45J Gandhara Med Dent Sci
July - September 2025
ORIGINAL ARTICLE
:
:
CLINICAL DENTAL LEARNING ENVIRONMENT: EXPLORING CHALLENGES AND
STRATEGIES FOR IMPROVEMENT
Hafsa Bibi1, Bushra Mehboob2, Fatima Abdul Qaiyum3, Munazza Baseer4, Amara Hayat Awan5
ABSTRACT
OBJECTIVES
This study aimed to explore the challenges and strategies for improvement in
Undergraduate Clinical Dental Education.
METHODOLOGY
A qualitative exploratory study was conducted at Peshawar Dental College,
Peshawar, from October to December 2023. The participants included
students (third-year and final-year) and clinical faculty in dentistry. For data
collection, a semi-structured interview guide with open-ended questions was
used. The interviews and focus group discussions were organized at
a scheduled time. One-on-one interviews with the clinical faculty and a focus
group discussion were conducted with the students. The focus group and
interviews were audio-recorded, transcribed, and analyzed using Braun and
Clarke’s thematic content analysis.
RESULTS
Eight students participated in the student focus group discussion, and six
interviews were conducted with faculty members. All the participants
belonged to the same institute. The identified themes were: 1. Approaching
Teaching and Learning in a Clinical Environment, 2. Challenges in Teaching
and Learning, 3. Solutions to Challenges, and 4. Mentoring and Support.
CONCLUSION
The findings of this study provided valuable insights into the multifaceted
nature of clinical dental education. Challenges such as student apathy, harsh
criticism from teachers, logistical limitations, and infrastructural constraints
were significant obstacles to effective teaching and learning. The study
highlights the vital role of mentorship and constructive feedback in fostering
student growth and development. The institute should provide logistics, a
planned curriculum, and simulated environments for skill development, and
the assessment should be structured with remediation strategies.
KEYWORDS: Workplace-based Learning, Undergraduate, Integration,
Challenges, Dentistry
How to cite this article
Bibi H, Mehboob B, Qaiyum FA,
Baseer M, Awan AH. Clinical Dental
Learning Environment:Exploring Challe
enges and Strategies for Improvement.
J Gandhara Med Dent Sci.Gandhara Med
Dent Sci.2025;12(3):45-49.https://doi.org
Date Submission: 17-01-2025
Date Revised: 14-03-2025
Date Acceptance: 03-06-2025
1Lecturer, Department of Health
Professions Education and Research
Peshawar Medical College, Riphah
International Institute Peshawar
3Senior Lecturer, Department of
Dental Education, Peshawar Dental
College, Riphah International
University, Peshawar Pakistan
4
5Senior Lecturer, Department of
Dental Education, Peshawar Dental
College, Riphah International
University Peshawar, Pakistan
Correspondence
2Bushra Mehboob, Assistant Professor
Dental Education, Department of
Dental Education, Peshawar Dental
College, Riphah International
University, Peshawar Pakistan
+92-333-9299542
bushesmmm@hotmail.com
INTRODUCTION
Dental education worldwide is transforming, shifting
towards an integrated curriculum that emphasizes broad
perspectives and seamlessly blends classroom learning
with real-world experiences.1 Dentistry is an efficient
field, and the quality of dental education plays a crucial
role in shaping the level of treatment delivered by
dental professionals. Traditional pedagogical methods
often fall short of effectively integrating theoretical
knowledge with practical application, leaving students
with limited clinical experience and potentially ill-
equipped for patient interaction.3 This gap is
particularly concerning given the crucial role of clinical
teaching in developing essential technical skills and
providing a foundation for lifelong learning in
dentistry.4 In modern dental education, effective clinical
teaching constitutes a major focus on ongoing
challenges for dental health faculties. The acquisition of
competent technical skills is fundamental for students
to achieve clinical proficiency and excellence. The
dental teaching clinic serves as a dynamic hub where
teachers, students, and patients converge, offering
invaluable opportunities for students to learn from
experienced clinicians. This interaction transcends mere
healthcare delivery, functioning as a critical training
ground for aspiring dental professionals.5 An effective
education system empowers teachers to adapt to diverse
learner needs and employ a variety of instructional
approaches. Teachers are essential in developing and
/10.37762/jgmds.12-3.669
Senior Lecturer, Department of Medical
Education, Peshawar Medical College,
Riphah International University,
Peshawar, Pakistan
46 J Gandhara Med Dent Sci
July - September 2025
networking concepts, which necessitates their active
involvement in classroom instruction and clinical
guidance. The clinical teacher may help students
identify the necessary information for patient care.6
Workplace-based learning (WBL) is successful when it
effectively places students in environments where they
can apply their knowledge and skills, aligning with the
desired learning outcomes. Successful WBL facilitates
a deeper understanding of knowledge application within
real-world professional contexts.7 The key challenge
lies in optimizing the connection between these two
settings to enhance the transfer of learning.1 To fully
benefit from clinical learning, it is essential to identify
and manage these challenges from both the student’s
and teacher’s point of view. Increasing curricular focus
on applied medical science and interprofessional
collaborative care might seem incompatible with
expanding and earlier introduction of clinical hours
dedicated to traditional dental care, alongside greater
immersion in new dental technologies.8 The study’s
objective was to explore the challenges and strategies
for improvement in Undergraduate Clinical Dental
Education.
