Comparison of clinical productivity of senior dental students in a dental school teaching clinic versus community externship rotations.

The aim of this study was to report on the clinical and monetary productivity of fourth-year dental students at community-based clinical sites and school-based clinics at the Harvard School of Dental Medicine (HSDM). This study included forty-seven students from the graduating classes of 2006, 2007, and 2008. These fourth-year students were required to spend twelve weeks at one of several participating community health centers throughout Massachusetts and New Hampshire. Students also treated their patient pool in the teaching practice at HSDM in the fourth year. The most common sixty American Dental Association procedure codes were compared, and variables were created by grouping them by specialty or type of service. HSDM dental students completed 8,365 procedures at an externship site during their community experience. An average of 178 procedures was completed per student, and mean revenue of $17,486 was produced. In comparison, the same students completed 3,640 procedures during an equal amount of time spent (normalized for this study) at the school teaching practice clinic, where each student completed an average of seventy-seven procedures and generated $16,802 in revenue. The results of this study show that fourth-year dental students at the community health centers, working under the supervision of adjunct faculty, completed more than double the number of procedures they did in the HSDM teaching practice clinic. However, the revenue generated was very similar at the two sites. In addition, the types of procedures performed by students at externship sites were simpler than the complex and specialized procedures performed at the HSDM clinic, which include fixed and removable prosthetics, periodontal surgery, and implantology.

Which factors influence students' selection of advanced graduate programs? One institution's experience.

The reasons that students choose certain specialties may be integral to the quality of specialty programs and the future of those specialties. The Harvard School of Dental Medicine (HSDM) has a high percentage (87.6 percent) of students who enroll in postgraduate programs. The goals of this study were to establish a baseline of factors that affect postgraduate program selection at HSDM and to determine if there was a significant difference in factor selection by gender, relationship status, graduation year, or choice to specialize versus choice to pursue advanced training in general dentistry. As a pilot study, we asked HSDM graduates from the classes of 2005 to 2007 to rank the importance of forty-two factors in selecting a field of dentistry and a particular program or institution within a specialty. Overall, students felt that intellectual content, challenging diagnostic problems, and possessing a special skill or talent unique to a specialty were the most important factors in choosing a field of dentistry. Influence of family members in dentistry was ranked as least important. In choice of a certain program or institution within a given field, clinical training and philosophy of training were ranked most highly. Students felt that the opportunity to moonlight was least important. Significant differences (p<0.05) were found regarding gender, relationship status, and students who chose to specialize versus those pursuing advanced general dentistry training. No significant differences were found among the students in different graduating classes.

Students' perceptions of prosthodontics in a PBL hybrid curriculum.

PURPOSE: A survey was distributed to the Harvard School of Dental Medicine (HSDM) predoctoral student classes of 2005 and 2006 to assess their perceptions regarding preclinical prosthodontics laboratory exercises. Prosthodontics curriculum clock hours, prosthodontics teaching participation, and plans for specialization were also analyzed. We hypothesized that reduced hours and perceived stress in the prosthodontics curriculum might impact students' choice of specialty at HSDM. MATERIALS AND METHODS: HSDM preclinical prosthodontics clock hours were compared with national means from published data. A survey was distributed to the HSDM classes of 2005 and 2006 (n = 70) at the end of their preclinical prosthodontics laboratory exercises, prior to students seeing their first patient in the clinics. RESULTS: A 100% response rate was achieved. Results from this study show that HSDM preclinical prosthodontics clock hours are on average shorter than other schools. The majority of the students felt stressed during the laboratory exercises, and they felt they did not gain adequate knowledge from the lectures, resulting in low self-esteem (confidence) in treating patients in the clinic. Despite this perception, HSDM students do just as well, if not better, than other students, as judged by external and internal outcome measures. Graduate prosthodontics specialization is still a specialty of choice among the graduates when compared to national data. CONCLUSIONS: The shortened preclinical didactic and laboratory exercises in prosthodontics at HSDM affect student anxiety, but not their didactic and clinical performances or their decisions in choosing their graduate program. Problem-based learning (PBL) tutorials help the students to integrate preclinical and clinical knowledge and skills in prosthodontics.

Attitudes toward patient safety standards in U.S. dental schools: a pilot study.

The objective of this study was to assess the patient safety culture among students, staff, and faculty in seven U.S. dental school clinics when compared to those from a similar study in twenty U.S. hospitals. A survey on patient safety culture developed by the Agency for Healthcare Research and Quality (AHRQ) was used to measure attitudes towards patient safety by anonymous faculty, students, and support staff members who work in the clinics of seven U.S. dental schools. This survey instrument was also administered to staff at twenty U.S. hospitals. In three of the twelve sections of the survey (Overall Perceptions of Safety, Management Support for Patient Safety, and Teamwork Across Units), dental school personnel responses rated above the hospital benchmark results. In Section 2 (Frequency of Adverse Events Reported) and Section 4 (Organizational Learning/ Continuous Improvement), average dental school responses were below those recorded for hospital personnel. The overall score from the twelve sections of the survey indicated that patient safety attitudes of dental school participants were higher than those of their hospital counterparts.

