The dental school learning milieu: students' perceptions at five academic dental institutions in Pakistan

The significance of the educational environment in health professions academic institutions, increasingly recognized on a global scale, is fundamental to effective student learning. This study was carried out to evaluate students' perceptions of the educational environment in five undergraduate dental institutions in Pakistan. This non-interventional study used a postal questionnaire based on the Dundee Ready Educational Environment Measure (DREEM). The subjects were dental students taking the final professional B.D.S. examination at five dental institutions affiliated with the University of Health Sciences, Lahore, Pakistan. A total of 197 students participated in the study (response rate of 83.82 percent). The overall DREEM score was 115.06 (Cronbach's alpha 0.87). Nine items recorded scores <2 and were flagged for remediation. Significant differences were observed between students' perceptions of learning and of teachers (p<0.05). Many issues challenge the quality and delivery of dental education in Pakistan, and dental institutions need to develop robust mechanisms to incorporate contemporary international trends in dental education in order to improve the educational environment.     

Dental students' knowledge and perceptions of non-invasive dental caries management

Background:  An evidence-based, risk-specific, and non-invasive modality for caries management was implemented in the University of Sydney dentistry curriculum. This study reviews its impact on student learning outcomes and their perceptions of the efficacy of a risk-based caries management.
Methods:  One hundred and nine Year 3 and Year 4 students were invited to complete a questionnaire to assess their understanding of the protocols and their perceptions of both the education process and value of the non-invasive treatment modality.
Results:  A response rate of 93% Year 3 and 46% Year 4 students was obtained. They correctly identified high and low risk cases but Year 3 students were inclined to misclassify medium risk cases. Most understood correctly that enamel lesions should be arrested and remineralized but were often more radical in dealing with dentine lesions. Students who believed the protocols were useful and who spent more time on preventive care were less likely to restore enamel and dentine lesions.
Conclusions:  A modest level of knowledge concerning application of the non-invasive caries management system to paper-based clinical case studies was demonstrated. Protocol misinterpretation may reflect inconsistent instruction by some clinical tutors. It is hoped that the promulgation of evidence-based dentistry will overcome these barriers in future.     

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.     

Brazilian dental students' perceptions about medical emergencies: a qualitative exploratory study

Dental students have little understanding about medical emergencies, and there is very little in-depth data about the importance they place on this important area that is fundamental to their professional training. This study aimed to identify the perceptions of a group of undergraduate dental students about the dentistry-medical emergency interface. Twenty undergraduate dental students at the Federal University of Goias, Brazil, took part in this study. The data were collected through in-depth interviews with these students and were interpreted using qualitative content analysis. Two themes emerged from this data analysis: dentistry as a comprehensive health science, and students' knowledge, feelings, and attitudes about medical emergencies in the dental office. Based on the students' perceptions, an interface between dentistry and medical emergencies in the dental office was proposed that is comprised of the following intertwined concepts: 1) dentistry is a health science profession that should focus on the whole patient instead of being limited to the oral cavity; 2) medical emergencies do occur in the dental office, but students' minimal knowledge about these incidents and their etiology causes feelings of insecurity, dissatisfaction, and a limited appreciation of the dentists' responsibility; and 3) the inability to perform proper basic life support (BLS) technique in the dental office is the ultimate consequence. Undergraduate health courses need to develop strategies to teach professionals and students appropriate behavior and attitudes when facing life-threatening emergencies.     

Dental practitioner attendances at postgraduate courses in a dental school

The attendance pattern of dental practitioners who resided in the West Midlands and attended postgraduate courses at Birmingham University Dental School was studied. Data were collected from the participants as to their name, the location of their practice and the type of course that they attended. Other information such as their qualifications or their attendance at other postgraduate courses was sought from appropriate records. The percentage of West Midlands' dentists who attended postgraduate courses at Birmingham University Dental School was found to be 41%, although this figure was higher amongst Birmingham (53%) and Wolverhampton (51%) practitioners. It is known that practitioners participated in other types of continuing educational activities elsewhere. The majority of dentists attending courses had been qualified for less than 15 years. There were multiple attendances from participants who were already involved in other postgraduate activities such as the MGDS. This study also highlighted the important role of university employed staff in providing postgraduate education for general dental practitioners.     

