Development of a competency-based clinical assessment instrument for exit level Oral Hygiene students at the University of Western Cape.

Seminal to the process of a health sciences curriculum evaluation is the periodic review of clinical assessment instruments that measure competency. An assessment of quality is facilitated by using a well-structured, authentic and reliable instrument. This process rests on designing and measuring the instrument against a sound framework and validating it for scientific merit. This paper documents the pedagogy and the process taken in developing an improved formative competency-based assessment instrument for the final year students of the Bachelor of Oral Health program (BOH) at the University of the Western Cape (UWC). METHODS: A qualitative research study design employing the Nominal Group Technique (NGT) was used as a method for gaining small group consensus on the clinical assessment instrument for exit level Oral Hygiene (BOH3) students within the parameters of assessment principles. The key contributors to the instrument development process were the academic staff of the Department of Oral Hygiene, involved in clinical teaching and assessment of student competency. RESULTS: The domains of ethics and professionalism, patient assessment, diagnosis, treatment planning and implementation was identified as the core elements in the assessment. The principles of assessment, which include, alignment with outcomes, feedback, transparency and validity, were used to guide the instrument development. The assessment criteria were cross examined for alignment to the learning outcomes of the module and the program whilst formative feedback was foregrounded as a central feature to support student learning and progress monitoring. Transparency was obtained by providing students access to the instrument before and after the assessment including the written feedback on their performance. The instrument embodied a range of criteria to be assessed rather than on the awarding of a cumulative score. This allowed for the identification of the criteria or domain within which a student is struggling or excelling. Consensus on the instrument design was achieved using the NGT phases throughout the instrument development process including the weighting of the domains and grading. This level of engagement together with the application of scientifically sound assessment principles contributed to the validation of the instrument. CONCLUSION: The development of a competency-based assessment instrument was the result of a structured, collaborative and scientifically engaged process framed around specific assessment principles. The process culminated in the development of a formative competency-based clinical assessment instrument that was fit for purpose in the Bachelor of Oral Health program.The Nominal Group Technique served to be a valuable approach for small group consensus in developing the instrument. It served to promote individual perspectives and to generate debate and group discussion between academics that were proficient in clinical teaching and, finally to facilitate group consensus on the instrument structure and system for administration.

Learning experiences of oral hygiene students in the clinical environment.

OBJECTIVES: To determine how students used daily and term-based clinical assessment tools, students' experience of clinical teaching and clinical assessment. METHODS: This was a descriptive, cross-sectional study. The study population included final-year Degree in Oral Health (BOH) students (n = 34). Data were collected by means of a self-administered questionnaire using open- and closed-ended questions. RESULTS: The response rate was 85% (n = 29). Respondents reported that term-based assessment tools were more useful than daily assessment tools in preparing for clinical sessions, in guiding their patient management and as a reflection of their competence. Factors influencing student experiences include authentic learning opportunities such as performing a variety of procedures, patient appreciation and positive reinforcement from supervisors; consistent and appropriate feedback on their performance, feedback in the presence of a patient; supervisor qualities of being patient, respectful, non-threatening and being positive role models; and organizational aspects such as punctuality and availability of supervisors. Inconsistencies were found in student experiences in terms of the quality of feedback received. Assessment experiences include inconsistency between supervisors and not being informed of assessment scores. Regular verbal feedback or being appraised of their assessment scores was reported more frequently for term-based assessment (77%) than for daily assessment (27%). CONCLUSION: The results of this study suggest that a blueprint defining assessment as a means to drive student learning is inadequate. A more comprehensive approach encompassing all the parameters that impact the learning process may be more useful.

Smoking practices of dental and oral health students at the University of the Western Cape.

INTRODUCTION: The World Health Organisation code of practice on tobacco control urges health care professionals to lead by example by reducing smoking among them, act as role models for their patients and introduce tobacco control in the public health agenda of their country. AIMS: Describe dental and oral health student smoking practices, risk perception and the association between smoking status and providing smoking related advice to patients. METHOD: A descriptive, cross sectional study of dental and oral health students using a self-administered questionnaire. RESULTS: The response rate was 62% (N = 375). Smoking status indicated that 15% were past smokers and 23% were current smokers (33.8% Male vs 17.6% Female: p < 0.001). The mean age of smoking initiation was 16 years (SD = 2.932). Students smoked because of "addiction", "stress", "habit'; "enjoyment", and "to socialise". Only 22% of current smokers felt able to stop smoking. There were no significant differences between smokers and non-smokers in their perceived knowledge, confidence and skill to provide smoking related advice to patients. CONCLUSION: The increasing prevalence of smoking among females observed globally is also evident in this population. Student smoking status does not influence practices in providing smoking related advice to their patients.

