Effective and ineffective supervision in postgraduate dental education: a qualitative study

Non-cognitive Support for Postgraduate Studies: A Systematic Review

Retention of postgraduate students is a complex problem at higher education institutions. To address this concern, various forms of academic support are offered by higher education institutions to nurture and develop the pipeline of postgraduate students. The support provided to postgraduate students tends to emphasize academic support at times at the expense of psychosocial or non-academic support. Non-cognitive skills were underscored as integral to determining academic and employment outcomes and thus, may need to be investigated more. This manuscript reports on an attempt to filter and consolidate the literature reporting on interventions for postgraduate students that include the development of non-cognitive skills. A systematic review was conducted, because it enabled rigorous and replicable process of consolidating literature. Covidence software was used as a digital platform for the systematic review. The review was conducted at four levels as per the PRISMA guideline namely, identification, screening, eligibility and final summation. The filtration process attempted to answer the following research questions: (1) How are non-cognitive factors or skills defined? (2) Which non-cognitive skills were included in support for postgraduate (Masters and Doctoral) students in the higher education setting?, and (3) How have non-cognitive skills been included in support interventions provided to retain postgraduate students? Descriptive and theory explicative metasynthesis was used for the summation and data extraction. The primary finding was that the term non-cognitive was not used explicitly in the included studies to describe skills or factors supporting student retention. The discourse centered around support and social support as non-academic factors and skills. This suggested that non-cognitive skills were constructed as co-curricular and not integrated into the postgraduate academic project or core learning outcomes. The findings highlighted the distinction between non-cognitive skills and factors and illustrated how skills and factors operate at different levels with different spheres of influence. The formats of support provide an intersectional space where skills and factors are combined.

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.

The dental healthcare professionals' competence in mentoring students in the clinical practice

OBJECTIVE

The aim of this study was to evaluate dentists', dental hygienists' and dental assistants' competence in mentoring students and to identify distinct mentor profiles.

METHODS

The study employed a cross-sectional design. Data were collected using the Mentors' Competence Instrument (MCI), which includes 45 items structured under seven mentoring competence sub-dimensions. The data were collected during autumn 2017 from dentists, dental hygienists and dental assistants working in the Finnish primary healthcare (n = 1097) using a paper survey, whilst dentists (n = 26) who have completed mentoring education in one university completed an electronic questionnaire. Cases with more than 5% missing data (n = 164) were listwise deleted, whilst the remaining data (n = 933) underwent analysis. K-mean clustering was used to identify significantly different mentor profiles, whilst comparisons of mentoring competence between the identified profiles were performed with Kruskal-Wallis and Mann-Whitney tests.

RESULTS

Three distinct mentor profiles (A, B and C) that differed in the level of mentoring competence were identified. The participants in profile A encompassed mostly dental assistants, profile B included mostly dental assistants and dentists, and profile C mainly comprised dentists and dental assistants. Profiles A, B and C differed significantly in terms of education, job title, role of mentor and participation in mentoring education. The largest difference in competence was observed between participants of profiles A and C. Each profile differed significantly from the other two across all seven competence areas. Most of the participants had not previously received any mentoring education.

CONCLUSION

There is room for improvement in the competence of dentistry student mentors, especially regarding knowledge of effective mentoring practices, goal-oriented mentoring, mentor characteristics and motivation for mentoring. Every mentor that works with oral healthcare students should receive mentoring training.

A multicenter study of dental curricula in Asia/Pacific nations: The views and experiences of final-year dental students

OBJECTIVES

The objective of this qualitative study was to gain greater understanding of final-year dental students' views on and experience of their dental curricula in 4 universities from different Asia/Pacific countries, including New Zealand, Australia, and Hong Kong (China).

METHODS

A qualitative study approach was used, with semistructured interviews conducted with final-year students from each of the 4 universities.

RESULTS

Interviews were conducted with 60 final-year dental students, and 5 main themes were extracted from the interviews: (1) the definition of an "ideal" dental curriculum, (2) theoretical teaching, (3) transitional tools, (4) assessment, and (5) grading.

