Oral surgery undergraduate teaching and experience in the United Kingdom: a national survey

A Comparison of Models for Teaching Suturing and Surgical Skills to Dental Students

Learning suturing skills is an important area of the undergraduate curriculum and ideally requires realistic and anatomically accurate surgical training models to prepare students for treating patients. Little is currently understood regarding which model might be perceived by students to be the best or which might most effectively facilitate their learning. The aim of this study was to compare four teaching models: a tabletop silicon dental model, a restricted access tabletop model, a traditional phantom head mounted model, and a Thiel cadaver. Student preferences were explored for each of the models. Following lecture and video-based teaching 67 fourth-year students attended a practical suturing teaching session followed by the second session more focused on the experience of cutting and suturing mucoperiosteal flaps. Forty-six students (67%) gave online anonymous feedback on the first session. The majority (95%) felt prepared to place a simple interrupted suture on a patient, and 88% felt confident to do so. Twenty-eight students (40%) provided feedback on the second session with 82% agreeing that they were prepared to cut a mucoperiosteal flap and 48% felt confident to do this for a patient. The cadaver model was rated as the best of the four models for both suturing and mucoperiosteal flap skills. These results support its use for teaching students to suturing and surgical skills. However, despite this teaching student-rated confidence to cut and suture flaps for a patient remains poor.

Evaluation of the efficacy of a simulation model used in oral and maxillofacial surgery education

BACKGROUND

The traditional teaching methods of dental education are gradually being replaced with futuristic education methods based on the usage of educational tools such as mannequin-based simulation models and virtual reality. However, the effectiveness of mannequin-based simulation models as a learning method in the field of oral surgery remains unclear. This study aims to investigate the efficacy of training on a tooth extraction model (TEM) in view of undergraduate dental students' experience and perception of their education.

METHODS

A quasi-experimental trial was implemented with two consecutive year classes, totaling 136 students at the Dentistry Faculty of Altinbas University, Turkiye. Two cohorts were created from dental students in the classes of 2023 and 2022 graduates. Cohort 1 (n = 71) received 14 h of theoretical education followed by 10 h of preclinical education on TEM. Cohort 2 (n = 65) received only 14 h of theoretical education. An anonymous questionnaire was prepared with four main sections including the preferences of learning style, participants' perceptions of the preclinical training methods, the students' competency and free text comments. Students' opinions were quantified with both 7-point Likert scales and thematic analysis. Anxiety levels were measured with the interval scale of anxiety response (ISAR). Descriptive statistics, inferential statistical and thematic analyses were conducted according to survey responses. Student characteristics were summarized and compared for two cohorts using a t-test. For all statistical analyses, the significance level was set atP ≤ 0.05.

RESULT

Cohort 1 was more comfortable with sequential motions performed with the forceps (P = 0.033) and felt more ready for their first clinical tooth extraction experience (P = 0.028). Cohort 2 showed a significantly higher preference for textbooks among supplementary materials (P = 0.04); however, they tended to exhibit lower self-confidence and higher anxiety levels, though without any statistical significance (P > 0.05).

CONCLUSION

It is clear that the students who have yet to start seeing patients benefit from increased practice with training models, which adequately reflect and represent real-life situations encountered in everyday practice.

Perceived confidence of dental students and new graduates in performing tooth extractions-An exploratory study

INTRODUCTION

The ability to perform uncomplicated tooth extractions is a core clinical skill in undergraduate dental education. The aim of this study was to evaluate pre-extraction assessment skills of dental students and interns and explore their self-perceived confidence in performing these tooth extractions.

MATERIALS AND METHODS

A cross-sectional survey investigated the self-perceived confidence to perform the extraction for a set of eight expert-rated cases. The participants were dental students at three different stages, that is, in Years 4 and 5 of the Bachelor of Dental Surgery (BDS) programme and interns. The participants were asked to rate the difficulty level of each of the eight tooth extraction cases. The self-perceived confidence of the participants to perform extraction of each was also explored. Finally, the participants were asked to identify the main reason for the perceived lack of confidence.

RESULTS

A total of 199 responded to the survey, yielding a response rate of 94.7%. The effect of grade of extraction (the expert rating of cases) and stage of education on difficulty ratings was assessed using a mixed three stage of education × 4-grade ANOVA, with response (Difficult = 1, Easy = 0) as the dependent variable. The results showed that there was a correlation between the stage of education and grade of extraction and affected the self-perceived confidence of the participants. Gender showed a significant impact with females categorizing significantly more cases as difficult. A three-way contingency table (counts of each confidence-level response by stage of education by expert rating of cases) suggests a statistically significant association between the three factors. Most participants identified limited clinical exposure as the main reason for their perceived lack of confidence.

CONCLUSION

The findings of this study show that a majority of the participants were able to recognize tooth extraction cases which were beyond the scope of their training stage with females reporting a lower confidence. Increased clinical exposure to a wider range of tooth extraction cases with varying levels of difficulty may contribute to improving the self-confidence of undergraduate dental students and interns.

