Are medical students confident in assessing the patient presenting with a neck lump?

Neck lumps are a common clinical presentation in both primary care, the emergency department and in specialist clinics. Foundation doctors and final year medical students are often not confident in the assessment of patients presenting with head and neck symptoms. We evaluated medical students confidence in performing a systematic neck lump examination, formulation of differential diagnosis and presentation to senior colleagues. An online survey was completed by 185 medical students across two English Universities; 122 (66.0%) students were from University A and 63 (34.0%) students were from University B. Students were in their third-fifth year of medical school. 98.4% (n=182) of participants reported receiving formal teaching of neck lump examination during medical school for the 66.0% (n=122) of medical students were confident in examining a neck lump but 62.4% (n=115) were not confident in presenting examination findings to a senior colleague. Totals of 78.4% (n= 145) and 64.8% (n=120) did not feel confident in generating a list of differential diagnoses for a patient with an anterior or posterior neck lump, respectively. A total of Despite being able to examine neck lumps, medical students did not feel confident in presenting their examination findings or proposing differential diagnoses. This may be due to superficial understanding and poor knowledge translation into clinical practice. Use of a lymphadenopathy simulator, the teaching of common malignancies and corresponding head and neck lymph node drainage may improve diagnostic reasoning and aid early detection of cancer and other conditions.     

Clinical anxieties among dental students

We analysed the perceived stresses associated with the transition from preclinical to clinical teaching among dental students at the Faculty of Dentistry, University of Otago. An anxiety questionnaire was completed by 120 students in their Second and Third Years of study. Because of the institution of a new curriculum, these students were uniquely in the same class. The highest levels of anxiety associated with general clinical situations were felt for getting diagnoses wrong, hurting patients, dealing with medical emergencies, and getting infected. In general, there were no significant gender or academic year differences. When faced with specific situations, students were most stressed by the prospect of surgical procedures, temporomandibular joint problems, and failed local analgesia. Significant differences between the two years centred on giving an inferior alveolar nerve block and in dealing with poor oral hygiene, the Second-year students showing the greater anxiety.     

Facial trauma education within two English medical schools

Facial trauma accounts for 5%-10% of all presentations to emergency departments (ED) in the UK, and it is often referred to the oral and maxillofacial surgery (OMFS) department by ED physicians. Undergraduate medical students often have limited exposure to OMFS, and this is likely to translate to reduced exposure to facial trauma. We investigated the exposure of undergraduate clinical medical students to facial trauma teaching and asked about their confidence to manage facial lacerations and their ability to diagnose common facial fractures. An online survey was completed by 237 medical students across two English universities, 154 (65%) from University A and 83 (35%) from University B. Of the students, 68% reported no exposure to any teaching in facial trauma up to their current year of medical school; no statistically significant differences were found among the year groups (p>0.05). The majority of facial fractures within our cohort were referred to ear, nose and throat (ENT) (43%), followed by OMFS (31%), and plastic surgery (12%). In total, 84% of students did not feel competent to manage facial lacerations, and 95% were not confident to present a facial injuries examination to a senior colleague. Exposure to facial trauma teaching remains poor. Future work should aim to devise a clear OMFS curriculum with objective teaching on facial trauma.     

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 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.     

Preparing dental students for careers as independent dental professionals: clinical audit and community-based clinical teaching

Community-based clinical teaching programmes are now an established feature of most UK dental school training programmes. Appropriately implemented, they enhance the educational achievements and competences achieved by dental students within the earlier part of their developing careers, while helping students to traverse the often-difficult transition between dental school and vocational/foundation training and independent practice. Dental school programmes have often been criticised for 'lagging behind' developments in general dental practice - an important example being the so-called 'business of dentistry', including clinical audit. As readers will be aware, clinical audit is an essential component of UK dental practice, with the aims of improving the quality of clinical care and optimising patient safety. The aim of this paper is to highlight how training in clinical audit has been successfully embedded in the community-based clinical teaching programme at Cardiff.     

