Designing a dental curriculum for the twenty-first century

A Comparison of Dental Students' Self-Assessment and Instructors' Assessment in Competency Examinations in a Preclinical Operative Dentistry Course

Objective

Student self-assessment is a skill that is taught, assessed, and attained in education for lifelong learning. In dental education, developing self-assessment is essential during the early stages of psychomotor learning. This study compared dental students' self-assessments and instructors' assessments in competency examinations and evaluated the progress and potential predictors of self-assessment performance, including achievement level and gender, in a Preclinical Operative Dentistry course.

Methods

The preclinical operative dentistry assessment and self-assessment records by instructors and students, respectively, were collected retrospectively from intra-semester and final examination assessment rubrics. The instructors' scoring agreement level was measured using inter-rater reliability and intra-class correlations (ICCs). Students' self-assessment data were compared with instructors' assessment data, and agreement was tested using inter-rater reliability estimates. The significance level was set at 0.05.

Results

Instructors were calibrated based on significant agreement (p < 0.001) between full-time and part-time instructors (ICCs = 0.888 and 0.859, respectively). A significant difference (p < 0.001) was found between instructors' and students' mean scores. Students' gender was significantly associated with their evaluation of performance in the intra-semester examination (p = 0.048). Most male students (58%) overestimated their performance, while the majority (44%) of female students tend to evaluate their performance accurately. There was no significant difference in the scoring of instructors and high achievers classified in the "excellent" category (p = 0.392).

Conclusion

In preclinical operative dentistry education, students' ability to accurately self-assess the quality of their work varies, and may be predicted by gender and achievement level. Students who underestimate their performance in self-assessment tend not to show improvement in their actual performance.

A study on digital tooth preparation assessment software in undergraduate pre-clinical skills teaching

INTRODUCTION

Aims This research aims to evaluate the effectiveness and efficiency of the PrepCheck digital system as an additional feedback tool in enhancing undergraduate dental students' tooth preparation skills and its potential to enhance students' learning experience.

MATERIAL AND METHODS

A total of 55 BDS3 students attending the "Crowns Course" and divided into three groups participated in the study. One group (n = 24) was randomly selected as the case group and received feedback using the digital tooth preparation analysis system, PrepCheck, alongside standard visual assessment. The other two groups (n = 31) served as controls and only received standard visual feedback. All students' tooth preparations for the final test were digitally assessed using PrepCheck against a faculty-approved master preparation. The tooth preparation quality was compared between the case and control groups, employing two distinct grading methods. Additionally, a questionnaire was provided to students who used the digital system to gather their feedback.

RESULTS

The findings revealed a positive trend in performance among the case group when using the PrepCheck system. However, the analysis showed no statistically significant differences between the groups in both the tutor assessment only and tutor assessment in addition to using the PrepCheck report. Despite the absence of statistically significant differences, qualitative feedback from participants indicated a favourable reception of the digital system.

CONCLUSIONS

While the PrepCheck digital system displayed potential in complementing traditional teaching methods and enhancing the learning experience, its integration posed challenges, particularly concerning time constraints. Further research is recommended to investigate further the potential longer-term effects and potential useful applications for integrating digital systems like PrepCheck into dental education.

A novel model for curriculum design: Preparation, planning, prototyping, and piloting

Dental education continuously strives to provide students with positive and meaningful learning experiences. Developing or improving a curriculum usually encompasses three main phases: design, implementation, and evaluation. Most research on curriculum development in dental education has focused on the last two phases. Our commentary addresses this gap by describing a new model for curriculum design that effectively guided the design phase of the complete overhaul of the four-year Doctor of Dental Surgery curriculum at the School of Dentistry, University of Alberta. Built on the strengths of pre-existing curriculum design models, the new model provided enough structure and rigour to support the complexity required during a complete curriculum redesign whilst still allowing sufficient consultation and flexibility to encourage stakeholder engagement. The steps of the new 4P's model (preparation, planning, prototyping, and piloting) and main actions within each step are described. Challenges observed in each step and strategies to address them are reported. Other institutions embarking on renewing or redesigning a curriculum at a program level may benefit from using a curriculum design process similar to the 4P's model. Recommendations are discussed including the inclusion of educational consultants in the curriculum renewal committee, the importance of a leadership that effectively supports curriculum reform, purposeful engagement of stakeholders during each step of the design phase and ensuring that project and change management occur concurrently.