Evaluation of Self-Perceived Confidence and Competence in Oral Surgery among Final Year Undergraduate Students in Greece

OBJECTIVES

 Oral surgery is an integral part of dentistry that deals with the diagnosis and management of pathology of the mouth and jaws that requires surgical intervention. The aim of undergraduate studies in oral surgery is, upon graduation, to be confident and competent to treat without assistance surgical cases in the spectrum of general dentistry. This study evaluates the senior Greek dental students' self-confidence and self-perceived competence to undertake cases within the scope of oral surgery. Evaluation of clinical experience gathered during training and self-perceived confidence and competence in generic oral surgery skills is included.

MATERIALS AND METHODS

 The present study was a questionnaire survey conducted during the academic year 2018-2019. The questionnaire comprised three sections. Section 1 included demographic data and four closed-ended questions concerning numerical data about procedures that they had already performed or observed, section 2 included four questions concerning their self-perceived competence to perform basic surgical techniques, and section 3 included 10 clinical case scenarios.

RESULTS

 One hundred and twenty-seven students participated in the study. Among the basic surgical skills, students were most confident with suturing, and they were least confident with bone removal. Students from the Aristotle University of Thessaloniki (AUTH) tend to show higher level of confidence compared with students from the National and Kapodistrian University of Athens (NKUA) in most questions.

CONCLUSION

 Greek graduate dental students report moderate levels of self-confidence in oral surgery. A realistic approach in increasing self-confidence and competence in oral surgery would be the focus on preclinical training in generic elementary surgical skills, in combination with increased observational sessions of oral surgery procedures or outreach training.

Clinical experience improves academic outcomes in dental Oral surgery education

INTRODUCTION

This paper aimed to determine if the level of a dental student's clinical experience in oral surgery influences the student's oral surgery academic outcomes.

MATERIALS AND METHODS

The oral surgery clinical activity and academic outcomes for all students who completed their dental training in 2017, 2018, 2019 and 2020 from the University of Sydney were analysed for correlation.

RESULTS

The clinical activity performed by 313 students was recorded. There was a weak, but statistically significant, Pearson correlation between total dental extractions and academic outcomes (r = .243, p = <.001). The total number of dental extractions performed was the only statistically significant variable on academic outcomes with linear regression analysis (β = .227, p = .005; model R2  = .077). The increase of a student's clinical experience from less than 45 to more than 65 dental extractions raised their oral surgery academic results by an average of 6.4%. There were no academic benefits to earlier clinical experience.

CONCLUSION

An increase in experience with dental extractions resulted in an increase in oral surgery academic outcomes, plateauing at 65 dental extractions. There was no academic advantage to dental student's having earlier clinical experience.

Teaching of silver diamine fluoride for the management of dental caries and hypersensitivity - situation in the Southeast Asia dental schools

BACKGROUND

Using silver diamine fluoride (SDF) for caries management has raised dentists' interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA.

METHODS

An online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF.

RESULTS

A total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82-97%), followed by for arresting early noncavitated lesions (69-82%), for preventing new caries development (66-79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available.

CONCLUSION

SDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.

Exodontia skills acquisition: Focusing on clinical teaching and training

OBJECTIVES

The aim of the research was to evaluate the traditional exodontia block course. The objectives were to explore the experiences and views of students, clinical teachers and dental practitioners of the various elements of the course curriculum.

METHODS

The study was a qualitative, participatory action research study using descriptive analysis. The study was conducted at a Dental Faculty in South Africa. A purposive sample of students, clinical teachers and dental practitioners were invited to participate. Focus group discussions were used to collect data which was analysed by an external coder.

RESULTS

The study population consisted of 15 undergraduate dentistry students, 10 clinical teachers and seven dental practitioners. Four broad themes with sub-themes emerged from the study. The main themes identified strengths and deficiencies of the traditional course and made recommendations for its improvement. The themes identified were i) Integration of knowledge and skills, ii) Block course structure, iii) Challenges associated, and iv) Recommendations for improvement. Overall, the participants were satisfied that the course met its objectives. The results pertaining to clinical skills acquisition identified that teaching the use of elevators and luxators in the course, and standardisation of terminology among all clinical teachers as areas requiring attention. Teaching and learning strategies such as community-based learning, peer learning, case reviews, feedback and visual technology were viewed by the student, as well as clinical teacher samples, as strategies most beneficial to clinical learning.

CONCLUSIONS

The review of the curriculum for exodontia skills acquisition and development, provided several benefits. Firstly, this research served as a quality assurance indicator. It further highlighted many teaching and learning strategies that would improve clinical skills development, reduce stress and anxiety, and support student learning. To a large extent, pertinent information was obtained that served to inform the subsequent redesigning of the course. The findings of the study augment the literature currently available on the best practice for exodontia skills acquisition and development and provide baseline information for the planning and redesign of related courses.

Dental student oral surgery training-Comparing the impact of COVID-19 and cohort sizes

INTRODUCTION

The response to the COVID-19 pandemic potentially reduced the clinical experience and academic education of dental trainees through reduced supervised clinical sessions. Graduating dental students, future employers and regulators may be concerned over the level of clinical experience of graduates trained within the COVID-19 pandemic. The purpose of this study was to try and document the evidence for, and significance of, this impact.