The impact of targeted shortened preclinical exercises on student perceptions and outcomes.

The Harvard School of Dental Medicine (HSDM) introduced problem-based learning (PBL) into the dental curriculum in 1994 as a part of curriculum reform. During the reorganization, departments were consolidated, and courses were taught in an interdisciplinary fashion rather than in a discipline-based approach. The changes required a reduction in lecture and preclinical clock hours, which might have affected student performance and anxiety levels. The objectives of this study were to 1) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics before and after PBL implementation; 2) compare the HSDM didactic and laboratory preclinical hours in Endodontics, Operative, and Prosthodontics with other schools nationwide; 3) measure students' perceptions of their levels of stress and self-confidence at two time points during their preclinical and clinical years; 4) investigate the correlation between the number of preclinical hours and the students' stress level and self-confidence; and 5) evaluate the impact of shortened preclinical hours on the performance of HSDM students on the National Board Dental Examination Parts I and II. A survey regarding the students' level of stress, self-confidence, and preparation to treat patients during preclinical laboratory exercises was distributed to the HSDM classes of 2005 and 2006 (n=70). The HSDM preclinical curriculum hours were compared to national data as reported by the American Dental Association (ADA). Cross-tabulations were constructed, and the Fisher's exact test was conducted to examine the relationships between the variables. We found that HSDM preclinical hours in Endodontics, Operative, and Prosthodontics were significantly lower than at other schools. During the preclinical exercises, the Prosthodontics preclinical exercises were found to be the most stressful and provided the lowest self-confidence in treating patients as compared to the other preclinical subject areas. HSDM students' scores on the National Board Part I and II examinations continue to be among the highest in the nation and have not been affected by the change in curriculum. We conclude that the change in HSDM's curriculum that resulted in targeted, shorter preclinical exercises has not affected clinical and didactic outcomes, but may have affected the anxiety that students feel when entering the clinic.

Problem-based learning at the Harvard School of Dental Medicine: self-assessment of performance in postdoctoral training.

Problem-based learning (PBL) was implemented into the dental curriculum at the Harvard School of Dental Medicine (HSDM) in 1994 with an expectation that this pedagogy would enhance students' critical thinking and communication skills as well as general professional competencies. Previous studies have described several aspects of the outcome of PBL curricula at the predoctoral level. However, there is no information available on the perceptions and performance of PBL graduates during their postdoctoral training in dentistry. The purpose of this study was to evaluate the effect of PBL methodology on the performance of HSDM graduates during their postdoctoral training in comparison with their non-HSDM (traditional) co-residents. Surveys containing traditional knowledge-based criteria, preclinical and clinical criteria, and PBL criteria were sent to HSDM graduates from the classes of 2002 through 2004 who were in postgraduate training programs. The HSDM and traditional graduates were asked to evaluate and compare their performance in selected areas with those of their co-residents from either a PBL curriculum or a traditional curriculum. The directors of each program were also asked to assess HSDM graduates relative to other graduates in the program based on the same aspects. Overall, HSDM graduates rated themselves more highly than non-HSDM graduates on all competencies. No significant difference between HSDM and non-HSDM responses was found in general dental knowledge, specialty specific knowledge, preclinical skills, clinical skills, communication with staff, and patient education, whereas significant differences (p<0.05) were found for communication with patients, critical thinking, independent learning, performance in small group settings, self-assessment, and teamwork. The data obtained from the program directors revealed corresponding results. The HSDM graduates' capacity for independent learning was rated as "excellent" by 65.31 percent of the directors and 80.95 percent of the HSDM graduates themselves. These findings suggest that the performance of HSDM graduates during their postdoctoral training met expectations and were similar to non-HSDM graduates for traditional residency program competencies. However, the PBL training appears to provide HSDM graduates with enhanced abilities in independent learning, communication, and cooperation skills.

The effect of aspirin intake on bleeding on probing in patients with gingivitis.

