Valoración del método de estudio de caso virtual en el posgrado académico / Assessment of the virtual case study method in the academic postgraduate

Introducción: El método de estudio de caso por vía virtual es una herramienta didáctica de gran valor en el proceso pedagógico del posgrado. Este método, promueve el aprendizaje activo de los residentes, y posee inestimable valor como instrumento del posgrado que se imparte, su ejecución favorece el perfeccionamiento del programa de formación académica de la especialidad. Objetivo: Valorar la satisfacción de los residentes y profesores de la especialidad de Periodoncia con el método de estudio de caso virtual como herramienta didáctica. Métodos: Se realizó una investigación descriptiva, con enfoque cualitativo, desarrollada de enero a abril del 2020, en la Facultad de Estomatología de la Universidad de Ciencias Médicas de Villa Clara y en la Universidad de Ciencias Médicas de las FAR. La población estuvo compuesta por 6 profesores y 7 residentes de la especialidad de Periodoncia y 3 profesores de otras especialidades estomatológicas. Satisfacción con la utilización del caso clínico, residentes y profesores, constituyeron variables del estudio. Resultados: Los casos clínicos preparados por cada profesor, incluían dificultades que no tenían una única solución, para favorecer la comprensión de problemas divergentes y la adopción de soluciones mediante la reflexión. En el análisis de la satisfacción, la mayoría de las respuestas seleccionadas por los residentes y profesores fue siempre. Conclusiones: La satisfacción de residentes y profesores con el uso del estudio de caso virtual fue alta(AU)

Introduction: The virtual case study method is a valuable teaching tool in the postgraduate pedagogical process that can be used for the development of meaningful and autonomous learning. The case study by virtual means, promotes the active learning of the residents, and has invaluable value as an instrument of the postgraduate course that is taught, its execution favors the improvement of the academic training program of the specialty. Objective: To assess the satisfaction of residents and teachers of the periodontics specialty with the virtual case study method as a teaching tool. Method: A descriptive research, with a qualitative approach, was carried out from January to April 2020, at the Faculty of Stomatology of Villa Clara and at the University of Medical Sciences of the FAR. The population was made up of 6 professors and 7 residents of the periodontology specialty and 3 professors from other dental specialties. Satisfaction with the use of the clinical case, residents and teachers, were study variables. Results: The clinical cases prepared by each teacher included difficulties that did not have a single solution, to favor the understanding of divergent problems and the adoption of solutions through reflection. In the analysis of satisfaction; Most of the responses selected by residents and teachers were always. Conclusions: The satisfaction of residents and teachers of the Periodontics specialty with the use of the virtual case study method was high(AU)

Influence of Self-Assessment on Dental Students' Performance on Technical Assessments in Periodontics.

Self-assessments were introduced into a third-year clinical periodontics course to enable dental students to self-assess and receive faculty feedback prior to technical assessment. The aims of this study were to determine if there was an improvement in the pass rate and average grade on the technical assessments following implementation of self-assessments and to analyze the accuracy of the student self-assessments by comparing them with faculty assessments. Scores from 106 third-year dental students for four periodontal procedures were included in the analysis. Faculty and student self-assessment scores, along with self-assessment and final technical assessments scores, were compared, as were the average number of self-assessment attempts for the various procedures and the pass rates. The average number of self-assessments per student was 6.5 compared to 4.2 for the technical assessments. There was no significant difference between students' self-assessment scores and faculty scores (average difference=0.005; p=0.7894). However, there was a significant increase in overall scores between students' self-assessments and technical assessments (average difference: 0.30 out of 5; p=0.0001). There was also a significant difference in pass rate between self-assessments and technical assessments (92.3% and 99.7%, respectively). The individual technical assessment with the greatest improvement was for scaling and root planing (average difference=0.47; p=0.0001), which also had significantly more self-assessments (2.3 vs. 1.2-1.7, p=0.0001). These results suggest that self-assessment and the subsequent faculty feedback provided students with information that enabled them to improve their performance on technical assessments.

Periodontal education and assessment in the undergraduate dental curriculum-A questionnaire-based survey in European countries.

