Evaluation of student readiness for clinical dental education at the end of preclinical education

OBJECTIVES

This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE.

METHODS

The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1 = 134) and B (class of 2025; n2 = 129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores.

RESULTS

Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p = 0.035) and the practical examination score (p = 0.03) while not associated with gender (p = 0.53) and the written examination score (p = 0.11).

CONCLUSION

Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

Correlation Between Student Performances on Case-Based Constructed-Response Formative Assessment and Summative Assessment

OBJECTIVES

This study aimed to evaluate the impact of formative assessment with case-based constructed-response question (CRQ) formats on student performance on the final summative assessment in the second-year periodontics course.

METHODS

Classroom quizzes with case-based CRQs were implemented as the formative assessment during the course. Each student received feedback on their responses from the course director. After all students (N = 128) took the second-year final examination, the Friedman test was conducted to compare student performances in each assessment over time. The multiple linear regression (MLR) model was used to evaluate the association between the second-year final examination score and plausible predictors-student gender, the second-year formative and midterm examination scores, and time spent on the final examination.

RESULTS

The mean % scores in the formative assessment (51) and midterm (84) examination were significantly lower than that of the final (87) examination (P < .01). The number of students who failed the final (6) examination was significantly lower than the midterm (16) examination (P = .03). The midterm (P < .0001) and the formative assessment (P = .0009) scores significantly affected the second-year final examination score while student gender (P = .59) and time spending (P = .83) showed no correlations.

CONCLUSION

Within the limitations of the study, student performance on case-based CRQs was correlated with student performance on the summative assessment.

Effectiveness of distance learning for preclinical periodontal education

INTRODUCTION

This study aimed to investigate the effectiveness of distance learning (DL) for the second-year periodontics course compared to classroom learning (CL). MATERIALS AND METHODS: DL for Class A (n1 = 126) and CL for Class B (n2 = 133) were implemented. The same instructors recorded or delivered the same lectures in the two learning modules during the second-year periodontics course. Classes A and B took the same final examinations (a total % score of 200). General linear model (GLM) and ordinal logistic regression (OLR) analyses were conducted after considering individual first-year final % scores as a covariate to test if the second-year final % scores and the distributions of letter grades were significantly different between Class A and B.

RESULTS

The mean second-year final % score of the DL group (166.4) was significantly higher than that of the CL group (160.8) (independent t-test, p = .019). However, in GLM, the first-year final % scores significantly affected the second-year scores (p = .016); the second-year final % scores between the two groups were not significantly different (p = .268) after considering the individual first-year scores. In OLR, there was no difference in the likelihood of getting lower grades in the second-year course between the two groups (odds ratio = 1.6; 95% confidence interval = [0.95, 2.72], p = .078) after considering the first-year final % scores.

CONCLUSION

Within the limitations of the study, the DL for preclinical periodontics resulted in comparable student learning outcomes when compared to the traditional CL.

A Sex-Specific Evaluation of Dental Students' Ability to Perform Subgingival Debridement: Randomized Trial

BACKGROUND

A successful periodontitis treatment demands good manual skills. A correlation between biological sex and dental students' manual dexterity is currently unknown.

OBJECTIVE

This study examines performance differences between male and female students within subgingival debridement.

METHODS

A total of 75 third-year dental students were divided by biological sex (male/female) and randomly assigned to one of two work methods (manual curettes n=38; power-driven instruments n=37). Students were trained on periodontitis models for 25 minutes daily over 10 days using the assigned manual or power-driven instrument. Practical training included subgingival debridement of all tooth types on phantom heads. Practical exams were performed after the training session (T1) and after 6 months (T2), and comprised subgingival debridement of four teeth within 20 minutes. The percentage of debrided root surface was assessed and statistically analyzed using a linear mixed-effects regression model (P<.05).

RESULTS

The analysis is based on 68 students (both groups n=34). The percentage of cleaned surfaces was not significantly different (P=.40) between male (mean 81.6%, SD 18.2%) and female (mean 76.3%, SD 21.1%) students, irrespective of the instrument used. The use of power-driven instruments (mean 81.3%, SD 20.5%) led to significantly better results than the use of manual curettes (mean 75.4%, SD 19.4%; P=.02), and the overall performance decreased over time (T1: mean 84.5%, SD 17.5%; T2: mean 72.3%, SD 20.8%; P<.001).

CONCLUSIONS

Female and male students performed equally well in subgingival debridement. Therefore, sex-differentiated teaching methods are not necessary.

Social Determinants of Health Screening by Preclinical Medical Students During the COVID-19 Pandemic: Service-Based Learning Case Study

BACKGROUND

The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health.

OBJECTIVE

This pilot project's objective was to evaluate the feasibility of using a real-world, service-based learning approach for training preclinical students to assess social needs and make relevant referrals via the electronic medical record during the COVID-19 pandemic (May to June 2020).

METHODS

This project was designed to address an acute community service need and to teach preclinical, second-year medical student volunteers (n=11) how to assess social needs and make referrals by using the 10-item Social Determinants of Health Screening Questionnaire in the electronic health record (EHR; Epic platform; Epic Systems Corporation). Third-year medical student volunteers (n=3), who had completed 6 clinical rotations, led the 2-hour skills development orientation and were available for ongoing mentoring and peer support. All student-patient communication was conducted by telephone, and bilingual (English and Spanish) students called the patients who preferred to communicate in Spanish. We analyzed EHR data extracted from Epic to evaluate screening and data extracted from REDCap (Research Electronic Data Capture; Vanderbilt University) to evaluate community health workers' notes. We elicited feedback from the participating preclinical students to evaluate the future use of this community-based service learning approach in our preclinical curriculum.

RESULTS

The preclinical students completed 45 screening interviews. Of the 45 screened patients, 20 (44%) screened positive for at least 1 social need. Almost all of these patients (19/20, 95%) were referred to the community health worker. Half (8/16, 50%) of the patients who had consultations with the community health worker were connected with a relevant social service resource. The preclinical students indicated that project participation increased their ability to assess social needs and make needed EHR referrals. Food insecurity was the most common social need.

