Record keeping by undergraduate dental students: a clinical audit

AIMS AND OBJECTIVES: An audit was carried out to assess the standard of clinical record keeping by undergraduate dental students, with the object of improving the quality of care of patients treated by these students. METHODOLOGY: One hundred sets of undergraduate student clinical treatment records were evaluated against a modified CRABEL scoring system. The results of this initial part of the audit were presented in tutorial form to a group of 20 students, together with a teaching session on good record keeping, after which the audit was repeated, and another 100 records were examined over five consecutive Fridays, thus completing one complete audit cycle. RESULTS: The most commonly absent record related to the department where the patient was seen followed by illegible signatures of both the demonstrator and the student. Almost all elements of record keeping investigated had improved in the second audit, most reaching 100% compliance, except for two (the updated medical history and the patient's most recent complaint). CONCLUSION: Positive changes can be achieved by creating awareness among dental students on the importance of keeping records.     

Competency assessment for infection control in the undergraduate dental curriculum

OBJECTIVES: This study aimed at investigating the introduction of an infection control competency assessment on undergraduate dental student's awareness and knowledge of infection control. METHOD: A short course, including an introductory lecture and a three component competency based assessment exercise testing student's knowledge and ability in infection control measures was incorporated into the previously established training programme. The assessment exercises included a written test of students' knowledge of the Infection Control Policy, a unit management exercise and a hand hygiene assessment. The infection control competency was initially incorporated into the final term of the second year in 2004 and is now an established part of the 5-year dental undergraduate degree programme. Re-assessments were scheduled (at the start of third year) for students failing to meet the required standard as successful completion of this course was compulsory prior to students being allowed to treat their first patients. Student performance over the last 2 years on this course and during their first year on clinic were analysed to determine potential improvements in student knowledge and application in infection control. Examination results from the year 3, infection control spot test were compared with those of earlier years. In addition, the opinions, as assessed by questionnaire analysis, of dental staff and students on the infection control competency were obtained. RESULTS: All students successfully completed the infection control competency (either at first or second attempt) and were subsequently allowed to enter clinical training in year 3. Significant improvements were seen in students passing the course at their initial attempt, 42% and 78%, in the 2004 and 2005 academic years, respectively. Also subsequent testing of these students during their first year on clinic showed marked increases in awareness and knowledge of the infection control protocols. Staff and student feedback on this course was also found to be highly supportive of the introduction of the infection control competency. CONCLUSION: Incorporation of additional formal pre-clinical teaching and introduction of an infection competency potentially provides enduring knowledge and clinical application benefits.     

Creating effective and engaging information literacy programmes for the dental curriculum

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. A template for an Information Literacy programme for undergraduate students is described. This was embedded within a compulsory course for each of the first and second years of the Bachelor of Oral Health programme and consisted of a hands‐on workshop (attendance voluntary), information literacy quiz, self‐evaluation and a summative assessment task, with the second year of the programme building upon the learning of the previous year. Effectiveness was measured in terms of demonstration of information literacy skills and confidence in using these skills. Integration of this programme within the learning activities and assessment of first‐ and second‐year courses resulted in enhanced information literacy skills and confidence. Self‐perceived high skill levels may be a potential barrier to student engagement with information literacy programmes.     

An audit of root canal treatment performed by undergraduate students

AIM: The objective of this study was to audit the quality of root canal treatment performed by undergraduate students on adult patients. METHODOLOGY: All root canal treatment completed by first and second clinical year undergraduates over a 12-month period were included in the study. The availability and readability of pretreatment, diagnostic length, try-in point and postoperative radiographs were noted for each case. All readable postoperative radiographs of primary treatments were examined for quality of the root filling, categorized as complete, incomplete apical, incomplete apical and lateral or not assessable. The distance from the radiographic apex of the root to the apical extent of each root filling was measured to 0.1 mm precision. RESULTS: Undergraduates performed primary treatment on 157 teeth. A postoperative radiograph was available in 97% of cases. A try-in point radiograph was unavailable in one-fifth of cases. Twenty-seven teeth (13%) were categorized as satisfactory in terms of both radiographic quality and distance of the root filling from the radiographic apex. CONCLUSIONS: Overall, the technical quality of root canal treatment completed by undergraduate students was poor.     

