Women in dental education and their desire to lead: A follow-up

The aim of this study was to provide a follow-up to the 2015 national survey of women in dental education to re-examine factors and perceived barriers to pursuing administrative and leadership roles. At the beginning of 2023, a survey was administered to full-time women faculty in predoctoral dental programs in the United States. The survey instrument employed a structured format along with open-ended questions to capture qualitative data. The overall response rate was 26% (527/1994) and included respondents from fifty-five of the sixty-seven dental schools contacted. Half of respondents indicated holding an administrative position and 20% reported administration as their primary appointment. There was a significant increase in the number of women holding a leadership role in 2023 (76%) compared to 2015 (53%). Those seeking a leadership position in 2023 were less likely to have participated in leadership training (p<0.01) and less likely to have previously sought an administrative position (p>0.01). Women in leadership and administrative roles were more likely to indicate receiving extra compensation for administrative duties (p<0.01) and a desire for higher rank (p = 0.04) compared to 2015, but perceptions persist among the majority of respondents (71%) that women are not being compensated equally to their male counterparts. Respondents highlighted the negative impact of the COVID-19 pandemic on career advancement and the positive culture changes that have contributed to greater workplace flexibility. Overall, respondents sent a resounding message that women in dental education need structural change to achieve success: pay equity, mentorship, and inclusive and supportive work environments.

Dental hygiene and direct access to care: Past and present

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider-patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be 'deployed' outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.

Dental Hygiene and Direct Access to Care: Past and present

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist, and maintain a provider-patient relationship. In 2000 there were nine direct access states; currently there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships which have influenced and advocated for direct access and the recognition of dental hygienists as primary health care providers. The National Governors Association (NGA) released a report in 2014 suggesting that dental hygienists be "deployed" outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies, and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential health care providers, prepared to deliver direct access to dental hygiene care.

Person-Centered Care in Dental Hygiene Education: Incorporation and evaluation of person-centered care in the curriculum

Purpose Patient and person-centered care are often used interchangeably. The abbreviation PCC is used in this paper in instances where patient/person centered care reflects the definition of person-centeredness. The purpose of this study was to assess how PCC is taught and evaluated in entry-level dental hygiene education programs to prepare graduates for future collaborations with oher health care pprofessionals in a wide range of practice settings.Methods A cross-sectional study was conducted using a 10-item survey emailed to directors of 325 accredited, entry-level dental hygiene education programs in the United States in December 2021. Descriptive statistics were calculated for all variables. Associations with curriculum settings, teaching, and evaluation methods for PCC, according to program degrees granted, were tested with Chi-square and Fisher's Exact tests.Results The response rate was 23% (n=75). Seventy percent offered an associate degree (AS) and 29% offered a baccalareate degree (BS); 42% reported more than half of their curriculum is allocated to teaching PCC. Didactic lectures (100%), case presentations (97%), and clinical instruction (97%) were the most common methods used for teaching PCC. Baccalaureate programs used external rotations more than associate programs for teaching and evaluation of PCC (84.2% vs. 45.5%; p<0.01). The most common PCC terms used in Quality Assurance Plans included providing individualized care (99%) and delivering evidence-based care (91%). Ninety-three percent strongly agree-agree that teaching PCC prepares graduates for working in different settings (e.g., schools, nursing homes, etc.), and 82% strongly agree-agree that PCC prepares graduates to work with a variety of providers.Conclusion The allocation of curricula time for PCC varied widely across respondents. Conversely, the majority felt their graduates were well-prepared to work in different settings where both PCC and IPP are likely to be practiced. This study serves as a baseline for further analysis of how dental hygiene education is preparing graduates for future practice settings.

Reliability of a grading rubric designed to evaluate the reflective ability of predoctoral dental students

INTRODUCTION

Reflection and self-assessment are critical skills for healthcare providers. Identification of gaps in knowledge, skills and attitudes, along with the ability to critically think and problem solve to fill gaps, is the ultimate outcome for lifelong learning. The aims of this study were to (a) refine an instrument used for measuring reflective ability, and conduct comprehensive reliability testing, and (b) describe a process for rater calibration.

MATERIALS AND METHODS

Students develop e-portfolios over a four-year span with assignments that require reflection and self-assessment. The final piece of the portfolio includes a global reflection written the last semester of the programme. Three faculty raters independently evaluated 106 dental students' global reflections using the revised grading rubric. An intraclass correlation coefficient measured the level of agreement between the three raters.

RESULTS

Analysis of the 318 faculty ratings (106/rater) resulted in an intraclass correlation of .708. Based on a 5-point grading scale (0 = does not respond to the assignment to 5 = reconstructing), the ratings of the 106 global reflections ranged from 1.3 to 5.0 (M = 3.1, SD =0.66).

DISCUSSION

This study provides confidence in the reliability of a grading rubric designed to assess reflective ability, along with suggestions for calibration. An overall mean of 3.1 (Level 3 = relating-includes evidence of lessons learned) illustrates the complexity of teaching reflection and self-assessment.

