Defining dental operative skills curricula: An ADEE consensus paper

Curriculum content for Environmental Sustainability in Dentistry

OBJECTIVES

(i) To identify suitable strategies and opportunities to embed Environmental Sustainability (ES) within an existing Oral Health Professional (OHP) curriculum through a series of focus groups with students and academic staff and (ii) To create high-level evidence-based and subject-specific ES content through an approach grounded in evidence and collaboration with key stakeholders in OHP education.

METHODS

Focus groups were used to explore academic staff and student views on appropriate teaching and assessment methods for ES. Content statements were developed from an extensive literature search, mapped to curriculum subjects, and validated through consultation with students, discipline-experts and education-experts.

RESULTS

Five themes were identified from the focus groups: ES transcends all disciplines of dentistry and oral healthcare; baseline knowledge transmission with relevant practical application; viewing and modifying existing teaching and assessment events through a different lens; normalising the topic of ES to support attitude and behaviour change and safeguarding against misinformation and disinformation. Forty-four content statements were developed and mapped to nineteen curriculum subjects.

CONCLUSIONS

This study identifies for the first time a comprehensive strategy for the inclusion and delivery of ES (method and content) in the curriculum. A novel method to define and map curriculum content has been explored and validated using a range of complementary methodologies. A comprehensive and robust list of evidence-based and subject-specific educational content statements have been defined in the field of Environmental Sustainability in dentistry and oral healthcare.

CLINICAL SIGNIFICANCE

Oral healthcare has a significant environmental impact, the key to all mitigation strategies is educating the profession at all levels.

Development of a three-dimensional printed model from a digital impression of a real patient for aesthetic dentistry undergraduate teaching

INTRODUCTION

The acquisition of skills and manual dexterity in aesthetic dentistry in undergraduate teaching requires preclinical practices with simulation that should approximate real clinical situations.

OBJECTIVE

We will present a digital procedure for the creation of three-dimensional (3D) resin models adapted to the practices of the Aesthetic Dentistry course.

MATERIAL AND METHOD

Stereolithography or Standard Tesellation Language (STL) files of a real patient were previously obtained with a 3-shape intraoral scanner. Using the Exocad computer programme for dental prosthesis design, various modifications were made, such as incisor rotation, surface alterations imitating dysplasias or erosions, the creation of diastemas, or even changes in tooth size. The virtual model was printed in resin for use by students. Once the practices were finished, the students and the teachers evaluated the use of the 3D printed models.

RESULTS

The result is the typodont model, in which seven laboratory sessions took place: 1-Restoration of conoid tooth morphology, 2-Cervical abrasion/ erosion restoration, 3-Direct Composite Veneer, 4-Aesthetic correction in a tooth with rotation, 5-Diastem closure, 6-Occlusal abrasions/ erosion, and 7-Maryland bridge. 90.48% of the students evaluated the designed 3D model as the best method for laboratory practice compared to other methods, obtaining a general assessment of 8.3 out of 10.

CONCLUSION

The method used has provided a reproducible standard analog model for direct aesthetic dental restoration practice, with a good assessment by students and teachers.

Structure, governance and delivery of specialist training programs in periodontology and implant dentistry

AIM

To update the competences and learning outcomes and their evaluation, educational methods and education quality assurance for the training of contemporary specialists in periodontology, including the impact of the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions (2018 Classification hereafter) and the European Federation of Periodontology (EFP) Clinical Practice Guidelines (CPGs).

METHODS

Evidence was gathered through scientific databases and by searching for European policies on higher education. In addition, two surveys were designed and sent to program directors and graduates.

RESULTS

Program directors reported that curricula were periodically adapted to incorporate advances in diagnosis, classification, treatment guidelines and clinical techniques, including the 2018 Classification and the EFP CPGs. Graduates evaluated their overall training positively, although satisfaction was limited for training in mucogingival and surgical procedures related to dental implants. Traditional educational methods, such as didactic lectures, are still commonly employed, but they are now often associated with more interactive methods such as case-based seminars and problem-based and simulation-based learning. The evaluation of competences/learning outcomes should employ multiple methods of assessment.

CONCLUSION

An update of competences and learning outcomes of specialist training in periodontology is proposed, including knowledge and practical application of the 2018 Classification and CPGs. Harmonizing specialist training in periodontology is a critical issue at the European level.

Consensus report of the second European Consensus Workshop on Education in Periodontology

BACKGROUND

The second European Consensus Workshop on Education in Periodontology was commissioned, as a result of the changes in the discipline and the advances in educational methods/technology, to update the 2009 Consensus report of the first European Federation of Periodontology (EFP) Workshop on the same topic that was jointly authored by the Association for Dental Education in Europe.

