Early-learners' expectations of and experience with IPE: A multi-institutional qualitative study.

BACKGROUND: Multi-institutional qualitative studies are scarce within the interprofessional education (IPE) literature; such a report would provide comprehensive evidence for the application of interprofessional instruction among earlier learners. OBJECTIVE: This investigation explored students' expectations of and barriers to introductory IPE across four institutions. DESIGN: Qualitative inductive content analysis was utilized to interpret students' narrative responses to assigned pre- and post-survey questions. SETTING: Health science schools of four U.S. institutions at Institution A, Institution B, Institution C, and Institution D. PARTICIPANTS: Twenty-two percent (n = 385) of eligible participants completed both pre- and post-surveys. Nursing student participation was greatest (n = 113, 33%), followed by occupational therapy (n = 44, 13%), and physical therapy (n = 36, 10%). All other program participation was <10%. In total, students' narrative comments from 19 degree programs were a part of the data set. METHODS: Responses from one pre-survey question on expectations of introductory IPE and two post-survey questions on IPE benefits and barriers were studied using qualitative inductive thematic analysis. RESULTS: Four themes emerged as IPE learning expectations and benefits: my own professional role, professional role of others, teamwork, and communication. The theme of interacting with peers surfaced as an additional IPE benefit. There were four themes noted as IPE barriers: course logistics, lack of context, course content, and social dynamics. CONCLUSION: This multi-institutional qualitative study adds to the literature by providing empirical evidence regarding early learner perceptions of IPE experiences. Student expectations and benefits of their introductory IPE course/curriculum aligned. Perceived barriers are useful in informing future IPE implementation and research.

Using a Mixed Methods Approach to Explore Perceptions of Early Learners in Classroom-Based Interprofessional Education Experiences.

Objective. To explore attitudes and learning outcomes among early-level health professions students who completed foundational interprofessional education (IPE) courses. Methods. This study used a mixed methods approach to examine assessment and evaluation data from two student cohorts enrolled in two one-credit, semester-long interprofessional courses taught in fall and spring 2017. Attitudinal changes following the fall course were measured and compared in a retrospective pretest-posttest manner across student disciplines using the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, version 2 (SPICE-R2). Course evaluation comments and narrative reflection assignments for both courses were analyzed qualitatively via data reduction and compilation to identify evidence of learning. Results. Significant increases in positive student perceptions regarding IPE were found, with variation in the increase seen between professions following the first course. Core themes identified in the narrative reflections demonstrated student learning in interprofessional attitudes, communication, professional identity, collaborative behaviors, and systems of care. Conclusion. Student attitudes toward interprofessional learning were more positive following completion of a foundational IPE course. In addition, learning in the course shaped students' professional identities, collaborative behaviors, and understanding of systems of care. These findings suggest value in early IPE and directions for better structuring curriculum and timing of IPE.

Virginia-based periodontists' perceptions: Current and future trends of the specialty.

BACKGROUND: The aim of this survey was threefold: (1) describe the demographics of periodontists and their practices in Virginia; (2) explore periodontists' perceptions of the impact that changes in the field of dentistry (i.e. increasing corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures done by general practitioners [GPs]) are having on the specialty; (3) explore how periodontists might adjust their practices to account for these trends. METHODS: An electronic survey was emailed to Virginia-based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in treatment modalities and practice models, and to survey how periodontists plan to adapt their practices for these trends. Virginia has large urban, suburban and rural municipalities, which renders the state a favorable representation of the United States as a whole. RESULTS: The response rate was 31% (n = 46). Most respondents (87%) were male and practiced full-time (70%). Respondents reported practicing predominantly in urban (n = 19, 41%) and suburban (n = 24, 52%) and less in rural areas (n = 3, 7%). In current practice, respondents reported greater numbers of referrals from more experienced GPs. Student debt after periodontal residency was significantly associated with age (P value = 0.0002), with 56% of respondents aged <40 years reporting student loans >$250,000 compared with 3% for those aged ≥40 years. Respondents ranked biologic advances, treatment of peri-implantitis, advances in digital dentistry, development of corporate and group practice models, and integration of more periodontal services in GP practices as the most likely trends to impact periodontal practices. The most commonly reported practice adjustments included expansion of existing services, increasing the number of periodontists in the practice, and joining with other specialists or GPs to create group practices. CONCLUSION: Periodontists perceive the need to expand services, increase the number of providers in their practices or create group practices to account for increased corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures performed by GPs.