CONCLUSIONS

Practical exposure to social needs assessment has the potential to help preclinical medical students develop the ability to address social concerns prior to entering clinical clerkships in their third year of medical school. The students can also become familiar with the EHR prior to entering third-year clerkships. Physicians, who are aware of social needs and have the electronic medical record tools and staff resources needed to act, can create workflows to make social needs assessments and services integral components of health care. Research studies and quality improvement initiatives need to investigate how to integrate screening for social needs and connecting patients to the appropriate social services into routine primary care procedures.

Effectiveness of remote simulation-based learning for periodontal instrumentation: A non-inferiority study

OBJECTIVES

While numerous virtual/remote simulation-based learning (SBL) modules were implemented due to the COVID-19 pandemic, limited data on their effectiveness are available. This study aimed to investigate the effectiveness of a remote SBL module for periodontal instrumentation compared to traditional onsite SBL modules.

METHODS

Calibrated faculty members have instructed in all modules. Synchronous remote SBL activities using a secure videoconferencing application, which replaced onsite practices, were conducted in a small group setting in the remote SBL module for the class of 2023. After the class took the onsite second-year practical examination, a set of multiple and logistic regression analyses (N = 389) were conducted to test if the second-year practical examination scores and the passing rates were significantly different between the remote SBL (class of 2023) and onsite SBL I and II (class of 2019 and 2022) groups.

RESULTS

Both mean practical examination score and passing rate from the remote SBL group (class of 2023) were significantly higher than those from the onsite SBL II group (class of 2022) when their first-year practical examination scores were not considered (p < 0.05). Once the first-year practical examination scores were considered, the remote SBL group was not significantly different from the onsite SBL I and II groups with respect to the mean second-year practical examination score and the passing rate.

CONCLUSION

The proposed remote SBL module achieved the comparable student learning outcomes compared to the onsite SBL modules while it utilized less staff, time, and material expenditure.

Remote Teaching in a Preclinical Phantom Course in Operative Dentistry During the COVID-19 Pandemic: Observational Case Study

BACKGROUND

During the acute COVID-19 pandemic, physical access to the University Medical Center Göttingen was restricted for students. For the first time at our dental school, theoretical knowledge was imparted to students via asynchronous online screencasts and discussed via synchronous video meetings only.

OBJECTIVE

We aimed to assess the acceptance and effectiveness of distance education as a new teaching format for theoretical knowledge within the preclinical course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany).

METHODS

The phantom course comprised distance education (first phase, 11 weeks) and subsequent on-site practical demonstrations and training (second phase, 10 weeks). All theoretical knowledge was taught via online screencasts during distance education (except for the first week, 3 screencasts were uploaded per week resulting in a total of 30 screencasts). Until the end of the term, all students (N=33) were able to view the screencasts for an unlimited number of times. Theoretical knowledge was assessed in a summative examination after practical on-site teaching. Acceptance and effectiveness of the new curriculum and distance education were also measured based on an evaluation survey and students' self-perceived learning outcome, which was compared to the outcome from the two pre-COVID-19 terms.

RESULTS

Each screencast was viewed by a mean of 24 (SD 3.3) students and accessed a mean of 5.6 (SD 1.2) times per user (ie, by students who accessed the respective screencast at least once). During distance education, the number of accesses showed a linear trend over time. During the practical training phase, screencast views declined and increased again prior to the examination. Screencasts covering topics in Cariology, Restorative Dentistry, and Preventive Dentistry were viewed by more students than screencasts covering topics in Endodontology or Periodontology (both P=.047). Examination items in Periodontology showed inferior results compared to the other topics (P<.001). Within the different topics, students' self-perceived learning outcome did not differ from that during the pre-COVID-19 terms. Although most students agreed that the presented screencasts contributed to their learning outcome, pre-COVID-19 term students more strongly felt that lectures significantly contributed to their learning outcome (P=.03).

CONCLUSIONS

Screencasts showed high acceptance and effectiveness among the students but were not used as a learning tool by all students. However, students who viewed the screencasts accessed each screencast more frequently than they could have attended a conventional lecture. Screencast views were mostly due to intrinsic motivation.

Anesthesiologists Have an Important Role in Preclinical Nurse Anesthesia Education

Anesthesiologists do not participate regularly in the preclinical portion of nurse anesthesia training programs (NAPs). This practice is predicated on a historical separation of the early educational tracks of physicians and advanced practice nurses whose professions ultimately came to occupy overlapping niches within the field of anesthesia. The state of affairs has been bolstered by territorial friction between professional organizations, and by the lack of a perceived need for anesthesiologists to become involved at an early stage of nurse anesthesia education given the large number of qualified certified registered nurse anesthesia instructors available to perform this role. Anesthesiologists, however, have significant pedagogical assets to offer NAPs, including expertise in critical analysis and decision-making skills related to perioperative adverse events. In addition, introduction of anesthesiologists into preclinical NAP education has the potential to inject added academic rigor into NAPs currently transitioning to Doctor of Nursing Practice programs. Likewise, NAPs offer a professional haven for those anesthesiologists seeking new challenges in education, and a unique opportunity to shape the future of anesthesia. Most importantly, introducing anesthesiologists into the initial educational phases of the nurse anesthesia profession provides an opportunity to grow trust and understanding between these two professions that are critical for safe, healthy, and lasting partnerships in future years.

Effect of a high-intensity one-week training programme and student-level variables on the bovine transrectal palpation and pregnancy diagnosis skills of final-year veterinary students

BACKGROUND

To improve bovine transrectal palpation (TRP) and pregnancy diagnosis (PD) training, the effect of a high-intensity one-week training programme for veterinary elective students (N=59) with an interest in production animal practice was evaluated.

