ORIGINAL PAPERS - Dental and Medical Problems

ORIGINAL PAPERS - Dental and Medical Problems

210
M. Kruszyńska-Rosada et al.
ORIGINAL PAPERS
Dent. Med. Probl. 2013, 50, 2, 210–216
ISSN 1644-387X
© Copyright by Wroclaw Medical University
and Polish Dental Society
Maria Kruszyńska-Rosada1, Maria Borysewicz-Lewicka1,
Tamara Pawlaczyk-Kamieńska1, Aleksander Przystanowicz2
Acquiring Practical Skills in Paediatric Dentistry
During Pregraduate Education – Opinion of Students
Nabycie umiejętności praktycznych w stomatologii dziecięcej
w kształceniu przeddyplomowym w opinii studentów
Department of Paediatric Dentistry, University of Medical Sciences, Poland
Department of Medical Education, University of Medical Sciences, Poland
1
2
A – concept; B – data collection; C – statistics; D – data interpretation; E – writing/editing the text;
F – compiling the bibliography
Abstract
Background. Paediatric dentistry is the science of the stomatognathic system of the developmental age. Teaching
paediatric dentistry mainly focuses on prevention, diagnosis and treatment of dental caries of primary and permanent teeth and also on prevention of periodontal diseases. Students are taught theoretically and practically how to
provide relevant dental care for the patients in developmental age.
Objectives. The aim of the research was to study the opinion of students, completing the undergraduate education,
about: the level of practical skills mastered in paediatric dentistry, the expected level of usefulness of particular
practical skills in professional practice, and the extent to which teaching paediatric dentistry influenced the correct performance of the examined skills. Students’ opinions, concerning the level of acquiring practical skills, were
confronted with the frequency performing particular skills during classes. The aim was to examine whether there
is a relation between student’s opinion on the level of his skills and the true number of practical performance.
Material and Methods. 94 dental students of the 5th year of study were examined, just after the final exam. They
were given the questionnaire where the students expressed their opinion on the level of acquiring the 22 practical
skills. The students expressed their opinion using a 7-degree scale, where point 1 showed the lowest level of mastering the skill and point 7 marked the highest. The method of document analysis was used in the study – “paediatric
dentistry student’s training cards”, where the numbers of particular practical interventions made during the 4th
and 5th year of study were collected.
Results. The study showed the predominance of positive opinions. There was no correlation between the extent
in which students acquired certain practical skills and the number of actual performances during classes. Existing
correlations were not statistically significant.
Conclusions. This study demonstrated that the level of mastering, usefulness and teaching of most of the particular
examined clinical skills was high. There was no correlation between the extent in which students acquired certain
practical skills and the number of actual performances during classes (Dent. Med. Probl. 2013, 50, 2, 210–216).
Key words: dental education, paediatric dentistry, clinical skill.
Streszczenie
Wprowadzenie. Stomatologia dziecięca jest nauką o układzie stomatognatycznym w okresie wieku rozwojowego.
W nauczaniu stomatologii dziecięcej szczególną uwagę zwraca się na zapobieganie, rozpoznanie i leczenie próchnicy
zębów mlecznych i stałych, a także na zapobieganie chorobom przyzębia. Przekazuje się wiadomości i kształtuje
umiejętności pozwalające na właściwą opiekę stomatologiczną nad pacjentem w wieku rozwojowym.
Cel pracy. Ocena opinii studentów kończących kształcenie przeddyplomowe na temat poziomu opanowania umiejętności praktycznych z zakresu stomatologii dziecięcej, spodziewanego poziomu wykorzystywania praktycznych
umiejętności w praktyce zawodowej oraz stopnia w jakim nauczanie stomatologii dziecięcej wpływa na poprawne
przeprowadzanie wybranych umiejętności praktycznych. Opinie studentów dotyczące poziomu nabytych umiejętności porównywano z liczbą wykonanych poszczególnych zabiegów podczas zajęć klinicznych. Celem była również
Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education
211
ocena zależności między deklarowaną opinią studentów na temat poziomu ich umiejętności a liczbą wykonanych
zabiegów.
