Managing a Cardiac Arrest: Evaluation of Final-Year Predoctoral Dental Students

Dental students' attitudes on cardiopulmonary resuscitation training via virtual reality: an exploratory study

Purpose Resuscitation guidelines have advocated the use of virtual learning as a form of pre-course e-learning. Virtual reality (VR) has been identified to provide a method of constructive learning with instant feedback. There are increasing publications of VR use in cardiopulmonary resuscitation (CPR) training; however, there is a dearth from the dental profession. Therefore, the aim of this exploratory study was to investigate dental students' opinions in CPR training using VR.Methods In total, 120 dental students undertook both conventional (manikin) and VR CPR training in a cross-over design. The VR scenario was in a hospital setting. Following, students completed a questionnaire evaluating their experiences.Results The majority of students (n = 88) reported that this was the first time that they had utilised VR. The experience of using VR in CPR training was rated as very good. Most students felt that the inclusion of VR in CPR training created a better learning experience and had a high learning potential. However, the hospital setting was not entirely relevant.Conclusion Dental students recommended that VR CPR training should be used as an adjunct to conventional training in dental education, but the VR scenario would benefit being a virtual dental environment.

The effect of game-based learning on basic life support skills training for undergraduate dental students

OBJECTIVES

The aim of this study was to investigate the impact of serious game training on the performance of undergraduate dental students during basic life support (BLS) training.

METHODS

Students at the Ankara University Faculty of Dentistry were divided into two groups at random: Serious Game (SG) (n = 46) and Traditional (Tr) (n = 45). Students completed the BLS pre-test following their lecture-based training. The SG set of students practiced until they achieved an 85 on the BLS Platform, after which they completed the BLS post-test. All students practiced cardiopulmonary resuscitation (CPR) on a manikin with the instructor's guidance, and then they independently applied CPR by using the model training component. The module evaluation scale was then used to determine each student's grade. Finally, the students provided input on surveys regarding technology perceptions of SG training, serious gaming, and hands-on training.

RESULTS

In the SG group, the BLS post-test scores were significantly higher than the pre-test results (p = 0.00). In the SG and Tr groups, there was no statistically significant difference in the overall hands-on training scores (p = 0.11). Students in both groups evaluated the hands-on training on the manikin favorably and with high levels of participation.

CONCLUSIONS

The SG-based training platform for BLS training has enhanced the BLS performance of undergraduate dental students in terms of knowledge and skill. It has been shown that digital learners have a beneficial impact on game-based learning outcomes; it is advised to use SGs and develop new games for various learning objectives.

Knowledge of handling medical emergencies among general dental practitioners pan India: a cross-sectional survery

BACKGROUND

Medical emergency situations in dental clinics have been contemplated to be an issue in most of the countries by reason of dentist's lack of knowledge and preparedness to attend emergency situations in dental offices. The aim of this paper is to observe the knowledge, attitude, and perceived confidence of the general dental practitioners regarding emergency medical care and its practical application. Questionnaire on knowledge assessment was circulated among 500 dentists using printed questionnaire formats and various social media platforms. The questionnaire included details on treating hypertensive patients, cardiopulmonary resuscitation training, accessibility of medical emergency equipments in the dental clinics, prevalence of medical emergency cases in the dental office and the self-assessed competence to handle medical emergency situations in the dental clinics. Data was surveyed and scrutinized using the Statistical Package for Social Sciences (SPSS), version 17 (SPSS Inc., Chicago IL). Descriptive statistics was tabulated and Chi square tests was applied.

