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

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.

Objective assessment of intra-oral suturing for certification of competency

INTRODUCTION

Suturing is an essential skill for dental surgeons, yet there is limited evidence for objective measures of competence in this field, which can be applied to licensing or certification processes for dental surgeons to ensure patient safety.

METHODS

In an objective structured clinical examination (OSCE), participants placed two simple interrupted sutures across a lower molar socket in different suturing environments: [A] commercial simulator, [B] suturing sponge mounted in a 3D printed model, [C] suturing sponge and [D] pig's jaw. Simulators [A] and [B] were mounted into phantom heads in dental chairs, and [C] and [D] were placed on bench tops. Performance indicators, overall task success, quality of sutures placed, length of suture remaining and time taken, were analysed against participants' characteristics such as previous suturing experience.

RESULTS

Participants (n = 38) took significantly longer to successfully complete the sutures on models mounted in a phantom head. Time points at which each model differentiated between competent (n = 11) and novice (n = 27) participants were as follows: model A (3:26 min), B (2:41), C (2:05) and D (2:06). Model A showed a significant association between task completion and previous suturing experience (p = .006).

CONCLUSION

Suturing simulators can be used to objectively differentiate between novice and competent dental surgeons. Model A demonstrated construct validity, as it reliably identified competence using time and task completion as objectively measurable parameters. Utilising model A, the candidate of unknown ability could be identified as appropriately skilled at intra-oral suturing. To ensure patient safety, further research is needed to identify other objective measures of competence in simulation environments.

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.

The effect of microsurgical training on novice medical students’ basic surgical skills—a randomized controlled trial

Background

It has been demonstrated that medical students are capable of learning microsurgical techniques. We hypothesize that microsurgical training might give insight into the importance of delicate tissue handling and correct knot tying that could have a positive influence on macrosurgical skills. The primary aim of this study was to evaluate the effect of microsurgical training on macrosurgical suturing skills in novice medical students.

Subjects and methods

In 2018, 46 novice medical students were enrolled and randomized into two groups. The intervention group received both macro- and microsurgical training and the control group received only microsurgical training. Both groups underwent an assessment test that consisted of macrosurgical tasks of three simple interrupted sutures with a square knot and continuous three-stitch long over-and-over sutures. These tests were individually filmed and assessed using the University of Bergen suturing skills assessment tool (UBAT) and the Objective Structured Assessment of Technical Skill global rating scale (OSATS). Questionnaires regarding future career ambitions and attitudes towards plastic surgery were also completed both prior to and following the tests.

Results

The intervention group needed a longer time to complete the tasks than the control group (12.2 min vs. 9.6 min,p > 0.001), and scored lower on both the UBAT (5.6 vs. 9.0,p > 0.001) and the OSATS (11.1 vs. 13.1,p > 0.001) assessments. The microsurgery course tended to positively influence the students’ attitudes towards a career in plastic surgery (p = 0.002). This study demonstrates poorer macrosurgical skills in the medical students group exposed to microsurgical training. The true effect of microsurgical training warrants further investigation.

Level of evidence: Level I, diagnostic study.

The effect of repeated testing vs repeated practice on skills learning in undergraduate dental education

OBJECTIVES

Recent studies in undergraduate medical education have demonstrated the advantage of repeated testing over repeated practice with regard to knowledge and skills retention. The aim of this study was to investigate whether this "testing effect" also applies to skills retention in undergraduate dental education.

METHODS

In this prospective, randomised controlled trial, fourth-year dental students at Göttingen University Medical Centre participated in a training session on surgical suturing in winter term 2014/2015. Following this, they were either assigned to two sessions of additional skills training (group A) or two sessions of skills assessment with feedback (group B). These sessions were spaced over a period of 4 weeks. Skills retention was assessed in a summative objective structured clinical examination (OSCE) at the end of term, that is 6 months after the initial teaching session.

RESULTS

A total of 32 students completed the study. With regard to suturing, OSCE performance was significantly better in group B than group A (81.9±13.1% vs 63.0±15.4%; P=0.001; Cohen's d=1.33). There was no significant OSCE performance difference in the two groups with regard to other learning objectives that were addressed in the end-of-term examination. Thus, the group difference was specific to suturing skills.

CONCLUSIONS

This is the first study to demonstrate that in dental education, repeated testing produces more favourable skills retention than repeated practice. Test-enhanced learning might be a viable concept for skills retention in undergraduate dentistry education.