METHODS

Training consisted of exposure to rectal examination simulators, abattoir organs, theory materials and live cow PDs supervised by experienced large animal practitioners. Palpation skills were assessed before and after training using a validated TRP Objective Structured Clinical Examination (OSCE) in non-pregnant cows. Each student then performed PDs (n=12) on cows of known pregnancy status. Students' PD accuracy was measured as sensitivity and specificity, being respectively defined as the proportion of pregnant and non-pregnant cows correctly identified.

RESULTS

Students' scores improved from the first to the second OSCE (P=0.03), mostly as a result of improved ability to identify uterine symmetry/asymmetry and the presence/absence of a corpus luteum on the right ovary (P<0.01 and P=0.03, respectively). Overall student sensitivity and specificity of PD were 89.1 per cent (95 per cent CI 78.1-92.2 per cent) and 67.7 per cent (95 per cent CI 60.1-74.5 per cent), respectively.

CONCLUSION

This prospective cohort study describes a strategy to improve students' TRP skills with the potential to reduce training time and animal use at teaching institutions by outsourcing student training to private practitioners.

Transitioning from pre-clinical to clinical dental radiology, a pilot study: Student perceived influences on confidence

INTRODUCTION

Producing radiographic images requires the use of ionizing radiation, which has been well documented for its potentially detrimental effects on human tissues. Therefore, dental hygiene students begin their radiographic training by practicing on manikins in a pre-clinical environment. Use of manikins does not allow for patient interaction factors. No published dental studies have examined factors important in helping dental hygiene students develop confidence during the transition from manikins to working with live patients in a clinical radiology setting.

PURPOSE/OBJECTIVES

The purpose of this study was to identify students' perceived influences on confidence and ultimately on performance when transitioning from a pre-clinical radiology setting to working with live patients. Specific research questions that were answered by this qualitative study were (1) What pre-clinical radiographic experiences did students feel were beneficial for transitioning from manikins to live patients? (2) What were the primary factors that students felt they struggled with when initially taking radiographs on patients?

METHODS

A qualitative study design was implemented in 2017. Data were obtained from students in a 2-year dental hygiene program. Survey responses, focus group feedback, and observation data were used to identify common themes. Emergent themes were reported using frequencies, emic and etic expressions.

RESULTS

Four themes surfaced surrounding patient management, communication, appointment mechanics, and infection control.

CONCLUSION

The use of standardized simulated patients may enhance clinical preparedness and confidence.

COVID-19 Can Catalyze the Modernization of Medical Education

Amid the coronavirus disease (COVID-19) crisis, we have witnessed true physicianship as our frontline doctors apply clinical problem-solving to an illness without a textbook algorithm. Yet, for over a century, medical education in the United States has plowed ahead with a system that prioritizes content delivery over problem-solving. As resident trainees, we are acutely aware that memorizing content is not enough. We need a preclinical system designed to steer early learners from "know" to "know how." Education leaders have long advocated for such changes to the medical school structure. For what may be the first time, we have a real chance to effect change. In response to the COVID-19 pandemic, medical educators have scrambled to conform curricula to social distancing mandates. The resulting online infrastructures are a rare chance for risk-averse medical institutions to modernize how we train our future physicians-starting by eliminating the traditional classroom lecture. Institutions should capitalize on new digital infrastructures and curricular flexibility to facilitate the eventual rollout of flipped classrooms-a system designed to cultivate not only knowledge acquisition but problem-solving skills and creativity. These skills are more vital than ever for modern physicians.

Does virtual reality training improve veterinary students' first canine surgical performance?

BACKGROUND

Virtual reality (VR) applications are effective tools in many educational disciplines. A minimally interactive VR application allowing stereoscopic viewing of surgical videos has been developed to aid veterinary students learning to perform surgery. We sought to describe how students used the VR application while preparing to perform their first canine sterilisation surgery and compare surgical performance of students who prepared using traditional methods with students who also used VR.

METHODS

Third-year veterinary students (n=44) were randomised into control and VR groups in a parallel superiority randomised controlled trial. All were given lectures, videos and skills practice on models. VR group students were also given a VR application and headset to view stereoscopic surgical videos. Blinded raters scored a subset of students (n=19) as they performed their first canine ovariohysterectomy.

RESULTS AND CONCLUSIONS

Groups spent similar time preparing to perform surgery, potentially because of the rigour of students' non-surgical course load. When VR training was added to an already comprehensive surgical skills curriculum, students watched VR videos for a median of 90 min. Groups did not differ in surgical performance scores or time. A larger study of the VR application with prescribed use guidelines would be a helpful subsequent study.

Preclinical Competency Testing in North American Dental Schools and Opinions About Possible Standardization

In the U.S., the Commission on Dental Accreditation (CODA) requires that dental schools use competency-based assessments and standardized levels of proficiency to ensure that students are prepared for patient care after graduation. No such comprehensive standardized preclinical testing is required in the CODA standards. The aim of this study was to determine the use of preclinical competency assessments for students transitioning from preclinical to clinical education in North American dental schools and respondents' perceptions of the need for standardization in preclinical testing. An electronic survey was sent to the academic deans of all 76 U.S. and Canadian dental schools in July 2018 asking if the school used competency exams to assess preclinical students prior to entering patient care and, if so, about the type of tests and disciplines tested, student remediation, and reasons for revisions. The survey also asked for the respondents' perspectives on potential preclinical assessment standardization. Respondents from 28 U.S. and two Canadian schools participated in the survey, for a 39.5% response rate. The majority (92.3%) of respondents said their school considered preclinical competency assessments to be good indicators of students' readiness for transitioning into patient care, yet 40.0% reported their schools had no comprehensive preclinical testing, and 13.8% had no preclinical testing in endodontics, periodontics, prosthetics, or restorative dentistry. Regarding type of comprehensive preclinical assessment used, 71.4% reported using typodont-based exams, 46.4% used written comprehensive exams, and 42.9% used objective structured clinical examinations (OSCEs); respondents could select all that applied on this item. Of the respondents whose schools had preclinical competency assessments, 72.4% had a review mechanism in place to evaluate its effectiveness. Overall, this study found that 60% of the participating schools had some form of preclinical testing, but there were no agreed-upon competencies to determine preclinical dental students' readiness for safe patient care in their clinical education.

