Challenges in the transition to clinical training in dentistry: An ADEE special interest group initial report.

INTRODUCTION: Curricular integration in higher education has been widely supported in the educational literature. As a result, several health care and specifically dental curricula have evolved from compartmentalised disciplinary training to integrated modalities; however, in many courses, a pre-clinical-clinical watershed remains a barrier to integration in dental education. This article introduces a general description of the pre-clinical-clinical transition in dentistry according to the outcomes of the discussion held during the first working group session of the "Transition to Clinical Training" Special Interest Group during the 2016 annual meeting of the Association for Dental Education in Europe. MATERIALS AND METHODS: An online questionnaire was made available before the meeting to survey the curricular characteristics of the participants' schools. During the meeting, a working session related to the pre-clinical-clinical transition occurred. Conclusions from the discussion are summarised in this article. RESULTS: Fourteen dental schools from 12 countries participated in the online survey. The included programmes had an average duration of 5.3 years (SD = 0.48), with high school or the local equivalent as the required entrance level for dentistry. The hybrid curriculum was the leading curriculum design (n = 9) followed by competence-based curricula (n = 3), with patient treatment as the core of clinical training in every included programme. CONCLUSION: The pre-clinical-clinical transition in dentistry is a recognisable matter in dental education that requires assessment and research to ease the management of a stage with relevant influence on educational outcomes. This article presents an initial framework for further research and educational intervention.

Innovation in dental education: The "On-the-Fly" approach to simultaneous development, implementation and evidence collection.

INTRODUCTION: This study outlines an approach for education innovation and addresses the ambivalence between evidence-based and non-evidence-based conditions. The "on-the-fly" approach was described as involving implementation during the development of an innovation for dental education. MATERIALS AND METHODS: The process of designing and implementing cutting-edge technology of the MOOG Simodont Dental Trainer (DT) whilst systematically collecting evidence illustrates the "on-the-fly" approach. RESULTS: Using the "on-the-fly" approach for developing, implementing and collecting evidence simultaneously in an academic environment appears feasible in serving both the professionals, users and developers and system designers. During the implementation of the new technology, growing evidence stepwise strengthened its position; therefore, showing stakeholders that evidence was used to improve the technology seemed to support and increase acceptance of the new technology. CONCLUSIONS: When pioneering an innovative technology in a specialty field, the development stage often precedes evidence for its effectiveness. Consciously choosing the "on-the-fly" approach clarifies to stakeholders in advance about the lack of evidence in an innovation and the need of their support to collect such evidence for improvement and in order to facilitate implementation.

[Real patients in virtual reality: the link between phantom heads and clinical dentistry]. / Echte patiënten in de virtuele realiteit: de schakel tussen fantoom en kliniek.

Preclinical training in phantom heads has until now been considered the 'gold standard' for restorative dental education, but the transition from preclinic to the treatment of real patients has remained a challenge. With the introduction of the latest generation of virtual reality simulators, students and dental practitioners can make digital impressions of their patients in virtual reality models and practice procedures in virtual reality before clinically performing them. In this way, clinical decisions can be investigated and practiced prior to actual treatment, enhancing the safety of the treatment and the self-confidence to perform it. With the 3M™ True Definition Scanner and the Moog Simodont Dental Trainer, 3 masters students and a general dental practitioner practiced their procedures in virtual reality prior to performing them on real patients. They were very satisfied with this preparation and the result of the treatment.

Effect of students' determination of testing time on their test performance.

This article investigates whether giving students control over preparing for and the moment of taking a test affects their test results in comparison with when the school is in control of the amount of training followed by a predetermined test moment. The students participated in training for manual dexterity. After the training, the students performed a test. The results of the test were stored in a database. Students from the group with freedom to select the moment of the test performed much better than those in the other group who did not have the freedom to select the moment for the test, with significantly fewer students requiring three attempts to pass the test. The fact that students when given the responsibility to develop manual skills performed better than when guided by the policy of the school is hopeful in the sense that students can learn in an early stage of their study to take responsibility for learning.

Student performance and appreciation using 3D vs. 2D vision in a virtual learning environment.