Understanding dental students' knowledge and perceptions of older people: toward a new model of geriatric dental education

Increasing numbers of older people and the decreasing rates of edentulism highlight the importance of dental education that focuses on oral health and aging. This evaluation study assessed dental students' knowledge and beliefs about older people as well as their awareness of the biopsychosocial concerns that are potential barriers to oral health care. Dental students' (N=202) knowledge and perceptions of older people were evaluated before and after the first year of a new educational program. Students completed the Palmore Facts on Aging Quiz II (FAQ II) and answered questions about health problems and social concerns that may influence patient care. The intervention was twofold: 1) the CARES (Counseling, Advocacy, Referral, Education, and Service) Program, a clinical collaboration between the schools of Dental Medicine and Social Work, was initiated; and 2) all students were exposed to geriatric educational interventions. FAQ II scores did not significantly change, but dental students' awareness of mental health, independence, and social concerns increased between Times 1 and 2. The results of the study suggest that positive interactions with older adults by health care providers may depend more on positive perceptions toward older people than increased knowledge about aging. Future research will focus on positive experiences with older adults and attitudes of dental students toward the elderly.     

Follow-up study of dental students' esthetic perceptions of mild dental fluorosis

OBJECTIVES: Several studies have assessed people's esthetic perceptions of dental fluorosis, suggesting that concerns may be greater than believed previously. Few studies have assessed dental students' perceptions and none has done so over time. The purpose of this paper is to report on changes in dental students' esthetic perceptions of dental fluorosis and other conditions. METHODS: Fourth-year dental students (n=45) completed questionnaires about computer-generated photographs of fluorosis and other conditions, using the same protocol as when they were entering dental students. Results were compared for each of the eight images at the individual level using paired statistical tests. RESULTS: Although many patterns were generally consistent, there were a substantial number of differences in results over time, concerning both the mild fluorosis and non-fluorosis images. In general, students tended to score both fluorosis and non-fluorosis images more favorably as fourth-year students. When rating images from very pleased (1) to very embarrassed (10), fourth-year students rated the images significantly more favorably than they had done as first-year students for normal/control, incisal third only dental fluorosis, and a more generalized, mild fluorosis. Similarly, with a visual analog scale from satisfactory (0) to unsatisfactory (69), fourth-year students reported significantly lower (more favorable) scores than they had done as first-year students for the normal/control, diastema/no fluorosis, more involved mild fluorosis, and incisal third only mild fluorosis. There were no obvious changes in the relative levels of favorable evaluation of fluorosis vs. the other conditions. CONCLUSIONS: Fourth-year dental students generally had more favorable esthetic perceptions of mild dental fluorosis and other conditions than they had reported as entering students.     

Admission level and students' performance at a Norwegian dental school

Data on students' performance at the Oslo Dental Faculty for 1977-86 were divided in two 5-year periods and analyzed in accordance with admission levels, largely on the basis of academic performance in junior college. During these years admission level decreased considerably, whereas the frequency of 'not passed', 'dropouts', and candidates using prolonged student time increased. The dental school grade average and the distribution of high- and low-performance candidates varied with the admission level. This trend was visible most clearly in the first 5-year period, when the admission point range included a considerable number of high admission level students. However, the admission level was not a good predictor of students' performance in the large middle or low admission level groups prominent in the second 5-year period. Poor preclinical results were not compensated for by clinical skills. All comparison of students' performance gave results in favor of the female students, but no sex-related differences were statistically significant. Most dropouts left dental school during the 1st year without visible examination difficulties. Students with several 'not passed' tended to repeat examinations, dropping out at a later stage or graduating after prolonged student time with poor results. With low interest in odontology, selection of students on the basis of minute differences in academic performance in the lower admission point scale is of limited value as a predictor of students' performance.     