Dental and Dental Hygiene Student Perceptions of Interprofessional Education.

Purpose: Commission on Dental Accreditation standards for dental and dental hygiene programs include interprofessional education (IPE) experiences within the curriculum; an initial step in the acquisition and application of IPE is for students to perceive it as relevant. The purpose of this study is to identify dental and dental hygiene students' attitudes regarding IPE following the completion of a novel interprofessional course involving health professional students from six different degree programs.Methods: Faculty members from the Schools of Allied Health Professions, Dentistry, Nursing, and Pharmacy designed a one-hour, required course focusing on collaborative practice, roles and responsibilities, teamwork, and communication. Students from six different professional programs were divided into interprofessional teams for the thirteen session IPE course. Upon completion of the course, all participants (n=487), were invited to complete an online course evaluation survey utilizing the Student Perceptions of Interprofessional Clinical Education (SPICE-R2) instrument. A retrospective pre-test-post-test approach was used to assess attitudinal change.Results: A total of 300 students from the six health care professions (n=300) completed the SPICE-R2 pre- and post-test surveys for a response rate of 62%. In general, students reported significantly more positive perceptions about IPE after completion (M = 39.7, SD = 7.57) than they did prior to the course (M = 36.6, SD = 7.13), t(299) = -9.24, p < .001; and the effect size was moderate (Cohen's d = .535). One-way analysis of variance revealed a significant main effect for student program on change in scores on the total SPICE-R2 scale. Although post- tests did not reveal differences between specific programs, dental hygiene students exhibited the greatest attitudinal change, while dental students demonstrated the lowest.Conclusions: Sample sizes from the six healthcare programs varied and serve as a limitation for this study. Findings suggest that dental hygiene students may perceive greater benefit from IPE because they see themselves as collaborative practitioners. while dental students may self-identify as leaders of the oral healthcare team. Further research is warranted to examine students' perceptions of IPE to determine the potential impact and success of these curricular activities.

Outcomes of Introducing Early Learners to Interprofessional Competencies in a Classroom Setting.

PROBLEM: Although interprofessional practice is important for improving healthcare delivery, there is little evidence describing interprofessional education (IPE) outcomes beyond changes in attitudes and knowledge of prelicensure learners. More rigorous evaluation of early IPE is needed to determine its impact on teaching interprofessional collaborative practice and providing a solid foundation for applying collaborative skills in the clinical environment. INTERVENTION: First-year students (N = 679) in 7 health professions programs participated in a 4-session series focusing on professional roles and responsibilities, teams and teamwork, and the healthcare system. Interprofessional teams of 5-6 students, from at least 3 professions, were assembled for the duration of the series and created a team charter during their first session to guide their work. Each subsequent session included a brief lecture and interactive exercises. Faculty facilitators from the participating programs provided support to students during the sessions. As a culminating project, each team created a short video depicting a barrier to interprofessional collaboration. Students evaluated the performance of their team members using a web-based peer assessment survey. A course evaluation with an embedded validated attitudinal scale was used to assess changes in student perceptions about IPE. A sample of videos were also scored by 2 faculty using a rubric linked to course expectations. CONTEXT: This educational offering took place on the health sciences campus of a large, mid-Atlantic research university with more than 3,200 clinical learners in schools of allied health professions, dentistry, medicine, nursing, and pharmacy. It was the first interprofessional activity for most of the learners. OUTCOME: There were 555 students who participated in some or all of the sessions. Comments indicated that students enjoyed interacting with their peers and prefer activities allowing them to apply content to their profession over lectures. The assessment measures revealed a disconnect between student ratings targeting interprofessional socialization and faculty ratings targeting the products of their teamwork. Although students provided positive feedback to their teammates through peer assessment, and the attitudinal scale showed a small but significant increase in positive attitudes toward IPE, the videos they created did not demonstrate a deep understanding of barriers to interprofessional practice. LESSONS LEARNED: This large-scale IPE activity for early learners supported progress toward interprofessional socialization, but student learning was inconsistently demonstrated in teamwork products. Course planners should augment self- and peer-reported interprofessional socialization measures with faculty-generated behavioral outcome assessments. Such triangulation produces a more robust data set to inform decisions about curricular revisions and development.

