Competence, competency-based education, and undergraduate dental education: a discussion paper

Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions

OBJECTIVE

This study aimed to define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation.

FINDINGS

Sixty-five studies were included from a variety of health professions in order to define competency based pharmacy education (CBPE) and identify barriers and benefits from the learner, faculty, institution, and society perspectives. From the 7 identified thematic categories, a CBPE definition was developed: "Competency-based pharmacy education is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet health care and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback) while deemphasizing time."

SUMMARY

This article provides a definition of CBE for its application within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

Assessing competency in exodontia: A UK perspective

INTRODUCTION

Assessment ensures that undergraduate students and postgraduate trainees are providing optimal patient care. Numerous assessment methods are currently being used within the United Kingdom. Therefore, the purpose of this review was to provide an overview of the methods used to assess competency in exodontia and compare methods against criteria defined for good assessment.

MATERIALS AND METHODS

A systematic narrative review was carried out. Databases were electronically searched for published studies assessing the competence of undergraduate students and postgraduate trainees in exodontia up to October 2023.The validity, reproducibility, equivalence, feasibility, educational impact, catalytic effect and acceptability of each assessment method was considered.

RESULTS

In this review, 591 undergraduate students (n = 529) and postgraduate dental trainees (n = 62) had their competence in exodontia assessed. Undergraduate students were assessed on simple exodontia with forceps and elevators, whereas postgraduate trainees were assessed on the surgical removal of mandibular third molars. Only one study took place in a simulated dental environment, the remaining (n = 7) took place in a clinical environment. A range of formative and summative assessment methods were identified including structured clinical objective tests (SCOT), self-assessment, peer assessment and logbooks. Common marking criteria such as global rating and checklist scales were also highlighted.

CONCLUSION

This review highlights the lack of evidence to support one form of assessment and the lack of consensus on assessment within the United Kingdom. Further research related to this topic, alongside the opinion of trainees and trainers is required to improve assessments. This will maximise learning opportunities for trainees and translate to better patient care.

Integrating hands-on practical and reflective feedback in teaching dental materials science to undergraduate dental students

INTRODUCTION

This study aimed to develop a module that incorporates hands-on and reflective feedback in teaching dental materials science and subsequently analyse undergraduate dental students' learning experiences with the module.

MATERIALS AND METHODS

The module was developed based on the ADDIE (Analyse, Design, Develop, Implement, Evaluate) model. First, a need analysis was conducted, followed by designing the module to address the needs. Next, the module sought experts' feedback and was piloted. The revised module was implemented among all second-year undergraduate dental students. Finally, a validated questionnaire (5-point Likert scale items and open-ended questions) was used to evaluate students' learning experiences. The questionnaire Likert scale items were analysed descriptively, whereas open-ended responses were analysed using content analysis.

RESULTS

In the analysis phase, a slight misalignment in cognitive competency levels was observed, alongside a need for the inclusion of more hands-on activities. In the design phase, learning objectives and resources were listed. Subsequently, a module consisting of four teaching sessions (3 h each) was developed, and the pilot test showed favourable feedback. The module was then implemented in small groups of 10-12 students. In the evaluation phase, 72 students (97% response rate) completed the questionnaire. The majority of students agreed with all items, with mean scores ranging from 4.53 to 4.72. Open-ended responses highlighted that hands-on activities and reflective feedback sessions were useful.

CONCLUSION

Students demonstrated positive learning experiences after participating in the module, advocating for dental educators to consider more hands-on activities and reflective feedback sessions in teaching dental materials science.

Navigating the Path to Independent Dentist: A Qualitative Phenomenological Exploration

OBJECTIVE

The objective of this study was to explore the process of becoming an independent dentist, extending beyond the entry-level period.

MATERIALS AND METHODS

Fifteen general dental practitioners were interviewed. The recorded interviews were transcribed verbatim, and utilizing Colaizzi's descriptive phenomenological method, we sought to exclude subjectivity and derive meanings and themes from participants' experiences concerning the process of becoming independent dentists.

RESULTS

The study identified 3 phases in the process of developing as an independent dentist: (1) the foundation phase, involving dental training as a student under faculty supervision; (2) the extension phase, expanding experience as an entry-level dentist; (3) the equilibrium phase, characterized by providing stable dental care based on diverse experience and professionalism.

CONCLUSION

Becoming an independent dentist entails more than unsupervised treatment provision; it involves developing the professionalism necessary for delivering quality dental care through deliberate practice and reflection.

CLINICAL RELEVANCE

The study outlines the stages of transitioning to an independent dentist, spanning foundational training, entry-level experience, and achieving stable care provision. Emphasizing the importance of professionalism and reflection, it provides a valuable framework for enhancing dental education and on-going professional development, fostering both technical proficiency and a commitment to quality patient care.