Should suicide risk assessment be embedded in undergraduate dental curricula?

Aims and objectives The aim of this Plan-Do-Study-Act cycle was to establish if undergraduate students believe they have a role to play in suicide risk assessment, and to discuss the implementation of suicide risk prevention into the undergraduate dental curriculum. Data gathered informed development of a subsequent suicide risk assessment educational workshop.Methodology An online questionnaire was disseminated to undergraduate students as part of a quality improvement service evaluation within a UK dental hospital and school. This sought to gain information on attitudes to suicide prevention, previous suicide awareness training, and the appetite and potential barriers to future training.Results A response rate of 23% (n = 30) was achieved. In total, 87% of undergraduate students responding reported having no experience or training in the identification of suicidal patients, 97% of respondents expressed a desire for training, and 80% stated not knowing what to do if a patient disclosed suicidal thoughts during an appointment.Conclusion The dental team have a role to play in suicide risk assessment and the signposting of at-risk patients to appropriate services. To embed this within daily practice, awareness and training must be introduced to undergraduate curricula.

Procedure Time and Students’ Perception Comparing Full Arch Digital Scans with Conventional Impressions: A Cross-Over Randomized Experimental Trial

Methods

Ninety-six dental students each prepared tooth #36 for an all-ceramic crown on typodont models and were then randomly assigned into either group A: performed digital scan first, or Group B: performed conventional impression first. Procedure time was recorded for both. Immediately following each procedure, students indicated their perceived procedure difficulty. After exposure to both techniques, they selected their preferred one.

Results

There was a statistically significant difference between the mean procedure time of both techniques (P < 0.0001), where students spent 663.76 ± 442.50 seconds to complete the conventional impression and 293.32 ± 181.49 seconds to complete the digital scan. Females were significantly faster in completing the conventional impression compared to males. On the contrary, male students were faster in digital scanning than female students. There were no carryover effects in the duration and the initially performed procedure. 76% (73 of 96) of participants preferred digital scanning with no statistical significance shown between the preferred and initially performed procedure. Participants perceived conventional impressions to be more difficult than digital scans. There was a weak positive correlation between the VAS score and the procedure time for the digital technique (R = 0.25) and a moderate positive correlation for the conventional technique (R = 0.45).

Conclusions

The digital technique was preferred and perceived as easier than the conventional among undergraduate dental students with no impression-making experience, suggesting their readiness for new technology uptake. However, no significant correlation was found between the initially performed procedure and preference.

Roboethics in Remote Human Interactions and Rehabilitative Therapeutics

Global aging, the need for continuous high-quality services, and the recent COVID-19 pandemic have caused many sectors to reduce in-person contact between individuals where possible, and to instead use remote communication technology. With increased robot use replacing in-person interventions, ethical considerations arise. The benefits of robotic technology must be weighed against the possibility of harm to humans. The first rules of roboethics were written by Isaac Asimov in 1942, but these pre-date the range of robotic applications used today. There is no central agency for oversight in Canada, although universities and funding organizations have developed guidelines. Roboethical considerations include data use and privacy, the common good, and safety. Humans may potentially form emotional bonds with robots. Loss of jobs to automation is also a concern, particularly when many workers have suffered job losses due to the pandemic. Some health care services have switched to a remote care model, to reduce the spread of COVID-19. Remote hand rehabilitation of patients with brain injury is possible with iManus. Using a portable smart-glove technology, patients practice rehabilitative hand movements that are analyzed remotely through a sensor that offers instantaneous feedback. A therapist monitors their patient’s progress remotely and designs individualized programs. This technology benefits humanity by improving access to care for patients globally. The importance of data security and privacy is emphasized. As patient progress will be monitored by a human (a therapist), the safety of iManus is not a concern. The principles discussed in this paper can help researchers and engineers design ethical robotics in remote health care settings.

