Impact of undergraduate medical training on housestaff problem-solving performance: implications for problem-based curricula.

This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used data-driven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found this pattern to be true for medical students trained in two different curriculum formats. Although all housestaff generated equal numbers of diagnostic hypotheses during the reasoning process, housestaff from the conventional curriculum generated a greater number of accurate hypotheses than residents in PBLC. These results are discussed in relation to assumptions in health professional curricula about the adequacy of hypothetico-deductive methods of reasoning as teaching mechanisms and the need for clinical and biomedical knowledge integration.     

Attitudes of Italian dental and dental hygiene students toward tobacco-use cessation

Objective:  The aim of this study was to investigate the smoking habits of Italian dental and dental hygiene students and to assess their knowledge on the health effects of cigarette smoking and their attitudes toward tobacco-use cessation (TUC) in dental practice.
Materials and methods:  Data was collected from 220 students attending the Dental and Dental Hygiene Schools (DS and DHS, respectively) at the University of Palermo (Italy).
Results:  The percentage of smokers amongst DS and DHS students was similar (32.78% vs. 32.5%) with 67.77% of DS students and 77.5% of DHS agreeing that the damages to health caused by smoking were covered in their didactic course work. A high percentage of DS (63.33%) and DHS (67.5%) students reported the relationship between smoking and a number of associated health conditions. Both DS and DHS students showed poor knowledge of TUC interventions. Both DS and DHS students reported to be conscious of their own role as a counsellor, with DHS students feeling more comfortable in approaching counselling in clinical practice. Although DS and DHS students reported a positive attitude toward TUC interventions, almost half of the students had some concerns about the effectiveness of smoking cessation activities.
Discussion:  The introduction of a comprehensive tobacco education curriculum in DS and DHS programs could further improve students' perceptions and attitudes and provide knowledge and clinical experience which would lead to the incorporation of TUC into subsequent professional practice.     

Special care dentistry for people with intellectual disability in dental education: an Italian experience

Aim:  This study documented: (i) the curriculum in special care dentistry in the Italian dental schools, as perceived by Deans and by students, (ii) the rate of satisfaction of dental students with their curricular education in special care dentistry, (iii) the attitude of the dental students towards special care dentistry and towards the 'Special Smiles' programme.
Methods:  The quality and amount of didactic and clinical training delivered by each dental school for subjects with intellectual disability (ID), the interest of students towards this health field and the 'Special Smiles' programme were collected. Self-administered surveys were sent to the Dean and to all the final year students of all dental schools in 20 Italian Universities.
Results:  Only four Deans of the 20 dental schools answered the survey, stating to provide didactic and clinical education in special care dentistry. A 51% of student response rate was obtained. Dental students reported to spend about 4% of didactic and 5% of clinical training in the dental care for ID subjects. Most students (83%) rated the training they had received on the topic to be poor. Over 50% of students expressed interest in working in dental offices specifically dedicated to ID patients and 25% of students wished to become Special Smiles volunteers.
Conclusions:  Although the paucity of didactic and clinical training in dental care for ID patients, this survey demonstrated a high level of student's interest in learning more about treating these subjects. The current results could suggest to revise the curricular standards of dental schools, by promoting ID-oriented education programmes.     

Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?

Introduction:  Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way.
Materials and methods:  Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures.
Results:  Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation.
Discussion:  The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry.
Conclusion:  Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education.     

Perceived sources of stress amongst Indian dental students

Introduction:  Dental students have to face the additional stress of their studies in addition to the stresses related to dentistry as a profession. Furthermore, increasing stress may result in declining student performance. The aim of the present study was to assess perceived sources of stress amongst dental undergraduate students at a private dental institution in India.
Materials and methods:  A modified dental environment stress (DES) questionnaire which consisted of 38 questions was used to assess the levels of stress.
Results:  The first major stressor for all the students was examination and grades with a mean score of 2.86 (SD 1.06) followed by full working day, receiving criticism from supervisors about academic or clinical work, amount of cheating in dental faculty, rules and regulations of the faculty and fear of unemployment after graduation. Amongst the six highest stressors in each year, at least three were dental faculty related. There was a significant difference in stress perception between genders with a predilection for males. Twelve of the 38 questionnaire items had significant differences across the year groups including clinical DES items.
Conclusion:  The primary sources of stress as perceived by nearly 275 students at one private dental school in India were examinations and grades followed by full working day and receiving criticism from supervisors about academic or clinical work. It appears there is a need for the establishment of student advisors and counsellors combined with a faculty advising system in addition to student-oriented programmes.     

