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Introduction The governing bodies of the dental industry in the UK and Ireland require dentists to be qualified and have the knowledge, skills and attributes to enable them to practice safely without supervision. The ways in which dental schools achieve this goal may vary and be modified in response to changes in the expectations of governing bodies and challenges in the educational environment. Therefore, it is important to determine which methods work well and disseminate the best practices described in the literature.
Objectives To use a scoping review to identify methods for teaching clinical dental skills from the published literature, including innovation, motivation for change, and factors influencing the quality and quality of teaching.
Methods. A scoping review method was used to select and analyze 57 articles published between 2008 and 2018.
Results. Developments in information technology and the development of virtual learning environments have facilitated innovation in teaching and promoted independent and autonomous learning. Preclinical hands-on training is conducted in clinical technology laboratories using mannequin heads, and some dental schools also use virtual reality simulators. Clinical experience is primarily acquired in multidisciplinary clinics and mobile training centers. Insufficient numbers of suitable patients, increasing student numbers, and decreasing faculty have been reported to result in decreased clinical experience with some treatment modalities.
Conclusion Current clinical dental skills training produces new graduates with good theoretical knowledge, prepared and confident in basic clinical skills, but lacking experience in complex care, which may result in reduced readiness to practice independently.
Draws on the literature and demonstrates the impact of the stated innovations on the effectiveness and implementation of dental clinical skills teaching across a range of clinical disciplines.
A number of concerns were identified by stakeholders in relation to specific clinical areas where the risk of insufficient preparation for independent practice was reported.
Useful for those involved in the development of teaching methods at the undergraduate level, as well as for those involved in the interface between undergraduate and basic training.
Dental schools are required to provide graduates with the skills and knowledge that will enable them to practice competently, compassionately, and independently without supervision, as described in the “Preparation for Practice” section. 1
The Irish Dental Council has a Code of Practice which sets out its expectations in a number of clinical areas. 2,3,4,5
Although the undergraduate program outcomes in each jurisdiction are clearly defined, each dental school has the right to develop its own curriculum. The key elements are the teaching of basic theory, the safe practice of basic surgical skills prior to patient contact, and the honing of patient skills under supervision.
Most recent graduates in the UK enter a one-year program called Foundation Training, funded by the National Health Service, where they work in a chosen school under the supervision of a so-called Head of Education (formerly an NHS Basic Patient Education Trainer in Primary Care Practice). help). . Participants attend a minimum of 30 required study days at a local graduate school for structured additional training. The course was developed by the Council of Deans and Directors of Postgraduate Dentistry in the UK. 6 Satisfactory completion of this course is required before a dentist can apply for a performer number and begin GP practice or join hospital service in the following year.
In Ireland, newly graduated dentists can enter general practice (GP) or hospital positions without further training.
The aim of this research project was to conduct a scoping literature review to explore and map the range of approaches to teaching clinical dental skills at undergraduate level in UK and Irish dental schools to determine if and why new teaching approaches have emerged. whether the teaching environment has changed, faculty and student perceptions of teaching, and how well teaching prepares students for life in dental practice.
The objectives of the above study are suitable for the survey research method. A scoping review is an ideal tool for determining the scope or scope of literature on a given topic and is used to provide an overview of the nature and quantity of scientific evidence available. In this way, knowledge gaps can be identified and thus suggest topics for systematic review.
The methodology for this review followed the framework described by Arksey and O’Malley 7 and refined by Levack et al. 8 The framework consists of a six‐step framework designed to guide researchers through each step of the review process.
Therefore, this scoping review included five steps: defining the research question (Step 1); identifying relevant studies (step 2); present the results (Step 5). The sixth stage – negotiations – was omitted. While Levac et al. 8 consider this an important step in the scoping review approach because stakeholder review increases the rigor of the study, Arksey et al. 7 consider this step optional.
Research questions are determined based on the objectives of the review, which are to examine what is shown in the literature:
Perceptions of stakeholders (students, clinical faculty, patients) about their experience teaching clinical skills in dental school and their preparation for practice.
The Medline All database was searched using the Ovid platform to identify first articles. This pilot search provided keywords used in subsequent searches. Search the Wiley and ERIC (EBSCO platform) databases using the keywords “dental education AND clinical skills training” OR “clinical skills training.” Search the UK database using the keywords “dental education AND clinical skills training” OR “Clinical skills development” Journal of Dentistry and The European Journal of Dental Education was searched.
The selection protocol was designed to ensure that the selection of articles was consistent and contained information that was expected to answer the research question (Table 1). Check the reference list of the selected article for other relevant articles. The PRISMA diagram in Figure 1 summarizes the results of the selection process.
Data diagrams were created to reflect the key features and findings expected to be presented in the selected features of the article. 7 The full texts of selected articles were reviewed to identify themes.
A total of 57 articles that met the criteria specified in the selection protocol were selected for inclusion in the literature review. The list is provided in the online supplementary information.
These articles are the result of work by a group of researchers from 11 dental schools (61% of dental schools in the UK and Ireland) (Fig. 2).
The 57 articles that met the inclusion criteria for the review examined various aspects of teaching clinical dental skills in different clinical disciplines. Through content analysis of the articles, each article was grouped into its corresponding clinical discipline. In some cases, the articles focused on the teaching of clinical skills within a single clinical discipline. Others looked at clinical dental skills or specific learning scenarios related to multiple clinical areas. The group called “Other” represents the last item type.
