Determining Recommendations for Improvement of Communication Skills Training in Dental Education: A Scoping Review

Assessment of the Satisfaction of Patients Treated by Undergraduate Dental Students at a Saudi Government University: A Cross Sectional Study

Purpose

The long-term success of any organization is highly dependent on client satisfaction. This applies to the medical and dental fields, where patient satisfaction is considered an indirect indicator of the quality of service provided. This study aimed to assess the level of satisfaction of patients treated by final-year undergraduate students at King Abdulaziz University Dental Hospital (KAUDH).

Patients and Methods

In this cross-sectional study, an online questionnaire was distributed to patients (aged ≥14 years) treated at KAUDH by sixth year students during the academic year 2020/2021. The questionnaire comprised 36 items, including demographic and general data, type of dental problems, type of dental treatment received, and satisfaction assessment based on the Dental Satisfaction Questionnaire. Data were analyzed using one-way ANOVA and independent sample t-tests (α=0.05).

Results

A total of 203 responses were received (58% response rate). The reliability of the satisfaction tool (Cronbach's alpha) was 0.88, indicating a high reliability. The overall satisfaction level was 80.1% (±14.2). The satisfaction levels related to pain management, quality of care, and access to care were 76.4% (±19.9), 86.2% (±17.1), and 77.5% (±16.5) respectively. The highest satisfaction level (91.5%) was related to the quality item "The student was always treating me with respect". Age, number of visits, length of treatment, case severity, and treatment complexity were not significantly correlated with patient satisfaction (p ≥ 0.116). New patients who had their files directly opened by a sixth-year student and were treated immediately were more satisfied than patients who already had files at KAUDH and were referred to sixth-year students for treatment (p=0.029).

Conclusion

Patients treated by final-year students at KAUDH showed high satisfaction levels in relation to pain management, treatment quality, and access. However, the satisfaction of existing old patients was lower than that of new patients, which warrants further assessment, particularly regarding the hospital referral system.

Implementation of a communication curriculum in undergraduate dental education-students' opinions during a 5-year development phase

INTRODUCTION

Communication training has become an essential part of the dental curriculum. The aim of this study was to evaluate the communication curriculum developed and introduced 2016-2021 at the University of Bern, School of Dental Medicine (SDM), Switzerland.

MATERIALS AND METHODS

The curriculum was implemented cumulatively in three phases: (1) lectures and accompanying role plays, (2) forum theatre and trainer-based communication training and (3) self-assessment. Students were surveyed 2016-2021 at the end of each semester using anonymous online questionnaires with five-point Likert scales (0-4).

RESULTS

A total of 191 fourth- and fifth-year students were surveyed, and 165 (86.4%) questionnaires were analysed. The mean age of the participants was 24.2 ± 1.4 and 45.5% were female. While students' opinions about the need to communicate increased during weekly lectures in phase 1, their opinions about their ability to communicate simultaneously decreased. During phase 2, fourth-year students' opinions on the need to communicate with dental patients increased from 3.22 ± 0.61 to 3.73 ± 0.45 (p = .001), anticipated benefits for dentists increased from 2.78 ± 0.71 to 3.43 ± 0.57 (p = .001) and for patients from 3.00 ± 0.76 to 3.47 ± 0.63 (p = .022). Only in phase 3, opinions on the ability to communicate statistically significantly increased for both fourth- (2.34 ± 0.71 to 2.72 ± 0.60, p = .033) and fifth-year (2.20 ± 0.63 to 2.86 ± 0.59, p = .001) students. Preferred teaching and assessment methods were trainer-based communication trainings (73.1%), lectures (67.3%) and self-assessments in the student clinic (59.6%).

CONCLUSION

Communication curricula in dental education using methods such as lectures and trainer-based communication trainings may additionally need to include self-assessments to be effective from the students' perspective.

Patient-dental student provider communication in an academic dental clinic setting: A dyadic data analysis

PURPOSE

Patient-dentist communication is an inherently dyadic social process; however, it is rarely regarded as such in research and pedagogy. This study utilizes a dyadic data analysis approach to study patient-dental student provider communication in an academic dental clinic.

PROCEDURES

Using pairwise data collected from patient-dental student provider dyads, we conducted unadjusted and adjusted actor-partner interdependence models to examine the association of intrapersonal (actor) and interpersonal (partner) effects of three communication skills on the assessment of appointment interaction among patient-dental student provider dyads in a pre-doctoral comprehensive care academic dental clinic setting.

