Primer on Preclinical Instruction and Evaluation

Thriving in foreign learning environments: The case of hands-on activities in early years of dental education

OBJECTIVES

Hands-on learning environments can challenge learners' wellbeing in dental education, given their unfamiliarity with students. As today's learners are more aware about their wellbeing needs, it is important to explore the depth and complexity of the challenges they experience and provide them with the necessary support strategies. This study aims to identify the challenges and sources of cognitive overload of early years' dental students across two time-points: 2012 and 2022. We also aim to describe the students' recommendations for future program revision considerations to support students' wellbeing.

METHODS

This study employs both qualitative and quantitative methods. Qualitatively, we utilized an Interpretive Description approach and conducted focus groups with first-year dental students in 2023. Quantitively, we utilized first-year dental students' responses to the Study Habits survey administered in 2012/2013.

RESULTS

Five main concerns and sources of cognitive load emerged from the focus groups and survey data: steepness of the learning curve, inconsistent feedback, stigma around asking for support, structural and organizational challenges, and lack of resources. Students also identified several suggestions to support their wellbeing, including time, instructor support, non-graded exercises, additional resources, and re-organizing the curriculum.

CONCLUSION

This study adopts a wellbeing lens to examine students' transition into hands-on learning activities. These findings were utilized to propose the TIPSS Support Framework (Time, Instructor Capacity Building, Peer Learning and Other Resources, Safe Learning Spaces, and Spiraling Curriculum). The proposed model can serve as a prototype for future studies to explore its applicability and effectiveness in other dental programs.

Contrasting student and staff perceptions of preclinical-to-clinical transition at a Chilean dental school

INTRODUCTION

Dental education is a challenging and demanding field of study as students are expected to acquire various competencies to fulfil their professional requirements after graduation. The objective of this study was to investigate and compare dental students' and clinical staff instructors' perceptions of the preclinical-to-clinical transition training at a Dental School in Santiago, Chile.

MATERIAL AND METHODS

Two questionnaires containing 11 quantitative and one qualitative item were developed to assess our year three, four and five (n = 244) dental undergraduate students' challenges when they begin treating patients, and clinical staff (n = 78) perceptions of the preparedness to treat patients of the same students. Both questionnaires were voluntarily and anonymously implemented eight weeks after the beginning of the 2019 academic year. Responses were analysed using a Chi-squared test for each quantitative question, while qualitative comments were studied to form themes and dimensions.

RESULTS

A total of 234 (96%) students and 60 (77%) instructors completed their respective questionnaire. There were considerable variations between students in the different years of the programme, as well as between students and staff members. Students and instructors felt the former had enough knowledge to treat patients though it was difficult for them to apply it in clinical practice. Again, both believed they could communicate with patients, but third year students asked for more training on this. Regarding practical skills, fourth- and fifth-year students felt prepared but not third year students, who preferred to work in pairs with senior students, a preference that was shared by the instructors. All student groups asked clinical staff to provide more frequent, constructive and consistent feedback and felt that the difference between simulation and clinical environments and the amount of clinical work to fulfil clinical requirements made them feel stressed. Another mentioned stressor was students' low self-confidence when working with patients. Among the requested improvements, students requested better training on how the dental clinic works to save time.

CONCLUSIONS

Preclinical-to-clinical transition training presents several challenges. Some of the problems highlighted by both students and clinical staff members persisted with the transition after three, four and even five years of training, which needs to be addressed.

Simulated skill complexity and perceived cognitive load during preclinical dental training

INTRODUCTION

Cognitive Load theory (CLT) focuses on the information processing aspect of learning and how the working memory handles the mental effort associated with new task. The aim of this study is to investigate the association between the perceived cognitive load and performance amongst dental students during preclinical simulation training at various levels of procedural task complexity. Additionally, some cognitive load-modifying factors were examined.

MATERIALS AND METHODS

This cross-sectional study evaluated the perceived cognitive load amongst second-year dental students (n = 34), using the validated National Aeronautics and Space Administration's Task Load Index (NASA TLX index) after training on four dental tasks at two levels of complexity, in addition to structured online anonymous questionnaire about demographics, feedback and performance. The NASA TLX raw scores and the weighted global score were calculated for each exercise. Descriptive statistics and Pearson's correlations between performance and the corresponding NASA TLX-weighted score were calculated. Mean differences in the perceived cognitive load across the exercise levels were assessed using RM-ANOVA with Bonferroni corrections at p < .05.

RESULTS

Reduced performance was significantly associated with higher cognitive load particularly in high complexity dental task (class II-mirror vision). Simulated exercise complexity significantly influenced the students' perceived mental demand, physical demand and temporal demand; all were significantly higher for class II- mirror vision task than for direct vision tasks. The majority of participants (82.1%) preferred detailed feedback from instructors, and more than half of the participants (60.7%) preferred continuous feedback throughout the training session.

CONCLUSION

Complex dental tasks are associated with higher cognitive load in novice dental students during preclinical training. The NASA TLX index is a useful instrument to explore the level of perceived cognitive load associated with performance of simulated complex dental skills. Cognitive load theory is relevant to simulation-based dental education to improve the preclinical instructional efficiency and to enhance students learning.

