Implementation process of all periodontal competences and assessments as proposed in the 2010 European consensus meeting into the existing local undergraduate curriculum.

AIM: To report on our implementation process within the existing local curriculum of all periodontal competences and assessments as proposed in the 2010 European consensus meeting. MATERIAL AND METHOD: In 2011, a workshop for all teaching staff at the Department of Periodontology, ACTA, an education and assessment blueprint, was developed to test for missing education and assessment of European competences, divided into seven domains. This was repeated in 2013. An oral evaluation of the staff followed both meetings. RESULTS: It appeared that eight of 58 (14%) European competences were not taught, and 21 (35%) competences were not assessed. After evaluation of the results on the actual curriculum and the assessment programme, shared decisions were made about how to teach and assess the missing competences within the local periodontal educational programme. The second workshop in 2013 revealed still 8 (14%) competences were not taught and 8 (14%) competences were not assessed. Staff appreciated the used method of validation; it gave insight and an overview of the curriculum. The existence of the European consensus report for undergraduate periodontal education, based on seven domains, has been instrumental and essential. CONCLUSION: The development of a blueprint from the education programme and concomitant assessment methods in periodontology by participating teaching staff gives a validation and appreciation of the curriculum and will improve the quality of education and assessment. It is advised that for quality control of the curriculum, dental schools could do this exercise for all their specialties if European consensus reports exist.

Influence of dental education in motivational interviewing on the efficacy of interventions for smoking cessation.

AIM: To test whether education of dental students in motivational interviewing (MI) for smoking cessation counselling will increase the number of patients and students who quit smoking and will improve knowledge and attitudes of dental students towards tobacco cessation counselling. METHODS: Over 2 years, during four successive undergraduate periodontal courses, student groups received either no education in MI or MI with increasing quality and extent of the education. Smoking habits were assessed before, and 1, 6 and 12 months after periodontal treatment by means of a questionnaire. In the same way, attitudes and knowledge related to tobacco cessation and the perceived quality of the education in MI of the students were evaluated. RESULTS: A significant reduction in smokers was achieved only in the group of students receiving the most extensive MI education followed by a formative assessment: 20% quit rate after 1 year for patients and 39% for students. Owing to MI education, the knowledge of the students on the relationship between smoking and periodontitis increased from 33% without MI to over 96% in the groups with MI. CONCLUSION: Engaging dental students in smoking cessation with MI has promise when incorporated in the periodontal education.

Treatment planning in dentistry using an electronic health record: implications for undergraduate education.

OBJECTIVE: Treatment planning, an essential component of clinical practice, has received little attention in the dental literature and there appears to be no consistent format being followed in the teaching and development of treatment plans within dental school curricula. No investigation, to our knowledge, has been carried out to explore the subject of treatment planning since the advent of electronic health record (EHR) use in dentistry. It is therefore important to examine the topic of treatment planning in the context of EHRs. METHODS: This paper reports on how 25 predoctoral dental students from two U.S. schools performed when asked to complete diagnosis and treatment planning exercises for two clinical scenarios in an EHR. Three calibrated clinical teaching faculty scored diagnosis entry, diagnosis-treatment (procedure) pairing, and sequencing of treatment according to criteria taught in their curriculum. Scores were then converted to percent correct and reported as means (with standard deviations). RESULTS: Overall, the participants earned 48.2% of the possible points. Participants at School 2 earned a mean of 54.3% compared with participants at School 1, who earned 41.9%. Students fared better selecting the appropriate treatment (59.8%) compared with choosing the correct diagnoses (41.9%) but performed least favorably when organizing the sequence of their treatment plans (41.7%). CONCLUSION: Our results highlight the need to improve the current process by which treatment planning is taught and also to consider the impact of technology on the fundamental skills of diagnosis and treatment planning within the modern educational setting.

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

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

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

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

Curriculum structure, content, learning and assessment in European undergraduate dental education - update 2010.

This paper presents an updated statement on behalf of the Association for Dental Education in Europe (ADEE) in relation to proposals for undergraduate Curriculum Structure, Content, Learning, Assessment and Student / Staff Exchange for dental education in Europe. A task force was constituted to consider these issues and the two previous, related publications produced by the Association (Plasschaert et al 2006 and 2007) were revised. The broad European dental community was circulated and contributed to the revisions. The paper was approved at the General Assembly of ADEE, held in Amsterdam in August 2010 and will be updated again in 2015.

Innovative educational methods and technologies applicable to continuing professional development in periodontology.