MAIN FINDINGS

Actor effects were most evident among the associations in the study. Dental student providers' assessment of their own shared decision-making predicted positive changes in their overall interaction assessment in both unadjusted and fully adjusted models. Patients' ratings of their dental student provider's capability/confidence predicted positive changes in their overall interaction assessment in both unadjusted and adjusted models.

CONCLUSIONS

This study suggests that dental students and their patients are primarily impacted by actor perspectives regarding dental student communication and its impact on the assessment of their respective overall appointment interaction. Findings suggest a need for the incorporation of interpersonal skill building in collaboration with patients to strengthen the communication skills and practice of dental students.

Experiences of newly qualified dentists in delivering oral health advice to parents/caregivers of young children-challenges and solutions

Introduction

A key skill for dental professionals to master is their ability to have effective preventive oral health conversations. On qualifying, UK dentists undertake a one-year foundation training programme in general practice. This study explored with Foundation Dentists, the barriers and facilitators to undertaking oral health conversations with parents/caregivers and their children, aged 0-11 years old.

Materials and methods

Approximately 100 Foundation Dentists from the Yorkshire and Humber region attended a series of focus groups. They discussed how they and their wider dental team undertake oral health conversations with parents/caregivers of young children, aged 0-11 years old. The data was analysed using thematic analysis.

Results

Five themes were identified as barriers and facilitators to providing oral health advice: (1) Lack of knowledge around parenting skills and child development; (2) Parental receptivity; (3) Motivation for changing behaviours; (4) Information content and inconsistency; and (5) Current National Health Service (NHS) structures of general dental practice.

Discussion

A multi-faceted approach is needed to develop the training of Foundation Dentists to undertake preventive oral health conversations with parents/caregivers and children. Such an approach has the potential to improve the patient-practitioner relationship and increase effective behaviour change conversations taking place in general dental care, thus improving children's oral health.

Implementation of game-based training in oral rehabilitation of edentulous patients in an undergraduate dental course

BACKGROUND

Coronavirus disease-19 dramatically changed the learning conditions of dental students, with restricted access to training sessions and clinical practice. The "Playdent" project proposed the integration of serious games (SGs) in the third-year curriculum, based on tailor-made scenarios questioning the first dental visit of edentulous patients, and examined whether training with the games would advance students' learning outcomes.

MATERIALS AND METHODS

Test scores of 89 students, allocated either to a "test" group that accessed SGs during a 4-week test period in addition to conventional lectures or to a "control" group that benefited solely from conventional lectures, were measured before and immediately after the test period. The subsequent satisfaction of students was assessed in the "test" group.

RESULTS

Scores obtained after the 4-week period significantly increased within the "test" group (11.1% ± 24.9%, p = 0.04, degree of freedom [df] = 30) while they did not change within the "control" group (p = 0.21, df = 57). Qualitative feedback expressed by students who played SGs during the 4-week period demonstrated that 71% of them rated the SGs as satisfactory and 91% of them judged the consistency of SGs content with lectures to be satisfactory.

CONCLUSION

Game-based learning showed a positive impact on the learning outcomes of third-year students. Qualitative assessments provide insights into the pertinence of SGs offered in addition to traditional lectures of third-year complete denture courses. SGs may consolidate skills in oral rehabilitation acquired through traditional passive learning formats proposed in preclinical courses.

Comparison of Digital Interactive Case-Based Educational Resource with Virtual Role Play in Dental Undergraduates in Clinical Oral Medicine/Oral Pathology Education

Case-based learning has always been a key element of dental education and the incorporation of technology into the concept became increasingly important during the COVID-19 pandemic. This study aimed to compare the effectiveness of a virtual interactive case resource in oral medicine/oral pathology, Virtual Oral Medicine Clinic (VOMC), with the virtual role play among third-year dental undergraduates. Fifty-one students were randomly assigned into two groups and the control group was subjected to a role play activity, whereas the experimental group was provided with VOMC. Both groups were assessed with an objective structured clinical examination (OSCE) before and after the intervention. Students’ self-perceived usefulness of the interventions was evaluated by a questionnaire and randomly selected students were invited for focus group discussions. Data were analysed using the Wilcoxon signed-rank test and the Mann−Whitney U test. Descriptive statistics were used to analyse student responses. Students in both groups demonstrated significant improvement (p < 0.001) in the post-test compared to the pre-test. Students in the experimental group demonstrated higher overall scores (p < 0.001) when compared to the control group. Though both methods were received favourably by the students, role play was more positively perceived when compared to digital resource. Though VOMC was shown to improve student scores, the perception of VOMC was not quantitatively superior to the role play activity. Hence VOMC can be recommended as an adjunct tool to enhance learning in oral medicine in undergraduate dental students.

