Showing papers in "Journal of Dental Education in 1999"

Sources of stress for Australian dental students

Abstract: The Dental Environment Stress questionnaire was used to identify and quantify sources of stress for 205 Australian Bachelor of Dental Surgery students. A factor analysis revealed negative self-efficacy beliefs accounted for almost one third of the total variance, and despite higher stress levels reported by females, a marked similarity in the dominant patterns emerged for males and females. In testing for differences in residency status, international students expressed significantly more stress from peer pressure, and this is discussed within a socio-cultural context. Irrespective of gender, residency status, and class year, students ranked examinations and grades as the single most stress-inducing concern. Overall, stress intensity tended to escalate over time, peaking in the fourth year of training. It is suggested that dental students may be prone to unhealthy perfectionism, placing them at risk for the harmful consequences of chronically elevated stress levels.

Influence of practice and personal characteristics on dental job satisfaction.

Abstract: Job satisfaction has been called a barometer of the dental profession. The Dentist Satisfaction Survey (DSS), an instrument that measures both specific facets related and overall job satisfaction of dentists, was administered to general dentists in Kentucky (N = 987). Independent variables included eleven job facets, plus practice characteristics and personal characteristics including student loan debt. Results of the stepwise multiple regression showed that 60 percent of the variance of the dependent variable, overall job satisfaction, was attributable to six job facets: respect, perception of income, delivery of care, stress, patient relations, and professional time. The most significant predictors of dental job satisfaction involved the intrinsic rewards of being a dentist and the delivery of dental health services. Less satisfying aspects of dentistry included business operations, including practice management and financial planning. Despite concern among educators about the potential influence of student loan debt, there was no significant correlation between student loan debt and overall job satisfaction. Findings from this study have implications for student recruitment, dental school curriculum design, and dental workforce planning.

Women's oral health issues.

Abstract: Because oral health is an integral part of general health, oral problems specific to the female population have to be addressed. Women have special oral health needs and considerations that men do not have.

Tobacco counseling practices of dentists compared to other health care providers in a midwestern region.

Abstract: Tobacco counseling practices of dentists and other health care professionals in a predominantly rural region in the Upper Midwest were assessed to determine the need for professional education. A survey was mailed to all dentists, physicians, chiropractors, nurse practitioners, physician assistants, and public health nurses in a 16-county region. Half (51.9 percent) of providers returned usable surveys (n = 614). While dentists were more likely than physicians and other health professionals to accurately estimate their patients9 tobacco use, they were less consistent than other professions in tobacco assessment and intervention, less supportive of tobacco intervention, less likely to report having strong tobacco cessation skill/knowledge levels, and more likely to perceive barriers to tobacco intervention. Three out of five dentists (61.1 percent) reported desire for further tobacco education. For dentists to effectively counsel patients regarding tobacco use, it is essential to integrate tobacco intervention education into dental school curricula and to offer continuing education regarding tobacco use intervention to practicing dentists. Recent state settlements with tobacco companies could provide funding for such education.

Student productivity under requirement and comprehensive care systems.

Abstract: This retrospective study reviews the educational and patient care effects of changing from a numerical requirements-driven clinical curriculum to aa comprehensive care model driven by patient needs and led by faculty group leaders. In September 1994, the Columbia University School of Dental and Oral Surgery implemented a program in which all patient care shifted to a patient care completion model. Core assumptions included creating an educational setting where students were assigned to groups with continuously assigned faculty as group leaders, with intensive case discussion and monitoring of students9 progress. All patient care took lace under the direction of the group leaders with involvement of other attending interdisciplinary faculty and auxiliary staff. Data suggest that, over the period of this study (1994-97), a significant increase occurred in the number of treatment plans completed by students with no compromise in the number of specific procedures completed by individual students. We concluded that a carefully structured and monitored comprehensive care/group leader-driven model is beneficial for both student education and patient care.

Exposures to blood and body fluids among dental school-based dental health care workers.

