A Systematic Review of the Use of Self-Assessment in Preclinical and Clinical Dental Education

A service-learning framework to address accreditation standards: Self-Assessment, communication skills, health literacy, and cultural competence

OBJECTIVES

Pre-doctoral dental programs must provide opportunities for students to become proficient in self-assessment, communication skills, health literacy, and cultural competence, essential for independent unsupervised practice. This study aimed to assess how student learning through a classroom education service-learning program addresses the Commission on Dental Accreditation (CODA) standards 2-11 and 2-17; specifically through the examination of self-assessment, communication skills, health literacy, and cultural competence.

METHODS

This 2022 retrospective mixed methods cohort study examined unstructured faculty comments on drafted lesson plans and structured evaluations of classroom education service-learning rehearsal sessions. A random sample of faculty comments from three academic years, 2018, 2019, and 2020, were deidentified and analyzed by five researchers for emerging themes using NVivo. Quantitative data from rehearsal presentations were analyzed with descriptive statistics to assess the concordance of self and faculty feedback on specific evaluation criteria.

RESULTS

Six major themes from faculty lesson plan feedback emerged: knowledge, professionalism, communication, presentation skills, cultural competence, and program logistics. Concordance between faculty feedback and student self-assessment ranged from 83% to 92.4% across all evaluation criteria over the 3 years: spoke clearly and confidently at the right pace, provided accurate dental terminology and facts, used grade-appropriate language, provided clear instructions to follow, appeared enthusiastic throughout the rehearsal presentation, and designed a well thought out lesson plan that will engage children for the entire presentation.

CONCLUSION

Findings support the classroom education service-learning program as a framework to provide opportunities for student self-assessment and feedback on communication skills, health literacy, and cultural competence aligned with CODA standards 2-11 and 2-17.

Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course

BACKGROUND

Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course.

METHODS

Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3.

RESULTS

The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001).

CONCLUSION

SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

Assessing competency in exodontia: A UK perspective

INTRODUCTION

Assessment ensures that undergraduate students and postgraduate trainees are providing optimal patient care. Numerous assessment methods are currently being used within the United Kingdom. Therefore, the purpose of this review was to provide an overview of the methods used to assess competency in exodontia and compare methods against criteria defined for good assessment.

MATERIALS AND METHODS

A systematic narrative review was carried out. Databases were electronically searched for published studies assessing the competence of undergraduate students and postgraduate trainees in exodontia up to October 2023.The validity, reproducibility, equivalence, feasibility, educational impact, catalytic effect and acceptability of each assessment method was considered.

RESULTS

In this review, 591 undergraduate students (n = 529) and postgraduate dental trainees (n = 62) had their competence in exodontia assessed. Undergraduate students were assessed on simple exodontia with forceps and elevators, whereas postgraduate trainees were assessed on the surgical removal of mandibular third molars. Only one study took place in a simulated dental environment, the remaining (n = 7) took place in a clinical environment. A range of formative and summative assessment methods were identified including structured clinical objective tests (SCOT), self-assessment, peer assessment and logbooks. Common marking criteria such as global rating and checklist scales were also highlighted.

CONCLUSION

This review highlights the lack of evidence to support one form of assessment and the lack of consensus on assessment within the United Kingdom. Further research related to this topic, alongside the opinion of trainees and trainers is required to improve assessments. This will maximise learning opportunities for trainees and translate to better patient care.

Dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on preclinical skills

INTRODUCTION

Assessing exemplars as a formative activity is thought to promote students' learning. This study aimed to investigate dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on students' preclinical skills.

MATERIALS AND METHODS

In a non-randomised controlled crossover trial with two intervention arms, 92 undergraduates in their first preclinical course self-enrolled in into the intervention group (A1-INT) or control group (B1-CT). The intervention group assessed photographic images of composite restorations before restoring an ivorine premolar with composite while the control group restored the same tooth without assessing the photographic exemplars. Intervention and control groups were swapped 3 days later in a second iteration (B2-INT, A2-CT). Data were analysed in SPSS® version 27 using nonparametric tests.

RESULTS

Students who did not complete all activities in the study were excluded. Therefore, 57 out of the 92 student participants were included in the study analysis. No significant differences were observed between intervention and control groups' ability to assess quality of photographic exemplars or restoring a tooth in both iterations.

CONCLUSION

Students were able to identify the quality of composite restorations in photographic exemplars. It appears that assessing photographic exemplars did not have an immediate impact on students' ability to restore a tooth with composite.

Evaluating dental student self-assessment across preclinical anatomy waxing and operative exercises

PURPOSE/OBJECTIVE

A career in healthcare is built on the foundations of continuous self-reflection and self-assessment. Previous studies have solely compared student self-assessment to faculty grades in a single discipline. The objective of this study was to investigate whether associations of a student's self-assessment skills exist across multiple disciplines in the predoctoral setting.

METHODS

Sixty-five students from two class years at the Harvard School of Dental Medicine completed preclinical competency exams in dental anatomy waxing and operative dentistry. The difference between the student's self-assessment score and average faculty grade for each exercise was calculated as the student‒faculty (S-F) gap, which served as a proxy to determine how students evaluate their work. Regression analysis was performed to assess associations between wax-up and preclinical operative S-F gaps.

RESULTS

Mean S-F gaps for waxing and preclinical operative procedures were positive (5.7 ± 6.1 and 7.6 ± 6.7, respectively). Additionally, students in the lower quartile tended to overestimate performance to a greater degree than their peers in the upper quartile. Furthermore, the waxing S-F gaps were positively associated with S-F gaps of each operative procedure, particularly with the combined operative exercise S-F gaps, where a statistically significant association was seen (coefficient = 0.28; p = 0.04).

CONCLUSION(S)

Previously, we identified a negative correlation between students' self-assessment skills (S-F gaps) and their preclinical performance. In this study, we further demonstrated an association of S-F gaps in two fundamental exercises: wax-up and operative dentistry. This underscores the roles of S-F gaps as possible indicators of students' preclinical and clinical performance, and it holds potential to become a widely standardized and applicable calculation that may help evaluate the effectiveness of the dental curricula and optimize student learning.

Evaluation of student readiness for clinical dental education at the end of preclinical education

OBJECTIVES

This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE.

METHODS

The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1 = 134) and B (class of 2025; n2 = 129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores.

RESULTS

Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p = 0.035) and the practical examination score (p = 0.03) while not associated with gender (p = 0.53) and the written examination score (p = 0.11).

CONCLUSION

Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

Can self-assessment ability predict student performance in a dental anatomy course?

INTRODUCTION

The development of early self-assessment skills and determining its correlation with academic performance could provide evidence to alter dental curricula. The aim of this retrospective study was to examine the relationships between students' early self-assessment ability in waxing and three different evaluation methods (waxing assessment, written examinations, and tooth identification examination) in a dental anatomy course.

MATERIALS AND METHODS

The dental anatomy scores during the academic years of 2018-2019 and 2019-2020 from two cohorts of second-year pre-doctoral dental students at the Harvard School of Dental Medicine were analyzed. Regression analyses were completed to assess the relationship between all evaluation methods.

RESULTS

There was a statistically significant correlation between self-assessment ability and the waxing assessment but no significant correlation between self-assessment ability and the other evaluation methods.

CONCLUSION

Our results showed that the introduction of self-assessments in dental anatomy waxing was correlated with successful waxing skills. Furthermore, a relevant finding is that students who received higher classifications were also capable of doing better self-assessments. These findings provide evidence that impacts dental curricula.

Self-assessment skills of undergraduate dental students in the preclinical course of complete removable prosthodontics at Tehran University of Medical Sciences

INTRODUCTION

This study evaluated the self-assessment skills of third-year dental students regarding their performance in complete removable prosthodontics (CRP) preclinical course.