The benefits of an innovative community engagement model in dental undergraduate education

Dental healthcare students at the Peninsula Dental School, University of Plymouth, UK undertake community engagement projects as a core part of their undergraduate curriculum. Students work with their peers to develop a student-led, evidence-based project working with target groups in the local community to address oral health needs. The aim of the programme is to further the students' understanding of health inequalities and the health needs of different groups in the community, while developing skills that will help them deliver holistic dental care as part of their future professional practice. This report highlights our model of education delivery in collaboration with the community, the student-learning outcomes and discusses some of the benefits of this approach including examples of projects that have benefitted the community. We highlight the further work needed to evaluate the longer-term impacts on students of undertaking social accountability programmes.

RoboEthics in COVID-19: A Case Study in Dentistry

The COVID-19 pandemic has caused dramatic effects on the healthcare system, businesses, and education. In many countries, businesses were shut down, universities and schools had to cancel in-person classes, and many workers had to work remotely and socially distance in order to prevent the spread of the virus. These measures opened the door for technologies such as robotics and artificial intelligence to play an important role in minimizing the negative effects of such closures. There have been many efforts in the design and development of robotic systems for applications such as disinfection and eldercare. Healthcare education has seen a lot of potential in simulation robots, which offer valuable opportunities for remote learning during the pandemic. However, there are ethical considerations that need to be deliberated in the design and development of such systems. In this paper, we discuss the principles of roboethics and how these can be applied in the new era of COVID-19. We focus on identifying the most relevant ethical principles and apply them to a case study in dentistry education. DenTeach was developed as a portable device that uses sensors and computer simulation to make dental education more efficient. DenTeach makes remote instruction possible by allowing students to learn and practice dental procedures from home. We evaluate DenTeach on the principles of data, common good, and safety, and highlight the importance of roboethics in Canada. The principles identified in this paper can inform researchers and educational institutions considering implementing robots in their curriculum.

Service-Learning in undergraduate dental education: Professional competence for clinical decision-making

OBJECTIVES

The objective of the present study was to evaluate a Service-Learning activity in a dental education programme and the clinical decision-making in the development of professional competence of undergraduate dental students.

METHODS

The study consisted of a single holistic case study that involved quantitative and qualitative analyses. A total of 246 last-semester students from a School of Dentistry in southern Brazil, between the years of 2013 and 2016, answered an anonymous online questionnaire with open- and closed-ended questions (5-point Likert scale). Two thematic axes were analysed: structural and pedagogical evaluation of the internship experience and development of professional competences (theory of Ergology). The SPSS program (16.0) was used to obtain means and standard deviations for a descriptive analysis of the data. Content analysis was performed for the qualitative data.

RESULTS

The scores ranged from neutral to positive concerning pedagogical dynamics (mean scores between 3.08 and 3.82). The preceptors were evaluated with the best mean score (3.82). All the components used to assess professional competences obtained positive scores with the exception of teamwork (2.95). Adaptations to the clinical protocols learned in class were made by 44% of the students.

CONCLUSIONS

The data showed that undergraduate dental students in the Service-Learning programme acquire competencies for clinical decision-making under unusual reality conditions. Adaptation of protocols was not related to less or greater knowledge of the protocols, which would be a negative condition, but to the students' ability to formulate connections between scientific knowledge and the clinical practice.

Transfer of basic science knowledge in a problem-based learning curriculum

AIM

The aim of this study was to evaluate transfer of basic science knowledge for clinical application in our BDS programme by exploring the correlations between student performance in integrated dental science (IDS) examinations and applied dental knowledge (ADK) tests.

METHODS

Numeric test scores were drawn from summative IDS and ADK assessments undertaken by BDS students spanning six academic years (2013-14 to 2018-19) for two cohorts (2013 and 2014). The data included a total of 13 test scores for each cohort with four IDS tests, taken in Years 1 and 2, and nine ADK tests taken in Years 3, 4 and 5.

RESULTS

The sample included 120 students across both cohorts with 65 females (54%) and 55 males (46%). The correlation coefficients between the successive tests and the combinations of IDS and ADK scores were positive, all being greater than 0.48, and all being significantly correlated (P < .001). Regarding correlation between standardised averages across all IDS tests and all ADK tests, performance remained significantly correlated: (2013 cohort: r (53) = .667, P < .001; 2014 cohort: r (50) = .700, P < .001).

