The Sheffield outreach teaching programme

Sheffield's School of Clinical Dentistry has developed a year-round dental outreach teaching programme of 20 weeks for each student in two or three of six already established general practices and five PCT clinics. On the programme, under local supervision, students provide comprehensive care for patients and complete associated projectwork. This paper first describes the development and management of the programme then the learning experiences of recent students.     

Ready for practice? A study of confidence levels of final year dental students at Cardiff University and University College Cork

Aim: The aim of this study was to describe the self‐reported confidence levels of final year students at the School of Dentistry, Cardiff University and at the University Dental School & Hospital, Cork, Ireland in performing a variety of dental procedures commonly completed in primary dental care settings. Method: A questionnaire was distributed to 61 final year students at Cardiff and 34 final year students at Cork. Information requested related to the respondents confidence in performing a variety of routine clinical tasks, using a five‐point scale (1 = very little confidence, 5 = very confident). Comparisons were made between the two schools, gender of the respondent, and whether or not a student intended completing a year of vocational training after graduation. Results: A response rate of 74% was achieved (n = 70). The greatest self‐reported confidence scores were for ‘scale and polish’ (4.61), fissure sealants (4.54) and delivery of oral hygiene instruction (4.51). Areas with the least confidence were placement of stainless steel crowns (2.83), vital tooth bleaching (2.39) and surgical extractions (2.26). Students at Cardiff were more confident than those at Cork in performing simple extractions (Cardiff: 4.31; Cork: 3.76) and surgical extractions (Cardiff: 2.61; Cork: 1.88), whilst students in Cork were more confident in caries diagnosis (Cork: 4.24; Cardiff: 3.89) fissure sealing (Cork: 4.76; Cardiff: 4.33) and placement of preventive resin restorations (Cork: 4.68; Cardiff: 4.22). Conclusion: Final year students at Cardiff and Cork were most confident in simpler procedures and procedures in which they had had most clinical experience. They were least confident in more complex procedures and procedures in which they had the least clinical experience. Increased clinical time in complex procedures may help in increasing final year students’ confidence in those areas.     

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 relevance of oral biology by dental students

Objectives: This study investigated the perception that dental students have regarding the relevance of oral biology (OB) to dental education and dentistry in general. Moreover, this study analysed students’ attitude towards OB learning approaches and resources. Methods: A questionnaire based on a Likert scale was used to survey pre‐clinical/second (BDS2)‐ and final/fifth (BDS5)‐year dental students at the School of Dentistry of the University of Birmingham (United Kingdom). In comparison, a small group of postgraduate specialist registrars were surveyed to evaluate the attitudes of practising dentists. Results: The results show that all study groups expressed a high level of perceived relevance of OB to dentistry. Students’ perception of OB for dental education, clinical training and practice also scored high. More than 40% of undergraduate students and about 55% of the postgraduates indicated a perceived change in their attitude towards OB with time characterised by increased appreciation of the subject. Lectures were considered as the most important teaching approach, whereas ‘group poster projects’ ranked lowest. Of the different study resources, lecture handouts received the overall highest importance score. Conclusions: The results indicate that dental students considered OB relevant for dental education and dentistry and suggest a positive attitude towards the subject. This study also suggested that dental students prefer teacher‐centred/led teaching rather than student‐directed learning of OB. The article addresses the role of OB and science‐related research projects within the dental curriculum and discusses that close integration of basic sciences with dental education may enrich dental education and overall learning experience.     

The Baltic dental programme at The Faculty of Dentistry of The Karolinska Institute: first evaluation

In 1992, The Faculty of Dentistry of The Karolinska Institute (KI) introduced a dental undergraduate programme specifically for Baltic students. Initiative for this programme came from both the Ministries of Health in Estonia and Latvia and a Member's Bill in the Swedish Committee for Foreign Affairs. The first 10 students were admitted in January 1992, and in 1994, a further 8 students were accepted. The main objective is to train Baltic students according to the Scandinavian model of dental education, in order to facilitate a positive development in dentistry in these countries. Candidates for the programme, dental students in Latvia or Estonia who had completed several preclinical years, were interviewed and tested in their home countries by a Swedish Admissions Committee. The curriculum comprises 7 semesters at the School of Dentistry, and includes complementary courses in basic science, preventive dentistry, and theoretical and practical courses in all fields of clinical dentistry. The students work with Increasing independence, treating patients with a great variety of oral diseases and from different age groups. A course in Informatics is central and forms a base for a research-based assignment in collaboration with the respective home universities. The Baltic Programme is the first time KI has designed and implemented a specially tailored dental undergraduate curriculum in English for a selected group of foreign undergraduates. The students have proved to be ambitious and industrious, with very high academic standards. Their results in the written examinations were equal to or better than those of the home students. Of the 9 students who to date have completed the course, all are working as dentists In their respective countries and 6 are associated with their university.     