Multisensory Preclinical Training Strategy of Periodontal Scaling for Undergraduates

BACKGROUND

Invisibility of subgingival scaling is the most important negative factor affecting the performance of periodontal treatment. A multisensory teaching strategy is used in the preclinical training of undergraduates in order to increase the haptic-auditory-visual feedback, aiming to overcome the invisibility and achieve minimal postoperative complications, improving patients' treatment experience.

METHODS

One hundred undergraduate dental students in grade 5 were divided into a multisensory teaching strategy group (MTS: n = 50) and a conventional training pattern group (CTP: n = 50). All participants attended a lecture on using an ultrasonic subgingival scaler (USS) and Gracey curettes (GRA), followed by a 3-week training programme. Students in the MTS group were trained in a haptic/auditory-visual feedback manner, whereas students in the CTP group were trained conventionally. After the training phase, paired students in the 2 different groups performed subgingival scaling in paired patients with equivalent teeth of periodontitis using USS and GRA. Objective and subjective postoperative evaluations were recorded. Probing depth (PD) and gingival index (GI) were evaluated before and 4 weeks after scaling by the same periodontal specialist.

RESULTS

MTS significantly reduced treatment time and ameliorated postoperative complications (gingival injury, haemorrhage and root surface roughness; P < .05). Postoperative sensitivity was reduced in the MTS group from day 1 to day 7 (D1-D5: P < .001; D6: P = .002; D7: P = .003), whereas postoperative pain was reduced on day 1 (P = .006), compared with that in the CTP group. The PD reduction was not significant between the groups (MTS: 3.17 ± 0.95 mm vs CTP: 3.07 ± 0.97 mm, P > .05), whereas the GI change showed a significant difference between the groups (MTS: 1.71 ± 0.41 vs CTP: 1.67 ± 0.41, P < .05).

CONCLUSIONS

Multisensory teaching strategies in the preclinical periodontal training of undergraduates can reduce postoperative complications (gingival injury, postoperative haemorrhage, and root surface roughness) and provide a better treatment experience (decreased treatment time and postoperative pain and sensitivity) for patients.

Exodontia skills acquisition: Focusing on clinical teaching and training

OBJECTIVES

The aim of the research was to evaluate the traditional exodontia block course. The objectives were to explore the experiences and views of students, clinical teachers and dental practitioners of the various elements of the course curriculum.

METHODS

The study was a qualitative, participatory action research study using descriptive analysis. The study was conducted at a Dental Faculty in South Africa. A purposive sample of students, clinical teachers and dental practitioners were invited to participate. Focus group discussions were used to collect data which was analysed by an external coder.

RESULTS

The study population consisted of 15 undergraduate dentistry students, 10 clinical teachers and seven dental practitioners. Four broad themes with sub-themes emerged from the study. The main themes identified strengths and deficiencies of the traditional course and made recommendations for its improvement. The themes identified were i) Integration of knowledge and skills, ii) Block course structure, iii) Challenges associated, and iv) Recommendations for improvement. Overall, the participants were satisfied that the course met its objectives. The results pertaining to clinical skills acquisition identified that teaching the use of elevators and luxators in the course, and standardisation of terminology among all clinical teachers as areas requiring attention. Teaching and learning strategies such as community-based learning, peer learning, case reviews, feedback and visual technology were viewed by the student, as well as clinical teacher samples, as strategies most beneficial to clinical learning.

CONCLUSIONS

The review of the curriculum for exodontia skills acquisition and development, provided several benefits. Firstly, this research served as a quality assurance indicator. It further highlighted many teaching and learning strategies that would improve clinical skills development, reduce stress and anxiety, and support student learning. To a large extent, pertinent information was obtained that served to inform the subsequent redesigning of the course. The findings of the study augment the literature currently available on the best practice for exodontia skills acquisition and development and provide baseline information for the planning and redesign of related courses.

The application of the spot the difference teaching method in clinical skills training for residents

BACKGROUND

Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China.

METHODS

First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann-Whitney-Wilcoxon tests, chi-square tests, and Cohen' s effect size (d). The Cohen' s d value was considered to be small (<0.2), medium (0.2-0.8), or large (>0.8).

RESULTS

The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p<0.05, d=0.5), taking medical history (t=2.665, p<0.05, d=0.59), and CMLE performance on practical skill (t=2.103, p<0.05, d=0.47). The SDTM members rated the curriculum more highly than the control on the items relating to interestingness and participation (p < 0.05) with large effect sizes (d >0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39).

CONCLUSIONS

SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN10598469 , 02/04/2022，retrospectively registered.

Application of WeChat-based flipped classroom on root canal filling teaching in a preclinical endodontic course

BACKGROUND

This study was aimed to evaluate the application of WeChat-based flipped classroom in root canal filling teaching in a preclinical endodontic course.

METHODS

A two-group comparative study was designed. The pre-class test, on-site quiz, and root canal filling on extracted premolars were performed by students from a lecture-based classroom group (LG, n = 30) and a WeChat-based flipped classroom group (WFG, n = 30). Results of the Pre-class test and on-site quiz were analyzed by independent samples t-test. Post-filling radiographs were taken and evaluated by a specialist in oral radiology who was blinded to grouping. Results of root canal fillings were analyzed by the Pearson chi-square test. Student responses in questionnaires were analyzed by Fisher's exact test.