Predicting Performance in Technical Preclinical Dental Courses Using Advanced Simulation.

The aim of this study was to investigate whether advanced simulation parameters, such as simulation exam scores, number of student self-evaluations, time to complete the simulation, and time to complete self-evaluations, served as predictors of dental students' preclinical performance. Students from three consecutive classes (n=282) at one U.S. dental school completed advanced simulation training and exams within the first four months of their dental curriculum. The students then completed conventional preclinical instruction and exams in operative dentistry (OD) and fixed prosthodontics (FP) courses, taken during the first and second years of dental school, respectively. Two advanced simulation exam scores (ASES1 and ASES2) were tested as predictors of performance in the two preclinical courses based on final course grades. ASES1 and ASES2 were found to be predictors of OD and FP preclinical course grades. Other advanced simulation parameters were not significantly related to grades in the preclinical courses. These results highlight the value of an early psychomotor skills assessment in dentistry. Advanced simulation scores may allow early intervention in students' learning process and assist in efficient allocation of resources such as faculty coverage and tutor assignment.

Dental patients' self-reported use of dietary supplements on medical history questionnaires.

Dietary supplement effects and drug interactions can lead to significant adverse health events, thus potentially impacting the safe delivery of oral healthcare. This study sought to determine the frequency of, and factors impacting, dietary supplement use among 209 dental patients and whether the design of a medical history questionnaire influences reporting of supplement use. Patients were randomly allocated to 1 of 2 groups in which they completed either a standard medical history questionnaire (n = 107) or the same questionnaire with an additional item about dietary supplement use (n = 102). All patients were then administered a survey with questions about their demographics, their use and knowledge of dietary supplements, and the person or persons who recommended dietary supplement use to the patient. While 62% of the total population (130/209) reported supplement use, specific prompting nearly doubled the number of supplements reported (mean with prompting: 1.53; mean without prompting: 0.76; P < 0.0001). Patients younger than 30 years of age reported significantly less dietary supplement use than all other age groups except the 30-40 age group (P = 0.0003). An estimated 70% of all respondents were not aware of potentially detrimental side effects of dietary supplement use or possible interactions with conventional drug therapies. Since patients tended to report a greater use of dietary supplements when specifically asked about their use on a medical history questionnaire, a checklist or set of designated questions may be a suitable first step toward gathering this essential information.

Evidence-Based Practice Knowledge, Perceptions, and Behavior: A Multi-Institutional, Cross-Sectional Study of a Population of U.S. Dental Students.

The aim of this study was to help inform faculty and curriculum leaders in academic dental institutions about the knowledge, skills, perceptions, and behavior of an institutionally diverse population of dental students with respect to evidence-based practice (EBP). A survey utilizing the validated Knowledge, Attitudes, Access, and Confidence Evaluation instrument developed by Hendricson et al. was conducted in 2012 with fourth-year dental students at seven geographically dispersed U.S. dental schools. The survey addressed elements of EBP knowledge, attitudes toward EBP, behavior in accessing evidence, and perceptions of competence in statistical analysis. A total of 138 students from the seven schools participated. A slight majority of these students correctly responded to the knowledge of critical appraisal questions. While the students demonstrated positive attitudes about EBP, they did not report high levels of confidence in their critical appraisal skills. The findings also showed that the students accessed various sources of evidence with differing frequencies. The most frequently accessed resources were colleagues, the Internet (excluding Cochrane Database of Systematic Reviews), and textbooks. The results of this study help to identify areas for improvement in EBP education in order to advance dental students' preparation to become evidence-based practitioners.