Design of a communication skills course in dentistry: Applying active-learning strategies to improve educational outcomes

PURPOSE/OBJECTIVE

Effective communication, between patient and dentist, is a core clinical skill that commands dedicated pedagogy similar to that of developing scientific knowledge and psychomotor skills. This study aimed to describe active-learning strategies in a dental communication skills course, which sits within a broader foundation dental course and evaluate students' educational outcomes.

METHODS

This is a two-phase retrospective, mono-centred study, completed in 2019 at an Australian dental school. Phase I, a case report, describes the Communication Skills for Oral Health (CSOH) course design and its active-learning strategies. Phase II analysed data from the course using Kirkpatrick's evaluation model to objectively measure the impact of the course and provide feedback to education designer. Students' perception (Level 1) was evaluated with an institutional, validated online survey. Descriptive and statistical analysis, included paired tests and Spearman's correlation analyses, used to investigate learning effect (Level 2) and student behaviour change (Level 3). To assess the impact of the CSOH course design (Level 4) the student grades from the course were analysed.

RESULTS

The CSOH course encompasses three major topics: Essentials of Communication Skills, Professional-Patient Relationship and Managing Difficult Situations. Each topic included didactic content complimented with a variety of active-learning strategies to teach and assess students. Positive outcomes were recorded across all Kirkpatrick levels.

CONCLUSIONS

This study suggests an efficient communication skills course design, which may assist in the development of communication skills courses in other dental education institutions.

Professionalism in the dental practice: perspectives from members of the public, dentists and dental care professionals

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups.

Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council.

Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism.

Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes.

Highlights the importance of communication skills as a core element of professionalism education.

Suggests that education about team working could foster a more collaborative approach to maintaining professionalism within the dental practice.

Recognises that lapses in professionalism can occur and should be reflected upon as part of ongoing learning.

Maximizing Student Clinical Communication Skills in Dental Education—A Narrative Review

Dental student training in clinical communication skills and behavioral aspects of treatment are lauded as clinically meaningful in the dental education literature. However, many dental school curricula still only provide didactic, one-time coursework with multiple choice examination assessment and little or no student skill-activating activities. This article aims to review literature relevant to optimizing clinical communication and behavioral skills in dental education. The review summarizes findings of several relevant reviews and usable models to focus on four themes: (1) special characteristics of dentistry relevant to communication skill needs, (2) essential components of dental student learning of communications skills, (3) clinical consultation guides or styles and (4) optimal curricular structure for communication learning effectiveness. Contexts of communications in the dental chair differ from medical and other allied health professions, given the current mostly dentist-dominant and patient-passive relationships. Patient-centered communication should be trained. Dental students need more practical learning in active listening and patient-centered skills including using role-play, videotaping and ultimately, real patient training. Medical consultation guides are often unwieldy and impractical in many dental contexts, so a shortened guide is proposed. Communication skills need to be learned and taught with the same rigor as other core dental skills over the entire course of the dental curriculum.

A video- and feedback-based approach to teaching communication skills in undergraduate clinical dental education: The student perspective

OBJECTIVE

Student evaluation of a communication-education programme that combined patient consultation videos with peer- or expert-based feedback.

METHODS

A self-perception questionnaire was given to undergraduate dental students who had undertaken a curricular communication training and feedback programme, in which each participant was videoed three times during a patient interview or consultation, subsequently receiving either peer (PG) or expert feedback (EG). The questionnaire used feedback programme content to evaluate student perspectives, ascertaining whether the students experienced a gain in knowledge and professional conversational skills, whether videos or feedback helped them improve more and general questions about the structure and content of the curriculum. Differences between feedback groups were analysed (Mann-Whitney U test).

RESULTS

45 participants (peer group: n = 23, expert group: n = 22) took part in the study. The peer group experienced watching their video (38%) and receiving feedback (33%) as their major beneficial aspect to improve communication skills (watching fellow student´s video: 17%, providing feedback: 12%). The expert group experienced the major effect in receiving expert feedback (73%, video watching: 27%). The students said that communication skills should be a core competency in dental education learning outcomes (PG: 4.48 ± 0.67, EG: 4.41 ± 0.67; P > 0.05) and that communication curricula should include video-based feedback (PG: 3.91 ± 0.73, EG: 4.00 ± 0.93; P > 0.05).

