Adult patient preference for an orthodontic care provider in Canada

INTRODUCTION

This study evaluated the factors influencing potential orthodontic patients' choice between an orthodontist, general dentist (GD), and direct-to-consumer (DTC) aligners for their treatment and their choice of orthodontic appliance type and explored their motivating factors for seeking orthodontic treatment and preference for appliance type.

METHODS

An electronic survey was administered to 330 Canadian adults to determine demographic background, choice of the orthodontic treatment provider, the preferred mode of treatment, orthodontic issues they wished to address, and motivation for treatment.

RESULTS

When participants were asked their preference in provider type, 49.4% of participants selected an orthodontist, 19.2% would follow the recommendation of their GD, 18.9% selected a GD, and 12.5% selected DTC aligners. Younger adult participants (P = 0.037) and those living in metropolitan areas (P = 0.0005) were significantly more likely to select an orthodontist than GD or DTC aligners. When asked about their preference in the mode of orthodontic treatment, 45.4% selected clear braces, 34.1% selected clear aligners, 14.3% selected metal braces, and 6.1% indicated they currently have no interest in orthodontic treatment. Older participants (P = 0.0005) and those in moderate-sized population centers (P = 0.001) were significantly more likely to select clear braces or aligners.

CONCLUSIONS

Adults in Canada have a high preference for orthodontic treatment performed by orthodontists, especially among younger participants and those in metropolitan areas. Although all ages preferred clear braces, younger adult participants tended to be more open to metal braces, whereas older participants' preference for clear braces was the strongest. Preference for clear aligners is positively correlated to increased community size.

Orthodontists' perceptions of and adaptations to nonspecialist and direct-to-consumer orthodontic service providers

OBJECTIVES

To evaluate orthodontists' perceived impacts on their practices as a result of general practitioners (GPs) and direct-to-consumer (DTC) orthodontic care providers and the adaptational changes implemented in the past 10 years.

MATERIALS AND METHODS

An electronic survey was administered to 270 orthodontists in Canada and the United States to determine demographic background, perception of perceived impact, and specific changes implemented to improve practice competitiveness.

RESULTS

More experienced orthodontists (P = .0001) and males (P = .027) were more likely to indicate a perceived impact from GP orthodontics. American orthodontists were significantly more likely than Canadian orthodontists to perceive an impact from DTC providers (P = .017). There was a positive association with orthodontists' years of experience and having implemented adaptational changes to their practice for a period greater than 10 years across multiple categories. Female orthodontists were more likely to have implemented adaptational changes for a period of less than 10 years across multiple categories.

CONCLUSIONS

The perceived impact of GPs providing orthodontic care was greater than that of DTC providers. American orthodontists were significantly more likely to perceive an impact from DTC providers. Orthodontists have experienced a reduction in referrals from GPs and an increase in referred case difficulty. Less experienced and female orthodontists have made the most adaptive changes to their practices in the past 10 years.

Assessing the Impact of Voice-Over Screen-Captured Presentations Delivered Online on Dental Students' Learning

The traditional lecturing method is still one of the most common forms of delivering content to students in dental education, but innovative learning technologies have the potential to improve the effectiveness and quality of teaching dental students. What challenges instructors is the extent to which these learning tools have a direct impact on student learning outcomes. The aim of this study was to assess the impact of a voice-over screen-captured learning tool by identifying a positive, nil, or negative impact on student learning as well as student engagement (affective, behavioral, and cognitive) when compared to the traditional face-to-face lecture. Extraneous variables thought to impact student learning were controlled by the use of baseline measures as well as random assignment of second-year dental students to one of two teaching conditions: voice-over screen-captured presentation delivered online and the traditional classroom lecture. A total of 28 students enrolled in the preclinical course in endodontics at a Canadian dental school participated in the study, 14 in each of the two teaching conditions. The results showed that, in most cases, the students who experienced the online lecture had somewhat higher posttest scores and perceived satisfaction levels than those in the face-to-face lecture group, but the differences did not achieve statistical significance except for their long-term recognition test scores. This study found that the students had comparable learning outcomes whether they experienced the face-to-face or the online lecture, but that the online lecture had a more positive impact on their long-term learning. The controls for extraneous variables used in this study suggest ways to improve research into the comparative impact of traditional and innovative teaching methods on student learning outcomes.