RESULTS

The students in WFG could get significantly higher scores in the on-site test and make better performances in root canal filling than those in LG. In terms of questionnaires, students from WFG were perceived to be more motivated to learn, better to understand the knowledge, better to improve communication and clinical skills, easier to perform root canal filling but spending more time.

CONCLUSION

The WeChat-based flipped classroom teaching can have a better effect than lecture-based teaching on root canal filling learning for students with limited endodontic experiences.

Technical skill training and assessment in dental education

Highly competent clinical practice requires cognitive, psychomotor and affective skills. Therefore, the ultimate goal of dental education is for practitioners to be competent in all of these domains. While many methods have been introduced to assess knowledge and non-technical skills, it is still very difficult for educators to assess technical skill. Assessment methods for technical skills are still not well established because it is very difficult to assure objectivity, validity and fairness. Nonetheless, technical skill is especially important in dental treatments, along with knowledge and attitude. The aim of this review was to summarize the methods of technical skill training in dental education and how they are assessed. This is a literature review. We searched PubMed MEDLINE using terms related to technical skill training and those assessment as of June 2020 and reviewed them. There have been many reports introducing methods of technical skill training and assessment, including the use of digital technology. However, no single assessment method had demonstrated validity of it. Technical skill training is very important in dental education and there are various ways of learning. The validity of current assessment methods is limited; therefore, a combination of several methods may achieve the best results.

Application and practice of a step-by-step method combined with case-based learning in Chinese otoendoscopy education

BACKGROUND

Standardized training allows more physicians to master otoendoscopic surgery. However, the lecture-based learning (LBL) applied in otoendoscopy teaching may not be conducive to training students in clinical thinking and surgical ability. It is necessary to explore innovative methods for otoendoscopy teaching. This study aimed to determine the effect of a step-by-step (SBS) method combined with case-based learning (CBL) in otoendoscopy teaching.

METHODS

Fifty-nine physicians who participated in otoendoscopy training were selected as the study subjects and randomly divided into two groups (A and B). Group A underwent training with the SBS & CBL method, while Group B underwent training with the LBL & CBL method. The effects of these two methods for otoendoscopy training were compared by evaluation of professional skills and questionnaires before and after the training.

RESULTS

Proficiency in otoendoscopic anatomy and grades for both professional knowledge and otoendoscopic skills were significantly higher in Group A than in Group B(P < 0.05). In terms of learning interest, surgical ability, acting capacity during surgery, reducing surgical complications, and satisfaction with learning experience, all responses from Group A were better than those from Group B(P < 0.05).

CONCLUSIONS

The SBS & CBL method may help to improve ability in otoendoscopic surgery and clinical thinking and appears suitable for endoscopy teaching.

Hands-on live demonstration vs. video-supported demonstration of an aesthetic composite restoration in undergraduate dental teaching

PURPOSE/OBJECTIVES

Live hands-on demonstration of dental procedures is a central format in undergraduate dental teaching. It captures the immediacy of the clinical situation and allows for direct communication between instructor and students, but it also requires an experienced instructor who is able to handle both the performed treatment and its visualization alongside the actual teaching. The aim of the present work is to compare the hands-on demonstration of a class IV composite restoration to a teaching format where the instructor guided the students through a prerecorded procedural video of the same treatment.

METHODS

The effect of both interventions on the students' self-perceived learning outcomes was analyzed by questionnaires (response rate 100%) in a randomized controlled double-blind (participants, outcome assessor) parallel group design (September 10 to October 3, 2019). In-class discussions were explored qualitatively by thematic analysis.

RESULTS

Both teaching formats increased the students' self-reported motivation, self-efficacy, and patient-centeredness in a similar way, with no significant differences between interventions. During in-class discussions, both the instructor and the students were more active in the video group. In contrast to the hands-on group, discussions in the video group also involved patient-related topics, such as aesthetics and general health. The video-supported teaching format considerably reduced the amount of time spent on optimizing the visualization of the performed treatment.

CONCLUSION

Video-supported instructor-guided demonstrations may represent a promising teaching format as an alternative to live hands-on demonstrations of dental procedures in undergraduate dental education.

Dental faculty and student views of didactic and clinical assessment: A qualitative description study

OBJECTIVE

Although assessment is essential to accurately represent student learning, little is currently known about student and faculty perceptions of assessment in dental schools. Our study aimed to explore faculty and student views of didactic and clinical assessments in the School of Dentistry at the University of Alberta.

METHOD

Qualitative description informed the study design. Data were collected through focus groups and analysed inductively using manifest content analysis.