OBJECTIVES: This survey aimed to evaluate whether periodontal education and assessment in undergraduate dental curricula amongst the member countries of the European Federation of Periodontology (EFP) follow the competency-based curricular guidelines and recommendations developed by the Association for Dental Education in Europe. MATERIALS AND METHODS: A multiple-choice questionnaire was emailed to 244 dental institutes amongst the 24 EFP member countries between November 2014 and July 2015. RESULTS: Data were received from 16 (66.7%) EFP member countries. Out of 117 responding dental institutes, 76 (64.95%) were included as valid responders. In most of the institutes (86.3%), a minimum set of competencies in periodontology was taken into account when constructing their dental education programmes. Out of 76 responders, 98.1% included lecture-based, 74.1% case-based and 57.1% problem-based teaching in their periodontal curricula, whilst a minority (15.9%) also used other methods. A similar pattern was also seen in the time allocation for these four educational methods, that is, the highest proportion (51.8%) was dedicated to lecture-based teaching and only a small proportion (5.7%) to other methods. Periodontal competencies and skills were most frequently assessed by clinical grading on clinic, multiple-choice examination (written examination) and oral examination, whereas competency tests and self-assessment were rarely used. Only in 11 (14.5%) cases, access flap procedures were performed by students. CONCLUSION: Great diversity in teaching methodology amongst the surveyed schools was demonstrated, and thus, to harmonise undergraduate periodontal education and assessment across Europe, a minimum set of recommendations could be developed and disseminated by the EFP.

Factors Influencing Dental Students' Interest in Advanced Periodontal Education: Perspectives of Department Chairs.

The number of graduates of U.S. dental schools enrolled in U.S. postdoctoral programs in periodontics has been decreasing. The aims of this study were to determine the perspectives of periodontics department chairs regarding 1) features of a school's predoctoral curriculum that promote student interest in advanced periodontal education and 2) characteristics of a periodontal residency program that make it more attractive to dental students over other specialty programs. In 2015, a 14-question survey was designed and sent to chairs of periodontics departments at all 65 U.S. dental schools at the time. Questions addressed number of instructional hours; specialty clinic rotations; elective courses; number of applicants to periodontal residency; existence of a residency program; length of the residency program; and externships, fellowships, and financial stipends offered. The survey response rate was 73.8%. The results showed that departments offering more than seven clinical credit hours in periodontics to predoctoral students had the greatest number of residency applicants. Most of the applicants were from institutions that offered specialty clinic rotations, elective courses, and residency programs in periodontics. The number of applicants did not change significantly if a stipend or fellowship was offered. However, the availability of an externship was significantly associated with a greater number of applicants (p=0.042). These results suggest that offering periodontal clinical rotations, elective courses, and especially externships in periodontics during predoctoral education may encourage more graduating students to pursue postdoctoral periodontal education.

A comprehensive clinical competency-based assessment in periodontics.

Traditional periodontics clinical examinations in dental education frequently assess a narrow set of clinical skills and do not adequately assess the ability of students to independently manage a periodontal patient. As an alternative, the authors developed a comprehensive periodontics competency case experience (CCCE) for senior dental students and surveyed students regarding their experience with the CCCE. Students challenging the CCCE must treat a patient with moderate periodontitis and must independently decide when a state of periodontal and oral health has been achieved. Students are also required to conduct an oral presentation to periodontology faculty. Dental students who completed the CCCE had a favourable impression of the experience, compared with the traditional clinical examinations taken in the junior year. The majority of students rated all the components of the CCCE as 'somewhat' or 'very helpful'. About 72.4% of students felt that being able to work independently on the examination was very helpful for learning about the clinical management of patients with periodontal disease, followed by 'simulation of care in private practice' (65.5%), and oral photography experience (55.2%). The greatest difficulty reported by students was finding an acceptable patient. About 62.1% of students rated 'finding the right patient' as very difficult. Students reported having to screen a mean of 5.9 patients (SD: 4.5) to find a qualified patient. The results of the survey will be useful in improving the examination as an assessment tool in periodontal therapy.

LGBT Coverage in U.S. Dental Schools and Dental Hygiene Programs: Results of a National Survey.