Admission level and students' performance at a Norwegian dental school

Data on students' performance at the Oslo Dental Faculty for 1977-86 were divided in two 5-year periods and analyzed in accordance with admission levels, largely on the basis of academic performance in junior college. During these years admission level decreased considerably, whereas the frequency of ‘not passed’, ‘dropouts’, and candidates using prolonged student time increased. The dental school grade average and the distribution of high-and low-performance candidates varied with the admission level. This trend was visible most clearly in the first 5-year period, when the admission point range included a considerable number of high admission level students. However, the admission level was not a good predictor of students' performance in the large middle or low admission level groups prominent in the second 5-year period. Poor preclinical results were not compensated for by clinical skills. All comparison of students' performance gave results in favor of the female students, but no sex-related differences were statistically significant. Most dropouts left dental school during the 1st year without visible examination difficulties. Students with several ‘not passed’ tended to repeat examinations, dropping out at a later stage or graduating after prolonged student time with poor results. With low interest in odontology, selection of students on the basis of minute differences in academic performance in the lower admission point scale is of limited value as a predictor of students' performance. □ Academic achievement; denial education; grades     

Dental students' perceptions of dental specialties and factors influencing specialty and career choices

The goals of this study were to 1) evaluate dental students' perceptions of dental specialties, 2) identify factors that play an important role in students' decision to pursue specialty training or career choices, and 3) establish a baseline of students' perceptions of the dental fields with the best future in terms of salary, personal and patient quality of life, and overall impact on the dental profession. Surveys were distributed to 494 students at the University of Pennsylvania School of Dental Medicine. Data were collected from 380 traditional four-year students and thirty advanced standing students. Chi-square tests, multivariate analysis, and logistic regressions were used to determine associations and independent contributions of student demographics to their perceptions of dental specialties and factors influencing specialty training or career choices. Debt was a statistically significant factor (p<0.001) in choosing specialty training or career independent of gender, age, or class year. Enjoyment of providing care in a specialty or field was identified as the single most important factor in choosing a specialty career. Half of the respondents had decided not to specialize. Pursuing postdoctoral general dentistry training and private practice in general dentistry were the most commonly reported plans after completion of dental school. Suggestions are made for ways to inform students about specialty training.     

Dental health education in the South Australian school dental programme

The role of dental health education as part of the school dental service is reviewed. Activities which promote dental health education and which involve school children, their parents, and dental therapists are also reviewed and comments are made on their evaluation. The effects of these programmes on the children's dental health, their health practices and their attitude to dental care is summarized.     

Dental students' attitudes toward underserved populations across four years of dental school

The objective of this study was to assess dental students' attitudes toward underserved populations across their four years of dental school. Students at the Herman Ostrow School of Dentistry of the University of Southern California were invited to take part in the study. Participating students completed a questionnaire on their attitudes toward the underserved at three time points: 1) during orientation week; 2) at the end of their second year after taking part in some community dental programs; and 3) at the end of their fourth year after they had completed all their mandatory and volunteer rotations in community dental programs. Students' attitudes were measured in four categories: societal expectations, dentist/student responsibility, personal efficacy, and access to care. First-year students scored 85 out of a maximum of 115 on the questionnaire. Female students scored higher than male students (P=0.006). Age, debt, and past history of volunteer work were not related to first-year students' total attitude scores; however, students with a history of volunteer experience scored higher on the dentist/student responsibility category (P=0.04). Students' attitude scores declined across the four years of dental school (P=0.001). The same patterns were evident for all categories except societal expectations. The decline was not related to age, gender, debt, or volunteer work experience. Follow-up studies are needed to help explain the factors that may be related to this decline.     