Identifying barriers and strategies for achieving competency in removable prosthodontics in undergraduate dental students: a mixed-method study

BACKGROUND

Developing competency in removable prosthodontics (RP) is challenging for undergraduate dental students because it involves threshold concepts and tacit knowledge. Understanding this process can enhance learning and professional development in RP. The objective of this study was to identify the barriers hindering knowledge (threshold concept) and skill (tacit knowledge) development, and to propose strategies for achieving RP competency.

METHODS

Adopting critical theory, quantitative and qualitative approaches were implemented. The participants were third- to sixth-year dental students and recent dental school graduates. An online questionnaire was used to investigate the knowledge and skills required for achieving RP competency and barriers to RP competency development. Four focus groups were conducted to gather in-depth information. The data was analyzed using descriptive statistics and thematic analysis.

RESULTS

A total of 322 respondents completed the questionnaire (67% response rate), and 26 of them participated in focus group interviews. The four threshold concepts to achieve RP competency were the basic principles of RP, removable partial denture design, occlusion, and dental materials. The two main tacit knowledges were impression making and material handling skills. The curriculum should integrate strategies to assist dental students in overcoming intrinsic barriers such as self-experience, revision, and spatial-temporal relationship, along with extrinsic factors such as clinical correlations of content, discussions, and immediate feedback.

CONCLUSIONS

Threshold concepts and tacit knowledge in RP for undergraduate dental students have been proposed The strategies to overcome barriers comprise intrinsic and extrinsic factors that include the adoption of experiential learning. This study suggests effective teaching methods and learning strategies to maximize student learning and RP competency development when designing the undergraduate RP curriculum in dental education.

Scaffolding competence-based learning design in the dental simulation curriculum

INTRODUCTION

Learning in a clinical domain in dentistry is complex and learners may face uncertain clinical scenarios. A simulation curriculum can be designed to have simple clinical scenarios and learning activities which progress in complexity and employ competence assessments of simulated clinical practice before students can undertake authentic practice on patients. This paper presents how scaffolding of competence can be used for designing learning with simulators (haptics and phantom head) demonstrated in a specific domain in restorative dentistry.

METHODS

A collaborative workshop as a research approach was undertaken to inform the iterative analysis, development, and discussion on scaffolding the learning design with respect to competence assessments of learning cavity preparation with simulation-based learning technologies. A workshop was conducted, which was collaborative and involved design negotiations between researchers, technologists, and teachers/practitioners in developing the simulation curriculum.

RESULTS

A competence assessment with feedback in a specific domain in preparing interproximal caries was used as a context to describe how the learning activities and outcomes were designed to meet assessment of competence with varied levels of simple to complex learning activities and structured sessions.

CONCLUSION

Simulation curriculum can be designed and implemented by scaffolding the level of competence that can be learned using simulation between haptics and phantom-head. This brings impetus to the need in meeting the relevant competence criteria in context to a specific affordance of the simulation-based learning technologies to provide optimal patient-centred holistic care.

[NKLZ 2.0: the further development of the National Competence-Based Learning Objectives Catalogue for Dentistry as a basis for the design of the new licensing regulations]

The National Competence-Based Catalogue of Learning Objectives in Dentistry (NKLZ) was adopted in 2015 and defines the learning objectives for dental training in Germany. It specifies which competences students should acquire and serves as a basis for the curricular design of the study programme, examinations and teaching materials. The NKLZ promotes a comprehensive education that includes clinical skills and abilities, professional behaviour and communication skills in addition to specialist knowledge. It contributes to the preparation of future dentists for their profession and standardizes training to ensure quality and comparability.This article describes the background, history, structure and further development of the NKLZ. Currently, the NKLZ is being further developed to version 2.0 in a multi-stage process. Its structure is based on the NKLM 2.0, the National Competence-Based Learning Objectives Catalogue for Medicine. The aim is to comprehensively map the requirements for the dental licensing regulations.An important prerequisite for the official recognition of the NKLZ as a basic guideline for the training of dentists is that it be anchored in a dental licensing regulation that is to be reformed soon. This creates clarity and liability for teachers and students. Such an anchoring also enables better coordination between training objectives and the requirements of professional practice. Since the licensing regulations are modified less frequently, the integration of the NKLZ offers the possibility of updating and adapting the catalogue of learning objectives in a structured and regulated manner. This ensures that training is in line with current standards and developments.

Perceptions of dental students, dental faculty, practicing dentists and industry dental professionals on the acquisition of dental competencies and clinical skills in the Dominican Republic

INTRODUCTION

This study gathered perceptions from four stakeholder groups in the Dominican Republic (DR) regarding acquiring professional dental competencies and clinical skills.

MATERIALS AND METHODS

Researcher-created surveys covering core dental competencies and clinical skills were distributed to stakeholder groups associated with nine different DR dental programs. Respondents included 153 undergraduate dental students, 153 dental faculty members, 108 practicing dentists (who had graduated in the past 5 years) and 42 industry professionals (who hire and supervise dentists). Data were examined using descriptive statistics, univariate ANOVA and multiple linear regressions.

