Acquiring psychomotor skills in operative dentistry: do innate ability and motivation matter?

Psychomotor Skills of Domestic and Internationally Trained Dental Students in Pre-Clinical Dental Education

INTRODUCTION

Evidence on the pre-clinical and clinical performance of internationally trained dental students compared with domestic students and competency standards is limited. The aim of this study was to compare, relatively and normatively, the psychomotor skills of domestic and internationally trained dental students who participated in the same pre-clinical, 9-week, fixed prosthodontics course.

MATERIALS AND METHODS

Course grades were collected for a total of 224 domestic and 66 internationally trained dental students between 2014 and 2020. Descriptive statistics, t-tests and chi-square tests were used to describe and compare the two groups.

RESULTS

At the start of the course, slightly developed or underdeveloped psychomotor skills were observed in 47.8% of domestic students and 34.8% of internationally trained dental students; however, at the end of the course, 78.1% of domestic students and 69.7% of internationally trained dental students had developed or very developed psychomotor skills. Internationally trained dental students had significantly higher psychomotor skills at the start (p = 0.009), but not at the end (p = 0.285) of the course compared to their domestic counterparts. The improvement in psychomotor skills observed in domestic students was significantly greater than that of internationally trained dental students (p = 0.003). At the start of the course, 85.7% of domestic students and 75.5% of internationally trained dental students exhibited training needs. Training needs decreased at the end of the course in both groups but remained sizable.

CONCLUSIONS

While internationally trained dental students outperformed domestic students at baseline, no significant differences were observed between the two groups by the end of the course. Both groups exhibited training needs at both time points, underscoring the necessity for continued scaffolded support.

Effectiveness of manual dexterity assessment methods for preclinical training in Dentistry

OBJECTIVE

This study aimed to verify the predictive capacity of manual dexterity assessment methods for pre-clinical training in Dentistry.

METHOD

Students from the fifth year of the undergraduate course in Dentistry (N = 95) participated in this study. Manual dexterity was investigated as a variable of interest, measured by the O'Connor Finger Dexterity Test methods-Model 32021, Purdue Pegboard Test-Model 32020A, Dental Manual Dexterity Assessment-DMDA, Class One Cavity Preparation Assessent-COCA and Class One Composite Resin Restoration Assessment-COCRA. The average score obtained in the evaluation of the quality of the cavity preparations and restorations was considered as gold standard, and from these data the sensitivity and specificity of the tests were estimated. Receiver Operating Characteristic (ROC) curves were constructed to assess the diagnostic performance of each dexterity test. The analysis included calculating the Area Under the Curve (AUROC) to evaluate their discriminative power, and cutoff points were determined that optimize the balance between sensitivity and specificity.

RESULTS

The DMDA test showed better performance, with statistical significance (p <0.001) and acceptable predictive ability (AUROC = 0.775), while the O'Connor test (AUROC = 0.644, p = 0.050) and Purdue Pegboard test (Purdue 1: AUROC = 0.542, p = 0.560; Purdue 2: AUROC = 0.564, p = 0.423; Purdue 3: AUROC = 0.517, p = 0.828; Purdue 4: AUROC = 0.608, p = 0.083) were not statistically significant.

CONCLUSION

The DMDA test presented the best performance, with statistical significance and acceptable discrimination, showing greater effectiveness for assessing students' manual dexterity. Therefore, the implementation of the DMDA test can significantly contribute to the early identification of motor dexterity difficulties in dental students, enabling more effective and targeted interventions.

Evaluation of manual dexterity when using a mirror of dental students and academicians with increasing professional experience

INTRODUCTION

To evaluate the manual dexterity of dentistry students and academicians when using a mirror according to increasing professional experience.

MATERIALS AND METHODS

The study included 72 subjects, grouped according to professional experience 5th year dentistry students (DS) accepted as no experience-academicians with 1-4 years experience (A5L)-academicians with ≥5 years experience (A5M). Direct and indirect visualisation using the mirror was evaluated with the completion times of the O'Connor Finger Dexterity Test.

RESULTS

The hand grip strength values of both left and right hand were found to be statistically significantly higher in all the males than in the females (p < .05). The indirect test times (ITT) using the mirror were significantly longer for males than for females (p = .001), and no significant difference was determined between the genders in the direct test times (DTT) (p > .05). For all the study participants, DTT shortened as professional experience increased (p < .05). In addition, the mean values of both DTT (p = .031) and ITT (p = .028) in the DS group were statistically significantly longer than the A5M group.

CONCLUSION

With increasing professional experience, manual dexterity was determined to increase, and females were found to be more successful in the direct manual dexterity tests independently of the groups. The statistical significance between the DS and A5M groups, especially in the hand dexterity test with a mirror, shows the importance of experience. The study results demonstrated that professional manual dexterity in dentistry can be developed with increasing practical application.