AIM

To identify and propose changes necessary in periodontal education at three levels, namely undergraduate, specialist and continuing professional development (CPD), with respect to learning outcomes, competencies and methods of learning/training and evaluation.

METHODS

Four working groups (WGs) considered education in periodontology at the undergraduate, specialist and CPD levels, and education methods. Four commissioned position papers, one per WG, summarized the relevant information. Workshop participants gathered at an in-person consensus meeting to discuss the individual reviews, and this consensus report summarizes the conclusions.

RESULTS

The learning outcomes for undergraduate and specialist education in periodontology have been updated, and a proposal for learning outcomes for CPD programmes was made. Learning/teaching/training and evaluation methods were proposed for each level of education, which included face-to-face, virtual and blended learning methods.

CONCLUSION

Developments in oral/dental medicine and in contemporary educational technologies have been translated into updated learning outcomes and learning/teaching/ training/evaluation methods relevant to education in periodontology.

O-HEALTH-EDU: A viewpoint into the current state of Oral Health Professional education in Europe: Part 1: Programme-level data

INTRODUCTION

Current legislation leaves Oral Health Professional (OHP) education open to wide interpretation and may result in significant variation in educational practice and resultant professional attributes across Europe. Data regarding the current state of OHP education across Europe is limited. The aim of Part 1 of this series is to provide programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education.

METHODS

A 91-item questionnaire was developed following the Delphi method. The questionnaire and the Articulate glossary of OHP education terms were developed concurrently to facilitate a common understanding of language. Piloting was performed in multiple stages and included institutions internal and external to the research group. The questionnaire was uploaded online and converted to a data hub, allowing dental schools to control their own data and update the data provided whenever they wish. All ADEE member schools (n = 144) were invited to provide data. Forty questions relating to school details, Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education were included in this part of the series.

RESULTS

Seventy-one institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Programme-level data for Primary Dental Degree Programmes, Dental Hygiene and Postgraduate Education is presented including programme length, funding, languages and fees, student numbers and demographics, student admission and selection processes and permission to practice after graduation.

CONCLUSION

This series of papers, as far as the authors are aware, are the first attempts to build a comprehensive picture of the current state of OHP education in Europe. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

O-Health-Edu: A viewpoint into the current state of oral health professional education in Europe: Part 2: Curriculum structure, facilities, staffing and quality assurance

INTRODUCTION

Oral health professional (OHP) education is likely to vary across Europe in accordance with an EU directive that is open to broad interpretation. It is not clear how OHP curricula are structured or delivered across Europe. The objectives of Part 2 of this paper series are: (i) to provide an overview of common practices in curriculum structure, the availability of facilities, staffing (faculty) and quality assurance processes and (ii) to consider how the existing programme structures align to stakeholder guidance documents.

METHODS

A total of 27 questions from a 91-item questionnaire were used for this manuscript. The questionnaire was developed following the Delphi method to establish consensus from a group of experts. Members of the research team and colleagues from other countries in Europe completed a multi-step piloting process. An online data hub was created to allow the respondents to be data controllers and respond to the questionnaire. ADEE member schools (n = 144) were invited to provide data.

RESULTS

Totally, 71 institutions from 25 European countries provided data between June 2021 and April 2023, which represents a response rate of 49.3% of ADEE members. Data on curriculum approaches, teaching methods, integration of topics of interest, clinical education, staff-student ratios, access to facilities and new technologies, teaching staff (faculty) and quality assurance processes are presented for Primary Dental Degree Programmes.

CONCLUSION

To the best of our knowledge, this series of papers are the first attempts to provide a comprehensive overview of OHP education in Europe. Results showed that the majority of European dental programmes are engaged in providing innovative and scientifically grounded education in order to develop quality future OHPs. Nevertheless, significant variability in the delivery of clinical education across the European OHP schools was notable in this dataset. A comprehensive view of the state of OHP education in Europe is not yet available but the O-Health-Edu data hub provides a means for all education providers in Europe to contribute data to reach this goal. It is anticipated that the data hub will be updated and built upon over time to continually establish a clearer picture of the state of OHP education in Europe.

Simulated skill complexity and perceived cognitive load during preclinical dental training

INTRODUCTION

Cognitive Load theory (CLT) focuses on the information processing aspect of learning and how the working memory handles the mental effort associated with new task. The aim of this study is to investigate the association between the perceived cognitive load and performance amongst dental students during preclinical simulation training at various levels of procedural task complexity. Additionally, some cognitive load-modifying factors were examined.