RESULTS

Dental school students and recent graduates now practicing dentists in the DR reflected moderate to solid confidence that they had learned most of the dental skills and competencies covered in the survey. Industry professionals were a bit less confident overall, while dental faculty offered the lowest scores, although those were often still in the moderately confident range. ANOVAs revealed significant differences when broken down by individual university dental programs. Regressions also revealed that individual university dental programs significantly predict confidence that dental skills and competencies were achieved.

CONCLUSION

Data show that DR's dental stakeholder groups generally felt optimistic about the learning occurring. However, the lower mean scores and higher standard deviations from faculty responses raise concern, as do the significant differences between individual dental programs and the dental program itself a significant predictor. Further review of programs is needed, and a national set of dental competencies should be considered in this country.

An evaluation of the relationship between clinical requirements and tests of competence in a competency-based curriculum in dentistry

BACKGROUND

The development of competencies in dentistry is a complicated process that calls for the development of not just cognitive and psychomotor abilities but also behaviors and attitudes that change as technical proficiency increases and meaningful patient encounters occur. This study examined the relationship between the number of clinical requirements completed by dental students and subsequent performance on tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence.

METHODS

Retrospective assessment data for 81 students were used in this analysis. Data included the amounts of clinical requirements completed for operative dentistry, endodontics, periodontics, and fixed prosthodontics together with data on the respective performance in tests of competence. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements using a non-parametric Spearman's Rho test at an alpha level of 0.05.

RESULTS

Fixed prosthodontics and posterior endodontics were the least common procedures completed by dental students. Statistically significant weak correlations were found between the amounts of clinical requirements performed for posterior endodontic(p = 0.005) and operative procedures (p = 0.006) and associated performance in tests of competence. A moderate correlation was found between the number of fixed prosthodontic procedures completed and associated performance in tests of competence. This latter correlation, however, was not statistically significant (p = 0.654). A significant weak correlation was found between requirements completed for periodontics and the associated test of competence (p = 0.04). A highly statistically significant moderate correlation was found between clinical requirements for anterior endodontics and the associated performance in the tests of competence (p < 0.001).

CONCLUSION

The null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform.

Dental Education: A Guide for Novice Tutors

The primary objective of undergraduate-level dental education is to produce proficient dental practitioners who can effectively address the oral health needs of the community and enhance the overall oral health of the population. The field of dental education is subject to continuous change that is shaped by many factors, including changing societal norms, shifting responsibilities of dental practitioners, changing healthcare environments, and rapidly evolving dental science. Learning theories significantly impact the advancement of dental education, and educators must recognize and acknowledge their influence. Dental faculties must be adequately prepared and motivated to use innovations, which enable them to impart knowledge in a practical and organized manner. This review provides an overview of teaching methodologies that have gained acceptance in recent years. It highlights the importance of their implementation in facilitating an effective teaching and learning process in consideration of their history, style, and core focus. A clearer understanding of these techniques can enhance education standards, help establish dental instructors' responsibilities and career advancement, and provide insights for future research.

Expert consensus on relevant topics for undergraduate paediatric dental curriculum using the fuzzy Delphi method: a new direction for Malaysian dental education

BACKGROUND

Paediatric dentistry is a branch of dental specialty that focuses on dental care for children from infancy through adolescence. However, there is no standardised national undergraduate paediatric dental curriculum in Malaysia. The present study aimed to identify relevant topics for undergraduate paediatric dental curricula and to determine the appropriate cognitive and psychomotor levels for each topic based on the consensus among paediatric dental experts.

METHODS

Potential relevant undergraduate paediatric dentistry topics were initially drafted and revised according to the revised national competency statement. The final draft included 65 topics clustered under 18 domains. A fuzzy Delphi method was used and experts who fulfilled the inclusion criteria were invited to anonymously ranked the importance of relevant topics using a five-point Likert scale and proposed suitable cognitive and psychomotor levels for each topic. Fuzzy evaluation was then performed, and experts were considered to have reached a consensus if the following three conditions were achieved: (a). the difference between the average and expert rating data was ≤ 0.2; (b). the average expert consensus was ˃70%; and (c). the average fuzzy number was ≥ 0.5. Subsequently, the mean ratings were used to determine the cognitive and psychomotor levels.

RESULTS

20 experts participated in the survey. 64 out of 65 paediatric dentistry topics were deemed acceptable. The average fuzzy number ranged from 0.36 to 0.85, while the average Likert score ranged from 3.05 to 5.00. The topic "Dental amalgam" was rejected based on expert consensus since the average fuzzy number was 0.36. The most significant topic was "Pit and fissure sealant", followed by "Preventive advice", "Early childhood caries", "Dental caries in children & adolescent", "Management of dental caries in paediatric patients", and "Consent" which were equally ranked as the second most important topics. According to Bloom's and Simpson's taxonomies, most of the paediatric dentistry topics were rated adequate for undergraduate students at the cognitive level of "Apply" (C3) and a psychomotor level of "Guided response" (P3).