Teaching best practice in hand hygiene: student use and performance with a gamified gesture recognition system

The use of an automated gesture recognition system to teach the commonly adopted, seven-stage hand hygiene technique to veterinary undergraduate students was evaluated. The system features moderate gamification, intended to motivate the student to use the machine repeatedly. The system records each handwash stage, and those found to be difficult are identified and reported back. The gamification element alone was not sufficient to encourage repeated use of the machine, with only 13.6 per cent of 611 eligible students interacting with the machine on one or more occasion. Overall engagement remained low (mean sessions per user: 3.5, ±0.60 confidence interval), even following recruitment of infection control ambassadors who were given a specific remit to encourage engagement with the system. Compliance monitoring was introduced to explore how students used the system. Hand hygiene performance did not improve with repeated use. There was evidence that the stages-fingers interlaced, rotation of the thumb, rotation of the fingertips and rotation of the wrists-were more challenging for students to master (p=0.0197 to p<0.0001) than the back of the hand and of the fingers. Veterinary schools wishing to use such a system should consider adopting approaches that encourage peer buy-in, and highlight the ability to practise difficult stages of the technique.

Use of Digital Technology to Improve Objective and Reliable Assessment in Dental Student Simulation Laboratories

The aim of this study was to assess inter-and intra-grader agreement with the use of digital scanning and a tooth preparation assessment software program in comparison to the current traditional visual grading method in a dental student simulation laboratory. Students' typodont teeth preparations from previous practical examinations were used (cast crown n=50; cast fixed partial denture abutments n=50). Five preclinical instructors received calibration training and evaluated each of the preparations by the traditional visual grading method using a rubric. The same preparations were assessed by the same instructors using a tooth preparation assessment software program (PrepCheck, Sirona). The results showed that intra-grader agreement was significantly higher when grades were determined by PrepCheck compared to the traditional visual grading method. The traditional method was associated with significantly greater inter-grader disagreement in comparison to grading using PrepCheck (p<0.05). When the average final grade for students' crown preparations by each grader was compared for the traditional method and PrepCheck, significant differences were found for all graders (p<0.001). In this study, the use of the PrepCheck software program greatly improved intra-and inter-grader agreement during grading in a student simulation laboratory. Digital technology may improve the objectivity and reliability of assessments by preclinical evaluators.

3D Printed Teeth for the Preclinical Education of Dental Students

A need for more realistic tooth models for education has often been expressed by dental students. The aim of this study was to design and create 3D printed teeth with anatomical details for use in preclinical dental education. A tooth with realistic carious lesions and pulp cavity was designed, and this tooth was used in 2018 with 47 dental students for preclinical education in caries excavation, direct capping of the pulp, core build-up, and crown preparation. The students had the ability to identify the carious lesions by a simulated radiograph and by tactile sense of the consistency. The benefits of the 3D printed tooth were evaluated by a questionnaire. The printed tooth was evaluated by grades (1=excellent, 2=good, 3=satisfactory, 4=adequate, 5=poor). The students gave the tooth an overall mean grade of 1.9, with a grade of 2.0 for the haptic impression, 1.5 for the exercise, 1.9 for the examination, and 1.5 for high practical relevance in contrast to a standard model tooth. The new features of the printed tooth were given a mean grade of 2.0 for the radiograph, 2.3 for consistency of the caries, 2.0 for the tooth filling, and 1.7 for the pulp capping as realistic. The students had the possibility to generate a complete concept for prosthodontic tooth treatment on an artificial 3D printed tooth.

The modern UK veterinary profession: photo-elicitation interviewing reveals that small animal and surgical images dominate

More than 80 per cent of vets are employed in clinical practice but other veterinary roles are vital for society. However, even clinical practice does not seem to fulfil some modern graduates, and an increasing number of veterinarians are leaving the profession to pursue other careers. Research suggests that less than 50 per cent of veterinarians would choose to undertake their career path again, so the profession faces a 'workforce crisis'. Through semi-structured photo-elicitation interviewing, this study has explored the image that students embarking on veterinary education have of the profession. The students' dominant image of the profession, and their perception of the public image, was small animal practice. A large proportion (n=16, 80 per cent) of participants saw themselves working in clinical practice, with many (n=8, 40 per cent) aspiring to focus on surgery. The image of the veterinary profession has changed since the 1970s when the James Herriot mixed practice model was well known to the public. The dominant small animal and surgical image emerging demonstrates a need for members of the profession to work together to educate public and entrant perception, emphasising the diversity of veterinary careers and their value to society, to allow aspiring veterinary entrants to develop a range of career goals.

Self-Paced Versus Instructor-Paced Preclinical Training in Operative Dentistry: A Case Study

Preclinical operative dentistry courses have traditionally involved a lockstep series of live lectures and laboratory exercises. The aims of this study were to assess the effects of an experimental self-paced operative dentistry course on students' perceptions and performance and to compare performance outcomes for this class with the classes two years prior and two years after, which were instructed with the traditional curriculum. In 2013, all lectures in one of three operative dentistry courses at the University of Minnesota School of Dentistry were placed online as narrated slide sequences. For the study, conducted in 2017, students' performance in the course in all five years was assessed, based on exams taken after the laboratory and lecture segments of the course and the practical exam. The experimental class was also invited to complete an end-of-course survey on perceptions of the learning experience. The number of students in classes using the traditional format (in 2011, 2012, 2014, and 2015) ranged from 103 to 108. In the experimental year (2013), 106 students were in the class; course assessments were done for all 106, and 104 responded to the survey (response rate 98%). The results showed no significant differences in assessments between the experimental class and the traditional classes. However, bench instructors reported feeling students in the experimental class were not as well prepared in laboratory sessions as were the traditionally trained students. On the survey, only 22% of students in the experimental class said they always viewed assigned material before the lab periods, with 78% viewing it often, sometimes, seldom, or never. In this class, 48% preferred the online lectures, 37% preferred live lectures, and 16% had no preference. These mixed results suggest caution when developing self-paced courses.

