A computerised third molar surgery simulator--results of supervision by different professionals.

The purpose of the study was to investigate which supervisory approach afforded the most efficient learning method for undergraduate students in oral and maxillofacial surgery (OMS) using a computerised third molar surgery simulator. Fifth year dental students participated voluntarily in a randomised experimental study using the simulator. The amount of time required and the number of trials used by each student were evaluated as a measure of skills development. Students had the opportunity to practise the procedure until no further visible improvements were achieved. The study assessed four different types of supervision to guide the students. The first group was where they were supported by a teacher/specialist in OMS, the second by a teaching assistant, the third group practised without any supervision and the fourth received help from a simulator technician/engineer. A protocol describing assessment criteria was designed for this purpose, and a questionnaire was completed by all participating students after the study. The average number of attempts required to virtually remove a third molar tooth in the simulator was 1.44 times for the group supervised by an OMS teacher; 1.5 times for those supervised by a teaching assistant; 2.8 times for those who had no supervision; and 3.6 times when support was provided only by a simulator technician. The results showed that the most efficient experience of the students was when they were helped by an OMS teacher or a teaching assistant. In a time and cost-effective perspective, supervision by a teaching assistant for a third molar surgery simulator would be the optimal choice.

A systematic approach to improve oral and maxillofacial surgery education.

To improve teaching quality and student satisfaction, a new curriculum in Oral Surgery was implemented at Karolinska Institutet in 2007. This paper describes the curriculum change as well as the results regarding quality, satisfaction, cost-effectiveness and workload for teachers and staff. To design the new curriculum, all members of the teaching staff participated in a series of group discussions where problems with the previous curriculum were identified and ideas on how to improve the curriculum were discussed. Cost-effectiveness was evaluated by comparing the number of teaching sessions between the new and the old curriculum. A questionnaire was used to investigate the staffs' perceived change in workload and teaching quality. The students' satisfaction and attitudes to learning was screened for by on-line questionnaires. The large amount of passive observational teaching was considered as the main problem with the old curriculum. Half of these sessions were replaced by either clinical seminars or demonstrations performed in an interactive form. Students rated the new curriculum as a clear improvement. Analyses of time and cost-effectiveness showed a decrease in teaching sessions by almost 50%. Generally, the teachers were more positive towards the changes compared to the non-teaching staff. The students rated the new type of learning activities relatively high, whilst the traditional observational teaching was seen as less satisfactory. They preferred to learn in a practical way and few indicated analytic or emotional preferences. The majority of the students reported a good alignment between the new course curriculum and the final exam.

Mixed virtual reality simulation--taking endoscopic simulation one step further.

This pilot study aimed to assess medical students' appraisals of a "mixed" virtual reality simulation for endoscopic surgery (with a virtual patient case in addition to a virtual colonoscopy) as well as the impact of this simulation set-up on students' performance. Findings indicate that virtual patients can enhance contextualization of simulated endoscopy and thus facilitate an authentic learning environment, which is important in order to increase motivation.

Web-based virtual patients in dentistry: factors influencing the use of cases in the Web-SP system.

We studied the students' acceptance and utilization of virtual patients (VPs) authored by faculty using the Web-SP system over two consecutive years. We also studied factors of importance for the utilization of VPs for self-assessment. Both year-groups studied found the Web-SP system easy to use and their overall opinion of Web-SP was positive (Median: 5, p25-p75: 4-5). They found the VPs engaging, realistic, fun to use, instructive and relevant to their course. Students used, on average, 9.68 VPs per course, which constitutes 43 percent of the available VPs. The number of VPs available seemed to be sufficient for the target course, even if some of the students preferred a higher number of VPs. Of the VPs encountered, 71% (CI: 68-75%) were VPs with feedback, and correspondingly 29% of the VPs chosen were without feedback. The difference in utilization between both types of VPs was significant, at p < 0.001. Thus, the students clearly favoured VPs with feedback compared to VPs without feedback. There were three modes of engagement in which the VP was utilized. Mode 1 was the preferred mode for VPs without feedback, while mode 3 was dominant for VPs with feedback.. Whether or not a VP was selected for review during a teacher led seminar or not, did not affect student behaviour, at least on the surface. Teacher led seminars may still be of importance to provide credibility to the VPs by integrating them into the curriculum.

The use of a virtual patient case in an OSCE-based exam--a pilot study.