Strategies for caries risk assessment in children and adolescents at public dental clinics in a Swedish county

Background.  Since caries prevalence has decreased and become polarized, high-risk preventive strategies have been widely adopted. The underlying factors leading to assessment and management of caries risk are poorly understood.
Aim.  The aim of this study was to identify the factors forming the basis for dentist's caries risk assessment in dental care for children and adolescents.
Design.  From all 3372 children in a Swedish county identified as at high risk for developing caries, a sample of dental records from 432 children, aged 3–19 years, were randomly selected to be analysed in the study. Information about medical and social history, dental status, dietary habits, oral hygiene, and salivary data was obtained from the records.
Results.  The results show that the only data registered in the majority of the dental records were dental status from the clinical examination and bitewing radiographs. In approximately half of the dental records, medical history and data concerning oral hygiene were registered. Dental history and dietary habits were noted in approximately 25% of the dental records, whereas other risk factors/indicators were occasionally registered.
Conclusions.  Dentists mainly base their caries risk assessments on past caries experience, a reliable risk indicator for assessing the risk of being affected by caries again. In children with no experience of caries, knowledge of other risk factors/indicators needs to be available to perform a caries risk assessment. In this study, documentation of such knowledge was strongly limited.     

Attitudes of final year dental students to the use of rubber dam

Aim  To investigate the attitudes of final year dental students in Wales and Ireland to the use of rubber dam.
Methods  A pre-piloted questionnaire was distributed to final year dental students in Cardiff and Cork Dental Schools in January 2008. Information sought included attitudes to, and the current and anticipated use of, rubber dam for a variety of operative and endodontic treatments.
Results  Of 93 questionnaires distributed, 87 were completed and returned (response rate = 94%; Cardiff: 89%, n  = 51; Cork: 100%, n  = 36). Rubber dam was routinely used by 98% of respondents ( n  = 85) on adult patients, but only 32% of respondents ( n  = 28) had used rubber dam on child patients ( P  < 0.05). Rubber dam was never used by 75% of respondents ( n  = 65) when placing posterior amalgam restorations, and by 21% of respondents ( n  = 18) when placing anterior composite restorations. Rubber dam was used by 98% of the respondents ( n  = 85) when performing root canal treatments. Sixty-two per cent of respondents ( n  = 54) believed their use of rubber dam would decrease once leaving the dental school.
Conclusion  Whilst dental students believe that rubber dam is relevant to clinical dentistry, there are negative perceptions associated with its use amongst dental students. More than half of those questioned predicted their use of rubber dam would decrease once in independent practice. Greater emphasis should be placed on the advantages of using rubber dam in clinical dentistry whilst at dental school.     

Student perspectives and opinions on their experience at an undergraduate outreach dental teaching centre at Cardiff: a 5-year study

Aim:  Outreach teaching is now regarded as a desirable component of undergraduate dental teaching programmes in the UK. A purpose-built undergraduate dental outreach-training centre was opened in Cardiff in 2002. The aim of this paper is to report student perspectives and opinions on their experience at this unit over a 5-year period.
Methods:  Final year dental students at Cardiff University were invited to report their comments on the St David's Primary Care Unit at various times during their placement there. Information was recorded for undergraduate students who commenced final year in 2003, 2004, 2005, 2006 and 2007 ( n = 257).
Results:  After 1 year, the most common favourable aspects reported by students included the availability of a suitably trained nurse for all procedures ( n  = 191), ready access to helpful/approachable teaching staff ( n  = 145), and closeness of learning experience to subsequent practice ( n  = 122). Many students commented on their growing confidence in their own abilities whilst in the unit.
Conclusion:  Overwhelmingly, students reported their enthusiasm for training in an outreach teaching unit, preferring it to traditional dental school environments. Inherent in the comments recorded for each student was a sense of growing confidence in their abilities and development of reflective practice. Further work is needed to identify the impact of this form of dental student training on subsequent practices in Vocational Training and independent clinical careers.     