Teaching periodontal pocket charting to dental students: a comparison of computer assisted learning and traditional tutorials

AIM: The aim of this study was to compare the effectiveness of a computer assisted learning (CAL) programme with that of traditional small group tutorials in teaching theoretical and practical aspects of periodontal pocket charting. METHOD: Sixty-one third year undergraduate dental students were randomized to either receive a tutorial or to work through the CAL programme. Students using the CAL programme completed questionnaires relating to previous computer experience and the ease of use of the programme. All students were assessed immediately after the intervention by means of a confidence log, a practical exercise and a further confidence log. They were assessed again three weeks later by means of a confidence log and a multiple-choice written test. RESULTS: There were very few significant differences between groups for any of the assessments used. However, subjective comments indicated that students occasionally felt disadvantaged if they had not received a tutorial. CONCLUSION: CAL and traditional teaching methods are equally effective in teaching periodontal pocket charting to undergraduate dental students.     

The effect of a community dental service outreach programme on the confidence of undergraduate students to treat children: a pilot study

OBJECTIVE: To examine the effect of a community dental service (CDS) outreach teaching programme on undergraduates' confidence to undertake a range of paediatric dental procedures. METHOD: Eighteen final year dental students completed a questionnaire prior to, and following participation in an outreach teaching programme. At each time point, the students were asked to identify how confident they felt to carry out a range of procedures commonly encountered in the treatment of children, employing a Likert scale modified to comprise six points where a rating of 1 represented 'not at all confident' and a rating of 6 'very confident'. RESULTS: The distribution of scores at each time point indicated that students were more confident to carry out each of the listed procedures following participation in the outreach teaching programme than they had been on completion of their paediatric dentistry sessions within the School of Dentistry. At the individual student level, 16 of the 18 students indicated that they were, overall, more confident following their placement than previously. CONCLUSIONS: It can be concluded that the long-established CDS outreach teaching programme run by the School of Dentistry, Wales College of Medicine in conjunction with the staff of Cardiff and Vale NHS Trust is a valuable adjunct to undergraduate teaching in paediatric dentistry.     

An assessment of the influence of clinical demonstrations on the confidence of undergraduate dental students, when treating patients requiring removable partial dentures.

AIM: This study was designed to assess the influence of clinical demonstrations, on the confidence of undergraduate dental students, when treating patients requiring removable partial dentures. METHOD: The confidence of 45 undergraduate dental students treating their first patient requiring removable partial dentures was assessed using questionnaires. 23 students were given demonstrations prior to carrying out the treatment; the remainder did not receive a demonstration. Outcome was assessed by the time taken to complete the procedures to a clinically acceptable standard. RESULTS: All the students indicated high levels of agreement with a statement expressing their confidence in coping with the clinical procedures undertaken. The more confident students completed their clinical procedures more quickly than other students, irrespective as to whether they had received a demonstration or not. There was a higher proportion of more confident students in the groups who had received a clinical demonstration; it can therefore be concluded that these groups performed better, as measured by the time taken to achieve the required clinical standard. All the students who had received a demonstration believed they had benefited from it, whilst 67% of the students who had not received a demonstration believed they would have benefited from one. Analysis of the students' comments indicated that demonstrations facilitated confidence, communication skills, understanding and recall in the clinical situation. Students who did not perceive a benefit from the demonstrations believed that they had more time for one to one teaching. CONCLUSION: This study showed that those students who had received a clinical demonstration immediately prior to treating their patients believed they were more confident and as a result their performance was improved. Clinical demonstrations are time consuming, but they would appear to be time well spent.     

Does performance in selection processes predict performance as a dental student?

