Situational simulation teaching effectively improves dental students' non-operational clinical competency and objective structured clinical examination performance

BACKGROUND

Appropriate communication with dental patients enhances treatment outcomes and patient satisfaction. Implementing simulated patient interviews courses can improve patient-centered care and reduce conflict during clerkship training. Therefore, this study explored the relationship among student participation in a situational simulation course (SSC), academic performance, clerkship performance, and objective structured clinical examination (OSCE) performance.

METHODS

This study was conducted with a sample of fifth-year dental students undergoing clerkship training. After implementing a situational simulation course to investigate the relationship among participation in SSC, academic performance, clerkship performance, and OSCE performance, a path analysis model was developed and tested.

RESULTS

Eighty-seven fifth-year dental students were eligible for the SSC, and most (n = 70, 80.46%) volunteered to participate. The path analysis model revealed that academic performance had a direct effect on OSCE performance (β = 0.281, P = 0.003) and clerkship performance (β = 0.441, P < 0.001). In addition, SSC teaching had a direct effect on OSCE performance (β = 0.356, P < 0.001).

CONCLUSIONS

SSCs can enhance dental students' non-operational clinical competency and OSCE performance effectively. Simulated patient encounters with feedback, incorporated into the dental curricula, have led to improved communication. Based on our findings, we suggest implementing SSC teaching before the OSCE to improve communication and cognitive skills.

Student standardized patients versus occupational standardized patients for improving clinical competency among TCM medical students: a 3-year prospective randomized study

BACKGROUND

Standardized patient (SP) simulations are well-recognized patterns for practicing clinical skills and interactions. Our previous study showed that a simulation program using occupational SP for Traditional Chinese Medicine (OSP-TCMs) was efficient, however, a high cost and time-intensive nature have limited its use. TCM postgraduates trained as student SPs (SSP-TCMs) present a potentially cost-effective alternative. The purpose of this study was to examine and determine whether SSP simulation offered more benefits over didactic training alone for improving clinical competency among TCM medical students, and conduct a multifaceted analysis comparing SSP-TCMs and OSP-TCMs.

METHODS

This was a prospective, single-blinded, randomized controlled trial. Fourth-year TCM undergraduates were recruited as trainees from the Clinical Medical School, Chengdu University of TCM. Data were collected from September 2018 to December 2020. Trainees were randomly divided into the three following groups: traditional method training group, OSP-TCM training group, and SSP-TCM training group (1:1:1). At the end of a 10-week curriculum, trainees received a two-station examination comprising a systematic online knowledge test and an offline clinical performance examination. Post-training and post-exam questionnaires were administered to collect feedback from these trainees.

RESULTS

Students assigned to the SSP-TCM training and OSP-TCM training groups received favorable marks for the "systematic knowledge test" and "TCM clinical skills" (2018, P^a=0.018, P^b=0.042; 2019, P^a=0.01, P^b=0.033; 2020, P^a=0.035, P^b=0.039) compared to the TM trainees. Additionally, trainees in the intervention groups demonstrated a positive post-training edge in scores of "medical records" (2018, P^a=0.042, P^b=0.034; 2019, P^a=0.032, P^b=0.042; 2020, P^a=0.026, P^b=0.03) and "TCM syndrome differentiation and therapeutic regimen" (2018, P^b=0.032; 2019, P^a=0.037, P^b=0.024; 2020, P^a=0.036, P^b=0.043). For the simulation encounter assessment given by SP-TCMs, OSP-TCM trainees and SSP-TCM trainees scored higher than TM trainees (2018, P^a=0.038, P^b=0.037; 2019, P^a=0.024, P^b=0.022; 2020, P^a=0.019, P^b=0.021). For the feedback questionnaires, the students in TM group provided less positive feedback for training efficacy and test performance compared to those in the SSP-TCM and OSP-TCM groups. The trainees responded that the training effect of clinical simulations was similar between the SSP-TCM and OSP-TCM groups. SSP-TCMs were more responsive to unexpected emergencies (P^a=0.022, P^b>0.05) and more likely to encourage questioning (P^a=0.029, P^b>0.05) but tended to provide implied hints (P^c=0.015) and utilize medical jargon (P^c=0.007) as compared to OSP-TCMs.

CONCLUSION

Simulation training for SSP-TCMs and OSP-TCMs showed great benefits for enhancing clinical competency. SSP-TCM simulation was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.