Graduating dental students' views of competency statements: importance, confidence, and time trends from 2008 to 2012

Competency documents are used in dental education as both an educational framework and an accreditation instrument. The aim of this study was to analyze the perceptions of graduating dental students at the University of British Columbia (UBC) regarding the importance of each competency statement, as well as to assess their confidence in their abilities associated with each statement. The instrument was based on the survey developed by Schönwetter et al. at the University of Manitoba using the Association of Canadian Faculties of Dentistry competency document. The current study surveyed UBC graduating students in the years 2008 through 2012. The response rates ranged from 66.7% to 95.9%, averaging 77.5% across all five years. The results showed that, overall, the students rated all the competencies as important, but they rated their confidence lower than the perceived importance. Correlation coefficients averaged a moderate correlation of 0.376 for all competency statements except the five with the greatest discrepancy between perceived importance and confidence. The competencies the students perceived as most important tended to be associated with tasks frequently performed during predoctoral dental education. The instrument used in this study can help other academic dental institutions identify patterns of students' perceived competency importance and confidence to inform allocation of teaching time and resources and adopt new methodologies to address identified areas of need.

Exploring professional development needs of educators in the health sciences professions

An increasing number of institutions of higher education are clustering their health sciences schools into a common unit. Therefore, it is imperative that the individual faculty development units assume new mandates to meet faculty development needs for stakeholders across these disciplines. Critical to providing current and relevant professional development activities is an awareness of the needs of academicians, including common as well as discipline-specific needs. Hence, the aim of this study was to explore the extent to which factors such as discipline, rank, gender, education, and years as an academician impact on perceived needs for faculty development. In February 2012, a cross-sectional survey of the perceived faculty development needs of academicians in the health sciences unit of a Canadian university was conducted using an online assessment tool. A total of 133 out of 1,409 potential participants completed the survey, for a response rate of 9.4%. The findings revealed more similarities than differences in terms of perceived faculty development needs. In addition, differences were found across all health professions schools and in factors such as discipline, academic rank, education, gender, and years as an academician. These findings suggest that faculty development and educational specialists should understand the shared as well as the unique needs of the individual health sciences schools in planning their professional development services.

Framework for e-learning assessment in dental education: a global model for the future

The framework presented in this article demonstrates strategies for a global approach to e-curricula in dental education by considering a collection of outcome assessment tools. By combining the outcomes for overall assessment, a global model for a pilot project that applies e-assessment tools to virtual learning environments (VLE), including haptics, is presented. Assessment strategies from two projects, HapTEL (Haptics in Technology Enhanced Learning) and UDENTE (Universal Dental E-learning), act as case-user studies that have helped develop the proposed global framework. They incorporate additional assessment tools and include evaluations from questionnaires and stakeholders' focus groups. These measure each of the factors affecting the classical teaching/learning theory framework as defined by Entwistle in a standardized manner. A mathematical combinatorial approach is proposed to join these results together as a global assessment. With the use of haptic-based simulation learning, exercises for tooth preparation assessing enamel and dentine were compared to plastic teeth in manikins. Equivalence for student performance for haptic versus traditional preparation methods was established, thus establishing the validity of the haptic solution for performing these exercises. Further data collected from HapTEL are still being analyzed, and pilots are being conducted to validate the proposed test measures. Initial results have been encouraging, but clearly the need persists to develop additional e-assessment methods for new learning domains.

Validity of scores from communication skills instruments for patients and their dental student-clinicians