The status of the scholarship of teaching and learning in dental education.

The purpose of this study was to determine the current status of the Scholarship of Teaching and Learning (SoTL) within academic dentistry. A twenty-two-item survey was distributed to faculty members of American Dental Education Association (ADEA) member schools asking about their awareness of SoTL practices, perceived barriers to SoTL application, and ways to enhance SoTL activity. Four hundred thirty surveys with equal distribution of assistant, associate, and full professors were received (this may be considered a response rate of 5.4 percent out of roughly 8,000 ADEA faculty members). Almost 70 percent of the respondents indicated that they highly valued SoTL; only 2.1 percent indicated they did not. The extent to which the respondents valued SoTL was positively correlated with their perception of SoTL's value among other faculty members in their program (r(322)=0.374, p<0.001), school (r(299)=0.204, p<0.001), and institution (r(233)=0.296, p<0.002). However, the respondents were generally unsure how SoTL was applied at their institutions. Respondents from private institutions reported making more SoTL presentations at conferences than did those from public institutions (t(303)=-2.761, p=0.006) and stronger promotion of SoTL in their institutional policies (t(330)= -3.004, p=0.003). Barriers to changing the perception and application of SoTL appeared to exist at both organizational and individual levels, and ADEA was perceived to be well positioned to assist with both.

The effect of esthetic crown lengthening on perceptions of a patient's attractiveness, friendliness, trustworthiness, intelligence, and self-confidence.

BACKGROUND: Smile esthetics have been shown to play a major role in the perception of whether a person is attractive, and whether they are perceived as friendly, trustworthy, intelligent, and self-confident. A proposed major determinant of the esthetics of a smile is the amount of gingival display, which can be excessive in cases of altered passive eruption. The aim of this study is to see whether altering the amount of gingival display of patients would affect dental professionals' and laypersons' perceptions of the aforementioned social parameters. METHODS: Patients were identified as having altered passive eruption and excessive gingival display. Smiling "control" photographs were taken and then digitally altered so as to lengthen the teeth and thus reduce the amount of gingival display. These became the "test" photographs. The control and test photographs were shown in random order. The control group of evaluators consisted of senior dental students, and the test group of evaluators comprised students who had no formal dental training. Groups were asked to rate, on a visual analog scale, each picture's attractiveness, friendliness, trustworthiness, intelligence, and self-confidence. RESULTS: The test pictures with less gingival display were consistently and statistically significantly rated higher for all five social parameters than were their control counterparts (P <0.0001). When analyzed as an isolated effect, there were no statistically significant differences between the control group and the test group of evaluators when rating the pictures. Pictures depicting African Americans were judged to be more trustworthy (P = 0.0467) and self-confident (P = 0.0490) than pictures depicting white individuals. Pictures depicting women were judged to be more trustworthy (P = 0.0159) and intelligent (P = 0.0329) than pictures depicting men. All the social parameters were positively and statistically significantly correlated with each other (P <0.0001). CONCLUSIONS: Excessive gingival display did negatively affect how attractive a person's smile is judged to be. In addition, how friendly, trustworthy, intelligent, and self-confident a person was perceived to be was inversely related to the amount of gingival display. Untrained laypeople were just as sensitive to these differences as senior dental students.

Evaluation of a revised curriculum: a four-year qualitative study of student perceptions.