CONCLUSION

Use of a reliable grading rubric for assessing reflective writing could assist schools interested in incorporating reflection and self-assessment into the curriculum, ultimately supporting lifelong and enhanced health care.

Using learning management software data to compare students' actual and self-reported viewing of video lectures

PURPOSE

Student engagement is typically measured by class attendance and questionnaires. Learning management systems (LMS) provide additional sources of objective data that can evaluate student performance. This study compared dental students' self-report of course video viewing with LMS data.

METHODS

Dental students in a 2018 flipped pediatric dentistry course were given a questionnaire after course completion that captured self-reported course video viewing. Student data and time spent on videos were extracted from the LMS and matched to the questionnaire. McNemar's test evaluated differences between self-reported and matching LMS data.

RESULTS

Of the 109 enrolled students, 99 (91%) completed the questionnaire. Most students self-reported that they watched more than half of the videos (71%), re-watched at least once (89%), and watched at times other than 8 a.m.-5 p.m. (80%). Of the 104 students with data from the LMS, 40% of students watched more than half of the videos, 49% re-watched at least one video, and 60% watched between 8 a.m.-5 p.m. LMS data showed 14 (13%) students did not watch any videos. Significant differences were found between self-reported video viewing and matched LMS video data in (1) percentage of videos watched, (2) number of times videos were re-watched, and (3) most frequent time for watching the videos (p < 0.001 for all).

CONCLUSION

Technology is a tool that helps instructors more accurately track students' study habits compared to observation or self-report. When evaluating time spent watching videos via an LMS, students tend to overestimate the amount of viewing time.

Expert consensus on Didactic Clinical Skills Development for orthodontic curricula

PURPOSE/OBJECTIVE

Competence is expected of each beginning dentist and orthodontist. However, the broad definition of competence presents a challenge to academic programs in identifying the level of cognition for students to achieve competence. This study aimed to determine the Didactic Clinical Skills Development curriculum content and competency in predoctoral and advanced education orthodontic programs.

METHOD

A modified Delphi method with a consensus threshold of 70% was employed using an expert panel of academic orthodontists.

RESULTS

Round One (n = 26) identified that all topics proposed by a focus group were necessary, except for predoctoral Appliances, which was at 65%. Round Two (n = 23) included subtopics of Appliances to confirm the lack of consensus, plus subtopics of all the other topics and the level of cognition required for each subtopic. The expert panel reached a consensus that all 24 subtopics, hence all topics, were necessary. In Round Three, subtopic responses in Round Two were assigned a value between 1 (remember) and 6 (create) to generate a hierarchical level-of-learning scale. Mean values were calculated for each subtopic response. For all subtopics, the mean level of cognition for predoctoral education was at understand; for advanced education, it was at evaluate.

CONCLUSION

This consensus suggests that, to be deemed competent, beginning dentists must learn these topics and subtopics in the cognitive domain of understand, and beginning orthodontists in the cognitive domain of evaluate. This study showed an expert consensus on Didactic Clinical Skills Development orthodontic curriculum content and a panorama of educational objectives that could be used as a template for curriculum design.

Associations of Self-Reported Oral Health Quality of Life with Actual Oral Health Status in Children

Purpose: Quality of life is considered a component of patient centered care. The purpose of this study was to examine the relationship between self-reported oral health related quality of life (OHRQoL) and the actual oral health status of children.Methods: This retrospective cohort study consisted of pediatric dental chart reviews from three clinics. Demographic and dental visit data along with the child's OHRQoL utilizing the Pediatric Oral health-related Quality of Life (POQL) instrument, were collected. Associations with untreated decay, treated decay, or POQL score were tested, using Chi-square, Fisher's exact test, 2-sample t-tests, or ANOVA. Linear regression was used to evaluate the effect of statistical confounders in the relationship between untreated decay and POQL scores. Significance level was set to 0.05.Results: Two hundred ninety-seven out of 336 children had both POQL and caries data. White children and children with untreated decay had significantly more negative POQL scores. Children rating their oral health as "excellent" or "very good" and children with sealants on molars had significantly more positive POQLs. Associations between POQL scores were significant with untreated decay, but not sealants, when considering both variables in the same model. After adjusting for having sealants, POQL scores were on average 7.5 points higher (more negative) in children with untreated decay, than in children without decay (p<0.001).Conclusions: Collecting OHRQoL data allows oral health providers to easily incorporate patient perceptions in their assessment and care and would ensure that all oral health needs of the patients are being met. This is important for children, who may have difficulty expressing their concerns, particularly in clinical environments.

