Are All Dentiform Teeth with Simulated Caries the Same? A Six-Year Retrospective Study in Preclinical Operative Dentistry

Dentiform teeth with simulated caries (DTSC), frequently used in preclinical courses, should show no variability in the amount of simulated caries from tooth to tooth. However, the level of caries variability among DTSC is currently unknown. The aim of this study was to assess the variation in simulated caries levels in one group of DTSC and determine whether variation among DTSC impacted the preclinical performance of dental students. In the study, 80 commercially available mandibular first molar DTSC with simulated mesio-occluso-distal caries were sectioned in coronal (n=40) and sagittal (n=40) planes where the caries depth/width was greatest. Section images were analyzed for variation in levels of simulated caries using image-processing software. Three years of practical performance data using DTSC were compared with three years of practical performance data using dentiform teeth without simulated caries, for a total of six years (students' performance on two exams, Practical 1 and Practical 2). The results showed that 70% of the coronally sectioned teeth had manufacturing defects that resulted in caries overextension at the dentino-enamel junctions (DEJs). Overextensions were found at the DEJ in 41.3% of the sagittally sectioned teeth. There was a statistically significant decrease in Practical 1 performance of the students who used DTSC as compared with students who used teeth without simulated caries (p=0.0001); there was no statistically significant difference on Practical 2 performance. Of the DTSC evaluated in this study, 56.6% contained manufacturing defects, and more than 80% were found to have excessive caries variation. Prediction of which DTSC will have caries overextension is not possible. Students preparing DTSC that contain caries overextension are therefore at increased risk of receiving undeserved negative summative assessment on practical examinations.

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

Agreement Among Dental Students, Peer Assessors, and Tutor in Assessing Students' Competence in Preclinical Skills

The aim of this study was to determine the level of agreement regarding assessments of competence among dental students, their student peers, and their clinical skills tutors in a preclinical skills program. In 2012-13 at the University of Edinburgh, second-year dental students learned to perform the following seven cavity preparations/restorations on primary and permanent Frasaco teeth: single-surface adhesive occlusal cavity; single-surface adhesive interproximal cavity; single-surface adhesive labial cavity; multi-surface adhesive cavity; multi-surface amalgam cavity; pre-formed metal crown preparation; and composite resin buildup of a fractured maxillary central incisor tooth. Each student, a randomly allocated student peer, and the clinical skills tutor used standardized descriptors to assign a competency grade to all the students' preparations/restorations. The grades were analyzed by chi-square analysis. Data were available for all 59 second-year students in the program. The results showed that both the students and their peers overestimated the students' competence compared to the tutor at the following levels: single-surface adhesive occlusal cavity (χ(2)=10.63, p=0.005); single-surface adhesive interproximal cavity (χ(2)=11.40, p=0.003); single-surface labial cavity (χ(2)=23.70, p=0.001); multi-surface adhesive cavity (χ(2)=12.56, p=0.002); multi-surface amalgam cavity (χ(2)=38.85, p=0.001); pre-formed metal crown preparation (χ(2)=40.41, p=0.001); and composite resin buildup (χ(2)=57.31, p=0.001). As expected, the lowest levels of agreement occurred on the most complicated procedures. These findings support the need for additional ways to help students better self-assess their work.

Dental School Vacant Budgeted Faculty Positions, Academic Years 2011-12 Through 2013-14

The American Dental Education Association (ADEA) Survey of Dental School Faculty is conducted annually to provide an overview of the hiring and retention activity of U.S. dental school faculty. The survey collects data on the dental faculty workforce, including vacant budgeted positions by appointment and discipline, number of new and lost positions, sources of new hires, and reasons for faculty separations. This report highlights the results of three years of survey data, from the 2011-12 academic year through the 2013-14 academic year. After declining in previous years, the number of vacant faculty positions in U.S. dental schools has begun to increase, rising to 242 full-time and 55 part-time positions in 2013-14. Additionally, the number of schools having more than ten vacancies increased from five to 12. Although the number of vacancies has increased, the length of faculty searches that took more than one year declined from 25% to 16% in the same period. Retirements as a share of full-time faculty separations increased from 14% in 2008-09 to 31% in 2013-14. The current average retirement age of dental school faculty members is 69.7 years. The percentage of full-time faculty members leaving for the private sector remained constant over the last three years at approximately 16%. Full-time faculty members were more likely to be recruited from other dental schools, while part-time faculty members were more likely to come from the private sector.

