Orthodontics rewired: A new approach to predoctoral competency training.

OBJECTIVE: To describe changes in a competency-based orthodontics course in response to the COVID-19 pandemic, and compare outcomes before and after these adaptations. METHODS: Exempted by NYU IRB (#FY2021-4795, #FY2021-5748). At NYU College of Dentistry, assessments and surveys for D3 course groups were compared: 2018 (N = 89, in-person) and 2022 (N = 109, hybrid; remote synchronous with cold-calling). Assessments were identical and proctored. Pass rates, mean scores, and score distributions were compared using t-tests and Z-scores. Internal consistency of surveys was evaluated with Cronbach's alpha. Six paired Likert items were categorized into Positive, Neutral, and Negative and compared using Fisher's exact test and phi coefficients. Four items were added to the 2022 survey to assess students' responses to "cold-calling" and were evaluated using descriptive statistical methods. RESULTS: No significant differences in pass rates or mean assessment scores were found between 2018 (79.8%, 1.45 ± 1.11) and 2022 (80.7%, 1.50 ± 0.97) groups. Surveys demonstrated high internal consistency (Cronbach's alpha: 0.95 and 0.81). Response rates were 79% and 80% for both groups with a median score of 4 (Agree) or higher, indicating positive confidence and motivation. Fisher's exact test and phi coefficients did not find significant differences across surveys (p ≤ 0.05). The four additional Likert items in the 2022 group survey suggested that cold-calling increased preparedness and anxiety. The median score for cold-call items = 4 (Agree). CONCLUSIONS: The null hypothesis was upheld. Assessment and survey outcomes for 2018 and 2022 were similar. Students displayed increased confidence and motivation. "Cold-calling" was associated with increased preparedness, engagement, and anxiety.

Learning Games: A New Tool for Orthodontic Education.

Learning games that are based on current scientific concepts are underutilized in dental education. This paper explores the relevant science of learning and discusses several principles that are conducive to learning and teaching in an educational setting, namely retrieval practice, feedback, motivation, and engagement. A discussion of learning games in health professional education ensues, followed by a description of relevant best practices in game design for learning. This paper concludes by presenting Dealodontics©, a card game developed at New York University College of Dentistry with the goal of helping second-year dental students review, practice, and apply basic skills relevant to their orthodontics competency requirements.

Making competency-based predoctoral orthodontics fun: Introducing Dealodontics.

OBJECTIVES: Dealodontics is a card game developed at New York University College of Dentistry for dental students to reinforce and apply basic orthodontic concepts. Dealodontics incorporates clinical photographs and questions to assess students' skills in diagnosis and patient management. The game was designed to be an enjoyable, interactive, and collaborative learning experience, supplementing competency-based instruction. The purpose of this project was to present this novel educational method and to evaluate dental students' engagement and game-playing experience. METHODS: The survey was modeled after the "Game Experience Questionnaire" and followed the same methodology collapsing 16 survey questions into eight categories. The 5-point Likert scale was collapsed into a 3-point graduated scale (negative, neutral, and positive). Results were tabulated and scored using methods developed by IJsselsteijn et.al. Comparisons were made between two years: 2019 (N = 385) and 2021 (N = 245). Additionally, students were asked an open-ended question, to list three words to describe the game-playing experience. RESULTS: Response rates declined from 72% in 2019 to 50.2% in 2021. Response trends were similar: Positive gameplay experiences (competence, positive affect, immersion, challenge, and learning) and lack of negative experiences (tension/annoyance, negative affect). In the category of flow, 2021 responses were more positive (42.68%) when compared to the responses in 2019 (38.3%). Open-ended responses were similar with "fun" being the most commonly occurring word. CONCLUSIONS: Dealodontics is an effective and engaging tool for learning which can be used to supplement traditional methods.

Types of Feedback in Competency-Based Predoctoral Orthodontics: Effects on Students' Attitudes and Confidence.

Feedback can exert a powerful influence on learning and achievement although its effect varies. The aim of this study was to investigate the effects of three types of feedback on dental students' attitudes and confidence in a competency-based course in predoctoral orthodontics at New York University College of Dentistry. In 2013-14, all 253 third-year students in a course using test-enhanced instructional methods received written feedback on formative assessments. The type of feedback varied across three groups: pass/fail grades (PF) N=77, emoticons (EM) N=90, or written comments (WC) N=86. At the end of the course, students completed surveys that included four statements addressing their attitudes toward course instruction and confidence in their abilities. The survey response rate ranged from 75% to 100% among groups. The lowest response rate (75%) was in the PF group. In attitudes toward course instruction and confidence in their abilities, the WC group trended to more positive responses than the other groups, while the PF group trended to negative responses. On two of the four statements, the trend for the WC group was significant (95% CI). In both statements concerning attitudes toward instruction, the PF group trended to negative responses that were significant (95% CI). These results support the effectiveness of descriptive written comments over pass/fail grades or emoticons in improving dental students' confidence in their abilities and their attitudes toward instruction.