Materiał i metody. Badanie, w którym wzięło udział 94 studentów stomatologii, przeprowadzono bezpośrednio po
egzaminie dyplomowym ze stomatologii dziecięcej. W ankiecie studenci oceniali poziom opanowania przez siebie
22 umiejętności praktycznych. Studenci wyrażali opinię za pomocą 7-stopniowej skali, w której punkt 1 oznaczał
najniższy poziom opanowania umiejętności, a 7 najwyższy. W badaniach analizowano również “studencką kartę
ćwiczeń”, w której są odnotowywane poszczególne zabiegi wykonane przez studentów podczas IV i V roku studiów.
Wyniki. Badania wykazały przewagę opinii pozytywnych. Nie stwierdzono zależności między poziomem opanowania przez studenta umiejętności praktycznych a liczbą wykonanych zabiegów podczas zajęć klinicznych.
Wnioski. Badania wykazały, że w ocenie studentów poziom opanowanych umiejętności, możliwość ich wykorzystania w praktyce oraz poziom nauczania umiejętności praktycznych był wysoki. Nie stwierdzono zależności między stopniem opanowania poszczególnych umiejętności praktycznych a liczbą wykonanych zabiegów podczas zajęć
klinicznych (Dent. Med. Probl. 2013, 50, 2, 210–216).
Słowa kluczowe: edukacja stomatologiczna, stomatologia dziecięca, umiejętności praktyczne.
Paediatric dentistry is the science of the stomatognathic system of the developmental age. It
is concerned with assessment of the stomatognathic system, taking the account of the anatomic and physiologic standards, working out prevention standards for most frequent oral diseases and
dental treatment methods with respect to the basic
dentistry specializations.
The teaching of paediatric dentistry mainly focuses on prevention, diagnosis and treatment of dental caries of primary and permanent teeth and also
on prevention of periodontal diseases. Students are
taught theoretically and practically how to provide
relevant dental care for the patients in the developmental age. The relationship between paediatric and
paediatric dentistry is demonstrated, especially with
respect to children’s diseases symptomatology [1].
Upon completion of the teaching cycle, the
student is expected to:
1. Know the principles of prevention provided
to optimum conditions for correct development of
the stomatognathic system.
2. Be able to plan and carry out caries and
periodontal preventive treatment taking account
of individual risk associated with the diseases.
3. Know specific features of the most frequent
stomatognathic system diseases in the developmental age.
4. Based on the medical history and clinical
examination, be able to recognize symptoms of
disorders and diseases of the stomatognathic system in the developmental age.
5. Be able to plan and correctly carry out basic
dental treatment of young patients.
6. Be able to recognize symptoms of some
general diseases occurring in the stomatognathic
system [1, 2].
The success in the clinical activity of paedodontist depends on the knowledge of paediatric dentistry
and the disciplines which are integrated with it, and
also on the clinical skills. The notion ”skill” means
the readiness to carry out some mental or practical
activity in a particular situation. Acquiring the skills
means that there is a possibility of performing particular tasks without any help or advice.
The skills (psychomotor skills), which lead
to achieve competent clinical goals in a professional practice of paedodontist are created during a long period of training because there is a necessity to establish a proper relationship between
a person’s perception and the motor reaction [3].
What is more, the effects of performing professional tasks are influenced by individual features
of persons. They cause that some people, especially at the beginning of the training, perform a low
(level) or even the lack of qualitative stability in
the level of result of the task. Because of that criteria, a number of repetitions is required to achieve
a satisfactory quality of the performed task, at the
beginning under supervision of a teacher and later
without his help. The length of the period of training and the necessary number of repetitions is different for different students. It is also important
that not only “teacher – student” interaction but also “patients – students” and “patient – teacher” interactions influence the result of the exercise [4].
The qualitative level of students’ practical
skills can be assessed objectively, using i.e. special
performance tests, where the person who assesses follows particular, convectional criteria. The
teacher’s objective opinion can be joined with the
student’s self-opinion (based on questionnaire),
which refers to the acquired skills.
Self-assessment is connected with the interest of
the results of the educational process, because “it can
be the beginning of institutional and human regeneration” [5]. Self-assessment can become a part of educational quality control and its result can be helpful in the self-regulation of university unit i.e. a clinic
or department. The use of the self-assessment method to define the level of a performed task is characteristic for studies on “student’s opinion on teaching
212
& learning” [4]. Such studies can lead to important
changes in education, in the content of education and
in the teaching – learning period [5, 6].
