The influence of staffing and timetabling on achieving competence in surgical extractions

Evaluation of the efficacy of a simulation model used in oral and maxillofacial surgery education

BACKGROUND

The traditional teaching methods of dental education are gradually being replaced with futuristic education methods based on the usage of educational tools such as mannequin-based simulation models and virtual reality. However, the effectiveness of mannequin-based simulation models as a learning method in the field of oral surgery remains unclear. This study aims to investigate the efficacy of training on a tooth extraction model (TEM) in view of undergraduate dental students' experience and perception of their education.

METHODS

A quasi-experimental trial was implemented with two consecutive year classes, totaling 136 students at the Dentistry Faculty of Altinbas University, Turkiye. Two cohorts were created from dental students in the classes of 2023 and 2022 graduates. Cohort 1 (n = 71) received 14 h of theoretical education followed by 10 h of preclinical education on TEM. Cohort 2 (n = 65) received only 14 h of theoretical education. An anonymous questionnaire was prepared with four main sections including the preferences of learning style, participants' perceptions of the preclinical training methods, the students' competency and free text comments. Students' opinions were quantified with both 7-point Likert scales and thematic analysis. Anxiety levels were measured with the interval scale of anxiety response (ISAR). Descriptive statistics, inferential statistical and thematic analyses were conducted according to survey responses. Student characteristics were summarized and compared for two cohorts using a t-test. For all statistical analyses, the significance level was set atP ≤ 0.05.

RESULT

Cohort 1 was more comfortable with sequential motions performed with the forceps (P = 0.033) and felt more ready for their first clinical tooth extraction experience (P = 0.028). Cohort 2 showed a significantly higher preference for textbooks among supplementary materials (P = 0.04); however, they tended to exhibit lower self-confidence and higher anxiety levels, though without any statistical significance (P > 0.05).

CONCLUSION

It is clear that the students who have yet to start seeing patients benefit from increased practice with training models, which adequately reflect and represent real-life situations encountered in everyday practice.

Evaluation of Self-Perceived Confidence and Competence in Oral Surgery among Final Year Undergraduate Students in Greece

OBJECTIVES

 Oral surgery is an integral part of dentistry that deals with the diagnosis and management of pathology of the mouth and jaws that requires surgical intervention. The aim of undergraduate studies in oral surgery is, upon graduation, to be confident and competent to treat without assistance surgical cases in the spectrum of general dentistry. This study evaluates the senior Greek dental students' self-confidence and self-perceived competence to undertake cases within the scope of oral surgery. Evaluation of clinical experience gathered during training and self-perceived confidence and competence in generic oral surgery skills is included.

MATERIALS AND METHODS

 The present study was a questionnaire survey conducted during the academic year 2018-2019. The questionnaire comprised three sections. Section 1 included demographic data and four closed-ended questions concerning numerical data about procedures that they had already performed or observed, section 2 included four questions concerning their self-perceived competence to perform basic surgical techniques, and section 3 included 10 clinical case scenarios.

RESULTS

 One hundred and twenty-seven students participated in the study. Among the basic surgical skills, students were most confident with suturing, and they were least confident with bone removal. Students from the Aristotle University of Thessaloniki (AUTH) tend to show higher level of confidence compared with students from the National and Kapodistrian University of Athens (NKUA) in most questions.

CONCLUSION

 Greek graduate dental students report moderate levels of self-confidence in oral surgery. A realistic approach in increasing self-confidence and competence in oral surgery would be the focus on preclinical training in generic elementary surgical skills, in combination with increased observational sessions of oral surgery procedures or outreach training.

A city-wide survey of dental students' opinions on undergraduate oral surgery teaching

PURPOSE

This study aimed to carry out a city-wide survey to evaluate undergraduate students' opinions on their oral surgery training by measuring their self-confidence.