A national survey of oral hygienists in South Africa.

AIM: To survey the status and views of practicing hygienists in South Africa. METHOD: A postal questionnaire was mailed to all registered hygienists in South Africa in 1999 (n = 853). Demographic variables; views on further study; conditions of employment; and issues hygienists' felt strongly about were explored. Two mailings resulted in a response rate of 51% (n = 439). RESULTS: Respondents' age ranged from 20-52 years (mean 33 years); they were all female (n = 435) except two; 60.9% were in full time and 39.1% part time employment; 73% were employed in private practice, 13% in non-traditional settings and a small number in commerce; 92.7% wished to expand on their current qualification with part time and distance learning as the choice of study; 45.7% of the full time and 18% of the part time hygienists reported to have a contract of employment. CONCLUSION: The results of this study show that South African hygienists envision an expanded role within the oral health team and wish to pursue their career beyond the two-year diploma in Oral Health/Oral Hygiene. The majority were not employed according to the BCEA in terms of benefits and the provision of a contract if employment.

Oral hygienists' education in transition.

In 1996 the Dental Faculty of the University of the Western Cape introduced a modular curriculum for Oral Hygiene students. The aim was to change from a subject-based to an outcomes-based programme, which would emphasise the competencies of hygienists. The development of this programme has meant ongoing evaluation and therefore amendments and revisions have been made throughout the course. This curriculum could be re-registered with the South African Qualifications Authority (SAQA) which describes competencies for the eight main level descriptors. This new approach to teaching allows for a laddered approach to training with intermediate exit qualifications. Oral hygienists' would thus for the first time have a career path in the oral health profession as it allows them to proceed from a Diploma to a Degree and to have the prospect of doing a Masters Degree.

The fate of the skin graft in laryngoplasty.

In laryngoplasty procedures, laryngotracheal soft tissue defects are often repaired using skin grafts. While stenting is necessary to approximate and immobilize the graft, prolonged stenting causes increased bacterial counts, granulation tissue formation, tissue ischemia, and graft failure. Optimal time for stent removal has not been experimentally defined. Using the ferret animal model, 24 laryngoplasty procedures were performed. The subjects were stented by group for 0, 3, 7, 14, or 28 days. Analysis consisted of quantitative bacteriology, dye perfusion, and quantitative histologic assessment of graft viability. Tissue culture results revealed that by 3 days after the procedure all groups had 10(5) CFU of bacteria per gram of tissue. Graft viability in successful procedures was maximal in the 7-day group and statistically significant from the 3-day to the 28-day groups. In conclusion, while stenting is necessary for graft adherence, prolonged exposure to local tissue sepsis leads to progressive graft destruction.

Videoendoscopic diagnosis and correction of velopharyngeal stress incompetence in a bassoonist.

Musicians who play woodwind or brass instruments must generate extremely high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as difficulty in holding high notes or in playing sustained music compositions, or noise production from turbulent nasal cavity emissions. Throughout the literature, there are few reports of these entities. We will present the case of a 31-year-old concert bassoonist who complained of "noise from her head" only when she played the bassoon. This resulted in numerous failed auditions and threatened her professional career. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthesia with the subject playing the bassoon. The use of videoendoscopic techniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.

Physical model evaluation of topical prodrug delivery--simultaneous transport and bioconversion of vidarabine-5'-valerate V: Mechanistic analysis of influence of nonhomogeneous enzyme distributions in hairless mouse skin.

The mathematical problem of simultaneous transport and metabolism in the case of nonuniform enzyme distributions in the skin was solved, and the solutions were used for analyzing experimental data. Experimental data were obtained from permeation experiments with 3H-vidarabine and its 5'-valerate using cellophane tape-stripped hairless mouse skin. Results of the analyses revealed that the esterase activity was four to nine times higher in the epidermis than in the dermis, whereas the deaminase activity was about the same in the two strata. These results were in good agreement with independent experiments using tissue homogenates. The enzyme distributions and the previously reported diffusivities were employed in generating concentration profiles for the prodrug and the drug in the skin. These results may be used in predicting the possible therapeutic effect of the prodrug when it is topically applied.