MATERIALS AND METHODS

From dental student data in the 2017, 2018, 2019 and 2020 cohorts attending the University of Sydney, Australia, the number of dental extractions and adjunct oral surgery procedures, as well as final end-of-year examination results, was recorded. Results were compared to determine whether differences in experience and final academic achievement existed between these cohorts.

RESULTS

The smallest student cohort, 2017, demonstrated greater clinical experience than the 2018, 2019 and 2020 cohorts. The 2020 COVID-19-affected cohort demonstrated no statistically significant reduction in clinical experience in all measured clinical procedures when compared to the 2018 and 2019 cohorts. The decrease in city teaching hospital clinical experience was compensated by an increase in rural placements. The 2020 cohort achieved the lowest academic results, and this was statistically significant.

CONCLUSION

The oral surgery clinical experience of the 2020 dental cohort at the University of Sydney was comparable to prior cohorts. Rural clinics were able to compensate for COVID-19 interruptions to clinical training. The number of students in a cohort, if all other variables remain constant, appeared to affect clinical exposure to a greater extent than COVID-19.

The Impact of a 1-Year COVID-19 Extension on Undergraduate Dentistry in Dundee: Final Year Students' Perspectives of Their Training in Oral Surgery

BACKGROUND

The detrimental impact of the COVID-19 pandemic on dental education prompted the Scottish Government to fund an additional year to the dental course to ensure that the students had the necessary clinical experience. The aim of the study was to better understand the final year student perceptions of this extension on their oral surgery experience at the University of Dundee.

METHODS

This mixed methods study consisted of an anonymous online questionnaire and a focus group.

RESULTS

Forty-one students (69.3%) completed the questionnaire and ten students participated in the focus group. Thirty-six (88.8%) students agreed that the oral surgery teaching provided sufficient knowledge to undertake independent practice. All of the students felt confident to carry out an extraction, and the majority of them (n = 40, 95%) felt confident to remove a retained root, however, their confidence with surgery was lower.

CONCLUSION

The extension gave the students sufficient experience in oral surgery to gain confidence in clinical skills and an appropriate level of knowledge in preparation for the next phase of their career. Most of the students agreed that the extension was necessary and beneficial. This cohort graduated with more oral surgery experience than any of the students did in the previous 4 years from Dundee and with experience that was comparable with the students at other schools in the pre-COVID-19 era.

Progress and challenges in the harmonisation of European undergraduate dental education: A systematic literature review with narrative synthesis

INTRODUCTION

Harmonising education to support workforce mobility has been a policy objective for the European Union. However, alignment across varied national contexts presents challenges in dental education.

METHODS

A systematic literature review with narrative synthesis. Searches of the electronic databases Embase [Ovid]; MEDLINE [Ovid]; Scopus; CINAHL; AMED and PsycINFO were conducted for relevant material published between 2000 and 2019 on undergraduate curricula, quality standards and learning outcomes in dentistry.

RESULTS

Seventy-six papers met the inclusion criteria. Fifty-three papers were commentaries or editorials, twenty-one were research studies, and two were literature reviews on specific dental subfields. Eighteen of the research studies reported surveys. The literature contains extensive proposals for undergraduate curricula or learning outcomes, either broadly or for subfields of dentistry. Included papers demonstrated the importance of EU policy and educator-led initiatives as drivers for harmonisation. There is limited evidence on the extent to which proposed pan-European curricula or learning outcomes have been implemented. The nature and extent of dental students' clinical experience with patients is an area of variance across European Union member states. Arrangements for the quality assurance of dental education differ between countries.

DISCUSSION

Harmonisation of European dental education has engaged educators, as seen in the publication of proposed curricula and learning outcomes. However, differences remain in key areas such as clinical experience with patients, which has serious implications if graduate dentists migrate to countries where different expectations exist. Mutual recognition of professional qualifications between countries relies on education which meets certain standards, but institutional autonomy makes drawing national comparisons problematic.

An Educational Evaluation of Thiel Cadavers as a Model for Teaching Suturing Skills to Dental Students during the COVID-19 Pandemic

Suturing is an essential skill in dentistry and not one easily acquired. The COVID-19 pandemic prompted a change to the use of Thiel cadavers and online resources with the aim of improving skill acquisition using the best model available. This study investigated the utility of the Thiel cadaver for teaching suturing skills and the potential impact of the lockdown. Fifty-seven year 4 students attended a teaching session. Student views on this teaching were explored via a questionnaire survey and qualitative data collected from a focus group. Data were analysed using an inductive approach. The response rate was 53% (30 students) for the questionnaire with 9 students participating in the focus group. Independent feedback was provided by two members of the teaching staff. Online video resources were very well received by the students with 97% agreeing that it was useful preparation. Ninety percent (90%) thought that the cadaveric model was suitable for this teaching and realistic. Positive emergent themes from the focus group centred on the use of the cadaveric model and the positive and relaxed teaching and learning environment. Staff perceived this model as superior to previously used models. There were no reported negative pandemic impacts and the cadaver model was well received.