Objective: This study investigated associations between the performance of dental students in each of the three components of the selection procedure [academic average, Undergraduate Medicine and Health Sciences Admission Test (UMAT) and structured interview], socio‐demographic characteristics and their academic success in an undergraduate dental surgery programme. Materials and methods: Longitudinal review of admissions data relating to students entering dental education at the University of Otago, New Zealand, between 2004 and 2009 was compared with academic performance throughout the dental programme. Results and discussion: After controlling for variables, pre‐admission academic average, UMAT scores and interview performance did not predict performance as a dental student. Class place in second year, however, was a strong predictor of class place in final year. Multivariate analysis demonstrated that the best predictors of higher class placement in the final year were New Zealand European ethnicity and domestic (rather than international) student status. Other socio‐demographic characteristics were not associated with performance. These interim findings provide a sound base for the ongoing study. Conclusion: The study found important socio‐demographic differences in pre‐admission test scores, but those scores did not predict performance in the dental programme, whether measured in second year or in final year.     

Difficulties encountered at the beginning of professional life: results of a 2003 pilot survey among undergraduate students in Paris Rene Descartes University (France)

In addition to dental hospital clinical activity, dental students at Paris Rene Descartes University have the opportunity in their final year of study to practise clinically in a dental office, as associates. This paper outlines a pilot, experimental study designed to assess student reaction to this Vocational Clinical Activity (VCA) in order to identify relevant weaknesses of the undergraduate programme. Using questionnaires, data were collected for each of the following clinical or management skills: clinical difficulty, therapeutic decision-making, patient/practitioner relationship, time management, administrative matters and technical problems. Students were asked to rank each item in order of difficulty (1, high level to 6, low level). A high response rate was observed (90%) among the 50 undergraduate VCA students. The results pointed out three main difficulties encountered by undergraduate students during the VCA: time management (90% of the students), administrative matters (85% of the students) and clinical decision-making (80% of the students). These preliminary results need further investigation. However, they give us the incentive to carry on with this type of assessment and to extend it to young, qualified colleagues' perceptions and to other French Universities.     

Paediatric dentistry experience of the first cohort of students to graduate from Dublin Dental School and Hospital under the new curriculum

AIM: To assess undergraduate clinical experience in Paediatric Dentistry in students graduating under a new curriculum. METHODS: An audit using logbooks completed by 34 students for all patients for whom they had provided treatment in the university paediatric dentistry clinic. RESULTS: A total of 177 child patients had received treatment from the students, age range 2-8 years. Students had performed an average of 13 restorative techniques. Sixty-eight percent had provided stainless steel crowns and 71% at least one pulpotomy for a primary tooth. All students had provided fissure sealants. Eighteen had carried out extractions and 8 had provided treatment for fractured incisors on this clinic. CONCLUSIONS: The cohort of students included had a wide range of experience of paediatric dentistry which compared favourably with accepted guidelines. A relative lack of experience of dental extractions currently remains a problem.     

口腔正畸学七年制教学方案的研究

该研究首先分析了当前口腔七年制正畸学教学的现状,然后总结出一套切实可行又适应七年制学员特点的教学方案.实践证明该教学方案能够提高学员学习兴趣,帮助学员更好的理解正畸理论知识,提高学员分析问题,解决问题的能力,取得了较好的教学效果.     

A comprehensive care clinic in Swedish dental undergraduate education: 3-year report.

In 1993, a new undergraduate curriculum was introduced at the Faculty of Dentistry, Karolinska Institute. The expanded comprehensive care clinic described in this 3-year report, is proposed as a potential model for a CC-clinic in dental undergraduate education. Students enter clinical training at the beginning of the 3rd year and continue through to their final semester, in the 5th year. The one student is responsible for the total oral care of all his/her patients. Patients are stratified on admission into 3 levels, depending on the complexity of treatment need. Before being assigned their 1st patients (patient level I), the students must fulfil specified requirements of theoretical knowledge and clinical procedures and obtain a proficiency certificate. After qualifying for higher proficiency certificates, denoting their level of clinical responsibility, the students assume successively greater responsibility for treatment of patients, with less supervision from clinical instructors. Clinical supervision is the responsibility of integrated multidisciplinary teams of faculty members. Each group of students is assigned a clinical tutor, who is responsible for overall treatment planning of their patients. The individual student's clinical progress and achievements are monitored by a specially designed computer program. Criteria for a final pass in the course are: (1) clinical maturity in overall patient management; (2) technical competence in conjunction with theoretical knowledge. 3 years experience of the new model for comprehensive clinical training in a patient-centred, multidisciplinary clinic has shown that; (a) students seem to acquire a greater understanding of comprehensive case management; (b) patients receive more co-ordinated care; (c) there has been no significant change in the number of clinical procedures completed; (d) difficulties arise in co-ordination of staff over the traditional specialist boundaries; (e) assessment of student maturity and professional responsibility is impeded by the lack of objective criteria.     