Following curricular revisions at the Virginia Commonwealth University School of Dentistry, this longitudinal study was designed to determine students' perceptions of their educational experience in the revised curriculum. A SWOT (Strengths, Weaknesses, Opportunities, and Threats) open-ended response questionnaire was administered to students in the class of 2011 (N=89) in January of each academic year, 2008 through 2011, followed by focus groups three months prior to graduation. The overall response rate for the questionnaire was 69 percent, and a total of fourteen students participated in four focus groups. Cumulatively, 1,382 responses (SWOT=984 and focus groups=398) were qualitatively analyzed, and five themes emerged: 1) early clinical experiences led to a perceived readiness for direct patient care; 2) the pace and organization of the revised condensed preclinical curriculum were perceived as hectic yet were appreciated as necessary preparation for patient care; 3) most faculty members were seen as committed to student learning, but a few were reported to have poor teaching skills and attitudes when interacting with students; 4) a perceived lack of patients led to fewer clinical experiences and a decrease in student confidence; and 5) some curricular content was seen to be redundant and irrelevant to future practice. The results indicate that the students were satisfied with aspects of their educational experience, suggesting the revised curriculum's preliminary success in meeting its goals of earlier patient care, a condensed preclinical curriculum, and a student-friendly environment. As the curriculum is adapted in response to student feedback, ongoing evaluation is necessary and should be complemented by other evaluation indicators such as faculty perceptions and student learning outcomes.

Faculty impressions of dental students' performance with and without virtual reality simulation.

This study compared faculty perceptions and expectations of dental students' abilities using virtual reality simulation (VRS) to those who did not use virtual reality simulation (non-VRS) in an operative dentistry preclinical course. A sixteen-item survey with a ten-point rating scale and three open-ended questions asked about students' abilities in ergonomics, confidence level, performance, preparation, and self-assessment. The surveys were administered three times to a small group of preclinical faculty members. First, faculty members (n=12, 92 percent response rate) gave their perceptions of non-VRS students' abilities at the end of their traditional course. Secondly, faculty members (n=13, 100 percent response rate) gave their expectations of the next incoming class's abilities (VRS students) prior to the start of the course with traditional and VRS components. Finally, faculty members (n=13, 100 percent response rate) gave their perceptions of VRS students' abilities after completion of the course. A Tukey's test for multiple comparisons measured significance among survey items. Faculty perceptions of VRS students' abilities were higher than for non-VRS students for most abilities examined. However, the faculty members' expectations of VRS training were higher than their perceptions of the students' abilities after VRS training for most abilities examined. Since ergonomic development and technical performance were positively impacted by VRS training, these results support the use of VRS in a preclinical dental curriculum.

Communication skills instruction: an analysis of self, peer-group, student instructors and faculty assessment.

OBJECTIVE: To explore the correlation of student and faculty assessments of, second-year dental students' (D2s) communicative skills during simulated patient interviews. METHODS: Eighty-two D2s, 14 student instructors and 8 faculty used a 5-point scale, (1=poor-5=excellent) to assess 12 specific communicative skills of D2s generating assessment sources of self, peer-group, student instructor, and faculty. Mean scores and comparisons between assessment sources were calculated. Spearman correlations evaluated relationships between specific skills and assessment sources. RESULTS: Mean assessment score and standard error for peer-group (4.14 ± 0.04), was higher than self (3.86 ± 0.06, p<0.05) yet slightly higher than student instructor (4.07 ± 0.04) and faculty (3.93±0.10). Regarding assessment sources, the degree of correlation from highest to lowest was peer-group and student instructor (ρ=0.46, p<0.0001), self and student instructor (ρ=0.35, p<0.002), self and peer-group (ρ=0.28, p<0.02). The correlations between student instructor and faculty, faculty and self, and faculty and peer-group were nonsignificant. CONCLUSION: Student assessments were different from faculty by mean score and correlation index. Future studies are needed to determine the nature of the differences found between student and faculty assessments. PRACTICE IMPLICATIONS: Peer, student instructor and faculty assessments of dental students' communicative skills are not necessarily interchangeable but may offer uniquely different and valuable feedback to students.

Dental anatomy carving computer-assisted instruction program: an assessment of student performance and perceptions.