Reporting of suspected dog fighting to the police, Royal Society for the Prevention of Cruelty to Animals and equivalents by veterinary professionals in the UK

Dog fighting became unlawful in the UK in 1835, yet it continues today (as reported by the Royal Society for the Prevention of Cruelty to Animals (RSPCA) and Crown Prosecution Service), although with an unknown prevalence. We used an online questionnaire to (1) determine the occurrence of dogs suspected of use in fighting in UK veterinary practices; (2) explore relative reporting of incidents to police, RSPCA or equivalent charity by registered veterinary nurses (RVN) and veterinarians; and (3) determine factors influencing reporting. Emails (n=2493) containing the questionnaire were sent to UK veterinary practices: 423 questionnaires (159 by RVNs, 264 by veterinarians) were completed. One or more cases of dog fighting were suspected by 14.4 per cent of respondents in 2015; 182 cases suspected in total. Proportionately more RVNs suspected dog fighting than veterinarians (P=0.0009). Thirty-two respondents (7.6 per cent, n=422) claimed to have reported suspicions to the police, the RSPCA or equivalent charity previously; 59 respondents (14.2 per cent) had previously chosen not to. Reasons not to report included: uncertainty of illegal activity (81.4 per cent), fear of the client not returning to the practice (35.6 per cent) and concerns regarding client confidentiality (22.0 per cent). Further work is required to address under-reporting of dog fighting by veterinary professionals.

Use of dynamic images in radiology education: Movies of CT and MRI in the anatomy classroom

Radiology education is a key component in many preclinical anatomy courses. However, the reported effectiveness of radiology education within such anatomy classrooms has varied. This study was conducted to determine if a novel educational method using dynamic images of movies of computed tomography (CT) and magnetic resonance imaging (MRI) was effective in radiology education during a preclinical anatomy course, aided by clay modeling, specific hand gestures (digit anatomy), and reports from dissection findings uploaded to the anatomy course website (digital reports). Feedback surveys using a five-point Likert scale were administered to better clarify students' opinions regarding their understanding of CT and MRI of anatomical structures, as well as to determine if such preclinical radiology education was helpful in their clinical studies. After completion of the anatomy course taught with dynamic images of CT and MRI, most students demonstrated an adequate understanding of basic CT and MR images. Additionally, students in later clinical years generally believed that their study of radiologic images during the preclinical anatomy course was helpful for their clinical studies and clerkship rotations. Moreover, student scores on imaging anatomy examinations demonstrated meaningful improvements in performance after using dynamic images from movies of CT and MRI.

Students' Perceptions of Trigger Warnings in Medical Education

Phenomenon: Trigger warnings are verbal statements or written warnings that alert students in advance to potentially distressing material. Medical education includes numerous subjects frequently identified as triggers, such as abuse, rape, self-injurious behaviors, eating disorders, drug and alcohol addiction, and suicide. Thus, exploring medical students' perceptions of trigger warnings may provide a valuable perspective on the use of these warnings in higher education.

APPROACH

As part of a larger descriptive, cross-sectional survey study on medical education, we assessed 1st- and 2nd-year medical students' perceptions of trigger warnings in the preclinical curriculum. Five questions specific to trigger warnings explored students' knowledge, prior experience, and perceptions of trigger warnings in medical education. Frequencies of individual question responses were calculated, and qualitative data were analyzed via content and thematic analyses.

FINDINGS

Of the 424 medical students invited to participate, 259 completed the survey (M = 24.8 years, SD + 3.4, 51.4% female, 76.1% White, 53.7% 1st-year students). Few students (11.2%) were aware of the term trigger warning and its definition. However, after being presented with a formal definition on the online survey, 38.6% reported having had a professor use one. When asked whether they supported the use of trigger warnings in medical education, respondents were distributed fairly equally by response (yes = 31.0%, maybe = 39.2%, no = 29.7%). Qualitative analysis revealed three themes: (a) Trigger Warnings Allow Students to Know What is Coming and Prepare Themselves: Respondents believed that trigger warnings would benefit students with a history of trauma by providing them additional time to prepare for the material and, if appropriate, seek professional help; (b) Students Need to Learn How to Handle Distressing Information: Respondents agreed that they needed to learn and cope with highly sensitive material because they would be confronted with difficult and unexpected situations in clinical practice; and (c) Trigger Warnings Help Students Understand the Severity of the Material: Respondents felt that trigger warnings may help students understand the severity of the material being covered and increase awareness about trauma and its effects on health and well-being. Insights: Findings did not reach consensus for or against the use of trigger warnings in medical school; however, students emphasized the importance of learning how to cope with distressing material. Trigger warnings may represent a teaching tool to facilitate classroom discussions about the severity of trauma-related material and problem-focused coping strategies.

3D printed simulation models based on real patient situations for hands-on practice

During the last few years, the curriculum of many dentistry schools in Germany has been reorganised. Two key aspects of the applied changes are the integration of up-to-date teaching methods and the promotion of interdisciplinarity. To support these efforts, an approach to fabricating individualised simulation models for hands-on courses employing 3D printing is presented. The models are based on real patients, thus providing students a more realistic preparation for real clinical situations. As a wide variety of dental procedures can be implemented, the simulation models can also contribute to a more interdisciplinary dental education. The data used for the construction of the models were acquired by 3D surface scanning. The data were further processed with 3D modelling software. Afterwards, the models were fabricated by 3D printing with the PolyJet technique. Three models serve as examples: a prosthodontic model for training veneer preparation, a conservative model for practicing dental bonding and an interdisciplinary model featuring carious teeth and an insufficient crown. The third model was evaluated in a hands-on course with 22 fourth-year dental students. The students answered a questionnaire and gave their personal opinion. Whilst the concept of the model received very positive feedback, some aspects of the implementation were criticised. We discuss these observations and suggest ways for further improvement.