The aims of this study were to assess curricular coverage of lesbian, gay, bisexual, and transgender (LGBT) content in U.S. and Canadian dental schools and U.S. dental hygiene programs, including hours of LGBT content, pedagogy used, and assessment methods, and to determine whether respondents perceived their institution's coverage as adequate. Data were collected from academic deans at 32 U.S. and two Canadian dental schools and from program directors at 71 U.S. dental hygiene programs (response rates 49%, 20%, 23%, respectively). The results showed that 29% of responding dental schools and 48% of responding dental hygiene programs did not cover LGBT content. Among the respondents, dental schools dedicated on average 3.68 hours and dental hygiene programs 1.25 hours in required settings to LGBT content. Lectures (dental schools 68%, dental hygiene programs 45%) and small group instruction (43%, 25%) were reported as the most common methodology used in teaching this content. Most of the responding dental schools and dental hygiene programs covered HIV (85%, 53%), oral disease risk (63%, 54%), and barriers to accessing health care for LGBT people (58%, 38%). Up to a third reported no need for coverage of topics such as sexual orientation (21%, 32%), coming out (29%, 37%), transitioning (29%, 38%), and sex reassignment surgery (32%, 35%). Assessment was through written examinations (41%, 30%) and faculty-observed patient interactions (21%, 23%); some respondents (20%, 33%) reported no assessment of learning outcomes. The most frequently endorsed strategies for increasing LGBT content were receiving curricular material focusing on LGBT-related health issues and health disparities and having trained faculty to teach LGBT content.

Dental School Vacant Budgeted Faculty Positions, Academic Years 2011-12 Through 2013-14.

The American Dental Education Association (ADEA) Survey of Dental School Faculty is conducted annually to provide an overview of the hiring and retention activity of U.S. dental school faculty. The survey collects data on the dental faculty workforce, including vacant budgeted positions by appointment and discipline, number of new and lost positions, sources of new hires, and reasons for faculty separations. This report highlights the results of three years of survey data, from the 2011-12 academic year through the 2013-14 academic year. After declining in previous years, the number of vacant faculty positions in U.S. dental schools has begun to increase, rising to 242 full-time and 55 part-time positions in 2013-14. Additionally, the number of schools having more than ten vacancies increased from five to 12. Although the number of vacancies has increased, the length of faculty searches that took more than one year declined from 25% to 16% in the same period. Retirements as a share of full-time faculty separations increased from 14% in 2008-09 to 31% in 2013-14. The current average retirement age of dental school faculty members is 69.7 years. The percentage of full-time faculty members leaving for the private sector remained constant over the last three years at approximately 16%. Full-time faculty members were more likely to be recruited from other dental schools, while part-time faculty members were more likely to come from the private sector.

Use of an Analytical Grading Rubric for Self-Assessment: A Pilot Study for a Periodontal Oral Competency Examination in Predoctoral Dental Education.

While educators agree that using self-assessment in education is valuable, a major challenge is the poor agreement often found between faculty assessment and student self-assessment. The aim of this study was to determine if use of a predefined grading rubric would improve reliability between faculty and dental student assessment on a periodontal oral competency examination. Faculty members used the grading rubric to assess students' performance on the exam. Immediately after taking the exam, students used the same rubric to self-assess their performance on it. Data were collected from all third- and/or fourth-year students in four classes at one U.S. dental school from 2011 to 2014. Since two of the four classes took the exam in both the third and fourth years, those data were compared to determine if those students' self-assessment skills improved over time. Statistical analyses were performed to determine agreement between the two faculty graders and between the students' and faculty assessments on each criterion in the rubric and the overall grade. Data from the upper and lower performing quartiles of students were sub-analyzed. The results showed that faculty reliability for the overall grades was high (K=0.829) and less so for individual criteria, while student-faculty reliability was weak to moderate for both overall grades (Spearman's rho=0.312) and individual criteria. Students in the upper quartile self-evaluated themselves more harshly than the faculty (p<0.0001), while the lower quartile students overestimated their performance (p=0.0445) compared to faculty evaluation. No significant improvement was found in assessment over time in the students who took the exam in the third and fourth years. This study found only limited support for the hypothesis that a grading rubric used by both faculty and students would increase correspondence between faculty and student assessment and points to a need to reexamine the rubric and instructional strategies to help students improve their ability to self-assess their work.