MATERIALS AND METHODS

A cross-sectional survey of 383 3rd year, 412 4th year and 363 5th year undergraduate dental students from six dental schools in Istanbul with a mean age of 22.73 ± 1.55 was conducted towards the end of the academic year. A web link to the questionnaire was sent to the contact person at the participating dental schools. The questionnaires were anonymously evaluated. Descriptive statistics were calculated, and Chi-square tests were performed to examine the data. A P-value of <.05 was considered to be statistically significant.

RESULTS

In total, 1158 responses were returned, representing 67% of the overall students in the 2018-2019 academic year. The male respondents were significantly more self-confident than females in the general aspects of surgical skills. More than half of the respondents (53%) felt confident in oral surgery knowledge to undertake independent practice. Although 5th year respondents felt more confident in the general aspect of the questionnaire, their ability of differentiation of odontogenic and non-odontogenic pain was lower than their counterparts. The majority (86%) of the participants disagreed that the only knowledge required for oral surgery was that of tooth and jaw anatomy.

CONCLUSION

This survey revealed perceived confidence in tooth and retained root extraction. The male respondents were found to be more self-confident. There is a need for improvement in surgical skills, recognition of malignancies and differentiation of the origin of the pain.

Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia

Introduction

Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a very commonly performed procedure.

Aim

The aim of this paper was to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia.

Materials and Methods

Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back and results from fully filled questionnaires were tabulated in Microsoft Excel 2007.

Results

Nearly 93.4% of the students perform extractions in their practice on a routine basis. Among those 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same.

Conclusion

This study revealed the need for increase in cases which will in turn help the students to transfer their theoretical knowledge into professional skills.

Students' perspectives on undergraduate oral surgery education

PURPOSE

This study evaluated students' perceptions of their self-confidence regarding aspects of their undergraduate oral and maxillofacial surgical training. It further aimed to develop a reliable Turkish version of the questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) Education Committee.

METHODS

A cross-sectional survey of 40 fourth-year and 47 fifth-year dentistry students of Yeditepe University Faculty of Dentistry in Turkey with a mean age of 23.30 ± 1.50 was conducted in January and February 2018. The ABAOMS questionnaire was adapted to the Turkish language and culture. The items were organized in five domains (general information, self-confidence in oral surgery, role of outreach, anatomy knowledge in relation to oral surgery, and career aspirations) with most response options on a five-point Likert-type scale. Reliability was assessed through an internal consistency analysis and a test-retest approach. Descriptive statistics, independent samples t-tests, and Chi-squared for contingency tests were used to examine the data.

RESULTS

Cronbach's alpha coefficient on the questionnaire was 0.89. The responses reflected general agreement among the respondents. Females were significantly more self-confident than males. Although the fifth-year respondents were more self-confident than the fourth-year respondents on items regarding anatomy knowledge, fourth-year respondents were more self confident in forceps extractions. Other than that no major differences in self-confidence were found between the two groups.

CONCLUSION

Though self-confidence was high regarding extraction of teeth and retained roots, the participants of this study lacked self-confidence in performing surgical extractions and its related procedures, recognition of malignancies, and ability to differentiate between pain of odontogenic or non-odontogenic origin. Female students were relatively more self-confident. Teaching should focus on practical applications that support students' sense of self-confidence in their abilities. The Turkish version of the questionnaire was a reliable instrument.

Student perceptions of exodontia competency assessment in a UK dental school

INTRODUCTION

Modern medical and dental training has migrated from assessing only the quantity of procedures performed to a combined assessment of both competency and quantity. This study explores student perceptions of competency assessment in exodontia at a UK dental school.

MATERIALS AND METHODS

Anonymous questionnaires were distributed to dental students in years three, four and five at the School of Dentistry, Cardiff University (n=149). Responses consisted of dichotomous tick boxes and 5-point Likert scales, with thematic analysis of free-text responses. Discrete variables were analysed using simple descriptive statistics. Recurring themes were identified from the responses.

RESULTS

A total of 129 questionnaires were returned (response rate 87%). Feedback from students indicated that they felt well prepared to undertake the competency assessment, agreeing that year three is the most appropriate year to assess competency (69%; n=86). In 50% of cases (n=65), the clinical supervisor was not present for the duration of the assessment. The undergraduate student body would like further teaching in the use of elevators (89%; n=114).