Scholarly Inquiry and Research: An assessment of graduate dental hygiene schools' requirements

Purpose: Scholarly inquiry and research are core competencies for graduate dental hygiene education as defined by American Dental Education Association (ADEA). The purpose of this study was to examine how graduate dental hygiene programs in the United States (US) are meeting these competencies.Methods: The study sample consisted of the graduate programs in the US that award a terminal degree specific to dental hygiene (n=14). Graduate program directors were invited via email to participate in an electronic survey. The survey questions were developed based on the ADEA graduate dental hygiene education competency for scholarly inquiry and research. Descriptive statistics including frequencies and percentages were used to analyze the data. Exploration of relationships between variables were conducted using correlational analyses and t-tests.Results: A response rate of 71% was achieved (n=10). There was a significant difference in the minimum number of scholarly activity requirements between programs with lower student enrollments (M=4.43, SD=1.61) versus those with higher enrollments (M=2.00, SD=0; t(8)=2.51, p=.036). A negative correlation was found between the submission of a manuscript to a peer reviewed journal and the number of students accepted per year in the graduate program (r (10)= -.655, p <.05), indicating that students graduating from programs with larger enrollments were less likely to submit their scholarly work for publication.Conclusions: All program directors reported requiring students to participate in at least one scholarly activity as defined in the ADEA Core Competencies for Graduate Dental Hygiene Education. Program size was the biggest variable in relationship to the number of scholarly requirements. Schools with smaller enrollments required their students to participate in over twice the number of scholarly activities as compared to programs with larger enrollments. More research is needed to evaluate how graduate level dental hygiene programs are meeting the ADEA competencies.

ADEA-ADEE Shaping the Future of Dental Education III: Assessment in competency-based dental education: Ways forward

Assessment in competency-based dental education continues to be a recognized area for growth and development within dental programs around the world. At the joint American Dental Education Association (ADEA) and the Association for Dental Education in Europe (ADEE) 2019 conference, Shaping the Future of Dental Education III, the workshop on assessment was designed to continue the discussion started in 2017 at the ADEA-ADEE Shaping the Future of Dental Education II.¹ The focus of the 2019 conference involved examining the potential of entrustable professional activities (EPAs) and current thinking about workplace-based assessment (WBA) within competency-based education in the 21st century. Approximately 30 years ago, George Miller wrote about the assessment of competence in medical education and challenged faculty to reach for higher levels of assessment than knowledge or skill.² Acknowledging that no one assessment method can result in a valid assessment of competence, Miller proposed a four-level framework for assessment. The lowest level involves measuring what students know ("knows"), followed by assessment of the skill with which knowledge is applied in relevant tasks or problems ("knows how"). Next is an assessment of task performance in standardized settings ("shows how"), and finally, the highest level assesses the student's performance in the unstandardized clinical workplace ("does"). The 2019 assessment workshop focused on advances in the assessment of learners in the unstandardized workplace-the highest level of Miller's assessment pyramid ("does"). Research has shown that dental education has struggled to implement assessment strategies that meet this level.³ The workshop brought together individuals from around the world, with an interest in assessment in dental education, to consider how assessment in the "does" level, specifically EPAs and WBA, factors into competence assessment in dentistry/dental education.

Predoctoral Curricular Revision for Dental Radiographic Interpretation Competence Based on OSCE Results

Teaching radiographic interpretation skills to predoctoral dental students is challenging. The results of an objective structured clinical examination (OSCE) at one U.S. dental school failed to yield expected outcomes for students' radiographic interpretation skills. The purpose of this article is to describe the development of the radiology OSCE and subsequent curricular revisions based on the outcomes. Examples of curricular changes are a series of self-assessed radiographic interpretation cases using the university learning management system. Each case contains a set of four intraoral radiographs and a series of questions. In year 4, an OSCE and final radiographic interpretation competency exam are administered; students are required to pass both exams. OSCE outcomes over a period of six years were used to evaluate the effectiveness of the curricular revisions. A questionnaire developed to capture student perceptions of the curricular changes was administered. The pilot OSCE of 2.9% first attempt pass rates initiated curricular revision. The strongest results to date occurred in 2018 with a 73.3% first attempt pass rate. Results from the questionnaire showed that students reported greater confidence in their interpretation skills when it came to recognizing radiographic errors, dental caries, and periodontal disease/pathologies (65%, 64%, and 57%, respectively). The use of the OSCE for programmatic assessment revealed the need for curricular revision in radiology. Students' participation in the newly revised radiology curriculum resulted in improved student performance and outcomes. This article emphasizes the importance of global and programmatic assessment for assessing student competence along with analysis of how assessment and accompanying data can inform curricular decisions.

Experiences of the Kansas Extended Care Permit Providers: A descriptive study

Purpose: A total of 40 states to date have expanded the role of dental hygienists with the goal of improving access to basic oral health services for underserved populations. In Kansas, legislative changes have resulted in the Extended Care Permit (ECP) designation. The purpose of this study is to describe the experiences of registered dental hygienists in Kansas holding ECP certificates (ECP RDH) as of July of 2014.Methods: Secondary data analysis was performed utilizing data collected from a survey conducted in 2014 by Oral Health Kansas. All registered ECP RDH's were sent the 32-item survey via Survey Monkey®. Descriptive statistical analyses consisted of frequency distributions, and measures of central tendency. Inferential analyses using t-tests and ANOVA were conducted to compare groups.Results: A total of 73 responses were received from the (n= 176) surveys that were e-mailed for a 41% response rate. Of the clinicians who responded, 80%, worked at least part-time and in school settings. The most consistent barriers to providing care were the inability to directly bill insurance (52%), financial sustainability (42%) and physical requirements (42%). Follow-up tests found significant differencs between clinician groups when examining barriers.Conclusion: Although the ECP legislation appears to be expanding access to care for citizens in Kansas, significant barriers still exist in making this a viable model for oral healthcare delivery.