Assessment of the calibration of periodontal diagnosis and treatment planning among dental students at three dental schools.

Calibration in diagnosis and treatment planning is difficult to achieve due to variations that exist in clinical interpretation. To determine if dental faculty members are consistent in teaching how to diagnose and treat periodontal disease, variations among dental students can be evaluated. A previous study reported high variability in diagnoses and treatment plans of periodontal cases at Indiana University School of Dentistry. This study aimed to build on that one by extending the research to two additional schools: Marquette University School of Dentistry and West Virginia University School of Dentistry. Diagnosis and treatment planning by 40 third- and fourth-year dental students were assessed at each of the schools. Students were asked to select the diagnosis and treatment plans on a questionnaire pertaining to 11 cases. Their responses were compared using chi-square tests, and multirater kappa statistics were used to assess agreement between classes and between schools. Logistic regression models were used to evaluate the effects of school, class year, prior experience, and GPA/class rank on correct responses. One case had a statistically significant difference in responses between third- and fourth-year dental students. Kappas for school agreement and class agreement were low. The students from Indiana University had higher diagnosis and treatment agreements than the Marquette University students, and the Marquette students fared better than the West Virginia University students. This study can help restructure future periodontal courses for a better understanding of periodontal diagnosis and treatment planning.

Background, training experiences, and career plans of U.S. periodontal residents: report of a web-based survey.

The purpose of this cross-sectional study was to survey the backgrounds and perspectives of U.S. periodontal residents in 2012. A 64-item web-based survey was distributed to all periodontal residents in the United States (544 residents enrolled in 54 graduate programs) via email in March 2012. Data on the residents' demographics, experiences during graduate periodontal training, and goals were collected and analyzed, and percentages were calculated. The survey had a 19.1% response rate. Most of the respondents (74%) had graduated from international dental schools, and 81.7% were in combined programs (clinical training combined with a Master's degree, PhD, or other doctoral degree). Almost one-fourth of the responding residents (24%) reported a total debt of more than $300,000 after graduation. More than 60% of the respondents planned to practice in a private setting as an associate, partner, or solo practice owner. The responding residents reported having chosen their graduate programs based mainly on the programs' clinical education and reputation (72% and 48%, respectively). Future studies will determine educational trends and outcomes for periodontal residents in the longer term.

Perceptions and practices of U.S. dental schools regarding curriculum integrated format and traditional format licensure exams.

The dental licensure exam in the United States has evolved over the past ten years, and two formats-the traditional format and curriculum integrated format-are now available for students to satisfy licensure requirements. The objective of this study was to examine the differences and relative merits of the two formats. A twenty-five-question survey was distributed to the fifty-seven U.S. dental schools at the time. The survey included both quantitative and discrete variables and followed a strategic sequential order. The first set of questions sought to determine what type of board preparatory/mock exam each dental school offered, and the next set of questions asked which licensure exam each school formally offered. The final questions were qualitative in nature and aimed to determine the school representatives' opinions about the curriculum integrated format versus traditional format. Of the fifty-seven schools contacted, thirty-seven agreed to participate (response rate=64.9 percent). Fourteen schools reported that they administer the traditional format only and twelve administer the curriculum integrated format only, while eleven offer both. Thirty-two schools offered mock board exams to their graduating students, and twenty-four of those said their mock exams were identical in format to the actual qualifying clinical exams offered at their institution. The respondents reported no significant advantage to preparing for the curriculum integrated format examination as compared to the traditional format examination with regards to number of clock hours taken from regular curriculum time. In reporting on this study, this article provides an overview of the relative advantages and disadvantages of the two examination formats used for the dental licensure process in the United States.

Assessment of tobacco dependence curricula in Italian dental hygiene schools.

