Student and clinical supervisor perceptions of community-based dental educational experiences: A scoping review

PURPOSE

This scoping review was conducted to map the breadth of experiences in community-based dental education (CBDE), as reported by students and clinical supervisors.

METHODS

This scoping review was conducted following the structured framework proposed by Arksey and O'Malley and adhering to PRISMA-SCR guidelines for scoping reviews. Applying specified eligibility criteria, a systematic search of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was followed by data extraction and data synthesis of full-text articles. Research was conducted between June 2022 and September 2022.

RESULTS

Sixteen articles were identified for the final full-text review. Utilizing a narrative thematic review, the following five domains emerged: preparation for autonomous practice, understanding of primary care dentistry, understanding of health disparities and patient needs, clinical confidence, clinical diversity, and skill development, and perspectives on quality of teaching and assessment.

CONCLUSION

Community/outreach dental education effectively supplements traditional dental school-based education from the perspectives of students and community-based clinical supervisors.

Integrating the social determinants of health into graduate medical education training: a scoping review

BACKGROUND

The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs.

METHODS

A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded.

RESULTS

The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum.

CONCLUSION

Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.

Community-based education programmes in the context of dental education: A scoping review

BACKGROUND

Community education programmes are vital tools for teaching skills, such as understanding the larger cultural, economic and social determinants of health and how these factors impact people's health. It is currently unclear whether community education programmes in the field of dentistry deliver adequate value. This review aims to scope, collate and analyse globally published evidence concerning community education programmes in dentistry from inception, to gain an understanding of the intentions for these programmes and establish whether outcomes have shifted over time from the original intentions.

METHODS

Arksey and O'Malley's framework for scoping reviews was employed to guide the reviewers. A systematic search of electronic databases and the reference lists in key papers was conducted.

RESULTS

A systematic search concerning community education in dentistry identified a total of 140 papers for full-text evaluations. After further exclusions, 115 articles were selected for data charting. There was a lack of clarity in the literature concerning programmes' definitions and strategies for achieving intentions. Origins, intentions and motivations of the programmes were identified. The literature largely focused on assessing students' clinical treatment skills, contradicting the programme's original idea and intentions. Only a few studies incorporated patient and community perspectives, and the majority of assessments were self-reported, primarily by students.

CONCLUSIONS

There is broad interest in integrating community education into dental curricula to teach complex concepts, dental public health principles and to ensure professional skills development. We identified issues in the literature around programme definitions, strategies, measurement approaches and programme success requiring additional research.

Dental students' clinical and academic experience during placement in a UK tertiary care children's hospital

INTRODUCTION

There are well-recognized difficulties across UK dental schools in recruiting paediatric patients who are willing to attend, have manageable dental disease, and do not require the behaviour management skills of an experienced dentist. This presents a concern for the skill development of the future workforce. At the School of Dentistry in Liverpool, the challenge to enable students to develop these core skills is supported by attendance at a tertiary care children's hospital. The present study investigates whether attendance of final-year dental students at a children's hospital affects perceptions of their surgical experience, self-reported preparation for working independently as a dentist, and understanding of specialist care.

MATERIALS AND METHODS

A self-administered online survey was distributed to final-year dental students (2020-2021). Quantitative and qualitative data were gathered using mixed item formats for descriptive analysis. Questions addressed themes including experience of primary tooth exodontia, understanding of general anaesthetic dental care and multidisciplinary patient management.

RESULTS

The response rate was 90% (n = 66). Attendance was beneficial to student learning and experience; responders reported increased surgical experience, self-confidence and understanding of multidisciplinary care. Students developed insight into future career pathways.

CONCLUSION

The present study supports the use of external clinic rotations, known as outreach placements, for dental student training. The findings support existing literature demonstrating the value of outreach placements in providing an experience not available in dental school environments. Dental students' perceptions of their surgical experience, knowledge of specialist care, and preparedness for independent practice may be enhanced by attendance to outreach placements.

Perception of recently graduated Dutch dentists of their education

INTRODUCTION

The curriculum of the three dental schools in the Netherlands consists of a three-year bachelor's and three-year master's course. The education programmes focus inter alia on clinical dental reasoning, thinking and acting scientifically, general oral healthcare activities, and communication and (inter)professional cooperation. This study examined how recently graduated dentists, in the light of their work experience, evaluate their education in retrospect.

MATERIALS AND METHODS

All 1074 dentists who graduated between 2012 and mid-2017 were invited by e-mail to answer a web survey. Of those, 314 (29%) took part in the study.

RESULTS

The majority of dentists were positive about their knowledge of general and clinical oral healthcare fields when they graduated (70% and 68%, respectively). Fewer dentists were satisfied with their skills in terms of some specific procedures (50%) and clinical professional areas (33%). By far, the majority (85%) were satisfied with the educational skills of their teachers. The majority (70%) felt that their education fitted in well with their professional practice. Nevertheless, 60% thought a year's trainee work experience would be a good idea. The overall evaluation of dentists who have their own practices was less positive than those who do not.