Comparative Analysis of Manual Dexterity of Dental Students at Ajman University following One Academic Year of Preclinical Training Sessions: A Longitudinal Cohort Study

OBJECTIVES

 Dental students must complete two stages of training, namely, preclinical training on phantom head models and clinical training on actual patients to acquire the practical skills required by their Bachelor of Dental Surgery program.Our objectives are to evaluate the level of improvement of the manual skills obtained by third-year dental students after one full academic year of preclinical training courses using dexterity tests under direct and indirect vision and to compare the improvement among male and female dental students under the same conditions.

MATERIALS AND METHODS

 A total of 72 preclinical students participated in our cohort trial, each of whom was assigned a random identification number that was only known to the researchers. After the beginning of the academic year, the experiment was performed under identical conditions for both the O'Connor Tweezer Dexterity Test and the Purdue Pegboard Test. The examinations were conducted at two distinct times: T0 before phantom laboratory training (the beginning of preclinical sessions) and T1 after phantom laboratory training (9 months after T0).

STATISTICAL ANALYSIS

 Signed-rank test of Wilcoxon over two separate periods (T0 and T1), comparisons were made between the direct and indirect visual dexterity test scores. In addition, the Mann-Whitney U test was used to compare results across gender. The statistical significance (p-value) was set at below 0.05 with a confidence level of 95%.

RESULTS

 A statistically significant difference was detected between the T0 and T1 assessments on the Purdue Pegboard Test and the O'Connor Tweezer Dexterity Test for all selected dentistry students in both direct and indirect conditions (p < 0.001).

CONCLUSION

 Further investigation in other dental departments or schools, particularly those with different entry standards, is required prior to making a definitive conclusion about the use of these dexterity assessments as predictors of prospective dental students' performance.

The impact of reflex-based recreational activities and preclinical training on psychomotor skills in an educational dental environment

BACKGROUND

Participating in recreational activities from a young age may have the potential enhance psychomotor skills early on, and conversely, low levels of participation in these activities may predict slower development of preclinical hand skills.

PURPOSE

This study aims to evaluate the eye-hand coordination benefits of leisure and reflex-based activities to those of typical instructional techniques among dental students.

DATA SOURCES

The databases used were PubMed, EBSCOhost, and Scopus.

STUDY SELECTION

Ten articles were selected from a total of 1135 articles found across three databases.

DATA EXTRACTION

The articles were screened by four investigators through a series of steps in accordance to inclusion and exclusion criteria and rid of any duplicates.

DATA SYNTHESIS

The majority of the 10 featured articles were conducted in the United States. All of the research included was cohort observational studies. This systematic review includes a total of 1975 participants from the publications selected for this purpose.

RESULTS

Manual dexterity may be taught and improved by practice, and tests designed to measure it should be used primarily to pinpoint which students would benefit most from individualized, close supervision during their education.

CONCLUSION

Researchers found that reflex-based activities helped students develop better hand-eye coordination in a classroom setting. However, more precise dental-related tests and questionnaires can always be developed through further study; doing so would yield a wealth of information that would be immensely useful to the dental sector.

Preclinical dental training: Association between fine motor skills and compliance with ergonomic posture techniques

OBJECTIVE

The aim of this study was to evaluate the dental students' fine motor skills and their compliance with ergonomic posture techniques over the course of a preclinical training year. The correlation between fine motor skills and compliance was also assessed.

METHODS

The ergonomic posture of students enrolled in the second year of a five-year undergraduate dental degree programme (n = 62) was assessed using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). This assessment relied on photographs of the students performing preclinical laboratory procedures during the school year. The photographs of each procedure received a score, and the final score obtained (0 to 10) corresponded to the extent of the student's compliance with ergonomic posture techniques. Initial compliance was calculated during the first two months of the training programme, whilst final compliance was calculated during the last two months. Fine motor skills were evaluated using the modified Dental Manual Dexterity Assessment (DMDA), which was also applied at the beginning and the end of the school year. Data were assessed statistically by Student's paired t test, and the correlation between fine motor skills and compliance with ergonomic posture techniques was estimated by Pearson's correlation coefficient (r) and Student's t test (α = 0.05).

RESULTS

The compliance scores were higher at the end of the academic year than at the beginning of year (p < 0.001; t = -5.300). Fine motor skills improved significantly with time (p < 0.001; t = -10.975). Non-significant correlations were found between students' fine motor skills and their economic posture compliance both at the beginning (r = -0.197; p = 0.126) and at the end of the training year (r = 0.226; p = 0.078).