METHODOLOGY
The exploratory qualitative study was conducted in
Peshawar Dental College, Peshawar, from October to
December 2023. Purposive sampling was employed to
collect the data. Students of the Third-Year BDS, Final -
Year BDS, and Clinical teaching Faculty with a
Teaching experience of at least 10 years were included.
Teachers who had not completed CHPE/MHPE and
were unwilling to participate were excluded. The
sample size was calculated based on data saturation.
The saturation in the study was determined to be when
participants' interviews started to yield similar answers,
and no new insights, patterns, or themes could be
generated. Details are added in the methodology
section.9 A semi-structured interview questionnaire was
designed after a literature search to explore challenges
in the clinical dental learning environment. It was
approved by three experts in the field of Medical
Education (Director of the Department of Medical
Education, HOD Department of Dental Education, and
HPE Ph.D. (Scholar). The questionnaire was piloted
with two potential participants not part of the original
study. Upon obtaining ethical approval
(Prime/IRB/2023-1058) from the Institutional Review
Board (IRB) of Peshawar Medical College, data
collection commenced by contacting the students and
faculty and acquiring their written consent.10 The
interview guide was used for one-on-one interviews
with the six expert faculty members in the Clinical field
and Focus Group Discussions with the eight third-year
and final-year BDS Students. Interviews are crucial
because they provide an in-depth exploration of
people’s perceptions and views.11 The duration of the
interviews was 20-25 minutes, and the focus group
discussion lasted 50 minutes. The data collection
process was continued to achieve data saturation.12 The
questions were centred on students‘ and instructors’
perceptions of in-field clinical education challenges.
The interview questions are presented in Table I.
Table 1: Interview Questions
1. How do you approach teaching and learning in a clinical
environment?
(Prompt: Most effective teaching and learning strategy)
2. What are the challenges that you have encountered when
teaching and learning in a clinical environment?
3. How can we improve teaching and learning in a clinical
environment?
4. In your opinion, what role does mentorship play in clinical
learning experience?
(Prompt: Fostering mentor/mentee relationship)
5. How do you perceive the role of feedback in your clinical
environment?
(Prompt: Feedback for the teacher; Feedback to students)
6. What are the challenges in assessment in a clinical
environment?
(Prompt: Ideal assessment)
Following Braun and Clark’s six-step approach to
thematic analysis, themes were generated.13 The
transcriptions were carefully read and underwent
inductive coding. Two coding techniques, "descriptive
coding" and "in-vivo coding", were employed. In the
first coding cycle, the codes were 94, and in the second
coding cycle, the codes were 24. After completing the
second cycle, the identified sub-themes and themes
were thoroughly reviewed. An independent observer
counter-checked the data analysis process. See Figure
1.
Figure 1: Braun and Clark’s Six-Step Thematic Analysis
RESULTS
A total of six clinical faculty members (mean age: 45
Years) had a work experience of at least 10 -15 years,
and Students in the Final Year of BDS (mean age: 21
Years) participated in the study. From the thematic
analysis, four main themes, eight subthemes, and
twenty-four categories were identified. See Table 2,
Clinical Dental Learning Environment: Exploring Challenges
47J Gandhara Med Dent Sci
July - September 2025
Table 2: Participant Information
Clinical Instructors n
Professors 02 29% male
Associate Professors 02
Assistant Professors 01 71% Female
Lecturer 01
Students (third year & Final year) 08
The details of themes, sub-themes, codes, and
representative quotes are presented in Table 3.
