Competence,competency‐based education,and undergraduate dental education: a discussion paper

Introduction

The aim of undergraduate dental education is to provide competent dentists to serve societal needs and improve population oral healthcare. Competency‐based education has influenced the development of dental education for decades but this term is problematic. This article explores components of competency‐based undergraduate health professional education in order to help the dental profession have a better understanding of the context and purposes of undergraduate dental education.

Methods

This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on competency‐based undergraduate education.

Results and Discussion

Competence comprises an integration of knowledge, skills and attitudes indicating a capability to perform professional tasks safely and ethically. The process of becoming a competent practitioner is complex. Four characteristics of competency‐based education are: curriculum components and content shaped by societal needs; focused on student‐centred learning; learning achievement; and limited attention to time‐based training and numerical targets. Alongside a competency‐based approach, undergraduate dental education can be influenced by institutional features and external factors but these receive little consideration in the literature.

Conclusion

Understanding competence, competency‐based education, and institutional and external factors will help to improve educational quality, define roles and professional development for the dental educator, and inform further research.     

Undergraduate endodontic teaching in New Zealand: Students’ experience,perceptions and self‐confidence levels

The aim was to investigate undergraduate students’ experiences, perceptions of future practice and self‐rated confidence levels across endodontic tasks. After ethical approval, a survey involved all fourth and fifth year students. Quantitative data were analysed in SPSS version 20.0. Qualitative data were analysed using a general inductive approach. The participation rate was 84% (n = 136 of 162). The mean number of canals completed was 2.6 by fourth years and 10.4 by fifth years. Maxillary premolars were the most common first tooth treated. Pulpal factors and root morphology were the most common reasons for experiencing difficulty. Self‐rated confidence levels were lower for the more junior students and complex procedures. Students felt that an increased use of extracted natural teeth would be beneficial in their pre‐clinical practice. A high level of interest was shown in future specialisation in endodontics. Students may benefit from further didactic teaching or pre‐clinical instruction in selected topics.     

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.     

Students’ perceptions of the educational environment in a Greek Dental School,as measured by DREEM

Aim: The aim of this study was to estimate the dental students’ perceptions of their educational environment and to identify any differences related both to their gender and semester of studies. Materials and methods: The translated and validated in Greek Dundee Ready Education Environment Measure (DREEM) questionnaire was distributed to all 2nd‐ to 5th‐year students of the Athens Dental School. The questionnaire consisted of 50 statements organised in five subscales (perceptions of learning, teachers, atmosphere, academic self‐perceptions and social self‐perceptions). Internal validity was checked with Cronbach alpha. Confirmatory factor analysis (CFA) was performed under the same conditions as the original inventory. Mean statement, subscale and overall scores were calculated and given as percentages. Results: The response rate was 64%. Overall Cronbach alpha was 0.93 (excellent). CFA produced five meaningful subscales, not matching the original ones. The overall DREEM mean score was 56%. Gender did not influence the findings. The students’ perceptions of the educational environment with the exception of the academic self‐perceptions were more positive in the pre‐clinical years. Statistically significant differences were revealed only for the ‘learning’ subscale between the 3rd‐ and the 4th‐year students. Seventy‐eight percent of the statements were in the positive side. The lowest scores were related to students’ stress, tiredness and lack of appropriate feedback from the teachers, and the highest were related to accommodation, school friends and perceptions that they feel socially comfortable in class. Conclusions: Students’ perceptions of the educational environment were reasonably positive, with no gender difference. However, some weaknesses were identified, particularly in the clinical years. Further research is needed to clarify appropriate interventions.     

Students’ perception of a problem‐based learning scenario in dental nurse education

Background: In July 2008, The General Dental Council implemented mandatory registration for Dental Nurses in the United Kingdom, recognising them as legally responsible for patient care. As dentistry comes to terms with the impact registration has on dental nurses, sustained advances in the teaching of students in other healthcare disciplines demonstrate the way in which the role of pedagogy in dental nurse education has been underdeveloped. In an attempt to see dental nursing stand in line with other progressive healthcare professionals, the authors have implemented Problem‐Based Learning (PBL) into a dental nurse program in NHS Education for Scotland, Glasgow. Aim: The aim of the research is to assess the perceptions of dental nurse students with regard to participation in active learning. Materials and Methods: The study is facilitated by a short PBL package which offers introductory exposure to this method of learning. A qualitative approach has been taken to gather experiential data using a questionnaire. Thematic analysis took place to reveal emergent themes. Results: Analysis reveals that the participants found PBL to be an enjoyable experience that could be valuable in the acquisition of deep knowledge and improved patient care. The participants raised concerns with regard to confidence in their own knowledge acquisition in PBL sessions and highlighted a need for improved feedback. Discussion and conclusion: While the participants enjoyed the self directed nature of PBL, it is important to note that the need for facilitator guidance was considered imperative, especially where the students had little or no experience of PBL, as in this study.