CONCLUSION

The students' manual dexterity and compliance with ergonomic posture techniques increased over the course of the preclinical training year, and the correlation between students' fine motor skills and their ergonomic posture compliance was not significant.

Spatial ability and anatomy learning performance among dental students

PURPOSE

Spatial perception is an essential skill for professional dentists. The objective of this study was to observe the spatial ability, as well as anatomy module grades, of dental students at a dental education center in Indonesia and relate these to gender and cohort.

METHODS

A cross-sectional study was carried out where dental students in years (cohorts) 1, 2, 4-6 were invited to take the Revised Purdue Spatial Visualization Test (PSVT-R) and the redrawn Vandenberg and Kuse Mental Rotation Test (MRT) in order to assess spatial ability. In addition, the 1st- and 2nd-year dental students carried out gross anatomy assessments. Spatial ability test results were compared using an independent t-test to detect gender differences, one-way analysis of variance to inspect cohort differences, and correlation relative to anatomy module scores.

RESULTS

A total of 326 dental students voluntarily participated. Statistically significant gender differences were found in both spatial ability tests in the overall sample (PSVT-R: p&lt;0.001; MRT: p=0.001). When the 1st- and 2nd-year dental students were pooled, significant gender differences were detected, in which males scored higher than females in both spatial ability tests (PSVT-R: p&lt;0.001; MRT: p=0.003). In anatomy, however, females scored higher than the males (p=0.005). In addition, there were weak to moderate, but significant correlations between spatial ability tests and anatomy scores.

CONCLUSION

This study indicated that spatial ability may not be the only factor predicting the academic performance of dental students. However, dental students with low spatial ability scores may need supplementary educational techniques when learning specific spatial tasks.

Potential of intraoral optical scanning to evaluate motor skills' improvement for tooth preparation: A prospective cohort study

INTRODUCTION

This prospective cohort study investigated the potential of digital assessment using intraoral scanning (IOS) combined with software analysis (prepCheck) to evaluate the outcome of repetitive tooth preparation and its influence on the acquisition of motor skills in dental students.

MATERIALS AND METHODS

Twenty-six students completed 177 full-crown preparations of the same tooth in six practice sessions followed by a final examination. Preparations were assessed digitally using prepCheck and conventionally by calibrated faculty instructors. In addition, students assessed their own performance and this was compared with the instructors' assessments.

RESULTS

Conventional assessment showed that students preparations improved over time, with 43.5% of students receiving score 2 (highest grade) at the fifth practice session. With the prepCheck assessment, statistically significant improvements indicated by an enlarged area within the tolerance range set at 0.2 mm were found between the first and the second practice session (7.5% improvement; 95% CI: 2.2%, 12.7%, p = 0.006), and between the first run and the final exam preparation (6.7%; 95% CI: 1.7%, 12.5%, p = 0.011). Agreement between instructor/student assessments was best immediately after students received visual feedback using prepCheck (76% agreement; Spearman's rho 0.78).

CONCLUSION

These data indicate that IOS technology was useful for student's self-evaluation by visual feedback.

A conceptual model for clinical psychomotor skill development in an era of simulated and virtual reality

Psychomotor skill development is central to a beginner practitioner's learning pathway. Curriculum constraints around time, access to facilities and resources in health professions education have prompted the growth in alternative approaches to clinical skill development in both simulation and direct patient care. Among these is the increased incorporation of virtual reality (VR) systems with haptic feedback alongside traditional, solid simulations. Given the rapid growth in the adoption of technological affordances to support skill development, it is cogent to pause and examine whether the underpinning concepts regarding psychomotor skill development that have driven much of the approaches to teach clinical skill acquisition in dentistry remain fit-for-purpose. This conceptual paper proposes a new taxonomy for clinical simulation psychomotor skill development in the era of increasing variety of simulation modalities.

A narrative review of psychomotor abilities in medical sciences: Definition, categorization, tests, and training