METHODS AND MATERIALS

This cross-sectional study was conducted on all third-year dental students attending the International Dental College of Tehran University of Medical Sciences. The students were requested to self-assess their performance in primary impression making, custom tray fabrication, border moulding, final impression making, master cast fabrication, record-base fabrication and tooth arrangement in CRP preclinical course. The performance of dental students in each step was scored by themselves and their mentors. Data were analysed by the Mann-Whitney U, Pearson's correlation and t-tests (α = 0.05).

RESULTS

Totally 25 male (55.6%) and 20 female (44.4%) dental students were evaluated. Significant differences were noted between male and female dental students in self-assessment scores regarding adequate extension of the custom tray (p = .027), the correct position of tray handle (p = .020), visibility of vestibular width and depth on the cast (p = .011), the coincidence of upper and lower midlines (p = .005) and correct orientation of maxillary and mandibular planes in the articulator (p = .036). The mean self-assessment score of female students was significantly higher than that of male students (p = .01). The scores given by the mentors were not significantly different for male and female students (p = .975). The difference between the self-assessment score of students and the mentor score was not significant (p = .067) either in males or in females (p > .05).

CONCLUSION

Undergraduate dental students favourably self-assessed their performance in all steps of the preclinical course of CRP, comparable with their mentor assessment.

Scaffolding Self-Regulated Learning in Operative Dentistry Through Self-Assessment Training

OBJECTIVES

This study aimed to investigate how effective self-assessment training is in improving the self-regulated learning (SRL) ability of operative dentistry students. The secondary aim was to explore students' attitudes towards self-assessment in clinical settings.

INTRODUCTION

Self-assessment has been the focus of dental education research for decades and has been claimed to be cornerstone in the SRL process.

METHODS

This is quasi-experimental study conducted at Damascus University Faculty of Dental Medicine, Syria. A modified direct observation of procedural skills (DOPS) assessment protocol with a self-assessment component was applied to a convenience sample of students across five clinical encounters in 2022. Data were collected during clinical training on the DOPS form and at the end of the experiment using a structured questionnaire with a single open-ended question. The qualitative part of the study followed a deductive theory-informed content analysis approach, relying on Zimmerman SRL theory.

RESULTS

A total number of 32 students participated in the study, eight of whom were male. During the experiment assessment, participants showed overwhelming positive attitudes towards the utility of self-assessment (m ≥ 3.5; max:4) and the overall assessment method (3.3 ≥ m ≥ 3.5; max:4). Cronbach's alpha for the post-experiment questionnaire was 0.888. A total of 84.4% of the participants strongly agreed that self-assessment is useful in clinical training. Data collected (qualitative and quantitative) from participants revealed the positive effects of self-assessment on all three phases of SRL, especially the reflection phase.

CONCLUSION

Self-assessment practice and training showed positive results in terms of improving SRL and performance in a clinical context; SRL appeared to be affected by self-assessment in all phases (forethought, performance, and reflection). Participants' perceptions of self-assessment were generally very positive. These findings imply the potential benefits of applying self-assessment training interventions to foster the SRL ability of learners within the clinical context.

Study of the use in autonomy of intraoral scanning systems to optimise dental students' performances in fixed prosthodontics practical learning in second year

AIM

The purpose of this study was to evaluate if the use of intraoral scanner analysis could help students to optimise their performance and their self-assessment abilities in prosthetic preparation without the teacher's assistance in the preclinical course.

MATERIALS AND METHODS

Ninety-five second-year dental students were randomly divided into three groups: Control group (C), CeRec group (CR) and PrepCheck group (PC). Group C only use silicon keys to control the preparation thickness. The students in Group CR analysed their work with Cerec™ software. The Group PC use a pedagogic software (PrepCheck™) which allowed comparison with the "master" preparation. They used control tools preparations for three consecutive training sessions. Then a final assessment session without control tool to evaluate their performance was organised. All preparations were objectively evaluated thanks to stl. analysis software (Geomagic® Control X). Each preparation was compared with the master preparation by defining tolerance ranges. An objective overall score out of 20 was assigned to each preparation according to their degree of correspondence. In addition, a questionnaire was performed to analyse the students' perceptions regarding the use of intraoral camera.

RESULTS

During the assessment session, no significant difference was revealed between the different groups with respect to the students' performance. The comparative analysis between the self-assessment scores and the objective scores using Geomagic® software showed that digital control tools did not help the student to improve their self-assessment abilities without the teacher's assistance.

CONCLUSIONS

The intraoral cameras and specific pedagogic software in autonomy could not improve students' performance for teeth preparation and self-assessment abilities in second year. These digital tools facilitate objective feedback on preparation defects, but constructive criticism needs human reflection. The teacher's opinions and advice remain essential to develop their students' performance and self-assessment skills. The use of digital tools must be integrated in dentistry course to develop the interpret of the results and optimise feedback.

Student Self-assessment: Reflecting on Physician Assistant Educator's Perceptions and Current Practices in Physician Assistant Training

PURPOSE

The purpose of this study was to examine relationships between physician assistant (PA) educators' perspectives on students' self-assessment (SA) accuracy and students' use of SA education practices and types of abilities assessed.

METHODS

Using correlation analysis and a novel, online survey, PA educators were asked about their perceptions of students' SA accuracy in relation to SA educational activities and assessed abilities.

RESULTS

A total of 308 educators responded. Most respondents used at least one type of SA activity, with feedback and practice being the most common types and comparative assessment, the least common type. Most respondents indicated that students self-assess noncognitive abilities more than cognitive abilities, with SA of communication skills occurring most. Spearman's correlation coefficient was used for correlation analysis with a significant, small correlation noted between the frequency of activities and educators' overall perceptions of students' SA accuracy (r = 0.15, P = .02) and SA accuracy of cognitive abilities (r = 0.17, P = .02). Educators' perceptions of students' SA accuracy were positively skewed, regardless of student training level (ie, didactic and clinical training phases). A mild predictive relationship exists between overall perception of students' SA accuracy and how frequently educators use SA activities (r = 0.29, P = .05).

CONCLUSION

Although respondents indicated they used practice and feedback activities, providing instruction on how to self-assess and using comparative evaluations to calibrate SAs will improve accuracy. Further research is needed to understand why educators perceive PA students' SA abilities as more accurate, regardless of training level.

Dental school quality assessment: Effect of student calibration on the outcomes of fixed prosthodontic cases

BACKGROUND

Quality assurance (QA) of predoctoral dental student laboratory work is an essential part of the learning process that involves evaluating the student's ability, providing constructive feedback, helping develop the students' ability to self-assess, and promoting collegiality and communication among students, faculty, and laboratories. Faculty calibration, while often difficult to coordinate, is also necessary to providing consistent student feedback.

AIM

The purpose of this study was to evaluate whether periodic calibration exercises with the fourth-year dental students and faculty impacted the number of student cases rejected during Quality Assurance evaluation of fixed prosthodontic cases submitted to The Dental College of Georgia laboratory tracking.

CONCLUSION

Findings from this study provided evidence that ongoing calibration did result in a reduced number of incoming QA rejections in all periods reviewed except for one in which there was significant turnover among department faculty affecting QA calibration for that time period.

Evaluation of a workplace assessment method designed to improve self-assessment in operative dentistry: a quasi-experiment

BACKGROUND

Dental education has placed continued emphasis on self-regulated learning (SRL) and its subprocess, self-assessment. This study set out to evaluate the effectiveness of a novel workplace assessment method in developing trainees' self-assessment of operative procedures.

METHODS

A Direct Observation of Procedural Skills (DOPS) form was modified for the use and measurement of self-assessment. Participants were trained on how to conduct self-assessment using the designed assessment form and its grading rubric. Feedback and feedforward sessions were given to address self-assessment and performance issues. A P-value less than 0.10 was considered significant and the confidence level was set at 90%.

RESULTS

Thirty-two Year 5 dental students with an age mean of 22.45 (SD = 0.8) completed five self DOPS encounters during the clinical operative dentistry module in 2022. The aggregated total deviation (absolute difference) between self-assessment and teacher assessment decreased consistently in the five assessment encounters with a significant mean difference and a medium effect size (P = 0.064, partial Eta squared = 0.069). Participants' self-assessment accuracy differed from one skill to another and their ability to identify areas of improvement as perceived by teachers improved significantly (P = 0.011, partial Eta squared = 0.099). Participants' attitudes towards the assessment method were positive.