Impact of Technique-Specific Operative Videos on First-Year Dental Students' Performance of Restorative Procedures

The aim of this study was to examine the impact of psychomotor operative video demonstrations on first-year dental students who are performing specific procedures for the first time in a preclinical setting. The class was randomly divided into two groups, and three restorative procedures were selected. On the date on which each procedure was to be performed in the preclinical laboratory for the first time, one group (experimental, n=50) was shown a technique video for that specific procedure immediately before commencing the exercise; the control cohort (n=50) did not view the video. Technical performance on procedures was evaluated by students and two calibrated and blinded examiners. The students' perceptions of the experience were also collected in a survey. All first-year students participated in the study, for a 100% response rate. A Mann-Whitney U test did not show any group differences in technical performance (mean values on preparation: 77.1 vs. 77.8; amalgam: 82.7 vs. 82.8; composite: 79.7 vs. 78.0). A Spearman rho test revealed a significantly higher correlation in 13 out of 25 evaluation categories between student self-assessment and blinded examiner assessment for the experimental group. A chi-square test of questionnaire responses revealed a positive student perception of administering these videos for the preparation (X(2)=4.8, p<0.03), the amalgam restoration (X(2)=12.4, p<0.001), and the composite restoration (X(2)=11.3, p<0.001). The psychomotor video demonstrations did not immediately improve student performance on preclinical operative procedures, but they were well received by students and augmented self-assessment ability. These findings suggest that videos can be a useful teaching aid in a preclinical environment, especially regarding comprehension of concepts.

Comparative Effectiveness of Dental Anatomy Carving Pedagogy: A Systematic Review

The aim of this study was to review the effectiveness of methods used for teaching dental anatomy carving to dental students in operative dentistry as evaluated in published studies. This systematic review is described in accordance with the PRISMA statement. Two independent reviewers performed a systematic literature search of research published from January 1945 until May 2014. Seven databases were screened: MedLine (PubMed), Lilacs, IBECS, Web of Science, Scopus, SciELO, and The Cochrane Library. After removing duplicates, only studies using dental carving to assess the practical knowledge of anatomy were selected. The tabulated data were organized by title of article, names of authors, number of students assessed, assessment method, material used, groups tested, main results, and conclusions. The methodology quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. Initially, 2,258 studies were identified in all databases. Five articles met the eligibility criteria and were included in this review. According to these studies, the geometric method, teaching step-by-step along with the teacher, and adjuvant methods such as the use of tutors and teaching through digital media with DVDs proved to be effective in improving learning. There is no standard technique that is widely accepted for the teaching of dental carving, nor is there an appropriately validated method of evaluation to verify whether the teaching methods used are effective for the acquisition of skills and expertise in dental anatomy by students.

Inter- and Intrarater Reliability Using Different Software Versions of E4D Compare in Dental Education

The problems associated with intra- and interexaminer reliability when assessing preclinical performance continue to hinder dental educators' ability to provide accurate and meaningful feedback to students. Many studies have been conducted to evaluate the validity of utilizing various technologies to assist educators in achieving that goal. The purpose of this study was to compare two different versions of E4D Compare software to determine if either could be expected to deliver consistent and reliable comparative results, independent of the individual utilizing the technology. Five faculty members obtained E4D digital images of students' attempts (sample model) at ideal gold crown preparations for tooth #30 performed on typodont teeth. These images were compared to an ideal (master model) preparation utilizing two versions of E4D Compare software. The percent correlations between and within these faculty members were recorded and averaged. The intraclass correlation coefficient was used to measure both inter- and intrarater agreement among the examiners. The study found that using the older version of E4D Compare did not result in acceptable intra- or interrater agreement among the examiners. However, the newer version of E4D Compare, when combined with the Nevo scanner, resulted in a remarkable degree of agreement both between and within the examiners. These results suggest that consistent and reliable results can be expected when utilizing this technology under the protocol described in this study.