Extensive research in the past decades has evidenced differences in the psychomotor ability of individuals resulting from varying levels of experience, age, gender, response precision, compatibility, performance, and ability. Many studies have called for the need to identify psychomotor ability and appropriate tests that can assess it. This review article surveys the definition, categorization, and tests of psychomotor ability as well as training based on psychomotor ability in medical sciences. We searched the literature with no time limit, using the ProQuest, PubMed, and Eric databases, as well as the Google Scholar search engine. The keywords for the search involved psychomotor, psychomotor performance, assessment, psychomotor ability, motor learning, education, training, psychomotor ability testing, and psychomotor skills. Other relevant papers found through hand searching and snowballing were also included in the review. The EndNote X8 was employed as a reference manager tool. Only abstracts of the papers whose full texts were accessible were reviewed after repetitious papers were excluded. The documents were categorized into five groups: definition of psychomotor skills and ability, psychomotor ability components, psychomotor ability tests, identification of psychomotor ability (task analysis), and training. This review article revealed that there is not a single definition for psychomotor ability and its components. However, it can be said that motor abilities are the foundation for the rapid acquisition of skills and according to the neuroplasticity process are learned through training and practice. Given psychomotor abilities vary among individuals, training courses should also provide different levels of psychomotor training for learners. The literature introduces psychomotor tests as a selection tool, a predictor of future professional behavior, and a means to evaluate progress in performance, academic guidance (ability-oriented medical specialty), and curriculum implementation tailored to the needs of learners of varying graduate disciplines. The tests should be profession-specific because each profession entails its peculiar characteristics and abilities. On the other hand, the major problem in studying and analyzing underlying psychomotor skills and abilities is that the components are being investigated by researchers from varying, and usually unrelated, scientific fields. Therefore, it is necessary to have a holistic view through close interaction between the researchers of different sciences to better understand this area.

Perception and outcomes after implementation of problem-based learning in predoctoral pediatric dentistry clinical education

PURPOSE

Problem-based learning (PBL) has been a useful addition to health-based curricula by supporting learning with contributory discussion, research, and critical analysis of evidence in a peer-supported learning format. The aim of this study was to determine the impact of PBL on pediatric dentistry clinical education.

METHODS

First-time pass-rates in clinical and objective structured clinical examinations were measured in student cohorts receiving pediatric curricular formats with (PBL+) or without a PBL (PBL-) experience. Student perceived learning outcomes were measured through a voluntary survey. The numbers of each competency attempt were compared between the study groups (PBL+ or PBL-) using Wilcoxon Rank-Sum tests or Fisher's exact tests. Mantel-Hanzel ordinal chi-square tested for differences in rates of agreement on survey responses from students in the PBL+ or PBL- groups. Significance was set at 0.05.

RESULTS

There was a significant improvement in the first-time pass-rates in five of seven competencies in the PBL+ group. A significantly higher proportion of students in the PBL+ group perceived that their predoctoral pediatric dentistry rotation improved their diagnostic skills compared to the students in the PBL- group (p < 0.001). However, there was no significant difference (p > 0.05) between the perceptions on satisfaction of clinical or non-clinical staff support, perceived self-improvement in radiographic or clinical skills or overall benefits of the predoctoral pediatric dentistry rotation.

CONCLUSION

The addition of a PBL component to a traditional curricular format in a pediatric dentistry clinical rotation had a positive impact on learning in a predoctoral dental program.

Influence of Preclinical Training on Root Canal Treatment Technical Quality and Confidence Level of Undergraduate Dental Students

Objectives

The aim of this study was to investigate the influence of exposure to additional preclinical endodontic training on undergraduate students' technical quality of root canal treatment and overall confidence levels in endodontics.

Methods

Technical quality of root canal treatment performed clinically by fifth-year undergraduate students was evaluated and divided into two groups: Group 1, teeth treated by students who had attended both a preclinical endodontic block course and an elective preclinical course. Group 2: teeth treated by students who had not attended the elective preclinical course. All students were also invited to participate in a survey to rate their undergraduate endodontic training and confidence levels performing endodontic treatment. Statistical analysis of data was performed using Person chi-square test, Fisher Freeman Halton exact test, and t-test. A p-value <0.05 was considered statistically significant.

Results

There was no significant difference between the two groups in overall obturation quality (p=0.619). However, more teeth treated by attendees were of adequate obturation length (p=0.015) and lacked procedural errors (p=0.004). Significantly more elective course attendees rated their undergraduate endodontic training as adequate (p=0.002), but there was no significant difference in the level of confidence between the attendees and the non-attendees.

Conclusion

Within the limitations of this study, additional preclinical training showed minimal effect on overall quality of root canal treatment performed clinically by undergraduate students and did not enhance their confidence levels; however, it was associated with more satisfaction with their undergraduate endodontic education.

Making use of three-dimensional models of teeth, manufactured by stereolithographic technology, in practical teaching of endodontics

INTRODUCTION

Making use of 3D printed teeth models in teaching students offers an innovative approach. The mistakes made by the students at the access cavity stage were assessed with the aid of 3D models, and their overall, hands-on learning progress was evaluated.

MATERIAL AND METHODS

Ninety 3D models of teeth were constructed using stereolithographic technology and then randomly divided into 9 groups. One dentistry student was randomly assigned to each group and then performed primary access cavity in 10 identical 3D models. Then the teeth were evaluated in the order of their preparation, relative to the model tooth.