CONCLUSION

The competency assessment was deemed fit for purpose by the undergraduate student body. Further developments in the areas of clinical supervision and teaching on the use of elevators were considered and recommendations made to the School of Dentistry, Cardiff University. The current oral surgery course incorporates some of the recommendations.

Tooth extraction education at dental schools across Europe

Objectives/Aims:

To explore students’ opinion about theoretical and clinical training in tooth extraction at different European dental schools.

Materials and Methods:

An online questionnaire, containing 36 dichotomous, multiple choice and Likert scale rating questions, was distributed among students of 56 different dental schools. After excluding schools where <20 students responded, 656 questionnaires from 23 dental schools remained for statistical analysis.

Results:

Dental schools showed a wide variation in the initial practical teaching of tooth extraction, from years 2 to 6. Several schools used a preclinical training model, and most students considered this useful. Some students considered their knowledge about forceps and elevators insufficient (6–60%), as well as their preparation for complications (5–60%). Students usually had received education in forceps and elevator techniques. Inclusion of (non)surgical removal of retained roots and surgical removal of third molars showed a wide variety between dental schools. Less than half of the students reported education in surgical removal of impacted teeth. Students from four of the 23 dental schools felt insufficiently prepared in tooth extraction (Likert scale ⩽3).

Conclusion:

There is a wide variation among European dental schools in teaching programs of tooth extraction and the rating of these programs by students.

Experimental study on strength evaluation applied for teeth extraction: an in vivo study

PURPOSE

The aim of this work was to analyse all the applied movements when extracting healthy upper and lower jaw premolars for orthodontic purposes. The authors wanted to demonstrate that the different bone densities of the mandible and maxilla are not a significant parameter when related to the extraction force applied. The buccal and palatal rocking movements, plus the twisting movements were also measured in this in-vivo study during premolar extraction for orthodontic purposes.

METHODS

THE PHYSICAL STRAINS OR FORCES TRANSFERRED ONTO THE TEETH DURING EXTRACTION ARE THE FOLLOWING THREE MOVEMENTS: gripping, twisting, and traction. A strain measurement gauge was attached onto an ordinary dentistry plier. The strain measurement gauge was constituted with an extensimetric washer with three 45º grids. The system operation was correlated to the variation of electrical resistance.

RESULTS

The variations of resistance (∆R) and all the different forces applied to the teeth (∆V) were recorded by a computerized system. Data results were processed through Microsoft Excel. The results underlined the stress distribution on the extracted teeth during gripping, twisting and flexion.

CONCLUSIONS

The obtained data showed that the strength required to effect teeth extraction is not influenced by the quality of the bone but is instead influenced by the shape of the tooth's root.

A national survey of UK final year students' opinion of undergraduate oral surgery teaching

BACKGROUND

A national survey was undertaken to establish a baseline of our final year students' perception of how their undergraduate oral surgery education has equipped them for key areas of general dental practice.

MATERIALS AND METHODS

Questionnaires were distributed to the 13 UK schools with final year students, towards the end of the academic year in 2009. The questionnaires were completed anonymously and were optically scanned.

RESULTS

In total, 632 questionnaires were returned, which represents 66% of the students of the graduating year. The majority (83%) of the respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practise. Most respondents (99%) felt confident to perform forceps exodontia, but confidence in the various aspects of surgical exodontia was lower. A majority (83%) had experience of an outreach scheme performing forceps exodontia (75%) and surgical exodontia (16%) in this environment. Twenty per cent indicated a desire to undertake a career in oral surgery, 6% in oral and maxillofacial surgery and 35% in another speciality.

CONCLUSION

This survey suggests that the majority of the students perceive that the oral surgery education has prepared them well for key areas of general practice. It also suggests that there is, however, a need to provide further improvement in the delivery of surgical skills and knowledge.