Mind the 'GAPP': a pre-graduation assessment of preparedness for practice amid a pandemic

Introduction 'Preparedness for practice' refers to a multifaceted concept, encompassing not only clinical skills, but also broader, non-clinical skills, such as communication and professionalism. Previous graduates have reported feeling less prepared for complex procedures, such as molar endodontics and surgical extractions. Dental students typically utilise their final year to refine their clinical skills, however, the COVID-19 pandemic has meant that newly qualified dentists will have had around six months where they have not performed clinical dentistry before beginning dental foundation training (DFT).

Aims This study aimed to explore final year students' self-reported preparedness for practice, identify areas of relative weakness that may influence future training needs and to highlight any perceived impact of the pandemic on final year experience and potential impact on DFT.

Materials and methods The current Graduate Assessment of Preparedness for Practice (GAPP) questionnaire was adapted for our specific research aims and piloted and the PreGAPP questionnaire distributed via the social media channels of dental school student societies. Analysis was carried out using IBM Statistical Package for the Social Sciences software using descriptive statistics and the Mann-Whitney U test for two unrelated variables.

Results Responses were received from final year students across all 16 UK dental schools. Students reported increased preparedness across domains in which they had the most experience; for example, providing preventative advice and administering local anaesthesia. Male students reported feeling significantly more prepared than female students, mature students significantly more than younger students, and students on four-year courses significantly more than traditional five-year courses. The COVID-19 pandemic was expected to have a major-to-severe impact on undergraduate experience and future DFT prospects.

Conclusion Dental graduates in the COVID-19 era may have significantly different training needs to those before them. Complex clinical procedures remain the areas where students feel they are least prepared for practice. The importance of a clinical passport to highlight current experience level to trainers, alongside the creation of a personal development plan at the beginning of DFT, will ensure that targeted and personalised training can be implemented where required.

Illustrates the perceived effect of the COVID-19 pandemic on final year students' preparedness for practice and the impact it may have on dental foundation training through quantitative and qualitative methods.

Highlights and explores the differences in the perceptions of preparedness for practice of final year students across sex, age and course length.

Explores various aspects of clinical supervision and assessment and reinforces the importance of appropriate student-staff ratios to ensure clinical learning is effective.

The impact of wrong-site surgery on dental undergraduate teaching: a survey of UK dental schools

INTRODUCTION

Patient safety within dental education is paramount. Wrong-site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools' undergraduate experience of NEs, safety interventions implemented and the impact on student experience.

METHODS

All 16 UK dental schools were surveyed via email.

RESULTS

The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre-operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus.

DISCUSSION

This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre-operative briefings.

CONCLUSION

UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre-operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

An investigation into the oral surgery curriculum and undergraduate experience in a sample of DFT's in the UK

AIM

There is conflicting evidence concerning the ability of recent graduates to meet the standards required in exodontia to be independent practitioners. In particular, there is a lack of confidence in surgical extractions. This study evaluated Foundation Trainee's confidence levels in their oral surgery experience and the teaching of oral surgery in UK dental schools.

MATERIALS AND METHODS

Two separate studies were carried out, and the first was a survey to all foundation trainees in the Yorkshire and Humber Deanary in 2019 which analysed their oral surgery experience and confidence levels. The second study surveyed all Dental Schools in the UK with regard to their contact hours, assessment methods, instruments taught and number of extractions in oral surgery for their undergraduate programmes.

RESULTS

There was a response rate of 52% for the foundation trainees which showed that they were confident in performing non-surgical extractions but lacked confidence with surgical extractions. There was a positive correlation between the amount of undergraduate experience and confidence levels in exodontia. The second survey which had a response rate of 71% showed variations in the numbers of hours taught for oral surgery, instruments taught and assessment methods, with the structured clinical operative test used more commonly. On average, 41 non-surgical extractions were performed by students before graduation and two surgical extractions.

CONCLUSION

There is a need to identify how oral surgery teaching can be improved in UK dental schools to ensure that foundation trainees are more confident and competent in both surgical and non-surgical exodontia. In addition, teaching and assessment methods need to be developed to reflect such requirements.

Assessment of undergraduate students in tooth extraction competence- A cohort study

AIM

The aim of the study was to determine the value of the number of patient encounters and tooth extractions on the competence of final-year Bachelor of Dental Surgery (BDS) students.

METHODS

Following ethics approval, the study employed purposive sampling to enrol final-year BDS students and assess their competence longitudinally over a full academic year. Students were assessed periodically on four separate occasions after they had gained experience in performing 15, 40, 70 and 100 patient encounters involving tooth extractions.

RESULTS

There were 177 students with complete profiles completing the tooth extraction assessments including 31 males (18%) and 146 females (82%). The age range of participants was 22 to 24 years (mean = 21.92; median = 22). The total number of assessment data points available for the four assessments was 1062. A chi-squared test was carried out to test the hypothesis that competence in tooth extraction increases with increasing exposure to patients. Students in Group 100 were most likely to pass the competency, whilst students in Group 15 were most likely to fail. There was a statistically significant variation in the proportion of "Below Standard," "Meets Standard" and "Exceeds Standard" judgements awarded to students with differing levels of prior experience (p < .001). Therefore, the hypothesis was accepted. Analysis of assessment results for differential performance of students by gender did not show significant differences.