Development and validation of a new assessment tool for suturing skills in medical students

Background

In recent years, emphasis has been put on that medical student should demonstrate pre-practice/pre-registration core procedural skills to ensure patient safety. Nonetheless, the formal teaching and training of basic suturing skills to medical students have received relatively little attention and there is no standard for what should be tested and how. The aim of this study was to develop and validate, using scientific methods, a tool for assessment of medical students’ suturing skills, measuring both micro- and macrosurgical qualities.

Methods

A tool was constructed and content, construct, concurrent validity, and inter-rater, inter-item, inter-test reliability were tested. Three groups were included: students with no training in suturing skills, students who have had training, plastic surgery.

Results

The results show promising reliability and validity when assessing novice medical students’ suturing skills.

Conclusions

Further studies are needed on implementation of the instrument. Moreover, how the instrument can be used to give formative feedback, evaluate if a required standard is met and for curriculum development needs further investigation.

Level of Evidence: Not ratable.

Assessment formats in dental medicine: An overview

AIM

At the annual meeting of German dentists in Frankfurt am Main in 2013, the Working Group for the Advancement of Dental Education (AKWLZ) initiated an interdisciplinary working group to address assessments in dental education. This paper presents an overview of the current work being done by this working group, some of whose members are also actively involved in the German Association for Medical Education's (GMA) working group for dental education. The aim is to present a summary of the current state of research on this topic for all those who participate in the design, administration and evaluation of university-specific assessments in dentistry.

METHOD

Based on systematic literature research, the testing scenarios listed in the National Competency-based Catalogue of Learning Objectives (NKLZ) have been compiled and presented in tables according to assessment value.

RESULTS

Different assessment scenarios are described briefly in table form addressing validity (V), reliability (R), acceptance (A), cost (C), feasibility (F), and the influence on teaching and learning (EI) as presented in the current literature. Infoboxes were deliberately chosen to allow readers quick access to the information and to facilitate comparisons between the various assessment formats. Following each description is a list summarizing the uses in dental and medical education.

CONCLUSION

This overview provides a summary of competency-based testing formats. It is meant to have a formative effect on dental and medical schools and provide support for developing workplace-based strategies in dental education for learning, teaching and testing in the future.

Study of the reliability and validity of objective structured clinical examination (OSCE) in the assessment of clinical skills of audiology students

Introduction:

Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students.

Methods:

Among the various procedures in which audiology students should possess demonstrated competence, 10 specific skills were selected and checklists were prepared. Faculty members of university’s Audiology Department were consulted to determine the validity of the checklists. Subsequently, the examination was administered to all 14 fourth-year audiology students in their final semester of study at Ahvaz Jundishapur University of Medical Sciences. The examination consisted of three question stations and seven procedure stations. Each station was managed by two examiners who independently used a checklist to score each student’s performance in a given procedure. To determine reliability, the Spearman test was used.

Results:

The correlation between each examiner’s scores of students at question stations was 0.908. The correlation between each examiner’s scores at procedure stations was 0.857 (p=0). The site of lesion test had the highest correlation (0.948) and immittance audiometry had the lowest correlation (0.585).

Conclusion:

The prepared checklists had good validity and reliability and can be used to evaluate the clinical competence of audiology students in their final semester of study.

In-patient operating exposure for dental undergraduates: a valuable experience?

The General Dental Council, the Association of Dental Education in Europe and the Association of British Academic Oral and Maxillofacial Surgeons have all issued syllabuses suggesting undergraduate dental students should gain experience of oral and maxillofacial in-patient operating.Aim To examine whether final year dental students in a UK dental school had observed, and were comfortable providing an explanation of, oral and maxillofacial in-patient operating.Materials and methods Students at Newcastle University's School of Dental Sciences have block allocations to in-patient operating (16 half-day sessions). A questionnaire was distributed to the whole of the final year (n = 78) at the end of these allocations examining different aspects of their exposure to in-patient operating.Results A response rate of 81% (n = 63) was achieved. Those responding reported that they had seen a wide variety of surgery. The most common procedural group that had not been observed was orthognathic surgery (n = 33, 52%). There was no correlation (p >0.05) between total number of procedural groups observed and total number of procedural groups that students were confident to explain, although there were significant correlations (p <0.05) between having observed specific operations and having the confidence to explain them. The students felt that the block allocations were beneficial (n = 46, 63%) and offered a variety of free-text reasons for this. Only a minority (n = 24, 38%) had been actively involved in the surgery they had observed, the majority of those individuals having undertaken some suturing (n = 11).Conclusions Students perceive allocations to oral and maxillofacial in-patient operating as beneficial for a variety of reasons. The relationship between having observed a procedure and the individual's perceived ability to explain it appears to be complex. It is difficult to achieve consistent exposure throughout a large year group of undergraduate students, but more targeted learning may be of benefit.