Technological aspects of dental education: will we still be reading a paper journal in 50 years?

The pace of technological change is relentless and how future innovations will impact our way of life is impossible to predict. In 1989, the World Wide Web was invented by Tim Berners-Lee at CERN and subsequently opened to the public in 1991.¹Dental Update wrote a series of articles on the WWW called ‘Walmsley’s Web Watch’ in 2000 and featured Google,² which had started 2 years earlier, as one of the sites described in the articles. YouTube, an internet video channel, started life in 2005. Podcasting was also beginning to be used³ and has now become firmly established as a method of discussing topics in dentistry. Meanwhile, the first iPhone was announced by Steve Jobs in 2007.⁴ Zoom came of age during the pandemic in 2020, and made teleconferencing acceptable.⁵ The list is endless, and many more technological innovations have taken place since Windows 3.1, launched in 1992, made the multimedia interface so easy to use.⁶

In the UK, one has instant access to information through a smartphone or, if a larger screen is required, through a laptop, tablet, or computer.⁷ Accessing information could not be easier. Technology and dentistry are intertwined and with the introduction of computerbased learning (CAL)⁸ and then the internet, dentists and dental students were always seen as early adopters of this technology. Educational research showed that students are early adopters and that their teachers were often struggling to keep up with these developments.⁹

Publications are supplied in a variety of formats, giving the reader the choice of interface, print and/or electronic. Scientific findings are constantly being updated, dental research is being reported and publications such as Dental Update publish up-to-date articles covering the latest techniques in dentistry. However, what is being challenged is the validity of the science, and the different sources of information may be in conflict. There is misinformation in healthcare that has been exacerbated by the worries and concerns of the pandemic. Never before is the need for high-quality peer-reviewed scientific information necessary.

But how can you predict changes after the unforeseen consequences of a pandemic? Previously, opinion pieces like this would have talked about changes. In reality, any predicted changes would be likely to be incremental because we have a very limited ability to look into the future. The pandemic changed traditional concepts. Unpredictability is the new normal, and so there will be changes in how people organize themselves and think about their future work plans. The pace of digital workflow will quicken.

This article reviews access and reading of dental publications. An argument put forward is that the ease of access to electronic material, such as video and podcasts, may make traditional paper-based publications obsolete. This article provides insight into answering this question.

The readers

Classifying the population into the different eras when they were born is no longer seen as amusing, but may provide useful insights into the attitudes of ongoing generations. This is not a scientific classification, but a convenient way of explaining the views of people in the world. The generation categories are Baby Boomers, Generation X, Millennials, and the Z generation.^10,11,12,13 While these categories are an obvious oversimplification, the concept has gained acceptance. Dentistry is not immune from such a classification, and all of us will look to see where we are on the list. Already the next generation coming through are termed ‘Alphas’, and over the next 50 years will make their impact on the future direction of the workforce.¹⁴. The different generations are described in Table 1.

Certain defining attributes have been given to each of these generational cohorts. These traits will surface in their attitudes to working life. For instance, Gen Zs are independent learners and adept problem solvers. If such people oversee publishing, then it may be argued that the journals of the future will be more focused on equality, fairness, the environment, and social justice.¹² This generation is driven by the desire to please their audience and show a strong caring attitude to others.¹⁵ The books and journals created by Gen Z are likely to use powerful collaborative digital tools and provide shorter lengths and more interactive content.

Using this crystal ball, what should we expect from the Alpha cohort and other future generations? Predictive studies and futurologists suggest that the next generation (Gen Alpha), will be the most educated, technology-supplied, and wealthiest generation ever.^16,17 Alphas will look for more personalized services, and ask for their formal education to become focused on accessing practical skills, building knowledge, and providing network opportunities for employment and enterprise. They would even be willing to pay for such approaches.^14,17 In a world immersed in online social networks, the first internet tech-savvy generation will be influenced by their Gen X and Y parents.¹⁴ The understanding of technologies and the unique skill set of future generations will direct their involvement in the ‘co-creation of knowledge’ instead of the mere transfer of information.¹⁸

The evolution of scientific journals and textbooks

Peer review has its origins in the scrutinization of published scientific letters that took place in the mid-1700s.

Before the arrival of the internet, printed scientific journals would only be accessed in large paper-based deposits. Such libraries are still present and have space to accommodate large volumes of paper. The digitalization of scientific journals that took place following the introduction of scanning technology facilitated the access and dissemination of information.¹⁹ However, it did bring about major changes in the process of peer-reviewing and how the readers interacted with the content. Paper format-based reading merely changed to screen-based access. The printed text often remained in the same format, which was true for the scanning of the back catalogue of papers. However, new journals are not shackled with such a back print catalogue, and they have moved forwards, adopting and taking advantage of the digital services that are on offer. Now video and other additional material, often interactive, are bundled online with the publications. The search facilities are linked to other sources of information. Authors can also see through altmetrics how well their article has been accepted in the scientific community and the readership at large. The lowerimpact journals benefited from being early adopters of such digital services.¹⁹ The speed of publication has increased, and several sites now allow preprints of their papers. These publications have not undergone peer review and allow the fast publication of the findings before the official peer review process. During the COVID pandemic, research information needed to be published quickly, and this is where the largest increase in the use of preprints occurred. However, this also allowed the circulation of findings that were scientifically incorrect, or biased, and such controversial findings fuelled alternative views of the official scientific findings.

