Showing papers in "Journal of Dental Education in 1997"

A comparison of self-reported dental health attitudes and behavior between selected Japanese and Australian students.

Abstract: To compare cross-cultural differences of dental health behavior, 376 dental students in Japan and 213 in Australia were surveyed using a twenty-item Hiroshima University-Dental Behavior Inventory (HU-DBI) questionnaire (in Japanese and English versions respectively). The mean DBI score of Year 1 Australian students was significantly greater than that of their Japanese peers (Australian 6.56, Japanese 5.57; P < 0.001), which suggested a higher level of dental health awareness in Australian students on entry. Only 7 percent of the Japanese students had been told by their dentist that they were performing a high level of plaque control, as contrasted with 50 percent of the Australian students. Furthermore, while only a small proportion of the Australian students (8 percent) reported a belief that they may eventually require dentures, 37 percent of the Japanese students held this belief (P < 0.001). The mean HU-DBI score of the Japanese students was lower than that of the Australian students until Year 4. Differences between the genders were not a major feature.

Dentist-patient interactions in treatment decision-making: a qualitative study.

Abstract: The growing involvement of patients, third party payers, and government in the financing, planning, and delivery of health services has heightened the demand for knowledge about the process of rendering care. This study used a qualitative methodology to examine dentist-patient interactions in treatment decision-making. A series of focus groups was conducted with dentists and patients participating in an ongoing investigation of dental treatment planning conducted at the University of North Carolina. Study findings indicate that dentist-patient interactions play an important role in treatment decision-making and that both are predicated on a variety of non-clinical factors. Dentists' intuition and judgment seem to be used not only to select desired health outcomes and the means for achieving them, but also to depart from the ideal and/or to modify treatment plan presentation on a patient-to-patient basis. Patients' impressions of dentists' examination styles, personalities, and ability to relate to them as individuals seem to mediate both treatment acceptance and willingness to participate in the decision-making process. Results of this investigation suggest that any effort aimed at improving dental treatment decision-making needs to acknowledge the interplay of clinical and psychosocial factors.

Alumni self-perception of competence at time of dental school graduation.

Abstract: A survey instrument was administered to recent alumni to evaluate self-perceived competency in twenty-one selected areas at the time of graduation. The questionnaire was completed by 439 (62.8 percent) alumni who graduated between the years 1985 and 1994, inclusive. Graduates generally felt most competent in their ability to treat dental caries and its sequelae and least competent in their ability to recognize myofascial pain and temporomandibular joint disorders. Very little association was demonstrated between demographic characteristics of the respondents and their competency self-ratings. The survey identified areas of strengths and weakness within the present comprehensive care curriculum as perceived by the graduating dentists.

Problem-based learning at the University of Southern California School of Dentistry.

Abstract: Responding to the recent Institute of Medicine report on dental education, the Center for Craniofacial Molecular Biology (CCMB) of the University of Southern California School of Dentistry has developed a parallel track program in dental education leading to the D.D.S. degree. This program was proposed in May of 1995, and the first class of twelve students was admitted in September of that year. Currently two classes are enrolled and plans to admit a further twelve students (Class of 2001) are in place. The educational strategy for this program is totally problem-based. Students work in groups of six with a faculty facilitator, not necessarily a content expert. Facilitators are largely drawn from the multidisciplinary pool of research faculty at the center. All learning is mediated through biomedical and biodental problem cases. No formal lectures or classes are scheduled. The learning of clinical dental skills is promoted through focussed dental patient simulations in which students review clinical charts, radiographs, medical reports and then explore identified, hands-on learning needs using patient simulators in a clinical context. Early patient exposure is obtained through dental office visits and other special patient clinics. Initial experience with this program suggests that the problem-based learning (PBL) students learn as well (if not better) than their traditional program peers and develop excellent group and cognitive analytical skills. The absence of a pool of dentally related biomedical cases suitable for a PBL program has necessitated the use of innovative approaches to their development and presentation. It is believed that this educational approach will produce dental clinicians equipped with the self-motivated, life-long learning skills required in the ever-changing world of bio-dental sciences in the twenty-first century.