Dental students' ability to assess their performance in a preclinical restorative course: comparison of students' and faculty members' assessments

Dental education consists of both theoretical and practical learning for students to develop competence in treating patients clinically. When dental students encounter practical courses in their first year as a new educational experience, they must also learn to evaluate themselves. Self-evaluation is an essential skill to learn for dental professionals to keep increasing their competence over the course of their careers. The aim of this study was to compare the assessment scores of second- and third-year dental students and the faculty in two consecutive preclinical practical exams in restorative dentistry courses in a dental school in Turkey. Faculty- and student-assigned scores were calculated from two consecutive preclinical examinations on tooth restorations performed on both artificial casts and phantom patients. The students were formally instructed on grading procedures for tooth preparations, base and restoration placement, and polishing criteria. After each step, each item was assessed by faculty members, the student, and another student. The results indicated that the initial differences between second-year students' assessments of their own preclinical practical ability and that of the faculty decreased among the third-year students. Self-evaluation scores did not indicate whether the third-year students tended to over- or underestimate the quality of their own work. However, the second-year students not only overestimated themselves but thought they were above average. The results point to the need to develop students' self-insight with more exercises and practical training.

Utilizing self-assessment software to evaluate student wax-ups in dental morphology

Traditionally, evaluating student work in preclinical courses has relied on the judgment of experienced clinicians utilizing visual inspection. However, research has shown significant disagreement between different evaluators (interrater reliability) and between results from the same evaluator at different times (intrarater reliability). This study evaluated a new experimental software (E4D Compare) to compare 66 student-produced tooth wax-ups at one U.S. dental school to an ideal standard after both had been digitally scanned. Using 3D surface-mapping technology, a numerical evaluation was generated by calculating the surface area of the student's work that was within a set range of the ideal. The aims of the study were to compare the reliability of faculty and software grades and to determine the ideal tolerance value for the software. The investigators hypothesized that the software would provide more consistent feedback than visual grading and that a tolerance value could be determined that closely correlated with the faculty grade. The results showed that a tolerance level of 450 μm provided 96% agreement of grades compared with only 53% agreement for faculty. The results suggest that this software could be used by faculty members as a mechanism to evaluate student work and for students to use as a self-assessment tool.

Effect of Employing Different Typodonts When Using E4D Compare for Dental Student Assessment

The use of computers to aid in instruction and help decrease the subjective component of assessment is steadily increasing. One of the potential barriers to the effective utilization of CAD/CAM technology for assessment purposes is the efficient scanning of the teeth being used for comparison. The purpose of this pilot study was to determine if the use of different typodonts, of the same make and model, has any significant effect on the percent comparison results when using E4D Compare. Tooth #30 was prepared by a faculty member to represent what dental students at Georgia Regents University are taught as the ideal preparation for a full gold crown. Ten typodonts of the same make and model were selected for comparison. Three different examples of students' preparations were scanned and compared to the ideal preparation. Each of the three student preparations was subjected to ten trials (occasions), one for each typodont, at five tolerance levels: 0.1 mm, 0.2 mm, 0.3 mm, 0.4 mm, and 0.5 mm. The intraclass correlation coefficient (ICC) was used to measure the intrarater agreement among the typodonts at the various tolerance levels. The agreement coefficients (0.971-0.984) indicated very little variability attributable to the use of a different typodont. The high agreement coefficients achieved using different typodonts of the same make and model provide evidence for the interchangeability of typodonts when assessing a student's performance in the preclinical simulation environment.

Evaluation of an Innovative Digital Assessment Tool in Dental Anatomy

AIM

The E4D Compare software is an innovative tool that provides immediate feedback to students' projects and competencies. It should provide consistent scores even when different scanners are used which may have inherent subtle differences in calibration. This study aimed to evaluate potential discrepancies in evaluation using the E4D Compare software based on four different NEVO scanners in dental anatomy projects. Additionally, correlation between digital and visual scores was evaluated.

MATERIALS AND METHODS

Thirty-five projects of maxillary left central incisors were evaluated. Among these, thirty wax-ups were performed by four operators and five consisted of standard dentoform teeth. Five scores were obtained for each project: one from an instructor that visually graded the project and from four different NEVO scanners. A faculty involved in teaching the dental anatomy course blindly scored the 35 projects. One operator scanned all projects to four NEVO scanners (D4D Technologies, Richardson, TX, USA). The images were aligned to the gold standard, and tolerance set at 0.3 mm to generate a score. The score reflected percentage match between the project and the gold standard. One-way ANOVA with repeated measures was used to determine whether there was a significant difference in scores among the four NEVO scanners. Paired-sample t-test was used to detect any difference between visual scores and the average scores of the four NEVO scanners. Pearson's correlation test was used to assess the relationship between visual and average scores of NEVO scanners.