Continuous professional development (CPD) in Periodontology refers to the overall framework of opportunities that facilitate a life-long learning practice, driven by the learner-practitioner and supported by a variety of institutions and individuals. CPD must address different needs for a great diversity of practitioners. It is clear that no particular methodology or technology is able to successfully accommodate the entire spectrum of CPD in Periodontology. Course designers must choose from and combine a wide array of methodologies and technologies, depending upon the needs of the learners and the objectives of the intended education. Research suggests that 'interactivity', 'flexibility', 'continuity' and 'relevance to learners' practice' are major characteristics of successful CPD. Various methods of mentoring, peer-learning environments and work-based learning have been combined with reflective practice and self-study to form the methodological backbone of CPD courses. Blended learning encompasses a wide array of technologies and methodologies and has been successfully used in CPD courses. Internet-based content learning management systems, portable Internet devices, powerful databases and search engines, together with initiatives such as 'open access' and 'open courseware' provide an array of effective instructional and communication tools. Assessment remains a key issue in CPD, providing learners with valuable feedback and it ensures the credibility and effectiveness of the learning process. Assessment is a multi-level process using different methods for different learning outcomes, as directed by current evidence and best practices. Finally, quality assurance of the education provided must follow CPD courses at all times through a structured and credible process.

Is the OSCE more stressful? Examination anxiety and its consequences in different assessment methods in dental education.

OBJECTIVE: To measure the levels of anxiety, self-perception of preparation and expectation for success induced by an objective structured clinical examination (OSCE), a written examination and a preclinical preparation test, and to examine the effects of the three predictive variables on the outcome of the assessments. MATERIALS AND METHODS: Test anxiety was measured with Spielberger's state anxiety inventory. Preparation for the assessment and expectation to succeed were quantified with 4-point Likert scales. The questionnaire was completed during an OSCE, a written examination, a preclinical crown and bridge preparation test and a non-examination situation. RESULTS: The OSCE was a most anxiety-provoking assessment method and students prepared more for the OSCE than for the other examinations. The expectation to succeed was also higher for the OSCE. State anxiety during the OSCE was associated with the level of preparation but not with scores obtained. The state anxiety during a written examination showed a positive relation with the scores obtained, but not with preparation or expectation to succeed. During the preclinical test, state anxiety showed a positive association with the preparation and expectation to succeed, but not with the scores for this test. No significant gender effects were observed for the state anxiety, level of preparation or the expectation to pass the examination. In the written examination female students scored significantly higher than male students. Such a gender effect was not found for the scores of the OSCE or the preclinical test. CONCLUSION: State anxiety was elevated during all three assessment methods. However, anxiety was not predictive of performance outcome in the OSCE, written examination or preclinical preparation test.

Who will pass the dental OSCE? Comparison of the Angoff and the borderline regression standard setting methods.

AIM: Aim of this study is to elucidate which standard setting method is optimal to prevent incompetent students to pass and competent students to fail a dental Objective Structured Clinical Examination (OSCE). MATERIAL AND METHODS: An OSCE with 14 test stations was used to assess the performance of 119 third year dental students in a training group practice. To establish the pass/fail standard per station, three standard setting methods were applied: the Angoff I method, the modified Angoff II with reality check and the Borderline Regression (BR) method. For the final decision about passing or failing the complete OSCE, three methods were compared: total compensatory (TC), a partial compensatory (PC) within clusters of competence and a non-compensatory (NC) model. The reliability of the pass/fail standard of the three methods was indicated by the root mean square error (RMSE). As a criterion measure, a sample of the students (n = 89) was rated in the clinic by their instructors and accordingly these students were divided into two groups: competent and incompetent students. The students' clinical rating (considered for this study as 'true qualification') was compared with the pass-fail classification resulting from the OSCE. Undeserved passing of an incompetent student was considered as more damaging than failing a competent student. RESULTS: The BR method showed more acceptable results than the two Angoff methods. In terms of pass rate the BR method showed the highest pass rates: for the TC model the Angoff method I and II and the BR showed pass rates of 86.6%, 86.6% and 97.5% respectively. For the PC model the pass rates were 30.3%, 34.5% and 61.3%, and for the NC model the pass rates were 0.8%, 1.7% and 7.6%. The BR method showed lower RMSEs (higher reliability): for the TC model the RMSEs were 1.3%, 1.0% and 0.3% for the Angoff I, Angoff II and BR method respectively, and for the PC model the RMSE of the clusters of competence range was 2.0-3.7% for Angoffs I; 1.8-2.2% for Angoff II and 0.6-0.7% for the BR method. In terms of incorrect decisions, the BR method had a higher loss due to incorrect decisions for the TC model than for the PC model which is in accordance with the results of other studies in medical education. CONCLUSIONS: Therefore we conclude that the BR method in a PC model provides defensible pass/fail standards and seems to be the optimal choice for OSCEs in health education.

On the reliability of a dental OSCE, using SEM: effect of different days.