The aim of this study was to assess the level of tobacco dependence education offered by Italian dental hygiene programs. A fifty-question survey was mailed to the thirty-one active public and private dental hygiene programs in Italy during the 2008-09 academic year. The survey assessed faculty confidence in teaching tobacco treatment, which courses contained tobacco dependence content, the number of minutes spent on specific content areas, and the level of clinical competence that dental hygiene graduates should be able to demonstrate. Surveys were returned by sixteen programs for a response rate of 52 percent. Respondents indicated tobacco dependence education was included in clinic or clinic seminar (56 percent), periodontics (44 percent), oral pathology (31 percent), and prevention (19 percent). All programs reported including the effects of tobacco on general and oral diseases in courses. However, more in-depth topics received less curriculum time; these included tobacco treatment strategies (63 percent) and discussion of cessation medications (31 percent). Interestingly, 62 percent of the respondents indicated they expected dental hygiene graduates to demonstrate a tobacco treatment competency level of a moderate intervention or higher (counseling, discussion of medications, follow-up) rather than a brief intervention in which patients are advised to quit then referred to a quitline. The results of this study indicated that Italian dental hygiene students are not currently receiving adequate instruction in tobacco treatment techniques nor are they being adequately assessed. This unique overview of Italian dental hygiene tobacco dependence education provides a basis for further discussion towards a national competency-based curriculum.

Use of intravenous sedation in periodontal practice: a national survey.

BACKGROUND: In the early 1990s, much of the periodontal profession perceived an upcoming shift in services performed by periodontists as many patients began to expect sedation for periodontal surgery. As a result, in 1993 the American Academy of Periodontology began encouraging postgraduate periodontal programs to train residents in the use of conscious sedation. The purpose of this study is to investigate trends in the training of intravenous (i.v.) sedation in residency and its use in periodontal practice. METHODS: An 18-question survey was mailed to a sample of 1596 active periodontists throughout the United States and Canada. Thirty-seven percent (596) of the surveys were returned. Twenty-two retired periodontists responded and were excluded from the analysis. The data from the remaining 574 surveys were analyzed with a statistical software package. RESULTS: Approximately half (49.8%) of the survey respondents offer i.v. sedation in their practices. Among respondents who completed residency prior to 1996, 42.6% offer i.v. sedation compared with 64.2% of respondents who completed residency in 1996 or later. The number of i.v. sedations performed in residency was moderately correlated with the number of i.v. sedations personally performed in periodontal practice (Spearman r = 0.5169, P <0.0001). The largest percentage of periodontists using i.v. sedation (74.0%) was reported from American Academy of Periodontology District 5 (south central United States), whereas District 7 (New Jersey and New York) reported the lowest usage (15.6%). CONCLUSIONS: Approximately half of all periodontists provide i.v. sedation, with more recent periodontal graduates more likely to personally offer and administer i.v. sedation services for their patients. Regional differences exist in the use and training of i.v. sedation.

Assessment of morbidity after periodontal resective surgery.

BACKGROUND: The goal of this study is to evaluate morbidity after periodontal surgery and to compare postoperative morbidity of male and female patients treated by experienced periodontists to patients treated by postgraduate (PG) periodontal students. METHODS: A total of 271 patients underwent resective periodontal surgery. Of them, 122 patients were treated by PG periodontal students and 149 patients were treated by experienced periodontists. One week after surgery a questionnaire was given to the patients to rate postoperative pain, swelling, thermal sensitivity, and bleeding. Tactile sensitivity was evaluated in terms of presence or absence. Data were analyzed statistically by applying the analysis of variance test for comparison of the values of bleeding and the Student t test for comparing pain, swelling, tenderness to percussion, and thermal sensitivity. RESULTS: Postoperative bleeding did not show statistically significant differences between surgeries performed by PG periodontal students and experienced periodontists. There were statistically significant differences in contact sensitivity, thermal sensitivity, edema, and pain between surgeries performed by PG periodontal students and experienced periodontists. There were no statistically significant differences in postoperative morbidity between male and female patients. CONCLUSIONS: Morbidity after resective periodontal surgery is low. Patients treated by experienced periodontists had lower postoperative morbidity than patients treated by PG periodontal students. There were no differences in morbidity between male and female patients.

Dental practitioners with a special interest in periodontics: the West Sussex experience.