Use of situational judgment tests for assessing non-cognitive attributes of final year dental students

OBJECTIVE

Situational judgment tests (SJT) have been previously used in the admission process of medical and dental undergraduate programs, but their utilization as an assessment tool is fairly new. The objective of this study was to explore essential non-cognitive attributes of dental graduates. We also aimed to assess the attributes of final year dental students utilizing SJT and later collected participants' reactions on the test.

METHODS

A mixed-method exploratory sequential study was conducted. One-on-one and group discussions were done with subject matter experts (SMEs) to explore the essential attributes of fresh dental graduates. Based on the thematic analysis, 10 SJT items per domain were constructed by one group of SMEs and expert validated by a different group of SMEs and vice versa. The final dental-SJT was piloted online on final year dental students and their perceptions were collected using a five-point Likert scale questionnaire. Descriptive statistics and Cronbach's alpha were calculated for the test.

RESULTS

The consultation with SMEs generated three main themes, namely, Conventional skills, Tribal skills, and Occupational skills. The 70-item dental-SJT piloted on 150 final year dental students revealed data were normally distributed. The internal reliability of test was good (0.738). Students scored highest in "management skills" (>70%) and lowest in "professional ethics" (56%) and "diverse experiences" (58%). The overall student perception about the test was good.

CONCLUSION

SJT is an effective tool to assess non-cognitive attributes of dental students. It has an overall positive perception about perceived predictive validity, perceived fairness, face and content validity.

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.

Implementing Standardized Patient Caregivers to Practice Difficult Conversations in a Pediatric Dentistry Course

INTRODUCTION

Standardized patient (SP) methodology has been used in health professional education to help students develop communication, deeper diagnostic reasoning, and critical thinking skills. Few examples demonstrate the use of SPs to practice difficult conversations with pediatric caregivers in the pediatric dentistry literature. The objective of this educational activity was to describe the implementation of three SPs in a pediatric dentistry course for second-year dental students.

METHODS

We developed three SP encounters covering interactions with caregivers of an infant with severe early childhood caries, an adolescent on the path to gender affirmation, and a child with autism and dental caries whose caregiver was resistant to fluoride- and silver-containing dental materials. We describe the case design process, rubric construction and calibration, student debriefing, and pandemic modifications. We evaluated the effectiveness of the implementation by thematic analysis of student reflections following each encounter using a qualitative descriptive framework.

RESULTS

Eighty-three students completed each encounter. Qualitative analysis showed that students preferred a more realistic encounter by having a child or other distraction present. Students relied on different elements of motivational interviewing depending on the objective of each encounter and the age of the patient. Overall, the SP encounters were well received by students and faculty as an alternative or supplement to traditional student evaluation methods.

DISCUSSION

We noted a number of lessons learned about implementing SP methodology in pediatric dental education. With these experiences now in place, future evaluations should measure student performance in the SP encounters against student performance during clinical care.

Assessment of clinical competency among TCM medical students using standardized patients of traditional Chinese medicine: A 5-year prospective randomized study

Background

Methods

Results

Conclusion

The utility of a formative one-station objective structured clinical examination for Substance use disorders in a dental curriculum

Substance use disorders (SUD) are chronic relapsing medical conditions characterised by compulsive substance seeking and use. They constitute a substantial disease burden globally. Labelling of persons with SUD has created barriers to treatment but there are effective management strategies. The dental profession has embraced reforms designed to address the SUD epidemic by promoting continuing education for practitioners and initiating curriculum changes in dental schools. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with SUD. The use of a formative 1-station Objective Structured Clinical Examination (OSCE) for learning and assessment in SBIRT, operationalised with the MD3 rating scale is presented in this study. In 3 years of implementation, the SBIRT OSCE successfully integrated into the curriculum of the College of Dental Medicine, Columbia University. Mean score of total adherent behaviours was 11.80 (SD =4.23) (range: 2 - 24) and Cronbach's coefficient alpha for across-items reliability in adherent behaviours was 0.66. Adherent behaviours correlated with the global ratings (r = 0.66). Mean of global rating scores were 2.90 (SD =1.01) for collaboration and 2.97 (SD =1.00) for empathy and the global rating scores correlated with each other (r = 0.85). Histograms of global rating scores resembled normal distribution. The 1-station OSCE is a good model for learning about SBIRT. Psychometric analysis was useful in understanding the underlying construct of the MD3 rating scale and supported its reliability, validity and utility in dental education.