The development of appropriate communication skills by healthcare providers is central to providing quality patient-centred care. Patients can provide valuable feedback to practitioners about their clinical communication. However, in oral health care, their involvement is uncommon and instruments specific for communication in oral health care have not been available. Recently, two complementary instruments have been developed by the Faculty of Dentistry, University of Manitoba for evaluating student-clinicians' clinical communication: one for patient evaluation and one for student self-evaluation. The aim of the current study was to provide validity evidence for the scores related to the internal structure of the revised 2007 versions of these instruments in two dental clinical/education contexts, namely the Universities of Manitoba, Canada (UM) and Adelaide, Australia (UA). The proposed factor structure and loadings, and their stability across contexts were assessed using confirmatory factor analysis, and the adequacy of the internal consistency reliability of the scores was analysed using Cronbach's alpha. The factor structure of the current 2007 versions of the patient and student instruments, derived from the previously developed longer versions of these instruments, was confirmed and was consistent across the two clinical/educational contexts. A model of partial invariance provided the best fit for these data due to variations in the magnitude of the factor loadings between sites. The internal consistency reliability of scores was high with a range of 0.88-0.97. In conclusion, the current study provides preliminary evidence regarding the validity of the scores of the current 2007 instruments, in terms of the internal structure, as measuring the five factors well. Replication of the factor structure of these instrument scores with more participants at both UA and other institutions is required.

Determining the validity and reliability of clinical communication assessment tools for dental patients and students

A shortcoming identified in the dental education literature is the scarcity of patient assessment of the quality of communication between student clinicians and patients. This study, the second in a series, attempts to address this scarcity by testing the communication components deemed critical to patients identified in the first article. Two instruments were tested: the Patient Communication Assessment Instrument (PCAI) and the Student Communication Assessment Instrument (SCAI). Item-to-total correlations and Cronbach's alpha were used to determine internal consistency reliability. Construct validity was examined through principal components factor analysis with varimax rotation using a total of 820 participants (410 patients and 410 students), who completed communication skills questionnaires collected in the 2006-07 school year as part of dental and dental hygiene clinical courses. Each component in the assessment instruments demonstrated internal consistency (alpha range=0.779-0.960). Based on a principal components analysis, six new factors were found to be significantly associated with communication skills: being caring and respectful, sharing information, interacting with team members, tending to comfort, professional relationship-building, and appointment preparation/follow-up. Correlational analysis demonstrated a core of critical instrument items to be considered for future assessment of the quality of communication between student clinicians and patients. Adequate estimates of reliability and validity for the PCAI and SCAI were demonstrated. Further research is needed in other countries and cultures to test and confirm the constructs.

Exploring the predictive ability of two new complementary instruments for assessing effective therapeutic communication skills of dental and dental hygiene students

Research on the development of effective therapeutic communication skills for oral health providers is slowly evolving. One of the initial steps in this research is to identify and address gaps in the work of previous researchers. Ultimately, the educational goal of competence in communications skills development is to provide improved patient care including improved patient satisfaction. This article is the third in a series describing the development of and findings from the new complementary Patient Communication Assessment Instrument (PCAI) and Student Communication Assessment Instrument (SCAI). The aim of the study reported here was to look at the relationship between communication skills and patient and student clinician gender interactions, sociodemographic factors (e.g., age, income), and changes in these interactions with length of treatment. A total of 410 patient assessments (PCAI) and 410 matching student self-assessments (SCAI) were used for further data analysis. Patients of female student clinicians, female patients, patients of a higher and the lowest income range, and older patients reported statistically significant higher student communication scores. The PCAI identified that certain groups of patients consistently report higher scores than other groups, whereas the SCAI identified differences between male and female student clinicians. The results have implications for educational protocols, communication strategies, and the need for continued research regarding sociodemographic factors and their relationship to patient satisfaction.

Developing new dental communication skills assessment tools by including patients and other stakeholders

Effectively using patients as teachers to provide authentic feedback is an underused strategy in dental education, but it has potential for integrating the teaching of therapeutic communication skills within the dental clinic setting. This study focuses on the absence of patient input into the design of instruments used to assess students' clinical communication skills and demonstrates how a holistic approach, with input from key stakeholders including patients, was used to produce two such instruments. The development of complementary communication assessment instruments, one for patient use and one for student use, took place in three phases. In Phase I the authors reviewed a sample of existing patient satisfaction surveys; in Phase II they captured input from stakeholders; and Phase III resulted in the generation of the patient communication assessment instrument and the student communication self-assessment instrument. This article highlights communication skill issues relevant to the education of oral health professionals and describes the rationale and process for the development of the first iteration of the patient assessment and student self-assessment clinical communication instruments.