RESULTS

Five focus groups were conducted with faculty (n = 34) and three with students (n = 19). Faculty and student views of assessment were related to improvements made (perceived positive changes), improvements needed (perceived limitations) and improvements recommended (recommendations to improve perceived limitations). Faculty and students reported that improvements made (eg adequacy of assessment to students' levels of training) varied across instructors, courses and learning environments. Both faculty and students perceived clinical assessments as less appropriate than didactic assessments. Faculty perceived limitations were mostly related to assessment appropriateness, especially assessment accuracy and comprehensiveness, whilst student perceived limitations included other issues related to appropriateness (eg misalignment with course objectives) as well as issues related to assessment volume, pace and scheduling. Similarly, faculty recommendations focused on enhancing the assessment of clinical competencies, whilst students' recommendations aimed to also improve assessment scheduling, volume and usage (eg for learning purposes).

CONCLUSIONS

Faculty and student views of assessment complemented one another. Our data show that assessment in dental education is multidimensional, so that multilevel strategies may be needed to improve this component of dental curricula.

Top-Cited Articles from Dental Education Journals, 2009 to 2018: A Bibliometric Analysis

The number of citations an article receives is an important indicator to quantify its influence in its field. The aim of this study was to identify and analyze the characteristics of the 50 top-cited articles addressing dental education published in two journals dedicated to dental education (European Journal of Dental Education and Journal of Dental Education). The Web of Science database was searched to retrieve the 50 most-cited articles from the two journals in December 2018. The top-cited articles were analyzed for journal of publication, number of citations, institution and country of origin, year of publication, study type, keywords, theme and subtheme, and international collaborations. The results showed the 50 top-cited articles were cited between 24 and 146 times each. The majority of these top-cited articles (n=34) were published in the Journal of Dental Education Half (n=25) of the articles were by authors in the U.S. The most common study types were surveys (n=26) and reviews (n=10). The main themes of these top-cited articles were curriculum and learner characteristics. This bibliometric analysis can serve as a reference for recognizing studies with the most impact in the scholarship of dental education.

Step-by-step teaching method improves the learner achievement in dental skill training

INTRODUCTION

This study aimed to assess and compare the outcomes of all-in-one and step-by-step teaching methods in dental skill training.

METHODS

Forty first-year dental residents were recruited into this study, which was a prospective, double-blind and randomised controlled trial. The learners were randomly allocated to either the all-in-one group (control group, n = 20) or the step-by-step group (experimental group, n = 20). They performed crown preparation on a plastic tooth under different training course structures. For the all-in-one group, the course comprised three parts: the teacher's lecture and demonstration and the learner's practice. Every part was carried out independently in turn. For the step-by-step group, the course was divided into six parts according to the procedures of crown preparation: incisal preparation, facial preparation, interproximal preparation, lingual preparation, marginal preparation, and finishing and polishing. Every part, consisting of the teacher's lecture and demonstration and the learner's practice, was carried out step-by-step. Thereafter, the training outcome was evaluated by the learners, two experts and a digital system.

RESULTS

For the outcomes of the all-in-one group and the step-by-step group, the learners' assessments were 6.15 ± 1.98 and 8.10 ± 1.41, the experts' assessments were 7.00 ± 1.75 and 8.40 ± 1.10, and the digital assessments were 6.43 ± 1.20 and 7.62 ± 0.51, respectively. In terms of each evaluation index, there was significant difference between the two groups (P < 0.05). Higher quality of crown preparation was attained in the step-by-step group.

CONCLUSION

The step-by-step teaching method can improve the learner's achievement in dental skill training.

Is a Picture Worth a Thousand Words? Effectiveness of iPad Technology in Preclinical Dental Laboratory Courses

Dental educators should consider alternative modalities of instruction when experiencing difficulties conveying feedback to students. The aim of this study was to determine if integrating iPad technology as a visual learning tool would enhance the exchange of assessment information and improve academic performance in Indiana University School of Dentistry's preclinical curriculum. In 2016, the first-year Tooth Morphology (TM) and second-year Fixed Prosthodontics (Fixed) courses implemented a project using iPad images that allowed instructors to annotate acceptable and deficient areas of students' tooth wax-ups and preparations. In the two courses, all students (TM n=106 and Fixed n=105) and instructors (TM n=21 and Fixed n=17) were given pre-intervention surveys to report their perceived effectiveness of verbal feedback and were given post-intervention surveys to rate their experiences with iPad image feedback. Response rates for students in the two courses on the pre surveys were TM 87.7% and Fixed 85.7% and on the post surveys were TM 26.4% and Fixed 76.2%. Response rates for instructors on the pre surveys were TM 52.4% and Fixed 82.4% and on the post surveys were TM 76.2% and Fixed 76.5%. The results showed that a majority of both groups preferred the combination of verbal and iPad image feedback: 53% of responding students in TM and 51% in Fixed, and 75% of instructors in TM and 77% in Fixed. In the TM course, responding instructors had a statistically significantly higher agreement than students that feedback with iPad images was superior to verbal feedback alone (p=0.008). Furthermore, a multi-year analysis of TM practical examination grades found statistically significant lower change scores for the first and second exams in 2014 and 2015 compared to the 2016 scores when the iPad intervention occurred. These results suggest that verbal feedback combined with iPad images resulted in an enhanced exchange of information and increased student grades, particularly in the first-year dental curriculum.

Comparative effectiveness of hand scaling by undergraduate dental students following a two-week pre-clinical training course

BACKGROUND

The Bologna reform resulted in a drastic restructuring of pre-clinical training courses at the University of Zurich. The aim of this study was to assess student pre-clinical scaling/root planning skills after just 8.5 hours of manual training.

