Ottawa 2020 consensus statement for programmatic assessment - 1. Agreement on the principles.

INTRODUCTION: In the Ottawa 2018 Consensus framework for good assessment, a set of criteria was presented for systems of assessment. Currently, programmatic assessment is being established in an increasing number of programmes. In this Ottawa 2020 consensus statement for programmatic assessment insights from practice and research are used to define the principles of programmatic assessment. METHODS: For fifteen programmes in health professions education affiliated with members of an expert group (n = 20), an inventory was completed for the perceived components, rationale, and importance of a programmatic assessment design. Input from attendees of a programmatic assessment workshop and symposium at the 2020 Ottawa conference was included. The outcome is discussed in concurrence with current theory and research. RESULTS AND DISCUSSION: Twelve principles are presented that are considered as important and recognisable facets of programmatic assessment. Overall these principles were used in the curriculum and assessment design, albeit with a range of approaches and rigor, suggesting that programmatic assessment is an achievable education and assessment model, embedded both in practice and research. Knowledge on and sharing how programmatic assessment is being operationalized may help support educators charting their own implementation journey of programmatic assessment in their respective programmes.

Ottawa 2020 consensus statements for programmatic assessment - 2. Implementation and practice.

INTRODUCTION: Programmatic assessment is a longitudinal, developmental approach that fosters and harnesses the learning function of assessment. Yet the implementation, a critical step to translate theory into practice, can be challenging. As part of the Ottawa 2020 consensus statement on programmatic assessment, we sought to provide descriptions of the implementation of the 12 principles of programmatic assessment and to gain insight into enablers and barriers across different institutions and contexts. METHODS: After the 2020 Ottawa conference, we surveyed 15 Health Profession Education programmes from six different countries about the implementation of the 12 principles of programmatic assessment. Survey responses were analysed using a deductive thematic analysis. RESULTS AND DISCUSSION: A wide range of implementations were reported although the principles remained, for the most part, faithful to the original enunciation and rationale. Enablers included strong leadership support, ongoing faculty development, providing students with clear expectations about assessment, simultaneous curriculum renewal and organisational commitment to change. Most barriers were related to the need for a paradigm shift in the culture of assessment. Descriptions of implementations in relation to the theoretical principles, across multiple educational contexts, coupled with explanations of enablers and barriers, provided new insights and a clearer understanding of the strategic and operational considerations in the implementation of programmatic assessment. Future research is needed to further explore how contextual and cultural factors affect implementation.

An integrated curriculum for dentists and dental therapists in Liverpool.

The role of the dental therapist has evolved over the course of the past 70 years, both in the UK and across the globe. The General Dental Council's Scope of practice guidance sets out the skills and abilities of each of the professional roles within the dental team, including the dental therapist. Scope of practice of the multidisciplinary team remains poorly understood, to the detriment of teamworking. The dental profession is under pressure and the development of a flexible and appropriately trained skill mix might help us adapt to meet the oral health needs of the population, while leveraging a sustainable workforce. In 2019, the School of Dentistry at the University of Liverpool introduced a novel 'centennial curriculum', designed to fully integrate the interprofessional training requirements of dentists and dental therapists, following application via two distinct routes of entry. Challenges have arisen and addressing these has required a culture of openness and honesty regarding the complexities of shared care and scope of practice.

Assessment and feedback in dental education: a journey.

The authors describe their personal experience of responding to changing perceptions of best practice and the expanding evidence base, in relation to assessment and feedback in dental education. Changes at a particular dental school over the years are described, along with a more general outlook, culminating in suggestions for future directions.

Online Unproctored Clinical Examinations: The Perceptions and Performance of Final Year Dental Students.

BACKGROUND: Take home, or open-book, examinations (OBE) are designed to be completed at a location of student choice, whilst providing comprehensive assessment of learning outcomes. Supporters of OBE refer to their authenticity, in that they reflect real-world practice where use of external resources is routine and encouraged. A contrasting view is that efficient practice requires a solid base of knowledge upon which to draw. The aim of this evaluation was to elicit learners' perceptions of the open-book, unproctored examination approach; we sought student views on authenticity, assessment preparation, use of resources, and anxiety. METHODS: Quantitative and qualitative data were gathered using an online, self-administered survey. We sought to determine the correlation between student views and examination performance via consideration of final examination marks. RESULTS: Heightened anxiety levels tended to increase assessment preparations and were found to be inversely related to learners' perceptions that the OBE was an authentic test. An inverse relationship was seen between learners' OBE examination performance and consulting resources during the examination. Examination marks were not significantly related to endorsement of continued online delivery of learning, time spent preparing for OBE in comparison to other types of assessment, greater anxiety than usual, perceptions of test authenticity, or experiencing a supportive test environment. CONCLUSIONS: The results of this study may inform curriculum and assessment development, learning and teaching practices, and support student voice and experience.

Is the number of procedures completed a valid indicator of final year student competency in operative dentistry?

Introduction Concerns regarding the preparedness of dental graduates often focus on the number of procedures undertaken before qualification.Aims To assess the validity of numerical requirements in determining whether a student has sufficient competency to graduate.Materials and methods In total, 50,821 observations of student activity while on the restorative clinic, for two integrated student cohorts (n = 139), were continuously recorded using the LiftUpp system from their third year to graduation. Analysis of data determined the most frequent type, location and difficulty of the direct restorations provided.Results Four groups of students, categorised by the total number of restorations they provided, were identified. Those with the most restorations (70+) had a statistically significantly greater experience in restoring different tooth surfaces, in different quadrants, on different patients than those with the least (40-49). However, increased numbers did not correlate with increasing difficulty, suggesting that students simply became more adept at easier procedures.Discussion Using a derived measure of 'consistency', it was observed that increased performance consistency was not correlated with greater overall experience. Furthermore, only 4% of students were 100% consistent in their performance in their final year.Conclusions These data suggest that a 'numerical requirements' approach cannot be used, in isolation, as a valid measure of the competency of an individual. Further work is needed to validate consistency as a holistic measurement to characterise the performance of graduates.

