Evaluating dental student self-assessment across preclinical anatomy waxing and operative exercises.

PURPOSE/OBJECTIVE: A career in healthcare is built on the foundations of continuous self-reflection and self-assessment. Previous studies have solely compared student self-assessment to faculty grades in a single discipline. The objective of this study was to investigate whether associations of a student's self-assessment skills exist across multiple disciplines in the predoctoral setting. METHODS: Sixty-five students from two class years at the Harvard School of Dental Medicine completed preclinical competency exams in dental anatomy waxing and operative dentistry. The difference between the student's self-assessment score and average faculty grade for each exercise was calculated as the student‒faculty (S-F) gap, which served as a proxy to determine how students evaluate their work. Regression analysis was performed to assess associations between wax-up and preclinical operative S-F gaps. RESULTS: Mean S-F gaps for waxing and preclinical operative procedures were positive (5.7 ± 6.1 and 7.6 ± 6.7, respectively). Additionally, students in the lower quartile tended to overestimate performance to a greater degree than their peers in the upper quartile. Furthermore, the waxing S-F gaps were positively associated with S-F gaps of each operative procedure, particularly with the combined operative exercise S-F gaps, where a statistically significant association was seen (coefficient = 0.28; p = 0.04). CONCLUSION(S): Previously, we identified a negative correlation between students' self-assessment skills (S-F gaps) and their preclinical performance. In this study, we further demonstrated an association of S-F gaps in two fundamental exercises: wax-up and operative dentistry. This underscores the roles of S-F gaps as possible indicators of students' preclinical and clinical performance, and it holds potential to become a widely standardized and applicable calculation that may help evaluate the effectiveness of the dental curricula and optimize student learning.

Importance of bitewing radiographs for the early detection of interproximal carious lesions and the impact on healthcare expenditure in Japan.

BACKGROUND: Globally, the direct cost of dental caries is approximately $298B yearly, consuming 5-10% of national healthcare budgets. Bitewing radiographs (BWR) are the standard method of diagnosing interproximal dental caries. In Japan, bitewing radiographs are rarely used. This retrospective observational study was conducted to measure the potential economic impact of carious lesions left undiagnosed and untreated due to this omission of bitewing radiographs. METHODS: The total number of existing carious lesions, the number of undiagnosed lesions, and costs of treating these lesions were calculated from the national database of Ministry of Health, Labor and Wellness in Japan between June 2013 and 2017. The number of affected teeth was estimated using prevalence data and undiagnosed lesions were estimated. The expense associated with treating progressed lesions was calculated using the standard Japanese fee structure. BWR trends were assessed, and analyses were performed to understand the differences between states and populations over time. RESULTS: The average number of BWR taken monthly per office was 48.3±1.1 (average ± SD). It was calculated that an average of 6,429,155 lesions went undiagnosed per month, 93.5 teeth per practice, and 1.6 teeth per patient. The cost of treating lesions that went undiagnosed and then progressed into more invasive restorations was estimated to be between $57M-$218M more (difference between NaF varnish and class II restorations), and $150M-$443M more (difference between Class II restoration and crown or crown with RCT). CONCLUSIONS: BWRs are crucial in diagnosing a significant number of carious lesions. There is considerable impact on health and cost to the national health system due to undiagnosed lesions. Practitioners need to be educated on reading and understanding BWR, and policy should be changed to cover BWR.

Comparing dental student preclinical self-assessment in the United States and Japan.

PURPOSE/OBJECTIVES: Self-assessment is an essential skill for dental professionals. Understanding global trends in self-assessment can highlight the learning needs of students across a diversity of cultural backgrounds. The aim of this study is to compare the self-assessment ability of dental students in the United States and Japan, where cultural backgrounds may differ. METHODS: Students in the United States (n = 176) completed a typodont premolar and anterior Class II and Class III preparation and restoration. Students in Japan (n = 175) completed a typodont premolar crown preparation. Students and faculty then evaluated the student performance using rubrics for each respective procedure. The difference between the student's self-assessment score and the average faculty score (S-F gap) was calculated and the data were analyzed. RESULTS: The mean S-F gap was 2.8% in Japan and 7.6% in the United States. This indicates that Japanese students tended to assess themselves closer to their faculty graders than students in the United States. On average, students in both countries scored themselves higher than their faculty graders. Students in the United States more frequently overestimated their performance and students in Japan more frequently underestimated their performance. For students in the lower quartile, the mean S-F gap was 5.1% in Japan and 14.6% in the United States, indicating a large cultural discrepancy in the lower quartile groups. CONCLUSIONS: Although different preclinical procedures were compared, our findings demonstrated that Japanese students may score themselves more closely to their faculty assessors than students in the United States. Further investigation with more students completing the same preclinical activity will be needed.