MATERIAL AND METHODS

Three consecutive classes of dental students (n = 41; n = 34; n = 48) were tasked with removing lacquer concrement from the maxillary left canine on a typodont using Gracey and universal (Deppeler M23A) curettes. At baseline (prior to instruction), a timed five-minute session of scaling/root planning was undertaken. The second scaling/root planning session was held immediately following training. Eight experienced dental hygienists and eight lay people served as positive and negative controls, using the same instruments and time limit, respectively. Instrumented teeth were collected, scanned and planimetrically analysed for the percentage of tooth surface cleaned. Statistical analyses were performed to assess the dental students' improvement after the training (Wilcoxon signed-rank test) and to compare it to that of laypeople and dental hygienists (Kruskal-Wallis rank sum test followed by Conover's post hoc test).

RESULTS

At baseline, the dental students' mean scaling scores of the cleaned surfaces were not significantly different than those of laypeople (29.8%, 31.0%, 42% vs 27.9%). However, after 8.5 hours of manual training, the students' ability to clean the maxillary tooth improved significantly and they achieved mean removal values of 61.7%, 79.5% and 76% compared to the 67.4% (P < .001) of the experienced dental hygienists (Tables Tables  and ). There were no statistically significant differences between the scores achieved by students after training and those achieved by experienced dental hygienists.

CONCLUSION

A shortened pre-clinical training time was sufficient for students to acquire the basic scaling/root planning skills needed in preparation for clinical training. Further research is needed to identify ways to help students consistently reach highest skill levels.

Investigating an errorless learning approach for developing dental operative technique skills: A pilot study

INTRODUCTION

Explicit instruction (conscious knowledge/rules) is generally used for learning dental operative skills; however, recent work has demonstrated advantages of learning skills implicitly with minimal accrual of conscious knowledge and reduced attentional demands. Therefore, this study examined the effects of learning handpiece manipulation skills explicitly (errorful) and implicitly (errorless: limited error detection/correction) under conditions of increased attentional demands (ie multitasking and additional instructions).

MATERIALS AND METHODS

Non-dental university students were randomly assigned to errorless (n = 11) or errorful (n = 8) groups. They used pencil lead instead of a bur, with errorless learners shading shapes from simple (small circle) to complex (cross), while errorful learners shaded the shapes in reverse. During testing, they completed simulated cavities in baseline, additional instructions and multitask conditions. Learning performance was calculated as per cent of the shape shaded successfully. Test performance was computed as error in cavity length/depth and was compared with dental students who had completed their operative technique course (n = 14).

RESULTS

Errorless learners were more accurate than errorful learners especially when shading difficult shapes (P = 0.042). With additional instructions, errorless and errorful learners did not differ in cavity depth (P = 0.057) or length (P = 0.540). When multitasking, errorless learners prepared the cavity length (P = 0.048) but not depth (P = 0.920) more accurately than errorful learners. Overall, performance of errorless learners was comparable to dental students.

CONCLUSIONS

These preliminary findings suggest handpiece skills can be acquired implicitly via errorless learning, and it is less attentionally demanding than errorful learning, as evident by maintenance of preparation performance when processing additional relevant instructions and multitasking.

Psychosocial impact, perceived stress and learning effect in undergraduate dental students during transition from pre-clinical to clinical education

INTRODUCTION

This study aimed to develop a suitable instrument for a comprehensive quantitative and qualitative assessment of perceived psychosocial impact, levels of stress and learning effect in undergraduate dental students during the transition from pre-clinical to clinical education. These findings might improve curricular structures and didactic organisation during this period.

MATERIALS AND METHODS

At the beginning of their first clinical year, undergraduate dental students were asked to complete an anonymous forty-item questionnaire. Two hundred and seventy-six undergraduate dental students were willing to participate and completed the questionnaire and participated during the years 2011-2016.

RESULTS

The response rate was between 45% and 96%. Correlational analysis (Spearman-Rho) in the field of psychosocial impact showed the dental teacher to be the most important multiplier of students' feelings. If the students feel that their teacher acts cooperatively, positive items increase and negative items decrease significantly (P < .0001). Also, students who report high levels of stress are affected significantly in their psychosocial interaction (P < .0001). Wilcoxon test yielded highest levels of stress in endodontology during the first weeks (P < .0001). During the same period, the greatest learning increment was seen for diagnostics and caries excavation.

CONCLUSION

In conclusion, teaching of undergraduate dental students during the transition period from pre-clinical to clinical education can be positively influenced by a supportive learning environment and by specific chronological modifications in the curriculum. Students should start their clinical training with diagnostics, preventive dentistry and initial periodontal treatment. Due to high levels of perceived stress, endodontology should be introduced later in the clinical curriculum.

Student performance in a flipped classroom dental anatomy course

PURPOSE

The purpose of this study was to assess dental student learning in a dental anatomy module between traditional lecture and flipped classroom cohorts.