CONCLUSIONS

The results of this study show that the students' knowledge of basic sciences correlates with their applied dental knowledge and may offer a predictive value. These findings may be attributed to a PBL curriculum and student-led learning at our school.

Oral health policymaking challenges in Iran: a qualitative approach

BACKGROUND

As the strategies proposed for oral health improvement in developed countries are not adapted for developing ones, this study aimed to identify the challenges of oral health policy implementation in Iran as a low-income developing country.

METHODS

This qualitative study was conducted in 2019 in Iran as a middle-eastern developing country. The study population consisted of experts who had experience in oral health and were willing to participate in the study. Snowball sampling was used to select 12 participants for semi-structured interviews and saturation was achieved after 16 interviews. Guba and Lincoln criteria including credibility, transferability, confirmability and dependability were used to determine reliability and transparency, and finally a five-step framework analysis method was used to analyze the data.

RESULTS

The analysis of the interviews resulted in identification of 7 main themes that were categorized into 5 problems of policy implementation as proposed by the Matus framework. The main themes of executive and preventive challenges to implement oral health policies were categorized as organizational problems, the main themes of educational and resource challenges were situated as material problems, and the main themes of insurance, policy making and trusteeship challenges were considered as legal, policymaking and perspective.

CONCLUSION

The implementation of oral health policies has faced some challenges. It seems that the national coverage of oral health and integration of these services in prevention and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health in Iran.

Effect of constant versus variable small-group facilitators on students' basic science knowledge in an enquiry-based dental curriculum

INTRODUCTION

The role of small-group facilitators is of pivotal importance for the success of curricula based on active learning. Disorganised tutorial processes and superficial study of the problem have been identified as main hindering factors for students' learning. The aim of this study was to evaluate the influence of consistency of facilitation on students' performance in knowledge-based basic science assessments in a hybrid, enquiry-based (EBL) undergraduate dental curriculum.

MATERIALS AND METHODS

This was a retrospective study of 519 first- and second-year undergraduate dental students, enrolled at Peninsula Dental School between 2013 and 2018. Twice in each academic year, students sat a 60-item single-best-answer, multiple-choice examination. Percentage and Z-scores were compared between students whose EBL groups had the same facilitator throughout the academic year, and those whose EBL group was facilitated by different members of staff. All EBL facilitators were dentally qualified but with different levels of expertise in basic dental sciences, prior EBL facilitation, involvement in the curriculum design and university affiliation.

RESULTS

No statistically significant difference was observed in the percentage or Z-scores of students whose EBL sessions were supported by consistent or variable facilitators in any of the 18 MCQ tests. Z-scores of first-year students were more variable than for second-year students. In addition, pairwise comparisons revealed no statistically significant differences in students' Z-scores between any of the permanent facilitators' groups.

CONCLUSIONS

The results of our study may influence the design and delivery of enquiry-based curricula as well as human resources management by shifting the focus from maintaining facilitator consistency to ensuring comparable training and approaches across facilitators.

A novel, integrated curriculum for dental hygiene-therapists and dentists

Introduction

In certain communities patients may struggle to find access to adequate dental treatment. One proposed strategy to help meet population need is to train more dental hygiene-therapists. However, established attitudes and hierarchies, along with a lack of clear understanding of different roles within some general practice environments has led to underutilised shared-care approaches. Integrating dentists and dental hygiene-therapists in undergraduate education may be an effective approach to promote inter-professional education, dispel inappropriate biases and hierarchies, and nurture team working from an early career stage. As such, we have developed a novel BSc Dental Therapy and Hygiene (BDHT) curriculum, which is integrated with the Bachelor of Dental Surgery (BDS) programme.

Aims

The aim of this paper is to describe how two separate BDHT and BDS undergraduate programmes have been uniquely integrated, and to share areas of best practice.

Design

The BDHT curriculum was developed based on our established BDS programme introduced in 2013 and is novel in two respects: BDHT students complete their academic and clinical training jointly with BDS students, and are assessed and trained to the same standards; and our patient-centred, primary care clinical training model is designed to prepare BDHT graduates to work under direct access.

Results

Key success indicators of the integrated BDHT-BDS programmes are: award of GDC sufficiency; 100% BDHT graduate employment; and 100% BDHT final year pass rate.