Development of an Online Asynchronous Clinical Learning Resource ("Ask the Expert") in Dental Education to Promote Personalized Learning

This article describes the development and testing of an online asynchronous clinical learning resource named "Ask the Expert" to enhance clinical learning in dentistry. After the resource development, dental students from years 3 and 4 were randomly allocated to two groups (Group A-"Ask the Expert" and L-"lecturer-led"). All the students attempted a pre-test related to replacement of teeth in the anterior aesthetic zone. Group A (33 students) underwent an online case-based learning session of 60 minutes' duration without a facilitator, while Group L (27 students) concurrently underwent a case-based learning session of 60 minutes' duration with a lecturer facilitating the session. An immediate post-test was conducted followed by a retention test after one week. Student feedback was obtained. There was a significant increase in the test scores (maximum score 10) for both groups when comparing the pre-test (Group A-5.61 ± 1.34, Group L-5.22 ± 1.57) and immediate post-test scores (Group A-7.42 ± 1.34, Group L-8.04 ± 1.22; paired t-test, p < 0.001). However, no significant difference was observed in the test scores when comparing Group A to Group L for both the immediate post-test as well as the retention test (Group A-5.36 ± 1.29, Group L-5.33 ± 1.39 (independent sample t-test, p > 0.05). To conclude, adequately structured online asynchronous learning resources are comparable in their effectiveness to online synchronous learning in the undergraduate dental curriculum.

Effectiveness of patient education training on health professional student performance: A systematic review

BACKGROUND

Despite the fundamental role of patient education, concerns have been raised by health professionals, students, and professional bodies regarding student preparation for this area of practice.

OBJECTIVE

To evaluate the effectiveness of patient education training on health professional student performance.

METHOD

A systematic search was performed across PubMed, Cinahl, Embase, and Cochrane Library. Reference and forward citation searches of included articles were conducted. Inclusion criteria were published journal articles from 2010 to 2020 regarding patient education training for health professional students with measures relating to patient education performance. Quality appraisal of individual studies was conducted using Cochrane risk-of-bias v2 or ROBINS-I; overall appraisal was also determined. Sixteen articles met eligibility criteria. Independent data extraction was undertaken.

RESULTS

Fourteen studies reported improvements in student performance following patient education training; two studies reported no significant improvements. Of different modalities examined, simulation-based learning appeared to be most effective.

CONCLUSION

Patient education training enhances health professional students' performance of patient education. Future research is needed to evaluate effectiveness of pedagogically informed interventions across health professions using objective approaches to assess student performance in clinically relevant settings.

PRACTICAL VALUE

This review supports the use of specific training approaches to improve student performance of patient education.

Simulation-based education for selected communication skills: exploring the perception of post-graduate dental students

PURPOSE

The role of simulation-based education (SBE) in enhancing communication has been established in the literature. To ensure achieving desired outcomes from SBE initiative, the individual learners, their experiences, and environments need to be considered. This study aimed at exploring the perception of post-graduate dental students regarding their participation in SBE sessions, around selected communication skills, designed in alignment with the assumptions of adult learning theory and steps of Kolb's experiential learning cycle.

METHODS

This study utilized a qualitative design. Six focus-group sessions were conducted following the SBE sessions. The generated data was inductively investigated using a multi-staged participant-focused approach to thematic analysis, based upon constructivist epistemology. NVivo was utilized to facilitate text Fragments' coding and categorization.

RESULTS

Forty-three post-graduate dental students participated. The analysis resulted in 16 categories spread across five sequential phases of the SBE experience. The "input" theme referred to the resources needed for the SBE process, and included three categories: facilities, personnel, and teaching materials. The second theme included steps of SBE "process": pre-brief, simulation, and debrief. The third, fourth, and fifth themes constituted the short- and longer-term results of the SBE intervention. The participants reported instant benefits on confidence in their expertise in communicating with patients and their guardians. Additionally, perceived effects on the empathy and professionalism were reported.

CONCLUSION

SBE, that is based upon adult and experiential learning theories, and developed after thorough consideration of the individual learners, and their experiences and learning environments, holds potential in enhancing communication skills among post-graduate dental students.