The purpose of this study was to compare the performance of students exposed to two different instructional modalities for dental anatomy wax carving: CAI (computer-assisted instruction) using DVD technology, or traditional laboratory instruction. Students' self-assessment scores were also compared to faculty scores, and students' perceptions of their teaching modality were analyzed. Seventy-three first-year dental students (response rate 81 percent) participated in this randomized single blind trial, in which faculty graders were blinded to student group assignment. There were no statistical differences, as determined by the Wilcoxon non-parametric test and a t-test, between the faculty grades on the wax carving from the two teaching methods the students experienced. The student self-assessments revealed higher mean grades (3.0 for the DVD-only group and 3.1 for the traditional group) than the faculty actual mean grades (2.2 for both the DVD-only group and the traditional group) by almost one grade level on a 4.0 grade scale. Similar percentages of students in the traditional group had either favorable or unfavorable perceptions of their learning experience, while more students in the DVD-only group reported favorable perceptions. Students from both groups said they wanted more faculty feedback in the course. Based on these objective and subjective data, merging CAI and traditional laboratory teaching may best enhance student learning needs.

Communication skills instruction utilizing interdisciplinary peer teachers: program development and student perceptions.

Lack of curricular time, faculty time, and funding are potential limitations for communication skills training in dentistry. Interdisciplinary collaboration amongst health care faculties could address these limitations. This article describes the development, implementation, and student perceptions of a communication skills program in dentistry. The program has four components: Knowledge, Observation, Simulation, and Experience (KOSE) and spans over the second and third years of dental school. KOSE allows students to obtain knowledge of and observe effective communication skills and practice these skills in the simulated and nonsimulated environment. A key feature of KOSE is the utilization of fourth-year medical and dental students as peer teachers. Evaluation of KOSE was geared toward student perceptions. Cross-sectional data were gathered via written surveys from 143 learners (second- and third-year dental students) in 2006-07. Students perceived the ability to recognize effective communication, demonstrated awareness of their communication strengths and weaknesses, and reported that skills gained were transferable to actual patient care. Interdisciplinary collaboration was a feasible way to address the lack of resources in the development of a communications skills program, which was perceived to be worthwhile by learners.

Periodontal services rendered by general practitioners.

BACKGROUND: There are few reports in the dental literature regarding the types of periodontal services offered by general practitioners (GPs). The purpose of this study was to determine the specific nature of periodontal services rendered by GPs and to investigate whether certain variables affect GPs' practice patterns. METHODS: A 13-item survey was mailed to a random sample of 600 dentists practicing in the state of Virginia. GPs were asked to identify the periodontal services rendered in their office within a 3-month period. Descriptive statistics, simple correlation, and stepwise multiple regression analysis were used to identify significant relationships between variables and periodontal services. RESULTS: Ninety percent of GPs reported treating at least one patient with scaling and root planing, and 16% of GPs reported rendering this service to >36 patients. Eighty-six percent of GPs reported providing periodontal maintenance in their practices. Approximately 50% of dentists reported up to 24 patients having received periodontal maintenance. Fifty-eight percent of GPs reported that >or=90% of scaling and root planing was done by the hygienists. Fifty-five percent of GPs treated at least one patient with site-specific therapy using chemotherapeutic agents. Twenty-eight percent of GPs treated one to five patients with low-dose antibiotic. Seventy percent of GPs treated at least one patient with occlusal therapies, and 50% reported treating one to five patients with occlusal therapies. The most common surgical services performed included crown lengthening and pocket reduction surgery, which were done by 38% and 21% of GPs, respectively. A few GPs (N = 26) performed the majority of periodontal surgical services. Variables found to influence specific services rendered by GPs included year of dental school graduation, recent hours of continuing education related to periodontics, combined number of dental hygienist days per week, percentage of periodontal patients in practice, and referral for non-surgical periodontal therapy. CONCLUSIONS: A variety of periodontal services were offered by GPs. The most common services were non-surgical in nature. Certain variables affected specific periodontal services rendered in general dental offices.

Accuracy and consistency of radiographic interpretation among clinical instructors in conjunction with a training program.