Undergraduate students’ experiences of outreach placements in dental secondary care settings

Introduction: Outreach teaching is delivered as part of the undergraduate curricula of many dental schools. Evaluations of outreach in primary care settings have found learning opportunities beyond those available in the dental school setting, but less is known about secondary care placements. The aim of this evaluation was to assess dental students’ experiences of an undergraduate outreach placement in secondary care. Materials and methods: Questionnaire survey based on a single cohort of final‐year undergraduate dental students at Cardiff University who had completed a 1‐week outreach secondment to a District General Hospital. Results: Fifty‐five of the 57 eligible students completed the questionnaire. Outreach placements in secondary care were experienced to provide positive additional educational benefit and were considered to be worthwhile by many (but not all) students. Clinical opportunities and staff teaching varied by site. Discussion: In the current programme, the variability of student experience during secondments to secondary care means that some students report more benefit than others. However, even apparently negative experiences, such as cancelled operating lists, can contribute to the overall outcome in that they accurately reflect the reality of hospital practice. Conclusion: Careful management of secondary care undergraduate secondments is needed to ensure worthwhile learning experiences.     

The changing patterns of drinking,illicit drug use,stress, anxiety and depression in dental students in a UK dental school: a longitudinal study

OBJECTIVE: To investigate alcohol and illicit drug use in a cohort of dental undergraduates through to VT year. SETTING: A UK dental school (with a medical school comparison group). SUBJECTS AND METHODS: A cohort of dental students anonymously completed a lifestyle questionnaire about drinking and smoking, illicit drug use, stress, anxiety and depression in the spring of 1995 and 1998 as second and final year undergraduate students respectively, and in the summer of 1999 after one year working as qualified dentists. A parallel cohort of medical students also anonymously completed the questionnaire at the same time points in their undergraduate course as for the dental students, and at the end of a year working as Pre-Registration House Officers (PRHOs). RESULTS: The proportion of dental students in Newcastle drinking above the recommended low risk limits of alcohol declined from 47% as second year students to 25% as final year students and then it increased to 41% as qualified dentists, whilst in medical students it steadily increased over the three time points of the survey (33% to 43% to 54%). A greater proportion of dental students were drinking at hazardous levels at all three time-points, compared with medical students. Experimentation with illicit drugs ranged from 47% as second year students to 54% as final year students and to 51% as dentists. The prevalence of illicit drug use in medical students was similar to that in dental students. Forty seven per cent of the dental student cohort as second year students, 67% as final year students and 16% as dentists suffered from possible pathological anxiety, compared with 47%, 26% and 30% in the medical student cohort. The proportion of dentists suffering from stress decreased from 72% as final year students to 19% as dentists. In the medical student group, the proportion increased from 32% as final year students to 39% as PRHOs. CONCLUSION: This longitudinal study revealed that a high proportion of dental students from Newcastle continue to drink excessively and experiment with illicit drugs both as undergraduates and as practising dentists. A significant proportion also suffer from anxiety and stress. Further measures are needed in order to reduce alcohol and substance misuse and stress and anxiety among dental students and dentists.     