FINDINGS

500 general dental practitioners pan India were involved in the study (294 were females and 207 were males). They were grouped into different age groups (20-30 yrs, 30-40 yrs, 40-50 yrs, 50 and above) and experience (0-5 yrs, 5-10 yrs and more than 10 years). 279 participants did not attend any medical emergency training whereas, 222 participants from all groups attended training program. It was observed that with increased experience in the field, the knowledge, awareness and confidence to treat medical emergency situation in the dental clinics was better. Dentists should update themselves from time-to-time with the latest technologies in the field and need to attend training programs to handle any medical emergency situations in the dental offices. Medical emergencies in a dental clinic can be encountered at any point of time and the clinician should have apt knowledge in handling such situations. Majority of the dentists feel subdued in managing medical situations in dental offices. Training and workshops for handling medical situations in the dental offices should be mandated at the undergraduate and postgraduate levels. This will help the dentist to shape one's confidence in managing such situations without apprehension. Availability of proper infrastructure and equipments is recommended in every dental clinics so as to ease the handling of the situation.

CONCLUSION

This paper enlightens the need of basic life support training on regular basis among the dentists to improve the competence among them and to improve the confidence in handling such situations.

Students' Evaluations of Simulations in Dentistry: A Multiple Cohort Study at a U.S. Dental School

Simulation may help translate didactic learning to patient care in areas such as communication skills and medical emergency management. The aims of this study were to investigate how multiple cohorts of dental students evaluated simulations utilizing standardized patients and manikins and to explore evaluations of a simulation that combined social determinants of health with oral health education. All approximately 600 second- and fourth-year dental students at one U.S. dental school participated in simulation activities for five years (2014-18). The activities involved clinical communication skills with an urgent care patient, medical emergency management, and communication skills with a parent with low income. After the simulations, students were invited to complete an evaluation of the experience. Questionnaire items addressed perceived applicability to patient care, value of the experience, and fulfillment of objectives; and open-ended questions asked for comments specific to the parent with low income simulation. A total of 497 responses from D2 and D4 students were collected over the five-year period, as well as from all 12 periodontics residents in 2017, for an overall 91.7% response rate. The vast majority (>90.6%) positively evaluated all items for each simulation. The positive ratings ranged from a mean of 99.3% for the urgent care simulation to 93.8% for the parent with low income simulation. Positive student comments often related to learning from/with others and effective practice of teach back and patient education tactics. Students' most frequent suggestions for improvement called for better preparation. In this study, simulations with both standardized patients and manikins led to positive evaluations as well as anticipated improvement of clinical performance. These results suggest that incorporating simulation into an already-crowded curriculum is worth it from the student perspective, especially for reinforcement of clinical skills not easily amenable to classroom instruction.

Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists

BACKGROUND

Medical emergencies in dental offices are considered a problem in most countries owing to dentists' concerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medical emergencies in dental offices and dentists' preparedness have been analysed in several countries but have never been studied in Poland.

AIM

To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists' preparedness and attitudes towards medical emergencies.

METHODS

An 18-item questionnaire was completed by 419 dentists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equipment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard deviation. Pearson's linear correlation coefficient was used to determine correlation strength.

RESULTS

The most common medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5-10 for 0.48% and more than 10 for 0%. As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing seizures.

CONCLUSION

The prevalence of medical emergencies in dental offices in Poland is comparable with that in other countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergraduate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency medical equipment in the dental office.

High-fidelity simulation in training dental students for medical life-threatening emergency

INTRODUCTION

Any dental surgeon may be faced with a critical life-threatening emergency situation. In our university, all students in dentistry receive a standard course on emergency first aid. The aim of this prospective, comparative, single-centre study was to determine whether additional training on a high-fidelity patient simulator would improve student performance.

METHODS

After approval by an Ethical Committee and written informed consent, the students of the Simulation group (n=42) had full-scale high-fidelity training on a patient simulator SimMan 3G^™ (3 hours by six students). They participated in pairs in two scenarios (airway obstruction, seizures, allergies, vasovagal syncope, asthma, chest pain). The first scenario was simple, and the second was a progression to cardiac arrest. Three months later, the Simulation group and the Control group (n=42) participated in a test session with two scenarios. The primary end point was the score at the test session (with a standardised scoring grill, direct observation and audio-video recording). Data were median and 25%-75% percentiles.