The sensitivity of the Geriatric Oral Health Assessment Index to dental care

Abstract: The sensitivity of the Geriatric Oral Health Assessment Index (GOHAI) to dental treatment was evaluated using data from a community-based oral health promotion project. Ninety-six subjects completed baseline and twenty-four-month follow-up interviews that included the GOHAI as well as other self-reported measures of oral health. Subjects were predominantly white, female, not currently married, with less than a high school education, and had average age of seventy-six years at baseline. Through the health promotion project, participants were offered low cost diagnostic and preventive services on a sliding fee basis. At twenty-four months, subjects9 records were abstracted regarding the receipt of dental hygiene, transportation, emergency, diagnostic, restorative, and prosthodontic services. Subjects were also asked about dental expenditures in the previous year and the type of dental care received, regardless of the source of care. The mean change in GOHAI scores from baseline to the twenty-four-month interview was 2.2 (std. dev. 6.6) and ranged from -15 to 30. Findings suggest that the GOHAI is sensitive to the provision of dental care, although additional research is needed to understand the impact of various dental services on the individual items of the GOHAI, as well as the overall index score. The potential applications of self-reported oral health outcome measures such as the GOHAI in dental education are discussed.

An outcomes assessment of a hybrid-PBL course in treatment planning.

Abstract: As part of an ongoing process of curriculum development, a new course was developed at the University of British Columbia (UBC) to address problems such as lack of student enjoyment of the learning process, poor student preparedness for clinical treatment planning, and underdeveloped critical thinking skills in students beginning their clinical experience. The new course utilized a hybrid problem-based learning (PBL) format that provided students with an overview in lecture format while encouraging active learning in small group tutorials and seminars. Half the second-year class was randomly selected to participate in the new course, while the other half received the standard lectures on the subject. An outcomes assessment examined whether the aforementioned problems had been addressed in the new course. Course participants completed a post-course evaluation, and all students completed a self-assessment of their preparedness and progress in treatment planning and diagnostic. Clinical instructors, who were blind to the identity of the new course participants, were asked to independently assess each student using the same criteria. Results indicate that students who participated in the hybrid-PBL course enjoyed the learning process and later rated themselves as being better prepared and improving more in the areas of treatment planning and diagnostic records than their counterparts, although the latter results were not routinely statistically significant (p < 0.1). Instructor evaluations supported these differences between the two groups.

Myers-Briggs Type Indicator and dental school performance

Abstract: The Myers-Briggs Type Indicator (MBTI) was administered to 256 dental students, representing four classes, at the University of Florida College of Dentistry. The results of this psychological instrument were then correlated with overall dental school performance based on results from the National Dental Board Examinations Part I and II (NB-I, NB-II), yearly class rank, and specific academic difficulties as measured by the Student Performance Evaluation Committee. Introverted students were found to display a significantly increased performance on NB-I (p = .038) and NB-II (p = .044). They were also found, however, to demonstrate a progressively lower class rank over the four-year period than extroverted students and were more likely to experience major academic difficulties as well. Judging and sensing individuals were found to earn a higher class rank over the four-year period than perceiving and intuitive students, respectively. Perceiving students were found to exhibit major difficulties or were placed on probation more often than judging individuals. These results may prove useful in counseling students to recognize potential problems before they commence their dental education or to anticipate and address specific weaknesses during the course of their education.

Assessment of preclinical problem-based learning versus lecture-based learning

Abstract: Academic performance on a standardized oral comprehensive exam (OCE) was compared for students taught basic science in a problem-based learning (PBL) curriculum and a lecture-based learning (LBL) curriculum. The OCE was administered to the graduating classes of 1991-1994 (n approximately 20/class) six months after completion of their basic science courses. The OCE contained six components including: Organization and Thoroughness, Diagnosis, Primary Treatment Plan, Alternate Treatment Plan, Science and Medical Knowledge, and Dental Knowledge. Six to eight examiners graded each of the students by using a standardized scoring system and by subjective comments. The class of 1991 was taught by LBL, classes of 1993 and 1994 by PBL, and the class of 1992 by an incomplete PBL teaching method. Mean OCE scores were not significantly different between classes; however, the Science and Medical Knowledge component score was significantly better for the class of 1994 than for 1991 (p < 0.05). There was a non-significant 40 percent increase (p = 0.07) in honors and a 269 percent (p < 0.001) increase in cumulative positive examiner comments between 1991 and 1994.