RESULTS

The material of 14 (15.5%) out of 90 teeth models sustained significant damage during the preparation. As regards the remaining 76 (84.5%) 3D models, the students committed the greatest number of mistakes on the incisors, and fewer on the molars and the least in the premolars. The difference in the number of errors between particular groups of teeth was statistically significant (P = .0001). The number of errors committed in subsequent repetitions amongst all students was significantly different for the incisors (P = .00215) and premolars (P = .00383), whereas insignificant in the case of molars (P = .77116).

CONCLUSIONS

Thanks to perfect representation of teeth anatomy; making use of 3D models in the teaching of endodontics may well be recommended as holding substantial potential in improving overall quality of training at the pre-clinical stage, with a view to appreciably reducing overall risk of encountering complications during the actual clinical work.

Online Problem-Based Learning in Clinical Dental Education: Students' Self-Perception and Motivation

The physical closure of higher education institutions due to coronavirus disease 2019 (COVID-19) shed a brighter light on the need to analyze, explore, and implement strategies that allow the development of clinical skills in a distance learning situation. This cross-sectional study aims to assess dental students’ self-perception, motivation, organization, acquired clinical skills, and knowledge using the online problem-based learning method, through the application of a 41-item questionnaire to 118 senior students. Answers were subjected to descriptive and inferential statistics analysis. Further, a principal component analysis was performed, in order to examine the factor structure of the questionnaire. Results show that online problem-based learning can be considered a relevant learning tool when utilized within the specific context of clinical dental education, displaying benefits over the traditional learning strategy. Overall, dental students prefer a hybrid system over the conventional one, in a distance learning context, and assume self-responsibility for their own learning, while knowledge thoroughness is perceived as inferior. This online active learning method is successful in improving information and clinical ability (visual/spatial and auditory) advancement in the scope of dental education, with similar results to presential settings. Further studies are required to assess clinical skill development through active learning methods, in a distance learning context.

Course induced dexterity development and cerebellar grey matter growth of dentistry students: a randomised trial

This study primarily focuses on the assessment of dentistry students’ improvement of manual skills resulting from their participation in courses. We aimed to prove that systematic manual skills development significantly improves dexterity. We hypothesized that the dexterity training regimen improves manual dexterity demonstrated by the HAM-Man (Hamburg Assessment Test for Medicine-Manual Dexterity) test scores and CGM (cerebellar grey matter) growth. Thirty volunteers were randomly divided into two equal groups (study and control). Firstly, volunteers were examined by the HAM-Man test and baseline MRI scans. Afterwards, a manual skills development course was launched for the “study group”. Secondly, all the manual skills of the students were evaluated longitudinally, by the HAM-Man test. Simultaneously, the follow-up MRI scans were taken to observe morphologic changes in the cerebellum. The Wilcoxon signed-rank test and Student Paired t-test were used for statistical analyses. Value p < 0.05 was considered significant. After the training, significant growth of CGM as well as improvement on manual skill assessment tests, were found in the study group. Training courses are suitable for preparing students with low levels of dexterity for performing demanding tasks. The improvement is demonstrable by a wire bending test and by bilateral CGM enlargement as well.

Predictors of preclinical hand skill performance in dental school

CONTEXT

Preclinical dental school instructors often observe some first-year students develop hand skills required for dental procedures more quickly and more easily than their peers. When questioned regarding prior experience, these advanced students often participated in physical activities that seem to predispose them to adapt their previously learned psychomotor hand skills to those required for dentistry.

OBJECTIVE

This study examines the results of an Institutional Review Board approved 22-question survey of various lifelong predental school activities and correlations to first-year and second-year simulation clinic practical exam performance.

DESIGN

The survey was taken anonymously at the Midwestern University College of Dental Medicine-Arizona by 4 consecutive dental school classes of 2017-2020 composed of 560 students, 552 of which responded. The purpose was to discover associations between lifelong activities and practical exam scores that may act as predictors of preclinical ability to develop visualization and psychomotor hand skills required for dental procedures.

RESULTS

Higher preclinical practical scores were found to have the most correlation with higher levels of participation in psychomotor, artistic and outdoor physical activities. Participation in computer, musical instrument and culinary activities had no significant correlation, and prior experience in the medical or dental field had a negative correlation.

CONCLUSION

The lack of participation in these predisposing lifelong activities may predict slower development of dental hand skills and signal the need for more hands-on tutorial instruction in the simulation clinic so these students do not lag behind their peers.

Development of e-portfolio in undergraduate clinical dentistry: How trainees select and reflect on evidence

INTRODUCTION

Self-reflection is a fundamental part of health professional development, especially in the unstructured clinical stage of dentistry, medical and health profession education, since it plays important role in experiential learning. A portfolio-both conventional and digital-records various aspects of knowledge, skills and attitudes over a long period of time to help students develop their professionalism by conducting self-reflection. This study aims to explore the process of selecting and reflecting on professionalism evidence recorded in e-portfolios during undergraduate clinical dentistry training.