CONCLUSION

Watching videos and both receiving and providing peer group feedback were experienced as helpful in improving students' communication skills. These findings suggest that a longitudinal communication curriculum, which includes both video-based peer feedback and correlated self-reflection, is a promising learning approach for dental education.

Longitudinal Curricular Assessment of Knowledge and Awareness of Intimate Partner Violence among First-Year Dental Students

BACKGROUND

Intimate partner violence (IPV) has previously been recognized as a major public health issue. Oral healthcare providers, such as dentists, are crucial to the screening and identifying of individuals experiencing IPV, since most injuries occur in the head and neck region. A lack of knowledge and awareness regarding teaching and learning about IPV in dental school curricula has been identified. Based upon the overall lack of knowledge, the objective of this study was to conduct a longitudinal assessment of knowledge, awareness, and beliefs regarding IPV among dental students in their first year of education.

METHODS

All students (n = 245) from three consecutive, first-year dental student cohorts (n = 81, n = 82, n = 82) were provided a brief and voluntary in-class survey in conjunction with an instructional workshop. The survey included questions designed to ascertain knowledge, awareness, and beliefs regarding IPV as a healthcare and dental issue before and after the instructional session. Differences in responses to the questions before and after the IPV educational workshop were measured using paired t-tests.

RESULTS

A total of n = 232 completed pre- and post-responses were received from all three first-year dental student cohorts (n = 76, n = 80, n = 76), representing an overall 94.6% response rate. Analysis of these data showed that the student population was predominantly male and white (non-minority), aged in their mid- to late twenties, with most students reporting no previous IPV education. The few students reporting previous IPV education were mainly younger (<25 years), which may represent more recent endeavors to increase awareness of IPV among students currently attending colleges and universities.

CONCLUSIONS

The results of this study may suggest that information-specific seminars within the curriculum might be adequate to provide dental students with awareness and knowledge of IPV and specific information regarding local resources and referrals for any patients experiencing IPV.

Simulation-based education for selected communication skills: exploring the perception of post-graduate dental students

PURPOSE

The role of simulation-based education (SBE) in enhancing communication has been established in the literature. To ensure achieving desired outcomes from SBE initiative, the individual learners, their experiences, and environments need to be considered. This study aimed at exploring the perception of post-graduate dental students regarding their participation in SBE sessions, around selected communication skills, designed in alignment with the assumptions of adult learning theory and steps of Kolb's experiential learning cycle.

METHODS

This study utilized a qualitative design. Six focus-group sessions were conducted following the SBE sessions. The generated data was inductively investigated using a multi-staged participant-focused approach to thematic analysis, based upon constructivist epistemology. NVivo was utilized to facilitate text Fragments' coding and categorization.

RESULTS

Forty-three post-graduate dental students participated. The analysis resulted in 16 categories spread across five sequential phases of the SBE experience. The "input" theme referred to the resources needed for the SBE process, and included three categories: facilities, personnel, and teaching materials. The second theme included steps of SBE "process": pre-brief, simulation, and debrief. The third, fourth, and fifth themes constituted the short- and longer-term results of the SBE intervention. The participants reported instant benefits on confidence in their expertise in communicating with patients and their guardians. Additionally, perceived effects on the empathy and professionalism were reported.

CONCLUSION

SBE, that is based upon adult and experiential learning theories, and developed after thorough consideration of the individual learners, and their experiences and learning environments, holds potential in enhancing communication skills among post-graduate dental students.

Just say "no": Can dentists refuse care on the basis of finances? A survey using an ethical vignette in an Iranian Dental School

Background

Decision making when patients ask a dentist for fee reduction is a real ethical dilemma at dental settings. The aim of this study was to evaluate how dental students and tutors think about their position for, or against fee reduction at dental offices.

Method

It was a questionnaire-based survey, which examined the ethical attitudes of students and tutors of an Iranian Dental School. The questionnaire included a vignette about an ethical dilemma at a dental office. Different ethical approaches, i.e. duty-based, virtue-oriented and consequentialist arguments, for or against fee reduction at dental office were suggested. Respondents were asked to rank those ethical options. Data was entered and analyzed in SPSS 16.0.

Result

121 dental students and thirty-six faculty members (dental specialists) participated in this study. It revealed that a majority of dental students and tutors (68%) are in favor of charging patients less, when facing an imagined request at dental office, using either virtue-oriented (54%) or consequentialist (14%) argument for fee reduction. The difference between rankings of four options was statistically significant, while no statistically significant difference exists neither between male and female respondents, nor students and tutors.