RESULTS

High-fidelity training strongly improved the score on the test obtained by the students of the Simulation group (146 [134-154]) which was much higher (P<.0001) than in the Control group (77 [67-85]). Technical as well as non-technical skills components of the scores were improved. In addition, performances of the Simulation group were increased between the training and the test. Simulation session was very positively assessed by the students.

CONCLUSIONS

The results support the systematic introduction of training to critical life-threatening emergency situations on high-fidelity patient simulators the dentistry curriculum. The impact on clinical practice in the dental office remains to be assessed.

Neither Basic Life Support knowledge nor self-efficacy are predictive of skills among dental students

AIM

Basic life support (BLS) is considered a core competence for the graduating dentist. This study aimed to measure BLS knowledge, self-efficacy and skills of undergraduate dental students in Dublin.

METHODS

This study consisted of a cross-sectional survey measuring BLS knowledge and self-efficacy, accompanied by a directly observed BLS skills assessment in a subsample of respondents. Data were collected in January 2014. Bivariate correlations between descriptive and outcome variables (knowledge, self-efficacy and skills) were tested using Pearson's chi-square. We included knowledge and self-efficacy as predictor variables, along with other variables showing association, into a binary logistic regression model with BLS skills as the outcome measure.

RESULTS

One hundred and thirty-five students participated. Almost all (n = 133, 98.5%) participants had BLS training within the last 2 years. One hundred and four (77%) felt that they were capable of providing effective BLS (self-efficacy), whilst only 46 (34.1%) scored >80% of knowledge items correct. Amongst the skills (n = 85) subsample, 38.8% (n = 33) were found to pass the BLS skills assessment. Controlling for gender, age and skills assessor, the regression model did not identify a predictive relationship between knowledge or self-efficacy and BLS skills.

CONCLUSIONS

Neither knowledge nor self-efficacy was predictive of BLS skills. Dental students had low levels of knowledge and skills in BLS. Despite this, their confidence in their ability to perform BLS was high and did not predict actual competence. There is a need for additional hands-on training, focusing on self-efficacy and BLS skills, particularly the use of AED.

Competency in managing cardiac arrest: A scenario-based evaluation of dental students

OBJECTIVE

Advanced Cardiovascular Life Support (ACLS) in life-threatening situations is perceived as a basic skill for dental professionals. However, medical emergency training in dental schools is often not standardized. The dental students' knowledge transfer to an ACLS setting thus remains questionable. The aim of the study was to evaluate dental pre-doctorate students' practical competence in ACLS in a standardized manner to enable the curriculum to be adapted to meet their particular needs.

MATERIALS AND METHODS

Thirty dental students (age 25.47 ± 1.81; 16 male/14 female) in their last year of dental studies were randomly assigned to 15 teams. Students' ability to successfully manage ACLS was assessed by a scenario-based approach (training module: Laerdal® ALS Skillmaster). Competence was assessed by means of (a) an observation chart, (b) video analysis and (c) training module analysis (Laerdal HeartSim®4000; Version 1.4). The evaluation was conducted by a trained anesthesiologist with regard to the 2010 guidelines of the European Resuscitation Council (ERC).

RESULTS

Only five teams (33.3%) checked for all three vital functions (response, breathing and circulation). All teams initiated cardiopulmonary resuscitation (CPR). Only 54.12% of the compressions performed during CPR were sufficient. Four teams stopped the CPR after initiation. In total, 93% of the teams used the equipment for bag-valve-mask ventilation and 53.3% used the AED (Automated external defibrillator).

CONCLUSIONS

ACLS training on a regular basis is necessary and, consistent with a close link between dentistry and medicine, should be a standardized part of the medical emergency curriculum for dental students with a specific focus on the deficiencies revealed in this study.