AIM: The aim of this study was to investigate the differences in the performance and appreciation of students working in a virtual learning environment with two (2D)- or three (3D)-dimensional vision. MATERIAL AND METHODS: One hundred and twenty-four randomly divided first-year dental students performed a manual dexterity exercise on the Simodont dental trainer with an automatic assessment. Group 1 practised in 2D vision and Group 2 in 3D. All of the students practised five times for 45 min and then took a test using the vision they had practised in. After test 1, all of the students switched the type of vision to control for the learning curve: Group 1 practised in 3D and took a test in 3D, whilst Group 2 practised in 2D and took the test in 2D. To pass, three of five exercises had to be successfully completed within a time limit. The students filled out a questionnaire after completing test 2. RESULTS: The results show that students working with 3D vision achieved significantly better results than students who worked in 2D. Ninety-five per cent of the students filled out the questionnaire, and over 90 per cent preferred 3D vision. CONCLUSION: The use of 3D vision in a virtual learning environment has a significant positive effect on the performance of the students as well as on their appreciation of the environment.

Evaluation of the appreciation of virtual teeth with and without pathology.

AIM: Virtual teeth with and without tooth pathology have been developed for use in a virtual learning environment in dental education. The objective of this study was to evaluate the appearance of these virtual teeth for use in dental education and to compare them with contemporary educational models, such as plastic teeth (Frasaco GmbH) and extracted human teeth. MATERIAL AND METHODS: Six sets of photographs representing six different teeth were shown to dentists, teachers (dentists) and dental students (bachelor's and master's degree students). Each set consisted of 15 pictures showing five views of the extracted human tooth, the similar virtual tooth and the plastic tooth. The five views represented the mesial, distal, occlusal, buccal and lingual surfaces. The virtual tooth was the same as the extracted tooth (scanned with a cone beam CT, coloured and edited in ColorMapEditor(®) ), and the plastic tooth presented the best possible match to the extracted tooth. The participants were asked to rate the appearance of the virtual teeth (overall and in terms of caries, restoration and colours), whether the virtual or plastic teeth resembled the extracted teeth better and from which teeth they expected to learn the most (extracted, virtual or plastic). RESULTS: Each group of participants found that the virtual teeth resembled the extracted teeth more than they resembled the plastic teeth; 71% of the participants expected to learn more from the virtual teeth than from the plastic teeth. CONCLUSION: The results show that the appearance of the virtual teeth was considered more realistic than the appearance of the plastic teeth. The expectation was that the learning opportunities of the virtual teeth are better than of the plastic teeth.

The creation of virtual teeth with and without tooth pathology for a virtual learning environment in dental education.

PURPOSE: To describe the development and opportunities for implementation of virtual teeth with and without pathology for use in a virtual learning environment in dental education. MATERIAL AND METHODS: The creation of virtual teeth begins by scanning a tooth with a cone beam CT. The resulting scan consists of multiple two-dimensional grey-scale images. The specially designed software program ColorMapEditor connects these two-dimensional images to create a three-dimensional tooth. With this software, any aspect of the tooth can be modified, including its colour, volume, shape and density, resulting in the creation of virtual teeth of any type. RESULTS: This article provides examples of realistic virtual teeth with and without pathology that can be used for dental education. ColorMapEditor offers infinite possibilities to adjust and add options for the optimisation of virtual teeth. DISCUSSION: Virtual teeth have unlimited availability for dental students, allowing them to practise as often as required. Virtual teeth can be made and adjusted to any shape with any type of pathology. Further developments in software and hardware technology are necessary to refine the ability to colour and shape the interior of the pulp chamber and surface of the tooth to enable not only treatment but also diagnostics and thus create a greater degree of realism. CONCLUSION: The creation and use of virtual teeth in dental education appears to be feasible but is still in development; it offers many opportunities for the creation of teeth with various pathologies, although an evaluation of its use in dental education is still required.

A community of learners in the evidence-based dental clinic.

UNLABELLED: An increasing emphasis has been placed on the need for an evidence-based approach in dentistry. This calls for effort in dental education to develop and implement tools for the application of evidence in clinical decision-making (evidence-based decision-making, EBDM). AIM: To evaluate whether the implementation of a community of learners (COL) within a clinical EBDM course enables students, clinical teachers and scientists to discuss the application of evidence in clinical decision-making and whether it stimulates a scientific approach in students. MATERIAL AND METHODS: A clinical course in EBDM was created. Students presented and discussed patient cases in a COL of student-peers, clinical teachers and scientists. From the discussion, clinical questions arose and were translated into PICO format (Problem, Intervention, Comparison and Outcome). Students searched for evidence in the literature. Four weeks later, they presented and discussed the evidence found. Before and after the implementation of the course, students, clinical teachers and scientists completed a questionnaire anonymously on the procedure adopted, its content, the learning outcomes and their appreciation of this course. Assessment of the competence EBDM was performed at the end of the course. Grading scores of students in the COL were compared with scores of a student group that did not participate in the COL and were not advised by scientists. RESULTS: Evaluation showed that scientists, clinical teachers and students gradually became more positive on the adopted procedure, content, learning outcomes and the appreciation of this course (ANOVA Bonferoni P<0.05). The student's evaluation showed the development of a more scientific approach. Assessment scores of EBDM were sufficient and promising. CONCLUSION: A stimulating arena was created: a COL, in which the evidence used in clinical decision-making, was discussed. The COL involved dental students, clinical teachers and scientists. In this setting, an EBDM course appeared to result in a more scientific approach from dental students. The COL provided a good working concept for EBDM in dental education.