A pilot study of the use and perceived utility of a scale to assess clinical dental teaching within a UK dental school restorative department

Introduction:  Feedback on individual teaching performance gives an important contribution and support to the reflective practices of educators. Unfortunately, feedback is an infrequent exercise provided to dental teachers about their teaching practices. The Effective Clinical Dental Teaching (ECDT) scale has been used previously to assess clinical teachers, but has not been used within the UK.
Methods:  This study looks at the use of the ECDT scale in the setting of a UK dental school, as a method of feedback collection and delivery in seven domains of clinical teaching. The ECDT was used to evaluate the teaching of 16 clinical teachers by dental undergraduates, and to investigate the opinions of these clinical teachers and clinical dental students about the utility of this scale.
Results:  The study identified that there was a disparity between self and student perception of teaching. The total ECDT scores ranged from a minimum of 55% 66.6/125 to a maximum of 90% 113.8/125, with a mean group score of 73% 91.6/125. Most clinicians evaluated by students scored above 3/5 for all teaching domains, although there appeared to be significant differences between the four teacher groups. The majority of staff and students were in favour of the use of such a scale to support the progression and development of teaching styles.
Conclusion:  The ECDT scale is a useful tool for highlighting the areas of strength and deficiency within clinical dental teaching. Its use may complement peer review for individual teachers and identify future topics for staff development sessions. Further research is recommended to identify the individual strengths and weaknesses that different types of teacher may bring to curriculum teaching.     

RCT of the effects of block absence for outreach placements on dental students' finals grades

Undergraduate dental curricula are being supplemented with primary care placements requiring periods away from the dental school. These absences may impact negatively on students' other studies.
Objective:  To compare the effect of outreach placement and traditional hospital-based training alone on students' final examination scores. Existing primary care placements in northern England about one year from students' qualification.
Subjects and Methods:  Analysis of secondary outcomes in a randomised controlled trial with students' final examination marks being compared on qualification. To reduce Type I error only 4 of 24 available scores were considered and multiple testing correction applied. Five-week block outreach placements for 25 of 49 students. Honours awarded and examination scores for children's dentistry, overall clinical work and theory.
Results:  Groups' final exam scores were similar: children's dentistry – outreach 64.9 (SD 2.1), hospital-based 65.0 (3.0); overall clinical work 58.3 (3.4) cf 60.7 (4.8) and theory 54.6 (3.5) cf 56.5 (4.0). The numbers of students awarded honours (outreach 1, hospital 4) showed no significant difference (Fisher's exact text P  = 0.19).
Conclusion:  Dental outreach training involving several weeks' absence from the school had no negative impact on students' finals scores.     

Developing information literacy with first year oral health students

Context:  In this time of rapid expansion of the scientific knowledge base, subject matter runs the risk of becoming outdated within a relatively short time. Instead of adding more content to already crowded curricula, the focus should be on equipping students to adapt to their changing world. The ability to access, evaluate and apply new knowledge for the benefit of patients has been acknowledged as an important goal for dental education. Information literacy is key to achieving this.
Methods:  An information literacy programme for first year oral health students was instituted. This was integrated within a biosciences course and linked with its assessment. Small group instruction reinforced by the use of a tailored online Assignment Guide was used in the context of a specific task. Effectiveness was measured in terms of assessment outcome, processes used and student experience.
Results:  Twenty-seven students participated in the intervention which was effective in enhancing foundation literacy skills and confidence of students in accessing and evaluating information sources in the context of a clinical problem. Improvement in higher level literacy skills required to articulate this information in the synthesis of a scientific review was not demonstrated.
Conclusions:  Integration of this information literacy programme within the learning activities and assessment of a basic sciences course resulted in significantly enhanced information literacy skills. As this is highly relevant for higher education students in general, the wider promotion of information literacy should be encouraged.     