To many academics, all these advances are the next step for scientific publication because it allows authors to provide extra content and for raw research data to be stored as part of the published paper, serving as a source of data for re-evaluation or further studies by other researchers.

Textbooks are now available to be purchased in a digital format, although books are still around. Laptops are often preferred to desktop computers because they are portable, and the trend for reading off tablets has also increased.

The dental learner can access written material in many ways, including via their phone.

Libraries

They will still exist in the future as a focus for the community. Universities and cities have built new buildings that are in keeping with the needs of the community that they serve. At the universities, libraries have comfortable seating areas, coffee shops, lecture spaces, and areas to relax and unwind. There are silent spaces to assist the user. A library still stores and loans books, but the buildings have more appealing places in which to linger. In large municipal cities, such as Birmingham, the library allows social interaction, and again is in tune with the needs of the community (Figure 1). The use of physical space in these libraries is imaginative and exciting, bringing the old and new together. They remain a place to read and study in comfort.

Scientific papers of the future

How will scientific publications look to publishers, editors, and authors in the future? What will the readership expect from journals? The expectation is that the scientific literature will remain a robust source of trustworthy peer-reviewed information, delivered to users in diverse ways, such as open access, with impact measured beyond the Impact Factor.²⁰ It is difficult to predict how social ‘influencer’ authors and social interaction of publications, such as freely accessible data and analytical codes, plain language summaries, preprints, evidence-informed decision-making, and altmetrics, will affect the impact of articles.²⁰

The American Dental Education Association brought together a collection of articles on the changes in education brought about by technology. The special issue ‘Advancing through Innovation’ discussed online learning. This was an extensive insight from different educators on how the student of tomorrow may look, together with recent working examples. There were ideas on instructional videos, augmented reality technology, and supplement reading using PechaKucha presentations (a talk in which 20 slides are displayed in exactly 20 seconds each).²¹ The Association for Dental Education in Europe has an online learning section to support educators in digital delivery and focus on online learning.²²

Where does the textbook fit in this new world? Learners value a textbook as it holds all the information in a single place. The disadvantage is that it may not be up-to-date and lack references to the most recent publications. Digitizing such large volumes of material has been carried out, but students are conservative in their learning habits. What is often favoured is a mixture of online material to supplement the core material, which is in printed format.

Paper format publications

The question raised is whether we will still be reading papers in the future, and yes, the basic format will certainly remain the same. There will be imaginative uses of the medium to enhance the basic structure. Journals such as Dental Update are excellent at distilling the advances of dentistry and then presenting it in an easily digestible three- to four-page format using text and pictures. The journal has brought the written word to life by embracing videoconferencing or face-to-face lectures. This allows the written content to be used as a reference. There are other publications, such as the Journal of Visualized Experiments (JoVE), which aims to bring science to life and has a small but growing dental area.²³ Dental education is present on YouTube and there have been several articles that have researched how this material is presented, and how it produces the content.²⁴

Artificial intelligence (AI)

A good story or a good article is still gripping even with the embellishments. Will the use of AI make our reading different by focusing the text on what we wish to read? AIs are already capable of writing compilations (Figure 2) and creating images (Figure 3 and 4).²⁵ In a few years, should we expect to read review articles produced by AIs? Last month’s Nature news alerted that publishers are struggling to regulate AI use in scientific publications.²⁶ This is an area that has much to offer, but also has many dangers.

The dangers of disinformation

Fake news is used to spread disinformation on many subjects to distort the truth. There has been a rise of fake news stories in dentistry, such as homemade whitening products, and misinformed information on how to strengthen your teeth. Such stories populate YouTube and other social media. Evidence-based dentistry does not provide all the answers, so patients and health professionals readily seek out information that confirms their views on the subject. There are tools available that may be used to verify the accuracy of such information and help to dispel fake news. The ideal way to deal with the influence of fake news is to empower individuals to publish and create an environment of ‘real news’. Publications such as Dental Update bring together the scientific and clinical findings of dentistry under a peer-reviewed publication. This enables learners to have the confidence that the material has been properly reviewed.

Conclusions

Who would have thought that vinyl records are enjoying a resurgence in popularity fuelled by the success of artists such as Taylor Swift? The revolution of the CD has gone, and although streaming is very popular, vinyl records have stubbornly refused to disappear. The Irish Times journalist, Shane Hegarty, argued that in 50 years²⁷ there will still be paper. The doomsayers who said books were dead 20 years ago have been proved wrong with the present increase in sales of printed books. The argument is that there is an equilibrium reached where the old technology can live with the new technology. Maybe Dental Update should consider the audiobook approach, but then dentistry is a pictorial subject and so it now has its own YouTube channel (www.youtube.com/@dentalupdatejournal/videos). The options are many, and the formats are varied. However, we are confident that there will be a paper version of the Dental Update on the CPD returns of dental practitioners.