Student Potential for Self-assessment in a Clinical Dentistry Practical Training Course on Communication Skills

This study aimed to investigate student potential for self-assessment in a clinical dentistry practical training course focused on communication skills. Participants were 124 fourth-year students (70 males, 54 females; all Japanese) in 2017 and 2018 at the Nippon Dental University, School of Life Dentistry at Niigata. Participating students belonged to different cohorts in 2017 and 2018. Participants were asked to complete a self-evaluation sheet at the end of each unit of the course. Their self-evaluation scores and the faculty evaluation scores for each student for Units 1-1, 1-2, and 1-3 were statistically analyzed. The results showed that females tended to rate themselves significantly higher than males. Furthermore, there were significant differences in evaluation scores between students and faculty for nine of 11 evaluation items for male students and 10 of 11 items for female students in Unit 1-3. Faculty expectations increased from Unit 1-1 to Unit 1-3, although students were satisfied with their performance and had a sense of achievement. However, students' actual performance was below faculty expectations, suggesting faculty evaluations were stricter than students' self-evaluation. Self-assessment may enhance students' ability for self-directed learning and may also inform how faculty can effectively educate dental students. Dental educators should support students to increase their levels of self-efficacy, which will enhance their self-evaluation skills.

Impact of simulated patients on students' self-assessment of competency in practice of geriatric dentistry

PURPOSE

The evaluation of the effectiveness of simulation training in dentistry has previously been focused primarily on psychomotor hand skills. This study explored the impact of simulated patient (SP) encounters in simulation on students' self-assessment of competency in their clinical and communication abilities with geriatric patients.

METHODS

Students from 2 cohorts were recruited for this study. Cohort 1 (n = 30) participated in the standard curriculum with no simulation training and served as the control group. Cohort 2 (n = 34) participated in a SP experience, simulating the initial stages of a care visit for 2 nursing home patients. Students' perceptions of competency to perform these clinical and communication tasks were assessed. A group debriefing session was held 5 weeks post-simulation where Cohort 2 completed a student feedback form.

RESULTS

A statistically significant change (P < 0.00001) was noted for both cohorts in their self-reported competence to perform clinical tasks following exposure to an independent clinical experience. In addition to this gain, individuals in Cohort 2 demonstrated improvements following simulation and expressed different responses of impact to questions related to treatment, pharmacology, and managing a complex medical history.

CONCLUSIONS

This study suggests that simulation of patient interactions using SPs can strengthen students' self-assessment of competency in their abilities, leading to more genuine interactions with actual patients. These findings will help inform the design of future SP encounters as a component of an evolving humanistic curriculum.

Agreement between simulated patients and faculty: Assessment of communication skills during objective structured clinical examination

Objective:

Ensuring competence in communication skills amongst trainees is essential in health professions education. Involving faculty members for the same is a challenge in Obstetrics and Gynecology (OBGYN) due to their clinical commitments. The present study compares scores of OBGYN faculty, non-OBGYN faculty and simulated patients (SPs) on communication skills of postgraduate trainees during formative Objective Structured Clinical Examination (OSCE).

Methods:

This is a psychometric study conducted in Feburary 2017 at the Aga Khan University Medical College (AKU-MC). All thirty-two postgraduate trainees of OBGYN gave consent. Each trainee was assessed by OBGYN faculty, non-OBGYN faculty and SP on communication skills at six stations using nine-point itemized rating-scale during formative OBGYN OSCE. The scores were reviewed using descriptive statistics, reliability was calculated using Cronbach’s alpha and inter-rater reliability was analyzed using Pearson correlation and intra-class correlation coefficient.

Results:

The score reliability of each of the examiners was >0.7. The mean scores showed that OBGYN faculty were most stringent while SPs were lenient examiners, however, non-OBGYN faculty scored in between. The inter-rater reliability among any two of the OBGYN, non-OBGYN and SP examiner was >0.84 using Pearson correlation and >0.9 using intra-class correlation.

Conclusion:

The SPs and non-OBGYN clinical faculty can also be used to assess communication and counseling skills on OBGYN OSCEs after required training as examiners.

Clinical dental technicians in the United Kingdom: A qualitative understanding of the experiences, of practices and challenges of communication for dental professionals

AIM

To investigate the roles and relationships of registered Clinical Dental Technicians (CDTs) in the dental team and healthcare systems, and their perspective as a professional group in the United Kingdom (UK).

METHODS

This qualitative study was conducted following a national questionnaire survey of CDTs, 18 of whom participated in semi-structured interviews; they were purposively sampled to represent the diversity and demography of CDTs. A topic guide, informed by the literature and survey findings, guided discussions which were recorded and transcribed verbatim. Drawing upon phenomenological and cultural relativistic theories, thematic analysis was conducted, thus enabling an "analytic story" of the lived experience to emerge.