CONCLUSIONS

The findings suggest that the self DOPS method was effective in developing participants' ability to self-assess. Future research should explore the effectiveness of this assessment method in a wider range of clinical procedures.

First evaluation of an app to optimize and organize the processes and assessments in dental clinical courses

BACKGROUND

Digital teaching and learning tools, such as computer/mobile apps, are becoming an important factor in modern university education. The objective of our study was to introduce, analyze, and assess an organization and dual assessment app for clinical courses in dental medicine.

METHODS

This was a survey-based study of dental students from the clinical study phase (4th/5th year; 8th/10th semester) of a department of prosthetic dentistry at a German university hospital about the benefits of a novel web-based and mobile app for organization and dual assessment of dental clinical courses. A total of eight questions were answered in an anonymous online survey. Data were analyzed using the Kolmogorov-Smirnov test, followed by an exploratory data analysis (α < 0.05).

RESULTS

The app was given an average grade of 2.4, whereby 56.9% of the respondents rated the app with a grade of 2 (2 = good). In all, 94.6% of the study participants had not experienced any technical problems when using the app. Concerning the assessment, teaching doctor assessment (51.5 [IQR: 44.0]) was rated significantly better (p = 0.002) than self-assessment (39.5 [IQR: 32.8]).

CONCLUSIONS

This investigation evaluated a newly introduced app to optimize dental clinical course workflows and assessment. The organizational feature was rated as good, while the daily self- and teaching doctor assessments were evaluated as less important. The results outline how the use of app technologies can provide an infrastructure for managing organization and daily assessments in dental education.

Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study

Background

With the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems.

Objective

This study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost.

Methods

The OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams.

Results

The OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students’ practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students’ skill level and the common sense transformation of educators in the virtual simulation technology environment.

Conclusions

The development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified.

Self-assessment and peer-assessment of the psychomotor skills in preclinical prosthodontics: A prospective study

INTRODUCTION

Students' self-assessment and peer assessments are essential to understand the rubrics criteria and improve their psychomotor skills. The purpose of this study was to assess the impact of self-assessment score (SAS), peer-assessment score (PAS) and teacher assessment score (TAS) on the final scores of the psychomotor skills of dental students in a preclinical fixed prosthodontics course.

MATERIALS AND METHODS

A prospective study included D2 students in a preclinical fixed prosthodontics course for two consecutive academic years from September 2017 to May 2019. Students' performance of various procedures over 14 sessions was assessed by SAS, PAS and TAS. Repeated-measures ANOVA was used to assess differences between the three scores and control charts showed their change over time. Multivariable linear regression was used to assess the association between two outcome variables: TAS and the total preclinical score and the explanatory variables: SAS, PAS, TAS, gender and GPA. The significance level was set at 5%.

RESULTS

SAS had a significantly higher mean (80.21) than TAS (79.32) and PAS (78.58). SAS reached higher levels earlier than TAS and PAS. PAS had a stronger association with TAS than SAS (partial eta squared, η2 = 0.17 and 0.13), whereas SAS significantly predicted total preclinical score (p < .0001).

CONCLUSIONS

PAS helped develop the skills of dental students during training, while SAS had an impact on their total preclinical score. Different student-centred activities are needed to support students' preclinical training in fixed prosthodontics courses.

The evaluation of an evidence-based model of feedback implemented on an undergraduate dental clinical learning environment

OBJECTIVES

Dental graduates must graduate with high levels of clinical skills. Education in the clinical environment needs to be more than didactic supervision of practice by clinical teachers. Appropriate feedback in this context, is therefore critical to the development of student competence and confidence. This study was conducted to enhance and develop the assessment and feedback processes during clinical sessions in a Dental University Hospital in an effort to contribute to the development of students' self-assessment skills, reflective ability and clinical competence.

METHODS

A new evidence-based model of feedback was introduced between clinical teachers and dental students. The implementation of this model was evaluated by students through a survey and focus groups. Descriptive and inferential statistics were applied to the quantitative data, while thematic analysis applied to the qualitative data.

RESULTS

Findings from the survey indicated that students perceived the new model of feedback to be a positive addition to their learning experiences. The majority indicated a preference to continue using it. Quantitative analysis also demonstrated that students placed a high value on the feedback they received through the new model and associated it with improved individual performance. Five themes generated from the qualitative analysis echoed the perception that the model of feedback enhanced learning opportunities, especially when it was focused on individual performance and incorporated peer feedback. Students' preferences in relation to feedback processes were also gleamed from quantitative and qualitative analyses, that is, provision of positive and constructive feedback, both in dialogue and in written formats, delivered during and after each clinical session and addressing their individual competency learning goals for the future. Some challenges to be addressed were also identified (e.g., time constraints, inter-personal issues, and non-conducive environments).

CONCLUSIONS

Feedback is central to learning and remains a complex and challenging area. By adopting effective and evidence-based feedback practices through the introduction of a feedback model, students can be supported in regulating their own learning in the clinical learning environment.

Comparison between students' self-evaluation and faculty members' evaluation in a clinical endodontic course at King Saud University

INTRODUCTION

The objective of this study was to compare faculty member evaluations with student self-evaluations in a clinical endodontic course in the dental school at King Saud University and to evaluate the reliability of the students' self-assessment scores after using a rubric with well-defined criteria.

MATERIALS AND METHODS

Evaluated and self-evaluated endodontic cases that were clinically treated by the fourth-year undergraduate dental students at the College of Dentistry, Girls University Campus, at King Saud University over 2 years (2017-2018) were included. Cases included anterior teeth, premolars and molars. The evaluation form was divided into six sections with well-defined criteria to cover all aspects of nonsurgical root canal treatment with a maximum grade of 10 points can be scored for each student per case. The students evaluated themselves for each section and then were evaluated by two faculty members. Student and faculty assessment agreement and the reliability of the students' self-assessment scores were measured. A p ≤ .05 was considered significant.

RESULTS

A total of 363 cases were included: 26.7% anterior teeth, 38.84% premolars and 34.43% molars. The students evaluated themselves with higher grades compared to the evaluators' grading in all steps and in the overall grading in all teeth types. The students' self-assessment scores showed good and moderate reliability in all steps and in the overall grading.

CONCLUSION

The students tend to overrate their performance, and their assessments have moderate to good reliability, which reflects the reliability of the rubric used as an accurate measurement tool that helps the evaluator and the student objectively assess their performance.

American Board of Orthodontics (ABO) Discrepancy Index and peer assessment rating (PAR) index with models versus photographs

BACKGROUND

The objectives of this study were to determine whether rating systems, such as the Peer Assessment Rating (PAR) and the American Board of Orthodontics Objective Grading System (ABO-OGS) can be applied to intraoral photographs.

METHODS

Models and photographs of 50 cases were graded by 4 raters, and a 20% repeat of randomized cases was completed 2 weeks later. Intraclass correlation coefficients (ICCs) were used to assess inter- and intra-rater agreements, as well as the level of agreement between the ratings on models and photographs.

RESULTS

The intra- and inter-rater agreements were considered good to excellent. The paired mean difference (model minus photo) for the PAR index and the ABO Discrepancy Index as a total was 2.405 and 1.156, respectively. Overjet was the subdomain that produced the highest differences between photos and models. The ABO- Discrepancy Index method on photographs was more reliable than the PAR index when grading pre-treatment and more-severe malocclusions.

CONCLUSIONS

Both methods can be used, but the choice depends on the purpose of the evaluation, and on consideration of the weaknesses and strengths of each relating to its use on photographs.

