Observation, Assisting, Apprenticeship: Cycles of Visual and Kinesthetic Learning in Dental Education

Clinical observation using virtual reality for dental education on surgical tooth extraction: A comparative study

BACKGROUND

Clinical observation conducted during the 3rd and 4th years of dental school is an important part of dental students' clinical education. However, conventional clinical observation is associated with several problems, including the lack of opportunity for all students to assist during surgery. Virtual reality (VR) technologies and devices can be used to demonstrate clinical processes that dental students need to learn through clinical observation. This study aimed to evaluate the effectiveness of teaching dental students the surgical tooth extraction procedure through clinical observation using VR.

METHODS

We recruited third- and fourth-year dental students and divided them into a VR clinical observation group (VR group) and a conventional clinical observation group (control group). The control group visited an outpatient clinic and observed an oral and maxillofacial specialist perform surgical tooth extraction, whereas the VR group watched a 360° video of surgical tooth extraction using a head-mounted display. After observation, both groups were surveyed regarding their satisfaction with the clinical observation and their understanding of the procedure.

RESULTS

Understanding of the procedure and satisfaction with the observation were significantly higher in the VR group than in the control group (p = 0.001 and p = 0.047, respectively). Compared with conventional clinical observation, VR clinical observation improved learning motivation and medical thinking and judgment skills; however, interaction between professors and students was lacking.

CONCLUSIONS

VR clinical observation using 360° videos might be an effective teaching method for students. However, to allow interaction between professors and students during clinical observations, using it along with conventional clinical observation is necessary.

Professional knowledge acquisition of dental students employed part-time as dental assistants

INTRODUCTION

Whilst admission to dental school in many jurisdictions requires applicants to shadow dentists or undertake work experience at a dental practice, little is known about the impacts on professional learning when dental students work part-time as dental assistants whilst concurrently studying dentistry. This paper explores what, how and from whom dental students who work as dental assistants acquire professional knowledges during employment.

METHODS

This study draws on a qualitative analysis of interviews with sixteen senior dental students who have extra-curricular part-time employment as dental assistants in private dental practices.

RESULTS

Analysis produced four themes that relate to students learning in the professional environment: students learn about the responsibilities, rhythms and routines of practice, as well as patient communication and interactions. Students embedded in the dental team noticed and related to the dispositions and the work of dentistry. Students learned from all members of the dental team including clinical and non-clinical staff (reception, administration, laboratory and sterilisation).

DISCUSSION

Students used their experiences in a practice setting to further their professional education. The ability to "read" a situation and formulate an appropriate response requires the integration of complex and actionable professional knowledges.

CONCLUSION

This research study presents insight into the ways dental students employed as dental assistants are embedded in and learn from the dental team in a critically evaluative manner. Students professionally notice and make sense of complex practice environments whilst undertaking university studies to learn about practice routines, rhythms and responsibilities as well as advancing confidence in relating with patients. This study provides a stimulus for further research about the contribution of workplace experiences to dental education.

Design of a communication skills course in dentistry: Applying active-learning strategies to improve educational outcomes

PURPOSE/OBJECTIVE

Effective communication, between patient and dentist, is a core clinical skill that commands dedicated pedagogy similar to that of developing scientific knowledge and psychomotor skills. This study aimed to describe active-learning strategies in a dental communication skills course, which sits within a broader foundation dental course and evaluate students' educational outcomes.

METHODS

This is a two-phase retrospective, mono-centred study, completed in 2019 at an Australian dental school. Phase I, a case report, describes the Communication Skills for Oral Health (CSOH) course design and its active-learning strategies. Phase II analysed data from the course using Kirkpatrick's evaluation model to objectively measure the impact of the course and provide feedback to education designer. Students' perception (Level 1) was evaluated with an institutional, validated online survey. Descriptive and statistical analysis, included paired tests and Spearman's correlation analyses, used to investigate learning effect (Level 2) and student behaviour change (Level 3). To assess the impact of the CSOH course design (Level 4) the student grades from the course were analysed.

RESULTS

The CSOH course encompasses three major topics: Essentials of Communication Skills, Professional-Patient Relationship and Managing Difficult Situations. Each topic included didactic content complimented with a variety of active-learning strategies to teach and assess students. Positive outcomes were recorded across all Kirkpatrick levels.

CONCLUSIONS

This study suggests an efficient communication skills course design, which may assist in the development of communication skills courses in other dental education institutions.