Test-Enhanced Learning in Competence-Based Predoctoral Orthodontics: A Four-Year Study.

Dental educators intend to promote integration of knowledge, skills, and values toward professional competence. Studies report that retrieval, in the form of testing, results in better learning with retention than traditional studying. The aim of this study was to evaluate test-enhanced experiences on demonstrations of competence in diagnosis and management of malocclusion and skeletal problems. The study participants were all third-year dental students (2011 N=88, 2012 N=74, 2013 N=91, 2014 N=85) at New York University College of Dentistry. The 2013 and 2014 groups received the test-enhanced method emphasizing formative assessments with written and dialogic delayed feedback, while the 2011 and 2012 groups received the traditional approach emphasizing lectures and classroom exercises. The students received six two-hour sessions, spaced one week apart. At the final session, a summative assessment consisting of the same four cases was administered. Students constructed a problem list, treatment objectives, and a treatment plan for each case, scored according to the same criteria. Grades were based on the number of cases without critical errors: A=0 critical errors on four cases, A-=0 critical errors on three cases, B+=0 critical errors on two cases, B=0 critical errors on one case, F=critical errors on four cases. Performance grades were categorized as high quality (B+, A-, A) and low quality (F, B). The results showed that the test-enhanced groups demonstrated statistically significant benefits at 95% confidence intervals compared to the traditional groups when comparing low- and high-quality grades. These performance trends support the continued use of the test-enhanced approach.

Photographic and videographic assessment of the smile: objective and subjective evaluations of posed and spontaneous smiles.

INTRODUCTION: Esthetic considerations play an increasingly important role in patient care, and clinicians need a methodology that includes imaging techniques to capture the dynamic nature of the smile. Photographs of the posed smile are routinely used to guide diagnosis and treatment, but there is no standardized and validated method for recording the dynamic smile. The purposes of this study were to (1) determine whether a posed smile is reproducible, (2) compare visual and verbal cues in eliciting a smile, and (3) compare the diagnostic value of videography and photography in evaluating a patient's smile. METHODS: The smiles of 22 subjects were simultaneously photographed and videotaped on 2 separate occasions. For objective comparisons, measurements of the smile were obtained from 8 × 10 color still photographs and selected digitized video images. A panel consisting of a layperson, an oral surgeon, an orthodontist, and a prosthodontist subjectively assessed the reproducibility of the smile, posed vs spontaneous smiles, and the diagnostic value of video vs still images. RESULTS: Objective measurements showed that the posed smile can be reliably reproduced, whether captured by videography or still photography. However, subjectively, the panel members detected differences between the posed smiles taken on different days 80% of the time. The clinician panel members expressed a strong preference for videography over photography and for the spontaneous over the posed smiles. CONCLUSIONS: This study emphasizes the need to continue to investigate and standardize the methods of eliciting and recording a smile of diagnostic quality.

Guiding dental student learning and assessing performance in critical thinking with analysis of emerging strategies.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises reflecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite specific examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

A process for developing assessments and instruction in competency-based dental education.

A process for the development of assessments and supporting instructional components in competency-based dental education is described. This process is illustrated using the example of an educational module in the management of malocclusion and skeletal problems at New York University College of Dentistry. The process begins with identifying the final outcome of the skill to be assessed and constructing an assessment that represents a relevant clinical situation. Such an assessment requires students to employ key enabling or foundational knowledge, specified subskills, and evaluative criteria. Once the components essential to mastering the assessment are identified, an instructional module that facilitates attainment of competence can be developed. This module is complemented by a companion piece that is content-specific and directs teachers and students to reach instructional targets. Assessments, supported by the components described in this process, increase the cognizance of the dental educator and provide mechanisms to evaluate student achievement and instructional effectiveness.

An "objectified" competency-based course in the management of malocclusion and skeletal problems.

A course developed at the New York University College of Dentistry provides third-year predoctoral students with instruction and formative experiences leading toward competence in the management of malocclusion and skeletal problems. Based on clearly defined evaluation criteria that can be objectively assessed, faculty and students share a common standardized language to evaluate malocclusion and skeletal problems. The course incorporates clinical simulation cases reflecting a variety of malocclusions and dentofacial conditions at different developmental stages. Formative experiences including interviewing techniques and cephalometric, facial, and study cast analyses build skills that are applied to diagnosis and treatment planning. Objectified competency evaluation criteria facilitate student instruction, faculty standardization, and assessment. Elements of this course may be used to create a more uniform competency-based approach to predoctoral orthodontic curricula across dental schools, while also providing a model for the development of courses in other areas of education, especially with regard to credentialing health providers.