RESULTS

There was no significant difference in mean scores among four different NEVO scanners [F(3, 102) = 2.27, p = 0.0852 one-way ANOVA with repeated measures]. Moreover, the data provided strong evidence that a significant difference existed between visual and digital scores (p = 0.0217; a paired - sample t-test). Mean visual scores were significantly lower than digital scores (72.4 vs 75.1). Pearson's correlation coefficient of 0.85 indicated a strong correlation between visual and digital scores (p < 0.0001).

CONCLUSION

The E4D Compare software provides consistent scores even when different scanners are used and correlates well with visual scores.

CLINICAL SIGNIFICANCE

The use of innovative digital assessment tools in dental education is promising with the E4D Compare software correlating well with visual scores and providing consistent scores even when different scanners are used.

Implementation of a patient-centered approach to clinical dental education: a five-year reflection

The intent of the redesign of the clinical component of the Harvard School of Dental Medicine (HSDM) curriculum from a traditional numerical procedures-based system to a patient-based comprehensive care system was to improve both patient care and student learning. The aim of this retrospective cohort study was to evaluate the outcomes of and students' perspectives on this patient-centered comprehensive care model introduced in 2009. Data were obtained from the school's Office of Dental Education for a study sample consisting of 205 fourth-year dental students in the graduating classes of 2009 through 2014 at HSDM. The results showed that students were completing more than the required number of comprehensive patient cases on average. A survey given to the Class of 2014 found that the respondents (35 of 36 students) were generally satisfied with the new curriculum and the clinical experience in relation to continuation of care and perceptions of comprehensive care. The results of this study suggest that the redesigned patient-centered assessment model of the clinical component of the curriculum helped improve patient care and student learning.

Relationship between hand-skill exercises and other admissions criteria and students' performance in dental school

The aim of this study was to investigate the existence of correlations between dental admissions criteria, including a chalk carving exercise, and students' subsequent academic performance. The retrospective cohort study examined the records of dental students at Louisiana State University Health Science Center School of Dentistry for the years 1998 to 2008. Only those students who could be categorized into the following four groups were included: 1) those who graduated in the top 10% of their class, 2) those who graduated in the bottom 10% of their class, 3) those who repeated a year of dental school, and 4) those who were dismissed or resigned. The study sample consisted of 176 students: 62 in the first group, 62 in the second group, 25 in the third group, and 27 in the fourth group. Data collected were each student's undergraduate grade point average (GPA); chalk carving score; undergraduate biology, chemistry, physics (BCP) GPA; Dental Admission Test (DAT) Academic Average; Perceptual Ability Test (PAT) score of the DAT; total DAT score; grade in preclinical operative dentistry class; grade in morphology and occlusion class; and dental school GPA at graduation. The results showed that only the undergraduate GPA and BCP GPA were significantly higher for students in the top 10% of their class than for other groups. The only positive correlation involving the chalk carving scores was with the preclinical operative dentistry course grade. This study thus found limited correlations between this institution's admissions criteria and its students' success in dental school.

Are more endodontic consultations needed in dental school clinic settings? A study of treatment decisions at one school

With no previous studies of the occurrence of interdisciplinary consultations for tooth extraction in a dental school clinic setting, the aim of this cross-sectional descriptive investigation was to measure and compare the consultation process that occurred among departments at one U.S. dental school for making treatment decisions on tooth extraction. A comprehensive computerized retrieval (Crystal Reports) was used to identify and gather data from patient records from July 1, 2007, to July 1, 2011. Treatment plans and progress notes were analyzed to determine why each tooth had been extracted and which department had recommended the extraction. Results showed that the clinical departments involved in treatment planning decisions were the DMD dental student clinic, Department of Periodontics, and Department of Endodontics. The narrative records of 227 patients who had 516 teeth extracted were examined. About three-fourths (73.26%) of the extracted teeth were extracted based on the recommendation of only one department. Of these extracted teeth, 22.0% (n=114) were previously endodontically treated, and only four were recommended for endodontic consultation prior to extraction. The study found that most extractions were performed without specialty consultations and that the Department of Endodontics was consulted the least of all departments. To foster interdisciplinary collaboration in dental school clinics and help students develop expertise in such collaborations, more specialty consultations are needed for teeth that are treatment planned for extraction in order to preclude needless extraction of potentially salvageable teeth. Doing so will provide benefits for both patient care and students' education.