BACKGROUND: This study focuses on a skills test based clinical assessment where 118 fourth-year medical students at the four teaching hospitals of Karolinska Institutet participated in the same 12-module OSCE. The goal of one of the twelve examination modules was to assess the students' skills and ability to solve a virtual patient (VP) case (the ISP system), which included medical history taking, lab tests, physical examinations and suggestion of a preliminary diagnosis. AIMS: The primary aim of this study was to evaluate the potential of a VP as a possible tool for assessment of clinical reasoning and problem solving ability among medical students. The feeling of realism of the VP and its possible affective impact on the student's confidence were also investigated. METHOD: We observed and analysed students' reactions, engagement and performance (activity log files) during their interactive sessions with the simulation. An individual human assistant was provided along with the computer simulation and the videotaped interaction student/assistant was then analysed in detail and related to the students' outcomes. RESULTS: The results indicate possible advantages of using ISP-like systems for assessment. The VP was for instance able to reliably differentiate between students' performances but some weaknesses were also identified, like a confounding influence on students' outcomes by the assistants used. Significant differences, affecting the results, were found between the students in their degree of affective response towards the system as well as the perceived usefulness of assistance. CONCLUSION: Students need to be trained beforehand in mastering the assessment tool. Rating compliance needs to be targeted before VP-based systems like ISP can be used in exams and if such systems would be used in high-stake exams, the use of human assistants should be limited and scoring rubrics validated (and preferably automated).

Computer-aided risk management--a software tool for the Hidep model.

OBJECTIVE: The Hidep risk management model has been developed and tested in clinical settings with promising results, but a tool facilitating the work has been suggested. The aim of the present study was to create and evaluate a computerized tool capable of creating overviews of the oral health situation as well as identifying risk factors and at-risk patients. The system developed should also facilitate the clinical work, for example, by assisting the user with automatic calculation of suitable Hidep groups and selection and printing of relevant patient information letters. METHOD AND MATERIALS: The system developed was based on the Hidep model, combining a number of available examination methods, risk estimation systems, and treatment suggestions. The development strategy included stepwise improvements and functionality increase based on continuous clinical applicability tests in a large international test bed. RESULTS: The results indicated that the software created was user friendly enough to be used in a common dental clinic and capable of handling the basic data of both patients and their oral health situation. The system could present useful statistics and graphs describing the overall oral health situation and identifying relevant risk groups and risk factors, based on virtually unlimited parameter combinations. CONCLUSION: The computer system developed seems to be an important step toward the possibility of creating a close-to-the-clinic model for oral health care management based on actual and locally derived patient data and risk factors. The results of this project encourage further studies of the Hidep model and its computer support.

A comparison between different models of the relation between recorded intradental nerve impulse activity and reported pain in man.

In this study three different models of the relation between intradental nerve impulse activity (INA) and pain report, expressed by finger-span (FS), in man were investigated. The techniques were (i) a previously described mathematical model, (ii) the relation between the Areas of INA and FS and (iii) the relation between the Peaks of INA and FS. Their usefulness in 533 clinical experiments on 15 subjects were evaluated by means of a statistical analysis of the variability and accuracy of the models. It was shown that the mathematical model was the most accurate and stable method of the three different methods investigated. This was indicated by, among other things, a significantly smaller variability for the mathematical model within experimental sessions than between sessions. The two other methods were found to be of less scientific value since they had an undesired high variability within sessions, and also showed contradicting results during control conditions.

Evaluation of a mathematical model analysing the relation between intradental nerve impulse activity and perceived pain in man.

In this investigation the usefulness and accuracy of the parameters of a mathematical model for the analysis of the effectiveness of different pain relieving procedures on pulpal pain were studied. The investigation was carried out using a previously developed mathematical/biological model on data from original subject recordings of Intradental Nerve Impulse Activity (INA) and pain estimations. Computer simulated INA and pain estimation curves were also used to enable calculation of the mathematical and biological conditions that are essential for the actual mathematical/biological model, and to facilitate the interpretation of the parameters of the model. It was shown by means of both real and simulated data that the mathematical model is well suited for the analysis of the effectiveness of some pain relieving procedures on pulpal pain. It was also shown that, by means of three new variables, the model could be made even more accurate and useful for this application.

The relation between intradental nerve activity and pulpal pain after heat stimulation.

The effects of tooth surface stimulation on intradental nerve activity (INA) and subsequent pain perception were studied in human lower incisors later to be extracted for periodontal reasons. The INA elicited by hot gutta-percha briefly applied to the tooth surface was monitored by means of labial electrodes deeply implanted in the dentin and perceived pain was continuously rated using a finger-span technique. After each stimulation the subject was also requested to select a sensory descriptor that was appropriate to describe the maximal pain intensity. The very first application of heat induced a typical pattern of nerve activity consisting of three phases. An initial burst of 3-5 s duration, phase I, was followed by a depression relative to the baseline lasting for 20-30 s, phase II, that gradually turned into phase III constituting a slowly increasing firing rate. The spontaneously emerging activity (phase III) in the absence of a physical stimulus passed unnoticed by all the subjects despite an average increase in firing rate of 67% relative to the prestimulus noise level. Repeated heat applications at short intervals led to a decrease and finally to abolishment of the whole nerve response. The lack of pain during phase III may be explained in two ways: the rate of increase in firing frequency may be too slow to trigger those perceptual pathways involved in processing of pain; the slow development of the increased sensory nerve activity may lead to central habituation.(ABSTRACT TRUNCATED AT 250 WORDS)