泰国牙科教学模式对我国口腔医学教学改革的启示——以玛希隆大学为个案

泰国现行的口腔医学教育体系是以学生为中心学习的教学方法学,实施双语教学,核心课程英文授课,要求书写英文病历。大学开始培养学生的科研思维,本科生参与多项科研活动。临床实践培养长期化,三年级开始进行临床实验室学习,从四年级到六年级进行临床实习,临床实践从易到难逐步过度。临床教学的同时培养学生的社会责任感,通过流动牙科服务等形式,召集大学生用所学知识回报社会。     

Teaching and assessment of Professional attitudes in UK dental schools – Commentary

The General Dental Council expects professionalism to be embedded and assessed through‐out the undergraduate dental programme. Curricula need therefore to accommodate these recommendations. A stroll poll of UK dental schools provided a basis for understanding the current methods of teaching and assessing professionalism. All respondent schools recognised the importance of professionalism and reported that this was taught and assessed within their curriculum. For most the methods involved were largely traditional, relying on lectures and seminars taught throughout the course. The most common form of assessment was by grading and providing formative feedback after a clinical encounter. Whilst clinical skills and knowledge can perhaps be readily taught and assessed using traditional methods, those involved in education are challenged to identify and implement effective methods of not only teaching, but also assessing professionalism. A variety of standalone methods need to be developed that assess professionalism and this will, in turn, allow the effectiveness of teaching methods to be assessed.     

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.     

Proposed career pathway for clinical academic general dental practitioners

The Modernising Medical Careers framework provides the opportunity for both medical specialists and general medical practitioners to follow training pathways that lead to appointments as National Health Service (NHS) consultants and to senior academic posts. Similar opportunities are available for dentists who wish to specialise. However, they are not available to dentists working in primary dental care who wish to become NHS consultants or senior academics in general dentistry. An alternative pathway is required that does not force committed primary care dentists who wish to become NHS consultants or senior academics down a path of specialisation. In this paper, the authors explore the situation in some detail and propose a career pathway with appropriate competencies for primary care dentists who aspire to become NHS consultants or senior academics. They justify why such posts should be created. The competencies have been developed using key guidelines and documents from the European Bologna Process and the Association for Dental Education in Europe, the Curriculum for UK Dental Foundation Programme Training, and the General Dental Council monospecialty curricula. It is hoped that the proposed pathway will produce highly trained generalists who will: (a) encourage and undertake research in primary dental care, where over 90% of dentistry is delivered, (b) support and lead outreach centres so that teaching and clinical cases reflect primary dental care, where students will spend their working lives post-qualification, and (c) provide a means of increasing the numbers of clinical dental academics, which have been in decline over the last 10 years.     

Pediatric behavior management techniques: a survey of predoctoral dental students

Dental schools are increasingly incorporating behavioral management strategies into the curriculum; however, little is known about the efficacy of this instruction. The purposes of this study were to evaluate student exposure to several categories of behavioral management techniques, assess student opportunity to observe faculty use of these techniques, and determine the extent of students' personal use of various behavioral management techniques. Third-year dental students (n=98, X age=26.52; s=4.05) were administered a survey assessing their exposure to and willingness to use behavioral management strategies. Results indicated differences between the techniques students recalled being taught and what they indicated they plan to use in their own future clinical practices. Student technique endorsement also varied as a function of student age, gender, ethnicity, and patient age. Despite increasing concerns regarding the use of these techniques, a significant minority of students stated that they were taught to use hand-over-mouth, verbal intimidation, and various forms of active and passive restraint/immobilization. While appreciation for behavioral management strategies within the dental school curriculum was demonstrated by the amount of didactic exposure students received, the need for increased experiential training is evident. Furthermore, student endorsement of controversial techniques appears to reflect the changing view of these techniques within the professional dental community.     

Assessing the anxious patient

Dental anxiety is a problem for many adults and children and for many patients anxiety acts as a barrier to treatment: avoidance of treatment, irregular attendance or attendance for emergency treatment only being typical ways of dealing with the problem. For the dental team a patient's anxiety poses major management problems, as an anxious patient may require more time for treatment, is very likely to miss appointments and may have raised pain thresholds. A major cause of stress for clinicians is the management of anxiety in their patients.     