Curriculum time compared to clinical procedures in amalgam and composite posterior restorations in U.S. dental schools: a preliminary study

Dental clinicians have an expanding range of biomaterial choices for restoring tooth structure. Scientific developments in cariology, advances in dental biomaterials, and patients' esthetic concerns have led to a reduction in amalgam restorations and an increase in composite restorations. The aim of this study was to compare teaching time with students' clinical procedures in amalgam and composite posterior restorations in dental schools across the United States. Academic deans in 60 schools were invited to complete a survey that asked for the amount of instructional time for amalgam and composite posterior restorations and the number of clinical restorations performed by their Classes of 2009, 2010, and 2011. Of these 60, 12 returned surveys with complete data, for a 20% response rate. Responses from these schools showed little change in lecture and preclinical laboratory instruction from 2009 to 2011. There was a slight increase in two-surface restorations for both amalgam and composites; however, the total number of reported composite and amalgam restorations remained the same. Of 204,864 restorations reported, 53% were composite, and 47% were amalgam. There were twice as many multisurface large or complex amalgam restorations as composites. One-surface composite restorations exceeded amalgams. Among the participating schools, there was little to no change between curriculum time and clinical procedures. Findings from this preliminary study reflect a modest increase in two-surface resin-based restorations placed by dental students from 2009 to 2011 and little change in curricular time devoted to teaching amalgam restorations. The total number of posterior composite restorations placed by students in these schools was slightly higher than amalgams.

Graduating dental students' views of competency statements: importance, confidence, and time trends from 2008 to 2012

Competency documents are used in dental education as both an educational framework and an accreditation instrument. The aim of this study was to analyze the perceptions of graduating dental students at the University of British Columbia (UBC) regarding the importance of each competency statement, as well as to assess their confidence in their abilities associated with each statement. The instrument was based on the survey developed by Schönwetter et al. at the University of Manitoba using the Association of Canadian Faculties of Dentistry competency document. The current study surveyed UBC graduating students in the years 2008 through 2012. The response rates ranged from 66.7% to 95.9%, averaging 77.5% across all five years. The results showed that, overall, the students rated all the competencies as important, but they rated their confidence lower than the perceived importance. Correlation coefficients averaged a moderate correlation of 0.376 for all competency statements except the five with the greatest discrepancy between perceived importance and confidence. The competencies the students perceived as most important tended to be associated with tasks frequently performed during predoctoral dental education. The instrument used in this study can help other academic dental institutions identify patterns of students' perceived competency importance and confidence to inform allocation of teaching time and resources and adopt new methodologies to address identified areas of need.

An overview of U.S. predoctoral dental implant programs and their directors

The aim of this study was to provide an overview of current predoctoral implant programs in the United States, including curricular characteristics and clinical practices regarding implant therapy education and program directors' characteristics. An electronic survey was sent to predoctoral implant program directors of all 64 accredited U.S. dental schools; 52 of the 60 eligible programs responded, for a response rate of 87%. The responding program directors were primarily affiliated with either prosthodontics departments (44%) or restorative dentistry departments (40%). Structurally, 80.8% of the responding schools integrate their implant programs into the third year of the curriculum. Clinical implant therapy exercises reported were simulation exercises without direct patient care (90.4% of responding schools) and direct patient care under supervision (94.2%). The most frequently taught restorative modalities are posterior single-tooth implant crown (96.2%), mandibular implant-retained overdenture (88.5%), and anterior implant-supported single crown (61.5%). A majority (74.5%) of responding programs utilize analog surgical guide planning, while 25.5% reported use of digital guided surgery planning software. All schools in the Northwest and 66.7% in the South Central regions utilize custom abutments as the primary abutment design, while a majority of schools in the North Central (62.5%), Northeast (53.8%), Southwest (66.7%), and Southeast (80%) regions use stock abutments (p=0.02). Regional differences were significant with regard to fixation modality, with all the Northwest programs using screw retention and 90% of Southeast and 87.5% of North Central programs using cement retention (p=0.002). This study demonstrated that while institutions share program director and curricular similarities, clinical practices and modalities vary significantly by region.