Abstract: A survey of United States dental schools was conducted to determine the annual incidence of reported percutaneous and mucosal exposures to blood and other body fluids among dental school-based dental health care workers (DHCW). A response rate of 51.9 percent provided information on 10,433 DHCW and 1.6 million student clinic and 169,836 school-based faculty practice patient visits. This response represents approximately half of all DHCW and student clinic visits in U.S. dental schools in AY 1996/1997. A total of 652 exposures were reported, of which 629 occurred in student clinics. Dental schools averaged twenty-three reported exposures per year, and the overall annual reported exposure rate in student clinics was 4.0/10,000 patient visits and 1.3/10,000 in faculty practice. Dental students accounted for 62.5 percent of all reported exposures, a rate of 106.3/1000 students per year. The exposure rate for dental students was significantly greater that any other category of DHCW. Expressed in terms of person years, an exposure rate of 0.17 was comparable to that reported for dental schools but considerably less than found in other dental care settings. A second survey directed to individual DHCW drew responses from only 8.3 percent of the 10,433 DHCW. Among these respondents, 31 percent of those acknowledging an exposure reported it. A judgment that the injury was not serious, the time necessary to report an exposure, and a belief that the patient was healthy were the primary reasons for not reporting. The results of this study provide dental schools with benchmarks for comparing their reported exposure experience and assessing programs intended to prevent and manage exposures.

Using standardized patients to assess presentation of a dental treatment plan.

Abstract: In this new era of relationship-based care, involvement in treatment planning and goal setting is a high priority for patient satisfaction. This study reports on the use of standardized patients (SPs) in training third-year dental students to gather dental, medical, and psychosocial information from patients and to involve the patient in the decision-making process leading to the dental treatment plan. Among the skill areas measured, students were most successful in gathering dental information, with 94 percent of the students obtaining the complete set. Students were least successful in identifying the patient's goals for treatment (81 percent of the students identified the patients' goals). Students were most challenged by discussing sensitive topics with patients such as grief-related depression (25 percent of the students recognized and discussed such topics). It is important that dental schools familiarize students with patient issues and teach them how to talk effectively to patients about personal issues and to incorporate those issues into a discussion of the treatment plan for the patient. Standardized patients can be used effectively toward this end.

Using choice-based conjoint to determine the relative importance of dental benefit plan attributes

Abstract: The purpose of this study was to use conjoint analysis to determine the importance of specific dental benefit plan features for University of Iowa (UI) staff and to build a model to predict enrollment. From a random sample of 2000 UI staff, 40 percent responded (N = 773). The survey instrument was developed using seven attributes (five dental benefit plan features and two facility characteristics) each offered at three levels (e.g., premium = $20, $15, $10/month). Pilot testing was used to find a realistic range of plan options. Twenty-seven hypothetical dental benefit plans were developed using fractional factorial combinations of the three levels for each of the seven attributes. For all of the hypothetical plans, dental care was to be provided in the UI predoctoral dental clinic. Plan profiles were arranged four per page by combining the existing plan with three hypothetical plans, for a total of nine pages. Respondents' task was to select one plan from each set of four. A regression-like statistical model (Multinomial Logit) was used to estimate importance of each attribute and each attribute level. Relative importance (and coefficients) for each of the seven attributes are as follows: maximum annual benefit (.98), orthodontic coverage (.72), routine restorative (.70), major restorative (.67), time to complete treatment (.61), clinic hours of operation (.47), premium (.18). For each attribute, relative importance of each of three levels will also be presented. These coefficients for each level are used to predict enrollment for plans with specific combinations of the dental benefit plan features.

Effect of powder-free latex examination glove use on airborne powder levels in a dental school clinic.