Eleven-year report on a predoctoral implant dentistry program.

PURPOSE: An elective program on implant dentistry was started in the summer of 1994 at the University of Detroit Mercy School of Dentistry (UDM). The program provides comprehensive didactic and clinical training in implant dentistry to a select group of senior dental students. This study describes the program and clinical results of the first 11 years of the elective program in implant dentistry at UDM. MATERIALS AND METHODS: The program is 1 year long and is offered to a group of 10 senior students out of a class of 72. In addition to a one-semester lecture course offered to all dental students, students in the elective program participate in a one-semester seminar which includes literature review and "hands-on" surgical and prosthodontic components. Patients are assigned during the summer term to students who work in pairs. Students actively participate in diagnosis and treatment planning, assist in surgery, and accomplish the prosthodontic procedures. Prosthodontic services include single-tooth restorations, multiple-unit fixed restorations, overdentures, and full-arch fixed prostheses. A retrospective analysis of the patients treated in the first 11 years of the program was conducted. RESULTS: During the first 11 years of the program, 159 implants were placed in 70 patients. There were a total of 10 failed implants in seven patients (failure rate 6.3%): eight implants prior to loading and two following loading. Minor complications included gold screw loosening, gold screw fracture, porcelain fracture, and soft tissue inflammation, which occurred in less than 5% of the patients. CONCLUSIONS: The rates of implant failure and complications in the first 11 years of the elective implant program at UDM appear to be within an acceptable range when compared to other educational programs and studies reported in the dental literature.     

Indications for and anticipated difficulty of third molar surgery: a comparison between a dental hospital and a specialist high street practice

OBJECTIVE: To investigate the indications for and anticipated difficulty of third molar surgery between two different referral settings. DESIGN: A prospective study involving completion of a proforma pre- and post-operatively. SETTING: A dental teaching hospital and a specialist surgical dentistry practice in 2003. SUBJECTS AND METHODS: Patients referred for the assessment of their third molars were recruited. Details of the clinical and radiographical assessment for each patient were recorded pre-operatively and the extent of surgery required post-operatively. RESULTS: The main indication for referral for third molar extraction was pericoronitis in both centres. A larger number of patients were assessed and treated in a shorter period of time at the surgical dentist compared with the dental hospital. The surgical dentist was accurate in his assessment of the difficulty of surgery 96% of the time compared with 66% for the dental hospital staff. CONCLUSIONS: This study highlights the benefits for patients in being treated by a surgical dentist. As dental students require exposure to surgical dentistry in order to attain a level of competence, a reduction in the number of patients being referred to dental hospitals may impact upon students' ability to both assess and perform surgical procedures. This may mean that undergraduates will be less able to fulfil the recommendations of the General Dental Council. An outreach programme for final year dental students to surgical dentistry practices would benefit all concerned.     

Implant dentistry in predoctoral education: The elective approach

In response to interest by dental students and patient needs, an elective program in implant dentistry was started at the University of Detroit Mercy School of Dentistry (UDM) in the summer of 1994. The 1-year program is offered to a group of 10 senior students out of a class of 72. Implant treatment is provided to selected edentulous and partially edentulous patients. Predoctoral students participate in diagnosis and treatment planning, assist in surgical placement, and perform the prosthodontic procedures. A survey was sent to 160 UDM graduates, and 90 responded. Out of the 90 respondents, 35% had participated in the elective implant program and 65% had not. A Pearson correlation matrix was used to analyze their responses. A stronger positive correlation with offering and restoring implants was seen in graduates who had completed the elective program in implant dentistry.     