CONCLUSION

The current study successfully identified relevant undergraduate paediatric dentistry topics using the fuzzy Delphi method, which can facilitate future educators to improve existing Malaysian undergraduate paediatric dental curricula.

The use of feedback in teaching undergraduate dental students: feedback sandwich or Ask-Tell-Ask model?

BACKGROUND

Feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on students' academic learning. The present study aimed to evaluate and compare students' perceptions of the use of two feedback models, namely feedback sandwich and Ask-Tell-Ask (ATA), in teaching dental materials science courses.

METHODS

All undergraduate second-year dental students were invited to participate in the dental materials science practical session and were randomly allocated into two groups: Group 1 (feedback) sandwich and Group 2 (ATA). The session began with the teacher giving a short briefing on the commonly used dental materials, followed by a short demonstration of the manipulation of those materials. Students were then allowed to mix and manipulate the materials, and teachers provided feedback accordingly. At the end of the session, 16 close-ended (five-point Likert scales) and an open-ended questionnaire were distributed to students to evaluate their perceptions of the feedback given. Internal reliability of the questionnaire items was evaluated using Cronbach's alpha. Mean feedback scores were analysed using an independent t-test with ANCOVA for controlling gender and ethnicity. Thematic analysis was used to code the qualitative data.

RESULTS

Sixty-nine students participated in the present study with the majority being females (72.5%) and Chinese (79.7%). Cronbach's alpha analysis suggested removing three Likert-scale items, with the remaining 13 items being accepted. Generally, no significant difference was noted between the two groups (p = 0.197), but three items were found to be significant (p < 0.05), with higher mean scores in the feedback sandwich group. Moreover, no significant difference was noted between the two feedback models (p = 0.325) when controlling gender and ethnicity. The open-ended question showed that students in the feedback sandwich group expressed greater positive perceptions.

CONCLUSION

Although students generally had positive perceptions of both feedback models, they tended to favour the feedback sandwich. Neither gender nor ethnicity affected the students' perceptions of the two feedback models.

Argument-based QUalitative Analysis strategy (AQUA) for analyzing free-text responses in health sciences Delphi studies

Delphi methods are mostly used in the health sciences to reach agreement among experts on unclear issues. Generally, consensus is reached after several rounds of Delphi using standardized items. Additional open-ended questions offer respondents the opportunity to provide reasons for judgments. Although these free-text responses contribute substantially to the steering and result generation of the Delphi process, so far no analytical strategy has been established which takes into account the context and methodological principles of the Delphi procedure. Moreover, in already published Delphi studies the analysis of qualitative data is often not sufficiently disclosed.•We provide an overview of analytical strategies for free-text responses. We critically reflect on them with regard to their use and suitability in the context of Delphi procedures.•Following established qualitative methods of qualitative content analysis according to Mayring and thematic analysis according to Braun & Clarke, we developed the Argument-based QUalitative Analysis strategy (AQUA) for Delphi studies in the health sciences and presented it using a concrete project example.•This newly developed strategy can significantly support the rule-governed and intersubjective evaluation of free-text responses in Delphi processes, the integration of the results into the feedback design, and thereby also the quality of the results.

Utilizing Evaluation and Development Frameworks to Engineer a College-Wide Evaluation and Reform of an Undergraduate Dental Curriculum

PURPOSE

To operationalize and analyze a college-wide evaluation of an undergraduate dental curriculum.

MATERIALS AND METHODS

A descriptive case study design was used with extensive multiple data collection methods that included literature review, document review of existing data, survey questionnaires, focus group semi-structured interviews and observation of clinical and laboratory tasks. This approach was based on Kern's curriculum development model and Fitzpatrick's practical guidelines and evaluation standards.

RESULTS

The evaluation outcomes indicated that a significant curricular change is needed. In hindsight, a thorough reflection on the evaluation strategy is provided highlighting several contextual factors. Actionable recommendations and comparisons are also drafted to shape a coherent curriculum reform implementation.

CONCLUSION

The process by which the evaluation was conducted, and the reform implementation is being instituted, while unique to this college, may offer insights for change at other dental colleges. In that, greater emphasis is placed on the general principles that remain applicable to other comparable contexts regardless of the distinctiveness in specificities.

