Comparing fourth-year dental student productivity and experiences in a dental school with community-based clinical education

Reports and articles by the Institute of Medicine, the American Dental Education Association (ADEA) Commission on Change and Innovation in Dental Education (CCI), and the Macy Foundation have examined the challenges confronting dental education and reached the conclusion that U.S. dental education is on the brink of major change. A recent "case for change" article by the CCI makes the argument that dental education, as currently structured, is quickly becoming obsolete, overpriced, and lacking in its ability to provide the education that future practitioners will need. The Ohio State University College of Dentistry (OSUCOD) began a major reorganization of its clinical education program upon receipt of a Robert Wood Johnson Foundation-sponsored Pipeline, Profession, and Practice grant. In our fourth year of the five-year grant program, known as the OHIO Project (Oral Health Improvement through Outreach), our fourth-year dental students approached the sixty-day target of time spent in community-based clinical education. The purpose of this report is to describe the productivity of students and the characteristics of the patient pool they care for in community-based sites as compared to our school-based clinics during that final year. This report reflects the activity of 102 students in the graduating class of 2006. Attendance (clinic utilization) was estimated to be 94 percent at OSUCOD and 99 percent at OHIO Project sites. In the aggregate, the OHIO Project-based students treated a total of 11,808 unique patients and completed 26,882 procedures in the community during their 41.9-day community experience. This translates into 116 unduplicated patients and 264 procedures per student in the community-based sites for the period studied. In comparison, the same students treated 19,344 unique patients and completed 28,680 procedures during ninety-three clinic days at the school. Each student treated 190 patients and completed 281 procedures. Fourth-year dental students completed as many procedures and generated similar revenue-equivalents in community sites as they did in a dental school clinic in half the time.     

Longevity of restorations in a dental school clinic

The longevity of 1,207 restorations placed by students was studied in 70 adult patients. The overall percentage of restorations lasting ten years or more (P10) was 75.4 percent and survival times were longer than in most previous restoration longevity studies. Cast restorations lasted significantly longer than amalgams, which in turn lasted significantly longer than composites. P10 values were 91.1 percent, 72.0 percent, and 55.9 percent, respectively. Analysis by surfaces involved indicated that single-surface lasted longer than multisurface restorations. The survival of restorations placed in patients aged 60 or more was less favorable (P10 = 56.8 percent) than for younger patients (P10 = 78.3 percent). A subset of the population was identified on the basis of a restoration failure rate of greater than 4.0 X 10(-2) failures/restoration year. This group, comprising 18.6 percent of the population, accounted for 56.1 percent of all restoration failures. The P10 value for this high-risk group was 55.8 percent, as compared with 83.9 percent for the remainder of the population.     

Comparison of personal values among freshman and senior dental students and dental faculty.

The purpose of this study was to test the effects of dental education on the values of dental students and dental faculty. This was accomplished by testing five hypotheses. The results of the study indicate no significant differences between freshmen and senior students' values; infer no apparent changes in student values during a dental education; indicate no significant differences between part-time faculty and full-time faculty; support a positive association among all groups, i.e., freshmen, seniors, full- and part-time faculty; rank-order the values for all groups from highest to lowest (theoretical, aesthetic, political, economic, social, and religious); and show some significant differences between students as a group and faculty as a group. If a more objective means of choosing dental students is desired, then further research will be needed to determine the characteristics of the type of practitioner that is needed. The presented data help in defining one aspect of the collective personality of dental students and dental faculties.     

Communication tendencies of senior dental students

Although the importance of dentist-patient communication is generally recognized, the dental literature does not specify what interpersonal behaviors can be used as a basis for evaluating dental students' communication skills. A set of behaviors based on clinical observations is described, and an evaluation of 25 senior students' behavioral skills is presented. Students often did not: (1) spend much time orienting patients before beginning treatment; (2) update medical histories; (3) ask patients if they had any questions before beginning treatment; (4) explain the operation and use of equipment; (5) forewarn patients about uncomfortable procedures; (6) attend to signs of patient discomfort; (7) reinforce praiseworthy patient behavior; (8) caution patients about numbness, chewing, and sensitivity; (9) thank patients for their time; and (10) use leading/motivating questions. There is a need to provide students with systematic feedback on their interpersonal behaviors.     