Conclusion

Inter-professional education is an established pedagogic approach to inhibit the formation of hierarchy and barriers that impede collaborative care. Our BDHT programme is the first of its kind to embed inter-professional education through the entirety of both the BDHT and BDS course structures and be entirely integrated. Further studies are required to provide quantitative and qualitative data to validate the success of our new integrated training programme. This paper presents our curriculum journey, from conception, to design, implementation and review. It describes our vision and its relevance for the future of inter-professional dental education.

To accept or decline academic remediation: What difference does it make?

Introduction: Academic remediation offered after failure in a knowledge-based progress-test assessment is voluntary and involves student-centered individualized support that helps students to learn most effectively for themselves. This paper explores whether accepting or declining the offer of academic remediation given to struggling students impacts their outcomes both short-term and longitudinally. Method: Data was collated from 2015-16, 2016-17, and 2017-18 and included all students offered academic remediation in the third, fourth, and fifth years of a five-year Dentistry program. Z-scores for each stage and test were calculated and centered on a triggering point; the point at which the offer of remediation was made. These students' average performance post-trigger test and longitudinal performance were analyzed. Results: While performance for both groups significantly improved for the immediate post-trigger test after academic remediation, those that accepted remediation sustained longitudinal improvements across subsequent tests compared to those that declined remediation. Discussion: Through the academic remediation support process students appear to increase their mastery of "learning to learn" and are able to implement sustainable effective learning strategies to carry with them throughout their program. Conclusion: Students who accept academic remediation maintain a more successful academic profile compared to those that do not take advantage of this.

In real life: evaluating primary care-based undergraduate dental education in Northwest England

Aim To explore how working at dental education centres (DECs), away from the university campus, has influenced the attitudes of dental students towards providing dental care in a primary setting, and whether students feel that this model of dental education meets their perceived training needs.Design Exploratory, qualitative interview study.Methods Semi-structured interviews with five fourth BDS students, analysed using thematic analysis.Results The main theme identified was 'real life dentistry', as students described how their clinical experiences and the teaching at DECs would prepare them for life as a general dental practitioner. Students felt they had a positive impact on their patients, and although some felt they could not comment on the impact to the community, others thought that this was likely to be positive.Conclusion Students believed they experienced 'real life dentistry' which would prepare them well for their foundation year and future practice. They also believed they had a positive impact on their patients.

Integrating student feedback during "Dental Curriculum Hack-A-thon"

BACKGROUND

The future of dental education is at crossroads. This study used the parameter of the 2016 Dental Curriculum Hack-a-Thon to assess intra- and inter-institutional agreement between student and faculty views regarding dental curriculums to determine if there is an impact in student perceptions towards dental education from before and after the event.

METHODS

This exploratory, cross-sectional study involved two surveys, with Survey 1 being distributed among four faculty-student pairs of the four participating dental schools answering 14 questions. Survey 2 assessed the views of 20 participating dental students through 26 questions in a pre- and post- event survey design. Descriptive statistics were used to explore differences in perceptions towards dental education across both instrument surveys.

RESULTS

The results revealed valuable student insights regarding intra- and inter-institutional agreement relevant for the change in dental curriculum that needs to occur. Survey 2 revealed that mandatory attendance in didactic courses, electronic based examination preferences, and the preference of preclinical courses being held in the first and second years of a four-year dental curriculum were of particular importance to student participants.

CONCLUSIONS

The results of this study indicate that exposure and participation in subjects pertaining to dental education can be influential on student preferences and opinions on how dental education should be delivered in a four-year curriculum.

Impact of early clinical exposure on the learning experience of undergraduate dental students

AIMS

The aim of this research was to evaluate the impact of early clinical exposure on the learning experiences of undergraduate dental students.

METHODS

This study was based on mixed methods. The first phase involved administering a purposely designed questionnaire consisting of 16 items, grouped into three subscales. The second phase of the research was conducted using qualitative semi-structured interviews to explore the perceptions and experiences of stakeholders regarding early clinical exposure.

RESULTS

In total, 134 undergraduate dental students and eight clinical supervisors responded to the questionnaire and reported positive perceptions regarding the learning experiences, professional relationship and learning environment. Qualitative interviews were conducted with 12 participants, and early clinical exposure was perceived to be useful in providing a context to theoretical learning and development of interpersonal skills. Curriculum overload and further need for consolidation were highlighted as the main challenges.