Abstract: Cornstarch powder on latex examination gloves acts as an airborne carrier of natural latex allergens resulting in cutaneous, conjunctival, and/or respiratory responses to latex, a particular concern in a dental school environment where concentrated use of latex examination gloves occurs. This study measured airborne powder levels associated with a trial substitution of powder-free latex examination gloves for powdered latex examination gloves in a dental school clinic. Secondary aims of the study were to assess user acceptance of powder-free gloves during the trial and to assess the financial impact of converting the entire dental school to a powder-free environment. Air was sampled from two areas (dispensary and treatment room) of a student clinic fifteen to thirty minutes before the beginning of normal clinic sessions and again about 1.5 hours into the clinic session. The samples were microscopically analyzed for particulate counts of cornstarch powder. A written survey instrument assessed user acceptance of the two types of gloves. Historical financial data were used to estimate the cost of converting the entire dental school to a powder-free environment. Both the dispensary and the treatment room showed significant reductions in airborne powder counts during use of powder-free latex gloves and a return to high powder counts with resumption of powdered glove use. During the weeks of powdered glove use, the powder counts were also significantly lower before the beginning of the clinic session and higher during the clinic session. User acceptance of the powder-free latex gloves was high. The increased cost per year to convert the entire dental school to a powder-free environment was estimated to be $13,943.

The effect of an extramural education program on the perceived clinical competence of dental hygiene students

Abstract: The purpose of this study is to evaluate the effect of an extramural rotation on dental hygiene student self-perceptions of competence in specific clinical areas. Dental hygiene students attending one midwestern university from 1992 through 1998 rated their perceived level of competence on nineteen dimensions of dental hygiene practice prior to beginning a four-week extramural rotation and again at the completion of the rotation. Results indicated that student perceptions of competence improved significantly on six of the nineteen dimensions in each of the study years. Study results suggest that an extramural rotation is a valuable component of a dental hygiene curriculum to enhance student self-perceptions of clinical competence.

Knowledge of ethical lapses and other experiences on clinical licensure examinations.

Abstract: While clinical licensure examinations claim to protect the public from incompetent practitioners, serious problems related to issues of validity, reliability, and ethics have been reported. The ethical lapses are difficult to document, and reports of problems have been strictly anecdotal. This study's primary purpose was to verify those anecdotal reports by mailing a twenty-one-item survey to a national random sample of one thousand general dentists who graduated from a United States-accredited dental school between 1980 and 1994. For those who responded (42.9 percent) results show that 23.9 percent did not arrange for follow-up care for the patient even though it was indicated. Eight percent reported knowledge of instances where a lesion was intentionally created; 19.3 percent knew of premature treatment provided for purposes of the examination; 13.7 percent knew of a colleague who coerced a patient into accepting treatment; 32.5 percent reported knowledge of unnecessary radiographs. About half of all respondents agreed that the examination was not an accurate assessment of ability, and a similar proportion doubted that human patients were necessary. A more reliable and valid assessment strategy that does not jeopardize patient care is needed.

Developing a competency-based curriculum for a dental hygiene program.

Abstract: A three-step process was used that involved developing a competency document, an evaluation plan, and a curriculum inventory. The competency document, Competencies for the Dental Hygienist, included three domains, nine major competencies, and fifty-four supporting competencies. These became the department's educational goals. The evaluation plan included multiple methods for assessing each of the nine major competencies. The faculty initially identified evaluation methods that were currently in place and then added strategies for the various gaps in the plan. The curriculum inventory defined the entire curriculum in terms of the competencies. For each supporting competency, there was a list of major and foundation topics, each linked to specific courses. The strategy used to identify both the evaluation methods and curriculum topics was to survey the faculty. Information from assessments and the curriculum inventory directed the modification of the curriculum for alignment with the competencies. This process has resulted in improvements in teaching, evaluation, and student learning. The strengths and weaknesses of this competency-based curriculum development are presented, with specific recommendations for other-programs undergoing similar curriculum development.

Postdoctoral education in dentistry: preparing dental practitioners to meet the oral health needs of America in the 21st century.

