Exploring environmental sustainability in dentistry among students and educators in the United Arab Emirates: a cross-sectional survey | BMC Medical Education

Following the publication of the consensus opinion arising from discussions at the ADEE sustainability workshop during the annual conference in Berlin in 2019, there has been a significant surge in interest in ESD. The consensus aimed to inform educators on the core principles outlined in the report on sustainable dental clinical practices and underscored the importance of integrating sustainability across the four educational domains and key competencies in general dentistry education [12]. This study was conducted to investigate, for the first time, the existing awareness and drivers among dental students and educators regarding ESD in the UAE. Additionally, the study sought to identify barriers and enablers influencing the adoption of ESD within dental education in the region.

Despite of the poor ESD awareness among students and educators in the UAE and the paucity of its official and clear inclusion in the current dental curricula shown in the current study, positive attitudes existed among most students and educators to adopt and integrate ESD into the curricula. These findings concur with numerous previous research in the literature on medical [28,29,30] and dental education [20,21,22, 25]. There is an evident awareness towards practical environmental protection within the young student generation, such as cycling and public transportation schemes, turning off energy-consuming equipment, and motion-sensing lights. However, significant barriers need to be addressed to integrate ESD in dental curricula including the lack of knowledge about ESD among students and educators, insufficient curriculum space and resources, lack of time for preparing the needed contents, and the tendency to not prioritize ESD learning outcomes in the dental curriculum. To overcome these barriers, this study recommends providing capacity building and training courses for educators and teaching staff on ESD “educate the educators”, integrating the subject in both classroom and clinical settings and focusing on setting ESD-related program objectives and learning outcomes. This list of recommendations does not necessarily require a complete overhaul of the educational program but rather incorporating ESD content into existing dental curricula. The barriers and enablers identified in this study share large similarities between sustainability-related barriers and enablers reported in previous studies. For instance, the results of our study are also in consonance with those obtained by Joury et al. in 2021 that explored ESD in dental schools in the US and UK [20]. Additionally, Gershberg et al. noted that there is limited room for additional curricular content. Nonetheless, their study findings indicated the feasibility of integrating ESD into existing courses [21]. A recent investigation conducted by Durnall et al. revealed that there is a notable interest and concern among undergraduate students in the UK on the topic of ESD. The abovementioned studies conducted in the UK served as a compelling catalyst for the incorporation of ESD into the academic curricula by the General Dental Council [20, 22]. In the USA, the situation mirrors that of the UK; Gershberg et al. highlighted the importance of assessing students’ interest and attitudes towards ESD to assist educators in devising effective strategies for its integration into the curriculum [21]. It is imperative to highlight that the primary emphasis should be on dental students, as they will play a pivotal role in fostering enduring sustainability-related attitudes and beliefs among future dental clinicians. The commencement of this endeavor should stem from their undergraduate dental education, serving as the foundation for instilling these values. Indeed, our study underscores the importance of students’ role as leaders and initiators for the promotion of environmental education. The enthusiasm among students for learning ESD, their acknowledgment of its relevance to their future practice, and the innate sense of responsibility towards the environment in younger generations suggest that engaging students in the planning and initiation of ESD activities and collaborations can pave the way for the successful implementation of ESD in both current curricula and future dental practice [20,21,22, 25]. Clinicians and students developing partnership in the learning process in this continuously developing field is of high importance [21]. The different institutes in the UAE that provide dental education can open the door to a shared collaboration between them to introduce ESD within their curricula, such agreement is a driver to accelerate the progress of ESD and the incorporation of the topic on a larger scope. Notwithstanding, funding, organizational factors and intellectual property challenges hinder such innovative measures that must take place in a wide spectrum, thus legislative authorities must address these challenges.

Similar to the findings of our study, Jamal et al. reported the desire of faculty to include ESD in their teaching, notwithstanding their limited foundational knowledge on the subject [25]. The efforts towards incorporating ESD in the dental curricula in the UAE can be facilitated by easing the way for educators to become competent in delivering ESD material through teaching techniques that students appreciate and benefit from such as Socratic seminars, reciprocal teaching and interdisciplinary learning. Moreover, laying the groundwork to achieve this goal require access to capacity building and training packages as well as creating a resource repository. Most available resources are medical based and do not fully encompass dentistry, or are outdated hence they need adaptation, modification and content update. Another innovative and practical method to educate dental faculty within the UAE on the importance of ESD is encouraging them to be part of associations and attend international conferences that are attempting to embed UNESCO’s SDGs into higher education [31, 32]. A further step is to increase their awareness on the country’s recent efforts for sustainable development, mainly in the healthcare sector such as Abu Dhabi’s healthcare sustainability goals announced in 2023, which aim to reduce carbon emissions with a focus on waste management [33].

Despite students’ and educators’ interest in ESD, having ESD legitimately embedded in the dental curricula in the UAE requires regulatory bodies such as the Ministry of Education (MOE), Commission for Academic Accreditation, Deans of UAE Colleges of Dentistry, Ministry of Health and Prevention and MOE National Qualification Centre to agree on incorporating sustainable dental practice into the learning outcomes, placing thereby an obligation on dental education providers to embed sustainability in their dental curricula. A structured Delphi approach could be ventured to identify a consensus view among dental students, educators, and other key allies about environmental sustainability learning outcomes in dental education and the possibility of making it part of the professional competency standards in the UAE [34]. Moreover, to advance environmental sustainability agenda in dental education and practice, more research is required on several aspects including the availability of materials, tools and equipment within the dental industry that comply with sustainability-related goals.

Despite the intriguing findings of the current study, there are several limitations. The low response rate might make it difficult to generalize the current findings to all students and educators at the various dental higher education institutes in the UAE. As such, it is possible that the present survey mainly included participants that were interested in and familiar with ESD. Nonetheless, the participants’ limited exposure to ESD, as demonstrated by their responses, actively works against such possibility. It is worth mentioning that previous surveys on environmental sustainability in dental education have also reported low response rates ranging between 37% and 5% [20,21,22, 25]. Lack of sufficient and in-depth qualitative data might be a further limitation. However, the present quantitative findings allowed the present study to achieve its aim in terms of exploring current ESD awareness and drivers among dental students and educators in the UAE and identify barriers and enablers to embrace it.