Teaching of direct composite restoration repair in undergraduate dental schools in the United Kingdom and Ireland

Aim: To investigate aspects of the teaching of restoration repair as a minimally invasive alternative to the replacement of defective direct composite restorations in teaching programmes in undergraduate curricula in dental schools in the United Kingdom and Ireland. Methods: An online questionnaire which sought information in relation to the current teaching of composite restoration repair was developed and distributed to the 17 established UK and Irish dental schools with undergraduate teaching programmes in Spring 2010. Results: Completed responses were received from all 17 schools (response rate= 100%). Fifteen schools reported that they included teaching of repair techniques for defective direct composite restorations in their programme. Of the two remaining schools, one indicated that it would introduce teaching of repair techniques during the next five years. The most common indication for a composite repair was that of ‘tooth substance preservation’ (15 schools). The defects in restorations considered appropriate for repair rather than replacement by the largest number of schools included partial loss of restoration (13 schools) and marginal defects (12 schools). The most commonly taught surface treatment when performing a repair was mechanical roughening of the existing composite with removal of the surface layer (14 schools). Thirteen schools taught etching and the application of an adhesive bonding agent to the prepared surfaces, while the most commonly taught material for completing the repair was a hybrid composite resin (12 schools). Popular finishing implements included diamond finishing instruments (13 schools) and finishing discs (11 schools). Conclusion: Not withstanding reluctance amongst general dental practitioners, the teaching of repair of a defective composite restoration, rather than total restoration replacement, is firmly established within UK and Irish dental school programmes. Repair techniques have clear advantages for patients, not least including a minimally invasive approach to treatment and avoidance of unnecessary loss of tooth tissue and pulpal damage. Dental practitioners should look more to repair techniques when managing defective composite restorations and clinical dental teachers should continue to research and refine composite repair techniques.     

In-patient operating exposure for dental undergraduates: a valuable experience?

The General Dental Council, the Association of Dental Education in Europe and the Association of British Academic Oral and Maxillofacial Surgeons have all issued syllabuses suggesting undergraduate dental students should gain experience of oral and maxillofacial in-patient operating.Aim To examine whether final year dental students in a UK dental school had observed, and were comfortable providing an explanation of, oral and maxillofacial in-patient operating.Materials and methods Students at Newcastle University's School of Dental Sciences have block allocations to in-patient operating (16 half-day sessions). A questionnaire was distributed to the whole of the final year (n = 78) at the end of these allocations examining different aspects of their exposure to in-patient operating.Results A response rate of 81% (n = 63) was achieved. Those responding reported that they had seen a wide variety of surgery. The most common procedural group that had not been observed was orthognathic surgery (n = 33, 52%). There was no correlation (p >0.05) between total number of procedural groups observed and total number of procedural groups that students were confident to explain, although there were significant correlations (p <0.05) between having observed specific operations and having the confidence to explain them. The students felt that the block allocations were beneficial (n = 46, 63%) and offered a variety of free-text reasons for this. Only a minority (n = 24, 38%) had been actively involved in the surgery they had observed, the majority of those individuals having undertaken some suturing (n = 11).Conclusions Students perceive allocations to oral and maxillofacial in-patient operating as beneficial for a variety of reasons. The relationship between having observed a procedure and the individual's perceived ability to explain it appears to be complex. It is difficult to achieve consistent exposure throughout a large year group of undergraduate students, but more targeted learning may be of benefit.     

UK dental students' ability and confidence in applying the Index of Orthodontic Treatment Need and determining appropriate orthodontic referral

Introduction

The aim was to assess the ability and confidence of UK undergraduate dental students in applying the Index of Orthodontic Treatment Need (IOTN) and determining appropriate orthodontic referral.

Materials and Methods

This was a cross-sectional survey using a case-based online questionnaire. Fourth and fifth year undergraduate dental students were recruited from UK dental schools through their university and social media. Six cases were presented and participants were asked to provide an IOTN score and judgement about referral. Participants were asked about their confidence, experience and orthodontic teaching.

Results

Sixty-nine responses were returned. A quarter of participants reported having used IOTN before in a clinical setting. Clinical experience with IOTN influenced confidence. Familiarity with making orthodontic referrals was low and only one participant reported having made an orthodontic referral. Correct IOTN scores were given by 68% of participants for a large 14 mm overjet (5a) case, 43% of participants for an impacted canine (5i) case and 26% of participants for an impacted premolar (5i) case. Incorrect IOTN was most common in hypodontia cases with only 19% correctly identifying mild hypodontia (4h) and 28% identifying severe hypodontia (5h). For the majority of cases, incorrect answers about referral were due to confusion between specialist practitioner and orthodontic consultant pathways.