CONCLUSION

The findings provide insight into final-year students' views of dental curricula and suggestions on possible areas of reform in the dental curriculum. Further investigations are necessary to provide a curriculum that enables students to become competent, future-ready dental practitioners.

Effect of individual structured and qualified feedback on improving clinical performance of dental students in clinical courses-randomised controlled study

AIM

Analysis of the effect of individual structured and qualified feedback (FB) on practical skills development of dental students during clinical courses.

METHODS

Fifty-three final-year dental students at Jena University Hospital participated in this prospective randomised controlled interventional study. Two calibrated assessors evaluated 128 pre- and post-assessments of 4 different dental treatment steps performed by dental students during the integrated clinical course in restorative dentistry and prosthodontics and the clinical course paediatric dentistry. The assessment included direct observation, graded and non-grading evaluation and was documented with a specific FB assessment tool. Dental students in the intervention group (IG) received an elaborated, structured and qualified FB after the pre-assessment that focussed on individual strengths and weaknesses, providing specific suggestions for improvement and establishing a personal learning goal. Participants were randomly allocated to the IG and the control group (CG).

RESULTS

In both groups, dental students significantly enhanced their performance, but the difference was higher in the IG than in the CG. Large effect sizes (ES) were observed in all observed items, but FB had largest effect size in improving technical skills (ES = 1.6), followed by management (ES = 1.3) and communication skills (ES = 0.8). Factors with the highest influence on FB in enhancing dental students' clinical performance were their insight into their own mistakes or omissions, the observed dental treatment step and the duration of FB.

CONCLUSION

Individual structured and qualified FB is an effective method to enhance dental students' professional performances and to individually guide the learning process.

Psychosocial student functioning in comprehensive dental clinic education: A qualitative study

INTRODUCTION

The aims were to describe first-year clinical dental students' psychosocial experiences in a known well-functioning comprehensive clinic teaching group (F+Grp) and a known dysfunctional group (Dys-Grp) and, thus, discover and describe phenomena related to psychosocial functioning of students. These groups were compared and contrasted regarding negative stress symptoms, perfectionism and coping with stress.

METHODS

Eight female dental students (mean 26 years old), four in each group, were interviewed after the first clinical year about learning and emotional experiences. The students also rated their perceived stress using a 0-10 scale, where 0 is no stress, and 10 is highest stress. Qualitative analyses involved searching for recurring themes and discovery of categories of clinical and social functioning. All 8 students were revisited as dentists after 8 years and filled out a 15-item survey as longitudinal validation of their first-year clinical experiences and to estimate group consensus and informant accuracy.

RESULTS

Both groups suffered from negative stress symptoms attributed to lack of time for clinical tasks, worries about work quality with confusion about their own expectations and worries about how others perceived them. Dys-Grp experienced higher negative stress and maladaptive perfectionism and described crying behaviours, withdrawal and unwillingness to cooperate with others. In contrast, students in F+Grp provided rich content about mutual cooperation related to social networking and positive support. The 8 subjects exhibited high internal consistency (α  =  .98) in their responses to the follow-up survey about their first year of clinic.

CONCLUSIONS

The comprehensive care teaching clinic environment with students working in groups appeared to provide a possibility for students to support each other for improved stress coping. Unfortunately, the opposite also occurred. Positive, supportive teacher supervision of student challenges related to perfectionism and stress is crucial and requires specific attention.

The learning environment in professional doctorate and postgraduate dental education: a qualitative study

INTRODUCTION

Currently, there is a lack of studies focusing on professional doctoral students' and graduates' perceptions of their learning environment, in particular, using a qualitative approach to elicit in-depth information. This article aims to contribute to the existing body of knowledge by systematically exploring, critically analysing and getting a deeper understanding of professional doctorate dental students' and graduates' insights into effective and ineffective clinical and physical learning environment characteristics.

METHODS

The study included a total of 20 participants. Participants included 16 final-year Doctor of Clinical Dentistry (DClinDent) students and four dental specialists (graduates of the DClinDent programme). Semi-structured, individual interviews were used. Participants were asked to reflect upon and describe in detail their effective and ineffective learning environment experiences. The critical incident technique was used to guide the data collection. Data were analysed using a general inductive qualitative approach.

