Assessing attitudes in dental education: is it worthwhile?
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Attitude↗
Biomedical subjects
M Manogue
Publications and source records attributed to M Manogue.
Scope of the OSCE.
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Clinical Competence↗
Clinical assessment of dental students: values and practices of teachers in restorative dentistry.
OBJECTIVES: To investigate the values and practices of assessment of the clinical practice of dental students by a sample of teachers in restorative dentistry. DESIGN: A questionnaire, based on the above objectives, was designed, piloted and redesigned. Its content was based on evidence-based good practice in assessment. Structured items in the questionnaire required responses on (i) frequency of use and (ii) estimates of value of various approaches and characteristics of the assessment systems that respondents were using. SETTING: The 14 undergraduate dental schools of the United Kingdom. SUBJECTS: Full-time clinical teachers of restorative dentistry in adults (comprising conservation (including endodontics), periodontology and prosthodontics). RESULTS: A total of 153 usable questionnaires were returned (response rate 70.8%), and 38 statistically significant differences were reported (of which 35 were very highly significant), based on the correlated t statistic. Values were in line with evidence-based good practice, but practices were not in line with values. Particularly noteworthy were the high values attached to objective structured clinical examinations, self- and peer-assessment, portfolio-based learning, feedback to students, the use of objective criteria, communication skills and oral health education. The corresponding frequency of usage of these aspects was relatively low. The reported aims of courses in restorative dentistry were not matched by the profile of assessment practices. CONCLUSIONS: The findings have implications for the development of student learning, assessment procedures and the management of quality and enhancement of dental programmes. Although this is a report of only one study, it relates to the major clinical component of undergraduate programmes in dentistry. The findings imply that the time is ripe for a reappraisal of approaches to the assessment of clinical competence in dentistry.
Clinical Competence↗
Assessment of dental students' competence.
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Clinical Competence↗
Improving student learning in root canal treatment using self-assessment.
AIM: This paper reports the first attempts to implement a new course in endodontology for undergraduate dental students based upon independent, reflective learning and self-assessment. METHODOLOGY: The responses were analysed of two successive cohorts of third-year students to laboratory courses in (i) the restoration of teeth with crowns and (ii) endodontology and root canal treatment. The major changes introduced to the endodontology course were a substantial reduction in the number of formal lectures, the introduction of a series of structured tutorials, time for private study and the use of self-assessment in practical classes. RESULTS: The evidence indicates that the new approach increased student confidence in practical skills, although the time available for operative practice was actually reduced; there was a perceived increase in problem-solving ability; and that students felt encouraged to pursue greater understanding. Reports from tutors suggested that students' self-assessments became more accurate as the courses proceeded. Seven experimental learning points were derived from the study. These included the importance of careful planning, well-designed assessment procedures and the creation of a climate of trust and openness. CONCLUSIONS: The task of developing fully the students' skills of accurate self-assessment remains a challenge.
Attitude of Health Personnel↗
The validity and reliability of an OSCE in dentistry.
The validity and reliability of a newly-developed objective structured clinical examination for 4th year dental students (OSCE(D)) were estimated by a range of quantitative and qualitative methods. The OSCE(D) consisted of 17 stations in conservation, periodontology and prosthetics. A blueprint was used to match the OSCE stations to clinical subject areas and to 7 skill clusters of clinical competence. Repeat measures of skills were undertaken in the OSCE(D) to maximise its validity and reliability. The primary purposes of the OSCE(D) were to assess clinical competence and to provide feedback to students. The results indicate that the OSCE(D) was intrinsically valid and a better predictor of performance in the final examination than either a concurrent 4th-year examination or Advanced-level university entry grades. The OSCE(D) scored relatively highly on internal consistency (Cronbach's alpha = 0.68). Intra-domain and inter-domain correlations were high and inter-examiner reliability was relatively high (eta 2 coefficients ranged from 0.00 to 0.10). There were no significant differences between performances in the morning and afternoon sessions of the examination so reproducibility is assumed to be high. Some improvement in individual stations and in inter-examiner reliability are required. A set of recommendations based on the experience of designing and testing a dental OSCE are provided.
Education, Dental↗
Success of OCSE examinations.
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Clinical Competence↗
In vitro dentinal penetration by tracers used in microleakage studies.
Many microleakage studies, in their methodology, employ different tracers which may penetrate around restorative materials to varying extents due to their physical or chemical characteristics. The present series of in vitro studies were designed to compare the ability of freshly obtained microleakage tracers to enter cut dentinal tubules. Tracers selected were 5% eosin, 2% methylene blue, 50% silver nitrate and Indian ink all buffered, where necessary, to a range of pH 6.9-7.2. The solution of Indian ink was further investigated by particle size analysis to determine the range of particle sizes within the solution. Particles ranged from < 1 micron to 600 microns. Buffered and unbuffered solutions of the tracers were applied for 1 h to open cavities, devoid of a smear layer, prepared in 42 premolars. Specimens were sectioned longitudinally through the cavities either with or without water coolant. Penetration into dentinal tubules by the tracer resulted in an area of stained dentine and this area was subsequently measured using image analysis. The results demonstrated that there were few statistically significant differences between the areas of dentinal penetration associated with each tracer. Neither the tracer used, its pH nor sectioning technique had a predictably significant effect on dentinal penetration. Indian ink was observed to be capable of entering dentinal tubules.
Analysis of Variance↗
Developing and implementing an OSCE in dentistry.