METHODS

Two cohorts of predoctoral dental students (N = 70 within each cohort) participated in a dental anatomy module within an Introduction to the Dental Patient (IDP) course ([traditional/lecture cohort: academic year (AY) 2012, 2013] and [flipped classroom cohort: AY 2014, 2015]). For the dental anatomy module, both cohorts were evaluated on pre-clinical tooth waxing exercises immediately after each of five lectures and tooth identification after all lectures were given. Additionally, the cohorts' performance on the overall IDP course examination was compared.

RESULTS

The flipped classroom cohort had statistically significant higher waxing scores (dental anatomy module) than students in the traditional classroom. There was no statistically significant difference for tooth identification scores and the overall IDP course examination between the traditional vs flipped approach cohorts. This is due to the latter two assessments conducted at the end of the course gave all students enough time to review the lecture content prior to the assessment resulting in similar scores for both cohorts.

CONCLUSION

The flipped classroom cohort promoted students' individual learning and resulted in improved students' performance on immediate evaluation but not on the end of the course evaluation. Redesign of courses to include a new pedagogical approach should be carefully implemented and evaluated for student's educational success.

Evaluating the efficiency of the Dental Teacher system as a digital preclinical teaching tool

AIM

To investigate the use of a preparation evaluation system for enhancing the learning and performance of undergraduate dental students when cutting preparations.

MATERIALS AND METHODS

Two groups of eighteen students each were randomly chosen from the fourth year of the dental programme. The task chosen for this study was to make a cavity in preparation for a mesio-occlusal ceramic onlay in a plastic tooth. The dimensions of the cavity were defined, and 2 burs of known size were used for preparation. For assessment, each tooth preparation was scanned with a digital scanner and analysed using the Dental Teacher software. In the control group, a second corrective preparation was made following the supervisor's instructions. In the test group, the second preparation was made based on Dental Teacher analysis. The final cavities were all scanned and assessed by Dental Teacher comparing the similarity of students' onlay cavity preparations to the ideal preparation. All data were recorded and analysed by the software, including cavity depth and width in the occlusal and proximal box, the extent of mesiobuccal cusp reduction and shoulder width around the mesiobuccal cusp. Finally, the data were statistically evaluated using a Wilcoxon matched pairs test and a Mann-Whitney U test.

RESULTS

Three of the 6 cavity dimension parameters improved significantly in the test group whilst no improvement was found in the control group. A positive correlation was found between the improvement and the deviation measured for the first preparations, and it was stronger in the test group than in the control group.

CONCLUSIONS

The use of Dental Teacher helped students to learn the preparation technique for onlay restorations more efficiently and seems to be a promising and useful method to facilitate their individual performance. Student feedback showed a great demand for digital aids in education.

Utilising an innovative digital software to grade pre-clinical crown preparation exercise

BACKGROUND

Accurate assessment of dental students' pre-clinical work is the most critical component of the dental education process. Thus, this study came to investigate the effectiveness of using technology in students' pre-clinical work evaluation; by comparing grades generated from a digital assessment software of a prepared tooth and a traditional visual inspection carried out by four calibrated faculty members.

METHODS

Ninety-six teeth were prepared for a ceramo-metal crown by fourth year dental students. The four examiners and the digital grading software evaluated independently each preparation once. A random sample of 20 preparations were graded twice to assess intra-rater reliability. Inter-class correlation (ICC) was used to measure agreement among the four examiners, and between the examiners and the digital grading software. Paired student t-test was used to assess the accuracy of grades generated from visual inspection when compared to the digital grading system.

RESULTS

Intra-rater reliability for examiners 1 and 2 were 0.73 and 0.78 and for the digital grading system was 0.99. The inter-rater reliability among the four examiners was very good, ICC of 0.76. However, the agreement between scores produced by the examiners and the digital system were mostly in the low to moderate range. The paired t-test demonstrated statistically significant differences between each examiner and the digital grading by 6-25 grades.

CONCLUSIONS

This study demonstrates that the digital grading system used in this study can reliably scan and compare students' tooth preparations to a known gold standard. Results of this study suggests that using digital grading will preclude the variability and the subjectivity that usually result from the traditional visual inspection grading.

Ergonomics Calibration Training Utilizing Photography for Dental Hygiene Faculty Members

Dental and dental hygiene clinical faculty members often do not provide consistent instruction, especially since most procedures involve clinical judgment. Although instructional variations frequently translate into variations in student performance, the effect of inconsistent instruction is unknown, especially related to ergonomics. The aim of this study was to determine whether photography-assisted calibration training would improve interrater reliability among dental hygiene faculty members in ergonomics evaluation. The photography-assisted ergonomics calibration program incorporated features to improve accessibility and optimize the quality of the training. The study used a two-group repeated measures design with a convenience sample of 11 dental hygiene faculty members (eight full-time and three part-time) during the autumn 2016 term at one U.S. dental school. At weeks one and seven, all participants evaluated imaged postures of five dental students using a modified-dental operator posture assessment instrument. During weeks three and five, training group participants completed calibration training using independent and group review of imaged postures. All pre-training and post-training evaluations were evaluated for interrater reliability. Two-way random effects intraclass coefficient (ICC) values were calculated to measure the effects of the training on interrater reliability. The average measure of ICC of the training group improved from 0.694 with a 95% confidence interval (CI) of 0.001 to 0.965 (F(4,8)=3.465, p>0.05) to 0.766 with a 95% CI of 0.098 to 0.972 (F(4,8)=7.913, p<0.01). The average measure of ICC of the control group improved from 0.821 with a 95% CI of 0.480 to 0.978 (F(4,28)=7.702, p<0.01) to 0.846 with a 95% CI of 0.542 to 0.981 (F(4,28)=8.561, p<0.01). These results showed that the photography-assisted calibration training with the opportunity to reconcile different opinions resulted in improved agreement among these faculty members.