Abstract: There has been increasing interest in the organization and accreditation of Postdoctoral General Dentistry Programs (PGD). In addition, numerous national organizations have called for increases in the number of first postdoctoral year (PGY-1) positions and programs. At the same time there has been a movement to incorporate concepts of competency-based education into dental education programs in order to stress the outcomes of education rather then the process. These movements have coincided with an increased recognition that dental education will be affected by the changing demographics of our population, the emerging trends in health care delivery and financing, and the need for an increase in the number of primary care providers in dentistry, trained at an advanced level, who are capable of caring for an increasingly socially diverse and medically complex population in our country in the next century. This paper reviews the history of postdoctoral education programs in dentistry and medicine with a focus on PGD education, describes the changing health care environment in which future dental professionals will practice, and relates the dental postdoctoral experience to that in medicine. A strategy is presented for the dental profession to prepare dental practitioners with the competencies needed for the future and to create enough training opportunities to prepare these practitioners to care for the oral health needs of the nation. This proposal calls for a "National Consensus Development Conference on the Future of Postdoctoral Primary Care Education in Dentistry". This conference would define the strategies necessary to prepare dental practitioners with the competencies needed for the future and develop approaches to create enough training opportunities to prepare these practitioners to care for the oral health needs of the nation.

Value in dental aptitude testing for minority applicants.

Abstract: Dental Admission Test (DAT) content is designed to be relevant to the scientific material encountered in the dental school curriculum. Before use, all items are examined to ensure that they are equally familiar to all groups participating in the testing program. Moreover, performance on the DAT has been found to be the best nationally available predictor of success in dental school programs. While differential test performance has been observed for the various groups participating in the testing program, the validity of the test is comparable across these groups. Clearly, evidence supports the use of the Dental Admission Test in dental school admissions for all applicants.

Employing oral examinations (viva voce) in assessing dental students' clinical reasoning skills.

Abstract: The development and evaluation of a comprehensive oral examination system are described. These examinations are designed to measure, in an authentic manner, graduating students9 understanding and use of the clinical reasoning and professional communications skills employed in the diagnosis, treatment, and management of realistic clinical situations. The examination cases were developed from actual clinic cases, enhanced to fit the requirements of the examination. Faculty members were provided with training sessions designed to promote consistency of administration and scoring. A mock oral examination was held to acquaint students with the process and to help reduce their anxiety. The results suggest that the oral examination is a reasonably valid and reliable approach to assessing clinical reasoning skills and that graduating students demonstrated competency in the areas tested.

Educational implications for copyright in a digital world.

Abstract: Statutory law and court cases currently leave fair use of copyrighted material poorly defined and fail to provide effective guidance for the use of others' work. Copyright legislation is undergoing significant change, accelerated by the evolution of computing and communication technologies. This paper reviews copyright issues, fair use guidelines, and applicable laws and statutes to help administrators and educators understand and comply with copyright regulations. The paper describes principles of copyright and ownership, the rights of copyright holders, and the conditions under which copyrighted material can be used by others. Recently introduced legislation, such as the 1998 Digital Millennium Copyright Act, may significantly affect how educators can use copyrighted material in the future. The integration of computer and communication technology into education raises a number of intellectual property issues for dental schools. This paper provides some general guidelines regarding copyright issues in academic environments.

Time management behaviors as potential explanatory factors in dental academic achievement

Abstract: DAT scores and predental GPAs have made the greatest but an imperfect contribution to the reliable estimation of dental students' academic success. One variable unaddressed yet having potential in accounting for unexplained variability in dental school performance is time management behaviors (TMB), a multidimensional attribute that is critical to success in a dental curriculum. Research has indicated a relationship of TMB dimensions (Setting Goals and Priorities, Mechanics of Time Management, Preference for Organization) with undergraduate academic achievement. The purposes of this study were: 1) to ascertain the levels of TMB dimensions reflected in predental students; 2) to validate in predental students the relationship of TMB dimensions and undergraduate academic achievement; and 3) to explore the relationship of TMB dimensions of predental students as explanatory variables of their early academic achievement in the dental curriculum. All individuals who were applicants interviewed for the 1997 entering D.D.S. class and the majority of members of the 1996 entering D.D.S. class participated in this study (n = 192). Each completed the TMB scale. High levels of TMB across dimensions were observed in predental and dental students. Unlike prior research, results showed virtually no relationship of TMB dimensions with undergraduate GPA of these subjects. Though a small relationship was found between dimensions and first-year dental GPAs, no dimension explained a significant amount of variance in any of these dental GPAs beyond that of undergraduate science GPA.