AIM: The first aim was to study the reliability of a dental objective structured clinical examination (OSCE) administered over multiple days, and the second was to assess the number of test stations required for a sufficiently reliable decision in three score interpretation perspectives of a dental OSCE administered over multiple days. MATERIALS AND METHODS: In four OSCE administrations, 463 students of the year 2005 and 2006 took the summative OSCE after a dental course in comprehensive dentistry. The OSCE had 16-18 5-min stations (scores 1-10), and was administered per OSCE on four different days of 1 week. ANOVA was used to test for examinee performance variation across days. Generalizability theory was used for reliability analyses. Reliability was studied from three interpretation perspectives: for relative (norm) decisions, for absolute (domain) and pass-fail (mastery) decisions. As an indicator of reproducibility of test scores in this dental OSCE, the standard error of measurement (SEM) was used. The benchmark of SEM was set at <0.51. This is corresponding to a 95% confidence interval (CI) of <1 on the original scoring scale that ranged from 1 to 10. RESULTS: The mean weighted total OSCE score was 7.14 on a 10-point scale. With the pass-fail score set at 6.2 for the four OSCE, 90% of the 463 students passed. There was no significant increase in scores over the different days the OSCE was administered. 'Wished' variance owing to students was 6.3%. Variance owing to interaction between student and stations and residual error was 66.3%, more than two times larger than variance owing to stations' difficulty (27.4%). The SEM norm was 0.42 with a CI of +/-0.83 and the SEM domain was 0.50, with a CI of +/-0.98. In order to make reliable relative decisions (SEM <0.51), the use of minimal 12 stations is necessary, and for reliable absolute and pass-fail decisions, the use of minimal 17 stations is necessary in this dental OSCE. CONCLUSIONS: It appeared reliable, when testing large numbers of students, to administer the OSCE on different days. In order to make reliable decisions for this dental OSCE, minimum 17 stations are needed. Clearly, wide sampling of stations is at the heart of obtaining reliable scores in OSCE, also in dental education.

Quality assurance, benchmarking, assessment and mutual international recognition of qualifications.

The aim of this report is to provide guidance to assist in the international convergence of quality assurance, benchmarking and assessment systems to improve dental education. Proposals are developed for mutual recognition of qualifications, to aid international movement and exchange of staff and students including and supporting developing countries. Quality assurance is the responsibility of all staff involved in dental education and involves three levels: internal, institutional and external. Benchmarking information provides a subject framework. Benchmarks are useful for a variety of purposes including design and validation of programmes, examination and review; they can also strengthen the accreditation process undertaken by professional and statutory bodies. Benchmark information can be used by institutions as part of their programme approval process, to set degree standards. The standards should be developed by the dental academic community through formal groups of experts. Assessment outcomes of student learning are a measure of the quality of the learning programme. The goal of an effective assessment strategy should be that it provides the starting point for students to adopt a positive approach to effective and competent practice, reflective and lifelong learning. All assessment methods should be evidence based or based upon research. Mutual recognition of professional qualifications means that qualifications gained in one country (the home country) are recognized in another country (the host country). It empowers movement of skilled workers, which can help resolve skills shortages within participating countries. These proposals are not intended to be either exhaustive or prescriptive; they are purely for guidance and derived from the identification of what is perceived to be 'best practice'.

Language background and OSCE performance: a study of potential bias.

AIM: To investigate whether Non-Native dental students perceive drawbacks in their education and examination experience because of their lack of language proficiency and to test whether prolonging Objective Structured Clinical Examination (OSCE) test-station duration improves their performance. MATERIALS AND METHODS: Dental students (n = 345) completed a questionnaire about their native country, their language background and the possible drawback they perceived in dental education and examination because of their language proficiency. Students were marked as 'native', when they were born in the Netherlands with Dutch as native language or 'Non-Native' when they were born outside the Netherlands, raised with a non-Dutch native language, or raised bilingually. A sample of 108 students was assessed by an OSCE testing a periodontal course with nine test-stations. Test-station topics were: (1) history taking, (2) measuring attachment level, (3) educating patients, (4) tracing a radiograph, (5) root-planing, (6) writing a prescription, (7) diagnostics and prognostics, (8) differential diagnostics and (9) writing a referral letter. The first five test-stations mentioned were of 5-min duration. The other four test-stations were provided in two modes: either with a short (5 min) or longer (10 min) version. Every student took at random two long and two short test-stations. RESULTS: In the group of 345 questionnaire responders, Non-Native students (n = 116) perceived significantly more drawback in education and examination than Native students (n = 229) (P < 0.001). When Non-Native students speak Dutch at home, around 38% of them reported perceived drawbacks in education, whereas when they speak their native language at home, around 60% reported perceived drawbacks in education (P = 0.005). In the periodontal OSCE (n = 108), the Native group (n = 70) had significantly higher total scores than the Non-Native (n = 38), (P = 0.009, d = 0.53). The Non-Native group had significantly lower mean scores in the communication station 'educating patients' (P = 0.034, d = 0.42). Prolonged test-station duration from 5 to 10 min had no positive effect in all experimental test-stations in the Native and Non-Native group. Female students in the Native group out-performed male in a communication test-stations. Female students in Native and Non-Native groups were found to be more successful in 'tracing bone loss on radiographs'. CONCLUSION: Non-Native students perceived a drawback in dental education and examination because of their language proficiency in Dutch, which is confirmed by their actual OSCE performance. Prolonging the time for a test-station did not improve OSCE performance of Non-Native students. It is recommended that students with problems in language ability need additional tuition and practice.

