A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results

With simulation clinics, dental schools have improved their preclinical laboratories to provide a more realistic clinical teaching environment. However, there is very little data to support the assumption that these facilities actually improve student performance of technical skills. This study compared the scores of two fixed preparations for full cast crowns by third-year dental students. One of the preparations was made in the simulation clinic manikin, and the other was prepared on the bench top. Three prosthodontic faculty members scored the preparations in the areas of occlusal reduction, axial reduction, resistance and retention, and margination. The study also compared the performance of three classes of dental students: one class with no experience in the simulation clinic, one with one year of experience, and one with two years of experience. The amount of time since completing the fixed prosthodontics course among the students was also evaluated. This was done because the third-year students at the University of Iowa rotate through a series often-week clerkships rather than a comprehensive care model. (Therefore, not all students start clinical prosthodontics at the same time.) In addition, all student participants completed a questionnaire that addressed their perception of their clinical readiness prior to treating their first fixed prosthodontic patient. When we compared the classes of years 1, 2, and 3 by average preparation score, we found a significant difference among the scores for teeth prepared on the bench top (p = 0.0001) but not for the teeth prepared in the mannequin (p = 0.1176). For Year 1 (no simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.57113 and 0.0661). For Year 2 (one year of simulation clinic experience), the elapsed time following completion of the fixed prosthodontic course was significant for the tooth prepared on the bench top (p = 0.0482), but it was not significant for the tooth prepared in the manikin (p = 0.2968). For Year 3 (two years of simulation clinic experience), the amount of elapsed time following completion of the fixed prosthodontic course was not significant for the tooth prepared on the bench top or in the manikin (p = 0.7275 and 0.6007). The questionnaire revealed that, in general, the majority of the students perceived their clinical readiness as more than adequate. These results are mixed in that students with more bench top experience scored better on the bench top, and students with more manikin experience scored equally in both environments.

Are traditional cognitive tests useful in predicting clinical success?

The purpose of this research was to determine the predictive value of the Dental Admission Test (DAT) for clinical success using Ackerman's theory of ability determinants of skilled performance. The Ackerman theory is a valid, reliable schema in the applied psychology literature used to predict complex skill acquisition. Inconsistent stimulus-response skill acquisition depends primarily on determinants of cognitive ability. Consistent information-processing tasks have been described as "automatic," in which stimuli and responses are mapped in a manner that allows for complete certainty once the relationships have been learned. It is theorized that the skills necessary for success in the clinical component of dental schools involve a significant amount of automatic processing demands and, as such, student performance in the clinics should begin to converge as task practice is realized and tasks become more consistent. Subtest scores of the DAT of four classes were correlated with final grades in nine clinical courses. Results showed that the DAT subtest scores played virtually no role with regard to the final clinical grades. Based on this information, the DAT scores were determined to be of no predictive value in clinical achievement.

The changing roles of the dentist and dental laboratory

There are growing pressures on the relationship between the profession and laboratories, including increased use of sophisticated prosthetic services, rapid evolution of materials, more "educated" patients, declining numbers of laboratory training programs and relatively reduced hours in dental schools in traditional prosthodontics subjects, and consolidation in the dental laboratory industry. Restorative services represent the greatest cost/value center in most practices, and the ADA's "Future of Dentistry Report" calls for the profession reasserting its "control" in this area. It is proposed instead that a partnership among the profession, laboratories, manufacturers, and education represents the most effective way to guide the emerging future of restorative dentistry for the benefit of patients and the concerned parties.

The selection of anterior teeth appropriate for the age and sex of the individual. How variable are dental staff in their choice?

As part of the development of a guide to aid the undergraduate in the selection of artificial teeth, the aim of this study was to investigate the variability in choice of dental staff to select teeth appropriate to the age and sex of the individual with the aid of a series of three-dimensional guides. Four three-dimensional guides were produced for use in the study. Fifty dentists were asked to complete a questionnaire designed to assess the variability in selection of anterior teeth appropriate for the age and sex of an individual. From this study it can be concluded that there was little consistency in the selection of the shade, mould and arrangement of anterior teeth appropriate for the age and sex of the individual by qualified dental staff. The development and implementation of an aesthetic proforma to guide dental staff, dental undergraduates and patients through the process of choosing tooth mould, shade and arrangement based on age and sex may be helpful.

Implant dentistry in predoctoral education: the elective approach

In response to interest by dental students and patient needs, an elective program in implant dentistry was started at the University of Detroit Mercy School of Dentistry (UDM) in the summer of 1994. The 1-year program is offered to a group of 10 senior students out of a class of 72. Implant treatment is provided to selected edentulous and partially edentulous patients. Predoctoral students participate in diagnosis and treatment planning, assist in surgical placement, and perform the prosthodontic procedures. A survey was sent to 160 UDM graduates, and 90 responded. Out of the 90 respondents, 35% had participated in the elective implant program and 65% had not. A Pearson correlation matrix was used to analyze their responses. A stronger positive correlation with offering and restoring implants was seen in graduates who had completed the elective program in implant dentistry.