MATERIALS AND METHODS

This cross-sectional study evaluated the perceived cognitive load amongst second-year dental students (n = 34), using the validated National Aeronautics and Space Administration's Task Load Index (NASA TLX index) after training on four dental tasks at two levels of complexity, in addition to structured online anonymous questionnaire about demographics, feedback and performance. The NASA TLX raw scores and the weighted global score were calculated for each exercise. Descriptive statistics and Pearson's correlations between performance and the corresponding NASA TLX-weighted score were calculated. Mean differences in the perceived cognitive load across the exercise levels were assessed using RM-ANOVA with Bonferroni corrections at p < .05.

RESULTS

Reduced performance was significantly associated with higher cognitive load particularly in high complexity dental task (class II-mirror vision). Simulated exercise complexity significantly influenced the students' perceived mental demand, physical demand and temporal demand; all were significantly higher for class II- mirror vision task than for direct vision tasks. The majority of participants (82.1%) preferred detailed feedback from instructors, and more than half of the participants (60.7%) preferred continuous feedback throughout the training session.

CONCLUSION

Complex dental tasks are associated with higher cognitive load in novice dental students during preclinical training. The NASA TLX index is a useful instrument to explore the level of perceived cognitive load associated with performance of simulated complex dental skills. Cognitive load theory is relevant to simulation-based dental education to improve the preclinical instructional efficiency and to enhance students learning.

Embedding environmental sustainability within oral health professional curricula-Recommendations for teaching and assessment of learning outcomes

The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

Interactive Crossword Puzzles as an Adjunct Tool in Teaching Undergraduate Dental Students

Background. In the restorative dentistry module of the undergraduate dental program, dental students encounter many new terms and concepts in a short period of time. The provision of adequate learning support to reinforce key concepts can be challenging. Aim. The purpose of this study is to determine student perceptions of how effective interactive crossword puzzles are as adjunctive tools to enhance the learning of restorative dentistry. Methods. Students completed interactive crossword puzzles created by the authors, with a reward awarded to the first group of students who completed the puzzles successfully. The interactive crossword platform was programmed using the ReactJS framework and designed using Tailwind CSS. An evaluation of the student's perception of this educational method was conducted using textual feedback and Likert-scale questionnaires. Results. Students found the crossword puzzles engaging, meaningful, and successful as indicated by their favorable Likert scores and feedback. Written comments revealed student enthusiasm for and a desire to be exposed to more of these exercises. Conclusions. This work sheds light on the potential advantages of incorporating interactive crossword puzzles into the restorative dentistry course from a student’s perspective. The crossword puzzles improved students’ ability to review and reinforce concepts and terminology and proved to be meaningful and enjoyable. The web-based nature of the tool ensured good student responsiveness and engaged the entire class in an interactive, competitive setting. Application of the hint option, which offered a text of relevant reading material, helped students understand, retain more knowledge, and engage with course material more than they might have otherwise.

Proficiency Based Progression (PBP) training- the future model for dental operative skills training?: A systematic review and meta-analysis of existing literature

OBJECTIVE

To evaluate the effectiveness of Proficiency-Based Progression (PBP) operative training using validated performance metrics, by comparing this to standard, conventional training methods.

DATA

This systematic review was conducted in accordance with the guidelines of the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA). Study quality was assessed using the MERSQI tool and the Cochrane Risk of Bias tool. Results were pooled using biased corrected standardized mean difference and ratio-of-means (ROM). Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. In quantitative synthesis testing for procedural errors, a pooled meta-analysis on 87 trainees was conducted using random-effects models. In a ROM analysis, PBP was estimated to reduce the mean rate of errors by 62%, when compared to standard training (ROM 0.38, 95% CI: 0.25; 0.58; p < 0.001) Sources: The electronic databases of PubMed, Embase, Web of Science, MEDLINE and Cochrane library's CENTRAL were searched from inception to 8/11/2021. Filters activated were Randomized Controlled trials, clinical trial.

STUDY SELECTION

13 studies were included for review with 11 included in the quantitative synthesis from 174 potentially relevant publications identified by the search strategy. Main inclusion criteria were studies comparing standard surgical/operative training with proficiency-based simulation training using validated metrics based on expert performance.

CONCLUSIONS

Our meta-analysis found that PBP training improved trainees' performances, by decreasing procedural errors. There is sufficient evidence to explore PBP training for use in dental skills training. PBP training was estimated to reduce the mean rate of operative errors by 62%, when compared to standard training. Given that there is a direct correlation between operative skill and patient outcomes, these data suggest that there is sufficient evidence to explore PBP training for use in dental skills training.