RESULTS

Learning environment characteristics which participants associated with effective learning included the following: sufficient opportunities for comprehensive treatment planning; introduction to a number of patient treatment philosophies; a sufficient number of complex cases; clinically oriented research and assignment topics; a focus on clinical training in the programme generally; a research topic of a realistic depth and breadth, suitable for their 'specialist training' degree; and a well-resourced and updated physical infrastructure. On the other hand, most participants indicated that the absence of an adequate number of clinical cases, an overemphasis on research (as opposed to clinical practice) in the DClinDent programme and an 'outdated' physical infrastructure in the dental school clinics could hamper effective clinical learning.

CONCLUSION

These findings contribute to the meaningful advancement of the literature on learning environment strategies through the exploration of (and in-depth qualitative insights into) what facilitated effective learning by New Zealand professional doctorate candidates and graduates. These findings provide a starting point for reflection by international academic directors, educational developers, curriculum planners, programme managers and clinical teachers in respect of the further development of the learning environment. Although the findings from this study may not be directly transferable to all international contexts, they have the potential to contribute to the further development of theory in this area.

Can performance on summative evaluation of wax-added dental anatomy projects be better predicted from the combination of supervised and unsupervised practice than from supervised practice alone?

PURPOSE

The study explored the effects of adding student-directed projects in pre-clinical dental anatomy laboratory on improving the predictability of students' eventual performance on summative evaluation exercises, given the presence of intervening faculty-controlled, in-class practice.

METHOD

All students from four consecutive classes (n = 555) completed wax-added home projects (HP), spending as much or as little time as desired and receiving no faculty feedback; followed by similar laboratory projects (LP) with time limits and feedback; and then summative practical projects (PP) in a timed format but without faculty feedback. Path analysis was used to assess if the student-directed HP had any effect over and above the laboratory projects.

RESULTS

Average scores were HP = 0.785 (SD = 0.089); LP = 0.736 (SD = 0.092); and PP = 0.743 (SD = 0.108). Path analysis was applied to show the effects of including a student-controlled home practice exercise on summative exercise performance. HP contributed 57% direct effect and 37% mediated effect through the LP condition.

CONCLUSION

Student-directed home practice provided a measureable improvement in ability to predict eventual performance in summative test cases over and above the predictive contribution of intervening faculty-controlled practice conditions.

Quality of supervision: postgraduate dental research trainees' perspectives

INTRODUCTION

Supervision is a pillar in enhancing the student's learning environment throughout her/his higher education. Multiple studies qualify graduate supervision among the most important contributors to the successful completion of a higher education degree and to graduate students' positive academic experience. The aim of this study was to assess the views of graduate students enrolled in the Dental Sciences and Craniofacial Research Graduate Programs at McGill University (n = 64) regarding the quality of supervision they are receiving.

METHODS AND MATERIALS

An online questionnaire composed of 22 open and closed-ended format items was used and covered five domains: student profile, supervisory relationship, conflict resolution, student progress/thesis writing and career development. Descriptive statistics, chi-square tests and interpretative qualitative analysis were used to evaluate students' perspectives.

RESULTS

Fifty-nine students completed the survey (92.2%). The distribution of sample in regard to the graduate student level was almost identical (M.Sc. level n = 28, Ph.D. n = 31). Overall, most graduate students appeared satisfied with the supervision they received and had similar perspectives about the surveyed domains. There was one statistically significant difference (P < 0.05) between MSc and PhD students when asked if their supervisors aided them in career development outside the supervisory relationship, where 77.4% (n = 24) of doctoral students agreed as opposed to 21.4% (n = 12) of Masters' students.

CONCLUSIONS

Our results showed that McGill graduate students appeared to be overall satisfied with the supervision they received. The main elements contributing to a positive supervision experience were support, guidance, availability and good communication between supervisees and supervisors.

Using discussion groups as a strategy for postgraduate implant dentistry students to reflect

INTRODUCTION

More than undergraduates, postgraduate students have the day-to-day clinical experience to reflect upon. Nevertheless, reflection in postgraduate dental education is less well studied. Hence, the purpose was to investigate the attitude towards reflection and the content of reflections in postgraduate implant dentistry education in the UK and Belgium.

