Learning climate and feedback as predictors of dental students' self-determined motivation: The mediating role of basic psychological needs satisfaction.

AIM: The aim of this study was to test the mediating role of the satisfaction of dental students' basic psychological needs of autonomy, competence and relatedness on the association between learning climate, feedback and student motivation. The latter was based on the self-determination theory's concepts of differentiation of autonomous motivation, controlled motivation and amotivation. METHODS: A cross-sectional correlational study was conducted where 924 students completed self-reported questionnaires measuring motivation, perception of the learning climate, feedback and basic psychological needs satisfaction. Descriptive statistics, Cronbach's alpha scores and bivariate correlations were computed. Mediation of basic needs on each predictor-outcome association was tested based on a series of regression analyses. Finally, all variables were integrated into one structural equation model, controlling for the effects of age, gender and year of study. RESULTS: Cronbach's alpha scores were acceptable (.655 to .905). Correlation analyses showed positive and significant associations between both an autonomy-supportive learning climate and the quantity and quality of feedback received, and students' autonomous motivation, which decreased and became negative when correlated with controlled motivation and amotivation, respectively. Regression analyses revealed that these associations were indirect and mediated by how these predictors satisfied students' basic psychological needs. These results were corroborated by the structural equation analysis, in which data fit the model well and regression paths were in the expected direction. CONCLUSION: An autonomy-supportive learning climate and the quantity and quality of feedback were positive predictors of students' autonomous motivation and negative predictors of amotivation. However, this was an indirect association mediated by the satisfaction of students' basic psychological needs. Consequently, supporting students' needs of autonomy, competence and relatedness might lead to optimal types of motivation, which has an important influence on dental education.

Encouraging intrinsic motivation in the clinical setting: teachers' perspectives from the self-determination theory.

INTRODUCTION: Self-determination theory postulates that the three basic psychological needs of autonomy, competence and relatedness have to be satisfied for students to achieve intrinsic motivation and internalisation of autonomous self-regulation towards academic activities. Consequently, the influence of the clinical teaching environment becomes crucial when satisfying these needs, particularly when promoting or diminishing students' intrinsic motivation. The aim of this study was to describe and understand how clinical teachers encourage intrinsic motivation in undergraduate dental students based on the three basic psychological needs described by the self-determination theory. METHODS: A qualitative case study approach was adopted, and data were collected through semistructured interviews with nine experienced undergraduate clinical teachers of one dental school in Santiago, Chile. Interview transcripts were analysed by two independent reviewers using a general inductive approach. FINDINGS: Several themes emerged outlining teaching strategies and behaviours. These themes included the control of external motivators; gradual transference of responsibility; identification and encouragement of personal interests; timely and constructive feedback; delivery of a vicarious learning experience; teamwork, team discussion, and presence of a safe environment, amongst others. Overall, teachers stressed the relevance of empowering, supporting and building a horizontal relationship with students. CONCLUSIONS: Our findings regarding dental education expand on the research outcomes from other health professions about how teachers may support students to internalise behaviours. An autonomy-supportive environment may lead students to value and engage in academic activities and eventually foster the use of an autonomy-supportive style to motivate their patients.

Peer assisted learning: teaching dental skills and enhancing graduate attributes.

This study describes a pilot project in which peer assisted learning (PAL) is used to teach dental clinical skills. A cluster randomised controlled trial compared opinions of Bachelor of Dental Surgery (BDS) students from peer-led groups versus staff-led groups in a clinical (impression taking) and a pre-clinical (handpiece skills) task. BDS5 (peer tutors) in their final year delivered teaching to BDS1 (tutees) for each task. Quantitative data from tutees and the peer tutors was gathered from questionnaires, along with open written comments. PAL was well received by both tutees and peer tutors. BDS1 tutees rated BDS5 peer tutors highly for delivery of information, and level of feedback. The tutees considered peer tutors more approachable and less intimidating than staff. Peer tutors reported their own knowledge had increased as a result of teaching. In a summative OSCE (objective structured clinical examination) four months following the teaching, no statistical significant difference between the performance of peer-led and staff-led groups was found at stations related to the subject matter in question. It is argued that PAL, as well as being a useful method of delivering subject-specific teaching, is able to contribute to the development of graduate attributes.

Reasons for tooth extraction in Scotland.

OBJECTIVES: A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey described in this paper, used a similar methodology and aimed to determine the reasons for the extraction of permanent teeth by general dental practitioners and investigate changes in the influences on tooth extraction over a 10 year period. METHODS: During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland, recorded the reasons for all permanent tooth extractions. RESULTS: A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma, pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients requested extraction in preference to other treatments. The proportion of extractions attributed to periodontal disease increased from age 31-60 years, but declined thereafter. CONCLUSIONS: Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted by each practitioner had reduced, the overall relative contribution of different reasons for extraction was similar.