Innovative Pedagogical Strategies in Health Professions Education: Active Learning in Dental Materials Science

Dental materials science education is frequently delivered via traditional didactic lectures in preclinical dental programs. This review aimed to appraise the current evidence on innovative pedagogical strategies in teaching dental materials science courses. English-language articles on teaching methods for dental materials science published between January 1990 to October 2022 were searched in nine online databases (Google Scholar, PubMed, Web of Science [WoS], Science Direct, Cochrane Library, EBSCO, LILACS, Open Grey, and EMBASE) according to PRISMA guidelines. The risk of bias (RoB) was assessed using the Cochrane RoB-2 and ROBIN-I tools, whereas the level of evidence was determined based on the OCEBM guidelines. Only 12 primary studies were included. Two randomized studies (RCTs) were deemed as being of "some concern", and one showed a high risk of bias (RoB). Three non-randomized controlled studies (NRS) demonstrated a moderate RoB, whereas the remaining seven were low. Most studies were ranked at Levels 2 and 3 of evidence. Several innovative pedagogical strategies were identified: flipped classrooms, clinical-based learning, computer-assisted learning, group discussion, microteaching with the BOPPPS (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) model, and game-based learning. The evidence suggested that students generally showed positive perceptions toward these pedagogical strategies. Dental educators should revise their current undergraduate dental materials science curricula and integrate more effective teaching methods.

Comparison of PRISM and numeric scale for self-assessment of learning progress during a clinical course in undergraduate dental students

OBJECTIVES

To compare Pictorial Representation of Illness and Self-Measure (PRISM) and a numeric scale for self-reflection in dental students.

METHODS

Fourth year dental students were randomly assigned to each receive one interview based on PRISM or a numeric scale to self-assess their competencies at the beginning (t1), the middle (t2) and the end (t3) of integrated clinical course. Questionnaires were used to assess self-perceived benefit of the interviews at each time points.

RESULTS

Students in PRISM group perceived a higher benefit regarding the self-assessment of their practical skills at all time points (P < 0.05), for theoretical knowledge at t2 and t3 (P < 0.05) and reaching the course objectives at t3 (P = 0.04). At all time points, PRISM group rated their interview (P = 0.04), the applied instrument (PRISM, P = 0.01) and the benefit of the combination of both higher than numeric scale group (P < 0.05).

CONCLUSION

In this preliminary study, PRISM was superior against a numeric scale and can be recommended for dental education to facilitate self-assessment.

Impact of public health and higher education policies on the profile of final-year Brazilian dental students: Challenges and future developments

INTRODUCTION

Brazil has experienced transformations in higher education and health services, including launching more inclusive public policies focused on these two areas.

OBJECTIVE

To evaluate the profile of final-year dental students from a Brazilian public university from 2010 to 2019, accompanied by changes in public health and higher education policies.

METHODS

A prospective observacional study was carried out with final-year dental students. A self-applicable semi-structured questionnaire was applied.

RESULT

Six-hundred and seventy-seven students participated, of which 71.5% were women, 72.9% aged between 21 and 25 years, 96.2% single, and 96.4% were without children. Over ten years, it was possible to identify trends in the profile explained by implementing public policies toward more inclusive access to Brazilian higher education by socioeconomically disadvantaged individuals. Students who completed the course between 2018 and 2019 did not have the state capital city (the wealthiest area) as their origin city and had lower parental education and income levels than dental students graduating between 2010 and 2011. Moreover, working as a primary care dentist in the Brazilian National Health System was considered a professional possibility by 61.4% of the students, and has gained prominence significantly over time, ranging from 21.1% in 2010 to 72.9% in 2019 (p < .05).

CONCLUSION

Over the study period, concomitantly to advances in public health and higher education policies in Brazil, more diverse access to public dental education was observed, allowing students from low socioeconomic positions to take the education. Changes have also impacted the students' perspectives regarding the need for postgraduate training and a career in public health dentistry. However, these trends need to be consolidated, and public policies continued and strengthened.

The objectives and instructional design of undergraduate endodontic program: multicenter cross-sectional study in Saudi Arabia

BACKGROUND

Identify the objectives and the instructional design of undergraduate endodontics in dental schools in Saudi Arabia.

METHODS

The online questionnaire was developed from an original survey conducted in the United Kingdom. The questionnaire was modified for purpose of the study and the region of interest. Then it was directed and emailed to the undergraduate endodontic program directors in twenty-six dental schools in Saudi Arabia. The results were analyzed using descriptive statistics and the Chi-square and Fisher's exact tests.

RESULTS

The response rate was 96.15%. The number of credit hours for preclinical endodontic courses was up to four credit hours (84%). Students were clinically trained to do vital pulp therapies (92%), root canal treatment (100%), and root canal retreatment (68%). The majority of dental schools define the minimum clinical requirements (92%). Practical and clinical competency exams were used to evaluate students' performance (92% and 84% respectively). The students were trained to treat cases of minimal (52%) to moderate complexity (48%). Endodontic treatment consent and difficulty assessment form were used by 32% and 60% of dental schools respectively. There was no significant difference in the instructional design between public and private dental schools (P > 0.05).

CONCLUSION

The endodontic undergraduate objectives were to graduate competent clinicians who acquired basic science of endodontics and who know their limitations as it is necessary for a safe general dental practice. The use of endodontic treatment consent and case difficulty assessment should be wisely considered in clinical training.