A review of the oral health-related quality of life (OHRQL) model for dental hygiene: Eighteen years later

PURPOSE

The purpose of this paper is to review available evidence to determine the impact of the oral health-related quality of life (OHRQL) Model for Dental Hygiene on education, research, and practice.

METHODS

A search was conducted in PubMed using the search terms oral health-related quality of life, OHRQL, and dental hygiene and limited to publications between 1998 and 2016. Google Scholar was also used to identify citations for the two original OHRQL model papers to capture the literature widely read by practicing dental hygienists but not indexed in PubMed. A total of 40 publications met the predetermined search strategy. Full publications were obtained and reviewed to determine how this research is being used in education, research, and practice.

FINDINGS

The OHRQL is being utilized to a very limited degree in education, research, and practice. The literature shows how the OHRQL is actively being used in the school where the model originated in addition to a dental hygiene programme in Japan. Studies have been conducted on a variety of research instruments, including the OHRQL, designed to capture OHRQL outcomes. Japanese researchers have used the OHRQL in studies designed to determine the impact of oral healthcare delivery on patients' oral health-related quality of life.

CONCLUSION

Eighteen years of the literature confirms that the OHRQL is being used minimally in education, research, and practice. Greater emphasis is needed around the collection and assessment of oral health-related quality of life measures for providing patient-centred care.

Student Preparation for the National Board Dental Hygiene Examination: A national survey of dental hygiene program directors

Purpose: Dental hygiene students nearing completion of their educational programs are required to take written and clinical examinations in order to be eligible for licensure. The written licensure exam, the National Board Dental Hygiene Examination (NBDHE), is administered by the Joint Commission of National Dental Examinations (JCNDE). Failing a licensing examination is a costly experience for students and has the potential for a negative impact on a program's accreditation status. Nursing programs have published extensively on strategies used to prepare students for licensure examinations. However, there appears to be a gap in the literature as to how dental hygiene programs prepare their students to take the NBDHE. The purpose of this study was to conduct a national survey of U.S. dental hygiene program directors to determine what strategies their programs employ to prepare students to take the NBDHE and to explore the viewpoints of dental hygiene program directors regarding student preparation methods for the NBDHE.Methods: An survey instrument was developed, pilot tested, revised and mailed to directors of the 335 CODA accredited U.S. dental hygiene programs. The survey consisted of a combination of response formats including forced choice, multiple allowable answered, and open-ended written comments.Results: A total of 154 surveys were returned, yielding an overall response rate of 45% (154/341). The vast majority of directors (93%) reported they use specific methods and practices to prepare students for the NBDHE. The top two strategies identified were dental hygiene review texts (84%) and a board review course (83%). The majority of directors (84%) reported supporting student participation in non-mandatory, commercial review courses. In regard to mock board exams, directors "agreed/strongly agreed" (75%) that the mock board exam is a useful coaching tool in the overall process of NBDHE preparations. A majority (65%) indicated they were not concerned with failure rates, and 43% reported failure rates do reflect on the program.Conclusion: These results suggest that the majority of dental hygiene programs are utilizing strategies to prepare students for the NBDHE with board review textbooks and board review courses named as the top two strategies.

Program Evaluation of a Distance Master's Degree Dental Hygiene Program: A Program Effectiveness Study

Purpose: The purpose of this study was to conduct a program evaluation of the University of Missouri-Kansas City Master of Science in Dental Hygiene Education Program (MSDH). This evaluation examined long-term outcomes in the context of stakeholders (the profession, the student, and the degree-granting institution).Methods: A mixed-methods approach was used to gather data from the 28 graduates from the MSDH program. An electronic questionnaire included both open- and closed-ended questions including demographic and practice data, and data related to alumni preparedness to reach their career goals. Virtual focus groups provided valuable insight into whether the program has achieved its goals, and prepared the graduates to meet their program competencies and future goals.Results: Out of a total of 28 individuals who have successfully completed the distance program (2001-2011), 19 participated in an online survey (67.8%). The majority of the participants (73.7%) participated in one of 3 focus groups. Sixty-three percent of the graduates are currently employed in dental hygiene education. Eighty-four percent of the respondents have published their research conducted while in the program, thereby contributing to the dental hygiene body of knowledge. Sixty-eight percent indicated that had the distance option not existed, they would not have been able to obtain their advanced degree in dental hygiene. Twenty-one percent of the respondents report either being currently enrolled in a doctoral program, or having completed a doctoral degree.Conclusion: These results suggest that the University of Missouri-Kansas City Master of Science in Dental Hygiene Education Program is meeting its goals from the perspective of all stakeholders and providing its graduates with access to education and educational resources to meet the program competencies and ultimately achieve their career goals.

