J Evidence Based Medicine - 2023 - Thomes - Lack of evidencebased practice discipline in the curriculums of the Brazilian

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Received: 6 April 2022 Accepted: 4 January 2023
DOI: 10.1111/jebm.12513
L E T T E R
Lack of evidence-based practice discipline in the curriculums
of the Brazilian undergraduate dentistry programs
Evidence-based practice (EBP) in dentistry helps to guide the decision-
making process of dentists facing clinical dilemmas.1 The inclusion and
increase in curriculum time devoted to the teaching of the principles
of EBP in the undergraduate dentistry curriculum has been suggested
to improve the ability to appraise the literature and to improve clini-
cal decisions.2 EBP training should be initiatedwhile an undergraduate
can perceive the value of this approach in real life. Furthermore,
learning EBP principles early increases the use of evidence-based
decisions in clinical practice.3,4 Pioneering efforts in teaching EBP in
dentistry have been carried out at the universities of United States and
Canada.5
The Brazilian National Curriculum Guidelines for the dentistry
Course6 guideminimal contents to the undergraduate curriculum. This
guideline endorses the importance of an EBP curriculum highlight-
ing that critical appraisal of scientific evidence is crucial for clinical
decision-making.6 Recently, a study proposed a minimum curriculum
for teaching EBP in healthcare programs in Brazil.3 We are unaware of
studies that investigated the proportion of Brazilian dentistry curricu-
lums provide EBP contents to undergraduate students. The aims of this
study were (1) to identify the presence of the evidence-based practice
discipline in Brazilian undergraduate dentistry programs; (2) to analyze
whether the contents offered are in accordancewith theminimumcur-
riculum for courses in the health area in Brazil; and (3) to identify the
offer of the contents across the undergraduate dentistry curriculum.
In this cross-sectional study, we searched for dentistry programs
registered on the Brazilian Ministry of Education website, which was
responsible for accrediting all higher education institutions (https://
emec.mec.gov.br/).We identified all undergraduatedentistry programs
registered in Brazil (July to September 2021), and extracted data
related to the state of each institution, the presence of an EPB disci-
pline and their contents. Two independent researchers collected data
using Research Electronic data capture.7 The data were exported to
further descriptive statistical assessment and chi-square test. Exclu-
sion criteria consisted of dentistry programs listed on the website
but discredited by the Ministry of Education; programs with no con-
tact information; programs with duplicated records on the Brazilian
Ministry of Education website; and those which did not provide
any information about curriculum content. In cases of the university
offered a dentistry course in different states, we considered only one
course since the curriculumwas the same. The curriculawere obtained
a priori on the website of the institution. Due to the absence of doc-
© 2023 Chinese Cochrane Center,West China Hospital of Sichuan University and JohnWiley & Sons Australia, Ltd.
uments on the website, contact was made via email (three times) or
telephone. This survey was carried out by two independent examiners
and a third carried out the consensus of disagreeing data.
Variables extracted from websites included characteristics of the
institution and EBP discipline. Other variables collected were related
to the EBP contents offered, considering the EBP curriculum pro-
posed by Araújo et al.3 We identified if EBP contents content were
presented in a specific EBP curriculum or another, such as research
methodology, epidemiology, biostatistics, or other. The curricula were
analyzed, and two independent examiners extracted data.We resolved
disagreements through discussion or arbitration by a third author.
We identified 581 dentistry programs in Brazil on the BrazilianMin-
istry of Education website. Programs were excluded due to: the same
programs but registered in different states (n= 162; 7.8%), discredited
programs (n = 10; 1.7%), accreditation under analysis and registration
approved but not started (n = 46; 7.9%). The final sample consisted of
363 (62.5%) eligible for analysis. Data were collected from 274 pro-
grams (75.4%) of eligible programs (n= 363) (Supplementary Figure 1).