Implementing an Objective Structured Clinical Examination (OSCE) in dental education: effects on students' learning strategies.

OBJECTIVES: To investigate the effect of an Objective Structured Clinical Examination (OSCE) on dental students' learning strategies and competence to manage periodontal diseases in patients. The implemented OSCE was expected to be superior to the existing Written Exam in fostering the acquisition of clinical competencies in terms of study strategies that are more oriented towards clinical practice, longer study time, greater clinical proficiency, and more realistic self-assessment. MATERIAL AND METHODS: After a clinical course in periodontology, 72 third year dental students were assessed summatively, either using a Written Exam or an OSCE (P-OSCE). The students were informed beforehand about the assessment formats. The self-assessed clinical competence, study time and strategies (i.e. practice with a manikin, peers and patient case) were evaluated by means of a questionnaire. After a comprehensive dental care course, all 72 students were assessed by an overall end-of-year OSCE, in which three periodontal stations were included 'measuring pockets', 'educating patients' and 'tracing an X-ray with bone-loss'. The competence of the previous Written Exam group and the P-OSCE group was investigated by determining the mean scores and pass-fail scores of three periodontal test-stations as well as the total score of the end-of-year OSCE. The degree of realistic self-assessment was studied by correlating the self-assessed competencies as evaluated by means of the questionnaire with the total score of the end-of-year OSCE. RESULTS: Self-assessed clinical competence, study time and study strategies showed no differences between the P-OSCE and the Written Exam-group. The clinical competence determined in the test-station 'measuring pockets' in the end of year overall OSCE was higher for the P-OSCE group (P = 0.05) when compared with the Written Exam group; the two groups performed equally well in the test station 'educating patients', whereas the performance in 'tracing an X-ray with bone-loss' was better in the Written Exam group. This group also had a higher total score in the end-of-year OSCE (P = 0.05). The degree of realistic self-assessment was higher in the P-OSCE group than in the Written Exam group: in the P-OSCE group the self-assessed clinical competencies correlated significantly with the total score of the overall end-of-year OSCE (P < or = 0.05). CONCLUSIONS: No effects of the implementation of an OSCE in undergraduate periodontal education were observed in study strategies, but the implementation of an OSCE in undergraduate periodontal education appears to stimulate learning, resulting in greater achievement of specific clinical competence and a greater level of realistic self-assessment.

An implementation strategy for introducing an OSCE into a dental school.

INTRODUCTION: The Objective Structured Clinical Examination (OSCE) uses a series of test-stations to test clinical competencies. The introduction of an OSCE in a dental school is always a new experience for both staff and students and may result in a change in assessment methods. As resistance could develop when changes are introduced into an organisation, the use of a strategy for the implementation of such change will help to diminish opposition and may therefore result in the co-operation of staff and their departments. The objective of this study was to investigate the effectiveness of an implementation strategy by measuring attitudes of both staff and students towards the OSCE as a new form of clinical assessment in a dental school (ACTA). MATERIALS AND METHODS: 'Stepwise' behaviour change (with information, participation and commitment as tools) was used as a strategy to minimise protective behaviour to the introduction of an OSCE. After lectures on assessment, 59 staff members participated in a mini-OSCE with eight test-stations, playing both the role of a student and observer. A questionnaire, designed to test attitudes and commitment towards the new OSCE was completed after the examination. Six months later, 22 staff of all departments had developed and run a pilot OSCE for 44 students. A similar questionnaire was answered by staff and students. A year later, another OSCE for all 103 third year students was designed, organised and evaluated with full co-operation of the clinical teaching staff. RESULTS: Staff total attitude grew positively (P = 0.001). Student's total attitude was lower than staff (P < 0.001) The results of the survey after the mini-staff-OSCE and pilot and final OSCE were favourable in terms of the acceptance of use of an OSCE for the assessment of clinical competences. CONCLUSION: The implementation strategy appears to have been successful. The objective of gaining the co-operation of staff and departments and avoiding resistance to change was achieved.