There are inaccuracies and inconsistencies of radiographic interpretation among clinical instructors. The purpose of this investigation was to determine if a training program could improve the accuracy and consistency of instructors' ratings of bone loss. A total of thirty-five clinical instructors consisting of periodontal faculty (periodontists and general dentists), dental hygiene faculty, and periodontal graduate students viewed projected digitized radiographic images and quantified bone loss for twenty-five teeth into four descriptive categories. Ratings of bone loss were made immediately before (pretest) and after (post-test 1) initiation of the training program and then again three months later (post-test 2). Ratings were compared to the correct choice categories as determined by direct measurement using the Schei ruler. Overall agreement with the correct choice improved over time (from 64.5 percent to 85.2 percent) with the greatest change from pretest (64.5 percent) to post-test 1 (76.5 percent). Mean and absolute differences improved in three of the four categories, but worsened in one from pretest to post-test 1. This category returned to its original high value at post-test 2. The greatest improvement in consistency among instructors' ratings was seen in one of the four categories, which was "none" (no bone loss). Extension of the training program may further enhance the accuracy and consistency of instructors' radiographic interpretation.

Demographic variables affecting patient referrals from general practice dentists to periodontists.

BACKGROUND: Within dentistry, a limited body of literature exists regarding the referral relationships between general practitioners (GPs) and specialists. The purpose of this study was to investigate the referral relationship between GPs and periodontists within the state of Virginia. METHODS: A survey was developed that focused on the demographic variables in the referral relationship between GPs and periodontists. The survey was mailed to 800 dentists throughout the state of Virginia. Descriptive statistics were completed along with multivariate logistic regression analysis comparing the responses with the number of patients referred per month to periodontists. RESULTS: Female respondents were more likely to refer three or more patients per month to a periodontist than a male respondent (P<0.02). Those dentists who practiced with one other dentist were twice as likely to refer more frequently when compared to solo practitioners or larger group practices (P<0.03). Dentists employing two hygienists were more likely to refer patients than those with fewer hygienists (P<0.02). Those whose practices were >5 miles from the nearest periodontist were more likely to refer patients compared to dentists geographically closer to a periodontist (P<0.02). No other variables had a significant effect on the referral of more patients per month to a periodontist. CONCLUSIONS: This study indicates that four demographic variables have a statistical influence on the number of referrals per month from a GP to a periodontist. These variables are as follows: female gender, practicing with one other dentist, employing two or more hygienists, and being >5 miles away from the nearest periodontist.

Accuracy and consistency of radiographic interpretation among clinical instructors using two viewing systems.

Accurate and consistent radiographic interpretation among clinical instructors is needed for assessment of teaching, student performance, and patient care. The purpose of this investigation was to determine if the method of radiographic viewing affects accuracy and consistency of instructors' determinations of bone loss. Forty-one clinicians who provide instruction in a dental school clinical teaching program (including periodontists, general dentists, periodontal graduate students, and dental hygienists) quantified bone loss for up to twenty-five teeth into four descriptive categories using a view box for plain film viewing or a projection system for digitized image viewing. Ratings were compared to the correct category as determined by direct measurement using the Schei ruler. Agreement with the correct choice for the view box and projection system was 70.2 percent and 64.5 percent, respectively. The mean difference was better for a projection system due to small rater error by graduate students. Projection system ratings were slightly less consistent than view box ratings. Dental hygiene faculty ratings were the most consistent but least accurate. Although the projection system resulted in slightly reduced accuracy and consistency among instructors, training sessions utilizing a single method for projecting digitized radiographic images have their advantages and may positively influence dental education and patient care by enhancing accuracy and consistency of radiographic interpretation among instructors.

Variation in periodontal diagnosis and treatment planning among clinical instructors.

Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty-seven clinical instructors (periodontists, general dentists, dental hygienists, and first- and second-year periodontal graduate students) reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors' rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compared to periodontal and dental hygiene faculty groups. Diagnoses offered for one of the three patients varied between gingivitis and chronic and aggressive periodontitis. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter-rater variation was qualitatively more prevalent than intra-rater variation. To our knowledge, this is the first study to document substantial variation among instructors in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student performance and patient care can be made but as yet remain unknown. Consistent use of accepted practice guidelines and greater consensus-building opportunities may decrease variation among faculty and enhance dental education.