A conceptual model for clinical psychomotor skill development in an era of simulated and virtual reality

Psychomotor skill development is central to a beginner practitioner's learning pathway. Curriculum constraints around time, access to facilities and resources in health professions education have prompted the growth in alternative approaches to clinical skill development in both simulation and direct patient care. Among these is the increased incorporation of virtual reality (VR) systems with haptic feedback alongside traditional, solid simulations. Given the rapid growth in the adoption of technological affordances to support skill development, it is cogent to pause and examine whether the underpinning concepts regarding psychomotor skill development that have driven much of the approaches to teach clinical skill acquisition in dentistry remain fit-for-purpose. This conceptual paper proposes a new taxonomy for clinical simulation psychomotor skill development in the era of increasing variety of simulation modalities.

Dental students' experience of conscious sedation: A qualitative review of student reflections

INTRODUCTION

The UK General Dental Council (GDC) requires dental graduates to competently identify, manage and refer patients with dental pain and anxiety. This study aimed to explore sedation training experience quantitatively and qualitatively through individual reflective logs.

MATERIALS & METHODS

A single-centred mixed-methods evaluation of teaching, within a UK university conscious sedation department. Fourth-year dental students undertook lectures and supervised clinical sessions following the undergraduate curriculum. Patient attendance patterns, individual experience and group experience were analysed descriptively. Reflective log sheets were analysed by Thematic Framework Analysis.

RESULTS

Seventy-two students participated. Of 153 booked patients, 79 (51.6%) attended of which 74 (48.4%) were treated by undergraduates. The mean performed inhalation sedation and intravenous sedation cases per student were 1 and 0.8, respectively. Three students (4%) assisted only. Group experience varied. Three themes arose from reflections: consolidation of theory and learning; confidence through experience; and responding to challenges.

DISCUSSION

Whilst experience quotas were not met, GDC requirements for increasing students' knowledge and confidence within CS were met. Practical experience enhanced learning. "Hands-on" experience was most valuable for self-reported confidence but learning by proxy also aided development. Students recognised challenges, but not the implications for themselves or their career. Strategies to reduce barriers to experience require research.

CONCLUSION

Whilst variable, all students were provided learning opportunities. Physical experience gave the greatest confidence. Opportunities afforded by the undergraduate curriculum allowed students to learn and develop through consolidation of theory, response to challenges and ultimately the gaining of confidence.

Empathetic, persistent and female: A snapshot of oral health therapy students in Australia and New Zealand

INTRODUCTION

Dental therapists, hygienists and oral health therapists constitute up to a third of the dental workforce in Australia and New Zealand. Personality is often explored in health professions to provide insights into traits that are conducive to workforce retention and to assist in planning and training. This study aimed to investigate the current demographic and personality characteristics of oral health students in Australia and New Zealand.

MATERIALS AND METHODS

Students in years one to three of all eight undergraduate Bachelor of Oral Health programs in Australia and New Zealand were invited to complete an online survey. The survey measured activities prior to entering into oral health, career intentions and included a personality questionnaire, the Temperament and Character Inventory (TCI).

RESULTS

Three quarters of participants (n = 336; 30% response rate; females = 90%) were single, from an urban area and 20-29 years of age. Oral health students overall portrayed high trait levels of Persistence and Cooperativeness. Cluster analysis of TCI traits identified three groups. Groups of students with high Persistence and Cooperativeness tended to be older, were working in non-dental and dental careers prior to their degree and were interested in working in regional areas after graduation.

CONCLUSIONS

Students with high levels of persistence and cooperativeness were interested in working in regional areas after graduation, highlighting the importance of industriousness and persistence in overcoming barriers to practicing in regional areas. Further research is warranted to investigate barriers and enablers in recruitment and retention of males in a primarily female dominated profession.

Student perceptions of exodontia competency assessment in a UK dental school

INTRODUCTION

Modern medical and dental training has migrated from assessing only the quantity of procedures performed to a combined assessment of both competency and quantity. This study explores student perceptions of competency assessment in exodontia at a UK dental school.

MATERIALS AND METHODS

Anonymous questionnaires were distributed to dental students in years three, four and five at the School of Dentistry, Cardiff University (n=149). Responses consisted of dichotomous tick boxes and 5-point Likert scales, with thematic analysis of free-text responses. Discrete variables were analysed using simple descriptive statistics. Recurring themes were identified from the responses.

RESULTS

A total of 129 questionnaires were returned (response rate 87%). Feedback from students indicated that they felt well prepared to undertake the competency assessment, agreeing that year three is the most appropriate year to assess competency (69%; n=86). In 50% of cases (n=65), the clinical supervisor was not present for the duration of the assessment. The undergraduate student body would like further teaching in the use of elevators (89%; n=114).