[Innovations in education for the digital student]. / Onderwijsinnovaties voor de digitale student.

A significant percentage of today's teaching staff received their professional training before the revolution in information and communication technology took place. Students, by contrast, are so-called 'digital natives': they grew up surrounded by digital technology. Present day students are used to multi-tasking and expect to be facilitated in using educationalfacilities regardless of time and place. Adapting higher education to present day students' study behaviour and expectations requires reconsideration of educationalform and methods. Several types of staff can be distinguished in their attitude towards technological innovation in education. Among them are staff who are reluctant in accepting innovations. Dental schools face the challenge of finding supportfor innovations with all their teaching staff and to better adapt to the twenty-first century student. In order to introduce technological innovations successfully, students need to become involved and sufficient attention must be paid to qualifying instructors.

[The Simodont in dental education]. / De Simodont in het onderwijs.

The Simodont is a virtual learning environment for students of dentistry which is intended to expand and optimize the preparation ofstudents for the treatment ofpatients so that the transition in education from pre-clinic to clinic is reduced. The Simodont makes it possible to offer students more realistic clinical problems. In that way, students can practice much more extensively than they can in the pre-clinic on phantom heads. The Simodont also provides a safe learning environment in which unlimited mistakes can be made without unfortunate consequencesfor the student and patient. The simulator is coordinated with reading material on a computer, which makes it possible to integrate techniques and theory in dental education. Virtual teeth, with and without pathology, have been created for application in the Simodont, to allow unlimited possibilities for practice. The future possibilities for the Simodont offer many opportunities for students in dental education, for supplementary and post-graduate education andfor the re-integration of dentists in their profession.

[Assessing the clinical competence of dental students]. / Het beoordelen van de klinische competenties van studenten tandheelkunde.

Nowadays, the competences of dental students are tested more on the basis of quality of their achievements than the quantity. 'Objective Structured Clinical Examinations' (OSCEs) can be used in a pre-clinical phase to test these clinical competences. For the clinical phase, the general examination and the digital portfolio have been developed. Tests are used to stimulate the learning process and to determine whether students are ready for the next step; in addition, the quality of the programme is protected by the set of examinations. The results of the last 5 general examinations reveal the pattern that the number of correct answers increases as the study progresses. The Amsterdam Academic Centre for Dentistry (ACTA) introduced a digital portfolio which was evaluated 1 year later with the help ofan anonymous questionnaire. Students judged the use of the digital portfolio in the clinic to be useful but also costly in time.

A framework of teaching competencies across the medical education continuum.

BACKGROUND: The quality of teachers in higher education is subject of increasing attention, as exemplified by the development and implementation of guidelines for teacher qualifications at Universities in The Netherlands. AIM: Because medical education takes a special position in higher education the Council of Deans of Medical Schools in The Netherlands installed a national task force to explore a method to weigh criteria for teacher qualifications of medical teachers. METHODS: A framework was developed covering competencies of teachers throughout the medical education continuum and including medicine, dentistry and veterinary medicine. RESULTS: The framework distinguishes 3 dimensions: (a) six domains of teaching (development - organization - execution - coaching - assessment - evaluation); (b) three levels in the organization at which teachers perform (micro, meso and macro level) and (c) competencies as integration of knowledge, skills and attitude and described as behaviour in specific context. The current framework is the result of several cycles of descriptions, feedback from the field and adaptations. It is meant as a guideline, leaving room for local detailing. CONCLUSION: The framework provides a common language that may be used not only by teachers and teacher trainers, but also by quality assurance committees, human resource managers and institutional boards.