CONCLUSIONS

The results of this study show a positive relationship between the number of tooth extractions performed and competence of final-year dental students. Over 90% students achieved competence after performing 100 patient encounters. Although competence in tooth extractions showed a linear relationship with experience of the participants in this study, the data were collected from a single cohort of students at one institution. Further multi-institution studies involving several cohorts are required to further explore the value of increased experience.

Self-confidence in oral and maxillofacial surgery: a cross-sectional study of undergraduate dental students at Kuwait University

BACKGROUND

To evaluate the self-confidence of undergraduate dental students in relation to oral and maxillofacial surgery (OMFS) to assess the teaching curriculum at Kuwait University using a validated questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS).

METHODS

A cross-sectional survey of sixth year (n = 20) and seventh year (n = 19) dentistry students was conducted by Kuwait University Faculty of Dentistry between the 1st and 15th of May 2020. The ABAOMS questionnaire is composed of 17 questions assessing various areas of the undergraduate OMFS curriculum. The response options to the questionnaire utilised a Likert scale. Independent sample t-tests were performed to assess the difference in responses between the 2 year groups. Spearman's rho correlations were calculated to measure the strength of association between confidence in all aspects of surgical and forceps exodontia.

RESULTS

A total of 39 questionnaires were completed by the students. The majority of students expressed feelings of confidence that they have enough knowledge to undertake independent practice (61%). General aspects of the questionnaire were answered favourably except for surgical extraction of teeth, in which both classes reported a lower level of self-confidence.

CONCLUSIONS

The ABAOMS survey revealed the students' self-confidence in undertaking independent practice and preforming basic oral surgery procedures. Students felt comfortable with exodontia using forceps and elevators, root removal, managing acute pericoronitis, managing haemorrhage from a socket, assessing impacted teeth, and recognising the clinical features of potentially malignant and malignant lesions of the oral cavity. They reported a lower level of confidence in performing surgical procedures.

Preparing dental students for independent practice: a scoping review of methods and trends in undergraduate clinical skills teaching in the UK and Ireland

Introduction The governing bodies for dentistry in the UK and Ireland require dentists, at graduation, to possess the knowledge, skills and attributes which enable them to practise safely, without supervision. The means by which dental schools achieve this may differ and may undergo modification in response to changes in the expectations of governing bodies and challenges within the teaching environment. It is therefore important to identify which of these approaches works well and to disseminate good practice described in the literature.Objectives To use a scoping review to identify from the published literature the methods used to teach clinical dental skills, including innovations, motivations for changes, and factors affecting the delivery and quality of teaching.Method Scoping review methodology was used to select and analyse 57 articles published between 2008 and 2018.Results Innovations in didactic teaching were facilitated by advances in IT and development of virtual learning environments, which promoted independent, self-directed learning. Pre-clinical practical teaching took place in clinical techniques laboratories utilising mannequin heads, with a minority of dental schools using virtual reality simulators in addition. Clinical experience was gained mainly in multi-disciplinary clinics and offsite outreach teaching centres. Insufficient numbers of suitable patients, increasing student numbers and a fall in teaching staff contributed to a reported reduction in clinical experience of certain treatments.Conclusions Contemporary clinical dental skills teaching produces new graduates who possess excellent theoretical knowledge, are prepared and confident in basic clinical skills, but are lacking in experience of complex treatments which may result in a reduced preparedness for independent practice.

An 8-year retrospective survey of assessment in postgraduate dental training in complicated tooth extraction competency

BACKGROUND/PURPOSE

Direct observation of procedural skills (DOPS) has been increasingly used in health education in recent years. This study evaluated the effect of education and trainees' perception of assessment on the clinical skills of postgraduate dental trainees in complicated tooth extraction.

MATERIALS AND METHODS

This study was conducted as a retrospective survey among postgraduate dental trainees learning complicated tooth extraction in Taipei and Linkou Chang Gung Memorial Hospital from 2012 to 2019. Practical skills were assessed using DOPS by trainees and faculty members. Each clinical case included a complicated extraction of a permanent tooth.

RESULTS

A total of 69 participants (26 men and 43 women, average age = 26.49 years, range = 24-34 years) were included in this study. Within the survey cohort, faculty assessments scored significantly higher than did trainees' self-assessments in each complicated tooth extraction procedure, with no difference between both sexes. The higher-performing trainees tended to underrate their performance much more than did the lower-performing trainees. More than 40% of the trainees evaluated themselves as having "poor capability" in some invasive surgical procedures, even though their actual performance was not lower than that of those who evaluated themselves as having adequate or good capability.

CONCLUSION

Self-assessment skills should be developed with more practice and experience. We hope that these findings can guide the planning of faculty development programs for clinical instructors, particularly the new cohort of faculty who will succeed the rapidly retiring boomer generation in the next 10 years.

How is paediatric dentistry taught? A survey to evaluate undergraduate dental teaching in dental schools in the United Kingdom

INTRODUCTION

The quality assurance of undergraduate dental education in the UK is regulated by the General Dental Council who describe the competencies expected of the newly qualified dentist or "safe beginner." Whilst the literature has explored the level of undergraduate training in a number of dental specialties within the UK, there is a paucity of information on the UK curriculum for undergraduate paediatric dental teaching.