Influence of community-based dental education on dental students' preparation and intent to treat underserved populations

This study examined the influence of community-based dental education (CBDE) on dental students' perceived ability to treat underserved patients and their selection of community dental clinics as a first career path. In a 2009 survey, fourth-year dental students at the University of Michigan recorded their attitudes, skill level, and confidence in treating underserved patients before and after CBDE rotations and estimated what percentage of their practice they planned to devote to Medicaid-eligible patients. The first career choices of graduates from 2005 to 2010 were also correlated with the number of weeks the students spent in CBDE rotations. The results showed an improvement in student skill and confidence in treating low-income patients after the rotations. The examination of first career choices showed that, after three to five weeks of CBDE rotations, 5.6 percent of the students planned to practice in a community-based dental clinic. However, in 2009 when rotations were increased to eight weeks and included multiple clinic types, 11.8 percent of the students in 2009 and 16.5 percent in 2010 selected a community-based dental clinic as their preferred practice location. These findings suggest that CBDE improves dental students' skill and confidence level in treating underserved patients and that more time spent in CBDE rotations, specifically more than five weeks in multiple clinic types, may increase the number of graduates who select practice in community-based clinics as a first career choice.     

Implant success rate in dental school setting: retrospective study

Implant dentistry is a successful way to replace missing teeth. The purpose of this study was to retrospectively assess the rate of implant survival in a graduate clinic and to relate the findings to the health of patients. The charts of 133 patients who received implants at the School of Dental Medicine at the University at Buffalo were randomly selected and reviewed. In all, 302 implants had been placed. The age of the patients ranged from 18 to 86 years. Of these, 111 were medically compromised (83.5%) and included active and former smokers. Eight implants failed, resulting in a 97.5% implant survival. The rate of implant success in a teaching setting is high considering that the majority of subjects presented with medical conditions.     

First-year students' perceptions about pediatric dental behavior guidance techniques: the effect of education

The purpose of this study was to evaluate the effect of a dental education component on dental students' perceptions toward behavior guidance techniques in pediatric dentistry. A questionnaire was completed by seventy-three first-year dental students, before and after a course on human development and behavior guidance techniques in pediatric dentistry. The acceptability of behavior guidance techniques and situations in pediatric dentistry was scored with a visual analog scale before and after the course, compared, and evaluated in relation to demographic data. After the course, statistically significant increases (ANOVA) in the acceptability of aversive behavior guidance (voice control, hand over mouth, and immobilization), sedation, general anesthesia, and modeling were found. Statistically significant decreases (ANOVA) in acceptability were found in mentioning the possibility of pain during treatment and with a parent being in the clinic or talking with the child during treatment. Female or married students, those who had previously received dental treatment, or those who had a dentist in the family showed statistically significant changes that indicated more empathy toward the children. We conclude that undergraduate dental education may have a significant short-term influence on dental students' perceptions of behavior guidance in pediatric dentistry.     

Entrepreneurship in continuing dental education: a dental school perspective

The definition of continuing dental education is presented, along with its benefits to the profession. The preeminence of dental schools in providing lifelong learning opportunities and freedom from commercial involvement that existed even twenty years ago has changed. Less than a quarter of CE takes place in school, and the focus there is increasingly on material with deep scientific background and hands-on learning. The newest innovations and those with the greatest commercial potential are taught elsewhere. Proposed changes in the ADA CERP standards would take on a "purist" approach that could place dental schools at a severe disadvantage while allowing "for profit" institutes to flourish and thus further undermine the role dental schools can play in providing quality professional development experiences.     

Canadian dental students' perceptions of stress

In this paper, we report the results of a survey on dental student stress carried out in April 2005. A questionnaire was used to collect data from 171 students (62% response rate). Identified stressors were academic, clinic-related, social and financial. "Examination and grades" produced the most academic stress, and inconsistent feedback from instructors created the most clinic-related stress. Students found that having a dual role--wife or husband and dental student--was the most burdensome social stressor. Approximately 60% of students reported marital problems and stress associated with "relations with members of the opposite sex." Survey results showed that students who expected a high graduating debt had higher total and academic stress scores. Total stress was not related to age, gender or marital status. Students living with parents during term time had significantly higher total stress scores than students living in other arrangements. Students residing with parents also had significantly higher debts on entry to dental school. Students with more predental education had (non-significantly) lower stress scores but also had higher student debts. Undergraduate subject major (biological science or non-science) had no bearing on reported stress. This study highlights the negative effects of student debt, the necessity for staff training and the need for further studies exploring relations among stress, psychological well-being and academic performance.