Effectiveness of an Endodontic Diagnosis Computer Simulation Program.

Abstract: The effectiveness of a recently developed endodontic diagnosis computer simulation program was examined. Third-year dental students (n = 90) in three successive academic classes were given a pre-test in endodontic diagnosis before any endodontic instruction, and then received ten lectures on diagnostic techniques, endodontic pathology, and radiographic interpretation. The students were subsequently divided into three equal groups not differing statistically on their pre-test results. The first group used an endodontic computer simulation program containing fifteen patient simulations for one hour. The second group had a small-group seminar aiming to cover the same material as in the computer program in the same time period. The third group (control) had no further instruction. The three groups then took a post-test to evaluate their diagnostic knowledge in endodontics. The improvement of scores from pre- to post-test in the three groups were statistically different (p = 0.018). The simulation group students improved significantly more than the seminar group (p = 0.05) and the Control Group (p = 0.0024). Difference in improvement between the seminar group and the control group was not statistically significant (p = 0.20). Students were able to cover more cases on average using the simulation program than were covered in the seminar (t-test, p < 0.0001).

Geriatric patient simulations for dental hygiene.

Abstract: The rapidly increasing number of this country9s elderly requires that dental hygiene students practice the clinical problem-solving skills of information gathering, assessment, and treatment applied to geriatric patients. Computer-based simulations are purported to provide this experience, but little research has been completed with simulations in the education of dental hygienists. This paper summarizes the process used to design, develop, and evaluate a series of eighteen computer-based geriatric simulated patients. It contains a brief description of the simulations and a description of the design, validation, authoring, and formative evaluation phases. The paper also describes the summative evaluation, provides implementation suggestions, and summarizes future directions. The summative evaluation, conducted at four institutions, suggests that computer-based simulations are an effective instructional method as measured by pre/post-tests. The results suggest that simulations can provide a standardized set of geriatric patient experiences. These simulations may prove especially valuable at institutions that are unable to provide clinical geriatric experiences or lack the expertise to conduct a didactic course in geriatrics.

Making science clinically relevant

Abstract: Clinical practice requires a sound foundation in the basic and clinical sciences. However, the traditional dental curriculum often separates the two in a variety of ways that reduce their integration. The basic sciences are commonly taught in the first two years by a basic science faculty with inconsistent integration with clinical dental practice. The clinical sciences are often taught by faculty who may not be actively involved in research-related activities. The curriculum is dense and is difficult to modify to adapt to evolving scientific discovery and application. The 1995 IOM report focuses much of its attention on these issues. The Harvard School of Dental Medicine has dramatically modified its curriculum twice in the recent past to more closely integrate the basic and clinical sciences and to promote the clinical relevance of the basic sciences. The class entering in 1980 began a five-year D.M.D. program that was designed to decompress the curriculum and increase experiences that enhance scientific and clinical integration. The class entering in 1994 initiated a four-year program that uses a problem-based learning design throughout the entire curriculum. Strategies for integrating the clinical and the basic sciences along with research training and experience were developed and implemented in both programs.

Dental health services research utilizing comprehensive clinical databases and information technology

Abstract: Marketplace pressures for accountability in dentistry have made clear dental delivery systems9 weaknesses in information generation, management, and analysis methods. Without this type of information, dentistry is unable to quantify and document the outcomes of the dental care services it provides. The Pew Health Professions Commission and the Institute of Medicine both suggest that dental schools should be among the leaders in the development and teaching of dental information capabilities, as well as the source of fundamental dental health services research. This paper argues that dental schools are the logical location for the development of valid, reliable, and acceptable health services research methods and databases. It describes the development of an insurance claims database to demonstrate the types of investigations possible, as well as the weaknesses and shortcomings of pure administrative data.

The effect of frequent quizzes on short- and long-term academic performance.