Which Way to Lean? A National Study of Women Dental Faculty Members' Career Aspirations and Choices

The aim of this first national study of women in academic dentistry was to explore factors and perceived barriers for why administrative/leadership positions were or were not sought via data collected from full-time women dental faculty members in the U.S. In fall 2015, the researchers conducted a survey that employed a combination of response formats: forced choice from a menu, multiple allowable answers, and open-ended written comments. The overall response rate for the survey was 35.6% (537/1504). Respondents were from 48 of the 65 U.S. dental schools. Half of the respondents indicated their primary appointment was in clinical sciences, 22.9% were in administration, 7.3% in research, 7.1% in basic science, and 2.5% in behavioral science. While a quarter of the respondents indicated administration as their primary appointment, over half reported holding administrative positions, and nearly all (92.4%) reported currently holding leadership roles at their institutions. For those not currently in administrative/leadership roles, 52.6% indicated a desire for an administrative role and 70.7% a leadership role. Of those in administrative/leadership roles, 62.1% indicated not receiving extra remuneration for those responsibilities. Half of the respondents perceived that they were paid less in their current position than men doing the same work. The most dominant theme emerging from qualitative analysis of barriers the respondents experienced was the difficulty women in dental education have in a traditionally male-dominated profession. The results confirmed that women faculty members are "leaning in" to seek administrative/leadership roles in academic dentistry. However, pay equity remains an issue, and faculty development and mentoring are needed for the advancement of academic dentistry and ultimately the dental profession.

Flipping the Classroom: Assessment of Strategies to Promote Student-Centered, Self-Directed Learning in a Dental School Course in Pediatric Dentistry

The aim of this study was to explore student and course director experiences with the redesign of a traditional lecture-based course into a flipped classroom for teaching didactic content in pediatric dentistry to second-year dental students. The study assessed student satisfaction, extent of student engagement, overall course grades, and course director satisfaction. The students enrolled in a flipped classroom pediatric dentistry course (spring semester 2014; SP14) were asked to complete pre- and post-course questionnaires to assess their perceptions of active learning, knowledge acquisition, and course satisfaction. The process was repeated with the class enrolled in the same course the following year (SP15). Responses for SP14 and SP15 resulted in an overall response rate of 95% on the pre questionnaire and 84% on the post questionnaire. The results showed that the greatest perceived advantage of the flipped classroom design was the availability and access to online content and course materials. Students reported enhanced learning due to heightened engagement in discussion. The results also showed that students' overall course grades improved and that the course director was satisfied with the experience, particularly after year two. Many calls have been made for educational strategies that encourage critical thinking instead of passive learning environments. This study provides one example of a course redesign and demonstrates the need for both faculty and student development to ensure success when a flipped classroom methodology is introduced.

Feasibility Study for a Satellite Program of an Established School of Dentistry

Creative thinking is required to solve the many challenges the oral health care delivery system faces in meeting the needs of the U.S.

POPULATION

Access to oral health care services varies widely across the country based on a host of factors including individual patient characteristics, demographic variables, and distribution of professionals by locale. There is also significant variability of need, so that many new solutions have been proposed to meet the needs of specific areas. In late 2012, the University of Missouri-Kansas City School of Dentistry embarked on a feasibility study to determine whether its existing DDS program could be extended closer to underserved areas of Missouri and surrounding regions by utilizing distance education and a clinical training facility in conjunction with another public university. This article describes the study and its outcomes. Other institutions may find this process useful as they assess factors that could impact the success of future programming and seek new solutions to long-standing problems.

Using Twitter for Teaching and Learning in an Oral and Maxillofacial Radiology Course

The aim of this study was to describe the implementation of one form of social media (Twitter) in an oral radiology course and evaluate dental students' use and perceptions of this technology for teaching and learning. An author-developed questionnaire was used to solicit second-year students' knowledge, use, and perceptions of Twitter for teaching and learning in an oral radiology course at one U.S. dental school. A combination of Likert scales, multiple allowable answers, and an open-ended comment question was employed. The questionnaire was piloted in spring 2010 followed by data collection in spring 2011. Out of 45 students, 40 (88.9%) completed the questionnaire. Of the respondents, 95% reported having not used Twitter prior to their second year of dental school; 55% of them created an account for the course. The top two reasons they gave for creating an account were viewing radiographic examples and staying informed about questions and answers that were posted. The top two reasons they gave for not creating an account were that the content was viewable online without an account and not wanting another online account. The students perceived the Twitter sessions as helpful and reported it improved accessibility to the instructor. The results of this study challenged the assumption that dental students are well versed in all forms of social media, but overall, these students agreed that the use of Twitter had enhanced the learning environment in the radiology course.

Self-Assessment: A Review of the Literature and Pedagogical Strategies for Its Promotion in Dental Education

In response to several publications drawing attention to self-assessment and revised Commission on Dental Accreditation standards that state graduates should possess and demonstrate the ability to self-assess, dental hygiene and pre-doctoral dental programs find themselves searching for ways in which to incorporate self-assessment practices into the curriculum. Research indicates that students are often not familiar with self-assessment strategies nor are they effective at self-assessment upon entering professional programs. Therefore, students must be taught strategies to self-assess and be given opportunities to practice and refine these skills. Opportunities to develop and demonstrate self-assessment skills can be incorporated across the curriculum at the classroom level and at the global level. Both the A.T. Still University Arizona School of Dentistry and Oral Health and the University of Missouri-Kansas City School of Dentistry utilize a capstone portfolio project to incorporate self-assessment throughout the curriculum. By combining artifacts from their dental and dental hygiene school experience with reflective writing essays, students can demonstrate attainment of program competencies. As more faculty members and students become involved and engaged in assessment strategies such as portfolios, they are also gaining a greater appreciation for the value of self-assessment.