Inclusion of oral-systemic health in predoctoral/undergraduate curricula of pharmacy, nursing, and medical schools around the world: a preliminary study

There is increasing evidence that oral health is a critical component of overall health and that poor oral health may lead to initiation or exacerbation of chronic inflammatory diseases/conditions and adverse pregnancy outcomes. Added to this is an increasing awareness that among non-dental health care professions curricula (e.g., medicine, nursing, pharmacy, and allied health) there is an apparent lack of information regarding the interrelationships between oral health and overall health or recognition of the significance of oral health in achieving and sustaining general health outcomes. This study explored the amount of information related to oral-systemic science currently being taught in the predoctoral/undergraduate professional curricula of pharmacy, nursing, and medical schools in English-speaking universities around the world. The Oral-Systemic Health Educational Curriculum Survey was circulated online to associate or academic deans at medical, nursing, and pharmacy schools in universities across Canada, the United States, Europe, Asia, Australia, and New Zealand. The survey found that 53.7 percent of the respondents ranked the inclusion of oral-systemic science as somewhat important, 51.2 percent reported no or limited requirements to incorporate oral health education within their curricula, and 59.6 percent rated their current curricula in oral-systemic health as inadequate. The majority of students in these programs are not being instructed to examine the mouth, nor are they being taught how to perform an oral examination. Despite growing awareness of emerging evidence of oral-systemic relationships and recommendations that all health care providers should contribute to enhancing oral health, this knowledge base appears to be substantially deficient in the curricula of pharmacy, nursing, and medical students in many universities. This study provides the first formal documentation that the curricula of non-dental health care professions, specifically in medicine, nursing, and pharmacy, do not contain adequate content related to oral-systemic health.

Assessing graduating dental students' competencies: the impact of classroom, clinic and externships learning experiences

OBJECTIVES

The present study assessed recent dental graduates' educational experiences with regard to competency development in different learning contexts and preparedness for independent professional performance.

METHODS

The present study employed a questionnaire examining University of Manitoba graduating dental students' confidence and perceived importance of 47 competencies expected by the ACFD/CDA by requiring students to rate each competency on a five-point Likert scale. In addition, contribution of each of the three learning environments (classroom, clinic, and externship) towards competency development was assessed.

RESULTS

Recent graduates reported most confidence in areas of basic clinical procedures involving radiographic, pharmacologic and caries management, with least confidence in implantology, orofacial pain, trauma and surgical management. Most importance was attributed to interpersonal-communication and basic clinical skills, with least importance in scientific research, implantology and prosthetic laboratory aspects. Overall, graduates felt that clinical setting contributed the most to competency development, followed by classroom and then externship contexts.

CONCLUSION

Graduating students' professional preparedness can reflect the quality of dental programme. However, the amount of importance that graduates place on each competency might impact their confidence in the associated competencies and vice versa. In addition, learning settings must be effectively utilised for particular competencies' development.

Developing reflective health care practitioners: learning from experience in dental hygiene education

Maintaining competence requires health care practitioners to remain current with research and implement practice changes. Having the capacity to reflect on practice experiences is a key skill, but reflective skills need to be taught and developed. This exploratory qualitative study examined the outcomes of a dental hygiene program requirement for developing reflective practitioners. Using a purposive convenience sample, students were solicited to participate in the study and submit reflective journals at the end of two terms. Eleven of twenty-six students participated in the study, providing sixty-four reflective entries that underwent qualitative thematic analysis. Using a reflective model, we identified themes, developed codes, and negotiated among ourselves to reach consensus. Results showed approximately two-thirds of the participants reached the central range as "reflectors" and most of the remaining fell within the lower range as "non-reflectors." We concluded that dental hygiene students reached similar levels of reflection to other groups and the triggers were varied, appropriate for early learners, and divided between positive and negative cues. However, the small sample represented less than one-half of the class, yielding a potentially biased sample. Therefore, we conclude that the findings provide a departure point for further research with a more cross-cutting sample in order to substantiate reflective educational requirements and validate these findings.

