Misconceptions amongst dental students: How can they be identified?

Using MCQ response certainty to determine how aspects of self-monitoring develop through a medical course

INTRODUCTION

Self-monitoring of clinical-decision-making is essential for health care professional practice. Using certainty in responses to assessment items could allow self-monitoring of clinical-decision-making by medical students to be tracked over time. This research introduces how aspects of insightfulness, safety and efficiency could be based on certainty in, and correctness of, multiple-choice question (MCQ) responses. We also show how these measures change over time.

METHODS

With each answer on twice yearly MCQ progress tests, medical students provided their certainty of correctness. An insightful student would be more likely to be correct for those answers given with increasing certainty. A safe student would be expected to have a high probability of being correct for answers given with a high certainty. An efficient student would be expected to have a sufficiently low probability of being correct when they have no certainty. The system was developed using first principles and data from one cohort of students. A dataset from a second cohort was then used as an independent validation sample.

RESULTS

The patterns of aspects of self-monitoring were similar for both cohorts. Almost all the students met the criteria for insightfulness on all tests. Most students had an undetermined outcome for the safety aspect. When a definitive result for safety was obtained, absence of safety was most prevalent in the middle of the course, while the presence of safety increased later. Most of the students met the criteria for efficiency, with the highest prevalence mid-course, but efficiency was more likely to be absent later.

DISCUSSION

Throughout the course, students showed reassuring levels of insightfulness. The results suggest that students may balance safety with efficiency. This may be explained by students learning the positive implications of decisions before the negative implications, making them initially more efficient, but later being more cautious and safer.

Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study

BACKGROUND

Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University.

METHODS

Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa.

RESULTS SURVEY

All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001).

OBSERVATION

The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors.

CONCLUSIONS

Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.

Misconceptions about Oral Diagnosis and Radiology among Dental Students: A Questionnaire Study

BACKGROUND

Misconceptions are learning deficits that may cause clinical judgments in a dental practice to be made incorrectly.

AIM

This study aimed to identify and look into students' misconceptions regarding Oral Diagnosis and Radiology.

MATERIALS AND METHODS

The fourth and fifth-grade students at the Altınbaş University Faculty of Dentistry were given a self-administered questionnaire that included multiple-choice questions about Oral Diagnosis/Medicine and Radiology. 106 students participated in the questionnaire and 50.9% of the participants were fourth-grade students, 49.1% of them were fifth-grade students. The questions were classified into two parts: five scenario-based questions and ten knowledge-based questions. Students' replies were evaluated for accuracy and confidence, and when a student was certain of giving an inaccurate response, misconceptions were noted. Two groups were compared using the Mann-Whitney-U test (P = 0.05).

RESULTS

A total of 1590 responses were collected. Regarding the question type, scenario-based questions had more misconceptions (19.6%) than knowledge-based questions (18.4%). Depending on the question, the majority of misconceptions were seen in the questions about denture stomatitis (46.2%) and radiographic contrast (38.7%).

CONCLUSIONS

To prevent misdiagnosis, it is essential to recognize and overcome misconceptions in Oral Diagnosis/Medicine and Radiology. Therefore this study assists students and lecturers in defining misconceptions and organizing precautions to avoid and fix them.

Endo-Perio Relationship Knowledge, Understanding, and Confidence Among Dentists

PURPOSE

Proper knowledge and confidence regarding Endo-Perio relationship plays an important role in correct clinical decisions and management of these conditions. The aim of this study is to assess dentists' knowledge and understanding, in addition, their confidence regarding Endo-Perio relationship, consequently, to investigate the prevalence of misconceptions.

METHODS

This cross-sectional study, conducted from December 2021 to March 2022, utilized voluntary anonymous questionnaire, distributed among general dentists, graduates of King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia, year of 2021 (n = 151). The questionnaire had two parts, demographic and 13 closed ended scientific questions to assess knowledge and understanding with 4 points Likert scale after each question to assess confidence and misconceptions. Descriptive statistics and Chi-square test at a statistical significance of P-value <0.05 were conducted to analyze the data using SPSS.

RESULTS

Total of 98 participants completed the questionnaire setting a response rate of (64.9%). Only (21.4%) had sufficient overall knowledge and understanding regarding Endo-Perio relationship with no significant association found between knowledge and gender (p = 0.8). A little more than one-third of our participants (37.83%) were overly confident; false confident, thus, had misconceptions.