Evaluation of the dentists' knowledge on medical urgency and emergency

This study aimed at evaluating how well dentists understand medical emergency/urgency procedures and issues during dental treatment at a hospital specialized in cleft lip and palate. It comprised a hundred dentists from the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP), Brazil, from different dental specialties. A questionnaire was applied to evaluate their knowledge of medical emergencies/urgencies from June through September 2011. The questionnaire was anonymous, confidential and constructed with closed questions and either yes-no or multiple-choice responses. Results showed that most professionals (87%) were trained in basic life support (BLS), but only 43% considered themselves capable of providing first aid and performing the necessary maneuvers. Most participants (94%) claimed that they knew the difference between medical urgencies and emergencies, and 69% had BLS training in their undergraduate courses, as opposed to 37%, during their specialization. Some participants (23%) mentioned that they had received knowledge of the subject during extracurricular courses and/or graduate courses (12%). Only 9% had not been educated on the subject; however, all participants showed interest in attending a course in BLS. In regard to assessing training that dentists who attended BLS courses received, 49% were satisfied and 42% were dissatisfied. Results of the present study emphasize that dentists from HRAC/USP have little knowledge about BLS procedures to perform them. Dentists must gain adequate education and training to minimize possible technical, ethical and legal problems associated with dental practice. It is necessary to improve both knowledge and practice in order to become well-qualified practitioners.

Final-year dental students' opinions of their training in medical emergency management

The management of medical emergencies is clearly of vital importance in dental practice. The starting point of training in this area is the undergraduate dental degree programme. The aim of this study was to examine the opinions of final-year dental students at Newcastle School of Dental Sciences in relation to their undergraduate training in medical emergency management. Overall the responses were positive but the need for further practical training in the use of emergency drugs and equipment was highlighted.

Practical skills training influences knowledge and attitude of dental students towards emergency medical care

BACKGROUND

Medical emergencies in dental practice are generally perceived as being rare. Nonetheless, recent studies have shown that incidents occur on a regular basis. Therefore, patients have the right to expect necessary skills to manage life-threatening situations from every dentist.

OBJECTIVE

To observe students' attitude and self-assessment towards emergency medical care (EMC) and its practical appliance.

MATERIAL AND METHODS

Students of dentistry took part in small group sessions for adult and paediatric basic life support. Participants filled out pre-post questionnaires regarding knowledge and attitude towards EMC (6, respectively, 10-point Likert scale). Additionally, feedback was asked for the quality of course and tutors.

RESULTS

Forty dental students in their last 2 years of study registered for the EMC courses. The majority had never attended any first-aid course; the mean age was 25% and 75% were women. A comparison between pre- and post-evaluation showed that the participation in practical training easily enhances the students' awareness of EMC importance as well as self-confidence in managing emergencies. After the course, 71% shared the opinion that retraining should be obligatory for all medical personnel. At the same time, students' self-assessment of confidence for specific tasks got significant upgrades in every aspect.

CONCLUSION

The evaluation data clearly show the participants' needs to deal with topics of EMC within the curriculum of dentistry. The proposed course is able to change participants' attitudes towards EMC and its importance for their daily practice. The considerable enhancement of self-confidence in performing EMC-techniques might also lead to more willingness to manage emergency situations.

Students' perception of the prognosis for a single-surface amalgam restoration

The aim of the study was to assess the self-rated skill, clinical judgement and competency of final-year pre-doctoral dental students. The study was also designed to determine whether the students' estimated durability of their single-surface restorations was determined by their confidence. Students were given a questionnaire and completed it anonymously. One hundred and ninety-six forms were returned from the 238 students (82% return rate). Complete analysis was possible on 169 questionnaires. The students' self-assessed skill and judgement were a significant factor in predicting how long they would tell a patient that their restoration would last. Those ranking themselves below average were more likely to state that their amalgam restorations would have a shorter life (odds increased by 2.82 for those ranking themselves lower than most others). There was a significant association between the students' self-assessed skill and judgement and their confidence in dealing with both the initial management of patients' medical emergencies (ρ = 0.244, P = 0.001, n = 191) and their general confidence in dealing with medical emergencies (ρ = 0.187, P = 0.01, n = 188). Given a conversational scenario with a patient, the treatment prognosis given by final-year pre-doctoral students for a single-surface amalgam restoration was dependent on their self-assessed competence, skill and judgement.