The impact of integrated team care taught using a live NHS contract on the educational experience of final year dental students

Mind the 'GAPP': a pre-graduation assessment of preparedness for practice amid a pandemic

Introduction 'Preparedness for practice' refers to a multifaceted concept, encompassing not only clinical skills, but also broader, non-clinical skills, such as communication and professionalism. Previous graduates have reported feeling less prepared for complex procedures, such as molar endodontics and surgical extractions. Dental students typically utilise their final year to refine their clinical skills, however, the COVID-19 pandemic has meant that newly qualified dentists will have had around six months where they have not performed clinical dentistry before beginning dental foundation training (DFT).

Aims This study aimed to explore final year students' self-reported preparedness for practice, identify areas of relative weakness that may influence future training needs and to highlight any perceived impact of the pandemic on final year experience and potential impact on DFT.

Materials and methods The current Graduate Assessment of Preparedness for Practice (GAPP) questionnaire was adapted for our specific research aims and piloted and the PreGAPP questionnaire distributed via the social media channels of dental school student societies. Analysis was carried out using IBM Statistical Package for the Social Sciences software using descriptive statistics and the Mann-Whitney U test for two unrelated variables.

Results Responses were received from final year students across all 16 UK dental schools. Students reported increased preparedness across domains in which they had the most experience; for example, providing preventative advice and administering local anaesthesia. Male students reported feeling significantly more prepared than female students, mature students significantly more than younger students, and students on four-year courses significantly more than traditional five-year courses. The COVID-19 pandemic was expected to have a major-to-severe impact on undergraduate experience and future DFT prospects.

Conclusion Dental graduates in the COVID-19 era may have significantly different training needs to those before them. Complex clinical procedures remain the areas where students feel they are least prepared for practice. The importance of a clinical passport to highlight current experience level to trainers, alongside the creation of a personal development plan at the beginning of DFT, will ensure that targeted and personalised training can be implemented where required.

Illustrates the perceived effect of the COVID-19 pandemic on final year students' preparedness for practice and the impact it may have on dental foundation training through quantitative and qualitative methods.

Highlights and explores the differences in the perceptions of preparedness for practice of final year students across sex, age and course length.

Explores various aspects of clinical supervision and assessment and reinforces the importance of appropriate student-staff ratios to ensure clinical learning is effective.

Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland

Introduction The governing bodies for dentistry in the UK and Ireland require dentists, at graduation, to possess the knowledge, skills and attributes which enable them to practise safely, without supervision. The means by which dental schools achieve this may differ and may undergo modification in response to changes in the expectations of governing bodies and challenges within the teaching environment. It is therefore important to identify which of these approaches works well and to disseminate good practice described in the literature.Objectives To use a scoping review to identify from the published literature the methods used to teach clinical dental skills, including innovations, motivations for changes, and factors affecting the delivery and quality of teaching.Method Scoping review methodology was used to select and analyse 57 articles published between 2008 and 2018.Results Innovations in didactic teaching were facilitated by advances in IT and development of virtual learning environments, which promoted independent, self-directed learning. Pre-clinical practical teaching took place in clinical techniques laboratories utilising mannequin heads, with a minority of dental schools using virtual reality simulators in addition. Clinical experience was gained mainly in multi-disciplinary clinics and offsite outreach teaching centres. Insufficient numbers of suitable patients, increasing student numbers and a fall in teaching staff contributed to a reported reduction in clinical experience of certain treatments.Conclusions Contemporary clinical dental skills teaching produces new graduates who possess excellent theoretical knowledge, are prepared and confident in basic clinical skills, but are lacking in experience of complex treatments which may result in a reduced preparedness for independent practice.

Belongingness in undergraduate dental education

Objective To undertake a detailed educational evaluation into dental students' experience of the concept of belongingness and their development as 'safe beginners' on an outreach placement at the University of Portsmouth Dental Academy (UPDA).Method The participants were asked two questions: Did you feel belongingness at UPDA?; and When in your year rotation did you feel this? They completed the educational evaluation anonymously in their last week of attendance. The quantitative data was handled with descriptive statistics and the qualitative data was analysed for recurring themes.Results A 95% response rate was achieved. Eighty six percent of respondents strongly agreed to feeling belongingness and 56% felt it after their first two weeks. Four themes were identified: 'Interaction with the preexisting people environment' (1a. Initial welcoming and warmth 1b. Continued interest in me as an individual); 'Developing collegiality' (2a. My group of fellow students 2b. Working with the dental team as a dentist 2c. The team of everyone at UPDA); 'In the clinical environment' (3a. Being a dentist with responsibility and respect 3b. The physical environment 3c. Becoming a reflective independent practitioner); and 'Leadership'.Conclusion Belongingness in dental education should be defined as:- a deeply personal and contextually mediated experience in which a student becomes an essential and respected part of the dental educational environment where all are accepted and equally valued by each other and which allows each individual student to develop autonomy, self-reflection and self-actualisation as a clinician.

Evaluation of an outreach education model over five years: Perception of dental students and their outreach clinical mentors

INTRODUCTION

The objective was to investigate changes in students' and clinical mentors' perceptions of a model for outreach education over a 5-year period, 2006-2010.

MATERIAL AND METHOD

Two cohorts of last-year students of a dental problem-based curriculum and their clinical mentors in the Public Dental Service (PDS) were invited to respond to a questionnaire. In 2006, 85% of 54 students and 72% of their 54 mentors responded; 98% of 40 students and 88% of 41 of the mentors did so in 2010. Participants scored their level of agreement with different statements on a numeric rating scale and gave comments.