Attitudes of South African oral hygienists towards compulsory community service

Abstract:  Compulsory Community Service (CCS) was introduced into the health service by the government to address the shortage and maldistribution of health professionals within the public sector. The aim of this study was to assess the perceptions of oral hygiene (OH) students, registered in 2004 at the five dental universities regarding the introduction of a 1-year-long CCS.
Objectives:  To determine: (a) the students' socio-demographic profile and (b) their attitudes towards CCS.
Methods:  A self-administered questionnaire was hand delivered to all OH students who were registered during 2004 at the respective dental universities.
Results:  The study yielded a response rate of 70% (109) with the average age of participants being 21.4 years. Most students were female (94%) and more than half were White (52%). More than half (53%) did not want to perform CCS even though 75% acknowledged its' importance. The most common concern for not supporting CCS was security (89%). Ninety per cent (90%) indicated that their preferred tasks would be to engage in clinical work and oral health promotion.
Conclusion:  Although the majority of participants supported the principles of CCS, a significant number were against the introduction citing security as their main concern. Most of the students preferred to perform clinical work and preventive programmes during their CCS.     

A comparison of sensation-seeking between dental and biological science students

Aim:   The aim of this study was to compare sensation-seeking behaviour amongst dental students and age-, sex-matched students studying for a standard 3-year degree in biological sciences at the Manchester University.
Methods:   A total of 268 sensation-seeking questionnaires were distributed to second- and third-year male and female dental and biological science students, studying for a degree at the University of Manchester. Each questionnaire was scored against Zuckerman's sensation-seeking scale.
Results:   A total of 268 questionnaires were distributed, 175 were returned. The return rate was 65%. The primary findings were:

• • 

  Biological Science students were more sensation-seeking in the dimensions of disinhibition and experience-seeking than dental students ( P  < 0.05).

       
  
  

Dental hygiene work in a clinical trial

Abstract:  Dental hygiene activities were developed as part of a randomized clinical trial designed to assess the safety of low-level mercury exposure from dental amalgam restorations. Along with dental-hygiene clinical work, a community programme was implemented after investigators noticed the poor oral hygiene habits of participants, and the need for urgent action to minimize oral health problems in the study population.
Objectives:  Clinical and community activity goal was to promote oral health and prevent new disease. Community activities involved participants and their fellow students and were aimed at providing education on oral health in a school environment.
Methods:  Dental hygienists developed clinical work with prophylaxis, sealants application and topical fluoride and implemented the community programme with in-class sessions on oral health themes. Twice a month fluoride mouthrinses and bi-annual tooth brushing instructional activity took place. Participation at dental-hygiene activities, sealed teeth with no need of restoration and dental-plaque-index were measures used to evaluate success of the programme for the participants.
Results:  Improvement in dental hygiene is shown by the decrease in dental plaque index scores ( P  < 0.0001); also sealants integrity is achieved in 86.3% of teeth. 888 (13.7%) teeth with sealants had to be restored or were lost. Children participated actively on dental hygiene activities. Teachers became aware of the problem and included oral-health in school curricula.
Conclusion:  Dental hygiene activities have shown to be helpful to promote dental hygiene, promote oral health and to provide school-age children with education on habits that will be important for their future good health.     

The effect of expertise on the interpretation of dental radiographic images

A difference exists in the way novices and experts interpret dental radiographs. For education in dental radiology knowledge about the expert strategy is important. The aim of this study was to determine how novices and experts differ in the way they judge dental radiographs. Therefore 16 radiographs with different types of pathologies in the hard tissues were observed by 15 observers with three different levels of expertise. Based on their verbal reports the information content of the radiographs was determined for the different expertise levels. One radiograph with the same information content for all levels was observed by 8 novices and 8 experts. The eye movements of the observers were registered during the interpretation. Based on the results it is concluded that the experts make a more adequate selection of the stimulus material. Recommendations are given for the structure of the educational programme in dental radiology.     

Development of a rural outplacement programme for dental undergraduates: students' perceptions

Objectives:  To describe the development and implementation of a new rural dental outplacement module in the final year curriculum and report initial student perceptions.
Methods:  The Melbourne Dental School, University of Melbourne, introduced a required 4-week rural outplacement [termed Rural Dental Rotation (RDR)] in July 2006 to provide education and clinical training to all final year students. Seventy dental students (Bachelor of Dental Science and Bachelor of Oral Health) were rostered in groups of 6—10 students to Shepparton (Victoria, Australia), from July 2006 to June 2007 for 4 weeks per group. Students were introduced to the culture and oral health needs of the indigenous population in the region, and were involved in oral health promotion in specific health programmes. At the end of each roster students provided feedback of their experiences through a voluntary anonymous questionnaire.
Results:  The RDR offered a rural learning experience to all final year dental undergraduates and also provided dental services to the local community on a continuing basis. Students agreed that the RDR was a worthwhile experience (mean 4.77 ± 0.46 on 1—5 scale) and was 'enjoyable' (mean 4.71 ± 0.45). There was only one student who did not consider rural practice in future. This was because of family reasons. The majority (79.1%) expressed definite affirmation, whereas some (19.4%) indicated the possibility of taking up rural practice.
Conclusions:  Overall feedback indicated that the students found it a very positive and enjoyable experience. It provided an opportunity to appreciate cultural safety and understand the specific oral health needs of indigenous Australians. The key benefit of such a programme to the community is the increased likelihood of attracting new dental graduates to rural areas.     