The aim of the research was to study the opinion of the students completing the undergraduate
part of education, in the subject of:
1. The level of mastering practical skills in
paediatric dentistry. Acquiring particular basic
skills is required by the syllabus. As a result a student should be able to solve certain clinical problems without any help [7].
2. The expected level of usefulness of particular practical skills in professional practice.
3. The extend to which teaching the paediatric dentistry influenced the correct performance
the examined skills.
The opinions made by students express a subjective evaluation of mastering practical skills and
the teaching quality and depend on their self-assessment ability.
Students’ opinions, concerning the level of acquiring practical skills, were confronted with the frequency of performing particular procedures during classes. The aim was to evaluate whether there is a relation
between the student’s opinion on the level of his skills
and the true number of practical performance.
Material and Methods
Research among students was made in the
Department of Paediatric Dentistry University of
Medical Sciences in Poznań. 94 dental students
of the 5th year were examined, just after the final exam. Data concerning the mastery of practical skills in paediatric dentistry by students was
obtained during two academic years. They were
given the questionnaire where the students expressed their opinion on the level of acquiring the
practical skills: varnishing, pit and fissure sealing, primary teeth restoration, young immature
permanent teeth restoration, impregnation – direct application of silver nitrate to carious lesion,
stainless steel crown restoration, direct pulp capping (permanent teeth), indirect pulp capping
(primary teeth), indirect pulp capping (permanent teeth), pulpotomy (primary teeth), pulpotomy (permanent teeth), pulpectomy (permanent
teeth), root canal obturation (primary teeth), root
canal obturation (permanent teeth), traumatic injury management (primary teeth), traumatic injury management (permanent teeth), primary tooth
extraction, permanent tooth extraction, topical
anaesthesia, infiltration anaesthesia, tooth vitality
testing, using a rubber dam (Table 1).
Students expressed their opinion using a 7-degree scale, where point “1” showed extreme negative
M. Kruszyńska-Rosada et al.
opinion – “a very low level of mastering the skill”
or “expected very low level of usefulness of particular skills in professional practice” or “very low level of teaching to learn correctly a proper skill”; and
point “7” marked an extremely positive opinion –
high level of mastering the skills”. The method of
analysis was used in the study – “paediatric dentistry student’s training cards”, where the numbers of
particular practical interventions made during 4th
and 5th year of study were collected.
Results
The study showed the predominance a high
level of students’ opinions in reference to all three
fields. They are in median interval 5 ≤ Me ≤ 6.
There appeared a tendency to formulate similar
opinions in the three fields. The exception was
an opinion that it is necessary to master the skill
of a ”stainless steel crown restoration” (Me = 4),
where students claimed that the level of mastering and teaching the skill is very low. They also
claimed that the level of mastering the skill of “using a rubber-dam” was very low and that this skill
would be very useful in professional practice and
indicated its average level of teaching.
With reference to the level of mastering particular practical skills, one skill – “impregnation”
– was placed on a very high level of performance
(Me = 7 in 7 degree scale). 15 other skills in the
opinions of the students are placed on a high level of performance (Me = 6) or a quite high (Me =
5). The low level of mastering the skill refers only
to “stainless steel crown restoration” (Me = 1) and
“using a rubber-dam” (Me = 2). Students showed
an average level of mastering the skills (Me = 3)
with references to “pulpotomy (primary and permanent teeth)” and “traumatic injury treatment of
primary teeth”; and “root canal obturation of primary teeth” (Me = 4) and “traumatic injury treatment of permanent teeth” (Me = 4).
There was no correlation between the extent
in which students acquired certain practical skills
and the number of actual performances during
classes. Existing correlations were not statistically significant.
Discussion
The study showed the predominance of a high
level of students’ opinion about the level of particular practical skills mastery. This opinion was
confronted with the number of procedures performed during classes. There was no correlation
between them.
