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General discussion1257may result in a change of the culture (Bremer et al. 2022). The newly implemented system also includes training of teachers in providing rich feedback to the students. It would be interesting to study whether this new system improves student’s development, as supposed, and to study how valid and reliable the EPA-based portfolio system is for determining whether an undergraduate dental student is ready for independent clinical practice outside the dental school. It would also be interesting to study the effects of this new system on the teaching staff. Other factors related to education in EndodontologyEducation in RadiologyMore training in taking periapical radiographs for Endodontics is necessary at ACTA (chapter 2). On top of the general difficulties of taking periapical radiographs, the cofferdam that is in place during a root canal treatment complicates taking periapical radiographs for Endodontics. Besides, one should be careful to not displace files or gutta-percha cones that could be present in the tooth and, moreover, the radiograph should be taken from an appropriate angle which can be challenging to accomplish. To reduce the number of failed radiographs and to expose patients to as little radiation as possible (ALARA principle), students should be trained well for this task. To accomplish this, it might be helpful to integrate part of the preclinical training in Radiology with the simulated clinical training in Endodontics. Training conditions that closely simulate the actual situation with a patient should be created for the students.Shortages The students at ACTA found it unfortunate that there were, to their perception, too few patients available for gaining clinical experience in performing root canal treatment (comments in questionnaire used in chapter 4). Shortage of resources is a widespread problem causing challenges. Shortages may include not only the available patients, but also available materials, time or staff for instance (chapters 2 and 4). The collateral finding that the number of root canal treatments performed by undergraduate students on patients was reduced by half from one year to another (chapter 6) caught our eye. This reduction in performed root canal treatments coincided with the implementation of a new course in Implantology in the undergraduate curriculum at ACTA (ACTA 2012). As part of this course, students Annemarie Baaij.indd 125 28-06-2023 12:26