CONCLUSION

Our study revealed that the majority of our participants had deficient knowledge regarding Endo-Perio relationship. Thus, to compensate for this reported deficiency, changing teaching strategies and implementing continuing education courses are suggested. More studies assessing the interaction between knowledge and confidence in different dental topics are needed.

Identifying misconceptions about oral radiology and medicine among dental students

PURPOSE/OBJECTIVES

Misconceptions are learning deficiencies that can lead to inappropriate clinical decision-making in dental practice. Although misconceptions are common among students, they are rarely analyzed in dental education. Thus, this study aimed to identify and analyze students' misconceptions about oral radiology and medicine at a Brazilian dental school.

METHODS

Between October 2019 and March 2020, a self-administered anonymous questionnaire was distributed to dental students at the Federal University of Pernambuco, Brazil, which comprised multiple-choice questions about oral radiology and medicine. The questions were divided into two groups: 10 knowledge-based questions (less demand for reasoning) and five scenario-based questions (higher demand for reasoning). The students' responses were assessed for correctness (correct or incorrect) and confidence (sure or unsure), while misconceptions were identified when a student was sure of an incorrect response. Pearson's chi-square test was used to analyze the variables (α = 0.05).

RESULTS

A total of 1380 responses were collected. Misconceptions represented 24.3% (n = 336) of the total responses and 56.8% of the incorrect responses. The mean misconceptions per student were 3.7 (range, 0-8). Students who chose incorrect answers tended to have higher confidence levels (p < 0.001). Moreover, misconceptions were more frequent for scenario-based questions (25.7%) than for knowledge-based questions (23.7%) (p = 0.000).

CONCLUSION

A large number of misconceptions existed among participants. Our findings will aid educators and students in identifying misconceptions and planning measures to prevent and correct them.

The interrelationship between confidence and correctness in a multiple-choice assessment: pointing out misconceptions and assuring valuable questions

Introduction

The aim of this study was to better understand the interfaces of being correct or incorrect and confident or unconfident; aiming to point out misconceptions and assure valuable questions.

Methods

This cross-sectional study was conducted using a convenience sample of second-year dental students (n = 29) attending a preclinical endodontics course. Students answered 20 multiple-choice questions (“basic” or “moderate” level) on endodontics, all of which were followed by one confidence question (scale). Our two research questions were: (1) How was the students’ performance, considering correctness, misconceptions, and level of confidence? (2) Were the questions valuable, appropriate and friendly, and which ones led to misconceptions? Four situations arouse from the interrelationship between question correctness and confidence level: (1st) correct and confident, (2nd) correct and unconfident, (3rd) incorrect and confident (misconception) and (4th) incorrect and unconfident. Statistical analysis (α = 5%) considered the interaction between (a) students’ performance with misconceptions and confidence; (b) question’s difficulty with correctness and confidence; and (c) misconceptions with clinical and negative questions.

Results

Students had 92.5% of correctness and 84.6% of confidence level. Nine students were responsible for the 12 misconceptions. Students who had more misconceptions had lower correctness (P < 0.001). High achieving students had low confidence in their incorrect responses (P = 0.047). ‘Moderate’ questions had more incorrectness (P < 0.05) and less confidence (P = 0.02) than ‘basic’. All questions were considered valuable [for example, the ones that presented images or required a mental picture of a clinical scenario, since they induced less misconception (P = 0.007)]. There was no difference in misconceptions between negative questions and other questions (P = 0.96).

Conclusion

Preclinical endodontic students were highly correct and very confident in their responses. Students who had more misconceptions had also the lowest performance in the assessment. Questions were valuable; but some will worth further improvement for the future. A multiple-choice assessment, when combined with confidence questions, provided helpful information regarding misconceptions and questions value.

Use of mind maps in dental education: An activity performed in a preclinical endodontic course

PURPOSE/OBJECTIVES

(1) to assess the ability of dental students to use mind maps to express the relationships of endodontic theory and technique; (2) to explore features illustrated from the highest- and lowest-graded mind maps; and (3) to evaluate improvements in successive mind maps from the same student.