Looking Back to Move Ahead: Interprofessional Education in Dental Education

Interprofessional education (IPE) is a widely recognized and critical component of dental and health professions education and is included in two of the predoctoral education standards required by the Commission on Dental Accreditation (CODA). Following a review of the literature on the state of IPE education in U.S. dental education programs, this article revisits six institutions identified in previous research as exemplars successfully implementing IPE on their campuses. Interviews were conducted with leaders at the following programs: Columbia University, Medical University of South Carolina, University of Colorado Anschutz Medical Campus, University of Florida, University of Minnesota, and Western University of Health Sciences. Strengths and weakness of IPE in dental education are discussed, along with opportunities for the future including reducing barriers to scheduling, increasing intraprofessional education, and consistent outcomes assessment. The article concludes with lessons learned by administrators and suggestions for improving incorporation of these requirements into predoctoral dental education programs by emphasizing the importance of IPE and dentistry's role in overall health. This article was written as part of the project "Advancing Dental Education in the 21^st Century."

Caries Removal by First-Year Dental Students: A Multisource Competency Assessment Strategy for Reflective Practice

Multisource assessment (MSA) uses multiple assessors to provide feedback. Little is known about the validity of using MSA feedback for improving students' ability to self-assess in a preclinical environment. Therefore, the aim of this study was to measure the validity of using a defined reflective process involving an MSA tool for building skill in dental students' self-evaluation of caries excavation on extracted teeth. As part of this process, 104 first-year students at one U.S. dental school used a self-generated study plan (SGSP) for structured reflection on MSA feedback during the 2013-14 academic year. Interrater agreement, determined through calculation of percentage-agreements in scoring, was measured among three assessor groups (self-, peer, and expert assessors) in formative assessment and between two assessor groups (self- and expert assessors) in summative assessment two weeks apart, allowing for reflective practice and completion of an SGSP between assessments. Validity for improving self-assessment was determined by measuring significance in positive shifts of agreement between self- and expert assessors. The results showed that interrater agreement between the self- and expert assessors increased significantly: from a 28% agreement in formative assessment to a 60% agreement in summative assessment. Significance in percentage shifts between assessments was demonstrated with a McNemar score of 0.26 (p<0.001). These results suggest that the described MSA tool and reflective process in an SGSP may be valid methods for improving skill in student self-evaluation of competence in caries excavation on extracted teeth.

Effectiveness of a Specially Designed Dental Model for Training, Evaluation, and Standardization of Pocket Probing

The aim of this study was to evaluate the effectiveness of a dental model in training, evaluation, and standardization of examiners in pocket probing and to determine the appropriate thresholds of accuracy and measuring time when using this model for evaluation of probing skills without measuring patients' pockets repeatedly. In 2011-12, a total of 66 dental professionals and 20 dental students in Japan measured the probing depths of 24 artificial teeth using the six-point method on a dental model. All examiners measured the probing depths of six tooth groups and then checked the correct depths in each group. Each examiner measured four groups in a group-by-group manner. For each group, the measuring time and examiner's accuracy were recorded. Receiver operating characteristic (ROC) curves for various thresholds of measuring time were drawn for thresholds of accuracies to determine the passing mark as a skilled examiner. The accuracy significantly increased from the first to the fourth measurements, and the measuring time was significantly reduced for both the professionals and students. The total measuring time was significantly longer for the students than the professionals. The students' accuracy was significantly lower than that of the professionals in the first measurement group. The increasing rate of accuracy was significantly higher for the students than the professionals. These results and ROC curves suggested that the dental model is effective for periodontal pocket probing training and for the evaluation and standardization of examiners' probing skill at a preclinical level. An examiner having accuracy ≥80% within four minutes for six tooth measurements in this model could be considered a skilled examiner.

Assessment skills of dental students as peer evaluators

The aim of this study was to evaluate the level of assessment skills of dental students as evaluators in an introductory dental anatomy preclinical course. Three groups of evaluators independently and separately evaluated each student's wax-ups: seven third-year student evaluators, five fourth-year student evaluators, and four faculty evaluators. There were 13 criteria on which the students' wax-ups for teeth #3, 6, 8, and 12 were evaluated on a scale ranging from 1=honors/highest score to 4=fail/lowest score. Of the three groups of evaluators, scores given by the third-year students were the highest with an average of 2.47 (SD=0.69), while faculty evaluators gave the lowest scores with an average of 2.61 (SD=0.68). The percentages of marginal passes and failing scores given by the third-year students were the lowest (marginal pass=15.8% and fail=17.2%) of the three evaluator groups. The results of the study indicated that assessments were influenced by the type of evaluator. In order to utilize students more effectively as evaluators in preclinical assessments, a calibration method for student and faculty evaluators should be established along with close mentorship by faculty. Involving dental students as peer teachers could reinforce the learning experience for them and encourage them to consider a future academic career.

Utilizing self-assessment software to evaluate student wax-ups in dental morphology

Traditionally, evaluating student work in preclinical courses has relied on the judgment of experienced clinicians utilizing visual inspection. However, research has shown significant disagreement between different evaluators (interrater reliability) and between results from the same evaluator at different times (intrarater reliability). This study evaluated a new experimental software (E4D Compare) to compare 66 student-produced tooth wax-ups at one U.S. dental school to an ideal standard after both had been digitally scanned. Using 3D surface-mapping technology, a numerical evaluation was generated by calculating the surface area of the student's work that was within a set range of the ideal. The aims of the study were to compare the reliability of faculty and software grades and to determine the ideal tolerance value for the software. The investigators hypothesized that the software would provide more consistent feedback than visual grading and that a tolerance value could be determined that closely correlated with the faculty grade. The results showed that a tolerance level of 450 μm provided 96% agreement of grades compared with only 53% agreement for faculty. The results suggest that this software could be used by faculty members as a mechanism to evaluate student work and for students to use as a self-assessment tool.