Use of an Analytical Grading Rubric for Self-Assessment: A Pilot Study for a Periodontal Oral Competency Examination in Predoctoral Dental Education

While educators agree that using self-assessment in education is valuable, a major challenge is the poor agreement often found between faculty assessment and student self-assessment. The aim of this study was to determine if use of a predefined grading rubric would improve reliability between faculty and dental student assessment on a periodontal oral competency examination. Faculty members used the grading rubric to assess students' performance on the exam. Immediately after taking the exam, students used the same rubric to self-assess their performance on it. Data were collected from all third- and/or fourth-year students in four classes at one U.S. dental school from 2011 to 2014. Since two of the four classes took the exam in both the third and fourth years, those data were compared to determine if those students' self-assessment skills improved over time. Statistical analyses were performed to determine agreement between the two faculty graders and between the students' and faculty assessments on each criterion in the rubric and the overall grade. Data from the upper and lower performing quartiles of students were sub-analyzed. The results showed that faculty reliability for the overall grades was high (K=0.829) and less so for individual criteria, while student-faculty reliability was weak to moderate for both overall grades (Spearman's rho=0.312) and individual criteria. Students in the upper quartile self-evaluated themselves more harshly than the faculty (p<0.0001), while the lower quartile students overestimated their performance (p=0.0445) compared to faculty evaluation. No significant improvement was found in assessment over time in the students who took the exam in the third and fourth years. This study found only limited support for the hypothesis that a grading rubric used by both faculty and students would increase correspondence between faculty and student assessment and points to a need to reexamine the rubric and instructional strategies to help students improve their ability to self-assess their work.

Faculty Development at One Midwestern Dental School: A Program Evaluation

Most dental school faculty members arrive on campus with a wealth of clinical experience but little to no teacher training. For the past two decades, there has been a call for schools to educate their faculty on a wide variety of topics including educational methodology and cutting-edge educational techniques through faculty development programs. Drawing on theories of general program evaluation as well as evaluation specific to educational programming, the aim of this study was to investigate outcomes of the Faculty Development Program at the University of Missouri-Kansas City School of Dentistry between 2007 and 2014. A mixed-methods research design gathered quantitative data via email survey sent to all eligible teaching faculty members; it received an overall response rate of 54% (N=51). Qualitative data came from open-ended survey questions and a focus group with seven volunteer faculty participants. The survey data suggested that the stated outcomes of faculty development were being met for all stakeholder groups with varying degrees of success. Focus group results indicated a need for a more formal new faculty orientation and better communication with all about the specific charge of faculty development within the school. Evaluation of faculty development activities in academic dental institutions is a necessary component of the ongoing improvement of dental education. Suggestions for future evaluations include the idea of collaborating with other dental schools to increase sample sizes, which would increase participants' perception of the level of confidentiality and make statistical analyses more robust.

ADEA/AAL Institute for Allied Health Educators: Program Evaluation

Revised accreditation standards for dental and dental hygiene education programs have increased emphasis on faculty development that can improve teaching and learning, foster curricular change including use of teaching and learning technologies, and enhance retention and satisfaction of faculty. The American Dental Education Association (ADEA) and Academy for Academic Leadership (AAL) established the Institute for Allied Health Educators (IAHE) in 2007 to address faculty development needs for allied dental and allied health educators. In 2009, it was transitioned to an online program, which resulted in increased enrollment and diversity of participants. After seven years, a comprehensive program evaluation was warranted. The authors developed an online questionnaire based on Kirkpatrick's four-level model of training evaluation; for this study, levels one (satisfaction), two (knowledge and skill acquisition), and three (behavior change) were examined. Of the 400 program participants invited to take part in the study, a 38% response rate was achieved, with the majority indicating full-time faculty status. Nearly all (95-97%) of the respondents agreed or strongly agreed the program contributed to their teaching effectiveness, and 88-96% agreed or strongly agreed it enhanced their knowledge of educational concepts and strategies. In addition, 83% agreed or strongly agreed the program helped them develop new skills and confidence with technology, with 69% agreeing or strongly agreeing that it helped them incorporate technology into their own educational setting. Nearly 90% were highly positive or positive in their overall assessment of the program; 95% indicated they would recommend it to a colleague; and 80% agreed or strongly agreed they had discussed what they learned with faculty colleagues at their home institutions who had not attended the program. Positive findings from this evaluation provide evidence that the IAHE has been able to meet its goals.

Perceptions of Kansas Extended Care Permit dental hygienists' impact on dental care

PURPOSE

In 2003, Kansas addressed their access to oral health care needs with amended state dental practice act for registered dental hygienists. The Extended Care Permits (ECP) I, II and III have expanded the dental hygiene scope of practice, allowing dental hygienists to provide oral care to Kansans in different settings beyond the dental office. The purpoase of this study was to examine the perceptions of Kansas ECP dental hygienists on change to oral care in Kansas.