The impact of COVID-19 pandemic on student performance and self-evaluation in preclinical operative dentistry

INTRODUCTION

During the COVID-19 pandemic, dental schools were required to reformat their curricula to accommodate regulations mandated to protect the health of students and faculty. For students enrolled in the Operative Dentistry preclinical courses at the Harvard School of Dental Medicine (HSDM), this modified curriculum included frontloading the course with lectures delivered remotely, followed by in-person laboratory exercises of learned concepts. The aim of this article was to determine the impact that the modifications had on student performance and student self-evaluation capabilities.

MATERIALS AND METHODS

Thirty-eight students were introduced to this restructured course. Their performance in a final multiple-choice (MC) examination, four preclinical laboratory competency assessments (class II amalgam preparation and restoration, class III composite preparation and restoration) and their self-assessment of these preclinical competency assessments were then compared with the pre-COVID pandemic (P-CP) classes from years 2014 to 2019 (n = 216 students). Linear regressions were performed to determine differences in mean faculty scores, self-assessment scores, student-faculty score gaps (S-F gaps) and absolute S-F gaps seen between the class impacted by the pandemic and the P-CP classes.

RESULTS

The results demonstrated that students during the COVID-19 pandemic (D-CP) had a higher average faculty score in all four preclinical laboratory competency assessments and in the final MC examination. In addition, the S-F gap was smaller in this cohort as compared with the P-CP classes.

CONCLUSION

Despite the challenges of restructuring the preclinical curricula, D-CP students performed better than their P-CP predecessors in multiple facets of this Operative Dentistry course including self-assessment accuracy.

Bridging the gap between self-assessment and faculty assessment of clinical performance in restorative dentistry: A prospective pilot study

Purpose/Objectives

The current study was undertaken to investigate whether self‐assessment of clinical skills of undergraduate dental students could be bridged with faculty assessment by deliberate training over an extended period. A secondary aim was to explore students' perception of self‐assessment and its effect on their learning and motivation.

Material and Methods

A prospective pilot study was conducted at the Department of Restorative Dentistry at Damascus University. Sixteen students participated in the study, ranging in age between 22 and 23 years. A modified Direct Observation of Procedural Skills form with a grading rubric was used to register and guide students' self‐assessment; both were pretested on four students before the study. In total, four clinical encounters were completed by each student. Students were trained on how to conduct proper self‐assessment before and after each clinical encounter. A postcourse questionnaire was used to investigate students' perception of self‐assessment.

Results

Bias in self‐assessment decreased consistently after each encounter, and the difference in bias between the first (bias = 0.77) and the last encounter (bias = 0.21) was significant with a medium effect size (p = .022, d = 0.64). The percentage of disconfirming performance dimensions decreased from 39.7% to 26.9%. Students' ability to exactly pinpoint strengths improved consistently and significantly. However, their ability to pinpoint areas of improvement was volatile and showed no significant difference. Bland–Altman graph plots showed higher levels of agreement between self‐assessment and faculty assessment. Moreover, students' perception of self‐assessment was very positive overall.

Conclusions

These findings suggest the possibility that the gap between self‐assessment and faculty assessment could be bridged through deliberate training. Future longitudinal research using a larger sample size is still required to further explore whether self‐assessment can be actively bridged with faculty assessment by deliberate training.

Assessment of communication and physical exam skills: A comparison of students, faculty and standardized patients

PURPOSE/OBJECTIVES

The objective of this retrospective study was twofold: it aimed to investigate dental students' communication and physical exam self-assessment skills by comparing students' self-evaluations with those completed by faculty and standardized patients (SPs). Second, it aimed to compare faculty and SPs assessment of students' communication skills.

METHODS

At the end of their first year of training, students (n = 127), participated in one SP encounter about an initial dental consultation. Students completed self-assessment before receiving feedback from faculty (n = 19) and SPs (n = 19). The data source included evaluation forms submitted by students, faculty and SPs. The Wilcoxon signed rank test was used to compare the overall scores between groups. Agreement between evaluations items were analyzed with McNemar's test (p < 0.05).

RESULTS

Overall, there were no statistically significant differences in how students and faculty graded for either communication (p = 0.6724) or physical exam (p = 0.1921) skills. However, both students and faculty provided less favorable marks than SPs for communication skills with a statistically significant difference in the overall grading between both students and SPs (p = 0.0146) and between faculty and SPs (p = 0.0045).

CONCLUSIONS

While there was disagreement between students and faculty versus SPs, they weren't meaningful differences in scores and the dissimilarities mainly consisted of ratings of explanation skills. We suggest that, when applicable, dental student's self-evaluations may represent an alternative to faculty assessments of communication and physical exam skills. Nonetheless, we recommend that SPs be included in the assessment of communication skills to provide students with comprehensive feedback that more realistically represents the natural patient-provider relationship.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis

INTRODUCTION

Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development.

MATERIALS AND METHODS

Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes.

RESULTS

Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate.

CONCLUSIONS

The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

An educational approach for early student self-assessment in clinical periodontology

BACKGROUND

Self-assessment is a mandated educational requirement for use in dental undergraduate programmes. It is weakly supported for use in early clinical training and studies are criticized for the conceptual and methodology shortfalls. The aim of the study was to compare the alignment of student self-assessment to both staff assessment and written exams in early clinical training using an educational approach.

METHODS

In 2014-2015, 55 third-year dental students completed three educational sessions comprising of (a) classroom teaching (lecture, video) with post-lesson written exam and (b) clinical activity with student self-assessment, staff assessment and student reflection. An intra-individual analysis approach, staff validation, and student scoring standardization were implemented. Cognitive (clinical competency) and non-cognitive (professionalism) items were separated in the analyses.

RESULTS

There were medium correlations (Spearman's rho, r) between student self-assessment and staff assessment scores for cognitive items (r, 0.32) and for non-cognitive items (r, 0.44) for all three combined sessions. There were large correlations for individual sessions. Compared to the post-lesson written exam, students showed small correlation (r, 0.22, 0.29) and staff showed medium correlation (r, 0.31, 0.34) for cognitive and non-cognitive items. Students showed improvements in their mean scores for both cognitive (t-test; p > 0.05) and non-cognitive items (t-test; p = 0.000). Mean scores of students were not different statistically from that of staff (p > 0.05).

CONCLUSIONS

Students may adequately act as self-assessors at the beginning of their clinical work in periodontology. Self-assessment may potentially improve the clinical performance. Self-assessment may be nurtured through clear guidelines, educational training strategies, feedback and reflection leading to better evaluative judgement and lifelong learning.

Effect of self-assessment in a removable prosthodontics preclinical course on skills and competence

PURPOSE

Self-assessment is increasingly implemented in medical professions' curricula. In this research, the authors measure the effects of self-assessment within a preclinical removable prosthodontics course among dental students in a private dental school according to the European qualifications framework descriptors.

MATERIALS AND METHODS

Thirty subjects, all fourth-year dental students, were included in this experiment. Fifteen subjects were included in each of the experimental and control groups during one semester. The experimental group subjects used the study roadmap tool in their preclinical tasks. The control group subjects executed the same preclinical tasks under instructor supervision only. All subjects were filmed, and an autonomy score was given to every subject per session. At the end of the semester, cognitive skills development was compared using the Kember et al. questionnaire while practical skills development was compared using a comparison of grades. Two focus groups were undertaken with experimental group subjects. Qualitative and quantitative data were collected and statistically analyzed (p < 0.005).

RESULTS

Subjects from the experimental group showed development in critical thinking, practical skills, autonomy, and taking responsibility, thus development in the competence level.

CONCLUSION

Implementation of self-assessment within preclinical courses may develop skills and competence among dental students, yet more studies are needed.

Feasibility and acceptability of virtually coaching residents on communication skills: a pilot study

BACKGROUND

Developing communication skills is a key competency for residents. Coaching, broadly accepted as a training modality in medical education, has been proven a successful tool for teaching communication skills. Little research is available thus far to investigate virtual coaching on communication skills for telemedicine encounters. The purpose of the study was to test the hypothesis that virtually coaching residents on communication skills is feasible and acceptable. We surveyed 21 resident-faculty pairs participating in a "fully virtual" coaching session (patient, coach, and resident were virtual).