Conclusion

This case study provides a basis for fruitful discussions in ethics courses for dental students. Our study suggests that financial issues should be considered as a part of ethical training within the dental student's curriculum.

Clinical Communication Skills Training in Dental Medical Education: The COVID-19 Pandemic Challenge

It is very important for healthcare professionals to have good clinical communication skills, especially dentists. Patient-centred care results in patient satisfaction, better outcomes, and less complaints from dental patients. Due to the onset of the COVID-19 pandemic, the clinical communications skills programme of the pre-graduate course in dental medicine at the University of Porto had to be transformed to an online format. Based on their role as faculty, the authors aimed to recount their initial reflections and concerns within this perspective, and to share how they adapted to the new reality of teaching clinical communication skills online, as well as the conclusions of our experience, in the hope that this will help others who may have to go through a similar process. The authors acknowledged that the students achieved the pre-established goals of the clinical communications skills programme through the new online format.

Effects of anxiety on dental students' noncognitive performance in their first objective structured clinical examination

Patient-dentist discourse is a core nonoperational competency in dental education. The skills of querying patients and responding to questions are noncognitive attributes, and their evaluation by the standardized patient objective structured clinical examination (OSCE) is particularly necessary. However, it is not clear whether students' test anxiety affects these attributes. This study aims to examine the relationship between dental students' state-trait anxiety, noncognitive performance, and examination results during their first OSCE. A single dental school cohort (n = 226) of 5 year students attending their first clinical examination from 2014 to 2017 was studied. Participants completed the Chinese Mandarin Version State-Trait Anxiety Inventory Y form before taking the OSCE. The difference between state and trait anxiety levels was compared by paired t test. Gender differences and the effect of age group in these anxiety levels were analyzed using multivariate analysis of variance. Moreover, gender, age group, state anxiety, and trait anxiety scores were compared with the OSCE items of noncognitive performance using a chi-square test. Students showed significantly higher state anxiety than trait anxiety levels; moreover, women showed significantly higher state anxiety than men. Furthermore, gender, age group, state anxiety, and trait anxiety had no association with the noncognitive performance examination results. Most participants showed moderate state and trait anxiety levels during their first OSCE. Further, the state-trait anxiety had no significant effect on their noncognitive performance. However, 26.5% of participants did not pass the examination; therefore, dental educators should increase communication skill training courses during clerkship training to improve students' noncognitive attributes.

Differences in Emotional and Pain-Related Language in Tweets About Dentists and Medical Doctors: Text Analysis of Twitter Content

Background

Social media provides people with easy ways to communicate their attitudes and feelings to a wide audience. Many people, unfortunately, have negative associations and feelings about dental treatment due to former painful experiences. Previous research indicates that there might be a pervasive and negative occupational stereotype related to dentists and that this stereotype is expressed in many different venues, including movies and literature.

Objective

This study investigates the language used in relation to dentists and medical doctors on the social media platform Twitter. The purpose is to compare the professions in terms of the use of emotional and pain-related words, which might underlie and reflect the pervasive negative stereotype identified in relation to dentists. We hypothesized that (A) tweets about dentists will have more negative emotion-related words than those about medical doctors and (B) pain-related words occur more frequently in tweets about dentists than in those about medical doctors.

Methods

Twitter content (“tweets”) about dentists and medical doctors was collected using the Twitter application program interface 140Dev over a 4-week period in 2015, scanning the search terms “dentist” and “doctor”. Word content of the selected tweets was analyzed using Linguistic Inquiry and Word Count software. The research hypotheses were investigated using nonparametric Wilcoxon-Mann-Whitney tests.

Results

Over 2.3 million tweets were collected in total, of which about one-third contained the word “dentist” and about two-thirds contained the word “doctor.” Hypothesis A was supported since a higher proportion of negative words was used in tweets about dentists than in those about medical doctors (z=−10.47; P<.001). Similarly, tests showed a difference in the proportions of anger words (z=−12.54; P<.001), anxiety words (z=−6.96; P<.001), and sadness words (z=−9.58; P<.001), with higher proportions of these words in tweets about dentists than in those about doctors. Also, Hypothesis B was supported since a higher proportion of pain-related words was used in tweets about dentists than in those about doctors (z=−8.02; P<.001).

Conclusions

The results from this study suggest that stereotypes regarding dentists and dental treatment are spread through social media such as Twitter and that social media also might represent an avenue for improving messaging and disseminating more positive attitudes toward dentists and dental treatment.