METHODS

A questionnaire was mailed to all ECP dental hygienists (n=158) registered with the Kansas Dental Board. Questions were open-ended, close-ended and Likert scale. Information was sought regarding demographics, areas of employment, work related activities and impact to oral health care. Study exclusions included ECP providers no longer practicing in Kansas, practice more than 50% in another state or no longer practice dental hygiene at all.

RESULTS

A total of 69 surveys were returned, with 9 surveys excluded for exclusion criteria. Most respondents (92%) agreed the ECP is a solution to oral health care access issues in Kansas. Barriers to utilizing their permits fully included: difficulty locating a sponsoring dentist (12%), locating start up finances (22%), limited work space (14%) and difficulty with facility administrators (39%). Many respondents (62%) agreed the proposed registered dental practitioner would improve access to oral health care to Kansans.

CONCLUSION

The Extended Care Permit providers in Kansas appear to be satisfied with their current employment situations and feel oral health care has improved for their patients served but they are unable to utilize their permits fully for various reasons.

Development and outcomes of an online-onsite hybrid dental admissions enhancement pilot program

The University of Missouri-Kansas City (UMKC) School of Dentistry has piloted two years of an Admissions Enhancement Program (AEP) with students from underrepresented minority groups and/or economically disadvantaged areas of Missouri interested in applying to dental school. The AEP utilizes an innovative online-onsite hybrid format to elevate students' foundational knowledge in biology, chemistry, organic chemistry, and quantitative reasoning. The online component includes interaction with UMKC instructors using tablet technology and Wimba virtual classroom sessions. The onsite component engages students in academic and professional development, enrichment activities targeting skills training, experience in dental labs and clinics, and mentoring in preparing the dental school application, essay writing, and interviewing. Results to date indicate overall program satisfaction among AEP participants and a dental school acceptance rate of 73.7 percent (14/19 students). Participants reported the mock interviews and essay-writing portions contributed to their becoming competitive candidates for the admission process, and the online material enhanced their preparation for the Dental Admission Test (DAT). Pre- and post-AEP data show participant DAT Academic Average scores increased by two points. The school will continue to monitor program participants in subsequent years.

Fifteen years of portfolio assessment of dental hygiene student competency: lessons learned

Adoption of portfolio assessment in the educational environment is gaining attention as a means to incorporate self-assessment into the curriculum and to use evidence to support learning outcomes and to demonstrate competency. Portfolios provide a medium for students to demonstrate and document their personal and professional growth across the curriculum. The purpose of this literature review is to discuss the drivers for portfolio education, the benefits to both students and program faculty/administrators, the barriers associated with portfolio use, and suggested solutions that have been determined through several years of "lessons learned." The University of Missouri Kansas City School of Dentistry, Division of Dental Hygiene department has been utilizing portfolio assessment for over 15 years and has collected data related to portfolio performance since 2001. Results from correlational statistics calculated on the 312 dental hygiene students that graduated from 2001 to 2013 demonstrate a positive and significant relationship between portfolio performance and overall GPA as well as portfolio performance and NBDHE scores.

A qualitative study of extended care permit dental hygienists in Kansas

Currently, 37 states allow some type of alternative practice settings for dental hygienists. This qualitative study was designed to explore the experiences of the Extended Care Permit (ECP) dental hygienist in the state of Kansas. As a first ever study of this workforce model, a qualitative research design was chosen to illuminate the education and experiences of extended dental hygiene practitioners in order to understand the impact ECP legislation has had on increasing the public's access to oral health care services and define the advantages and limitation of this model as one potential solution to access to oral care. Snowball sampling was used to identify study participants who were actively engaged in extended care practice. Nine subjects, which included one ECP consultant and eight ECP providers, participated in this study. Data obtained via personal interviews and through document analysis data were subsequently coded and thematically analyzed by three examiners. An independent audit was conducted by a fourth examiner to confirm dependability of results. Seven major categories emerged from the data analysis: entrepreneur dental hygienist, partnerships, funding, barriers, sustainability, models of care and the impact of the ECP. The findings of this study revealed that ECP hygienists are making an impact with underserved populations, primarily children, the elderly and special needs patients.

Validity and reliability of portfolio assessment of student competence in two dental school populations: a four-year study

The purpose of this study was to empirically investigate the validity and reliability of portfolio assessment in two U.S. dental schools using a unified framework for validity. In the process of validation, it is not the test that is validated but rather the claims (interpretations and uses) about test scores that are validated. Kane's argument-based validation framework provided the structure for reporting results where validity claims are followed by evidence to support the argument. This multivariate generalizability theory study found that the greatest source of variance was attributable to faculty raters, suggesting that portfolio assessment would benefit from two raters' evaluating each portfolio independently. The results are generally supportive of holistic scoring, but analytical scoring deserves further research. Correlational analyses between student portfolios and traditional measures of student competence and readiness for licensure resulted in significant correlations between portfolios and National Board Dental Examination Part I (r=0.323, p<0.01) and Part II scores (r=0.268, p<0.05) and small and non-significant correlations with grade point average and scores on the Western Regional Examining Board (WREB) exam. It is incumbent upon the users of portfolio assessment to determine if the claims and evidence arguments set forth in this study support the proposed claims for and decisions about portfolio assessment in their respective institutions.