METHODS

We asked 50 neurology resident-faculty coach pairs to complete one "fully virtual" coaching session between May 20 and August 31, 2020. After each session, the resident and coach completed a 15-item survey, including Likert-style scale and open-ended questions, assessing feasibility and acceptability. Descriptive statistics and qualitative content and thematic analyses were performed.

RESULTS

Forty-two percent (21/50) of all eligible residents completed "fully virtual" coaching sessions. The overall survey response rate was 91 % (38/42). The majority of respondents agreed that the direct observation and debriefing conversation were easy to schedule and occurred without technical difficulties and that debriefing elements (self-reflection, feedback, takeaways) were useful for residents. Ninety-five percent of respondents rated the coach's virtual presence to be not at all disruptive to the resident-patient interaction. Virtual coaching alleviated resident stress associated with observation and was perceived as an opportunity for immediate feedback and a unique approach for resident education that will persist into the future.

CONCLUSIONS

In this pilot study, residents and faculty coaches found virtual coaching on communication skills feasible and acceptable for telemedicine encounters. Many elements of our intervention may be adoptable by other residency programs. For example, residents may share their communication goals with clinic faculty supervisors and then invite them to directly observe virtual encounters what could facilitate targeted feedback related to the resident's goals. Moreover, virtual coaching on communication skills in both the in-person and telemedicine settings may particularly benefit residents in challenging encounters such as those with cognitively impaired patients or with surrogate decision-makers.

Comparing dental student preclinical self-assessment in the United States and Japan

PURPOSE/OBJECTIVES

Self-assessment is an essential skill for dental professionals. Understanding global trends in self-assessment can highlight the learning needs of students across a diversity of cultural backgrounds. The aim of this study is to compare the self-assessment ability of dental students in the United States and Japan, where cultural backgrounds may differ.

METHODS

Students in the United States (n = 176) completed a typodont premolar and anterior Class II and Class III preparation and restoration. Students in Japan (n = 175) completed a typodont premolar crown preparation. Students and faculty then evaluated the student performance using rubrics for each respective procedure. The difference between the student's self-assessment score and the average faculty score (S-F gap) was calculated and the data were analyzed.

RESULTS

The mean S-F gap was 2.8% in Japan and 7.6% in the United States. This indicates that Japanese students tended to assess themselves closer to their faculty graders than students in the United States. On average, students in both countries scored themselves higher than their faculty graders. Students in the United States more frequently overestimated their performance and students in Japan more frequently underestimated their performance. For students in the lower quartile, the mean S-F gap was 5.1% in Japan and 14.6% in the United States, indicating a large cultural discrepancy in the lower quartile groups.

CONCLUSIONS

Although different preclinical procedures were compared, our findings demonstrated that Japanese students may score themselves more closely to their faculty assessors than students in the United States. Further investigation with more students completing the same preclinical activity will be needed.

Effects of active engagement and spaced retrieval practice on knowledge and application of a self-assessment rubric

PURPOSE/OBJECTIVES

This study examined effects of active engagement (ENG) and spaced retrieval practice (SRP) on D1 dental students' self-assessment knowledge acquisition.

METHODS

D1 dental students (N = 120) were randomly assigned to one of four conditions in a 2 (ENG or no ENG) X 2 (SRP or no SRP) design. Students were tested on their knowledge of a self-assessment grading rubric (on a 30-item multiple-choice exam) and their ability to apply the rubric (on a simulated dentoform assessment).

RESULTS

There were significant main effects of both ENG and SRP on both outcome measures. Both ENG and SRP increased students' knowledge of, and ability to apply, the self-assessment rubric. Effects of ENG were larger than those of SRP. There was also a significant ENG X SRP interaction on the knowledge measure. The effect of SRP was larger in the no-ENG conditions than the ENG conditions, which may reflect a ceiling effect in the ENG conditions.

CONCLUSIONS

ENG and SRP have the potential to substantially enhance D1 dental students' learning outcomes. These results should motivate dental educators to reject outdated instructional techniques and thereby unleash students' full learning potential. Additional research is needed with a wider range of dental students and learner topics.

Evaluation of an eLearning teaching innovation to assist clinical radiation therapy educators in the provision of student feedback

BACKGROUND

Clinical placement is an integral part of the Radiation Therapy undergraduate programme. Feedback and formative assessment during clinical placement are regarded as key to developing clinical skills and competencies. Students regularly report dissatisfaction with the feedback process while clinical educators report heavy clinical workloads and a lack of guidance on feedback mechanisms as barriers to providing meaningful student feedback.

METHODS

An eLearning teaching intervention was developed to support radiation therapists in the provision of student feedback in the clinic. Thematic analysis was used to report attitudes to feedback and feedback practices collected in a pre and a post intervention evaluation.

RESULTS

30 radiation therapists completed the module and pre and post intervention evaluations. Prior to taking the module just over half of respondents stated that they offered regular and on-going feedback throughout the student's placement. Positive attitudes to feedback were reported. Following completion of the eLearning tool respondents reported a higher level of confidence in the provision of student feedback and almost 70% said the module had changed how they would approach the feedback process by using feedback models in the future.

DISCUSSION

Good and timely feedback is essential and allows a student opportunity to improve prior to the end of the placement. It also teaches students how to self-assess and self-reflect - skills that they can use in continuous professional development after they graduate. Radiation therapists appreciate the structure that using a model in the feedback process offers.

CONCLUSION

This eLearning teaching intervention was received favourably by radiation therapists who are key to creating a culture of feedback in the clinical environment that will facilitate students in becoming competent healthcare professionals.

Developing a self-assessment tool for dental faculty to map professional growth

Although self-assessment is a lifelong skill practiced in predoctoral training, the utility of this mechanism is seldom linked to competencies that encompass the broad range of skill sets and roles of an academic dentist. Literature defining faculty competencies and/or roles in medical and dental education is limited in scope focusing primarily on teaching and research. Identifying the broad spectrum of dental faculty skill sets and connecting them to self-assessment and professional development needs to be explored. Furthermore, a mechanism that can serve as a professional roadmap with identified areas to develop and catapult faculty into a self-reflection growth process is lacking in dental academia. The purpose of this study was to define the broad spectrum of competencies, or skill sets of an academic dentist and develop a faculty self-assessment tool grounded in self-regulation theory to help faculty track and plan professional growth. A mixed-methods approach including a faculty focus group was used to refine and verify the relevance of pre-defined faculty roles and skill sets. A self-assessment instrument was then developed with 31 broad skills and two scales that ascertained faculty interest in developing and development stage for each skill set. The intended utility of the self-assessment tool is to provide an introspective mechanism to obtain specific information about a wide range of faculty professional growth areas beyond teaching and research. The instrument can also be used to facilitate mentoring and may have implications for determining faculty development programming.

Self-confidence as a predictor of senior dental student academic success

PURPOSE

Noncognitive indicators, such as personality type and self-confidence, have been used as predictors of achievement. Accordingly, we investigated whether self-confidence in clinical skills predicts academic success among predoctoral senior dental students.

METHODS

Two consecutive cohorts (N = 336) of predoctoral senior dental students were invited to rate their self-confidence in clinical procedures twice: at the beginning and at the end of the academic year. Academic performance in clinical assessments was retrieved from scholastic records. Multiple linear regression models were constructed to predict clinical assessment grades using self-confidence scores as a predictor after controlling for possible confounders.

RESULTS

Self-confidence scores in clinical procedures were positively correlated with clinical and academic performance. Self-confidence in clinical procedures and grade point averages were consistent predictors of student performance. Additionally, self-confidence had improved at the end of the senior year (p = 0.003).

CONCLUSIONS

Self-confidence in clinical procedures was a predictor of future clinical success. Therefore, fostering and nurturing the confidence of students and integrating self-confidence assessment into the curricula at relevant timepoints should be a goal in dental education. Moreover, self-assessment of confidence in clinical skills could be used to guide students and graduates in developing their own personal development plan.