Development of an electronic learning progression dashboard to monitor student clinical experiences

INTRODUCTION

Clinical experience tracking mechanisms for students at dental schools provide patient assignment, student experience, and learning progression feedback. The purpose of this study was to evaluate dental students' clinical experiences following the implementation of a learning progression dashboard (LPD).

METHODS

After developing and deploying an electronic LPD using PHP, secondary data analysis on dental students' clinical experiences from 2017-2019 was conducted. Student experience differences were compared between the year before continuous use of the LPD and the first year using it. LPD data contained the required clinical procedures dentistry students must perform across all disciplines and the number of planned, in progress, and completed tasks each student has accomplished. Using two time points, the students' experiences were compared. Univariate statistics and independent t-tests were conducted in R for detecting the differences in the number and categories of codes.

RESULTS

The number and category of codes showed significant differences between the academic year 2017-2018 and 2018-2019 for both third- and fourth-year dental students after one and two terms. Overall, students recorded a 26% greater number of treatment codes and experienced a 26% greater number of code categories compared to the previous year.

CONCLUSION

Applying information management methods such as dashboards can better inform educators on student clinical experiences and improve clinical learning outcomes for students.

Using self-study as a methodology for dental educators' professional inquiry

INTRODUCTION

Dental educators play crucial roles in dental education and in the functioning of dental schools. Whilst it is recognised that dental educators need more than relevant disciplinary expertise and that scholarly development of dental educators is important, there is a lack of knowledge about ways research can be used to promote professional development. This article aims to showcase a research methodology for professional inquiry that is widely used in teacher education to promote the view that dental education is a professional practice.

APPROACH

Self-study methodology was employed by four dental educators to illuminate their theory-informed practice. We chose to frame the inquiry around technology and accumulated three forms of data: individual journaling, video-call discussions and Padlet/bricolage. Analysis of this data focused on how the learning was co-constructed by the group.

FINDINGS AND DISCUSSION

Five key elements of our self-study were constructed into narratives: understanding technology as a dental educator, being a learner and embodied scholarship, the (expanded) roles of a teacher in a technological environment, advancing our own professional identity as an educator, and possibilities and limits for self-study in the dental education context.

CONCLUSION

Professionalisation of dental educators is critical to sustainable dental education. By educators researching their own practice, research approaches such as self-study can perform a dual role of facilitating scholarly development and contributing to the generation of new knowledge about becoming and being a dental educator.

Perceptions of a comprehensive dental care teaching clinic among stakeholders in a dental teaching hospital in South India: A baseline assessment

Background

When the dentist starts practicing independently, they need to plan and treat comprehensively and prioritise the procedures accordingly. This contrasts with dental students learning years where they deal with only a clinical subject during a fixed period. To improve this scenario a comprehensive dental care teaching clinic was introduced, and baseline assessment was performed.

Methods

The perceptions of patients, dental undergraduate students, clinical instructors, and clinic co-ordinators regarding Comprehensive Dental Care was evaluated by a cross sectional survey. The questionnaire was developed through a focus group discussion and content validation was performed by experts. Three domains including orientation to the clinics, clinical training of undergraduates and clinic management were assessed. Descriptive statistics were performed using SPSS.

Results

The results reveal, 53.5% of undergraduate students and 61.3% of clinic instructors agreeing that students trained under comprehensive system can confidently manage patients independently. Good collaboration (80%) among the dental team and regular monitoring of the clinic management (80%) were reported by clinic co-ordinators. The challenges ahead for this teaching clinic includes instrument and facilities availability, which has found to higher disagreement percentages by undergraduate students (43.7%), clinic instructors (38.7%) as well as clinic co-ordinators (50%). Patient satisfaction for all three domains were noted to be high.

Conclusion

With the introduction of the comprehensive dental care teaching clinic better patient management and improved clinical training of undergraduate students were reported by the stakeholders. This new system is a major shift in dental service delivery and can be adopted to similar settings to improve patient care and dental education.

Competency-based education in pharmacy: A review of its development, applications, and challenges

RATIONALE, AIMS, AND OBJECTIVES

There has been a resurgence of interest in the application of competency-based education (CBE) in health care professionals' education in recent years, including the pharmacy profession. This model strives to prepare a competent pharmacy workforce to help meet societal needs for effective, safe, and economical health care services. The aim of this narrative review is to provide an overview of the applications of CBE in the education and training of pharmacists, the process for constructing a competency-based pharmacy curriculum, and the potential advantages and challenges associated with its implementation.

METHOD

A comprehensive literature review was conducted via PubMed and Scopus databases using a variety of keywords related to the topic (from 1975 to 2019). Other electronic resources (Google Scholar and the Education Resources Information Center) were searched to identify educational outcomes of pharmacy programmes emphasizing competency development and competency frameworks/standards for the pharmacy profession that were published up to 2019.