Evaluating externship programs: impact of program length on clinical productivity

Community-based dental education programs such as externship programs have become an integral component of dental school education. Qualitative evaluation of externship programs has captured increased confidence, efficiency, skill, and independence among students. To better understand these findings, quantitative evaluation of the externship experience is necessary. The current study investigated the clinical care (defined as dental procedures) provided by Boston University School of Dental Medicine students who completed six-week general dentistry externships compared to those completing ten-week general dentistry externships. Results indicate that the scope of services provided in the ten-week externship differed from the six-week externship. The longer externships allowed for students to perform more complex procedures toward the latter part of their externships. Students participating in the ten-week externship also provided more procedures per week than students in the six-week externship. Because scheduling of patient appointments is generally a function of the site, number of patient visits and procedures performed per patient did not differ between the two groups. Our findings provide insight into the reason why longer externships increase clinical confidence, efficiency, and skill. In the continuing effort to improve the externship experience in dental schools, these findings should be taken into consideration.     

Underreporting of bloodborne exposures in a dental school clinic

This study explored the rate of underreporting of bloodborne exposures among dental students in a U.S. dental school during the final two years of clinical practice. It also explored the reasons students cite for failing to report bloodborne exposures. Surveys of the dental students found that senior students reported only 43 percent of the exposure incidents they experienced in their final year of clinical education and that the rate of reporting declined from the junior year to the senior year. We subsequently undertook an educational campaign to raise awareness among the students regarding the importance of reporting exposure incidents. Surveys were repeated for the next two years at the end of each academic year. The following year, the senior class indicated they had reported 79 percent of the experienced exposure incidents. This was not only a significant improvement over the previous year, but also demonstrated an improvement in reporting from their junior year to senior year, reversing the previously noted trend for exposure reporting to drop off in the senior year.     

Self-reported mental illness in a dental school clinic population

The purpose of this study is to assess the prevalence of mental illness in a university-based dental clinic population. Dentists routinely review the patient's medical history to identify any physical disease or condition that may impact dental treatment. Mental illness may also affect dental treatment and patient management. This study examined the degree to which patients seeking routine dental care report these diagnoses. Data was gathered from records of 508 consecutive new patients whose treatment plans were submitted for faculty approval. The patient's self-reported mental illness was obtained from the patient questionnaire and physical evaluation forms of the dental record. One hundred thirty-six patients (26.77 percent) reported at least one mental illness. Of all diseases and disorders recorded in the medical history, self-reported depression was second only to hypertension in frequency. Substance abuse, anxiety, anorexia, bulimia, insomnia, bipolar disorder, and post-traumatic stress disorder were also common findings. This study establishes the need for training of dental students to recognize and manage psychologically compromised patients. The dental curriculum must address these issues.     

Prevention-oriented practice of Iranian senior dental students

OBJECTIVES: To investigate self-reported preventive practice of Iranian senior dental students in dental caries management. SUBJECTS AND METHODS: To obtain an estimated sample size of 250 subjects, seven state dental schools were selected based on a stratified random sampling approach. All the senior dental students (n = 327) were asked to voluntarily fill in a self-administered pre-tested questionnaire during the spring term in 2005. In the questionnaire two hypothetical patient cases (a high-risk and a low-risk patient) were presented and the students were asked to express their conceptions on a five-point Likert scale about including each of nine given alternatives in the patients' treatment plans. The respondents' self-reported oral self-care (OSC), preventive knowledge, attitude towards prevention and self-perceived competency in giving preventive care were also assessed. Chi-squared test and logistic regression model served for statistical analyses. RESULTS: A total of 270 students filled in the questionnaire (response rate = 82%). Acquiring high scores of preventive practice as assessed by patient cases was found to be more frequent among those reporting recommended OSC (P = 0.007) and those with higher attitude scores (P < 0.001). Also, those reporting being competent in giving preventive care had higher scores of preventive practice compared with the others (P = 0.02). In the regression model, recommended OSC (P = 0.05, OR = 1.9) and positive attitudes towards preventive dentistry (P = 0.001, OR = 3.3) showed significant association with acquiring highest scores of preventive practice. CONCLUSION: To improve their preventive practice in the future, more emphasis should be placed on the dental students' own oral health behaviour and attitudes related to it.