CONCLUSIONS

This study provided insights into the clinical training model in an undergraduate dental programme and highlights the benefits and challenges of early clinical exposure in the study population. The study served as a vehicle for engagement with a range of stakeholders using a mixed methods approach to inform further development of the training model.

Are dental students ready for supercomplex dental practice?

Contemporary dental practice requires practitioners who are able to draw upon varying interconnected knowledge and skills, in order to make judgments and take action when faced with multiple, often contradictory, ways of interpreting a situation. However, the curricula that prepare students for dental practice are traditionally based on the theoretical knowledge and technical skills to be gained by students. This is despite evidence in the dental literature of a collective desire for graduates to have more range and depth in their repertoire. Examination of contemporary dental practice through the lens of supercomplexity (Higher Education, 40, 409 and 2000) provides contextual understanding and a platform to explore the types of learning and curriculum approaches that can best prepare students for professional practice. From the insights offered by examples from other professional fields, we, as dental educators, can begin to conceptualise learning dentistry as much more than competency frameworks or descriptions of what students need to know and be able to do. Rather, to equip graduates for contemporary dental practice, the dental curriculum needs to become a vehicle for students to develop personally and professionally as well as teaching the theoretical and technical aspects of dentistry.

Comparison of graduate-entry and direct school leaver student performance on an applied dental knowledge test

AIMS

To compare the academic performance of graduate-entry and direct school leavers in an undergraduate dental programme.

METHODS

This study examined the results of students in applied dental knowledge (ADK) progress tests conducted during two academic years. A mixed model analysis of variance (ANOVA) was conducted to compare the performance of graduate-entry and direct school leavers. ADK was treated as a repeated measures variable, and the outcome variable of interest was percentage score on the ADK.

RESULTS

The results show statistically significant main effects for ADK [F (1,113) = 61.58, P < 0.001, η²_p = 0.35], Cohort [F (1,113) = 88.57, P < 0.001, η²_p = 0.44] and Entry [F (1,113) = 11.31, P = 0.001, η²_p = 0.09]. That is, students do better on each subsequent test (main effect of ADK), students in later years of the programme perform better than those in earlier years (main effect of cohort), and graduate-entry students outperform direct school leavers.

CONCLUSIONS

This is the first study to explore the differences in the academic performance of graduate-entry and direct school leavers in an undergraduate dental programme. The results show that the academic performance of graduate students was better than the direct school leavers in years 2 and 3. Further research is required to compare the performance of students longitudinally across the entire duration of undergraduate dental programmes and evaluate whether this difference persists throughout.

Academic performance of undergraduate dental students with learning disabilities

Aims To compare the academic performance of undergraduate dental students with known learning disabilities (LDs) to their peers.Methods This study analysed the results of students in applied dental knowledge (ADK) progress tests across four cohorts of dental students. A mixed model analysis of variance (ANOVA) was conducted to compare the performance of students with known disability to their peers. ADK test sitting was treated as a repeated measures variable, and the outcome variable of interest was percentage score on the ADK.Results Students' performance data on five ADK test sittings (ADK15, ADK16, ADK17, ADK18, and ADK19) by disability showed a significant main effect of test but no significant effect of disability or any interaction between disability and test.Conclusions This is the first study that explores the academic performance of dental students with a diagnosis of disability. The findings give reassurance to all stakeholders that, within the study population, students with LDs are not disadvantaged in knowledge-based assessments, demonstrating compliance with the legal obligations. Further research is required to explore how generalisable these findings are, as well as assess academic, clinical, and behavioural attributes of students with learning disabilities.

Virtual courses: enhancing a curriculum

INTRODUCTION

Providers of education programmes are required to demonstrate to students, staff and external regulators the content of the programme and how this aligns to key outcomes. Whilst many programme themes are straightforward to illustrate, other integral themes prove challenging to demonstrate independently.

INNOVATION

A virtual course takes elements within the current programme relating to a specific theme, repackages and maps them to provide clear signposting by highlighting each occasion the theme is taught, experienced and assessed. The individual elements remain within their current course, so there is no disruption to the established curriculum, but there is an enhancement in terms of transparently displaying linkages within a theme.

