistry; and Dental emergencies in paediatric dentistry) and was converted into a survey questionnaire by one investigator, who entered the information into a Google Form survey tool.

Content validation was conducted by two paediatric dental specialists (one from the Ministry of Health Malaysia and another from a Malaysian private dental school) to provide a preliminary assessment of the acceptability of the content. No amendment was required. The Fuzzy Delphi method was applied to identify expert opinions in the present study [19]. 25 experts who are currently affiliated to any local dental schools, private sectors or the Malaysian Ministry of Health and fulfilled the inclusion criteria were chosen for the present study, which was performed with the recommended optimum number of experts between 10 and 50 [18]. The inclusion criteria for experts were those with a valid annual practising certificate and fulfilled one of the following: completed a paediatric dental specialist training postgraduate programme or currently enrolled in any postgraduate clinical training programme related to paediatric dentistry science or published in a peer-reviewed paediatric dental journal or actively involved in paediatric dental associations that uphold the best interests of paediatric dental education. Meanwhile, international faculty members were excluded from the current study.

A purposive sampling was used, and the survey items were sent out via an online Google Form to experts from various regions of Malaysia. Each expert is required to score the questionnaire items based on a five-point Likert scale (1 = Not important at all; 2 = Not important; 3 = Neutral; 4 = Important and 5 = Very important) and determine the appropriate cognitive and psychomotor levels using Bloom’s cognitive (1 = remember, 2 = understand, 3 = apply, 4 = analyse, 5 = evaluate, 6 = create) and Simpson’s psychomotor (1 = perception, 2 = set, 3 = guided response, 4 = mechanism, 5 = complex overt response, 6 = adaptation, 7 = origination) taxonomies. The survey was given to the experts with three weeks to complete it, and reminders were sent at the end of the second and third weeks.

The included experts anonymously assessed the importance of relevant topics that should be covered in the Malaysian undergraduate paediatric dental curriculum. Along with each topic, experts were asked to suggest acceptable cognitive and psychomotor levels. They were also given the freedom to add any new topics that were not on the list. This is followed by the translation of linguistic variables to fuzzy numbers. Three numbers for each recorded answer were used to identify the average lowest value, the fair value, and the highest value represented by m1, m2, and m3, respectively [20]. The m values in the present context showed the probability of experts agreeing that the paediatric dentistry topics were important.

Three requirements were used to choose whether to maintain or eliminate topics. First, experts were considered to have reached a consensus on the topics if the difference between the average and expert rating data was ≤ 0.2 [21]. By calculating the difference between each expert’s fuzzy number and the average fuzzy number, the d-construct threshold value for each item was found. To calculate the difference between the averages, the vertex approach was used [22]. Second, a consensus of ˃70% among the experts was acceptable [18], and no further cycle of the survey is needed. Finally, an accepted topic should have an average fuzzy number of ≥ 0.5. A framework of curriculum content in undergraduate paediatric dentistry was then modelled using fuzzy assessments. This stage involved sorting the topics according to the experts’ opinions, with the most important topic in the model receiving the highest value [20].

Bloom’s and Simpson’s levels each received scores ranging from 1 to 6 and 1 to 7, respectively. The average mean scores were calculated using numbers assigned to each topic [23]. The mean ratings were used to establish the appropriate cognitive and psychomotor levels [7], but they did not take into account responses that were deemed as missing.