MATERIALS AND METHODS

To investigate the attitude towards reflection, a questionnaire was administered to the 10 postgraduates at UCL Eastman Dental Institute (EDI) and 6 postgraduates at Ghent University (UGent). Additionally, students were invited to attend two reflective sessions (60-90 minutes). The sessions' audio recordings were transcribed and analysed using a thematic approach.

RESULTS

In total, 16 postgraduate implant dentistry students participated. Although the majority reported prior experience with reflection, there was variation in the provided definitions of reflection. EDI students agreed with reflection being beneficial for professional development/clinical reasoning and were positive about discussing clinical experiences in groups, but were divided about individual/group reflections. Their UGent counterparts were more indecisive (=neutral), but were positive about discussing clinical experiences. Thematic analysis identified recurring themes as individual learning process, learning and clinical experiences, attitude towards implant dentistry and course programme. EDI postgraduates' reflections focussed on specific clinical situations, while UGent postgraduates' reflections described general considerations.

CONCLUSION

Although students/professionals often report to reflect, it is not clear whether/how they actually reflect, due to the all-purpose word reflection has become. A strategy, using group discussions along with supervision/guidance in how to reflect, demonstrated to expand clinical reasoning into reflections about postgraduate students' clinical actions and professional growth.

Faculty development for clinical teachers in dental education

Dental education has been reviewed, and suggestions for further enhancement include the implementation of faculty development activities to enhance teaching and learning environments.

PURPOSE

The aim of this study was to gain insight into the participants' perceptions of outcomes of faculty development for clinical teachers and clinical learning environments as well as into the sustainability of such outcomes.

METHODS

The program was organized in the form of (i) a 2-day seminar; (ii) collegial supervision and development projects; and (iii) a 1-day follow-up seminar. The participants' perceptions from the five-first programs were studied. A Web-based questionnaire was sent to all participants, that is 3-27 months after completion of the program (follow-up survey).

RESULTS

The outcomes of the program (response rate 70%) indicate a strong impact of the program on the clinical teachers' competence and on the clinical learning environments. The teachers report that they think more about what their students really learn, have become more conscious about how they supervise and have been stimulated to become better teachers. The learning environment as well as collaboration, and calibration between teachers have improved. The novice teachers report greater benefits than do the experienced teachers. The participants initiated a variety of development projects during the program. The majority of the participants continued the development activities.

CONCLUSIONS

The faculty development program presented confirms that faculty development activities for clinical teachers based on theories of learning and experiences documented in the literature can be implemented with positive outcomes for individual teachers and for the learning environments.

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.

Developing implant dentistry education in Europe: the continuum from undergraduate to postgraduate education and continuing professional development

INTRODUCTION

Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways.

METHODS

A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development.

RESULTS

The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper.

CONCLUSIONS

Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes.

Contemporary undergraduate implant dentistry education: a systematic review

INTRODUCTION

Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competence in implant dentistry, including basic competences in diagnostics, treatment planning, restorative, straightforward surgical and maintenance procedures. In response, undergraduate curricula need to integrate implant dentistry. This narrative review explores educational programmes in terms of competences, related research and barriers or reflections, regarding implementation in undergraduate curricula.

MATERIALS AND METHODS

Publications (2008-2013) were searched systematically in WoS, PubMed and ERIC and screened independently by two authors in four stages: removal of duplicates, title screening, abstract screening and full-text reading. Inclusion criteria encompassed implant dentistry in undergraduate education.

RESULTS

Finally, 37 of 420 papers were included. Detailed information regarding programme content, number of participants, staff input, logistics/funding issues is scattered. Theoretical education is predominant, and pre-clinical/clinical training is offered minimally, often carried out in elective programmes. However, selected straightforward cases treated by undergraduates yield positive outcomes with low failure rates, few complications, high patient satisfaction and student appreciation. Barriers to implementing implant dentistry in the undergraduate curriculum include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experience-based implant education affects future practice as well-informed students propose more restorative alternatives to their patients.

CONCLUSION

Although implant dentistry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience-based education. To support further advancement, universities should report comprehensively on their implant programmes to allow comparison and reproduction in other environments.