The processes of development, implementation and perceived usefulness of an objective structured clinical examination in restorative dentistry (OSCE(D)) are reported. An OSCE is a system of assessment. It consists of a set of standardised 'stations'. At each station, a student is tested on a specific clinical task. Each student moves from one station to the next so that by the end of the OSCE, every student has completed every station. The primary purpose of this OSCE was to provide feedback to 49 4th year students on their performance in the clinical areas of conservative dentistry, periodontology and prosthetics. Individual profiles were provided to students and the overall results discussed by staff. There were no significant differences in overall performance between genders or between students in the morning and afternoon examinations. There was a significant difference between performance in prosthetics and the other areas and there were some significant differences among the skill clusters of clinical knowledge, procedures, clinical reasoning, history-taking, techniques and communication. Students and staff perceived the OSCE(D) as a valuable tool for providing feedback. The development of the OSCE and the findings described in this paper will be of value to clinical staff who are developing OSCEs in all areas of dentistry.
Clinical Competence↗
A model for the teaching of clinical techniques in root canal treatment.
A practical model to aid the understanding and practice of endodontic techniques is described. The model uses extracted teeth mounted in light-cured acrylic resin and set in a preformed model tray. Before mounting, the root surfaces of teeth are dipped in wax to simulate the periodontal ligament space. This model allows endodontic techniques to be practised in the operative technique classroom in a way that simulates the clinical situation and enables radiographs of good diagnostic quality to be taken during treatment. Subsequently, teeth can be reset to allow restoration of the root-filled tooth.
Audiovisual Aids↗
Clinical guidelines and self-assessment in dental education.
This paper describes an educational programme where clinical guidelines are used in dental education and assesses the value of these guidelines as perceived by undergraduate students. It presents a comparison of students' own assessments of their performance with those of their instructors, according to such guidelines. The educational programme at the Faculty of Odontology, Lund University, is described through 3 main principles: problem-based learning, adoption of a holistic attitude to patient care and the promotion of oral health. The dental curriculum occupies 5 years comprising 10 semesters. 41, 5th semester students (16 male and 25 female) participated in the study. Students were introduced to guidelines in group discussions at the beginning of the semester. At the completion of a patient's planned course of treatment, the outcome was formally assessed both by students and clinical instructors. Performance was scored in various categories as "excellent", "acceptable" or "unacceptable" according to the standards defined. A total of 1373 scores were made by both students and instructors. 88% cent of students used the guidelines often or almost always and found them useful. Overall, no students received an "unacceptable" score and 40% of students achieved a score of "excellent". Female students tended towards a higher score, but this was not significant. Instructors' and students' scores agreed in almost 90% of instances. Students under-scored their performance more frequently than they over-scored it. It appears that the use of clinical guidelines may encourage an increased awareness of the decision-making processes involved in clinical practice, but it must be acknowledged that these guidelines are complex both in derivation and application.
Curriculum↗
In vitro radiographic representation of the extent of voids within obturated root canals.
The aim of this study was to determine whether radiographs provide an accurate representation of the degree of root canal obturation following a cold lateral condensation technique. A total of 40 extracted single-rooted lower premolar teeth were prepared using either a standardized step-back technique or an ultrasonic device by one of two operators. The four groups each of 10 teeth were obturated using lateral condensation by a third operator. To assess apical leakage the obturated teeth were coated with nail varnish to within 2 mm of the apex and immersed in methylene blue for 48 h. The teeth were then radiographed in bucco-lingual and mesio-distal planes prior to subsequent sectioning in a bucco-lingual plane. Sections and radiographs were analysed using an image analysis apparatus to determine the proportion of root canal occupied by gutta-percha, void and/or sealer. Mean percentages of void calculated from the bucco-lingual radiographs, mesiodistal radiographs and tooth sections were 4.14%, 5.98% and 4.98%, respectively. Statistical analysis showed no significant differences between the radiographic views and the tooth sections (P > 0.05). Both planes of radiograph accurately represented the proportion of void when compared with the tooth section.
Analysis of Variance↗
Influence of age on the extent of voids in root canals sealed using a cold lateral condensation technique.
The aim of this study was to examine whether it is more difficult to achieve complete obturation of the root canal in teeth from different age groups, using the measurement of voids within the obturated canal to determine the quality of endodontic therapy. One-hundred and fifty-two single-rooted premolar teeth extracted from patients of known age were collected. Following cleaning and storage the teeth were decoronated and radiographed. Forty selected teeth were allocated to one of four age-groups, (under 20, 20-35, 36-50, over 50 years) each consisting of 10 teeth. The working length was determined radiographically and preparation was carried out using the step-back technique. Each canal was obturated using cold lateral condensation with Tubliseal cement. The roots were then sectioned longitudinally and photographed. Sections and transparencies were subjected to image analysis to determine the total areas of root canal, sealer and voids respectively and statistical analysis of the differences between the various age groups was undertaken. There was a trend towards a reduction in the areas of sealer and sealer plus void with respect to increasing age group, although no significant differences existed. A significant relationship (P < 0.05) was found between the area of voids found in the youngest group when compared with all other groups, the greatest cumulative area of voids being found in the youngest teeth.
Adult↗
Changes in patient age and tooth distribution for root canal treatment in a teaching hospital over a 15-year period.
This study was undertaken to determine the changing pattern of root canal treatment undertaken by undergraduates in a teaching hospital over a period between 1976 and 1990 in terms of the incidence of root canal treatment, noting particularly changes in the types of tooth treated and in the age distribution of patients receiving treatment. It was found that the pattern of provision of root canal treatment has altered in recent years to involve a greater proportion of multi-rooted posterior teeth. More treatment is also being provided for older patients. The trends are comparable with those that have occurred in general dental practice.
Adult↗
Management of a recurrent follicular ameloblastoma.
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Adult↗