Most dentistry programs are in the southeast (36.8%) and northeast
(24.8%) regions. The distribution between eligible and included pro-
grams in the analysis in the country’s regions did not vary significantly
(p > 0.05). EPB discipline was offered in 10 (3.6%; 95%CI: 2.5% to
4.7%) of the 274 institutions included. The states where these courses
were located were Rio Grande do Sul (n = 3, 0.05%), São Paulo (n =
1, 0.018%), Pernambuco (n = 1, 0.02%), Rio Grande do Norte (n = 1,
0.02%), Espírito Santo (n = 1, 0.02%), Rio de Janeiro (n = 2, 0.03%),
and Federal District (n = 1, 0.02%). It was evident that none of the
17 programs from the north region included EBP in their curriculum.
Frequencies, proportions and 95% confidence intervals of the propor-
tions of dentistry programs that offered EBP disciplines in Brazil are
presented in Table 1.
It was observed that 60.0% (n = 6) were private, and 40% (n = 4)
were public institutions. In a program, the EBP discipline was offered
for all periods as not obligatory (optional) and without prerequisite. In
30% (n = 3) of them, there was no prerequisite for the EBP discipline,
and in 50%, there was no prerequisite information. In one program,
the disciplines Epidemiology, Descriptive Statistics, Course Conclu-
sionWork I, and Health Communication were prerequisites for EBP. In
another program, theResearchMethods andNormswas a prerequisite
for taking the EBP discipline. The mean workload was 44.1 h (±16.5),
ranging from 30 to 80 h. It was also noted that in 70.0% of cases, EBP
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2 LETTER
TABLE 1 Distribution of dentistry programs in Brazil and the evidence-based practical discipline according to region
Region
Total programs
elegibles (n, %)
Total programs
included (n, %)
Frequency of EBP
curriculum (n, %) 95%CI†
Southeast 141 (38.8) 101 (36.8) 4 (3.9) 1.9% to 5.9%
South 62 (17.1) 56 (20.4) 3 (5.3) 3.5% to 7.1%
North 26 (7.2) 17 (6.2) 0 (0.0) 0.0% to 0.0%
Northeast 91 (25.1) 68 (24.8) 2 (2.9) 0.9% to 4.9%
Midwest 43 (11.8) 32 (11.6) 1 (3.1) 0.0% to 6.2%
Total 363 (100.0) 274 (100.0) 10/274 (3.6) 2.5% to 4.7%
†95% confidence interval. The eligible population in each regionwas considered.
was mandatory (n = 7), being offered from the second to the eighth
semester. The contents covered in EBP curriculum, according to rec-
ommendations to Brazilian healthcare schools,3 were also identified
(Supplementary Table 1).
The results showed that therehadbeenaprecariousness in teaching
EBP, considering the limited number of EBP curriculumand insufficient
contents offered in Brazilian dentistry programs. There needed to be
morenational curriculumguidelines3,6 recommendations since the five
steps of EBP were not included. The EBP teaching with definitive inte-
gration of academic curriculum was in the very initial process of being
implemented in Brazil. Teaching EBP, integrating research and clini-
cal practice, was a more effective method which could be performed
during the undergraduate course.8,9There were doubts about offering it for the first periods or
after prerequisites were taken (research methods, epidemiology, and
biostatistics).10 However, the curriculum suggested for programs in
Brazil3 had argued that EBP should have epidemiology and biostatis-
tics as prerequisites. Richards et al.11 warned that including EBP in
the already crowded dental curriculum, with a restricted and over-
loaded staff, would represent a challenge that could bring benefits in
the future. It had been observed, even 15 years later, that the steps
on this path still needed to be made available. Therefore, the subject
deserves attention from the academic community, especially in Brazil.
The EBP teaching-learning process was challenging, and it required
students to integrate the conceptual model of EBP, by combining the
best available research evidence with clinical experience and patient
preferences to provide the best quality care.10 To face the challenges in
dentistry, to implement the PBE, in academic4,6 and clinical practice,12
it was suggested to follow what the national curriculum guidelines
signal, a paradigm shift in the formation of a critical professional, capa-
ble of “learning to learn.”13,14 With the recent update of the national
curriculum guidelines, Brazil can change the scenario regarding the
teaching of EBP. With the restructuring of the curriculum of the den-
tistry programs, it was suggested that the teaching of the EBP be
covered by them.