Dental Anatomy and Occlusion: Mandibular Incisors-Flipped Classroom Learning Module

INTRODUCTION

This dental anatomy module is the second in a series that develops skills in analyzing the morphology, function, anomalies, and development of human teeth. Learning the visual details associated with teeth has often proven difficult using the lecture format; thus, we have utilized computer-assisted flipped learning, which has been shown to be just as effective as lectures and frees up class time for active learning.

METHODS

In a flipped classroom approach, students learn basic knowledge with a self-paced, interactive tutorial prior to class. In class, students are assigned to small groups and start with a readiness assessment quiz, administered first individually and then to each team. This is followed by a review for the whole class. The teams then practice critical thinking through practical application scenarios; a laboratory exercise follows where students wax tooth #25 and tooth #26.

RESULTS

Students rated faculty members who used team-based learning higher than those who used lecture format for similar morphology lectures. For the first 3 years that this flipped classroom technique was used, students consistently scored it higher than the lecture format on a 5-point Likert scale. Multiple positive comments indicated their preference for this method.

DISCUSSION

Teaching students to see the subtle variations in tooth morphology takes time and attention. In a lecture, each key point is covered only once, and images appear fleetingly. A key advantage of the self-paced interactive tutorial coupled with flipped classroom activities is that each learner can take the time needed with each image in a tutorial.

Electrotactile Augmentation for Carving Guidance

In this study, we presented an efficient and unobtrusive tactile feedback system, which is used to train dental technicians in carving tasks using a wax stick and knife. First, we developed a method for generating performance metrics using a model-based estimation of clearance angles between an object's surface and the carving blade. The calculated clearance angles are compared with desired angles obtained from expert operators. Then, angular errors are presented as tactile cues to the user's finger pads through electrical stimuli at the middle phalanx of the index finger and the thumb. Subsequently, we conducted a feasibility test with novice dental technicians, who showed improvement in initial clearance angles of carving strokes. Moreover, the results showed significant reduction in the occurrence rate of poor-carving when using the proposed system. From these results, we concluded that electrotactile augmentation can provide effective guidance for carving tasks.

Satisfaction of undergraduate students at University of Jordan after root canal treatment of posterior teeth using rotary or hand preparation

The aim of this study was to report the satisfaction of fifth year undergraduate students on the clinical use of rotary endodontic preparation compared with stainless steel standard technique and to evaluate the impact of rotary nickel-titanium instruments on undergraduate teaching. This study was carried out by the fifth year undergraduate students attending peer review sessions as a part of their training program using a questionnaire to assess their satisfaction with these two techniques. The overall results indicated a statistically significant satisfaction of the undergraduate students with the use of the nickel-titanium system (P < 0.001) compared to stainless steel standard technique. Under the conditions of this study, the results showed a positive acceptance and consensus among novice dental students regarding the use of ProTaper rotary files and the need for undergraduate teaching of rotary nickel-titanium systems in Jordan.

Dental students' peer assessment: a prospective pilot study

INTRODUCTION

Peer assessment is increasingly used in health education. The aims of this study were to evaluate the reliability, accuracy, educational impact and student's perceptions of undergraduate pre-clinical and clinical dental students' structured and prospective Peer assessment and peer feedback protocol.

MATERIALS AND METHODS

Two Direct Observation of Procedural Skills (DOPS) forms were modified for use in pre-clinical and clinical peer assessment. Ten year two dental students working in a phantom-heads skills laboratory and 16-year five dental students attending a comprehensive care clinic piloted both peer DOPS forms. After training, pairs of students observed, assessed and provided immediate feedback to each other using their respective peer DOPS forms as frameworks. At the end of the 3-month study period, students anonymously provided their perceptions of the protocol.

RESULTS

Year 2 and year 5 students completed 57 and 104 peer DOPS forms, respectively. The generalizability coefficient was 0.62 for year 2 (six encounters) and 0.67 for year 5 (seven encounters). Both groups were able to differentiate amongst peer-assessed domains and so detect improvement in peers' performance over time. Peer DOPS scores of both groups showed a positive correlation with their mean end-of-year examination marks (r ≥ 0.505, P ≥ 0.051) although this was not statistically significant. There was no difference (P ≥ 0.094) between the end-of-year examination marks of the participating students and the rest of their respective classes. The vast majority of both groups expressed positive perceptions of the piloted protocol.

DISCUSSION

There are no data in the literature on the prospective use of peer assessment in the dental undergraduate setting. In the current study, both pre-clinical and clinical students demonstrated the ability to identify those domains where peers performed better, as well as those which needed improvement. Despite no observable educational impact, most students reported positive perceptions of the peer DOPS protocol.