Orthodontic teaching practice and undergraduate knowledge in British dental schools

AIM: The aim was to survey current orthodontic teaching practice in the undergraduate syllabus at British dental schools and to test the abilities of undergraduate students according to the requirements of the GDC regulations. MATERIALS AND METHODS: Information collected by means of a questionnaire sent to each dental school in 1998 was compared with similar data from 1994. The orthodontic knowledge and treatment planning ability of students was assessed by a multiple-choice examination paper completed by a random 10% sample of students from each dental school. RESULTS: In 1998 on average 195 curriculum hours were devoted to orthodontics and each student treated five patients. The teaching of fixed appliances had increased considerably between 1994 and 1998. The average MCQ score was 58% (range 39-72%). Students scored well on questions that tested basic knowledge but much less well when they were required to apply that knowledge. Only three schools felt that it was realistic to expect undergraduates to formulate orthodontic treatment plans, as they are required to do by the GDC. CONCLUSION: Results support the view that undergraduate orthodontic training should concentrate on diagnosis and recognition of problems rather than on providing limited exposure to treatment techniques.     

Assessing competency in Dentoalveolar surgery: a 3-year study of cumulative experience in the undergraduate curriculum

AIM: To assess and observe the development of competence in oral surgical skills during a 3-year undergraduate programme. METHOD: Over a 3-year period 75 students were followed through from the beginning of their clinical course to their Bachelor of Dental Surgery graduation and their surgical experience monitored by the use of logbooks. Their development of competence was assessed objectively through structured assessments and subjectively by a single tutor responsible for each year. Assessments were made of their ability in exodontia, pre-surgical assessment and the surgical extraction of teeth/roots. RESULTS: Seventy-three students completed the course (97%). Successful completion rates for the objective testing were 100% for both exodontia and pre-surgical assessment. The surgical assessment, (surgical extraction of a tooth or root) had a successful completion rate of only 23% and the caseload for students was low with a mean of four teeth removed surgically upon graduation. Relationships were examined between total numbers of teeth extracted, total number of minor oral surgical procedures completed and the successful completion of the surgical competence assessment, but no significant relationships were found. CONCLUSIONS: This study demonstrates that it is possible to achieve objectively measurable levels of competence in undergraduates undertaking oral surgery procedures. It is however, a labour and time intensive process and appropriate clinical and teaching resources are required. National co-operation towards agreed standardised competencies should be encouraged to allow data to be pooled and more powerful analyses to occur.     

Developing an assessment in dental public health for clinical undergraduates attending a primary dental care outreach programme

Abstract Background: This paper describes the development and implementation of a Dental Public Health (DPH) assessment within the Primary Dental Care Outreach (PDCO) course at Newcastle University. The assessment was piloted alongside the delivery of the Bachelor of Dental Surgery (BDS) curriculum in accordance with established learning outcomes. Aim: To design and implement a pilot summative assessment, incorporating patients’ social histories obtained by undergraduate students attending primary dental care outreach clinics. Method: Undergraduates were tasked with obtaining a detailed social history from a patient seen during their two‐year outreach attachment. Each student submitted a written account of their patient’s social history and placed this in context by researching a number of demographic and social variables centred upon their patient’s home residence. The final component involved writing a concise case feature for a nominated newspaper based upon the case history, where students were encouraged to identify one or more public health messages using language appropriate to a lay readership. Results: Seventy one clinical undergraduates (98.6% of the year‐group) subsequently submitted all components of the assessment. Eighty six per cent of the year‐group was deemed to have passed the assessment with 9.9% achieving a ‘Merit’ grade and 76% a ‘Satisfactory’ grade. Following the assessment, students and clinical teachers were asked for their feedback through a focus group for staff, and a brief feedback form for students. Conclusion: Undergraduates subsequently reported greater awareness of the significance and importance of obtaining a detailed social history and its relevance when devising appropriate and realistic treatment plans.     