METHOD

This pilot study is a qualitative study with a phenomenological design. The selection of respondents was conducted using a maximum variety sampling method. Following a 6-week pilot programme, a total of six in-depth interviews and five focus group discussions were conducted with undergraduate students representing different clinical rotations to explore the process conducted by undergraduate clinical dentistry students in e-portfolio development. The study of documents was also conducted on the respondents' reflective writing from the e-portfolio back-end data to explore their self-reflection skills.

RESULT

The results of the present study highlighted two different approaches used amongst trainees in developing a reflective e-portfolio: selective and non-selective. The observed reflective e-portfolio utilisation frequency and trainees' self-reflection skills were low, with several affecting factors identified. These identified factors consisted of external factors, such as the undergraduate clinical dentistry programme curriculum, the hidden curriculum, the availability of feedback, the availability of role models, and features of the e-portfolio and internal factors, such as understanding the self-reflection concept, the availability of time and mood, cultural factors, and understanding the content reflected.

CONCLUSION

Through the process of independently selecting and recording learning activities in e-portfolios as well as repeatedly conducting self-reflection, trainees can improve their overall reflective abilities. However, producing a systematic approach to forming a reflective learning environment is necessary to aid the implementation of reflective e-portfolios, especially at the early stage of e-portfolio implementation.

Assessing likelihood of using the Bruininks-Oseretsky test of motor proficiency to predict preclinical performance of dental students

Objective

The acquisition of motor skills is a key competency for the practice of dentistry, and innate abilities have been shown to influence motor performance. Thus, finding the most efficient manual dexterity tests may predict performance of dental students. The current study used the Bruininks-Oseretsky Test of Motor Proficiency, to assess motor skills of first year (D1) and second year (D2) dental students.

Materials and methods

Three fine motor subsets of the BOT-2-fine motor precision, fine motor integration, and manual dexterity-were administered to D1 and D2 dental students in 2017 and 2018. The BOT-2 subset scores of D1 students were compared with those of D2 students, who had preclinical dental experiences. For D2 students, we tested for correlations between BOT-2 subset scores and performance scores in a preclinical operative dentistry course.

Results

No differences were found between D1 and D2 students for any BOT-2 subtest scores (all Ps > .09). No correlations were found between total scores of each BOT-2 subtest and the operative dentistry course for D2 students (all Ps > .20).

Conclusions

Our results suggested the BOT-2 was not predictive of manual skills of dental applicants or preclinical dental students. Although we assumed students would perform well with instruction, practice, and feedback, we were unable to determine whether innate abilities influenced acquisition of manual dexterity skills. More research about the acquisition of technical clinical skills in dentistry is required.

Comparative effectiveness of hand scaling by undergraduate dental students following a two-week pre-clinical training course

BACKGROUND

The Bologna reform resulted in a drastic restructuring of pre-clinical training courses at the University of Zurich. The aim of this study was to assess student pre-clinical scaling/root planning skills after just 8.5 hours of manual training.

MATERIAL AND METHODS

Three consecutive classes of dental students (n = 41; n = 34; n = 48) were tasked with removing lacquer concrement from the maxillary left canine on a typodont using Gracey and universal (Deppeler M23A) curettes. At baseline (prior to instruction), a timed five-minute session of scaling/root planning was undertaken. The second scaling/root planning session was held immediately following training. Eight experienced dental hygienists and eight lay people served as positive and negative controls, using the same instruments and time limit, respectively. Instrumented teeth were collected, scanned and planimetrically analysed for the percentage of tooth surface cleaned. Statistical analyses were performed to assess the dental students' improvement after the training (Wilcoxon signed-rank test) and to compare it to that of laypeople and dental hygienists (Kruskal-Wallis rank sum test followed by Conover's post hoc test).

RESULTS

At baseline, the dental students' mean scaling scores of the cleaned surfaces were not significantly different than those of laypeople (29.8%, 31.0%, 42% vs 27.9%). However, after 8.5 hours of manual training, the students' ability to clean the maxillary tooth improved significantly and they achieved mean removal values of 61.7%, 79.5% and 76% compared to the 67.4% (P < .001) of the experienced dental hygienists (Tables Tables  and ). There were no statistically significant differences between the scores achieved by students after training and those achieved by experienced dental hygienists.

CONCLUSION

A shortened pre-clinical training time was sufficient for students to acquire the basic scaling/root planning skills needed in preparation for clinical training. Further research is needed to identify ways to help students consistently reach highest skill levels.