BACKGROUND: Bleeding indices are used as a screen for periodontal disease activity, a measure of disease prevalence, and a measure of effectiveness in clinical trials. Bleeding on probing (BOP) is widely interpreted as a sign of disease activity whereas its absence is interpreted as both a sign and predictor of health. Aspirin use has become increasingly common in the prevention of cerebrovascular and cardiovascular diseases. Because of its anti-platelet activity, aspirin is a non-disease factor that has the potential to affect the appearance of BOP. The hypothesis being tested is that short-term aspirin use in doses of 81 mg and 325 mg will increase the number of bleeding sites in a population with gingivitis. METHODS: Fifty-four subjects were screened initially, those subjects with 20% to 30% whole mouth BOP were randomly assigned to one of three arms: placebo group, 81 mg aspirin group, or 325 mg aspirin group. Before and after exposure to the respective regimens, clinical parameters were measured on all the teeth: the plaque index was recorded at four sites per tooth, and probing depth and BOP were evaluated at six sites per tooth using an automated pressure-sensitive probe. RESULTS: The data obtained in this clinical trial were analyzed utilizing a linear regression analysis to control for confounding variables. The primary measure of interest was BOP in patients clinically demonstrating naturally occurring gingivitis. The results of this study indicate that while controlling for age, gender, and plaque, "low dose" 81 mg and "regular dose" 325 mg of aspirin demonstrated a statistically significant 5.30 (P = 0.001) and 4.13 (P = 0.010) increase from baseline, respectively, in percent BOP. CONCLUSION: Failure to consider the effects of aspirin on BOP could impair proper diagnosis and treatment planning for clinicians and introduce a significant confounding variable in research situations.

1.4 Research and the dental student.

There has been significant concern that the dental curriculum and system of clinical education, in particular, is not designed to take advantage of the explosion in knowledge in biomedical science and its application to the health of the public. Although there are some examples of innovations in dental education on a global scale that have the capacity to increase the assimilation of basic and clinical knowledge, most of the dental education models are mired in the traditional '2 + 2' approach to education. This can be seen in North America and the European '2 + 3' model or the stomatological '4 + 2' approach. In each of these systems, the basic and behavioural science courses continue to be perceived as hurdles over which students must leap in order to reach the clinical programmes where there is little opportunity to use basic science information to advance patient care and treatment. Examples of issues that are not well represented include: innovations in imaging; diagnosis; bio-materials; science-based approaches to clinical practice; novel approaches to therapeutics; interactions between the oral, dental and craniofacial complex and systemic health and disorders; the role of oral infections and systemic disease; the increasing appreciation of chronic diseases and disorders such as osteoporosis and diabetes that affect oral tissues; the promise of bioengineering, tissue engineering and biomimetics; the potential use of saliva as a diagnostic tool; the understanding of oral complications of cancer treatment; the treatments of HIV/AIDS diseases and hepatitis; the use of dental and dental hygiene staff on health-care teams to deal with issues such as birth defects, orofacial trauma, head and neck cancer, chronic pain management and so on. There seems to be an excessive emphasis on restorative dentistry and, to a lesser extent, on the more biological approaches to diagnosis, prevention and therapeutics. This continued lack of integration of basic and clinical sciences in the curriculum continues to foster a dental workforce that is highly technically competent to provide specific clinical services but poorly equipped to evaluate and implement new biological approaches to diagnosis, therapeutics and intervention. Unfortunately, after many attempts by organized dental symposia aimed at the integration of basic and clinical sciences, there has been little discernible curricular change. It appears that there is an opportunity through this global congress to identify the best practices in the various global curricula that could change this paradigm in dental education and lead us toward the education of a more scientifically orientated practitioner-one who can take advantage of innovations in new and emerging technologies in their application to patient care. It is the challenge of this section to try to ascertain the best method or methods by which dental education promotes research to the dental student and what research represents in terms of critical thinking and evidence-based approaches to dental education and clinical practice.

The effect of aspirin on the periodontal parameter bleeding on probing.

BACKGROUND: The absence or presence of bleeding on probing (BOP) is a sign of periodontal health or disease, but the presence of BOP is not an accurate predictor of disease progression. Aspirin is increasingly used in the prevention of cerebrovascular and cardiovascular diseases and is a non-disease factor that may modify bleeding indices given its antithrombolytic activity. The purpose of this double-blind placebo-controlled randomized clinical trial was to study the effect of short-term daily aspirin ingestion on the clinical parameter BOP. METHODS: A total of 46 periodontally healthy subjects were included in this study: 16 received placebo, 15 low-dose aspirin (81 mg), and 15 regular dose (325 mg) aspirin. Clinical parameters assessed included plaque index, periodontal probing depth, and BOP using an automated pressure-sensitive probe. Measurements were recorded before and after 7-day exposure to placebo and aspirin regimens. RESULTS: A statistically significant difference in BOP was found in patients with > or = 20% of bleeding sites during the visit prior to placebo or aspirin exposure (n = 11). The group treated with 325 mg aspirin exhibited a moderate yet statistically significant increase in BOP (12.4%) compared to the placebo group (there was no significant difference between the 81 mg aspirin group and placebo). The tendency to bleed was not statistically significant in the group which exhibited <20% (n = 35) of bleeding sites during the visit prior to exposure. CONCLUSION: Aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing in a population that had > or = 20% BOP sites.