The experience of a pilot service involving practitioners with a special interest in periodontics is described. The service functioned as a clinical network between the primary and secondary sector and featured consultant outreach. Between June 2006 and May 2007 it experienced 441 referrals. It improved patient access to periodontal care and was successful in targeting specific disease categories and in meeting key performance indicators. The service was non-surgical and emphasised patient self-efficacy. It produced highly effective clinical outcomes. It was well accepted by both patients and referring practitioners. It did not replace the need for a consultant-led service in the eyes of the referring practitioners. The BPE was used to identify suitable patients; audit indicated that there was a tendency for practitioners to underscore the level of periodontal disease.

Review of outcomes from a change in faculty clinic management in a U.S. dental school.

Dental schools use a variety of clinic management models with the goals of promoting patient care, student education, and fiscal responsibility. In 2004, the University of the Pacific Arthur A. Dugoni School of Dentistry transitioned to a more generalist model with these goals in mind. The purpose of this study was to evaluate the outcomes of this clinic model change relative to the quantity of specific procedures completed by students. The quantity of procedures completed by each student from the classes of 1995 through 2009 were compiled from our electronic clinic management system and analyzed. The post-transition group (2004-09) showed a greater number of completed oral diagnosis and treatment planning and root planing procedures per student compared to the pre-transition group (1995-2003), but fewer crowns, root canals, operative procedures, and dentures. Because the higher procedure numbers were for low-cost procedures, our transition to a generalist model did not necessarily enhance clinic income but may support student learning and enhanced patient care.

Assessment of surgical competence in North American graduate periodontics programs: a survey of current practices.

This cross-sectional study was designed to document the methods utilized by North American graduate periodontics programs in assessing their residents' surgical skills. A survey of clinical skills assessment was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. Thirty-four programs (59 percent) responded. The data collected were analyzed using SPSS version 15.0. The results demonstrate that the most common practice for providing feedback and documenting residents' surgical skills in the programs surveyed was daily one-on-one verbal feedback given by an instructor. The next two most commonly reported methods were a standard checklist developed at program level and a combination of a checklist and verbal comments. The majority of the programs reported that the instructors met collectively once per term to evaluate the residents' progress. The results suggest that graduate periodontics programs provide their residents frequent opportunities for daily practice with verbal feedback from instructors. However, assessment strategies identified in other health professions as beneficial in fostering the integration of clinical skills practices are not employed.

Providing care for underserved patients: periodontists' and periodontal residents' educational experiences, attitudes, and behaviors.

BACKGROUND: Patients with special health care needs (SHCNs) and patients from underrepresented minority and/or low socioeconomic backgrounds are more likely to have problems accessing oral health care services. The objectives of this study are: 1) to explore how well the dental education of periodontists prepared them to treat these underserved patients, 2) to assess related professional attitudes and confidence when treating these patients as well as professional behaviors, and 3) whether educational experiences are related with attitudes, confidence, and behaviors in this context. METHODS: Survey data were collected from a randomly selected sample of 291 members of the American Academy of Periodontology (AAP) and 64 periodontal residents. RESULTS: Overall, large percentages of residents agreed that their predoctoral and graduate dental educations had prepared them well to treat patients with special needs (predoctoral education: 58%; clinical graduate education: 45%; and classroom-based graduate education: 37%), from different ethnic/racial backgrounds (predoctoral education: 74%; clinical graduate education: 74%; and classroom-based graduate education: 60%), and on Medicaid (predoctoral education: 60%; clinical graduate education: 61%; and classroom-based graduate education: 42%). Practicing clinicians were least positive about their educations. Students were more positive about treating patients on Medicaid and pro bono cases than practicing clinicians. However, the two groups did not differ in their confidence when treating underserved patients. The quality of predoctoral and graduate educations regarding underserved patients correlates with the attitudes, confidence, and behaviors of providers concerning providing care for these patients. CONCLUSIONS: The findings of this study stress the importance of preparing future periodontists in their predoctoral and graduate programs for providing care for underserved patients such as patients with SHCNs. The better that dental education prepares future periodontists to provide care for underserved patients, the more confident periodontists will be when encountering these patients in their own practices and the more likely they will be to contribute to reducing disparities in oral health care access in the United States by treating these patients.