Dental students' knowledge and perceptions of non-invasive dental caries management

Background:  An evidence-based, risk-specific, and non-invasive modality for caries management was implemented in the University of Sydney dentistry curriculum. This study reviews its impact on student learning outcomes and their perceptions of the efficacy of a risk-based caries management.
Methods:  One hundred and nine Year 3 and Year 4 students were invited to complete a questionnaire to assess their understanding of the protocols and their perceptions of both the education process and value of the non-invasive treatment modality.
Results:  A response rate of 93% Year 3 and 46% Year 4 students was obtained. They correctly identified high and low risk cases but Year 3 students were inclined to misclassify medium risk cases. Most understood correctly that enamel lesions should be arrested and remineralized but were often more radical in dealing with dentine lesions. Students who believed the protocols were useful and who spent more time on preventive care were less likely to restore enamel and dentine lesions.
Conclusions:  A modest level of knowledge concerning application of the non-invasive caries management system to paper-based clinical case studies was demonstrated. Protocol misinterpretation may reflect inconsistent instruction by some clinical tutors. It is hoped that the promulgation of evidence-based dentistry will overcome these barriers in future.     

Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education

Objective:  To measure the levels of anxiety, self-perception of preparation and expectation for success induced by an objective structured clinical examination (OSCE), a written examination and a preclinical preparation test, and to examine the effects of the three predictive variables on the outcome of the assessments.
Materials and methods:  Test anxiety was measured with Spielberger's state anxiety inventory. Preparation for the assessment and expectation to succeed were quantified with 4-point Likert scales. The questionnaire was completed during an OSCE, a written examination, a preclinical crown and bridge preparation test and a non-examination situation.
Results:  The OSCE was a most anxiety-provoking assessment method and students prepared more for the OSCE than for the other examinations. The expectation to succeed was also higher for the OSCE. State anxiety during the OSCE was associated with the level of preparation but not with scores obtained. The state anxiety during a written examination showed a positive relation with the scores obtained, but not with preparation or expectation to succeed. During the preclinical test, state anxiety showed a positive association with the preparation and expectation to succeed, but not with the scores for this test.
No significant gender effects were observed for the state anxiety, level of preparation or the expectation to pass the examination. In the written examination female students scored significantly higher than male students. Such a gender effect was not found for the scores of the OSCE or the preclinical test.
Conclusion:  State anxiety was elevated during all three assessment methods. However, anxiety was not predictive of performance outcome in the OSCE, written examination or preclinical preparation test.     

Does exposure to dental education change the perceptions of Nigerian students to dentistry as a profession?

Aim:  To assess any effect of exposure to dental education and training on the perception and acceptance of dentistry by dental students at a Nigerian dental school.
Participants and methods:  The study was conducted by means of an anonymous self-administered questionnaire distributed to second-, fifth- and sixth-year dental students at the College of Medicine, University of Lagos. Participation was voluntary and 67 students agreed to participate in the study. Majority (51%) were aged between 24 and 27 years. The questionnaire contained questions on demography, preferred choice of course on admission, attempts at change of course, their present perception to dentistry and future dental practice.
Result:  Over 90% of them were admitted through the Joint admission and matriculation board and 40 (60%) chose Medicine as their first course choice. Of the 40, 18 had attempted a change of course and eight were still interested in a career change (four were in the fifth year). Most of the change in attitude occurred in fourth year. Sixty (90%) intend to practice dentistry but 38 (63%) of these would like to practice outside Nigeria.
Conclusion:  Exposure to dental training appears to improve students' perception about dental practice but uncertainty about future prospects in Nigeria may lead to brain drain in the dental profession.