Lessons learned from the development of a distance-learning programme.

The development of an effective educational programme, i.e. one that not only delivers education but which also fosters change, requires both educational skills and subject expertise from the producers. This paper looks at the key lessons learned when developing a distance-learning programme. These seven key lessons, which focus heavily on needs assessment as well as team working and the need to consider a multiprofessional approach, offer practical advice to those in the medical and dental professions wishing to produce their own educational programmes.

A survey of Scottish primary care dental practitioners' oral cancer-related practices and training requirements.

OBJECTIVE: The study sought to investigate current examination habits and preventive practices of Scottish dental primary care professionals, with respect to oral cancer, and to determine any training needs of these practitioners in relation to the disease. BASIC RESEARCH DESIGN: A questionnaire was sent to a random sample of 331 general dental practitioners and community dental officers throughout Scotland, achieving an overall response rate of 68%. MAIN OUTCOME MEASURES: The study investigated examination and health promotion practices in relation to oral cancer. Confidence in, and barriers to, participating in these activities were studied, and information sought both on past training and future education needs regarding oral cancer. RESULTS: Although 58% of respondents reported examining regularly for signs of oral cancer in those aged >16 years, 63% indicated they felt less than confident in detecting oral cancer, with only 43% expressing confidence about discussing suspicious findings with patients. Practitioners were well aware of the importance of smoking and alcohol as risk factors, but had mixed views on the health-promoting role of the dentist regarding these issues. Furthermore, while only 3% reported training on these topics, over half expressed a desire to develop appropriate counselling skills. Overall, 87% and 79% of respondents wanted further training in oral cancer detection and prevention, respectively. CONCLUSION: The study indicated a need for continuing education programmes for dental primary care practitioners in oral cancer-related activities. Postgraduate education, utilising a variety of media formats, should aim to improve diagnostic skills and seek to increase practitioners' participation in both smoking and alcohol counselling.

Smoking cessation counselling--a role for the dental profession?

Whilst several studies have investigated the views of North American dentists on providing advice to patients on stopping smoking, the role of their UK counterparts in this area is uncertain. Thus this study aimed: 1. to examine dentists' awareness of the effect of smoking on general and oral health, 2. to determine their views on counselling patients to give up smoking, 3. to investigate the extent to which they currently engage in this activity, and 4. to survey barriers to providing such advice. Data were collected via a postal questionnaire mailed to 587 Scottish dental practitioners, of which 448 (76.3%) were completed and returned. The importance of smoking as a cause of ill health and death was acknowledged universally, and most were aware of the adverse consequences of smoking on the oral tissues. Over half the respondents (245 or 54.7%) thought dentists had a role in counselling patients to give up smoking and whilst 107 (23.8%) were uncertain, the remaining 95 (21.2%) felt this was outside their remit. Nonetheless, 384 (85.6%) reported that, at least occasionally, they advised patients to quit. Lack of time was seen as an important barrier to tobacco counselling, as was lack of training. Further studies are required to determine the most useful strategies or approaches, and to determine their effectiveness.

A survey of general anaesthesia, sedation and resuscitation in general dental practice.

The Poswillo Report, published in 1990, made recommendations regarding general anaesthesia (GA), sedation and resuscitation in dentistry. The aims of the present study were to examine the level of provision of GA and sedation by general dental practitioners (GDPs) a few years after the publication of the report, and to estimate the degree of compliance of GDPs with a number of its principal recommendations. In May 1994, a questionnaire was sent to 268 GDPs in two Scottish Health Boards, and a response rate of 80% was achieved. Thirteen per cent of respondents had treated GA cases during 1993-94 while 18% indicated that they had stopped providing a GA service since the immediate pre-Poswillo years. However, 91% had referred some patients elsewhere for treatment under GA. There was very little evidence of a replacement of GA by sedative techniques. The percentages of respondents using inhalation or intravenous sedation during the previous year were 9% and 27%, respectively. Almost all of the respondents reported that they had been trained in cardiopulmonary resuscitation and 60% stated that resuscitation exercises were practised at least once a year. While over 80% of the practitioners indicated that their dental surgeries stocked the emergency drugs recommended in the Poswillo Report, 12% expressed concern regarding the length and content of the drug list.

Dentists, pills and pregnancies.

Unplanned pregnancies may occur if antibiotics are prescribed to women using the combined oral contraceptive pill. To investigate awareness of the potential for this interaction among general dental practitioners, the authors designed a cross-sectional questionnaire based study and sent it out to a random sample of GDPs in Scotland.

The role of primary healthcare professionals in oral cancer prevention and detection.

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities.

Mercury vapour levels in dental practices and body mercury levels of dentists and controls.