Several limitations should be presented, including difficulties in
data collection, such as access to programs; outdated websites; com-
municating with the institutions; lack of fundamental and complete
information in the programs; heterogeneity in the titles of disciplines
and their contents, despite having the same scope. To overcome
these limitations, keywords were selected in the names and contents,
identified as common to the disciplines. Several contactsweremade by
two examiners, who independently searched for the same information.
Future studies explore the environment, learning style, knowledge,
skills, and students’ attitudes about validated EBP learning assessment
methods or tools, as well as the feasibility of the curriculum.3,11,15
Furthermore, the EBP discipline as a separate curriculum component
is needed. It would also be essential to analyze the impact of incor-
porating EBP in student education and its impact on the quality of
care.
In conclusion, the study finds a reduced number of EBP disciplines
and a need for several EBP contents in Brazilian undergraduate den-
tistry programs. It highlights the urgent need for universities to revise
their curricula to EBP content.
ACKNOWLEDGMENTS
We are grateful to Prof. Silvia das Dores Rissino and Doglas Gobbi
Marchesi, from the Research Eletronic Data Capture (REDCAP) Man-
agement Committee, at the Federal University of Espírito Santo
(UFES)/CEUNES, who helped in the elaboration of the REDCAP
project.
CONFLICT OF INTEREST
The author declares that there is no conflict of interest that could be
perceived as prejudicing the impartiality of the research reported.
DISCLOSURE STATEMENT
All authors have nothing to disclose.
DATA AVAILABILITY STATEMENT
The data supporting this study’s findings are available on request from
the corresponding author. The data are not publicly available due to
privacy or ethical restrictions.
Caroline Rodrigues Thomes1
Carlos Vagner Gonçalves Peres1
MaryEllen Almonfrey Totolla1
Liliana Aparecida Pimenta de Barros2
Elizabeth Pimentel Rosetti2
LeonardoOliveira Pena Costa3
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LETTER 3
Luciana Butini Oliveira4
Felipe José Jandre dos Reis5,6
Luciana Faria Sanglard2
1Course of Dentistry, Federal University of Espírito Santo, Vitória, Espírito
Santo, Brazil
2Department of Clinical Dentistry, Federal University of Espírito Santo,
Vitória, Espírito Santo, Brazil
3Masters & Doctoral Programs in Physical Therapy, Universidade Cidade de
São Paulo, São Paulo, Brazil
4Division of Pediatric Dentistry, Faculdade São LeopoldoMandic,
Campinas, São Paulo, Brazil
5Instituto Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
6Pain in Motion Research Group, Faculty of Physical Education &
Physiotherapy, Department of Physiotherapy, Human Physiology and
Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
Correspondence
Luciana Faria Sanglard, Department of Clinical Dentistry, Federal
University of Espírito Santo, Vitória, Espírito Santo, Brazil.
Email: lusanglard@gmail.com
ORCID
LucianaFaria Sanglard https://orcid.org/0000-0002-2520-7062
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Additional supporting information can be found online in the Support-
ing Information section at the end of this article.
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onditions (https://onlinelibrary.w
iley.com
/term
s-and-conditions) on W
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ibrary for rules of use; O
A
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reative C
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icense
https://orcid.org/0000-0002-2520-7062
mailto:lusanglard@gmail.com
https://orcid.org/0000-0002-2520-7062
https://orcid.org/0000-0002-2520-7062
	Lack of evidence-based practice discipline in the curriculums of the Brazilian undergraduate dentistry programs
	ACKNOWLEDGMENTS
	CONFLICT OF INTEREST
	DISCLOSURE STATEMENT
	DATA AVAILABILITY STATEMENT
	ORCID
	REFERENCES
	SUPPORTING INFORMATION