METHODS

A total of 31 second-year students were asked to configure a mind map on root canal cleaning-shaping and then 18 weeks later develop a second mind map on root canal obturation. Faculty visually analyzed the mind maps using a qualitative approach: a multilayered process of thematic analysis. Codes and themes were generated to investigate if students were able to express appropriate and evidence-based ideas on the topics (accuracy of relationships and depth of information presented). Two of the highest- and 2 of the lowest-graded mind maps for each activity were directly compared. Improvement by the same student from the first to second mind map was also evaluated based on trend/style and creativity.

RESULTS

The majority of the students accurately expressed the scientific basis for root canal cleaning-shaping and obturation. The highest-graded mind maps displayed the biomedical and humanistic conceptions of critical thinking. In comparing the second mind map to the first, nearly 50% of the students incorporated more detail and artistic expression in the second map.

CONCLUSIONS

using mind maps in dental education can benefit students with different learning styles and help the instructor to identify the level of conceptualization that the student had developed about a topic.

Defining and tracking medical student self-monitoring using multiple-choice question item certainty

BACKGROUND

Self-monitoring is an important component of clinical practice. It is underpinned by the framework of self-efficacy which is concerned with judgments of how well one believes one can achieve or perform a task. This research aimed to develop criteria for adequate self-monitoring, then to measure patterns of self-monitoring, and to explore how these patterns relate to a student's year in a medical course and to patterns of knowledge.

METHODS

Analysis of individuals' levels of correctness in answering assessment items and their certainty in correctness may be used to inform assessments of ability to self-monitor. Two criteria were proposed and applied to define adequate self-monitoring. Firstly, increasing proportions correct with increasing levels of certainty. Secondly, having a proportion correct for high certainty responses that was not lower than cohort levels. Student responses in progress tests comprising multiple-choice questions (MCQs) and associated certainty were analysed. Criteria for the presence of adequate self-monitoring and for adequate knowledge were applied to the results of each of four tests conducted over 2 years, and used to categorise patterns of self-monitoring and knowledge.

RESULTS

Data from 3 year group cohorts totalling 737 students were analysed. The majority (58%) of students demonstrated adequate knowledge and met both criteria for adequate self-monitoring across all four tests. The most advanced year group cohort had the highest rates of adequate knowledge and the highest rates of meeting both self-monitoring criteria. The patterns of self-monitoring were the same as the patterns of knowledge across the four tests for 454 students, but for the remaining 283 the patterns of self-monitoring and knowledge differed.

CONCLUSION

Analysis of responses to item level certainty has informed development of a definition of adequate self-monitoring that may be applied to individual student's responses from a single test, and to track the adequacy of a student's self-monitoring over time. Patterns of self-monitoring tend to match patterns of knowledge, but not in all cases, suggesting the self-monitoring measure could provide additional information about student ability.

Informing the uninformed: a multitier approach to uncover students' misconceptions on cardiovascular physiology

Misconceptions about physiology are a major threat to accurate scientific and clinical reasoning in medical education. Awareness is often mentioned as a prerequisite to achieve conceptual understanding; however, students are frequently unaware of their incorrect understanding. We explored the multitier approach as a tool to obtain insight into students' awareness and misconceptions regarding cardiovascular physiology. Biomedical sciences students ( N = 81) participated in a diagnostic multitier assessment on cardiovascular physiology. Each question consisted of an answer tier and an explanation tier. Both tiers were paired with confidence tiers, i.e., 5-point Likert scales, which were used as an indicator for metacognitive evaluation, i.e., awareness. The average test score was 3.07 (maximum 4.0) for the answer tier only, and reduced to 1.57 when answer and explanation tiers were combined. A weak correlation ( R² = 0.13, P = 0.001) between students' confidence and their test scores was found for the combined responses. Correct combined answers were associated with an increase in confidence score of 0.27 vs. incorrect answers. Using a Bland-Altman analysis, we showed that students generally overestimated their knowledge. In total, 28.7% of all responses were classified as misconceptions, defined as incorrect answers paired with high confidence. In all, findings indicate that the multitier approach is useful to study students' conceptual understanding and uncover misconceptions on cardiovascular physiology. Furthermore, this study supports the need for metacognitive measures in order to improve teaching and learning in medical education.