Evaluation of a U.K. community-based clinical teaching/outreach program by former dental students two and five years after graduation

Over the past few years, community-based clinical teaching/outreach teaching programs have been established in many dental schools in the United Kingdom. One such program was developed by Cardiff University at the local St. David's Hospital in 2002. Students visit this unit throughout their dental school program--as an assistant/observer initially, but gaining a significant amount of clinical operating experience within the unit during their final year of studies. While contemporaneous feedback from current dental students at this and other programs has been positive, very little information exists on the impact of this form of training on the subsequent clinical careers and working practices of qualified dentists. In autumn 2009, a postal questionnaire was distributed to dentists who graduated from the School of Dentistry at Cardiff in 2004 (n=41) and 2007 (n=51). Fifty-eight responses were returned, for a response rate of 63 percent: 2004 (66 percent), 2007 (61 percent). Forty-seven respondents (81 percent) reported that their learning experience at the St. David's outreach teaching program had been of significant assistance in their professional development in their subsequent clinical careers. Positive features of the program included the availability of a suitably trained dental nurse for all procedures (n=26, 45 percent), ready access to helpful/approachable teaching staff (n=24, 41 percent), and a good working atmosphere (n=23, 40 percent). Overwhelmingly, former dental students reported that the educational experiences they gained were positive and have had a beneficial effect on their subsequent clinical careers. Further development of community-based clinical teaching/outreach training as part of dental school training programs is encouraged.     

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.     

Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students

OBJECTIVE: To determine whether any differences existed in dental health behaviour between Japanese and Finnish dental students. SETTING: Hiroshima University School of Dentistry and the University of Helsinki. DESIGN: Comparison of cross-cultural differences of self-reported oral health behaviour. SUBJECTS: Dental students, 337 in Japan and 113 in Finland. METHOD: Subjects were surveyed using the Japanese and Finnish versions of a 20-item questionnaire entitled Hiroshima University--Dental Behavioural Inventory (HU-DBI). RESULTS: Only 2 per cent of Finnish students reported that they put off going to the dentist until they had toothache, compared to 56 per cent of Japanese students. Similarly, significantly more Japanese students thought that their teeth were getting worse despite their daily brushing, compared to their Finnish peers. The mean HU-DBI score of Year 1 Finnish students was higher than that of their Japanese peers, which suggested a higher level of dental health awareness in Finnish students upon entry into dental school. The mean scores of the Japanese students were lower than those of their Finnish peers until Year 3. The mean scores of Year 5 and Year 6 Japanese students were higher than that of Year 1 students, indicating raised self-care levels influenced by the course in preventive dentistry. The gender difference of the HU-DBI score was not a major feature in either country. CONCLUSIONS: Self-reported oral health behaviours seemed to be very different between the two countries, which reflected different culture and/or health education systems of the students.     

Acceptance of psychology teaching in paediatric dentistry by undergraduate dental students

By means of a questionnaire, 4 cohorts of undergraduate students (n = 144) were asked before and after the clinical course in paediatric dentistry about their acceptance of the teaching of psychological aspects in dentistry. A generally very high interest was found for psychology as well as for child-related psychology. The teaching of this topic by means of lectures was thought to be useful, but other didactic means were demanded to supplement teaching. For many of the aspects taught, more information was requested. Moreover, teaching of aspects not taught in the lectures was also requested. The more obvious the practical relevance of each topic appeared, the greater was the students' interest. Psychology was thought to be useful as an aid to paediatric treatment. However, interest dropped after the completion of the paediatric dentistry course. It is concluded that undergraduate dental students have no particular inclination towards the treatment of children but rather a need for guidelines to avoid potential problems in dealing with this demanding group of patients.     

Repair or replacement of defective direct resin-based composite restorations: contemporary teaching in U.S. and Canadian dental schools

BackgroundOpportunities exist to promote minimally invasive dentistry by repairing rather than replacing defective and failing direct resin-based composite restorations. The authors conducted a study to investigate the current teaching of such techniques in U.S. and Canadian dental schools.MethodsIn late 2010, the authors, with the assistance of the Consortium of Operative Dentistry Educators, invited 67 U.S. and Canadian dental schools to participate in an Internet-based survey.ResultsThe response rate was 72 percent. Eighty-eight percent of the dental schools taught repair of defective direct resin-based composite restorations. Of these schools, 79 percent reported providing both didactic and clinical teaching.ConclusionsAlthough teaching repair of defective resin-based composite restorations was included in the didactic curricula of most schools, students in some schools did not gain experience in minimally invasive management of defective resin-based composite restorations by means of performing repair procedures. The American Dental Association's Code on Dental Procedures and Nomenclature does not have a procedure code for resin-based composite restoration repairs, which may limit patients' access to this dental treatment.Clinical ImplicationsTeaching dental students minimally invasive dentistry procedures, including restoration repair, extends the longevity of dental restorations and reduces detrimental effects on teeth induced by invasive procedures, thereby serving the interests of patients.     