Abstract: This investigation examined the effect of frequent quiz administration on the performance of dental students on course examinations, post-tests, and attitudes toward instruction. Students in an introductory radiology course were randomly divided into two groups. Quiz Group (QG) students were given a quiz at the beginning of each class, while students in the Control Group (CG) did not take the quizzes. All students took a midterm and final examination as well as post-tests at four months and ten months after the end of the course. Students also completed a questionnaire assessing the course and instructor. The QG scored higher than the CG on all exams, but these differences were significant only for the midterm and final exams (p 0.05). Evaluations of course content and instructor performance were significantly higher among QG students regarding appropriateness of examinations and overall evaluation of course (p

Toward a competency analysis of operative dentistry technique skills

Abstract: This research seeks ways to distinguish beginners from competent students based on the manner in which they perform. Five "beginner" students who had passed preclinical operative dentistry technique and six "competent" students one month prior to graduation were videotaped performing an occlusal amalgam preparation on #19 on a typodont. The tapes were scored for time in cutting the preparation and observing it and for "unproductive work" (nonfluencies). The number of changes from one operation to another and the use of instruments as aids in measurement were also recorded. Three processes were identified in every student9s performance: rough outline form, making walls parallel and cavosurfaces level, and refinement. All preparations were scored as being clinically acceptable and indistinguishable in quality between the two groups. Beginning students required over twice as long to complete the preparation and changed operations more than twice as often as their competent classmates. Most of these differences between groups occurred in the third, refinement, process. Compared to beginners, competent students showed more evidence of using powerful, internalized schema to guide their performance, were smoother, and seemed less rule-driven.

What should biomedical sciences education in dental schools achieve

Abstract: Education for the first professional degree in dentistry is intended to produce graduates capable of offering a wide range of high quality dental services to the general public. More than that, it is expected that graduates will be firmly grounded in the scientific basis for their professional practices and be equipped to evaluate critically and integrate selectively new scientific findings that emerge during their professional lifetimes. In addition, they are expected to be able to work effectively with diverse patient populations and to conduct their practices with a high level of sensitivity to the ethical and psychosocial dimensions of patient care. Indiana University School of Dentistry has undergone a process of curriculum reform that has yielded a new first professional degree program. Its hallmarks are large, multidisciplinary courses (seven courses in the first two years) that are taught using a variety of strategies including problem-based learning in small groups as well as lectures. The biomedical sciences curriculum is concept-based. Students will demonstrate their understanding of science concepts and methods by applying them to the solution of research and health care problems. Biomedical sciences will be taught at a level that will provide a comprehensive understanding of the functioning of the human body in health and disease, allow students to assimilate the coming revolution in molecular medicine, and selectively use new diagnostics, preventives, and therapeutics that evolve as molecular biological technologies yield solutions to current medical and dental problems. Using the biomedical sciences curriculum as a vehicle, we will also achieve the goal of training dentists as critical thinkers, problem solvers, lifelong learners, and ethical practitioners, skillful in peer and self-evaluation, and cognizant of the psychosocial as well as biomedical perspective of health and disease.

Analyzing the sources of unreliability in fixed prosthodontics mock board examinations.

Abstract: Mock board examinations in fixed prosthodontics were submitted to generalizability analysis in order to determine which sources of unwanted variance of measurement contribute to grade decisions and whether this lack of reliability is of practical significance. Students completed approximately three fixed prosthodontics test cases during their final year of clinic, and each case was scored by two faculty members. Of the subsamples of students where two test cases (trials) per student were graded by the same two raters, the subsamples with the highest and the lowest inter-rater reliability coefficients were chosen. Typical generalizability coefficients (reliability considering both raters and trials as sources of error) are much lower than the inter-rater reliability estimate, and the standard error of measurement is 80 percent of a grade interval on a five-point scale. In all analyses, the largest source of variance was the student-by-trial interaction, accounting for about 80 percent of the standard error of measurement or one-half a grade on a five-point scale. Even in the subsample with lowest inter-rater reliability, rater, rater-by-student interaction, and rater-by-trial interaction made no contribution to measurement error. Nor did students show evidence of improving over time. There is no possible improvement through the use of rater calibration or additional raters that would equal the improvement made by using two test cases rather than one. The concept of gradient of generalizability is introduced, and implications for initial licensure examinations are discussed.

Results of the National Dental Examining Board of Canada written examination and implications for certification.