Lessons from a pilot project in cognitive task analysis: the potential role of intermediates in preclinical teaching in dental education

The purpose of this study was to explore the use of cognitive task analysis to inform the teaching of psychomotor skills and cognitive strategies in clinical tasks in dental education. Methods used were observing and videotaping an expert at one dental school thinking aloud while performing a specific preclinical task (in a simulated environment), interviewing the expert to probe deeper into his thinking processes, and applying the same procedures to analyze the performance of three second-year dental students who had recently learned the analyzed task and who represented a spectrum of their cohort's ability to undertake the procedure. The investigators sought to understand how experts (clinical educators) and intermediates (trained students) overlapped and differed at points in the procedure that represented the highest cognitive load, known as "critical incidents." Findings from this study and previous research identified possible limitations of current clinical teaching as a result of expert blind spots. These findings coupled with the growing evidence of the effectiveness of peer teaching suggest the potential role of intermediates in helping novices learn preclinical dentistry tasks.

Dentists' requirements for continuing professional development in Ireland. A pilot study conducted at University College Cork

AIMS

To determine the self-assessed continuing professional development (CPD) needs of dental practitioners and identify how each discipline can best be served by a dental CPD programme. To set findings in the context of the available literature and contribute to the development of CPD programmes.

METHOD

Topics were arranged into eight disciplines: practice management; paediatric dentistry; preventive dentistry; orthodontics; behaviour management; dentistry for people with a disability; oral medicine and surgery; and, restorative dentistry. A web-based questionnaire was constructed and administered using a MarkClass 2.21 online survey tool.

RESULTS

Fifty-six self-reported assessment responses were received, with three-quarters of participants having graduated within the past 10 years. Topics in oral medicine and surgery attracted consistently high levels of interest. A tendency to favour topics with a perceived direct clinical application was observed. Topics recommended by the Dental Council as core areas for CPD were given a high level of priority by respondents.

CONCLUSIONS

Traditional lectures remain a valued mode of CPD participation. Practical courses were valued across all dental topics offered. A varied approach to determining the requirements of dentists is essential to appropriately support the practitioner.

Features of an effective operative dentistry learning environment: students' perceptions and relationship with performance

OBJECTIVE

Students' perceptions of their learning environment influence the quality of outcomes they achieve. Learning dental operative techniques in a simulated clinic environment is characterised by reciprocal interactions between skills training, staff- and student-related factors. However, few studies have examined how students perceive their operative learning environments and whether there is a relationship between their perceptions and subsequent performance. Therefore, this study aimed to clarify which learning activities and interactions students perceived as supporting their operative skills learning and to examine relationships with their outcomes.

METHODS

Longitudinal data about examples of operative laboratory sessions that were perceived as effective or ineffective for learning were collected twice a semester, using written critical incidents and interviews. Emergent themes from these data were identified using thematic analysis. Associations between perceptions of learning effectiveness and performance were analysed using chi-square tests.

RESULTS

Students indicated that an effective learning environment involved interactions with tutors and peers. This included tutors arranging group discussions to clarify processes and outcomes, providing demonstrations and constructive feedback. Feedback focused on mistakes, and not improvement, was reported as being ineffective for learning. However, there was no significant association between students' perceptions of the effectiveness of their learning experiences and subsequent performance.

CONCLUSIONS

It was clear that learning in an operative technique setting involved various factors related not only to social interactions and observational aspects of learning but also to cognitive, motivational and affective processes. Consistent with studies that have demonstrated complex interactions between students, their learning environment and outcomes, other factors need investigation.

Recognizing Clinical Styles in a Dental Surgery Simulator

Recognizing clinical style is essential for generating intelligent guidance in virtual reality simulators for dental skill acquisition. The aim of this study was to determine the potential of Dynamic Time Warping (DTW) in matching novices' tooth cutting sequences with those of experts. Forty dental students and four expert dentists were enrolled to perform access opening to the root canals with a simulator. Four experts performed in manners that differed widely in the tooth preparation sequence. Forty students were randomly allocated into four groups and were trained following each expert. DTW was performed between each student's sequence and all the expert sequences to determine the best match. Overall, the accuracy of the matching was high (95%). The current results suggest that the DTW is a useful technique to find the best matching expert for a student so that feedback based on that expert's performance can be given to the novice in clinical skill training.