RESULTS

CBE has been increasingly adopted in pharmacy education, mainly in developed countries. A number of competency frameworks have been advanced to support the design of CBE curricula, accreditation standards of pharmacy programmes, and professional pharmacy registration/licensure. Several examples of the application of competency-based pharmacy education (CBPE) were identified at undergraduate, postgraduate, and professional development levels. Transforming a traditional pharmacy programme into CBPE offers several potential benefits but can also be associated with significant challenges. Successful implementation of CBPE programmes requires strong and supportive institutional leadership; proper curricular design, implementation, and management; and focus on faculty training and development.

CONCLUSION

The adoption of CBPE can enhance the ability of pharmacy education to meet the rapidly evolving societal health care needs. This model has been applied in developed countries at different levels throughout the pharmacist's learning continuum. It has also been investigated in some developing regions.

Integrating Competency-Based Didactic and Experiential Global Health Learning for Dental Students: The Global Health Learning Helix Model

The aim of this study was to evaluate the feasibility and preliminary outcomes of immersive integrated experiential and didactic courses in strengthening competency-based global health learning in dental education. To address global inequities in oral health and student interest in global health, the Harvard School of Dental Medicine introduced two global health courses in 2017-18. The first was a didactic course in the core predoctoral curriculum, and the second, in collaboration with the Inter-American Center for Global Health, was a five-day elective experiential learning course in rural Costa Rica. The experiential course was an extension of the didactic course. All 33 second-year dental students completed the didactic course, and three of those students completed the experiential course. A pre-post survey and a six-month follow-up survey on self-reported knowledge based on course learning objectives were administered. The experiential course students also completed journals and interviews for qualitative analysis. Thirty-two students completed the pre-post didactic course surveys, for a response rate of 94%. There was a 100% response rate on the pre-post didactic surveys by those students who participated in the experiential learning course. While the experiential learning group scored similarly to the class average before the didactic course, they had higher scores than the class averages both immediately after and at the six-month follow-up. All three students reported that the experiential learning course was "extremely effective" in building on what they learned in the didactic course. Qualitative analysis of the journals and interviews suggested enhanced learning from the combination of didactic and experiential methods. These preliminary results support the Global Health Learning Helix Model, a theoretical competency-based teaching model for ethical student global health engagement to better prepare the future generation in tackling oral health disparities both locally and worldwide.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.

Developing an Open Access, Competency-Based Global Oral Health Curriculum: A Global Health Starter Kit

Dental education has seen increases in global health and international educational experiences in many dental schools' curricula. In response, the Consortium of Universities for Global Health's Global Oral Health Interest Group aims to develop readily available, open access resources for competency-based global oral health teaching and learning. The aim of this study was to develop and evaluate a Global Health Starter Kit (GHSK), an interdisciplinary, competency-based, open access curriculum for dental faculty members who wish to teach global oral health in their courses. Phase I (2012-17) evaluated longitudinal outcomes from two Harvard School of Dental Medicine pilot global health courses with 32 advanced and 34 predoctoral dental students. In Phase II (2018), the Phase I outcomes informed development, implementation, and evaluation of the open access GHSK (45 enrollees) written by an interdisciplinary, international team of 13 content experts and consisting of five modules: Global Trends, Global Goals, Back to Basics: Primary Care, Social Determinants and Risks, and Ethics and Sustainability. In Phase III (summer and fall 2018), five additional pilot institutions (two U.S. dental schools, one U.S. dental hygiene program, and two dental schools in low- and middle-income countries) participated in an early adoption of the GHSK curriculum. The increase in perceived knowledge scores of students enrolled in the pilot global health courses was similar to those enrolled in the GHSK, suggesting the kit educated students as well or better in nearly all categories than prior course materials. This study found the GHSK led to improvements in learning in the short term and may also contribute to long-term career planning and decision making by providing competency-based global health education.

Experiences during the execution of emergency endodontic treatment and levels of anxiety in dental students

PURPOSE

This study aims to evaluate the experience of dental students and assess their anxiety levels when performing emergency endodontic treatments.

METHODS

Undergraduate students completed the STAI-Trait/State and a questionnaire to assess their confidence level to perform each step of an emergency endodontic procedure. They also answered a numerical scale (NRS) for anxiety before and after emergency care. Ten randomly selected students from the same sample further participated in a focus group aimed at obtaining qualitative data on their perception of endodontic treatments' conduction and the learning process necessary to perform them.

RESULTS

A total of 23 students joined the study. The majority of the participants reported feeling "confident" when performing local anaesthesia (57.6%), rubber dam placement (57.6%) and coronal sealing (72.7%). However, a small number reported feeling "little confident" to perform access cavity (15.2%) or pulpotomy/pulpectomy (24.2%). Students who scored above the 3rd quartile of STAI-Trait/State were classified as "highly anxious," and comprised 26.1% of the sample. The values of NRS scale were higher in the preoperative when compared with the post-operative assessment. All students classified as "highly anxious" reported low confidence in performing "access cavity" and "pulpotomy/pulpectomy."