U.S. dental hygiene faculty perceptions of learner outcomes in distance education courses

The purpose of this study was to determine perceptions of full-time, entry-level dental hygiene educators regarding the ability to achieve interaction in their distance education courses and the impact of interaction on learning outcomes. The specific interactions explored were student-instructor, student-content, and student-student. A survey was developed, pilot tested, revised, and mailed to 287 educators across the United States, generating an overall response rate of 22.3 percent. The majority of respondents perceived interaction to be achievable in their distance courses, to increase through technology, and to positively influence learning outcomes. Nearly 90 percent reported student-instructor interaction as achievable, 95.3 percent reported student-content interaction as achievable, and 79.7 percent reported student-student interaction as achievable. Learning outcomes were defined in this study as the student's achievement of course objectives and competencies at course completion. Approximately 81 percent of the respondents reported a positive influence from student-instructor interaction, 79.7 percent from student-content interaction, and 70.3 percent from student-student interaction. This study also examined which modalities were perceived as being most influential in achieving interaction. The results demonstrated a prevalence of discussion board posting in an environment in which numerous Web 2.0 tools are available and respondents were not as positive about their ability to achieve student-student interaction in the distance learning environment. The authors conclude that faculty development is critical in achieving quality outcomes in dental hygiene distance education courses.

Technology is a critical game changer to the practice of dental hygiene

Dental hygienists will need to embrace 21st century technology to adapt to workplace settings.

BACKGROUND AND PURPOSE

To stay relevant in the workforce, dental hygienists need mastery of new skills and technologies. The purpose of this paper is to elucidate the vast array of technological advances impacting dental practice and the consequent implications for oral health care providers.

CRITICAL ANALYSIS

New technologies have provided unparalleled opportunities for degree and career advancement for dental hygienists. Advances in science and technology are providing patients with better quality and more convenient oral health care. Dental hygienists need technological skills that enable them to fully utilize technology as a strategy for consultation with dentists and other health care professionals and for other purposes. Continuing education and life-long learning factor into preparing dental hygienists for 21st century technologies.

CONCLUSION

With technological advances, less adaptive professionals could potentially see a decrease in demand for their services. Possessing a high level of knowledge of dentistry and dental hygiene does not ensure a position in the workforce. Knowledge of technologies and associated skills are required for quality patient care and career and personal growth.

Using tablet technology and instructional videos to enhance preclinical dental laboratory learning

The purpose of this pilot study was to examine if tablet technology with accompanying instructional videos enhanced the teaching and learning outcomes in a preclinical dental laboratory setting. Two procedures deemed most challenging in Operative Dentistry II were chosen for the development of instructional videos. A random sample of thirty students was chosen to participate in the pilot. Comparison of faculty evaluations of the procedures between the experimental (tablet) and control (no tablet) groups resulted in no significant differences; however, there was a trend toward fewer failures in the experimental group. Examination of the ability to accurately self-assess was compared by exploring correlations between faculty and student evaluations. While correlations were stronger in the experimental group, the control group had significant correlations for all three procedures, while the experimental group had significant correlations on only two of the procedures. Students strongly perceived that the tablets and videos helped them perform better and more accurately self-assess their work products. Students did not support requiring that they purchase/obtain a specific brand of technology. As a result of this pilot study, further development of ideal and non-ideal videos are in progress, and the school will be implementing a "Bring Your Own Device" policy with incoming students.

Extending oral health care services to underserved children through a school-based collaboration: Part 3--A cost analysis

PURPOSE

The purpose of this manuscript was to conduct a cost analysis of the Miles of Smiles Program, a collaboration between the University of Missouri-Kansas City School of Dentistry and the Olathe School District in Kansas. This preventive program was implemented to improve the access to oral health care for low income children within the school district.

METHODS

An inventory list and de-identified patient records were used to determine the costs associated with operating the program to serve 339 elementary school students during the 2008 to 2009 school term. Costs related to equipment, supplies and personnel were included. The costs were then compared to the amount of Medicaid reimbursement obtained for the services provided. Additionally, the cost of operating a similar program, if staffed by dental professionals rather than supervised dental hygiene students, was estimated.

RESULTS

The cost of operating the program during the 2008 to 2009 school term was $107,515.74. The program received Medicaid reimbursement for approximately 1.5% of the total operating cost of and approximately 6.3% of the total billable services, however, challenges with submitting and billing Medicaid claims for the first time contributed to this low rate of reimbursement. If a similar program that utilized dental professionals was implemented and treated the same number of patients, the cost would be approximately $37,529.65 more due to higher expenses associated with personnel and supplies.

CONCLUSION

The program is not self-sustainable based on Medicaid government-funded insurance reimbursement alone, and therefore continuous external sources of funding or a change in the program design would be necessary for long-term sustainability of the program.