Table 3: Themes, Subthemes and Categories
Theme Sub-theme Category
Theme
1:Approaching
Teaching and
Learning in Clinic
al Environment
Stepwise
Teaching
� Observation before
performing
� Knowledg
e of the
procedure
� Organized
Learning
Performing
Procedures
� Skill Lab
� Recent
Procedures
Theme
2:Challenges in
teaching and
learning
Issues in
behaviour
� Teacher’s
Issues
� Learner’s
Issues
� Patient’s
Issues
Learning
Environment
� Challenges in
assessment
� Infrastructure and
resources
� Teaching
Environment
� Time Management
Theme-
3:Solution to
challenges
Planning and
development
� Planning
curriculum
� Infrastructure and
resources
� Continued
Professional
Development
The solution to
challenges in
assessment
� WPBA
� Remediation
� Structured
Assessment
Theme-4:
Mentoring and
Support
Mentoring
� Attributes
of mentor
� Benefits of
mentor
� Fostering
mentor-mentee
relationship
Feedback
� Role of
Feedback
� Challenges of
feedback
� Feedback
structure
Theme 1: Approaching Teaching and Learning in
Clinical Environment
The first theme that emerged from the data analysis was
the observation that performing before an audience is
an essential step in any procedure, as it helps identify
potential risks. Similarly, knowing the process
beforehand is crucial for accurate performance.
Students recognized that organized learning and skill
lab sessions can help alleviate self-doubt and anxiety.
Recent procedures must be taught to students to help
them keep pace with the fast-changing world of
technology.
"Most important, in my opinion, is observation,
observing. They should observe before they have ample
knowledge, and then they observe it that will help them
in performing the procedure." (F-4, Faculty)
"If we could first perform on dummies in the OMFS
and other Departments, that would boost our confidence
level" (Student-1, FGD)
Theme 2: Challenges in teaching and learning
The respondent teachers and students identified
multiple challenges. The teachers mentioned the
learners‘ non-serious attitude as an impediment to
effective learning. Similarly, students recognized that
hostile and harsh teacher comments lead to increased
self-doubt and stress in students. Additionally, the lack
of patient cooperation and discomfort in the learning
environment, resulting from inadequate logistics and
infrastructure, hinders students from reaching their full
potential.
"…. They start commenting negatively in front of the
patients; if we do anything wrong, we get more
confused." (Student-4, FGD)
"We lacked space, we can't just perform the OSCEs
properly as per the requirement." (F-1)
Theme-3: Solution to challenges
The participants mentioned that the institute should
provide logistics and resources to support learning in
the clinical environment. The curriculum should be
well-planned, and assessments should be structured.
Remediation strategies should be regularly arranged for
students.
"We have to provide a comfortable environment,
friendly atmosphere in which our attendant, our staff,
and our student are cooperative with the patient, and the
patient also cooperates." (F-3)
"If the student is weak in any topic, so we will give a
task or assignment to them to make a PowerPoint
presentation, Infrastructure and resources…." (F-2)
Theme-4: Mentoring and Support
The respondents mentioned that to improve teaching
and learning in the clinical environment. Students and
faculty members appreciated a mentor's positive role as
a guide. Understanding attitude, being knowledgeable,
and acting as a guide were identified as attributes. The
participants mentioned that contact with mentors
through social media apps and regular mentoring
sessions are essential to foster mentor-mentee
relationships.
"A mentor would be a great guidance for us because
Clinical Dental Learning Environment: Exploring Challenges
48 J Gandhara Med Dent Sci
July - September 2025
we don’t know our path." (Student 3, FGD)
"Benefits of mentor Fostering mentor-mentee
relationship, Role of feedback, Challenges of feedback
structure, If we get feedback, we will be able to identify
our shortcomings; what we lack" (F-4 Faculty).
DISCUSSION
The findings from the interviews and focus group
discussions conducted with faculty members and
students reveal critical insights into the dynamics of
teaching and learning in the clinical dental
environment. The identified themes included
approaches to teaching and learning, challenges in
teaching and learning, solutions to these challenges, and
the role of mentoring and support, providing a
comprehensive overview of the current state of clinical
education and highlighting areas for improvement.