Teaching an engine-driven preparation technique to undergraduates: initial observations

AIM: This paper describes the initial experiences following the introduction of a rotary engine-driven preparation technique into the undergraduate endodontic programme at the Zurich University Dental Centre. METHODS: Forty third-year students practised the ProFile.04 (PF.04) technique between January and July 2001 in a preclinical course. Between November 2001 and February 2002, 20 of these students (Group A) root-treated 51 teeth in their clinical course using either PF.04, the balanced force technique (BFT) or a combination of both. The second group of 20 students (Group B) similarly treated another 36 randomly selected teeth between April and July 2002. Types of teeth treated by the students and the canal preparation techniques were recorded. The students also completed a short questionnaire, evaluating their opinions of the new course. RESULTS: Of the 87 teeth endodontically treated during the clinical course, 34, 14 and 39 were shaped using PF.04 alone, a combination of PF.04 and BFT and BFT alone, respectively. No rotary instruments were fractured during the 1-year clinical course, although some instruments were fractured during the preclinical laboratory course. Overall, the students rated the rotary technique as positive. CONCLUSION: A rotary technique was successfully introduced into an undergraduate endodontic programme (this will be continued in the foreseeable future). However, the continuity between the preclinical and the clinical courses was poor as a result of the constraints of the general teaching programme.     

Undergraduate basic science preparation for dental school

In the Institute of Medicines report Dental Education at the Crossroads, it was suggested that dental schools across the country move toward integrated basic science education for dental and medical students in their curricula. To do so, dental school admission requirements and recommendations must be closely reviewed to ensure that students are adequately prepared for this coursework. The purpose of our study was twofold: 1) to identify student dentists' perceptions of their predental preparation as it relates to course content, and 2) to track student dentists' undergraduate basic science course preparation and relate that to DAT performance, basic science course performance in dental school, and Part I and Part II National Board performance. In the first part of the research, a total of ninety student dentists (forty-five from each class) from the entering classes of 1996 and 1997 were asked to respond to a survey. The survey instrument was distributed to each class of students after each completed the largest basic science class given in their second-year curriculum. The survey investigated the area of undergraduate major, a checklist of courses completed in their undergraduate preparation, the relevance of the undergraduate classes to the block basic science courses, and the strength of requiring or recommending the listed undergraduate courses as a part of admission to dental school. Results of the survey, using frequency analysis, indicate that students felt that the following classes should be required, not recommended, for admission to dental school: Microbiology 70 percent, Biochemistry 54.4 percent, Immunology 57.78 percent, Anatomy 50 percent, Physiology 58.89 percent, and Cell Biology 50 percent. The second part of the research involved anonymously tracking undergraduate basic science preparation of the same students with DAT scores, the grade received in a representative large basic science course, and Part I and Part II National Board performance. Using T-test analysis correlations, results indicate that having completed multiple undergraduate basic science courses (as reported by AADSAS BCP hours) did not significantly (p < .05) enhance student performance in any of these parameters. Based on these results, we conclude that student dentists with undergraduate preparation in science and nonscience majors can successfully negotiate the dental school curriculum, even though the students themselves would increase admission requirements to include more basic science courses than commonly required. Basically, the students' recommendations for required undergraduate basic science courses would replicate the standard basic science coursework found in most dental schools: anatomy, histology, biochemistry, microbiology, physiology, and immunology plus the universal foundation course of biology.     

Effect of using electronic apex locators on selected endodontic treatment parameters

The purpose of this study was to determine the effect of using electronic apex locators on the number of radiographs taken and the adequacy in length of the final obturation. Patients in an undergraduate student endodontics clinic participated in the study. The working length (WL) was estimated by the authors for all cases (36 teeth; 58 canals), using both a preoperative standardized radiograph and an electronic measurement. The students were then asked to place WL files to one of the estimates (electronic or radiographic; chosen by random assignment) and take a WL radiograph. Neither the students nor their instructors knew which method was chosen for the estimates. Once treatment was completed, the total number of working radiographs was counted. The number of cases with acceptable (0 to 2 mm short of the apex) or unacceptable obturation was also blindly registered. An electronic estimate of the WL improved length quality of the final obturation, compared with a radiographic estimate. The number of working radiographs taken was less in the electronic apex locator group in anterior and premolar teeth, but not in molars.