CONCLUSION

Knowledge and skills relating to managing a practice were not sufficiently addressed in the programme. The introduction of a practical internship would be desirable, preferably during the education. But when they look back, the majority of recently graduated dentists in the Netherlands are generally positive about the education they received.

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Dental students' experience and perceived confidence level in different restorative procedures

PURPOSE

Graduating confident students who are able to flourish and develop in their future careers is an importance outcome of the dental education. This study aims to evaluate self-perceived level of confidence of fifth-year dental students in different restorative-related tasks and the relationship between their clinical training and its corresponding confidence.

METHODS

Fifth-year graduate dental students (n = 202) were asked to fill a questionnaire that rated their level of confidence in different clinical restorative dentistry tasks. Additionally, they were asked about the number of times they performed tasks prior to attempting the equivalent competency and in which sub-specialty they felt the most confident.

RESULTS

Completed responses were received from 120 students giving a response rate of 59%. Students felt the most prepared and confident in direct restorations and simple endodontic treatment, and they seemed less confident in indirect restorations and complex endodontic treatment. Regarding the steps of indirect restorations, students expressed least confidence in crown preparation compared to impression making and try-in procedures (P < .05). Students rated their confidence highest in operative dentistry, followed by endodontics and lastly fixed prosthodontics.

CONCLUSION

The results highlight the areas in which students exhibit the least confidence. Enhancement of student clinical skills and directed exposure is necessary to raise the level of perceived confidence which will reflect positively on their current and future professional performance.

Service-Learning in undergraduate dental education: Professional competence for clinical decision-making

OBJECTIVES

The objective of the present study was to evaluate a Service-Learning activity in a dental education programme and the clinical decision-making in the development of professional competence of undergraduate dental students.

METHODS

The study consisted of a single holistic case study that involved quantitative and qualitative analyses. A total of 246 last-semester students from a School of Dentistry in southern Brazil, between the years of 2013 and 2016, answered an anonymous online questionnaire with open- and closed-ended questions (5-point Likert scale). Two thematic axes were analysed: structural and pedagogical evaluation of the internship experience and development of professional competences (theory of Ergology). The SPSS program (16.0) was used to obtain means and standard deviations for a descriptive analysis of the data. Content analysis was performed for the qualitative data.

RESULTS

The scores ranged from neutral to positive concerning pedagogical dynamics (mean scores between 3.08 and 3.82). The preceptors were evaluated with the best mean score (3.82). All the components used to assess professional competences obtained positive scores with the exception of teamwork (2.95). Adaptations to the clinical protocols learned in class were made by 44% of the students.

CONCLUSIONS

The data showed that undergraduate dental students in the Service-Learning programme acquire competencies for clinical decision-making under unusual reality conditions. Adaptation of protocols was not related to less or greater knowledge of the protocols, which would be a negative condition, but to the students' ability to formulate connections between scientific knowledge and the clinical practice.

Leadership in dental education

Dental school education continues to evolve at a significant pace. The challenge for those in leadership positions in dental education is to deliver a curriculum which is contemporary, evidence-based, and at the same time meeting the expectations of regulators and the established dental workforce - the latter being professional colleagues, including employers of future graduates. An important change in recent years is the acceptance that dental education itself is no longer a 'start-stop process', beginning at entry to dental school and concluding at graduation. Rather, dental education should be viewed as a continuous and life-long continuum. Perhaps one of the greatest attributes we can develop in our students is the desire and ability to seek to update, refresh and develop their knowledge and skills in the ever-advancing world of dental practice.

Self-perceived preparedness of final year dental students in a developing country-A multi-institution study

AIMS

To evaluate the self-perceived preparedness to practice of final year dental undergraduate students in three dental institutions.

METHODS

Dental undergraduate students in their final year from three dental institutions in Pakistan were invited to participate in an online study to assess self-perceived preparedness using a validated preparedness assessment scale.

RESULTS

In total, 134 students responded to the questionnaire yielding a response rate of 72%. Students felt adequately prepared to carry out several clinical procedures including clinical assessment, fillings, tooth extractions and communication skills. However, perceived preparedness was low in the students' ability to undertake intraoral radiographs, treatment planning, crowns, multirooted endodontics, research skills, referral for suspected oral cancer and raising concerns regarding inappropriate behaviour of colleagues.

CONCLUSIONS

This is the first study which investigates the self-perceived preparedness of final year undergraduate dental students in Pakistan. The results show that the self-perceived preparedness of final year students was satisfactory for a range of clinical and affective skills. However, several areas of weaknesses were identified which underscore the need for additional training and consolidation.

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.

The undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff

Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures.Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness.Results 71% (N = 51) responded of which 55% (N = 28) were female. Over half reported being 'anxious that the supervisor was not helping enough' (57%) and 'relying heavily on supervisor for help' (53%). Eighty percent 'felt unprepared for the clinical work presented' and gender differences were most notable here (male: 65% N = 33; females: 93% N = 47). Mean confidence scores were calculated for each clinical procedure (1 = lowest; 5 = highest). Confidence was highest in performing 'simple scale' and 'fissure sealant' (mean-score = 5). Lowest scores were reported for 'surgical extractions involving a flap (mean-score = 2.28)', 'simple surgical procedures' (mean-score = 2.58) and the 'design/fit/adjustment of orthodontic appliances' (mean-score = 2.88).Conclusions As expected complex procedures that were least practised scored the lowest in overall mean confidence. Gender differences were noted in self-reported confidence for carrying out treatment unsupervised and feeling unprepared for clinical work.