Effective clinical education necessitates a strong
emphasis on observation and pre-procedural knowledge
acquisition. Students consistently highlighted the
importance of observing experienced clinicians perform
procedures before attempting them themselves,
recognizing this as a crucial step in identifying potential
risks and building confidence. Simulated environments,
such as skill labs and practice on models (e.g., dummies
in Oral and Maxillofacial Surgery), were identified as
valuable tools to bridge the gap between theoretical
knowledge and practical application, mitigating anxiety
and enhancing a sense of preparedness. The results
were consistent with the study by Chukwuka Elendu,
who considers simulation technology, including high-
fidelity mannequins, virtual reality (VR) environments,
standardized patients, and hybrid simulations, important
for clinical learning. 14 Furthermore, the rapid
advancements in dental technology underscore the need
for continuous curricular updates to ensure students are
equipped with the latest knowledge and skills to excel
in their future careers. Subha Rahmani’s study is
consistent with the current research, which emphasises
faculty training in clinical skills and teaching methods.
Several significant challenges were identified in the
clinical learning environment. From the faculty’s
perspective, student apathy and a lack of seriousness in
their approach to learning were perceived as major
obstacles to effective teaching. Conversely, students
expressed concerns about the negative impact of harsh
criticism and hostile comments from instructors, which
can erode self-confidence and increase stress levels.
The study of Ramani aligns and emphasizes
acknowledging and celebrating accomplishments while
providing constructive feedback and guidance to
address areas for improvement in knowledge, skills, or
attitudes15. Furthermore, both groups acknowledged the
detrimental effects of logistical and infrastructural
shortcomings, such as inadequate space and limited
resources, on the quality of clinical training. These
limitations, coupled with the challenges posed by
uncooperative patients, can significantly hinder student
learning and prevent them from reaching their full
potential. Participants strongly emphasized the value of
mentorship in enhancing the clinical learning
experience. Students and faculty alike recognized the
positive impact of mentors who possess qualities such
as understanding, knowledge, and the ability to provide
effective guidance. The results of the Hagrass et al.,
study are aligned and emphasized the role of training
programs for effective mentorship.16 Mentors play a
crucial role in navigating the complexities of clinical
practice and enhancing professional growth. The study
by Nora M. Kilcullen is consistent with the present
study and emphasises the importance of providing a
conducive learning environment.17 Effective mentor-
mentee relationships can be cultivated through regular
mentoring sessions and accessible communication
channels, such as social media platforms. The study of
Aysha et al. is consistent for the accessibility of
different modes of communication like email.18
Feedback constitutes a cornerstone of effective
mentorship. Constructive feedback is essential for
student growth and development. The challenges such
as the delivery of feedback in a supportive and
constructive manner and the development of effective
feedback structures need to be addressed. The results
are aligned with Heather Schopper‘s study.19 Students
acknowledged the importance of feedback in
identifying their shortcomings and areas for
improvement, highlighting the need for clear and
actionable feedback that facilitates skill development
and enhances overall learning.20 The results are aligned
with Andrew William‘s study. Future research with
more extensive and diverse samples, including both
genders and multiple institutions, is necessary to gain a
comprehensive understanding of the topic.
LIMITATIONS
A small sample size from only one institute in the
Khyber Pakhtunkhwa province was selected for data
collection.
CONCLUSIONS
The findings of this study provided valuable insights
into the multifaceted nature of clinical dental education.
Challenges such as student apathy, harsh criticism from
teachers, logistical limitations, and infrastructural
constraints were significant obstacles to effective
teaching and learning. The study highlights the vital
role of mentorship and constructive feedback in
Clinical Dental Learning Environment: Exploring Challenges
49J Gandhara Med Dent Sci
July - September 2025
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fostering student growth and development. The institute
should provide logistics, a planned curriculum, and
simulated environments for skill development, and the
assessment should be structured with remediation
strategies.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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Hafsa Bibi - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Bushra Mehboob - Concept & Design; Data Acquisition;
Fatima Abdul Qaiyum - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript;
Final Approval
Munazza Baseer - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript;
Critical Revision; Supervision; Final Approval
Amara Hayat Awan - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript; Final
Approval
Data Analysis/Interpretation; Drafting Manuscript;
Final Approval
AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
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