A systematic literature review of assessment feedback in preclinical dental education

INTRODUCTION

Development of evaluative judgement abilities through assessment and feedback strategies is crucial in students' progress to become self-regulated lifelong learners. Dentists' ability to appraise the quality of treatment provided to their patients starts with development of competences in a simulated preclinical training environment. However, the effectiveness of these assessment and feedback strategies is not well understood.

MATERIAL AND METHODS

This literature review aimed to identify the assessment and feedback interventions and their effect on dental students' appraisal and psychomotor skills during preclinical training. A search of the electronic databases PubMed, Ebscohost (Dentistry and Oral Health), Scopus, Web of Science and EMBASE was conducted of studies published until October 2019.

RESULTS

Twelve studies met the inclusion criteria. Two studies were randomised controlled trials and ten non-randomised studies. All studies included students' self-assessment and grading criteria as part of their feedback interventions. Feedback utilisation training was reported in 66% of the included studies. Evidence suggests feedback strategies improve psychomotor skills and increase agreement between students' and teachers' awarded grades. However, these improvements vary with the complexity of the task. Only one study shows self-directed learning significantly contributing to students' psychomotor skill improvement.

CONCLUSION

Although assessment and feedback are regarded as crucial for developing students' evaluative judgement capabilities to become self-regulated lifelong learners, there is limited empirical evidence of the assessment and feedback conditions that enhance students' judgement abilities, performance and self-regulation. Further research is needed to investigate and compare the effect of different assessment and feedback interventions on students' appraisal skills, their impact on learning and self-regulation.

An 8-year retrospective survey of assessment in postgraduate dental training in complicated tooth extraction competency

BACKGROUND/PURPOSE

Direct observation of procedural skills (DOPS) has been increasingly used in health education in recent years. This study evaluated the effect of education and trainees' perception of assessment on the clinical skills of postgraduate dental trainees in complicated tooth extraction.

MATERIALS AND METHODS

This study was conducted as a retrospective survey among postgraduate dental trainees learning complicated tooth extraction in Taipei and Linkou Chang Gung Memorial Hospital from 2012 to 2019. Practical skills were assessed using DOPS by trainees and faculty members. Each clinical case included a complicated extraction of a permanent tooth.

RESULTS

A total of 69 participants (26 men and 43 women, average age = 26.49 years, range = 24-34 years) were included in this study. Within the survey cohort, faculty assessments scored significantly higher than did trainees' self-assessments in each complicated tooth extraction procedure, with no difference between both sexes. The higher-performing trainees tended to underrate their performance much more than did the lower-performing trainees. More than 40% of the trainees evaluated themselves as having "poor capability" in some invasive surgical procedures, even though their actual performance was not lower than that of those who evaluated themselves as having adequate or good capability.

CONCLUSION

Self-assessment skills should be developed with more practice and experience. We hope that these findings can guide the planning of faculty development programs for clinical instructors, particularly the new cohort of faculty who will succeed the rapidly retiring boomer generation in the next 10 years.

Association between emotional intelligence and professionalism among dental hygiene students

INTRODUCTION

Emotional intelligence (EI) includes the ability to evaluate and govern the emotions of oneself and others. Limited evidence exists in determining whether EI is related to professionalism.

PURPOSE

The purpose of this study was to determine whether relationships exist between EI and professionalism among undergraduate dental hygiene students.

METHODS

Using a quantitative cross-sectional survey research design, the study instrument consisted of 3 parts: (1) The Emotional Quotient Self-Assessment Checklist (EQSAC) included 30 questions measuring 6 domains of EI; (2) The Patient Management and Professionalism Scale (PMPS) included 10 questions measuring 5 domains of professionalism; and (3) Demographic questions. Descriptive statistics, correlational statistics, and multiple linear regression were used to analyze the data.

RESULTS

The responses from 49 participants were used, which represented a response rate of 80.3%. Most undergraduate dental hygiene student participants had EI and professionalism scores in the moderate range. Total EI scores were significant predictors of total professionalism scores (P < 0.001) and EI domain scores were found to be significant predictors of professionalism domain scores (P < 0.01).

CONCLUSION

Since EI was found to be a predictor of professionalism, improving EI levels may bolster the development of professionalism among undergraduate dental hygiene students. Further research should utilize a larger population of dental hygiene students across multiple institutions.

Rethinking Assessment Concepts in Dental Education

Introduction

Dental education involves teaching and assessing the acquisition of verifiable domains that require superior psychomotor, communication, and cognitive skills. Evolving technologies and methods of assessment could enhance student's learning environment and improve tutor assessment experience. The aim of this study was to review the current body of research and evaluate the effectiveness of various methods of assessments in improving learning and performance in preclinical and clinical dental practice.

Materials and Methods

A search strategy was implemented using electronic search in major databases. The following key terms, clinical skills, preclinical, dental students, and assessment, were included in the search. Two reviewers independently screened all the articles retrieved following very specific inclusion criteria.

Results

The initial search generated 5371 articles and 24 articles were selected for review and data extraction. Cohen's kappa coefficient was used to measure interrater agreement and a score of 94.7% was obtained.

Conclusion

Preclinical assessment is an effective tool for promoting skills transfer to clinical phase. Early psychomotor skills assessment is valuable. It allows early intervention in the learning process and assists in effective utilization of learning resources. Technology-enhanced assessment systems allow better patient simulation, enhance learning and self-assessment experiences, and improve performance evaluation. However, these systems serve as an adjunct to conventional assessment methods. Further research should aim at calibrating and integrating these systems to optimize students learning and performance.

Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials

BACKGROUND

To investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods.

METHODS

A comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool.

RESULTS

A total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students' performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies.

CONCLUSIONS

Technology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students' performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.

Final year dental students' self-assessed confidence in general dentistry

BACKGROUND

Self-assessment is an important introspective skill that dental professionals will utilise throughout their professional career. Its value lies in its ability to help individuals identify areas of strengths and weakness, and subsequently seek further development of professional skills where needed. The aim of this study was to investigate the correlation between self-assessed confidence and the assessment grade of final year dental students based on the professional attributes and competencies of newly qualified dentists outlined by the Australian Dental Council (ADC).

METHODS

Ethical approval was obtained prior to distribution of a questionnaire with 45 statements to final year dental students. The survey was created based on the learning outcomes of the ADC guidelines in the domains of "scientific and clinical knowledge" and "patient care." Participants indicated their level of self-assessed confidence by marking "X" on a visual analogue scale (VAS) from zero ("No Confidence") to 10 cm ("Very Confident"). The assessment grade was based on OSCE, viva voce, case report and written paper.

RESULTS

A total of 58 (71.6%) dental students participated in the survey. The reported self-assessed confidence over two domains were under "patient care": clinical information gathering 8.92 ± 1.07 cm (range =3.94-10.0 cm: n = 58; 100%), clinical diagnosis and management planning 8.26 ± 1.34 cm (range =0.50-9.95 cm: n = 55; 94.8%), clinical treatment and evaluation, 6.07 ± 1.69 cm (range =0-10.00 cm: n = 55; 94.8%), and "scientific and clinical knowledge": 6.98 ± 1.58 cm (range =0-10.00 cm: n = 58; 100.0%). Within these categories, high confidence was reported for routine dental care (caries management and preventive care) whilst lower confidence was reported for the management of oral medicine and pathologies, dental emergencies, trauma, paediatric dentistry and prosthodontics. Correlation between the assessment grade and the overall score of self-assessed confidence is low positive (r = .225) and not statistically significant (n = 46; P = .132, Spearman'sρ).

CONCLUSIONS

The final year dental students appear to have good overall self-assessed confidence in core areas of general dentistry. However, confidence seems to be over-estimated when compared with summative assessment.