[Discussing and evaluating professional behaviour. 2. Amsterdam Dental School]. / Bespreken en beoordelen van professioneel gedrag. 2 Academisch Centrum Tandheelkunde Amsterdam.

Since the introduction of the bachelor-master structure five years ago at the Amsterdam Dental School, the evaluation and assessment of professional behaviour has been an examination subject in the bachelor programme. Professional behaviour is understood to be the student's observable behaviour in the educational setting, as distinguished from someone's inner beliefs or convictions. The core of this element in the curriculum is the feedback which the student regularly receives from several teachers concerning their behavior, given whatis expected from a medical professional. The programme's requirement is that a third year student demonstrably has sufficient satisfactory evaluations to earn the necessary study credits.

Assessment of dental anxiety in edentulous subjects.

In this investigation an anxiety scale was constructed to measure dental anxiety in full denture patients. Furthermore, the relationship of this anxiety scale with denture history, denture satisfaction, and personality traits was investigated. A group of 125 patients who were on a waiting list to have new dentures constructed participated in this study. The coefficient alpha value of the anxiety scale was 0.81. Significant correlations were found with number of years with complete dentures (r = -0.20), with denture complaints (r = 0.18-0.19) and with some personality traits (r = 0.21-0.32). Further research into the role of dental anxiety with respect to dental behaviour and dental satisfaction in edentulous populations seems useful.

Relative importance of psychologic factors in denture satisfaction.

The aim of this investigation was to explore the relative importance of psychologic variables in explaining the degree of denture satisfaction in full denture patients. A group of 125 patients who were on a waiting list to have new dentures constructed participated in this study. The patients completed the Dutch version of the Hopkins Symptom Checklist, the Dutch Personality Inventory, a denture satisfaction questionnaire and a denture complaint questionnaire. No relation was found between the personality variables and denture satisfaction as measured by the denture satisfaction questionnaire. When the different aspects of denture satisfaction were measured by means of complaint scales, satisfaction was related to personality traits. Functional complaints of the mandibular denture and complaints about a hollow face were related to the personality trait "extraversion-introversion". Vague denture complaints and complaints about a bulbous face were related to "neuroticism".

Assessment of denture satisfaction.

The aim of this investigation was to evaluate the reliability and validity of a complaints questionnaire, designed to measure different aspects of denture satisfaction. Two groups of patients with full maxillary and mandibular dentures participated in the study. The patients in Group 1 (n = 113) were on a waiting list for new dentures, patients in Group 2 (n = 102) had recently had new dentures fitted. Five denture complaint scales were constructed from the questionnaire. The internal consistency (coefficient alpha) of the scales varied from 0.65 to 0.92. Furthermore, the scales showed a discriminatory ability between the patient groups (P less than or equal to 0.001) and significant Pearson correlation coefficients with satisfaction-related questions (r = 0.25-0.79). The scores on the scales can be considered a quantitative measure of denture satisfaction.

Reproducibility of an assessment scale of denture quality.

Assessment of denture quality is important in prosthetic research. The aim of this investigation was to determine the intra- and interexaminer reliability of denture quality assessment. Three groups of patients with full maxillary and mandibular dentures and two dentists participated. The patients in group 1 (n = 195) were examined by the two dentists independently, in group 2 (n = 35) twice by one of the dentists and in group 3 (n = 20) twice by the other dentist. A denture quality scale was constructed containing nine variables. The internal consistency (coefficient alpha) of this scale was 0.60. The intra- and interexaminer reliability was between 0.59 and 0.86. For individual items of this scale these values were between 0.22 and 1.00.

Development and implementation of new educational concepts in a dental curriculum.

The Academic Centre for Dentistry Amsterdam introduced a fully renewed 5-year dental curriculum in September 2003. In this article, the educational principles and didactic choices that form the basis of the curriculum development are presented and attention is given to the process of development and the implementation strategy that constitute such an important part of the success of introducing a new curriculum. Special characteristics of the new curriculum are the clinical training practice, professional conduct, the elective profiles and academic education. In clinical practice, groups of students from different levels run a group practice in which they learn to work together, delegate tasks, solve clinical problems and apply evidence-based dentistry. In the new curriculum students learn to conduct themselves as professionals. In the third and in the fifth year, students choose an elective profile oriented, respectively, on research and on clinical knowledge and skills. Academic education is an important spearhead in this curriculum in which students not only learn why research is important to dentistry but also how dentists can use research to their own benefit. In development and implementation, a stepwise approach was used in which as many people as logistically possible were involved.