Dental student suturing skills: a multicentre trial of a checklist-based assessment

BACKGROUND

The assessment of clinical skills is essential to determine whether an undergraduate is competent to perform the tasks outlined in the curriculum. Such assessments in dentistry have historically not been subjected to large scale validity and reliability testing due the relatively small student numbers at each institute. The aims of this study were to test the validity and reliability of a standardised, checklist-based, suturing objective structured clinical examination (OSCE) and then to perform a multicentre trial to determine its performance over a large cohort of students.

MATERIALS AND METHODS

A total of seven UK schools agreed to take part in the trial. To test the validity and reliability of the checklist, the examiner at each institution reviewed and scored video footage of 10 students performing the assessment. Each institution then carried out the assessment providing a checklist score and a global score for each of their own students.

RESULTS

The assessment was well received by the staff, with acceptable inter-examiner variability. In total, 496 students completed the suturing OSCE with a success rate of 81% with a variation between schools of between 66% and 96%. A significant correlation was found between the checklist score and the global score (r = 0.361, P = 0.000). No one item on the checklist was found to be a determinant factor in the outcome of the OSCE.

CONCLUSIONS

This checklist-based assessment of suturing skills was found to have face and content validity. Its reliability was promising, but merits further investigation. There may be an argument for the standardisation of the assessment of this core surgical skill throughout several UK-based dental schools.

Implementation and validation of an extraction course using mannequin models for undergraduate dental students

OBJECTIVE

There is a gap in the education of dental undergraduate students between theoretical knowledge and the practical procedure of tooth extraction. It was the aim of this study to implement and validate an undergraduate course for oral extraction using mannequin models, in order to enhance practical competence in this field of dentistry.

MATERIAL AND METHODS

A one-term oral extraction course was implemented as part of the oral surgery curriculum for undergraduate dental students, including 4 h of theoretical education, followed by 4 h of practical training in tooth extraction on mannequin models, with the students divided into small groups. Forty-nine students attending this extraction course were asked to validate their training in dental extraction using a questionnaire (TRIL-mod; University of Trier, Trier, Germany). The students' practical competence in oral extraction was assessed by a senior supervisor at the end of the course, using a standardized checklist.

RESULTS

All questionnaires were returned. Overall, the course was rated with an average score of 4.7 (rating range: 1-6; 1 = worst/6 = best). The assessment of practical skills yielded a successful and complete performance of tooth extraction by 94% of the students.

CONCLUSIONS

A tooth extraction course using a mannequin model is appreciated by dental students and can achieve a sufficient level of competence in tooth extraction with reasonable educational efforts.

Invited commentary: Issues with assessing competence in undergraduate dental education

Competence of practising dentists is an issue that is being addressed in both the undergraduate and postgraduate environment in dental education. The Association of Dental Education in Europe has opened the debate further with guidelines for qualifying dentists in Europe. This puts further pressure on dental schools to produce graduates who are transparently competent. This invited commentary examines the differing concepts of competence and how they might be assessed in the undergraduate dental curriculum.

The retention of suturing skills in dental undergraduates

BACKGROUND

The ability to place sutures is an essential skill in dentistry. In our institution, the introduction of a video teaching aid and a checklist-based assessment has improved the standardisation of teaching as well as the transparency and objectivity of the assessment of suture skills. The aim of this study was to determine whether this skill once acquired is retained in the short term.

MATERIALS AND METHODS

The same cohort of 67 fourth-year students performed the same assessment at two different time points 2 months apart. The first was a formative assessment and the second was a summative assessment. Feedback was collected on both occasions.

RESULTS

On the first sitting of the assessment, 93% of the students were successful compared with 79% on the second occasion. Student feedback was similar on both occasions with 77% and 75% reporting that they thought it was an easy exam. On the first occasion, 27% thought that it was a stressful examination compared with 43% on the second occasion, which may have affected their performance.

CONCLUSIONS

These findings suggest that regular reinforcement is required to avoid deterioration of suturing skills even in the short term. This might involve exposing the students to surgery earlier in the course and introducing regular formative assessments which the students appear to associate with less stress.