RESULTS

Dental students and their clinical mentors reported that they shared a consistent and favourable perception of this outreach education model over 5 years. The students reported increased professional confidence and self-reliance. Clinical mentors expressed a transfer of knowledge to their clinics. Differences in scoring were seen between students and mentors for two statements in 2006 and two statements in 2010 (P < 0.05).

CONCLUSIONS

The current model for outreach education received favourable and stable ratings over the 5-year period. This model resulted in that students perceived that they became self-reliant, which may facilitate their transition from being a student to becoming a professional. The current model supports exchange and professional development for students, faculty and outreach clinics. This leads us to look at outreach education as an opportunity to form a mutual learning community comprised of the outreach clinics and the dental school.

Dental students' perceptions of their experience at a residential outreach centre

INTRODUCTION

The Portsmouth Dental Academy delivers an interprofessional education to dental students on outreach placement from King's College London Dental Institute.

AIM

To establish what the dental students' attitudes to the placement are and how these correlate to the perceptions of the staff who work with them.

METHOD

Using Delphi consensus procedures, a simple, closed, two-question questionnaire was developed. The questionnaire was completed by the students and then, to triangulate the results, was subsequently applied to staff who teach and assist them on clinic.

RESULTS

To the question: Why do you think the experience that is commonly termed the 'Portsmouth experience' is so successful 'in the eyes of the students'?, the students ranked first the response: 'Students gain experience in primary dental care clinical practice under the current NHS contract - UDAs and KPIs'. To the second question: What do you think the students most enjoyed about working in Portsmouth?, the students ranked first: 'A sense of independence - being made to make their own decisions'.

CONCLUSION

The students' major perception of the 'Portsmouth experience' centres around the placement being a realistic preparation for their future practising career. This is combined with a strong sense of belonging when studying and working at the Academy.

Dental Treatment in a State-Funded Primary Dental Care Facility: Contextual and Individual Predictors of Treatment Need?

Objective

This study examined individual and contextual factors which predict the dental care received by patients in a state-funded primary dental care training facility in England.

Methods

Routine clinical and demographic data were extracted from a live dental patient management system in a state-funded facility using novel methods. The data, spanning a four-year period [2008–2012] were cleaned, validated, linked by means of postcode to deprivation status, and analysed to identify factors which predict dental treatment need. The predictive relationship between patients’ individual characteristics (demography, smoking, payment status) and contextual experience (deprivation based on area of residence), with common dental treatments received was examined using unadjusted analysis and adjusted logistic regression. Additionally, multilevel modelling was used to establish the isolated influence of area of residence on treatments.

Results

Data on 6,351 dental patients extracted comprised of 147,417 treatment procedures delivered across 10,371 courses of care. Individual level factors associated with the treatments were age, sex, payment exemption and smoking status and deprivation associated with area of residence was a contextual predictor of treatment. More than 50% of children (<18 years) and older adults (≥65 years) received preventive care in the form of ‘instruction and advice’, compared with 46% of working age adults (18–64 years); p = 0.001. The odds of receiving treatment increased with each increasing year of age amongst adults (p = 0.001): ‘partial dentures’ (7%); ‘scale and polish’ (3.7%); ‘tooth extraction’ (3%; p = 0.001), and ‘instruction and advice’ (3%; p = 0.001). Smokers had a higher likelihood of receiving all treatments; and were notably over four times more likely to receive ‘instruction and advice’ than non-smokers (OR 4.124; 95% CI: 3.088–5.508; p = 0.01). A further new finding from the multilevel models was a significant difference in treatment related to area of residence; adults from the most deprived quintile were more likely to receive ‘tooth extraction’ when compared with least deprived, and less likely to receive preventive ‘instruction and advice’ (p = 0.01).

Conclusion

This is the first study to model patient management data from a state-funded dental service and show that individual and contextual factors predict common treatments received. Implications of this research include the importance of making provision for our aging population and ensuring that preventative care is available to all. Further research is required to explain the interaction of organisational and system policies, practitioner and patient perspectives on care and, thus, inform effective commissioning and provision of dental services.

Outreach clinical dental education: the Portsmouth experience - a 4-year follow-up study

BACKGROUND

The Portsmouth Dental Academy (UPDA) was opened in September 2010 and was a development from the highly successful School of Professionals Complementary to Dentistry (2004-2010). The aim of the Academy was to provide integrated team education for all dental professionals in a primary care setting. The dental students are on outreach from King's College London, and the dental care professional students are registered at the University of Portsmouth.

OBJECTIVES

To evaluate the dental students response to the residential outreach educational experience at the UPDA.

METHODS

A 49-item questionnaire divided into nine domains that provided both qualitative data and quantitative data were administered at the end of the longitudinal 10-week placement, to four successive cohorts of students in 2010-2014.

RESULTS

A 95% return rate was achieved. Students valued highly the quality of the clinical teaching. Through their experience, they felt they understood fully the role of the dentist in care planning in primary care and felt well prepared for dental foundation training. This educational success is unpinned with successful maintenance factors including a well-organised induction period and giving the students a sense of belongingness, empowerment and autonomy for their personal development as new graduates.

CONCLUSION

Within the limitations of the questionnaire study over the 4-year period, the students were very positive about all the aspects of this residential outreach education at the UPDA but particularly valued the immersion in clinical dentistry and the bridging from dental school to their dental foundation training.