Articles focusing on teaching communication skills and developing reflective practice were placed under the “Soft Skills” group. At many dental schools, students treat adult patients in multidisciplinary clinics that address all aspects of their oral health. The “comprehensive patient care” group refers to articles describing clinical education initiatives in these settings.
In terms of clinical disciplines, the distribution of the 57 review articles is shown in Figure 3.
After analyzing the data, five key themes emerged, each with several subthemes. Some articles contain data on multiple topics, such as information on teaching theoretical concepts and methods for teaching practical clinical skills. Opinion topics are primarily based on questionnaire-based research reflecting the views of department heads, researchers, patients and other stakeholders. In addition, the opinion theme provided an important “student voice” with direct quotes in 16 articles representing the opinions of 2042 student participants (Figure 4).
Despite significant differences in teaching time across subjects, there is considerable consistency in the approach to teaching theoretical concepts. Lectures, seminars, and trainings were reported to be provided at all dental schools, with some adopting problem-based learning. The use of technology to enhance (potentially boring) content through audiovisual means has been found to be common in traditionally taught courses.
Teaching was provided by clinical academic staff (senior and junior), general practitioners and specialist specialists (eg radiologists). Printed resources have largely been replaced by online portals through which students can access course resources.
All preclinical clinical skills training in dental school occurs in the Phantom Lab. Rotary instruments, hand instruments, and x-ray equipment are the same as those used in the clinic, so in addition to learning dental surgery skills in a simulated environment, you can become familiar with equipment, ergonomics, and patient safety. Basic restorative skills are taught in the first and second years, followed by endodontics, fixed prosthodontics and oral surgery in subsequent years (third to fifth years).
Live demonstrations of clinical skills have largely been replaced by video resources provided by dental school virtual learning environments (VLEs). Faculty include university clinical teachers and general practitioners. Several dental schools have installed virtual reality simulators.
Communication skills training is conducted on a workshop basis, using classmates and specially presented actors as simulated patients to practice communication scenarios prior to patient contact, although video technology is used to demonstrate best practices and allow students to evaluate their own performance.
During the preclinical phase, students extracted teeth from Thiel’s embalmed cadavers to enhance realism.
Most dental schools have established multispecialty clinics in which all of a patient’s treatment needs are met in one clinic rather than many single-specialty clinics, which many authors believe is the best model for primary care practice.
Clinical supervisors provide feedback based on the student’s performance in clinical procedures, and subsequent reflection on this feedback can guide future learning of similar skills.
The individuals in charge of this “department” have most likely received some post-graduate training in the field of education.
Reliability at the clinical level has been reported to be improved through the use of multidisciplinary clinics in dental schools and the development of small outreach clinics known as outreach centers. Outreach programs are an integral part of the education of high school students: final year students spend up to 50% of their time in such clinics. Specialist clinics, NHS community dental clinics and GP placements were involved. Dental supervisors vary depending on the type of location, as does the type of clinical experience gained due to differences in patient populations. Students gained experience working with other dental care professionals and gained a deep understanding of interprofessional pathways. Claimed benefits include a larger and more diverse patient population at outreach centers compared to school-based dental clinics.
Virtual reality workstations have been developed as an alternative to traditional phantom head devices for preclinical skills training in a limited number of dental schools. Students wear 3D glasses to create a virtual reality environment. Audiovisual and auditory cues provide operators with objective and immediate performance information. Students work independently. There are a variety of procedures to choose from, from simple cavity preparation for beginners to crown and bridge preparation for advanced students. Benefits are reported to include lower supervision requirements, which can potentially improve productivity and reduce operating costs compared to traditional supervisor-led courses.
The Computer Virtual Reality Simulator (CVRS) combines traditional phantom head units and hardware with infrared cameras and computers to create a three-dimensional virtual reality of the cavity, overlaying the attempts of a student with ideal training on a screen.
VR/haptic devices complement rather than replace traditional methods, and students reportedly prefer a combination of supervision and computer feedback.
Most dental schools use VLE to enable students to access resources and participate in online activities with varying degrees of interactivity, such as webinars, tutorials, and lectures. The benefits of VLE are reported to include greater flexibility and independence as students can set their own pace, time and location of learning. Online resources created by the parent dental schools themselves (as well as many other sources created nationally and internationally) have led to the globalization of learning. E-learning is often combined with traditional face-to-face learning (blended learning). This approach is believed to be more effective than either method alone.
Some dental clinics provide laptops that allow students to access VLE resources during treatment.
The experience of giving and receiving diplomatic criticism increases coworkers’ task engagement. Students noted that they were developing reflective and critical skills.
Untutored group work, where students conduct their own workshops using resources provided by the VLE dental school, is considered an effective way of developing the self-management and collaboration skills required for independent practice.
Most dental schools use portfolios (documents of work progress) and electronic portfolios. Such a portfolio provides a formal record of achievements and experience, deepens understanding through reflection on experience, and is an excellent way to develop professionalism and self-assessment skills.
There is a reported shortage of suitable patients to meet the demand for clinical expertise. Possible explanations include unreliable patient attendance, chronically ill patients with little or no disease, patient noncompliance with treatment, and inability to reach treatment sites.
Screening and assessment clinics are encouraged to increase patient accessibility. Several articles raised concerns that the lack of clinical application of some treatments could cause problems when Foundation trainees encounter such treatments in practice.
There is an increasing reliance on part-time GDP and clinical faculty within the restorative dental practice workforce, with the role of senior clinical faculty becoming increasingly supervisory and strategic responsible for specific areas of course content. A total of 16/57 (28%) articles mentioned shortages of clinical staff at teaching and leadership levels.
Post time: Aug-29-2024