Student perspective on outcomes and process – Recommendations for implementing competency-based medical education

Purpose: Competency-based medical education (CBME) seeks to prepare undergraduate and postgraduate trainees for clinical practice. Its major emphasis is on outcomes, but questions about how best to reach these remain. One key issue is the need to integrate what matters most to students when setting educational goals: this is crucial if we are to design curricula that trainees understand and engage with, and that promote successful achievement of competencies.

Method: We interviewed medical students in years 4 and 6 of a 6-year medical degree and used thematic analysis to understand their main educational priorities and how these fit with the aims of CBME.

Results: Two major themes emerged: features of content and process. For content, students wanted clear guidance on what constitutes competence, finding broad outcome statements abstract and difficult to understand as novices. They also attach critical importance to features of process such as being welcomed, included in clinical teams and being known personally – these promote motivation, understanding, and professional development.

Conclusions: We present recommendations for those designing CBME curricula to emphasize the student perspective: what kind of guidance on outcomes is required, and features of process that must not be neglected if competence is to be achieved.     

Treatment timing for rapid maxillary expansion

The aim of this study was to evaluate the short-term and long-term treatment effects of rapid maxillary expansion in 2 groups of subjects treated with the Haas appliance. Treatment outcomes were evaluated before and after the peak in skeletal maturation, as assessed by the cervical vertebral maturation (CVM) method, in a sample of 42 patients compared to a control sample of 20 subjects. Posteroanterior cephalograms were analyzed for the treated subjects at T1 (pretreatment), T2 (immediate post-expansion) and T3 (long-term observation), and were available at T1 and at T3 for the controls. The mean age (years: months) at T1 was 11:10 for both the treated and the control groups. The mean ages at T3 also were comparable (20:6 for the treated group and 17:8 for the controls). Following expansion and retention (2 months on average), fixed standard edgewise appliances were placed. The study included transverse measurements on dentoalveolar structures, maxillary and mandibular bases and other craniofacial regions (nasal, zygomatic, orbital, and cranial). Treated and control samples were divided into 2 groups according to individual skeletal maturation. The early-treated and early-control groups had not reached the pubertal peak in skeletal growth velocity at T1 (CVM 1 to 3), whereas the late-treated and late-control groups were during or slightly after the peak at T1 (CVM 4 to 6). The group treated before the pubertal peak showed significantly greater short-term increases in the width of the nasal cavities. In the long-term, maxillary skeletal width, maxillary intermolar width, lateronasal width, and lateroorbitale width were significantly greater in the early-treated group. The late-treated group exhibited significant increases in lateronasal width and in maxillary and mandibular intermolar widths. Rapid Maxillary Expansion treatment before the peak in skeletal growth velocity is able to induce more pronounced transverse craniofacial changes at the skeletal level.     

Comparison of remifentanil with fentanyl for deep sedation in oral surgery.

PURPOSE: The aim of this study was to compare recovery for oral surgery patients given a deep sedation regimen of midazolam, propofol, and remifentanil with a standard control of fentanyl in place of remifentanil. MATERIALS AND METHODS: This investigation was designed as a randomized, prospective, single-blinded controlled study. Group 1, the control, received midazolam 0.03 mg/kg, fentanyl 1 microg/kg, and propofol initially at 140 microg/kg/min. Group 2 received midazolam 0.03 mg/kg, remifentanil: propofol (1:500) given at an initial propofol infusion rate of 40 microg/kg/min. Outcome measures included time to response to verbal command, Aldrete score = 9, Postanesthesia Discharge Scoring System = 7, and assessment by the Digit Symbol Substitution Test. RESULTS: Forty-seven subjects were entered in the study. Baseline findings were homogenous between the 2 groups. Subjects in group 2 recovered earlier (P < .005) and required less propofol for both the induction (0.8 +/- 0.4 versus 1.2 +/- 0.6 mg/kg; mean +/- SD, P < .01) and maintenance of deep sedation (46 +/- 9 versus 131 +/- 17 microg/kg/min; P < .005). There were minor differences in vital signs. CONCLUSIONS: This study demonstrated that this remifentanil regimen provided significantly more rapid recovery and used significantly less propofol compared with the fentanyl regimen.     

