Looking forward: educating tomorrow's dental team

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Is the number of procedures completed a valid indicator of final year student competency in operative dentistry?

Introduction Concerns regarding the preparedness of dental graduates often focus on the number of procedures undertaken before qualification.

Aims To assess the validity of numerical requirements in determining whether a student has sufficient competency to graduate.

Materials and methods In total, 50,821 observations of student activity while on the restorative clinic, for two integrated student cohorts (n = 139), were continuously recorded using the LiftUpp system from their third year to graduation. Analysis of data determined the most frequent type, location and difficulty of the direct restorations provided.

Results Four groups of students, categorised by the total number of restorations they provided, were identified. Those with the most restorations (70+) had a statistically significantly greater experience in restoring different tooth surfaces, in different quadrants, on different patients than those with the least (40-49). However, increased numbers did not correlate with increasing difficulty, suggesting that students simply became more adept at easier procedures.

Discussion Using a derived measure of 'consistency', it was observed that increased performance consistency was not correlated with greater overall experience. Furthermore, only 4% of students were 100% consistent in their performance in their final year.

Conclusions These data suggest that a 'numerical requirements' approach cannot be used, in isolation, as a valid measure of the competency of an individual. Further work is needed to validate consistency as a holistic measurement to characterise the performance of graduates.

The numerical requirement approach alone should not be used to make valid judgements over the competency of a dental student to undertake direct restorations.

Consistency as a holistic measure of performance may be more suitable to assess the set of skills required.

Students are not usually 100% consistent in their performance by graduation.

A Pilot Study to Assess Feasibility of Lay Representation in Dental School Admissions Interviews

Regulatory bodies in the dental profession often include members of the public as a way to ensure that patient interests are represented. With student selection for admission to dental school being a multifaceted, highly competitive process, this study was motivated by curiosity about the value of involving members of the public in the admissions process. At Newcastle University School of Dental Sciences, UK, semi-structured selection interviews conducted by two members of the faculty staff are part of the process. In the 2016-17 and 2017-18 admissions cycles, four lay representatives joined a number of the interview sessions. The aim of this study was to determine the feasibility of having a lay person present during the selection interview and whether this could become an integral part of the admissions process. A secondary purpose was to internally validate the processes in place for the interviews by considering the alignment of judgments of the panel and lay representatives. This study followed a two-stage, mixed-methods design. Quantitative analysis compared numerical interview scores awarded by the panel and lay representative when present. Scores for each question domain and overall interview score were compared. Qualitative analysis was carried out by conducting a focus group with lay representatives to seek insight into their experience and reflections on the interview processes. Thematic analysis was used, and overarching themes identified. The results showed no statistically significant difference between the interview panel and lay persons' scores for each domain or overall score awarded for the interview. The thematic analysis identified three overarching themes: reason for volunteering, process and training, and thoughts on style of interview used. These results suggest that involvement of lay people from the local community was feasible, and there was interest in continuing this involvement from the volunteers themselves.

Interprofessional Education in an Orthodontic Outreach Training Centre

Interprofessional education (IPE) describes those occasions when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. In the UK, orthodontic treatment is now delivered by a highly skilled team. Historically, education and training for orthodontic team members has been delivered 'uniprofessionally' in secondary care hospital settings, despite 96% of dental care, including orthodontics, being delivered in primary care. This paper describes an evaluation of IPE in Leamington Spa Orthodontics (LSO), a University-approved, primary care outreach training centre, where all members of the orthodontic team deliver patient care and are educated together in an IPE environment. The study methodology is realist evaluation, which aims to describe and understand the educational environment and identify how stakeholders perceive their experiences. This study describes a quality assured, primary care model of integrated education and patient care, which enhances interprofessionality and offers an alternative strategy for the future for commissioning of education and clinical care.

Self-perceived work preparedness of the graduating dental students

OBJECTIVES

The primary goal of dental education is to prepare students to work independently in a dental practice setting following graduation. Whilst academicians assess students' work preparedness through examinations and evaluations, it is equally important to understand the work preparedness as perceived by students.

METHODS

All students in their final year of the graduate programme in dentistry were selected for this study. The questionnaire assessed the self-perceived confidence in skills and awareness needed to integrate into a general dental practice. Personal data such as gender, age and income status were optionally recorded. The questionnaire included open-ended questions relevant to the educational experiences and suggestions for improvement from student perspective.

RESULTS

Sixty-three students (81.9%) responded to the questionnaire. The majority of the respondents (85.7%) perceived that their education had prepared them well for a career in dentistry, and 52.4% of the students considered that the combination of community placement and in-house training helped them to enhance clinical skills. Students' suggestion for improvements indicated that a large number would wish for more clinical sessions (71.4%), whilst only 28.6% preferred an equal distribution between general clinical placements, speciality clinical placement and didactic teaching as the essential factors in attaining competency.

CONCLUSIONS

Analysing and understanding the student's self-perspective on their dental education and work preparedness contribute towards the quality management of the dental curriculum philosophies: in holistic patient health care, lifelong learning, integration knowledge and skills, leading to the ultimate goal of clinical proficiency.

Clinical educators' views on the quality of undergraduate clinical restorative dentistry in the UK and ROI

INTRODUCTION

Following concerns expressed regarding recently expanded dental education, a survey was conducted on United Kingdom and Republic of Ireland clinical educators' perceptions of their work and the educational experiences they provide in clinical restorative dentistry. Many of the challenges facing dental education are common to all countries, and it would be of interest to note if the views reported are representative of the greater European perspective. The results of this survey represent a European regional picture.

METHODS AND MATERIALS

This is a survey of clinical staff in restorative dentistry departments across all of the fully established UK and ROI dental schools. The survey covered factors affecting the quality of undergraduate learning in restorative dentistry and the implications of these for programme delivery. Thematic analysis was applied to qualitative responses.

RESULTS

One hundred and eighty-eight responses were received across the gamut of clinical educators' roles and across 15 of the 16 schools. Themes identified were personal workload, teaching effectiveness, students' clinical experiences, provision of teaching, departmental organisation and job satisfaction.

DISCUSSION

The survey findings had many parallels with other recent reports but also suggested some developments.

CONCLUSION

The survey provided an accurate snapshot of staff views on the quality of undergraduate clinical training in restorative dentistry. Despite experiencing difficulties in many areas of their work resulting in poor morale, staff considered teaching rewarding although undervalued by others. A number of recommendations are made for the development of undergraduate teaching.

Students' clinical experience on outreach placements

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development.

OBJECTIVE

To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings.

SETTING

One dental hospital and eight existing primary care block placements in England.

SUBJECTS AND METHODS

Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared.

MAIN OUTCOME MEASURES

(1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales.

RESULTS

Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting.

CONCLUSION

Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

Education for the dental team: make your practice a centre of learning excellence

This paper discusses the future educational needs of the changing dental team, the potential for new institutions and teachers to deliver and assess that education, including outreach-based teaching and learning, and interchangeability of educational credits between institutions. The author's opinion is that primary care practices can become 'centres of learning' where all members of the dental team can interact to teach and learn together at the same time. The development of a career pathway for dental care professionals (DCPs), a more unified pan-Europe approach to integrated dental education and the development of further roles for senior dental students are proposed. The importance of dentistry acting upon sound, innovative concepts, and of not resisting educational change, is stressed.