Advanced placement, qualifying, and degree completion programs for internationally trained dentists in Canada and the United States: an overview

Canadian and U.S. universities are faced with the challenge that they are not graduating enough dentists to meet the future needs of the Canadian and U.S. populations. Foreign-trained dentists represent a valuable resource to society and the economy. Dental programs have been established to train foreign-trained dentists for some or all of the following reasons: public need for health care services, income generation for universities, and demand by foreign-trained dentists who desire to practice dentistry in Canada or the United States rather than in their own nation. Changes implemented by the National Dental Examining Board (NDEB) of Canada in 2000 and by the Commission on Dental Accreditation (CODA) in the United States in 1986 have resulted in foreign-trained dentists no longer being able to gain dental licensure in these countries strictly through a certification examination. Foreign-trained dentists are now required to apply for and complete a two- to three-year advanced placement, qualifying, or degree program at a Canadian or U.S. dental school prior to receiving licensure to practice. The study reported in this article investigated the various types of advanced placement, qualifying, or degree programs available to foreign-trained dentists wishing to practice in either Canada or the United States and the differences among these programs. This research provides a better understanding of the various commonalities and differences among Canadian and U.S. programs for internationally trained dentists.

Dental service utilization by independently dwelling older adults in Manitoba, Canada

OBJECTIVES

The objectives of this study were to determine the rate of use of dental services by independently living older dentate and edentulous adults and the factors affecting utilization.

METHODS

Data were derived from the cross-sectional Manitoba Study of Health and Aging. A personal interview included over 240 questions addressing sociodemographics, well-being, oral and general health, and health service utilization. Variables that were significantly associated with visitation on bivariate analysis were entered into separate logistic regressions for dentate and edentulous participants. The Anderson model of health service utilization was used to categorize variables with significant independent effects as predisposing, enabling and need factors.

RESULTS

The 1,751 participants had a mean age of 76.2 years (standard deviation 7.1); 58.5% were women and 72.7% were edentulous. Only 383 participants (21.9%) reported having visited a dentist in the past 6 months. The visitation rate for dentate seniors (36.2%) was significantly higher (p < 0.001) than that for edentulous seniors (13.5%). Multiple logistic regression analysis revealed significant independent effects of 5 variables for each group. Predisposing factors predicting visitation for both groups were higher level of education and frequent use of professional services. For dentate adults, dental visitation was predicted by 3 enabling factors (main supporting person not a family member, fewer restrictions on activities of daily living and residence in a major urban centre) but no need factors. For edentulous participants, dental visitation was predicted by only 1 enabling factor (higher income) and 2 need factors (recent dental problems and longer duration of denture use).

DISCUSSION

Regular dental visits are important in maintaining good health, for edentulous as well as dentate seniors. Despite this fact, older Manitobans, especially the edentulous, are not accessing care in an appropriate manner. One unexpected finding was that despite equivalent abilities, cognitive status and health problems, those who had a family member as their main supporting person were less likely to have a dental visit than those supported by non-family members. This may relate to resistance from family members to provide appropriate support for dental visits, an issue considered by some to be a form of elder abuse.

CONCLUSION

Despite some common predisposing factors, the variables influencing dental utilization were different for dentate and edentulous participants, with enabling factors playing a bigger role for the dentate and need factors of greater importance for the edentulous. These findings seem to indicate that older dentate adults who visit the dentist do so because they can, while older edentulous adults who visit the dentist do so because they must.

Students' perceptions of effective classroom and clinical teaching in dental and dental hygiene education

Effective teaching behaviors have been studied in various arenas in higher education. However, there is limited research documenting effective teaching behaviors in dentistry and dental hygiene. Our qualitative study attempts to define effective teaching in both the classroom and clinic for dentistry and dental hygiene students. A total of 175 dental and dental hygiene undergraduate students nominated a total of forty instructors for teaching awards, providing a total of 695 qualitative statements reflecting their teaching in two learning contexts: the classroom and the clinic. Seven categories of effective teaching qualities were identified: individual rapport, organization, enthusiasm, learning, group interaction, exams and assignments, and breadth. Based on the frequency of the themes, effective teaching in the classroom was best defined by organization and rapport, whereas in the clinic, rapport was the most frequently described behavior. Moreover, dentistry students perceived enthusiasm as an effective teaching quality more frequently than did dental hygiene students, whereas dental hygiene students provided more responses to learning. These findings can provide guidance in preparing undergraduate dental and dental hygiene educators to enter the teaching environment. The ultimate goal to be achieved from identification of effective teaching qualities, as determined in this study, is improvement in clinical and classroom teaching for dentistry and dental hygiene programs.