CONCLUSION

Both quantitative and qualitative analysis showed different anxiety levels in dental students. It can possibly contribute to a reduction in confidence prior to emergency endodontic procedures. The current findings suggest it might be important to rearrange activities in order to allow for more practical classes in Endodontics.

Developing educators of European undergraduate dental students: Towards an agreed curriculum

INTRODUCTION

Recent developments in European dental education are student-focused, concerned with competency-based and problem-based learning. The development of dental educators has so far received little consideration. This study aimed to agree curriculum content for developing dental educators so that they are better able to support changing undergraduate dental education.

METHODS

Adopting consensus methodology, a 2-round Delphi was conducted in 2012. Fifty-three dental educators and 39 dental students across Europe volunteered to take part. The Delphi questionnaire was developed based on literature, piloted and sent to participants to gather opinions and seek consensus on educational content using rating scales and open-ended questions. Numeric data were analysed using descriptive statistics, and qualitative data were analysed thematically.

RESULTS AND DISCUSSION

This study revealed 7 domains of curriculum content for dental educators. Four of these domains were considered essential: educational principles; educational practice in dentistry; curriculum, quality and improvement; and educational professionalism. Three domains were viewed as optional and could be tailored to local needs: educational principles in relation to specific contexts, educational research, and educational and healthcare management. When developing training for dental educators, factors which need consideration were identified as the academic position and teaching experience of educators, and the nature of clinical dental education.

CONCLUSION

The results are beneficial for individual educators to inform professional development plans; institutions to devise faculty developments; ADEE to inform policies on developing European dental educators; and other disciplines to inform training for their educators.

What can dental education gain by understanding student experience of the curriculum?

INTRODUCTION

Within higher education, there is increasing recognition that understanding the ways students experience the educational environment is critical to developing programmes that can educate our future professionals. There is a small body of literature about how students experience the dental educational environment; however, none that adopts a qualitative phenomenographic approach. This study aims to contribute to our understanding by asking what is the variation in the ways dental students experience their curriculum?

METHODS

This study uses a phenomenographic methodology. Phenomenography investigates the variation in the way a group of people experience a situation, and how they ascribe meaning to it. Interviews were conducted with 14 senior dental students at the University of Sydney. Transcripts were analysed using a phenomenographic approach.

RESULTS

Six increasingly sophisticated, qualitatively distinct categories of description were identified from the collective of transcripts: surviving the education system; following a guide or manual, learning how to treat teeth, learning how to meet patient treatment needs, learning how to relate with patients and understanding the complexities of dental practice. The outcome space consists of ways the categories of description are related; considering interactions with teachers, ways of coping with multiple opinions and integration of disciplinary learning.

CONCLUSION

This study provides new insights into the multifaceted and relational ways that dental students experience their educational environment. It could point curriculum designers towards strategies that assist students develop sophisticated understandings about themselves as practitioners, patients and the complexities of dental practice. Suggestions about the practical implications of the findings of this research are given.

Patient safety issues and concerns in Bhutan's healthcare system: a qualitative exploratory descriptive study

OBJECTIVES

To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan's healthcare system.

DESIGN

Qualitative exploratory descriptive inquiry.

SETTINGS

Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan.

PARTICIPANTS

In total, 140 healthcare professionals and managers.

METHODS

Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies.

RESULTS

The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting 'good' communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system.

CONCLUSION

Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised.

Developing a national dental education research strategy: priorities, barriers and enablers

OBJECTIVES

This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER.

SETTING

Scotland.

PARTICIPANTS

In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire.

RESULTS

Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology.

CONCLUSIONS

This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation.

Perception of Dental Public Health Competency among recent graduates

Aims and Objectives:

This study aimed to assess how competent the recent dental graduates perceive themselves to be in Dental Public Health.

Materials and Methods:

A 21-item structured, close-ended questionnaire study was carried out at the KLEVK Institute of Dental Sciences, Belgaum, India. Students assessed their competencies using a three-point ordinal scale. One hundred and thirty-three students were asked to rate their proficiency on a 21-item matrix of the dental public health program. The responses were grouped using the Likert-type scale. Frequencies descriptive data were generated, and statistical analysis of examined variables was carried out using the Chi-square test. Mann–Whitney test was conducted to identify the correlation between variables.

Results:

The overall mean score was 22.61 ± 10.94, highlighting confidence of the graduates in managing the oral health problems at the community level. Females showed higher competencies in functions related “to develop activities to motivate the community development,” “to motivate health and oral health through health education,” and “to motivate health and oral health through the creation of healthy settings.” While males reported greater competency for the function “to adjust the dental practice to situations of restrictions that limits it.”

Conclusion:

Recent dental graduates at the Institute perceived themselves competent in managing oral and dental health problems at the public level. Additional countrywide evidence regarding teaching and learning of public health dentistry is essential to compare the current experiences of dental graduates and ultimately enhance patient care.