Decision tree protocol for demineralized gingival margin extension in class II composite cavity preparations.

This study proposed the development of a protocol for class-II preparations with demineralized gingival margins for the improvement of the longevity of restorations. Evidence sources such as location/color/surface hardness/width of demineralized gingival margin with enamel/demineralized enamel (DE)/dentin/cementum were reviewed based on methodological studies and systematic reviews. A decision tree protocol was developed with criteria (i) lesion location: demineralized gingival margins in enamel must be removed, but if close to cementoenamel-junction, color should be evaluated. (ii) Color: yellow/brown lesions must be removed, but if white/opaque, then the surface hardness should be evaluated. (iii) Surface hardness: soft/demineralized gingival margin must be removed, but if adequately hard, width should be evaluated. (iv) Width: lesions less than half-enamel thickness and impenetrable by an explorer, remineralization is possible and the lesion does not need to be removed. A decision tree protocol was set up with the current available literature. Further continued investigations will be needed for the appropriate protocol updates.

The effect of gender on student self-assessment skills in operative preclinical dentistry.

PURPOSE/OBJECTIVE: Self-assessment is a fundamental skill for dentists and other health care providers. It enables these professionals' ability to critically evaluate the quality of their clinical work and improve through self-directed learning. Researchers have investigated how gender affects self-assessment skills and have shown that male students tend to overestimate their performance while female students tend to underestimate theirs as compared to peer or faculty assessment. The goal of this study was to evaluate how the self-assessment skills of dental students differ by gender in operative preclinical dentistry. METHODS: Third-year dental students (N = 208, Class of 2016-2021) self-assessed their work using the same rubrics as faculty on four operative dentistry competency examination procedures: Class II amalgam preparation and restoration and Class III resin-composite preparation and restoration. Two calibrated full-time faculty graded all procedures independently. The Student self-assessment-Faculty grade (S-F) gap scores were calculated and statistically analyzed. RESULTS: Overall, both genders overestimated their self-assessment for all four procedures as compared to actual scores given by faculty. Males overestimated more significantly than females for Class II Amalgam preparation, but not for the other three procedures. However, when the S-F gap for all procedures was combined and analyzed together, male students significantly overestimated their self-assessments compared to female students. When female and male students grading scores were stratified into quartiles, there were significantly larger differences between males and females in the lower quartiles, which suggest that difference in self-assessment abilities was more prominent among the lower performing students. CONCLUSION: The results of this study demonstrate that gender may affect the accuracy of self-assessment in operative preclinical dentistry.

The Relationship Between Dental Students' Assessment Ability and Preclinical and Academic Performance in Operative Dentistry.

Self-assessment is a critical skill for health care professionals. Because these professionals must be lifelong, self-directed learners and self-regulating practitioners, the ability to self-assess is essential for them. The aims of this study were to measure how dental students self-assessed and peer-assessed their performance in preclinical operative procedures and to evaluate any relationship between their assessment ability and preclinical skills or academic performance. The study was conducted from 2015 to 2016. Third-year students at Harvard School of Dental Medicine self-assessed their work on four preclinical practical exams: Class II amalgam preparation, Class II amalgam restoration, Class III composite preparation, and Class III composite restoration. Three faculty members graded the same preparations and restorations. The difference between the students' self-assessment and the mean faculty assessment was calculated as the student-faculty (S-F) gap. An absolute S-F gap was also calculated with absolute values of differences. A total of 71 students completed these practical exams: 36 in the Class of 2016 and 35 in the Class of 2017. All 71 self-assessments for each of the four practical exams were collected for a response rate of 100%. The results showed that the mean S-F gap ranged from 2% to 8%, and the absolute S-F gap ranged from 7% to 12%. Preclinical performance was correlated with self-assessment accuracy. Low-performing students significantly overestimated their self-assessments compared to the rest of the class. High-performing students had more accurate self-assessments and tended to underestimate themselves. Overall, these results showed that the students had room for improving the accuracy of their self-assessments.