Conclusions

Dental students' ability and confidence in correctly applying the IOTN Dental Health Component and selecting the appropriate referral pathway was inadequate. Responses suggest a lack of clinical experience in assessing patients, applying the IOTN and making referrals. The low response rate is disappointing and limits the scope for making recommendations.     

An investigation into the use of the FDI tooth notation system by dental schools in the UK

This study investigated the use of the FDI tooth notation system in UK Dental Schools. In addition, the notation system used by dentists referring patients to Manchester Dental Hospital was recorded. A questionnaire was sent to the Deans of all Dental Schools in the UK and letters of referral to Manchester Dental Hospitals Paediatric GA Service were monitored for 1 month. The results showed that only Manchester University Dental School used the FDI system but 6 other schools instructed students in its use. The Palmer system was used by all the other schools for recording clinical information. 136 referral letters were received, only one used the FDI notation, 15 used both FDI and Palmer and the remainder (120) requested extractions using the Palmer notation. The FDI notation system is not used in the majority of UK dental schools. Despite the fact the Dental School in Manchester has been teaching and using the FDI system for over 10 years, it has not been adopted by General Dental Practitioners referring patients into the hospital. The FDI should review the use of their system in other countries, to ascertain whether it has fulfilled its rôle as an international notation system.     

Differences in the perception of seven behaviour‐modifying techniques in paediatric dentistry by undergraduate students using lecturing and video sequences for teaching

Whilst preparing undergraduate students for a clinical course in paediatric dentistry, four consecutive classes (n = 107) were divided into two groups. Seven behaviour‐modifying techniques were introduced: systematic desensitization, operant conditioning, modelling, Tell, Show, Do‐principle, substitution, change of roles and the active involvement of the patient. The behaviour‐modifying techniques that had been taught to group one (n = 57) through lecturing were taught to group two (n = 50) through video sequences and vice versa in the following semester. Immediately after the presentations, students were asked by means of a questionnaire about their perceptions of ease of using the different techniques and their intention for clinical application of each technique. After completion of the clinical course, they were asked about which behaviour‐modifying techniques they had actually used when dealing with patients. Concerning the perception of ease of using the different techniques, there were considerable differences for six of the seven techniques (P < 0.05). Whilst some techniques seemed more difficult to apply clinically after lecturing, others seemed more difficult after video‐based teaching. Concerning the intention for clinical application and the actual clinical application, there were higher percentages for all techniques taught after video‐based teaching. However, the differences were significant only for two techniques in each case (P < 0.05). It is concluded that the use of video based teaching enhances the intention for application and the actual clinical application only for a limited number of behaviour‐modifying techniques.     

Students' Perceptions of Prosthodontics in a PBL Hybrid Curriculum

Purpose: A survey was distributed to the Harvard School of Dental Medicine (HSDM) predoctoral student classes of 2005 and 2006 to assess their perceptions regarding preclinical prosthodontics laboratory exercises. Prosthodontics curriculum clock hours, prosthodontics teaching participation, and plans for specialization were also analyzed. We hypothesized that reduced hours and perceived stress in the prosthodontics curriculum might impact students' choice of specialty at HSDM
Materials and Methods: HSDM preclinical prosthodontics clock hours were compared with national means from published data. A survey was distributed to the HSDM classes of 2005 and 2006 (n = 70) at the end of their preclinical prosthodontics laboratory exercises, prior to students seeing their first patient in the clinics.
Results: A 100% response rate was achieved. Results from this study show that HSDM preclinical prosthodontics clock hours are on average shorter than other schools. The majority of the students felt stressed during the laboratory exercises, and they felt they did not gain adequate knowledge from the lectures, resulting in low self-esteem (confidence) in treating patients in the clinic. Despite this perception, HSDM students do just as well, if not better, than other students, as judged by external and internal outcome measures. Graduate prosthodontics specialization is still a specialty of choice among the graduates when compared to national data.
Conclusions: The shortened preclinical didactic and laboratory exercises in prosthodontics at HSDM affect student anxiety, but not their didactic and clinical performances or their decisions in choosing their graduate program. Problem-based learning (PBL) tutorials help the students to integrate preclinical and clinical knowledge and skills in prosthodontics.