A community of learners in the evidence‐based dental clinic

An increasing emphasis has been placed on the need for an evidence‐based approach in dentistry. This calls for effort in dental education to develop and implement tools for the application of evidence in clinical decision‐making (evidence‐based decision‐making, EBDM). Aim: To evaluate whether the implementation of a community of learners (COL) within a clinical EBDM course enables students, clinical teachers and scientists to discuss the application of evidence in clinical decision‐making and whether it stimulates a scientific approach in students. Material and Methods: A clinical course in EBDM was created. Students presented and discussed patient cases in a COL of student‐peers, clinical teachers and scientists. From the discussion, clinical questions arose and were translated into PICO format (Problem, Intervention, Comparison and Outcome). Students searched for evidence in the literature. Four weeks later, they presented and discussed the evidence found. Before and after the implementation of the course, students, clinical teachers and scientists completed a questionnaire anonymously on the procedure adopted, its content, the learning outcomes and their appreciation of this course. Assessment of the competence EBDM was performed at the end of the course. Grading scores of students in the COL were compared with scores of a student group that did not participate in the COL and were not advised by scientists. Results: Evaluation showed that scientists, clinical teachers and students gradually became more positive on the adopted procedure, content, learning outcomes and the appreciation of this course (ANOVA Bonferoni P < 0.05). The student’s evaluation showed the development of a more scientific approach. Assessment scores of EBDM were sufficient and promising. Conclusion: A stimulating arena was created: a COL, in which the evidence used in clinical decision‐making, was discussed. The COL involved dental students, clinical teachers and scientists. In this setting, an EBDM course appeared to result in a more scientific approach from dental students. The COL provided a good working concept for EBDM in dental education.     

An approach on defining competency in evidence‐based dentistry

Introduction

Assessment of evidence‐based dentistry (EBD) knowledge and behaviour is hampered by lack of explicit competency criteria. This void impedes instructional design and assessment of student growth during the educational process.

Methods

Knowledge and cognitive domains supporting educational objectives in a pre‐doctoral dental programme were identified for each level of the EBD five‐step process. We articulated educational objectives with behavioural expectations for each level of skill acquisition at each step of the EBD process. Outcome evaluation criteria identify students’ progressive level of skill acquisition from novice to expert.

Results

The educational objectives, type of knowledge, and nature of the cognitive process supporting these objectives are presented for each step of the EBD process. For example, educational objectives of the “Ask” step include (i) to construct a question from the patient presentation and knowledge limitations that addresses the clinical problem and (ii) to articulate the Problem, Intervention/Exposure, Comparison, Outcome (PICO) components. Achievement of these objectives requires both factual information regarding the PICO format and the cognitive process of understanding. Educational outcome criteria consistent with a competent clinician include clear articulation of the PICO with identifiable pieces that relate to the clinical situation.

Discussion

Assessment strategies for progression towards EBD competency are limited due to the complexity associated with evaluating EBD knowledge and behaviours. To evaluate performance, the EBD academic community must define competency expectations for entry into unsupervised general dental practice.

Conclusion

This framework offers measurable outcome evaluation criteria to initiate a conversation with academic peers regarding current gaps in EBD assessment.     

Use of online sources of information by dental practitioners: findings from The Dental Practice‐Based Research Network

Objective: Estimate the proportion of dental practitioners who use online sources of information for practice guidance. Methods: From a survey of 657 dental practitioners in The Dental Practice‐Based Research Network, four indicators of online use for practice guidance were calculated: read journals online, obtained continuing education (CDE) through online sources, rated an online source as most influential, and reported frequently using an online source for guidance. Demographics, journals read, and use of various sources of information for practice guidance in terms of frequency and influence were ascertained for each. Results: Overall, 21 percent (n = 138) were classified into one of the four indicators of online use: 14 percent (n = 89) rated an online source as most influential and 13 percent (n = 87) reported frequently using an online source for guidance; few practitioners (5 percent, n = 34) read journals online, fewer (3 percent, n = 17) obtained CDE through online sources. Use of online information sources varied considerably by region and practice characteristics. In general, the four indicators represented practitioners with as many differences as similarities to each other and to offline users. Conclusion: A relatively small proportion of dental practitioners use information from online sources for practice guidance. Variation exists regarding practitioners' use of online source resources and how they rate the value of offline information sources for practice guidance.     

The effect of partially exposed connective tissue graft on root‐coverage outcomes: a systematic review and meta‐analysis

The aim of this systematic review was to compare the root‐coverage outcomes of using a partially exposed connective tissue graft (CTG) technique with a fully covered CTG technique for root coverage. An electronic search up to February 28^th, 2017, was performed to identify human clinical studies with data comparing outcomes of root coverage using CTG, with and without a partially exposed graft. Five clinical studies were selected for inclusion in this review. For each study, the gain of keratinized gingiva, reduction of recession depth, number of surgical sites achieving complete root coverage, percentage of root coverage, gain of tissue thickness, and changes of probing depth and clinical attachment level were recorded. Meta‐analysis for the comparison of complete root coverage between the two techniques presented no statistically significant differences. A statistically significant gain of keratinized tissue in favor of the sites with an exposed CTG and a tendency of greater reduction in recession depth were seen at the sites with a fully covered CTG. Based on the results, the use of a partially exposed CTG in root‐coverage procedures could achieve greater gain in keratinized gingiva, while a fully covered CTG might be indicated for procedures aiming to reduce recession depth.