AIMS

This study aimed to assess the undergraduate teaching of paediatric dentistry within dental schools in the UK.

METHODS

An anonymous questionnaire was distributed to all 16 UK dental schools via email.

RESULTS

Twelve questionnaires were completed, giving a response rate of 75%. First exposure to both academic teaching and clinical teaching in paediatric dentistry ranged from years 1-4. Whilst there were broad similarities between units with regard to core components of the curricula, there were notable differences including the teaching of regenerative endodontics (75%) and the use of the titanium trauma splint (58%). Silver diamine fluoride was only used clinically in one unit (8%), and non-vital pulpotomy was taught by two units (16%). There was also considerable heterogeneity in assessment methods between universities.

CONCLUSION

The undergraduate paediatric dental curriculum is broadly similar between UK dental schools. However, there are discrepancies in assessment methods and the teaching of new advances.

A city-wide survey of dental students' opinions on undergraduate oral surgery teaching

PURPOSE

This study aimed to carry out a city-wide survey to evaluate undergraduate students' opinions on their oral surgery training by measuring their self-confidence.

MATERIALS AND METHODS

A cross-sectional survey of 383 3rd year, 412 4th year and 363 5th year undergraduate dental students from six dental schools in Istanbul with a mean age of 22.73 ± 1.55 was conducted towards the end of the academic year. A web link to the questionnaire was sent to the contact person at the participating dental schools. The questionnaires were anonymously evaluated. Descriptive statistics were calculated, and Chi-square tests were performed to examine the data. A P-value of <.05 was considered to be statistically significant.

RESULTS

In total, 1158 responses were returned, representing 67% of the overall students in the 2018-2019 academic year. The male respondents were significantly more self-confident than females in the general aspects of surgical skills. More than half of the respondents (53%) felt confident in oral surgery knowledge to undertake independent practice. Although 5th year respondents felt more confident in the general aspect of the questionnaire, their ability of differentiation of odontogenic and non-odontogenic pain was lower than their counterparts. The majority (86%) of the participants disagreed that the only knowledge required for oral surgery was that of tooth and jaw anatomy.

CONCLUSION

This survey revealed perceived confidence in tooth and retained root extraction. The male respondents were found to be more self-confident. There is a need for improvement in surgical skills, recognition of malignancies and differentiation of the origin of the pain.

Perceptions of foundation dentists on minor oral surgery teaching in dental foundation training

AIMS

The aim of this service evaluation was to explore the experiences of foundation dentists (FDs) during their dental foundation year (DFT) in the field of oral surgery and surgical extractions.

METHODS

A phenomenological approach was taken aiming to explore the FDs' experiences through a qualitative design. All FDs in the region deemed eligible for the evaluation were invited to attend a semi-structured interview or answer a qualitative questionnaire when attending for their exit interview at the completion of DFT. The interviews were then transcribed and thematic analysis was undertaken.

RESULTS

79 FDs took part in the evaluation, representing 86% of trainees eligible for inclusion. Findings showed that not all FDs had the opportunity to undertake surgical extractions independently during the year. Data was analysed and 4 main themes generated when evaluating FDs' experiences; specific learning encounters, influence of the educational supervisor, supportive learning environment and ready for independent practice.

CONCLUSIONS

This evaluation shows that there are a number of factors associated with FDs' experience during DFT, and not all FDs are leaving the training with a positive experience, with a query as to whether they are fulfilling the aims of training to become an "independent practitioner." It poses questions about what can be done to improve future training and what exactly does DFT need to achieve in terms of experience in surgical extractions.

Students' perspectives on undergraduate oral surgery education

PURPOSE

This study evaluated students' perceptions of their self-confidence regarding aspects of their undergraduate oral and maxillofacial surgical training. It further aimed to develop a reliable Turkish version of the questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) Education Committee.

METHODS

A cross-sectional survey of 40 fourth-year and 47 fifth-year dentistry students of Yeditepe University Faculty of Dentistry in Turkey with a mean age of 23.30 ± 1.50 was conducted in January and February 2018. The ABAOMS questionnaire was adapted to the Turkish language and culture. The items were organized in five domains (general information, self-confidence in oral surgery, role of outreach, anatomy knowledge in relation to oral surgery, and career aspirations) with most response options on a five-point Likert-type scale. Reliability was assessed through an internal consistency analysis and a test-retest approach. Descriptive statistics, independent samples t-tests, and Chi-squared for contingency tests were used to examine the data.

RESULTS

Cronbach's alpha coefficient on the questionnaire was 0.89. The responses reflected general agreement among the respondents. Females were significantly more self-confident than males. Although the fifth-year respondents were more self-confident than the fourth-year respondents on items regarding anatomy knowledge, fourth-year respondents were more self confident in forceps extractions. Other than that no major differences in self-confidence were found between the two groups.

CONCLUSION

Though self-confidence was high regarding extraction of teeth and retained roots, the participants of this study lacked self-confidence in performing surgical extractions and its related procedures, recognition of malignancies, and ability to differentiate between pain of odontogenic or non-odontogenic origin. Female students were relatively more self-confident. Teaching should focus on practical applications that support students' sense of self-confidence in their abilities. The Turkish version of the questionnaire was a reliable instrument.