Ensuring success in alveolar bone grafting: a three-dimensional approach

Alveolar bone grafting is an integral part of correcting dental arch interruption in those with cleft lip and palate. Often included within a combination of treatment modalities, alveolar grafting must be conducted in a technically effective manner and at the appropriate stage of development in order to maximize outcome and avoid morbidity. Although much regarding this procedure remains unclear, continued research and experience has provided several key insights. Bone grafting appears optimal between maxillary growth completion and maxillary canine eruption (usually between 8 and 10 years of age). Coordination of efforts and planning between surgeon and orthodontist is imperative. Correction of the alveolar defect helps not only restores dental arch continuity, but also supports the nasal base, stabilizes the maxilla, and restores volume to the lip. Appreciation of the 3-dimensional nature of the defect helps to reliably correct the defect in an anatomically correct fashion. Optimization of soft tissue, bony, and, periodontal conditions adjacent to the cleft help maximize the likelihood of success. Staging of the procedure is often necessary to maximize outcome and avoid unnecessary procedures. Here, we review several variables of alveolar bone grating based on current literature as well as our own experience.     

Hypodontia of the permanent dentition. Case reports

Hypodontia has been observed as one of the most common human dental developmental anomalies. It may be defined as agenesis of one or more teeth. The prevalence in the permanent lower central and lateral incisor region is low, ranging from 0.23 per cent to 0.08 per cent, respectively. This is compared with an overall incidence of hypodontia of 3.49 per cent. However, significant racial variation occurs. Treatment options generally available are: no treatment, closure of spaces orthodontically, or prosthetic replacement. Aetiology, associated anomalies, and factors involved in treatment choice are discussed. A report of four cases of hypodontia of the permanent lower anterior teeth and their orthodontic management is presented.     

A comparison of arch widths in adults with normal occlusion and adults with class II, Division 1 malocclusion

This study compares arch widths and other cast and cephalometric measurements of 36 normal-occlusion subjects (19 males, 17 females) with 39 Class II, Division 1 subjects (20 males, 19 females). None of the subjects had received orthodontic treatment. Analysis of variance demonstrated that subjects with normal occlusion had larger maxillary molar widths, maxillary canine widths, and maxillary alveolar widths than subjects with malocclusion; only male subjects with normal occlusion had larger mandibular molar widths and mandibular alveolar widths than the malocclusion subjects; the normal occlusion and malocclusion groups had similar mandibular canine widths; and when the lower molar and alveolar widths were subtracted from corresponding upper widths, the remainders of the Class II group were negative instead of positive, contrary to the normal group. This revealed a posterior crossbite tendency in the Class II group.     

Small mouths ... Big problems? A review of scleroderma and its oral health implications

Scleroderma, or progressive systemic sclerosis (PSS), an autoimmune rheumatic condition affecting the connective tissues, has a profound impact on oral health. Common orofacial findings include xerostomia, gastroesophageal reflux disease and limited mouth opening. This review article describes scleroderma, or PSS, and its various manifestations. The features of CREST syndrome and morphea are reviewed. Concerns relevant to the prevention of dental disease and the safe delivery of dental care in this group of challenging patients are emphasized.     

Evaluation of a parenting program for children with behavioural problems: Signposts in Singapore

Abstract

Background The Signposts for Building Better Behaviour program, developed by the Parenting Research Centre, Victoria, Australia, was conducted at a public hospital facility in Singapore.

Method More than 1,000 parents completed the program, and filled in questionnaires about their child's behaviours.

Results Parents rated themselves in the questionnaires as being significantly less hassled, stressed, depressed, and anxious after attending the program. They were more confident and satisfied with managing their child, and rated their children's behaviours as having improved. Effect sizes ranged from 0.12 to 0.59. The findings were maintained 3 months after completion of the program.

Conclusions The study provides evidence of the cross-cultural applicability of the principles underlying the Signposts program. As there are long-term repercussions when children's behaviour problems are not dealt with appropriately, such behaviour management programs should be made more available to parents and caregivers.