Abstract: In 1994, following a request from the ten Provincial Licensing Authorities, the National Dental Examining Board of Canada (NDEB) implemented significant changes to the certification process for dentists seeking a license to practice in Canada. Prior to 1994, graduates of accredited Canadian dental programs were certified without further examination while graduates of United States and other international programs (non-Canadian, non-U.S.) were required to complete successfully a written and three-phase clinical certification examination. Changes implemented in 1994 required graduates of accredited Canadian programs to take both a Written and Objective Structured Clinical Examination (OSCE) Examination. The analysis of the results of the Written Examination for all candidates over the 1994-1996 period supports the following conclusions. There was no meaningful difference in performance of graduates across the ten Canadian dental programs; there was a small difference between the performance of graduates of Canadian and U.S. programs; and Canadian and U.S. graduates performed significantly better than graduates of other international programs. This level of candidate performance and changes to the respective accreditation processes supported the formal agreement providing reciprocal recognition of dental accreditation in Canada and the United States. As of January 1, 1997, graduates of dental programs in Canada and the United States are required to take the same certification examination while international graduates are required to complete a different certification process. These changes to the certification process were ratified by all ten Provincial Licensing Authorities, therefore maintaining a system of national portability for dental licensure in Canada that does not require preclinical or clinical board examinations for graduates of accredited North American dental programs.

Variation in the use of crowns and their alternatives.

Abstract: The use of crowns and their alternatives for the restoration of compromised posterior teeth is of interest to educators, purchasers, and patients. Considerable curricular time is devoted to learning these techniques, substantial amounts of money are spent on these procedures, and differences in the outcomes of these treatments may have consequences for tooth survival. To begin to understand more about the actual use of these procedures, the provision rates of these services in a sample of U.S. dental practices were examined. This study reports on the extent to which utilization patterns and subsequent costs of crowns and their alternatives were associated with certain patient and practice characteristics. Insurance claims for dental services submitted by general dental practices through an electronic claims clearinghouse were used. Crown ratios (crowns/crowns plus alternatives) were calculated for dental practices to evaluate relationships with available explanatory variables. Findings indicated that older patients were significantly more likely to receive crowns than those in younger groups, resulting in as much as a 33 percent increase in the mean per tooth cost of treatment in the oldest group. Regional variation existed in the provision of crowns and resulted in up to a 31 percent difference in the mean per tooth treatment cost between regions. Crown ratios exhibited variation beyond that accounted for by patient and practice factors, thus raising questions about the consistency of treatment recommendations among dentists. These findings support the need to examine further the consistency of crown use among general dentists and to modify current approaches for teaching treatment planning in predoctoral restorative curricula.

Using questions to facilitate motor skill acquisition

Abstract: For the process of question-guided problem-solving to work successfully, several conditions must exist: 1) presence of valid and reliable criteria for evaluating product (DO) and performance (DP), 2) development of learning resources such as life-sized examples, 3) training sessions in the application of criteria and use of the process for both faculty and students, and 4) faculty commitment to the process The process helps to establish conditions in which learning occurs Underlying its structure is the requirement for incorporation of discrimination tasks Question-guided problem-solving structures the learner9s approach to the task in a way that facilitates the refinement of independent learning strategies over time Further, it promotes effective use of time in laboratory or clinic Through repeated interactions, the faculty may better monitor student progress, diagnose student learning problems, suggest remedial strategies, and evaluate their outcomes By providing instruction that includes opportunities to practice the subskills of problem-solving in an interactive cooperative environment, students systematically monitor learning by asking good questions and, through questioning, are empowered to solve problems

Exploring attitudes of white dental students regarding willingness to treat people with HIV.

Abstract: This descriptive field study examines the willingness of ninety white dental students to provide care to people with Human Immunodeficiency Virus disease (HIV disease). This study suggests that perceived clinical ability, attitudes toward gay men, and white racial attitudes account for white dental students9 willingness to provide dental care to patients with HIV disease. Likewise, this study suggests that white dental students9 perception of risk of occupational infection with HIV is uniquely predicted by the same variables. A hierarchical regression found that in white dental students, racial attitudes were significant predictors of willingness to treat persons with HIV disease beyond the significant contributions of perceived clinical competence and attitudes toward gay men. In terms of perceptions of occupational risk, results of the hierarchical regression were that both perceived clinical competence and attitudes toward gay men were significant predictors. Thus, the results of this study show that attitudes regarding cultural diversity can influence clinical intentions.