AIM: A study of 180 dentists in the West of Scotland was conducted to determine their exposure to mercury during the course of their work and the effects on their health and cognitive function. DESIGN: Data were obtained from questionnaires distributed to dentists and by visiting their surgeries to take measurements of environmental mercury. METHODS: Dentists were asked to complete a questionnaire including items on handling of amalgam, symptoms experienced, diet and possible influences on psychomotor function such as levels of stress and alcohol intake. They also completed the 12-item General Health Questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair and nails for mercury analysis. The dentists were visited at their surgeries where environmental measurements were made in eight areas of the surgery and they undertook a computerised package of psychomotor tests. One hundred and eighty control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair and nail samples and undergoing the psychomotor test procedure. RESULTS: Dentists were found to have, on average, urinary mercury levels over 4 times that of control subjects although all but one dentist had urinary mercury below the Health and Safety Executive health guidance value of 20 mumol mmol(-1) creatinine. Urine was found to be a better biological marker for mercury exposure than hair or nails.Dentists were significantly more likely than control subjects to have suffered from disorders of the kidney but these symptoms were not significantly associated with their level of mercury exposure as measured in urine. One hundred and twenty two (67.8%) of the 180 surgeries visited had environmental mercury measurements in one or more areas above the Occupational Exposure Standard (OES) set by the Health and Safety Executive. In the majority of these surgeries the high levels of mercury were found at the skirting and around the base of the dental chair. In 45 surgeries (25%) the personal dosimetry measurement (ie in the breathing zone of dental staff) was above the OES. CONCLUSION: On the basis of these findings, it is recommended that greater emphasis should be made relating to safe handling of amalgam in the training and continuing professional development of dentists, that further studies are carried out on levels of mercury exposure of dental team members during the course of their working day, and that periodic health surveillance, including urinary mercury monitoring, of dental personnel should be conducted to identify possible effects of practising dentistry.

The validation of self-reported smoking status by analysing cotinine levels in stimulated and unstimulated saliva, serum and urine.

OBJECTIVES: Cotinine, a nicotine metabolite, can be used to measure exposure to tobacco smoke. The aim of this study was to compare cotinine levels in different biological fluids collected from both smokers and non-smokers and to relate the findings to self-reported smoking status. Data were also collected concerning the acceptability of the differing methods of sample collection. MATERIAL AND METHOD: Patients recruited to the study were asked to provide samples of urine, blood and saliva (both stimulated and unstimulated). Data collected from patients by questionnaire included information on smoking behaviour such as daily number of cigarettes and environmental exposure to smoke. After the sample collection, patients were asked to rate the acceptability of each sampling method. Samples were analysed using enzyme immunoassay (EIA) kits. RESULTS: In total, 80 patients participated, with 49 being smokers and 31 being non-smokers. There was clear differentiation between smokers and non-smokers (P < 0.001) for all the different samples in terms of cotinine. A significant relationship was seen between cotinine and daily number of cigarettes for both salivas and urine (all P < 0.001) but not for serum. Participants found serum and urine collection methodologies 'very acceptable' (67 and 66%, respectively) whereas 9% found collection of stimulated saliva 'not at all acceptable'. CONCLUSION: Cotinine, whatever the collection method and analysed by EIA kits, shows good differentiation between smokers and non-smokers. Salivary samples have the advantage of being non-invasive, although collection methodology is important, as cotinine levels may vary.

Health and neuropsychological functioning of dentists exposed to mercury.

OBJECTIVES: A cross sectional survey of dentists in the west of Scotland and unmatched controls was conducted to find the effect of chronic exposure to mercury on health and cognitive functioning. METHODS: 180 dentists were asked to complete a questionnaire that included items on handling of amalgam, symptoms experienced, possible influences on psychomotor function, and the 12 item general health questionnaire. Dentists were asked to complete a dental chart of their own mouths and to give samples of urine, hair, and nails for mercury analysis. Environmental measurements of mercury in dentists' surgeries were made and participants undertook a package of computerised psychomotor tests. 180 control subjects underwent a similar procedure, completing a questionnaire, having their amalgam surfaces counted, giving urine, hair, and nail samples and undergoing the psychomotor test package. RESULTS: Dentists had, on average, urinary mercury concentrations over four times that of control subjects, but all but one dentist had urinary mercury below the Health and Safety Executive health guidance value. Dentists were significantly more likely than control subjects to have had disorders of the kidney and memory disturbance. These symptoms were not significantly associated with urinary mercury concentration. Differences were found between the psychomotor performance of dentists and controls after adjusting for age and sex, but there was no significant association between changes in psychomotor response and mercury concentrations in urine, hair, or nails. CONCLUSIONS: Several differences in health and cognitive functioning between dentists and controls were found. These differences could not be directly attributed to their exposure to mercury. However, as similar health effects are known to be associated with mercury exposure, it would be appropriate to consider a system of health surveillance of dental staff with particular emphasis on symptoms associated with mercury toxicity where there is evidence of high levels of exposure to environmental mercury.