A role for nitric oxide-mediated glandular hypofunction in a non-apoptotic model for Sjogren's syndrome.

OBJECTIVE: To investigate a role for the inflammatory mediator, nitric oxide (NO) in SS, an autoimmune condition characterized by salivary and lacrimal gland hypofunction resulting from failure of acinar cells to secrete. METHODS: FURA-2 microfluorimetry was used to measure agonist-evoked changes of [Ca(2+)](i) in isolated mouse and human salivary acinar cells following exposure to NO donors. RESULTS: NO had a biphasic effect on salivary acinar function. Acute exposure to NO (2 min) caused a cyclic guanosine monophosphate (GMP)-dependent, 1-H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-sensitive increase in the Ca(2+) signal elicited in response to acetylcholine (ACh) stimulation, consistent with stimulation of ryanodine receptors by cyclic adenosine diphosphate ribose. Prolonged exposure to NO (>40 min) significantly reduced the ACh-evoked Ca(2+) signal by a mechanism independent of cyclic GMP. We found no differences between the responses of human and mouse acinar cells. CONCLUSION: Our data show that chronic exposure to NO, which is known to be elevated in SS, could have a role in salivary gland hypofunction. We note a similarity in the response to stimulation of salivary acinar exposed to NO and that which we have previously reported in salivary acinar cells isolated from patients with SS. We speculate that NO-mediated nitrosylation of one or more elements of the signal transduction pathway could underlie down-regulation of salivary function in SS.

What did they do next? A survey of dentists who have passed the Overseas Registration Examination of the General Dental Council.

Aims To establish what work a sample of Overseas Registration Examination (ORE) registrants were undertaking and understand what had facilitated or impeded them from finding suitable employment as dentists. Method An online questionnaire, consisting of both closed and open questions, was used to capture data from a population of 1,106 former ORE candidates who passed the examination between 2009 and 2014 and were registered by the General Dental Council (GDC). The data were analysed and presented in the form of tables, figures and a presentation of the major themes that emerged from the responses. Results There was a 42% response rate. Seventy-one percent of respondents were employed as dentists in the UK, with the majority providing a mixture of private and NHS patient treatment. Most who were not working as dentists were actively seeking training places. Additional themes that were identified included: the availability of Dental Foundation/Vocational Training places; poor employment practices; perceptions of the strengths and weaknesses of the ORE; and some ideas about the future responsibilities of the GDC. Conclusions This survey has highlighted some difficulties that many ORE registrants face finding suitable work as dentists. Stakeholders should be aware of these challenges.

Autoantibodies and Sjögren's syndrome: a physiologist's perspective.

Sjögren's syndrome is a systemic autoimmune condition centred around salivary gland dysfunction and atrophy. There are a plethora of antibodies that mark the decline of the salivary glands, most of which relate to apoptopic mediated destruction of acinar cells. The best known of these autoantibodies, anti-Ro and anti-La form part of the diagnostic criteria for the condition. An emerging viewpoint in recent years is that glandular dysfunction precedes rather than follows glandular atrophy and attention has shifted to the interface between the immune system and the secretory process. An autoantibody against the muscarinic type 3 acetylcholine receptor occupies precisely this position because it inhibits the acetylcholine receptor which controls salivary and lacrimal fluid secretion. The consequence of identifying an autoantibody that can cause rather than simply reflect the disease process are manifold and could have a huge impact on development of therapeutic treatments. Furthermore, a "functional" autoantibody directed against an important component of the autonomic nervous system could also account for some of the extraglandular features of Sjögren's syndrome.

The further development and validation of the Liverpool Oral Rehabilitation Questionnaire (LORQ) version 3: a cross-sectional survey of patients referred to a dental hospital for removable prostheses replacement.

STATEMENT OF PROBLEM: The Liverpool Oral Rehabilitation Questionnaire (LORQ) is a health-related quality of life instrument assessing the impact of oral rehabilitation on patients' health-related quality of life (HRQOL) following treatment for oral cancer. The small number of patients wearing prostheses in previous studies limited the validation of the denture/denture satisfaction part of the questionnaire. PURPOSE: The purpose of this study was to further validate the LORQ by obtaining HRQOL data from patients requiring replacement dentures. MATERIAL AND METHODS: The LORQv3, together with items assessing mood and anxiety, was administered with the Oral Health Impact Profile 14-item (OHIP-14) questionnaire to 104 consecutive patients, between the ages of 40 and 79, referred by their general dentists to the department of prosthodontics at the Liverpool University Dental Hospital for replacement of removable prostheses between November 2004 and June 2005. The Mann-Whitney and Kruskal-Wallis tests compared scores between patient groups. Internal consistency was measured by Cronbach's alpha. Spearman's correlation investigated associations between items on the LORQv3 and items from the OHIP-14. Test-retest was measured by the kappa coefficient, weighted by applying standard weights according to the number of categories in error. RESULTS: Patients wearing complete dentures in 1 or both arches generally scored worse for oral function and mandibular denture problems/satisfaction than patients wearing removable partial dentures. Thirty-three percent of patients were somewhat or extremely depressed, 25% were anxious or very anxious, and 15% were both depressed and anxious. CONCLUSIONS: The denture section of the LORQv3 identified expected differences among various patient subgroups in this cohort confirmed by similar findings for the OHIP-14 and the literature. Thus, this part of the LORQv3 referring to dentures and patient satisfaction demonstrated good construct and criterion validity.