Dental hygiene graduates' educational preparedness: Self-confidence ratings of the CDHA baccalaureate competencies

PURPOSE

In 2015, the Canadian Dental Hygienists Association (CDHA) published the first Canadian Competencies for Baccalaureate Dental Hygiene Programs (CCBDHP). To date, there is little evidence to support that baccalaureate graduates have gained these abilities. The purpose of the study was to investigate the confidence levels of baccalaureate graduates in their ability to demonstrate the CCBDHP.

METHODS

An online, anonymous study was conducted with the 2013-2016 graduates of the University of British Columbia to rate their confidence level in the 13 competency domains and associated 110 sub-competencies of the CCBDHP based on a 5-point scale ranging from not confident to confident.

RESULTS

Thirty of the 84 graduates responded to the survey for a 36% response rate. The mostly confident and confident scores were added to determine the number of sub-competencies within each domain in which 75% to 100% of respondents identified such confidence. The competency domains in which graduates expressed the highest confidence included Collaboration (100%), Communication (100%), Clinical Therapy (100%), Disease Prevention (100%), Oral Health Education (90%), Professionalism (90%), Research Use (90%) and Leadership (90%). They expressed the least confidence in the competency domains of Health Promotion (50%), Advocacy (22%) and Policy Use (0%).

CONCLUSION

These data provided the UBC faculty with important insights into the educational preparedness of baccalaureate graduates. The findings are also relevant for other Canadian programmes and contribute to a larger national dialogue about the CCBDHP and the transition of graduates into practice.

Self-Assessment of Surgical Skills: A Systematic Review

OBJECTIVE

Self-assessment is fundamental in surgical training to enhance learning in the absence of trainer feedback. The primary objective of this review was to assess the factors that influence accuracy of self-assessment at technical skills across all surgical specialties. The secondary objective was to assess whether there are any innate factors or attributes to predict those that will carry out effective self-assessment.

DESIGN

A systematic review was carried out in accordance with PRISMA guidelines. A search strategy encompassing MEDLINE, EMBASE, ERIC, WHO, and the Cochrane database was conducted to identify studies investigating self-assessment at any surgical task. Quality was assessed using the Newcastle-Ottawa scale. A summary table was created to describe specialty, participants, task, setting, assessment tool, and correlation coefficient between self and expert assessment. The review protocol was registered in PROSPERO.

RESULTS

Of 24,638 citations, 40 met inclusion criteria. In total 1753 participants performed 68 procedures. Twenty-six studies investigated skills in general surgery with the remaining 14 in various other surgical specialties. Accuracy of self-assessment is superior in those with greater experience and age, and with use of retrospective video playback. Accuracy tends to be reflected by overestimation of performance. Stressful environments reduce accuracy. There is limited evidence in the literature regarding predicting traits for those who will carry out accurate self-assessment.

CONCLUSIONS

The ability to perform accurate self-assessment is an important skill in surgical training, with accuracy being influenced by a multitude of factors. The use of self-assessment from retrospective video playback may be of benefit in surgical training curricula to enhance learning of technical skills. Further studies are required to define predictors of good self-assessment, which will strengthen recruitment and mentoring to assist trainee learning.

Longitudinal effects of utilising photography on the accuracy of ergonomic self-assessments amongst dental hygiene students

PURPOSE

The purpose of this study was to determine the longitudinal effects of feedback involving photography and self-assessment on the accuracy of ergonomic self-assessments and ergonomic scores amongst dental hygiene students.

MATERIALS AND METHODS

The study involved an experimental design. Data collection took place over 4 months, divided into weeks 1-4 and after 3 months. At weeks 1 through 4 and 3 months, all participants completed ergonomic self-evaluations, using a Modified-Dental Operator Posture Assessment Instrument. At week 1, week 4 and 3 months, all participants were photographed, and in weeks 2 and 3, only participants in the training group were photographed and used those photographs to complete ergonomic self-assessments. All participants' photographs were evaluated by three faculty raters.

RESULTS

A mixed-design ANOVA of Kappa coefficient values between student and rater scores measured the effects of the feedback with photography on the accuracy of student self-assessments. A main effect for group was not found to be significant (F(1,30) = 2.90, P = .101). A mixed-design ANOVA measured the effects of the feedback with photography on the ergonomic scores. No significant main effects were found (F(1,120) = 1.55, P = .216).

CONCLUSION

Although self-assessment utilising photographs resulted in initial improvements in the accuracy of ergonomic self-assessments and ergonomic scores after 4 weeks, both ergonomic accuracy and scores significantly decreased after 3 months. Improvement in ergonomic accuracy and scores may be sustained by the continual facilitated use of photographs and self-assessment by dental and dental hygiene educators.

Improving the Awareness of Musculoskeletal Disorder Risks Among Dental Educators

Prolonged and static postures among dental workforce personnel may lead to work-related musculoskeletal disorders (WMSDs). The aim of this study was to determine whether feedback involving photography and self-assessment would improve dental educators' postures and accuracy of ergonomic self-assessment. This study used a randomized control design. The Modified-Dental Operator Posture Assessment Instrument (M-DOPAI) was used for all ergonomic evaluations over a four-week period at one U.S. dental school. At week 1, all 30 participating dental educators were photographed and completed an M-DOPAI without viewing the photographs. In weeks 2 and 3, the educators in the control group (N=15) completed an M-DOPAI without any additional photographs. The educators in the training group (N=15) had additional photographs taken and used the photographs to complete an ergonomic self-assessment with the principal investigator. From week 1 to week 4, the ergonomics training utilizing photography resulted in improvements in the dental educators' ergonomic scores but not the accuracy of their ergonomic self-assessments. All participants strongly agreed it was important for both dental students and dentists to understand proper ergonomics, properly apply proper ergonomics, and have accurate ergonomic self-assessment skills in clinical practice. Although these dental educators valued ergonomic principles, they lacked training in applying these principles with dental students. Without additional training in ergonomics and self-assessment, the development of these skills in dental students will be affected.

Evaluation of the use of a guided bur during preclinical teaching of tooth preparation: A pilot study

Objectives

An innovative calibrated bur, aiming to improve precision during reduction of the incisal edge, was recently proposed to guide practitioners during tooth preparation. However, limited information is available concerning its usefulness in dental preclinical education. The aim of this study was to evaluate whether using this innovative guided bur improves learning experience quality and the performance of students during tooth preparation.

Material and methods

After having provided written consent, 60 second-year students were divided into two groups. One group used a 1-mm rounded bur to perform depth grooves, whereas the second group used the innovative guided bur, consisting in a 2-mm-depth marker with a stopping surface. Once the grooves were obtained, they were then connected using the same wheel bur in both groups. The aim was to obtain a final 2-mm reduction of the incisal edge. Quality of the learning experience (stress level, motivation to restart, self-evaluation of the preparation, and difficulty) was quantified using a visual analog scale. Duration of the procedure was also measured in both groups. 3D measurements for each tooth were performed using an STL comparison software.

Results

There were no significant differences between groups in terms of stress and self-evaluation of the preparation. Students in the guided bur group reported significantly lower perception of exercise difficulty (p < .001) and significantly higher motivation to restart the procedure (p < .001). The guided bur group performed the procedure in 16.4% less time than the rounded bur group. The use of the guided bur led to a 23% over-reduction, whereas the use of the rounded bur led to a 10% under-reduction.

Conclusions

Overall, the present study shows that the guided bur provides significant improvement in the student's learning experience with increased motivation and decreased perception of difficulty. It shortens the duration of procedure performance, but it also induces a reduction in preparation accuracy.

How Does Pretesting for PubMed Knowledge Spark Student Learning?

Predoctoral students enter dental school with varying skill levels for searching biomedical databases and a tendency to overestimate their abilities. Accordingly, PubMed instruction is embedded within a required dental course and includes a graded component. This article describes a pretest/intervention/posttest developed for the PubMed session. The expectation for this new assessment was that motivation to learn PubMed would increase during the intervention if pretesting objectively showed students the difference between their self-perceived versus actual PubMed abilities. The goals were to help students better self-assess their genuine searching abilities, spark learning during the instruction session, and elicit measurable improvement in skills.