RESULTS

Clinical dental technicians expressed pride, passion and satisfaction in their work yet feel misunderstood in their role. Experiences of being accepted and incorporated into the wider dental profession are strained. Ultimately, there is a complex web of inter-dependence between all actors-a triadic relationship-bounded by policymakers and regulators which directly impacts on best practice and the balance between collaboration and autonomy. Looking to the future, Ideal practice may involve different models of care, with examples of good practice emerging.

CONCLUSION

This paper provides a unique examination of the lived experience, feelings and relationships of CDTs. The perceptions of their role, their inter-professional relations and the progression as a professional group must be addressed, and their potential to work collaboratively actively engaged to serve our ageing population.

Students' Evaluations of Simulations in Dentistry: A Multiple Cohort Study at a U.S. Dental School

Simulation may help translate didactic learning to patient care in areas such as communication skills and medical emergency management. The aims of this study were to investigate how multiple cohorts of dental students evaluated simulations utilizing standardized patients and manikins and to explore evaluations of a simulation that combined social determinants of health with oral health education. All approximately 600 second- and fourth-year dental students at one U.S. dental school participated in simulation activities for five years (2014-18). The activities involved clinical communication skills with an urgent care patient, medical emergency management, and communication skills with a parent with low income. After the simulations, students were invited to complete an evaluation of the experience. Questionnaire items addressed perceived applicability to patient care, value of the experience, and fulfillment of objectives; and open-ended questions asked for comments specific to the parent with low income simulation. A total of 497 responses from D2 and D4 students were collected over the five-year period, as well as from all 12 periodontics residents in 2017, for an overall 91.7% response rate. The vast majority (>90.6%) positively evaluated all items for each simulation. The positive ratings ranged from a mean of 99.3% for the urgent care simulation to 93.8% for the parent with low income simulation. Positive student comments often related to learning from/with others and effective practice of teach back and patient education tactics. Students' most frequent suggestions for improvement called for better preparation. In this study, simulations with both standardized patients and manikins led to positive evaluations as well as anticipated improvement of clinical performance. These results suggest that incorporating simulation into an already-crowded curriculum is worth it from the student perspective, especially for reinforcement of clinical skills not easily amenable to classroom instruction.

Teaching and Assessment of Dentist-Patient Communication Skills: A Systematic Review to Identify Best-Evidence Methods

Dentist-patient communication skills are important aspects of contemporary oral health care, as shared decision making with patients becomes more common. The aim of this systematic review of the literature on teaching and assessment methodologies for communication skills in dental practice was to categorize those skills most relevant to dental practice and determine the best-evidence teaching and assessment methods. The systematic review was conducted using MEDLINE, EBM-Cochrane Libraries, Embase, ERIC, BIOSIS, CAB Abstracts, and PsycINFO using the OVID search engine, together with manually searching relevant journal articles. Relevant data were extracted from all included articles, and thematic analysis, categorization, and quality review of the articles was performed. Fifty articles published between 2000 and 2016 were identified as relevant to this study. Most were comparative design studies. The largest numbers were single group studies with before and after tests and cross-sectional studies. A total of 26 communication skills were identified and grouped into four major categories: generic skills, case-specific skills, time-specific skills, and emerging skills. Review of the teaching methods described in those articles showed that educators used a combination of passive and active strategies. All the assessment measures were considered to be valid and reliable. This categorization of essential dentist-patient communication skills reported in the literature may be used to assist in curriculum design along with use of tested teaching methods and validated assessment measures. The review highlights the need for more robust study designs for research in this important aspect of dental education.

Comparison of Dental Students' Self-Evaluation and Faculty Evaluation of Communication Skills During a Standardized Patient Exercise

The aims of this retrospective study, conducted in 2017, were to explore dental students' perceptions of their first standardized patient encounters and to assess the relationship between students' self-evaluation and faculty members' evaluation of students' communication skills in those encounters. Data from a simulation training laboratory at one U.S. dental school were obtained for all 46 second-year students, who had a standardized patient communication learning session. The students had completed self-evaluations before and after a debriefing with a clinical psychology and/or social work faculty member and three or four student peers. The faculty members had also completed evaluations of the students' communications skills. The results showed that the students found the standardized patient encounter helpful. The students rated "making an introduction" most positively. Students had a weighted Kappa agreement of 0.22 (p=0.024) with the faculty evaluations on their post-debriefing evaluation of overall communication skills, which was within the 0.21-0.40 range of fair agreement. This study found that, during their first standardized patient simulation exercise, the second-year students rated their overall communication skills in fair agreement with the faculty member after debriefing.