Student perceptions of exodontia competency assessment in a UK dental school

INTRODUCTION

Modern medical and dental training has migrated from assessing only the quantity of procedures performed to a combined assessment of both competency and quantity. This study explores student perceptions of competency assessment in exodontia at a UK dental school.

MATERIALS AND METHODS

Anonymous questionnaires were distributed to dental students in years three, four and five at the School of Dentistry, Cardiff University (n=149). Responses consisted of dichotomous tick boxes and 5-point Likert scales, with thematic analysis of free-text responses. Discrete variables were analysed using simple descriptive statistics. Recurring themes were identified from the responses.

RESULTS

A total of 129 questionnaires were returned (response rate 87%). Feedback from students indicated that they felt well prepared to undertake the competency assessment, agreeing that year three is the most appropriate year to assess competency (69%; n=86). In 50% of cases (n=65), the clinical supervisor was not present for the duration of the assessment. The undergraduate student body would like further teaching in the use of elevators (89%; n=114).

CONCLUSION

The competency assessment was deemed fit for purpose by the undergraduate student body. Further developments in the areas of clinical supervision and teaching on the use of elevators were considered and recommendations made to the School of Dentistry, Cardiff University. The current oral surgery course incorporates some of the recommendations.

Do dental undergraduates think that Thiel-embalmed cadavers are a more realistic model for teaching exodontia?

INTRODUCTION

Teaching exodontia to novice undergraduates requires a realistic model. Thiel-embalmed cadavers retain the flexibility of the soft tissues and could be used to teach exodontia.

OBJECTIVE

The objective was to determine whether Thiel-embalmed cadavers were perceived to be a more realistic model by undergraduates in comparison with mannequins.

MATERIALS AND METHODS

Over a period of 4 years (2011-2014), students were randomly assigned into two groups: those taught exodontia on mannequins only (NT) and those who also experienced cadaveric teaching (T). This was followed by an assessment.

RESULTS

There were 174 students in the T group and 108 in the NT group. Sixty-five per cent of the T group and 69% of the NT group provided feedback. Ninety-eight per cent (98%) felt that they had been advantaged by being included in the group compared with 95% in the NT who felt disadvantaged. The majority (98%) thought that using the cadavers was advantageous and gave a realistic feel for soft tissue management (89%) and that it was similar to managing a patient (81%). Self-reported confidence in undertaking an extraction was not different between the two groups (P=.078), and performance in the extraction assessment was not significantly different between the two groups over the 4 years (P=.8).

CONCLUSION

The Thiel-embalmed cadavers were well received by the students who found it a more realistic model for exodontia than a mannequin, even though this did not impact on their performance in a following assessment. Future work on these cadavers may be expanded to include surgical procedures.

Tooth extraction education at dental schools across Europe

Objectives/Aims:

To explore students’ opinion about theoretical and clinical training in tooth extraction at different European dental schools.

Materials and Methods:

An online questionnaire, containing 36 dichotomous, multiple choice and Likert scale rating questions, was distributed among students of 56 different dental schools. After excluding schools where <20 students responded, 656 questionnaires from 23 dental schools remained for statistical analysis.

Results:

Dental schools showed a wide variation in the initial practical teaching of tooth extraction, from years 2 to 6. Several schools used a preclinical training model, and most students considered this useful. Some students considered their knowledge about forceps and elevators insufficient (6–60%), as well as their preparation for complications (5–60%). Students usually had received education in forceps and elevator techniques. Inclusion of (non)surgical removal of retained roots and surgical removal of third molars showed a wide variety between dental schools. Less than half of the students reported education in surgical removal of impacted teeth. Students from four of the 23 dental schools felt insufficiently prepared in tooth extraction (Likert scale ⩽3).

Conclusion:

There is a wide variation among European dental schools in teaching programs of tooth extraction and the rating of these programs by students.

Management of impacted wisdom teeth: teaching of undergraduate students in UK dental schools

INTRODUCTION

Wisdom tooth removal is one of the most common oral surgical procedures performed across the world. The aim of this study was to gauge the teaching and training of impacted wisdom teeth in undergraduate dental programmes across the UK. The objectives were to identify consistencies and variations in theoretical instructions and clinical training as well as approaches to management of impacted wisdom teeth.

METHODS

This was a cross-sectional survey utilising an online questionnaire. A purposefully designed pro forma with open- as well as closed-ended questions was used. The questionnaire was hosted online on the school's blackboard academic suite (Emily). Prior to conducting the study, approval was gained from the Research and Ethics Committee, and all the ethical principles pertaining to data protection were strictly followed. E-mail invitations were sent to oral surgery leads in all dental schools in the UK. The participants were provided with an information sheet, and an informed consent was obtained. The participants were invited by e-mail to complete the questionnaire online voluntarily.

RESULTS

A total of 16 dental schools offering an undergraduate course in dentistry in the UK, 13 responded positively. (response rate = 81.25%). In majority of dental schools, this subject is taught in the 4th and 5th years. A pre-clinical competency on phantom heads is a requirement in six schools, whilst only one school requires the students to pass a clinical competency. The clinical exposure of students to wisdom tooth surgery is quite variable. Although the dental schools are fairly consistent in their teaching with regard to the indications for surgical intervention, diagnostic/treatment modalities as well as the post-operative care, interesting variations were also observed.