Influence of Self-Assessment on Dental Students' Performance on Technical Assessments in Periodontics

Self-assessments were introduced into a third-year clinical periodontics course to enable dental students to self-assess and receive faculty feedback prior to technical assessment. The aims of this study were to determine if there was an improvement in the pass rate and average grade on the technical assessments following implementation of self-assessments and to analyze the accuracy of the student self-assessments by comparing them with faculty assessments. Scores from 106 third-year dental students for four periodontal procedures were included in the analysis. Faculty and student self-assessment scores, along with self-assessment and final technical assessments scores, were compared, as were the average number of self-assessment attempts for the various procedures and the pass rates. The average number of self-assessments per student was 6.5 compared to 4.2 for the technical assessments. There was no significant difference between students' self-assessment scores and faculty scores (average difference=0.005; p=0.7894). However, there was a significant increase in overall scores between students' self-assessments and technical assessments (average difference: 0.30 out of 5; p=0.0001). There was also a significant difference in pass rate between self-assessments and technical assessments (92.3% and 99.7%, respectively). The individual technical assessment with the greatest improvement was for scaling and root planing (average difference=0.47; p=0.0001), which also had significantly more self-assessments (2.3 vs. 1.2-1.7, p=0.0001). These results suggest that self-assessment and the subsequent faculty feedback provided students with information that enabled them to improve their performance on technical assessments.

Agreement between faculty member assessments and student self-assessments in a preclinical endodontic programme

This study aimed to evaluate the agreement between faculty member assessments and student self-assessments regarding the latter's performance in a preclinical endodontic course. The data were collected from 30 undergraduate dental students enrolled in a preclinical endodontic course at Taibah University in Saudi Arabia during 2017-2018 academic year. One course coordinator calibrated the grading method and distributed it to all staff and students. Students were asked to appraise their own performance of a root canal treatment for a tooth with a single canal. After the student self-assessments, two staff members also graded student performance using the same grading scale. The assessment agreement was compared between student and faculty evaluations using a Wilcoxon signed-rank test with a 0.05 significance level. There was a significant difference (P < 0.05) between student and staff member assessment scores. Student scores were lower and had a weak reliability compared to those of staff members.

Self-assessment of ergonomics amongst dental students utilising photography: RCT

INTRODUCTION

Dental professionals are at high risk of musculoskeletal disorders (MSDs) due to static working positions for extended periods of time. Musculoskeletal pain has been identified as early as during their entry-level dental education. The purpose of this study was to determine whether feedback involving photography and self-assessment would improve ergonomic scores and the accuracy of ergonomic self-assessments amongst dental students.

MATERIALS AND METHODS

The study involved a randomised control design of 135 dental students. At weeks 1 and 4, participants were photographed, and at weeks 1 through 4, participants completed ergonomic self-evaluations, using a Modified-Dental Operator Posture Assessment Instrument (M-DOPAI). During weeks 2 and 3, participants in the training group were photographed and used those photographs to complete ergonomic self-assessments. All participants' pre-training and post-training photographs were evaluated for ergonomic scores by two raters.

RESULTS

A mixed-design ANOVA of ergonomic scores revealed that ergonomic scores improved for all students who received the ergonomics training (F(1,254)=17.41, P < .001). In addition, a mixed-design ANOVA of kappa coefficient values between student and rater scores revealed that the accuracy of self-assessments improved for all students who received the ergonomics training (F(1,127)=6.33, P < .05).

CONCLUSION

The use of photographs and self-assessment provides dental and dental hygiene educators with a pragmatic method to improve self-assessment skills, increase student awareness of any postural deviations from ideal and improve musculoskeletal health.

Enhancing Dental Student Learning and Skill with Dental Bonding Utilizing a Shear Bond Strength Test

Teaching dental students the proper protocol and application of bonding agents for improved composite restorations in the preclinical setting can be challenging due to difficulty in translating their bonding technique to clinical outcomes. The aim of this study was to examine the effectiveness of utilizing a shear bond strength test and to evaluate if it improved student performance and confidence in adhesive dentistry. All 106 third-year and 106 fourth-year dental students (total N=212) at the University of California, Los Angeles, School of Dentistry were invited to participate in a shear bond strength workshop in 2016. The hands-on workshop used a bond strength testing instrument to demonstrate the various principles and techniques of adhesive dentistry. A total of 54 third-year and 34 fourth-year students (total N=88) participated, for response rates of 51% and 32%, respectively. For the total students, there was a significant difference in the mean bond strength between the first and second attempts (p<0.001). For the third-year students, an increase in the mean shear bond strength was seen but was not significant (p=0.097). For the fourth-year students, there was a significant difference between the first and second attempts (p<0.001). A significant difference was also found in the aggregate self-ratings before and after the exercise (p<0.001). The students rated the exercise as an enjoyable way to learn about adhesive dentistry and agreed that it increased their confidence in performing bonding procedures. This exercise served as an innovative method of emphasizing proper technique with adhesive dentistry, while helping to build student confidence in the preclinical laboratory.

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.

Assessing self-assessment practices: A survey of U.S. colleges and schools of pharmacy

OBJECTIVE

This study quantifies and describes student self-assessment approaches in colleges of pharmacy across the United States.

METHODS

Faculty members identified as assessment directors from college websites at U.S. colleges of pharmacy were electronically surveyed. Prior to distribution, feedback and question validation was sought from select assessment directors. Surveys were distributed and recorded, via Qualtrics^® survey software and analyzed in Microsoft Excel^®.

RESULTS

Responses were received from 49 colleges of pharmacy (n = 49/134, 37% response rate). The most commonly used strategies were reflective essays (n = 44/49, 90%), portfolios (n = 40/49, 82%), student self-evaluations (n = 35/49, 71%) and questionnaires/surveys/checklists (n = 29/49, 59%). Out of 49 submitted surveys, 35 programs noted students received feedback on self-assessment. Feedback came most commonly from faculty (n = 31/35, 88%). Thirty-four programs responded regarding self-assessment integration including fifteen colleges (n = 15/34, 44%) that integrated self-assessment both into the curriculum and co-curricular activities, while 14 (n = 14/34, 41%) integrated self-assessment exclusively into the curriculum, and five (n = 5/34, 15%) used self-assessment exclusively in co-curricular activities.

DISCUSSION AND CONCLUSIONS

Student self-assessment is a critical first step of the Continuing Professional Development (CPD) process. Colleges and schools of pharmacy use a wide variety of methods to develop this skill in preparing future practitioners.

Does the acceptance of hybrid learning affect learning approaches in France?

PURPOSE

Acceptance of a learning technology affects students' intention to use that technology, but the influence of the acceptance of a learning technology on learning approaches has not been investigated in the literature. A deep learning approach is important in the field of health, where links must be created between skills, knowledge, and habits. Our hypothesis was that acceptance of a hybrid learning model would affect students' way of learning.

METHODS

We analysed these concepts, and their correlations, in the context of a flipped classroom method using a local learning management system. In a sample of all students within a single year of study in the midwifery program (n= 38), we used 3 validated scales to evaluate these concepts (the Study Process Questionnaire, My Intellectual Work Tools, and the Hybrid E-Learning Acceptance Model: Learner Perceptions).

RESULTS

Our sample had a positive acceptance of the learning model, but a neutral intention to use it. Students reported that they were distractible during distance learning. They presented a better mean score for the deep approach than for the superficial approach (P< 0.001), which is consistent with their declared learning strategies (personal reorganization of information; search and use of examples). There was no correlation between poor acceptance of the learning model and inadequate learning approaches. The strategy of using deep learning techniques was moderately correlated with acceptance of the learning model (r_s= 0.42, P= 0.03).

CONCLUSION

Learning approaches were not affected by acceptance of a hybrid learning model, due to the flexibility of the tool. However, we identified problems in the students' time utilization, which explains their neutral intention to use the system.