CONCLUSIONS

The results of this pilot study support the need for and the potential benefit of a larger- and longer-term follow-up study utilising the protocol.

Training and certification of doctors of chiropractic in delivering manual cervical traction forces: Results of a longitudinal observational study

Objective : Doctors of chiropractic (DCs) use manual cervical distraction to treat patients with neck pain. Previous research demonstrates variability in traction forces generated by different DCs. This article reports on a training protocol and monthly certification process using bioengineering technology to standardize cervical traction force delivery among clinicians. Methods : This longitudinal observational study evaluated a training and certification process for DCs who provided force-based manual cervical distraction during a randomized clinical trial. The DCs completed a 7-week initial training that included instructional lectures, observation, and guided practice by a clinical expert, followed by 3 hours of weekly practice sessions delivering the technique to asymptomatic volunteers who served as simulated patients. An instrument-modified table and computer software provided the DCs with real-time audible and visual feedback on the traction forces they generated and graphical displays of the magnitude of traction forces as a function of time immediately after the delivery of the treatment. The DCs completed monthly certifications on traction force delivery throughout the trial. Descriptive accounts of certification attempts are provided. Results : Two DCs achieved certification in traction force delivery over 10 consecutive months. No certification required more than 3 attempts at C5 and occiput contacts for 3 force ranges (0-20 N, 21-50 N, and 51-100 N). Conclusions : This study demonstrates the feasibility of a training protocol and certification process using bioengineering technology for training DCs to deliver manual cervical distraction within specified traction force ranges over a 10-month period.

Assessing palpation thresholds of osteopathic medical students using static models of the lumbar spine

CONTEXT

Although spinal somatic dysfunction diagnosis is taught at all colleges of osteopathic medicine, few objective measures have been used to evaluate student accuracy.

OBJECTIVE

To assess the palpatory skills of osteopathic medical students in evaluating positional asymmetry in the transverse plane using static block transverse process and lumbar spine models.

METHODS

For this observational study, first-year osteopathic medical students completed 3 palpatory assessments using uncovered and covered block transverse process and lumbar spine models to simulate a range of positional asymmetries of the transverse processes. With use of logistic regression, 80%, 90%, and 95% thresholds were defined as the magnitude of asymmetry for which the predicted probability of students correctly determining the direction of asymmetry exceeded a specified amount (.80, .90, or .95).

RESULTS

A total of 346 students completed the assessments. For the uncovered block transverse process model (assessment 1), students correctly identified the direction of asymmetry with .89 probability at 1 mm of asymmetry (80% threshold), .94 probability at 2 mm (90% threshold), and .95 probability at 3 mm (95% threshold). For the covered block transverse process model, students correctly identified the direction of asymmetry with .80 probability at 1 mm (80% threshold), .92 probability at 2 mm (90% threshold), and .98 probability at 3 mm (95% threshold) by the third assessment. For the uncovered lumbar spine model (assessment 2), students correctly identified the direction of asymmetry with .93 probability at 2 mm (80% and 90% thresholds) and .95 probability at 3 mm (95% threshold). For the covered lumbar spine model (assessments 2 and 3), students correctly identified the direction of asymmetry with .87 probability at 4 mm (80% threshold); 90% and 95% thresholds were not reached with the range of asymmetries tested.

CONCLUSION

Most first-year osteopathic medical students were able to discern the direction of positional asymmetry of transverse processes on static models. Depending on the model type, student performance improved (block transverse process models) or declined (lumbar spine models) over time. Future studies should evaluate whether accuracy of palpating lumbar spine models translates to accuracy of palpating human lumbar spines.

First-year oral health and dentistry student perceptions of future professional work

OBJECTIVES

To explore and compare how pre-doctoral dentistry (BDS) and oral health (BOH) students characterise their future professional work at the start and end of their first-year professional programme.

MATERIALS AND METHODS

All BDS and BOH students were given an anonymous survey on the first and last days of their 2009 course. Start and end surveys (ES) were completed by 75% of BDS (51) and 83% of BOH students (33). This paper examines students' responses to two questions asking them to identify a situation characterising their future professional work and a professional difficulty they would likely encounter. Student responses were analysed inductively to identify key themes and confirm each theme's 'weighting' based on frequency of mention.

RESULTS

Students' answers to both questions revealed eight characterisations of future professional work involving the following: restorative tasks, patient-related concerns, patient emotion and behaviour, population-level/public health concerns, disease prevention and monitoring, communication, teamwork and self-management. In ES responses, BDS students emphasised restorative tasks as central to a dentist's work, and in both surveys perceived 'dealing with patients' as a central difficulty. In contrast, BOH students' answers to both questions revealed a patient care emphasis, and in both surveys, BOH students emphasised patient-related concerns as a likely difficulty.

CONCLUSION

Bachelor of Dentistry students characterised their work as primarily interventive, and BOH students, as primarily patient-centred, communicative, and preventive. Whilst BDS students apparently valued restorative capabilities, BOH students valued the ability to ensure patient well-being. Further research will examine students' differing perceptions and how these change over time.