Undergraduate students' experiences of outreach placements in dental secondary care settings

INTRODUCTION

Outreach teaching is delivered as part of the undergraduate curricula of many dental schools. Evaluations of outreach in primary care settings have found learning opportunities beyond those available in the dental school setting, but less is known about secondary care placements. The aim of this evaluation was to assess dental students' experiences of an undergraduate outreach placement in secondary care.

MATERIALS AND METHODS

Questionnaire survey based on a single cohort of final-year undergraduate dental students at Cardiff University who had completed a 1-week outreach secondment to a District General Hospital.

RESULTS

Fifty-five of the 57 eligible students completed the questionnaire. Outreach placements in secondary care were experienced to provide positive additional educational benefit and were considered to be worthwhile by many (but not all) students. Clinical opportunities and staff teaching varied by site.

DISCUSSION

In the current programme, the variability of student experience during secondments to secondary care means that some students report more benefit than others. However, even apparently negative experiences, such as cancelled operating lists, can contribute to the overall outcome in that they accurately reflect the reality of hospital practice.

CONCLUSION

Careful management of secondary care undergraduate secondments is needed to ensure worthwhile learning experiences.

Evaluation of a community-based clinical teaching programme by current and former student dental therapists and dental hygienists: a pilot investigation

AIM

There has been considerable expansion in the involvement of community-based clinical teaching programmes (sometimes termed 'outreach teaching') in UK and other international dental schools. While there has been much interest in the role of this educational methodology in the professional and educational development of student dentists, there has been little, if no, consideration of this form of teaching in relation to dental care professional (DCP) students. The aim of this pilot investigation was to report the feedback and evaluation of current and former student dental therapists and dental hygienists on their experience on the St David's community-based clinical teaching programme at Cardiff.

METHODS

In Autumn 2009, a questionnaire was distributed by hand to the current second year student dental therapist and dental hygiene class at Cardiff (n = 18) and by post to the dental therapist and dental hygiene classes of 2004 (n = 16) and 2007 (n = 17). The questionnaire included both 'open' and 'closed' questions.

RESULTS

Thirty responses were returned (response rate = 59%; 2004 (n = 5, 31%), 2007 (n = 9, 53%), current class (n = 16, 89%)). Seventy percent of respondents (n = 21) reported that they found the community-based clinical teaching programme to be a pleasant working environment and close to subsequent independent practice. Seventy-seven percent (n = 23) reported that their confidence performing nonsurgical periodontal treatment had increased while at the programme. One respondent commented that the programme was '...an invaluable and insightful introduction to what it would be like working in practice. Without being given the experience, it would have been a big shock to the system when I started working in practice...'

CONCLUSION

This pilot investigation has revealed that current and former dental therapist and dental hygiene students are enthusiastic in their support for the inclusion of community-based clinical teaching programmes in their educational and professional development. Most former and current dental therapist and dental hygiene students noted the positive effects of this form of training on their subsequent clinical careers.

Perception and valuations of community-based education and service by alumni at Makerere University College of Health Sciences

Background

Training of health professionals can be deliberately structured to enhance rural recruitment by exposing the trainees to the realities of rural life and practice through Community-Based Education and Service (COBE) programs. Few studies have surveyed the alumni of these programs to establish their post-university views and whether the positive impact of COBE programs endures into the post-university life. This study surveyed the alumni of COBE at Makerere to obtain their perceptions of the management and administration of COBE and whether COBE had helped develop their confidence as health workers, competence in primary health care and willingness and ability to work in rural communities.

Objectives

• To assess the efficiency of the management and administration of COBES.

• To obtain the views of the impact of COBES on its alumni.

Methods

A mixed qualitative and quantitative study was conducted using focus group discussions (FGD) and a telephone administered questionnaire. From a total of 300 COBES alumni 150 were contacted. Twenty four Alumni (13 females and 11 males) were purposefully selected by discipline, gender and place of work, and invited for the focus group discussion. The discussions were transcribed and analyzed using a manifest content analysis table. The thematic issues from the FGDs were used to develop a structured questionnaire which was administered by telephone by the authors. The data were entered into Microsoft excel template and exported to Stata for analysis. The findings of the telephone survey were used to cross-match the views expressed during the focus group discussions.

Results

The alumni almost unanimously agree that the initial three years of COBES were very successful in terms of administration and coordination. COBES was credited for contributing to development of confidence as health workers, team work, communication skills, competence in primary health care and willingness to work in rural areas. The COBES alumni also identified various challenges associated with administration and coordination of COBES at Makerere.

Conclusions

This study has established that the positive impact of COBES endures with the alumni of the program. Health planners should take advantage of the impact of COBES and provide it with more support.