Dental students' perceived preparedness to treat patients in clinic after a fixed prosthodontics course: survey results of a case study

Previous research regarding dental students has found modest predictive value in preclinical didactic course grades in predicting clinical performance, but systematic assessment of students' feedback on their perceived preparedness has received little attention as a preclinical assessment methodology. The aim of this study was to assess the perceptions of the dental students at one U.S. academic dental institution regarding their preparedness for clinical performance following the preclinical fixed prosthodontics course. Third- and fourth-year dental students participated in a survey about their perceived preparedness to diagnose and treat patients with fixed prosthodontics needs in the school's dental clinics. The respondents (79 out of 161 students, for a response rate of 49%) rated each item on a five-point Likert scale. Responses about which preclinical procedures of the course prepared students the least and the best were consistent for the third- and fourth-year students. Less than 60% of all responding students felt prepared for planning complex cases and performing laboratory-related procedures. The findings of this study indicate that improvement is required in teaching students about laboratory procedures and problem-solving to adequately prepare them for clinical treatment of patients with fixed prosthodontics needs.

Lessons from a pilot project in cognitive task analysis: the potential role of intermediates in preclinical teaching in dental education

The purpose of this study was to explore the use of cognitive task analysis to inform the teaching of psychomotor skills and cognitive strategies in clinical tasks in dental education. Methods used were observing and videotaping an expert at one dental school thinking aloud while performing a specific preclinical task (in a simulated environment), interviewing the expert to probe deeper into his thinking processes, and applying the same procedures to analyze the performance of three second-year dental students who had recently learned the analyzed task and who represented a spectrum of their cohort's ability to undertake the procedure. The investigators sought to understand how experts (clinical educators) and intermediates (trained students) overlapped and differed at points in the procedure that represented the highest cognitive load, known as "critical incidents." Findings from this study and previous research identified possible limitations of current clinical teaching as a result of expert blind spots. These findings coupled with the growing evidence of the effectiveness of peer teaching suggest the potential role of intermediates in helping novices learn preclinical dentistry tasks.

A model of blended learning in a preclinical course in prosthetic dentistry

The aim of this study was to evaluate the use of blending learning that added online tools to traditional learning methods in a preclinical course in prosthetic dentistry at one dental school in Germany. The e-learning modules were comprised of three main components: fundamental principles, additional information, and learning objective tests. Video recordings of practical demonstrations were prepared and cut into sequences meant to achieve single learning goals. The films were accompanied by background information and, after digital processing, were made available online. Additionally, learning objective tests and learning contents were integrated. Evaluations of 71 of 89 students (response rate: 80%) in the course with the integrated e-learning content were available for the study. Compared with evaluation results of the previous years, a substantial and statistically significant increase in satisfaction with learning content (from 30% and 34% to 86%, p<0.001) and learning effect (from 65% and 63% to 83%, p<0.05) was observed. Satisfaction ratings stayed on a high level in three subsequent courses with the modules. Qualitative evaluation revealed mostly positive responses, with not a single negative comment regarding the blended learning concept. The results showed that the e-learning tool was appreciated by the students and suggest that learning objective tests can be successfully implemented in blended learning.

Dental students' preferences and performance in crown design: conventional wax-added versus CAD

The purpose of this study was to evaluate dental students' perceptions of traditional waxing vs. computer-aided crown design and to determine the effectiveness of either technique through comparative grading of the final products. On one of twoidentical tooth preparations, second-year students at one dental school fabricated a wax pattern for a full contour crown; on the second tooth preparation, the same students designed and fabricated an all-ceramic crown using computer-aided design (CAD) and computer-aided manufacturing (CAM) technology. Projects were graded for occlusion and anatomic form by three faculty members. On completion of the projects, 100 percent of the students (n=50) completed an eight-question, five-point Likert scalesurvey, designed to assess their perceptions of and learning associated with the two design techniques. The average grades for the crown design projects were 78.3 (CAD) and 79.1 (wax design). The mean numbers of occlusal contacts were 3.8 (CAD) and 2.9(wax design), which was significantly higher for CAD (p=0.02). The survey results indicated that students enjoyed designing afull contour crown using CAD as compared to using conventional wax techniques and spent less time designing the crown using CAD. From a learning perspective, students felt that they learned more about position and the size/strength of occlusal contacts using CAD. However, students recognized that CAD technology has limits in terms of representing anatomic contours and excursive occlusion compared to conventional wax techniques. The results suggest that crown design using CAD could be considered as an adjunct to conventional wax-added techniques in preclinical fixed prosthodontic curricula.

Effectiveness and feasibility of utilizing E4D technology as a teaching tool in a preclinical dental education environment

Recent efforts have been directed towards utilizing CAD/CAM technology in the education of future dentists. The purpose of this pilot study was to investigate the feasibility of implementing CAD/CAM technology in instruction on preparing a tooth for restoration. Students at one dental school were assigned access to CAD/CAM technology vs. traditional preparation methods in a randomized, crossover design. In a convenience sample of a second-year class, seventy-six of the seventy-nine students volunteered to participate, for a response rate of 96 percent. Two analyses were performed on this pilot data: a primary effectiveness analysis comparing students' competency exam scores by intervention group (intention-to-treat analysis) and a secondary efficacy analysis comparing competency exam scores among students who reported using CAD/CAM versus those who did not. The effectiveness analysis showed no difference in outcomes by intervention group assignment. While student survey results indicated interest in utilizing the technology, the actual utilization rate was much less than one might anticipate, yielding a sample size that limited statistical power. The secondary analysis demonstrated higher mean competency exam scores for students reporting use of CAD/CAM compared to those who did not use the technology, but these results did not reach statistical significance (p=0.075). Prior research has investigated the efficacy of CAD/CAM in a controlled educational trial, but this study adds to the literature by investigating student use of CAD/CAM in a real-world, self-study fashion. Further studies should investigate ways in which to increase student utilization of CAD/CAM and whether or not increased utilization, with a larger sample size, would yield significant outcomes.