DISCUSSION

Using the concept of virtual courses we have found we can respond to new initiatives and requirements of external regulators, as well as providing improved signposting for staff and students. This can be undertaken without the need to redesign a whole curriculum.

CONCLUSION

In well-designed and currently effective curricula, we would like to recommend that virtual course development can enhance programme transparency, demonstrate external regulatory requirements and promote quality assurance without disruption to current content.

Student perceptions of a spiral curriculum

AIM

The aim of this study was evaluation of constructive alignment of student perceptions to a spiral curriculum, as a pre-requisite to successful learning.

METHOD

A survey was undertaken to evaluate student thoughts and experiences of a spiral curriculum, by participation in an anonymous voluntary questionnaire. Students were asked to rate their thoughts on their understanding, perceived benefit of and confusion with their spiral curriculum at the current time and retrospectively during previous years, and to answer free-text questions on the impact, effects on learning and future suggestions for their spiral curriculum.

RESULTS

Sixty (86%) students completed the questionnaire. Understanding the spiral curriculum worked enhanced with time, with the benefit of the spiral curriculum being felt more conclusively in the latter years, and the majority of students not being confused by the spiral curriculum. Those students who were most confused by the spiral curriculum were the ones who were least likely to appreciate its benefits. The opportunity for consolidation of previously visited knowledge was a perceived predominant advantage, with re-visitation of topics helping to deepen understanding and learning. Clarity on the depth of knowledge at each stage prevents information overload. A spiral curriculum must spiral and not be a repetition of previously delivered topics.

CONCLUSIONS

This study provided insights into students' perceptions of an integrated spiral curriculum, and whilst predominantly positive, there are challenges to enhance the student experience. The spiral curriculum provides an opportunity to revisit and consolidate learning to the apparent benefit of the student.

Progress testing in undergraduate dental education: the Peninsula experience and future opportunities

BACKGROUND

Progress testing is well established as a longitudinal form of assessment in undergraduate medical programmes to measure growth in knowledge. Peninsula Dental School is the first school to use progress testing and remains the only one to do so.

AIMS

To share the experience of developing progress testing in an undergraduate dental programme as a major summative assessment tool at a newly established dental school in the United Kingdom.

METHODS

Data were collected for progress tests conducted from 2007 to 14. The tests were formative in the first 2 years of the programme and summative in subsequent years. Each test was based on 100 single best answer multiple-choice items with an appropriate vignette. The students chose their answer from 5 options. A score 1 mark is awarded for each correct answer, minus 0.25 for an incorrect answer and 0 for 'don't know' (DK). The standard setting for each sitting was carried out using Angoff and Hofstee methods.

RESULTS

There were two tests per year with each cohort undertaking eight tests in their 4 years of study providing a total 14 test occasions. The reliability of each test for each student cohort tests was measured using Cronbach's alpha. The average reliability over 42 test/cohort combinations was 0.753 (±SD 0.08). Data analyses show growth in knowledge of dental students across successive years with the largest increase in knowledge observed between tests 1 and 5 and concomitant reduction in DK responses.

CONCLUSION

This is the first study to report the establishment and use of progress testing as the principle form of written summative testing in an undergraduate dental curriculum. Progress testing is a valid and reliable tool to assess growth in knowledge longitudinally over the duration of a dental programme. Although a labour-intensive process, progress testing merits more widespread use in dental programmes.

Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.

Oral health care in residential aged care services: barriers to engaging health-care providers

The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved.

Embedding a population oral health perspective in the dental curriculum

Over the past 40 years, oral healthcare has changed dramatically as a consequence of changing disease profiles and population demography. However, dental disease continues to be highly prevalent and costly to treat. Furthermore, it has been recognized that there are inequalities, with tooth loss being influenced by social, cultural and economic factors. Undergraduate education has been task oriented, with a heavy emphasis on training in technical aspects of treating disease. However, oral healthcare education needs to include a population health perspective, and each professional programme should describe appropriate learning outcomes for population oral health. This includes the need to understand health systems and health trends, and to have knowledge of the evidence base for community prevention strategies and health promotion. A key challenge in embedding population oral health into the curriculum is to break down traditional boundaries in the curriculum and to make teaching of this subject context specific and interdisciplinary. Embedding population oral health offers the potential to create synergies between educators and health service providers with the ultimate benefit of producing a reflective and holistic oral health practitioner. There are challenges, but it is important to produce graduates whose attitudes and clinical practices will be shaped by a sound knowledge of population oral health.

