Recording and understanding social histories by dental undergraduates in a community-based clinical programme

Outreach training: the special interest group's report

Following three sessions at ADEE Annual Meetings, the special interest group on outreach training presents a brief report of its proceedings. Outreach, here, is clinical teaching away from the home dental school. After covering the diversity and benefits of programmes, the report considers different models and the relationship between contexts and outcomes. It concludes that: outreach provides access to additional resources; programmes prepare students for the demands of the profession; a programme's design should harmonise with both its context and its objectives; and, the educational benefits warrant the additional organisation involved.

Developing an assessment in dental public health for clinical undergraduates attending a primary dental care outreach programme

BACKGROUND

This paper describes the development and implementation of a Dental Public Health (DPH) assessment within the Primary Dental Care Outreach (PDCO) course at Newcastle University. The assessment was piloted alongside the delivery of the Bachelor of Dental Surgery (BDS) curriculum in accordance with established learning outcomes.

AIM

To design and implement a pilot summative assessment, incorporating patients' social histories obtained by undergraduate students attending primary dental care outreach clinics.

METHOD

Undergraduates were tasked with obtaining a detailed social history from a patient seen during their two-year outreach attachment. Each student submitted a written account of their patient's social history and placed this in context by researching a number of demographic and social variables centred upon their patient's home residence. The final component involved writing a concise case feature for a nominated newspaper based upon the case history, where students were encouraged to identify one or more public health messages using language appropriate to a lay readership.

RESULTS

Seventy one clinical undergraduates (98.6% of the year-group) subsequently submitted all components of the assessment. Eighty six per cent of the year-group was deemed to have passed the assessment with 9.9% achieving a 'Merit' grade and 76% a 'Satisfactory' grade. Following the assessment, students and clinical teachers were asked for their feedback through a focus group for staff, and a brief feedback form for students.

CONCLUSION

Undergraduates subsequently reported greater awareness of the significance and importance of obtaining a detailed social history and its relevance when devising appropriate and realistic treatment plans.

Clinical competency exercises: some student perceptions

Clinical competency assessments are an important part of dental curricula-to satisfy national requirements, maintain professionalism and ensure graduates are prepared for independent clinical practice. It has been observed within Newcastle Dental School (UK) that students tend to undertake the majority of their competency assessments at a very late stage. A questionnaire was designed to investigate student perceptions of two different competency assessment processes (formative structured clinical operative tests vs. summative grading), assess why they chose to undertake competency exercises at a particular time, investigate how well prepared they felt, and finally to evaluate potential barriers that students perceived within the competency process. Data regarding the timing of competency assessments and grades achieved were analysed. Fifty-nine per cent of students reported preferring the summative grading system. Most students felt that they undertook their competency assessments at about the right time (54%: conservation department, 66%: paediatric department) and the majority felt adequately prepared to undertake each exercise (68-98%). The greatest barrier stated to undertaking competency assessments was a lack of suitable patients both on which to practise and to undertake the exercise. No correlation was found between when students took summative assessments and the grades achieved. Therefore, we must encourage students to undertake their competency assessments once they have accrued sufficient clinical experience and reassure them that timing has little effect on the grade achieved. We should assist them to locate suitable patients wherever possible.

A randomised controlled trial of the effect of outreach placement on treatment planning by dental students

Undergraduate dental students' curricula are being supplemented with primary care placements.

OBJECTIVE

To compare the effect of outreach placement and traditional hospital-based training alone on students' treatment planning ability.

DESIGN

Randomised controlled trial.Setting Four existing primary care placements in England during 2004.

SUBJECTS AND METHODS

At follow-up the fourth-year students took a history from a standard 'patient' then recorded a treatment plan. Interview skill was scored. The history and plan were assessed by clinicians blind to the intervention.

INTERVENTION

Five-week block outreach placements for 25 of 49 students.

MAIN OUTCOME MEASURES

Interviewing skill, quality of dental and social histories, the appropriateness of planned treatments and the consideration of wider issues.

RESULTS

The two groups were similar in the scores for interviewing and taking a dental history. The outreach group scored higher for capturing a social history (outreach mean 4.4, SD = 2.1, n = 22 and hospital 2.8, SD = 1.9, n = 23; p = 0.01) and for developing an appropriate treatment plan (5.6 [SD = 2.1] and 3.9 [SD = 2.3]; p = 0.01). There were no differences in scores relating to the wider issues.

CONCLUSION

Dental outreach training was significantly more effective than traditional training alone in improving students' ability to capture relevant points of social history from a patient and to consider them when planning treatment.

Student perspectives on their recent dental outreach placement experiences

BACKGROUND

Dental schools are developing new curricula, with outreach placements enhancing the hospital-based training.

OBJECTIVES

To assess the students' experience of outreach as one component of determining the value and feasibility of outreach placements.

INTERVENTION

Six-week block placements for 10 undergraduates and 3 weeks for 11 hygiene and hygiene and therapy students in existing primary care clinics, in areas of need, to work supervised by local dentists.

METHODS

Semi-structured interviews with 20 students by staff independent of the course team. Interviews were audio-recorded, transcribed and content analysed before being verified by a second observer. Findings were triangulated against a peer-run focus group and students' clinical records.

RESULTS

Students were very positive about their experience and the potential role of outreach training in dental education. They described: gaining greater experience of new types of patients and their communities; learning from broader clinical experience, alternative approaches and practicing or observing dentistry in different settings; the benefits of team working; and, acquiring a more holistic and pragmatic view of health care. Many students reported gaining greater confidence, wider awareness of potential careers in dentistry and a greater sense of realism in their experience. Some reflected on their own training needs. Students also discussed the importance of preparation for the placements and the merits of different styles of supervision.

CONCLUSION

Dental outreach training can provide students with valuable learning experience in a range of areas. It requires careful management to ensure those experiences match individuals' needs and the programme's purposes.