CONCLUSIONS

This study, perhaps the first of its kind, provides useful insights into management of impacted wisdom teeth, as taught in the undergraduate dental programmes across the UK.

A national survey of UK final year students' opinion of undergraduate oral surgery teaching

BACKGROUND

A national survey was undertaken to establish a baseline of our final year students' perception of how their undergraduate oral surgery education has equipped them for key areas of general dental practice.

MATERIALS AND METHODS

Questionnaires were distributed to the 13 UK schools with final year students, towards the end of the academic year in 2009. The questionnaires were completed anonymously and were optically scanned.

RESULTS

In total, 632 questionnaires were returned, which represents 66% of the students of the graduating year. The majority (83%) of the respondents perceived that the teaching in oral surgery had given them sufficient knowledge to undertake independent practise. Most respondents (99%) felt confident to perform forceps exodontia, but confidence in the various aspects of surgical exodontia was lower. A majority (83%) had experience of an outreach scheme performing forceps exodontia (75%) and surgical exodontia (16%) in this environment. Twenty per cent indicated a desire to undertake a career in oral surgery, 6% in oral and maxillofacial surgery and 35% in another speciality.

CONCLUSION

This survey suggests that the majority of the students perceive that the oral surgery education has prepared them well for key areas of general practice. It also suggests that there is, however, a need to provide further improvement in the delivery of surgical skills and knowledge.

Dental student suturing skills: a multicentre trial of a checklist-based assessment

BACKGROUND

The assessment of clinical skills is essential to determine whether an undergraduate is competent to perform the tasks outlined in the curriculum. Such assessments in dentistry have historically not been subjected to large scale validity and reliability testing due the relatively small student numbers at each institute. The aims of this study were to test the validity and reliability of a standardised, checklist-based, suturing objective structured clinical examination (OSCE) and then to perform a multicentre trial to determine its performance over a large cohort of students.

MATERIALS AND METHODS

A total of seven UK schools agreed to take part in the trial. To test the validity and reliability of the checklist, the examiner at each institution reviewed and scored video footage of 10 students performing the assessment. Each institution then carried out the assessment providing a checklist score and a global score for each of their own students.

RESULTS

The assessment was well received by the staff, with acceptable inter-examiner variability. In total, 496 students completed the suturing OSCE with a success rate of 81% with a variation between schools of between 66% and 96%. A significant correlation was found between the checklist score and the global score (r = 0.361, P = 0.000). No one item on the checklist was found to be a determinant factor in the outcome of the OSCE.

CONCLUSIONS

This checklist-based assessment of suturing skills was found to have face and content validity. Its reliability was promising, but merits further investigation. There may be an argument for the standardisation of the assessment of this core surgical skill throughout several UK-based dental schools.

Implementation and validation of an extraction course using mannequin models for undergraduate dental students

OBJECTIVE

There is a gap in the education of dental undergraduate students between theoretical knowledge and the practical procedure of tooth extraction. It was the aim of this study to implement and validate an undergraduate course for oral extraction using mannequin models, in order to enhance practical competence in this field of dentistry.

MATERIAL AND METHODS

A one-term oral extraction course was implemented as part of the oral surgery curriculum for undergraduate dental students, including 4 h of theoretical education, followed by 4 h of practical training in tooth extraction on mannequin models, with the students divided into small groups. Forty-nine students attending this extraction course were asked to validate their training in dental extraction using a questionnaire (TRIL-mod; University of Trier, Trier, Germany). The students' practical competence in oral extraction was assessed by a senior supervisor at the end of the course, using a standardized checklist.

RESULTS

All questionnaires were returned. Overall, the course was rated with an average score of 4.7 (rating range: 1-6; 1 = worst/6 = best). The assessment of practical skills yielded a successful and complete performance of tooth extraction by 94% of the students.

CONCLUSIONS

A tooth extraction course using a mannequin model is appreciated by dental students and can achieve a sufficient level of competence in tooth extraction with reasonable educational efforts.

The retention of suturing skills in dental undergraduates

BACKGROUND

The ability to place sutures is an essential skill in dentistry. In our institution, the introduction of a video teaching aid and a checklist-based assessment has improved the standardisation of teaching as well as the transparency and objectivity of the assessment of suture skills. The aim of this study was to determine whether this skill once acquired is retained in the short term.

MATERIALS AND METHODS

The same cohort of 67 fourth-year students performed the same assessment at two different time points 2 months apart. The first was a formative assessment and the second was a summative assessment. Feedback was collected on both occasions.

RESULTS

On the first sitting of the assessment, 93% of the students were successful compared with 79% on the second occasion. Student feedback was similar on both occasions with 77% and 75% reporting that they thought it was an easy exam. On the first occasion, 27% thought that it was a stressful examination compared with 43% on the second occasion, which may have affected their performance.

CONCLUSIONS

These findings suggest that regular reinforcement is required to avoid deterioration of suturing skills even in the short term. This might involve exposing the students to surgery earlier in the course and introducing regular formative assessments which the students appear to associate with less stress.