Environmental sustainability: the attitudes and experiences of UK students in the oral health care profession

Students from 13 schools completed the survey, resulting in a school response rate of 68.4%, showing a strong representation of this student population across the UK. Six schools did not respond or wish to participate, identifying student survey fatigue and academic burden as a concern.

The student response rate (as a function of the total number of registered undergraduate students) was 24.5%, with a total of 263 students taking part in the survey from across 13 UK-based dental schools.

From the written responses, it is clear that the students had varying degrees of clinical experience dependent on individual levels of progression in their respective courses, with the following key findings as depicted in Figure 1 and Table 1:

Responses demonstrate the level of concern students express towards environmental sustainability in everyday life

• There was no difference in opinions of students at different stages of progression within their own dental school curriculum, all showing equal interest in their profession’s environmental impact

• The level of concern for their own personal environmental impact identified that 77.9% of respondents were concerned, of which 17.5% were very concerned (Fig. 1)

• Despite this apparent level of baseline concern, only 27% of respondents ‘always try’ to reduce their personal impact on a day-to-day basis, compared to 54% sometimes trying

• A total of 16% of respondents stated that ‘I would like to do more but don’t know how’ (Fig. 2)

  

  Results identify students’ current level of proactivity regarding reducing their personal impact on the environment

• In total, 90% of students have considered the impact that the provision of oral health care has on the environment, with 85.6% believing that it is our responsibility as oral health care workers to provide care in an environmentally sustainable manner

• And 46.4% believe that ‘the provision of oral health care is my priority as a clinician and this has unavoidable environmental consequences that we need accept’ (Table 2). One student responded that ‘environmentally friendly solutions always seem to contradict infection control and therefore cannot be done for patient safety’. Cross-infection control and being in a hospital setting were identified by students as barriers to them engaging with impactful solutions at an undergraduate level.

Regarding students’ own level of concern for the effect that the provision of oral health care has on the environment, 76.8% expressed that they are concerned. This was conveyed in the free-answer question, with many students identifying cross-infection control policies and procedures, specifically the use of single-use plastics and personal protective equipment (PPE), as a barrier to them engaging with impactful solutions to make the provision of oral health care more sustainable. A common view among many dental students on this topic was clearly expressed by one particular statement: ‘as dental professionals we use a lot of plastic single-use items due to cross infection, but this is very concerning to me and wish there was another way to be more sustainable’.

A further common finding was their perceived lack of power within the hierarchy of a hospital setting and that their ‘student voice’ lacked any form of influence. This sentiment is captured by the comment ‘as a student we just follow the protocols and guidelines set out by staff or the hospital or the trust the hospital is a part of. It doesn’t feel like we can do anything to change any of it’. A suggestion captured in the responses is to create a mechanism that allows students to have a greater voice with regards to ESD within dental schools. For example, the introduction of sustainability action groups that allows like-minded students and staff to convene and discuss local strategies and action plans to that will make a difference. Sheffield Dental School introduced the Sheffield Oral Sustainability group in 2022; this group has allowed students to partake in local campaigns to promote ESD. Students have expressed that after ‘joining a sustainability group, I feel more positive about this and feel like my voice is more heard’.

In total, 23.2% of undergraduate students were neither concerned or unconcerned about the effect of oral health care on the environment. Another barrier identified by students was a lack of care and/or a lack of time. Many students have the view that ‘it’s hard enough to do the whole course without having the extra worries, I think it should become more of a concern once you are a practising clinician rather than as a student’.

Currently, there is very limited exposure to undergraduate students about the effect that oral health care provision has on the environment, with 51% saying it’s only been mentioned briefly through staff members or informal conversations with peers (53.2%) (Table 3). Only 9% of students believe that they have been taught ESD through more formal means such as lectures. However, despite this lack of current emphasis in the curriculum, 97.3% of students believe that the dental profession should be more actively engaged in ESD (Fig. 3).

Shows that 97.3% of students believe that the dental profession should be more actively engaged with environmental sustainability

Current level of student engagement in ESD

Despite a desire for greater education in ESD, students are unlikely to proactively seek information about it, as only 23% of respondents independently researched ESD outside of the undergraduate curriculum, either part of a group or independently (Table 3), with 76.4% admitting to not doing any additional research on the topic. This implies students will only engage with ESD if it is part of the curriculum and not optional or extra-curricular, as students feel they lack the time to research ESD independently, typified by the comment ‘the effect we have on the environment is not taught to us and not much time is available to research this’.

It is important for us to acknowledge that eco-anxiety is recognised as a true emotional response to the predicted impact of climate change and is defined as ‘a chronic fear of environmental doom’.^26,27,28 One student authenticated this fear leading to an avoidance of the topic by saying ‘the environmental impacts of dentistry etc can feel very overwhelming. This is not a feeling which results in productive action’.

Methods for improving engagement with students

Students identified social media (66.4%), professional talks (74.9%) and tutor-led discussions (58.9%) as the best way to increase awareness of the impact that oral health provision has on the environment (Fig. 4). This, combined with opinions such as ‘I think a compulsory attendance tutorial with no extra work could be a good way of delivery the teaching’, suggest that students have a preference for information on ESD to be delivered from credible sources, in a manner that does not significantly increase their workload. However, despite expressing interest in attending professional seminars relating to ESD, students face a significant barrier in that the majority of these events are aimed at qualified clinicians and therefore require a UK GDC number to register, something students do not possess.

Students identified social media, professional talks and tutor-led discussions as the best way to increase awareness of the impact that oral health provision has on the environment

In total, 97.7% of respondents have said that being taught ESD at an undergraduate level would have a positive effect on the future impact that dentistry as a profession has on the environment. No participants said that it would have a negative impact and only 2.3% believe that there will be no impact by as a result of the change (Table 3). These results show an overwhelming support for increasing awareness and education surrounding the environmental impact of dentistry, suggesting a very positive student response to the inclusion of ESD into the curriculum.

The GDC recently distributed their Safe Practitioners domains for consideration and commentary, which included two learning outcomes relating to environmental sustainability, inspired by the ADEE’s 2022 conference that specifically discussed sustainability in dental education.²¹ The learning outcomes include: describing the main principles of sustainable oral health care; any challenges or barriers to implementing ESD; and understanding the environmental impact of common treatments. If agreed upon and included, this is a positive first step into the implementation of ESD learning objectives into the UK undergraduate dental curriculum. This also highlights that sustainability is a topic that is going to be a common theme in the provision of oral health care in coming years and something that will impact all practitioners.

Barriers to engagement – identified by the student community

Seven key themes were identified by students as barriers to engagement in solutions for managing the effects of oral health care on the environment. These are (listed in the order of incidence of responses):

• Hierarchy of a hospital setting (27% of responses)

• Lack of knowledge (23.2%)

• Cross-infection control policy, especially with regard to COVID-19 pandemic (16.4%)

• Lack of time (8.2%)

• Eco-anxiety (6.1%)

• Lack of care (3.7%)

• Limited knowledge base within academic tutors (3.7%).

It should be noted that 2% of respondents did not believe there were any barriers in place and 9.2% did not respond to the question.

The barriers identified confirmed the findings raised throughout the survey. Students identified that their main barrier to becoming more sustainable while at dental school was the hierarchy present within hospital settings and the standard operating procedures and policies put in place by management. This was summarised by one student: ‘as students, we do not have as much impact/authority to help create a change…following correct procedure for PPE is a main thing that prevents us from reducing waste’.