Dental students' opinions of preparation assessment with E4D compare software versus traditional methods

The aim of this study was to evaluate dental students' opinions regarding the utilization of a new grading software program for student self-assessment and a faculty-grading tool in a preclinical course. Using surface mapping technology, this program, called E4D Compare, yields a digital model of a student's preparation that is color-coded to show deficient areas. The program has now been used for two years at the James B. Edwards College of Dental Medicine at the Medical University of South Carolina, and the students previously assessed with E4D Compare have now entered into the dental clinics. For this study, students were asked to complete an anonymous survey for the investigators to evaluate students' attitudes and opinions on the effectiveness of this software in their preclinical courses to determine if this type of feedback helped them develop clinical skills. The survey also sought to collect students' opinions on the traditional objective criteria-based grading system. The survey was distributed to all members of the Classes of 2014 and 2015; it yielded a 59 percent response rate for the two classes, with a total of eighty-one students responding. Overall, the majority of students preferred the E4D Compare grading system over traditional hand-grading methods. The grading system provided instant, objective, and visual feedback that allowed students to easily see where their deficiencies were and encouraged them to work towards an ideal final product.

Reliability of CAD CAM technology in assessing crown preparations in a preclinical dental school environment

In order to use CAD CAM (Computer Aided Design, Computer Aided Manufacturing) technology as an assessment tool when evaluating the preclinical performance of dental students, it is imperative that one has confidence in the reliability of the process. In this study, a variety of alignment methods were compared to determine both the consistency and accuracy of each method. Although the "Tooth Dots Diagonal" method exhibited the best precision (coefficient of variation=5.4 percent), it also represented the least accurate method when compared to the other methods tested. Using "Small Dots Diagonal" on the gingiva appears to be the best option, exhibiting an acceptable coefficient of variation (17.6 percent) and a high degree of accuracy in terms of tolerance (mean ± standard deviation=0.163 ± 0.029). Based on the results of this study, further investigation of CAD CAM technology for the purpose of assessment and education of dental students is recommended.

Seeing through the dentist's eyes: video-based clinical demonstrations in preclinical dental training

The clinical demonstration is an established way of bridging the disciplinary content in preclinical and clinical courses. In dentistry, however, clinical demonstrations have often been perceived as less rewarding due to the restricted visual access to the details of the treatment. This study investigated a course in endodontics at the University of Gothenburg, Sweden, in which traditional clinical demonstrations were replaced by instructor-led seminars that enabled students to follow and discuss broadcasted root canal treatments. Two cameras provided overviews of the operating room, whereas a third camera attached to a surgical microscope offered a magnified view of procedures carried out in the inner parts of teeth. The hypothesis was that this arrangement would increase the students' sense of the clinical relevance of basic scientific knowledge. Two focus group interviews were designed to explore the students' perceptions of this change. The students expressed that the video-based seminars offered ample opportunities to integrate theoretical and clinical understanding. The major reasons were that the visualization displayed procedures on a sufficiently detailed level; instructors demonstrated clinical reasoning in situ and provided the context necessary for understanding procedures; and the interactive format encouraged discussions on the generalizability of knowledge beyond the specific case.

Students' perceptions of materials and techniques used at European dental schools in the education of fixed prosthodontics

The aim of this study was to explore the materials and procedures used by students in dental schools across Europe for teaching fixed prosthodontics. An online questionnaire, containing twenty-eight dichotomous, multiple-choice, and Likert scale rating questions, was sent to students in forty dental schools. After excluding dental schools in which less than 10 percent of the students responded, 775 questionnaires from ten schools remained for statistical analysis. Among these respondents, acrylic resin teeth were said to be the most commonly used material during preclinical practice (46-96 percent), and use of extracted teeth varied from 8 to 65 percent. At nine of the ten institutions, metal-ceramic was reported to be most commonly used for fixed dental prostheses. There was large variation in the type of finish line for a metal-ceramic fixed dental prosthesis: students at five institutions reported using a shoulder finish line, three a chamfer finish line, and two a shoulder-bevel finish line. A similar variation was observed with regard to the final cementation of metal-ceramic fixed dental prostheses: students at four institutions reporting most frequently using glass ionomer cement, with three using zinc phosphate cement and three using carboxylate cement. The responding European dental students varied considerably in their opinions about whether they were preclinically properly trained for the first preparation on a patient and in their overall rating of their education in fixed prosthodontics. Responding students in the United Kingdom, Sweden, and Nijmegen, The Netherlands, rated their fixed prosthodontics training overall the highest. Overall, this study found a wide variation amongst dental schools with regard to their education in fixed prosthodontics and their rating of this teaching.

Critical appraisal-based learning in a dental college in India: a randomized control study

This study examined the effect of critical appraisal exercises on the quality of preclinical tooth preparation skills and the confidence level of undergraduate dental students at a dental college in India. Forty-two student volunteers were randomly divided into critical appraisal (CA; n=19) and control (C; n=23) groups. Both groups were given conventional lecture and video demonstration; the CA group was also given critical appraisal exercises. Four evaluators assessed the incisor, canine, premolar, and molar preparations made by all students. The mean overall scores (reported as mean±SD) assigned to the CA group by all evaluators were significantly higher (independent t-test, p<0.05) than the C group for incisor (CA: 6.19±1.47, C: 5.09±1.52), canine (CA: 5.64±1.36, C: 4.50±1.35), premolar (CA: 5.88±1.03, C: 4.88±1.18), and molar (CA: 5.98±1.16, C: 5.20±0.71) teeth. The CA group also demonstrated a significant increase in self-confidence over that of the C group (repeated measures general linear model F=8.554, p=0.006). In this study, the critical appraisal exercises significantly improved the preclinical incisor, canine, premolar, and molar tooth preparation skills and the confidence level of the undergraduate dental students.