An interventional study for improving the manual dexterity of dentistry students

Objectives

Traditionally, the acquisition of manual skills in most dental schools worldwide is based on exercises on plastic teeth placed in a "phantom head simulator". No manual trainings are done at home. Studies revealed that preliminary training of one motoric task leads to significant improvement in performance of the required motoric task that has similar components. Performing tasks indirectly via a dental mirror are complicated for the young dental students. We hypothesized that instructed training of basic skills required in dentistry at home on a tool simulating the phantom laboratory will improve the capabilities of the students and will be reflected by their clinical grades.

Methods

We developed a portable tool PhantHome which is composed of jaws, gingival tissue, rubber cover and a compatible stand. Specific teeth produced by a 3D printer with drills in different directions were placed in both jaws. Students were requested to insert pins by using tweezers and dental mirror according to instructions initiating with easy tasks and continue to ones that are more complicated. 106 first clinical year dental students participated in the study; 65 trained only in the traditional phantom lab (control). 41 trained at home by the PhantHome tool two weeks before and 2 months during the initial stage of phantom lab. The students grades routinely provided in the phantom laboratory at different stages were compared.

Results

Students who trained with the portable tool performed better than the control group in the first direct and second indirect preparations (p<0.05). These exams were taken when the PhantHome was available to the students. Then, the tool was returned and the phantom course continued regularly. We believe that this is why no differences between the grades of the groups were observed further on.

Conclusions

Training by the PhantHome improves motor skills and consequently the clinical performances.

Predicting the clinical performance of dental students with a manual dexterity test

Dentists must be skilled when using dental mirrors. Working with mirrors requires spatial perception, bimanual coordination, perceptual learning and fine motor skills. Many studies have attempted to determine the predictors of manual skills among pre-clinical students, but consensus has yet to be reached. We hypothesized that valid and reliable occupational therapy test performance regarding indirect vision would differ between dental students and junior dentists and would explain the variance in manual skill performance in pre-clinical courses. To test this hypothesis, we applied the Purdue Pegboard test and O’Connor Tweezer Dexterity test under different conditions of direct and indirect vision. We administered these tests to students in phantom-head academic courses in 2015 and 2016 and to junior dentists. Students performed the tests at three time points: before phantom training (T0), at the end of the training (T1) and in the middle of the following year of study (T2). Dentists performed the same tests twice at 1^st and 2^nd trials one week apart. The results showed that indirect tasks were significantly more difficult to perform for both groups. These dexterity tests were sensitive enough to detect students’ improvement after phantom training. The dentists’ performances were significantly better than those of students at T0, specifically with regard to the use of tweezers under direct and indirect vision (the O’Connor test). A regression analysis showed that students’ manual grades obtained at the beginning of the phantom course, their performance on the Purdue test using both hands, and their performance on the O’Connor test under indirect vision predicted phantom course success in 80% of cases. The O’Connor test under indirect vision is the most informative means of monitoring and predicting the manual skills required in the pre-clinical year of dentistry studies.

Dental Students' Perceived Clinical Competence in Prosthodontics: Comparison of Traditional and Problem-Based Learning Methodologies

The aim of this study was to compare the perceived competence for treating prosthodontic patients of two samples of fourth-year dental students: those educated using traditional methodologies and those educated using problem-based learning (PBL). Two cohorts of fourth-year dental students at a dental school in Spain were surveyed: the traditional methods cohort (n=46) was comprised of all students in academic years 2012 and 2013, and the PBL cohort (n=57) was comprised of all students in academic years 2014 and 2015. Students in both cohorts reported the number of prosthodontic treatments they carried out per year and their perceived level of competence in performing such treatments. The results showed that the average number of treatments performed was similar for the two cohorts, except the number of metal-based removable partial dentures was significantly higher for students in the traditional (0.8±1.0) than the PBL (0.4±0.6) cohort. The level of perceived competence to treat complete denture patients for the combined cohorts was significantly higher (7.3±1.1) than that for partial acrylic dentures (6.7±1.5) and combined dentures (5.7±1.3). Students' clinical competence in prosthodontics mainly depended on number of treatments performed as the operator as well as the assistant. Students in the traditional methods cohort considered themselves to be significantly more competent at treating patients for removable partial and fixed prostheses (7.8±1.1 and 7.6±1.1, respectively) than did students in the PBL cohort (6.4±1.5 and 6.6±1.5, respectively). Overall, however, the study found that practical experiences were more important than the teaching method used to achieve students' perceived competence.

Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study

BACKGROUND

The Learner-Centered Student-run Clinic (LC-SRC) was designed to teach and train prescribing skills grounded in a real-life context, to provide students with early clinical experience and responsibility. The current studies' theoretical framework was based on the Self-determination Theory. According to the Self-determination Theory, early involvement in clinical practice combined with a high level of responsibility makes the LC-SRC an environment that can stimulate intrinsic motivation. We investigated the different types of motivation and the proficiency in CanMEDS competencies of the participating students.

METHOD

Type of motivation was measured using the Academic Motivation Scale and Intrinsic Motivation Inventory. CanMEDS competencies were evaluated by faculty using a mini-clinical examination and by the students themselves using a post-participation questionnaire.

RESULTS

The 29 participating students were highly intrinsic motivated for this project on all subscales of the Intrinsic Motivation Inventory. Motivation for medical school on the Academic Motivation Scale was high before and was not significantly changed after participation. Students considered that their CanMEDS competencies "Collaborator", "Communicator", "Academic", and "Medical expert" had improved. Their actual clinical team competence was judged by faculty to be at a junior doctor level.

CONCLUSION

Students showed a high level of intrinsic motivation to participate in the LC-SRC and perceived an improvement in competence. Furthermore their actual clinical competence was at junior doctor level in all CanMEDS competencies. The stimulating characteristics of the LC-SRC, the high levels of intrinsic motivation and the qualitative comments of the students in this study makes the LC-SRC an attractive place for learning.

Acquisition of dental skills in preclinical technique courses: influence of spatial and manual abilities

Sixty years of research have not added up to a concordant evaluation of the influence of spatial and manual abilities on dental skill acquisition. We used Ackerman's theory of ability determinants of skill acquisition to explain the influence of spatial visualization and manual dexterity on the task performance of dental students in two consecutive preclinical technique courses. We measured spatial and manual abilities of applicants to Hamburg Dental School by means of a multiple choice test on Technical Aptitude and a wire-bending test, respectively. Preclinical dental technique tasks were categorized as consistent-simple and inconsistent-complex based on their contents. For analysis, we used robust regression to circumvent typical limitations in dental studies like small sample size and non-normal residual distributions. We found that manual, but not spatial ability exhibited a moderate influence on the performance in consistent-simple tasks during dental skill acquisition in preclinical dentistry. Both abilities revealed a moderate relation with the performance in inconsistent-complex tasks. These findings support the hypotheses which we had postulated on the basis of Ackerman's work. Therefore, spatial as well as manual ability are required for the acquisition of dental skills in preclinical technique courses. These results support the view that both abilities should be addressed in dental admission procedures in addition to cognitive measures.

Features of an effective operative dentistry learning environment: students' perceptions and relationship with performance

OBJECTIVE

Students' perceptions of their learning environment influence the quality of outcomes they achieve. Learning dental operative techniques in a simulated clinic environment is characterised by reciprocal interactions between skills training, staff- and student-related factors. However, few studies have examined how students perceive their operative learning environments and whether there is a relationship between their perceptions and subsequent performance. Therefore, this study aimed to clarify which learning activities and interactions students perceived as supporting their operative skills learning and to examine relationships with their outcomes.

METHODS

Longitudinal data about examples of operative laboratory sessions that were perceived as effective or ineffective for learning were collected twice a semester, using written critical incidents and interviews. Emergent themes from these data were identified using thematic analysis. Associations between perceptions of learning effectiveness and performance were analysed using chi-square tests.

RESULTS

Students indicated that an effective learning environment involved interactions with tutors and peers. This included tutors arranging group discussions to clarify processes and outcomes, providing demonstrations and constructive feedback. Feedback focused on mistakes, and not improvement, was reported as being ineffective for learning. However, there was no significant association between students' perceptions of the effectiveness of their learning experiences and subsequent performance.

CONCLUSIONS

It was clear that learning in an operative technique setting involved various factors related not only to social interactions and observational aspects of learning but also to cognitive, motivational and affective processes. Consistent with studies that have demonstrated complex interactions between students, their learning environment and outcomes, other factors need investigation.

Use of objective psychomotor tests in health professionals

Evaluation of psychomotor skills is undertaken in a number of broad contexts. This includes testing of health professional populations as a measure of innate ability, to evaluate skill acquisition, or to compare professions. However, the use of psychomotor tests is frequently confounded by a lack of understanding of a particular tool's psychometric properties, strengths, and weaknesses. To identify and appraise the most commonly used tests on health professional populations, 86 articles were reviewed and the top nine tests identified. Few tests have had sufficient validity or reliability testing on health professionals. Based on the evidence available, use of the Grooved Pegboard Test, the Purdue Pegboard Test, or the Finger Tapping Test is recommended for the evaluation of dexterity in a health professional population; however, this choice may be dependent on the task(s) to which findings are generalised. More rigorous evaluation of validity and other psychometric properties is required.