Interprofessional learning enhances knowledge of roles but is less able to shift attitudes: a case study from dental education

Introduction: Interprofessional education (IPE) purports to improve team working through improved knowledge of the roles of others, and by engendering mutual respect. This case study aimed to determine the impact of an IPE curriculum on knowledge and attitudes of dentistry and dental technology students undertaking these curricula in the new School of Dentistry and Oral Health at Griffith University. All dental technology students and third‐ and final‐ (fifth) year dentistry students were invited to participate. Method: A mixed‐method approach was used to compare attitudes, perceptions and experiences of students involved in our IPE curricula. Quantitative data were evaluated with the Statistical Package for the Social Sciences (SPSS), and qualitative findings were explored through an Excel^® spreadsheet coding frame tested against Leximancer^TM qualitative software for consistency. Results: Forty‐six of the 131 eligible students participated. Readiness for Interprofessional Learning Scales (RIPLS) and focus groups consistently showed that IPE positively influenced professional identity and improved communication between and amongst all students and assisted them in developing their roles. A prevailing sense of greater importance and a lack of mutual respect between dentistry and dental technology students were, unfortunately, evident. The process was, however, sufficient to enhance teamwork and collaboration when planned learning revolved around explicit patient care in the provision of dental prostheses. Conclusion: Further development of such curricula is needed to maximise IP learning (IPL) opportunities, to shift traditional attitudes and, potentially, to improve the outcomes of patient care. To enable this, academic and clinical leaders need to embrace the ideals of IPE.     

Mentoring: a professional responsibility

Dental and dental hygiene students were surveyed to determine how many students had participated in high school or college career exploration courses sponsored/supported by Oregon Health & Science University (OHSU) School of Dentistry. The participants were asked to identify which aspects of the programs were the most influential in shaping their exploration of a dental or dental hygiene career and why they decided to apply to the dental or dental hygiene program. These aspects included the availability and the cost of the courses, lecture content, hands-on activities in the laboratory, observations in dental offices, mentoring activities of dentists, dental hygienists, dental/dental hygiene students, and perceived value for applicant competitiveness. The faculty evaluated their level of participation in relation to teaching responsibilities and time commitment. An analysis of the direct and indirect costs to the school was examined. Results of the surveys indicated that between 20-42% of the entering classes had participated in one or more career exploration activities or programs. Participants identified mentoring relationships with their current dentist and dental hygienist as the most important factor in determining their decision to choose dentistry or dental hygiene as a career. Observations in dental offices, encouragement from a dental and/or dental hygiene student, hands-on activities, and repetitive positive career experiences were also significant factors.     

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.     

Acceptance of video-based teaching in paediatric dentistry by undergraduate dental students

Five cohorts of undergraduate students (n = 160) were filmed on video tape while performing paediatric treatments. Sequences of these recordings were shown 1 day later and discussed. Thus, within one term each student was able to view himself as well as fellow students on video. After the completion of the clinical course in paediatric dentistry, students were asked by means of a questionnaire about the acceptance and benefits of video-based teaching in paediatric dentistry. 95.5% welcomed the use of video in paediatric dentistry. Concerning the benefits gained from the video showing the treatment that had been performed by the student himself, 83.4% said they had gained new insights in their own behaviour and 80.3% thought these insights to be useful for their clinical work. For the video showing treatments by fellow students, numbers were higher: 84.7 and 89.8%, respectively. Gender-specific differences revealed that women feel more disturbed by the fact that they are being filmed (7.8% vs. 14.9%), some even think that they would have performed a better treatment without the video. Out of four didactical means, video gained the highest vote, followed by seminars, lectures and slides. It is concluded that the use of video is a valuable didactical means that should be considered in teaching undergraduate students.