Academic environment in a newly established dental school with an enquiry-based curriculum: perceptions of students from the inaugural cohorts

INTRODUCTION

Established in 2007, Peninsula Dental School offers a highly innovative, enquiry-based, student-led, patient-centred curriculum. It is one of the first dental schools in UK to be based exclusively in a primary care setting. This study was carried out to evaluate the academic environment at Peninsula Dental School and to identify differences between expectations of new entrants and perceptions of senior cohorts.

METHODS

This was a cross-sectional survey utilising an online questionnaire based on Dundee Ready Educational Environment Measure (DREEM). The subjects were 234 dental students from all years in this enquiry-based Bachelor of Dental Surgery programme.

RESULTS

The response rate to the questionnaire was 56.42% with an equal gender distribution of the participants. The overall mean DREEM score of the four cohorts was 143.58 (SD ± 20.84), and the mean score for individual items was 2.87 (SD ± 0.41). The reliability of the DREEM data as a whole was strong (α = 0.93). The difference in questionnaire means for the new entrants and the senior cohorts was not significant (P > 0.05). The ANOVA results showed that there were no significant effects of age, gender or ethnicity on the mean DREEM scores. The MANOVA results showed a significant effect of ethnicity with regard to perceptions of teachers and atmosphere.

CONCLUSIONS

An enquiry-based, student-centred curriculum at the Peninsula Dental School provides a positive academic environment for the students.

First-year oral health and dentistry student perceptions of future professional work

OBJECTIVES

To explore and compare how pre-doctoral dentistry (BDS) and oral health (BOH) students characterise their future professional work at the start and end of their first-year professional programme.

MATERIALS AND METHODS

All BDS and BOH students were given an anonymous survey on the first and last days of their 2009 course. Start and end surveys (ES) were completed by 75% of BDS (51) and 83% of BOH students (33). This paper examines students' responses to two questions asking them to identify a situation characterising their future professional work and a professional difficulty they would likely encounter. Student responses were analysed inductively to identify key themes and confirm each theme's 'weighting' based on frequency of mention.

RESULTS

Students' answers to both questions revealed eight characterisations of future professional work involving the following: restorative tasks, patient-related concerns, patient emotion and behaviour, population-level/public health concerns, disease prevention and monitoring, communication, teamwork and self-management. In ES responses, BDS students emphasised restorative tasks as central to a dentist's work, and in both surveys perceived 'dealing with patients' as a central difficulty. In contrast, BOH students' answers to both questions revealed a patient care emphasis, and in both surveys, BOH students emphasised patient-related concerns as a likely difficulty.

CONCLUSION

Bachelor of Dentistry students characterised their work as primarily interventive, and BOH students, as primarily patient-centred, communicative, and preventive. Whilst BDS students apparently valued restorative capabilities, BOH students valued the ability to ensure patient well-being. Further research will examine students' differing perceptions and how these change over time.

Threshold concepts in dental education

The paper presents a conceptual framework to inform dental education. Drawing from a vast body of research into student learning, the simple model presented here has an explanatory value in describing what is currently observed to happen and a predictive value in guiding future teaching practices. We introduce to dental education the application of threshold concepts that have a transformative role in offering a new vision of the curriculum that helps to move away from the medieval transmission model of higher education towards a dual processing model that better reflects the way in which professionals operate within the discipline. Threshold concepts give a role for the student voice in offering a novice perspective which is paradoxically something that is out of reach of the subject expert. Finally, the application of threshold concepts highlights some of the weaknesses in the competency-based training model of clinical teaching.

The older dental patient - who cares?

People in the United Kingdom are living for longer and taking their natural dentitions with them into old age. If the dental profession as a whole is to be prepared to support the care of older people, a clear understanding of what it is to be old will be needed. But with much talk of this heavy metal generation having complex restorative needs, the technical aspects of care are being emphasised. This paper suggests that there may be more basic needs to be addressed.

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.