CONCLUSION

The competency assessment was deemed fit for purpose by the undergraduate student body. Further developments in the areas of clinical supervision and teaching on the use of elevators were considered and recommendations made to the School of Dentistry, Cardiff University. The current oral surgery course incorporates some of the recommendations.

Competence, competency-based education, and undergraduate dental education: a discussion paper

INTRODUCTION

The aim of undergraduate dental education is to provide competent dentists to serve societal needs and improve population oral healthcare. Competency-based education has influenced the development of dental education for decades but this term is problematic. This article explores components of competency-based undergraduate health professional education in order to help the dental profession have a better understanding of the context and purposes of undergraduate dental education.

METHODS

This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on competency-based undergraduate education.

RESULTS AND DISCUSSION

Competence comprises an integration of knowledge, skills and attitudes indicating a capability to perform professional tasks safely and ethically. The process of becoming a competent practitioner is complex. Four characteristics of competency-based education are: curriculum components and content shaped by societal needs; focused on student-centred learning; learning achievement; and limited attention to time-based training and numerical targets. Alongside a competency-based approach, undergraduate dental education can be influenced by institutional features and external factors but these receive little consideration in the literature.

CONCLUSION

Understanding competence, competency-based education, and institutional and external factors will help to improve educational quality, define roles and professional development for the dental educator, and inform further research.

The need for virtual reality simulators in dental education: A review

Virtual reality simulators are becoming an essential part of modern education. The benefits of Virtual reality in dentistry is constantly being assessed as a method or an adjunct to improve fine motor skills, hand-eye coordination in pre-clinical settings and overcome the monetary and intellectual challenges involved with such training. This article, while providing an overview of the virtual reality dental simulators, also looks at the link between virtual reality simulation and current pedagogical knowledge.

A blended learning approach to teaching pre-clinical complete denture prosthodontics

PURPOSE

The current study tested the hypothesis that a blended learning curriculum would develop competency in both pre-clinical laboratory and didactic learning with less direct supervision than in a traditional curriculum, and be positively accepted by both the students and the faculty. With the ability to efficiently deliver course material electronically came the ability to blend the traditional delivery of course material with an asynchronous approach involving online lecture presentations and online laboratory demonstrations.

METHODS

The class was divided into two groups with bench space available to accommodate self-paced learning. All audio-visual and written support materials for both didactic and laboratory procedures were provided to the students at the beginning of the semester on a DVD. These materials included online access through the Blackboard Learning System™.

RESULTS

Students' performance and satisfaction in the course as well as the supporting faculty response to the course were very favourable to the new blended curriculum.

CONCLUSIONS

Making use of the technologically advanced environment, the blended curriculum fostered student-focused learning to develop the didactic and laboratory skills necessary for competency in a pre-clinical setting.

Tacit knowledge in dental clinical teaching

The term 'tacit' is used to describe knowledge that is not necessarily understood in words. We frequently make use of such knowledge without conscious awareness that we are doing so. This article explores two different conceptions of tacit knowledge and considers their implications for the clinical teaching of dentistry. It recognises the communication barrier that clinical dependence on tacit knowledge creates between teacher and student. It identifies the ability to surface tacit clinical knowledge for the student as one of the most significant skills of the clinical teacher. Finally, the article examines the potential for conflict between the evidence-based practice paradigm, with its dependence on codified, explicit knowledge and the notion of clinical practice, which is at least partly experiential and tacit.

The retention of suturing skills in dental undergraduates

BACKGROUND

The ability to place sutures is an essential skill in dentistry. In our institution, the introduction of a video teaching aid and a checklist-based assessment has improved the standardisation of teaching as well as the transparency and objectivity of the assessment of suture skills. The aim of this study was to determine whether this skill once acquired is retained in the short term.

MATERIALS AND METHODS

The same cohort of 67 fourth-year students performed the same assessment at two different time points 2 months apart. The first was a formative assessment and the second was a summative assessment. Feedback was collected on both occasions.

RESULTS

On the first sitting of the assessment, 93% of the students were successful compared with 79% on the second occasion. Student feedback was similar on both occasions with 77% and 75% reporting that they thought it was an easy exam. On the first occasion, 27% thought that it was a stressful examination compared with 43% on the second occasion, which may have affected their performance.

CONCLUSIONS

These findings suggest that regular reinforcement is required to avoid deterioration of suturing skills even in the short term. This might involve exposing the students to surgery earlier in the course and introducing regular formative assessments which the students appear to associate with less stress.