Practical skills
(Umiejętności praktyczne)
Varnishing
(Lakierowanie)
Pit and fissure sealing
(Uszczelnianie bruzd)
Primary teeth restoration
(Odbudowa zębów mlecznych)
Young immature permanent teeth restoration
(Odbudowa zębów stałych niedojrzałych)
Impregnation – directly application silver nitrate to carious lesion
(Impregnacja – bezpośrednia aplikacja azotanu srebra na zmianę
próchnicową)
Stainless steel crown restoration
(Odbudowa za pomocą koron stalowych)
Direct pulp capping – permanent teeth
(Bezpośrednie pokrycie miazgi – zęby stałe)
Indirect pulp capping – primary teeth
(Pośrednie pokrycie miazgi – zęby mleczne)
Indirect pulp capping – permanent teeth
(Pośrednie pokrycie miazgi – zęby stałe)
Pulpotomy – primary teeth
(Pulpotomia – zęby mleczne)
Pulpotomy – permanent teeth
(Pulpotomia – zęby stałe)
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
1
1
1
1
3
3
3
3
3
3
3
3
3
1
6 7
5
6
4 5
2 3 4
6
4 5
6
6
6
4 5
5
6
7
7
7
7
7
7
1
5 6 7
5
1
7
5 6
1
1
1
1
1
1
1
7
5 6
1
7
5 6
5
4
4
4
4
4
4
4
2 3
2
2
2
2
1
1
2
2
2
2
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
4
4
4
4
4
3
3
3
3
3
6
6
4 5
6
4 5 6
4 5
7
7
7
7
7
7
7
7
7
7
6 7
5 6
5
5
5 6
5 6
5 6
5 6
4 5 6
4
3 4
3
3
3
3
3
The expected level of usefulness of
particular skills in professional practice
(Spodziewany poziom wykorzystania
poszczególnych umiejętności praktycznych w praktyce zawodowej)
The level of mastering
the practical skill
(Poziom opanowania
umiejętności praktycznych)
1
2
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3
3
3
3
3
3
2 3
5
5
5
5
4 5
7
6
6
6
6
6
7
7
7
7
7
7
6 7
5 6
5 6 7
4 5
4
7
5 6 7
5 6
4 5 6
4
4
4
4
4
4
2 3 4
2
2
2
2
2
2
2
2
2
The extend to which teaching the
paediatric dentistry influenced in the
correct performance the examined skills
(Wpływu nauczania stomatologii dziecięcej na
prawidłowe wykonywanie badanych umiejętności)
3
Date: ………………………………
1
Questions
Name ……………………………………………………
Tabela 1. Nabycie umiejętności praktycznych ze stomatologii dziecięcej (ankieta)
Table 1. Acquiring practical skills in paediatric dentistry (the questionnaire)
Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education
213
Pulpectomy – permanent teeth
(Pulpectomia – zęby stałe)
Root canal obturation – primary teeth
(Wypełnienie kanału korzeniowego – zęby mleczne)
Root canal obturation – permanent teeth
(Wypełnienie kanału korzeniowego – zęby stałe)
Traumatic injury management – primary teeth
(Leczenie urazów - zęby mleczne)
Traumatic injury management – permanent teeth
(Leczenie urazów – zęby stałe)
Primary tooth extraction
(Ekstrakcja zębów mlecznych)
Permanent tooth extraction
(Ekstrakcja zębów stałych)
Topical anaesthesia
(Znieczulenie powierzchniowe)
Infiltration anaesthesia
(Znieczulenie nasiękowe)
Tooth vitality testing
(Badanie żywotności zęba)
Using a rubber dam
(Zastosowanie koferdamu)
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
3
3
1 2
3
3
3
3
7
5 6
4
4
4
4
7
5 6
7
7
5 6
6
7
5 6
5
7
6
4 5
4
7
7
6
6
5
3 4
3
2
2
2
2
2
5
7
4 5 6
4
7
7
6
5
4 5 6
3 4
3
2 3
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
4
3
3
3
3
3
3
3
4
4
4
4
4
4
4
6
7
7
7
7
7
7
7
7
5 6
7
5 6 7
5 6
5 6 7
5 6
5 6
5 6
5
5 6
6
5 6
4 5
4
3 4
3
3
3
3
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
6
6
6
6
6
7
7
7
7
7
5
6
5 6
5 6
5 6
6
7
7
7
7
7
5 6 7
5
5
4 5
4
3 4
4
4 5
5
4 5
3 4
3
2 3
2
2
2
1 2
1
1
1
1
1
1
1
1
1
1
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M. Kruszyńska-Rosada et al.
Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education
Seddon reported that individual students’
clinical experience is very variable. Procedures
that were performed on average more then 10
times were experienced by every student. All the
students would have had some experience of this
particular procedure, although that experience
was uneven throughout the intake, some students having performed the procedure once or
twice only, while others might have performed the
same procedure as much as 20 times. Procedures,
that were performed on average two to four times
within a year group would be experienced by only 80–90% of the group and less frequently performed procedures would only have been experienced by a minority of graduates. To first category
come administering a local analgesic and fissure
sealing, to second: amalgam restoration in primary teeth, preventive resin restoration and assessing
an emergency patient, and to third category: primary molar pulp treatment or preparing and fitting a performed crown [8].
The aim of study of dental students completing the undergraduate education, made in University of Medical Science in Poznań in 1999 was
the estimation of the level of readiness to dental
practice. The study showed that about 50% of students estimate their readiness in average level, 47%
in very high, and only 3% in low level [9]. There
were some differences between particular subjects.
A higher than average self-competence in conservative dentistry declared 69% of the examined, in
paediatric dentistry 48%, in dental radiology 44%,
in dental surgery 34% and in periodontology 21%
[9]. A low level of competence in conservative dentistry declared only 3% of students, in paediatric
dentistry 7% and in dental surgery 9% [9].
In 1999 the European Academy of Paediatric
Dentistry was carrying out the survey on under-
215
graduate education and training in paediatric dentistry in European dental schools. The aim of the
study was twofold, first to promote an exchange
of information regarding the curriculum in paediatric dentistry between dental schools in the EU
countries; secondly, to provide baseline data for the
development of curriculum guidelines for undergraduate education in paediatric dentistry. A questionnaire was sent out to 140 dental schools in the
15 EU countries. Questionnaires were returned
from 61 EU dental schools, resulting in a 44% response rate. In 67% of the schools, paediatric dentistry was taught in separate departments devoted only to paediatric dentistry. In most schools
the students began to treat children on the 4th year
and continued on the 5th year. The total number
of hours devoted to clinical training in paediatric
dentistry varied between 20–462 (median 96). In
University of Medical Sciences in Poznań the total
number of hours in clinical training in the course
was 112 (to the 2008 year) and now is 256. The
number of children treated by the students during
the course varied from 0 to 200 (median 20). The
estimated number of fillings made by the student
ranged from 0 to 500 (median 20), pulpotomies
from 0 to 40 (median 3) and extractions from 0 to
90 (median 5), respectively. In University of Medical Sciences in Poznań students made 15 fillings,
1 pulpotomie and 1 extraction [1, 10]. The results
of the study clearly show that both theoretical and
clinical training in paediatric dentistry vary extremely between dental schools in Europe [10–13].
This study demonstrated that the level of mastering, usefulness and teaching of most of the particular examined clinical skills was high. There
was no correlation between the extent in which
students acquired certain practical skills and the
number of actual performances during classes.
References
[1] Competence Based Curriculum (CBC) Paediatric Dentistry. Description of the course. Department of Paediatric
Dentistry, University of Medical Sciences, Poznań, Poland.
[2] A guineline framework for undergraduate education in Paediatric Dentistry. Eur Arch Paediatr Dent 2009, 10 (2),
114–119.
[3] Andrés de A.G., Sánchez E., Hidalgo J.J., Diaz M.J.: Appraisal of psychomotor skills of dental students at University Complutencse of Madrid. Eur. J. Dent. Educ. 2004, 8, 24–30.
[4] Fugill M.: Teaching and learning in dental student clinical practice. Eur. J. Dent. Educ. 2005, 9, 131–136.
[5] Kells H.R.: Self-study processes. A guide to self-evaluation in higher education. Wyd. UMCS, Lublin 2000. [in
Polish]
[6] Prosper M.: A student learning perspective on teaching and learning, with implications for problem-based learning. Eur. J. Dent. Educ. 2004, 8, 51–58.
[7] Hietala E.-L., Karjalainen A., Raustia A.: Renewal of the clinical-phase dental curriculum to promote better
learning at the University of Oulu. Eur. J. Dent. Educ. 2004, 8, 120–126.
[8] Seddon R.P.: Undergraduate experience of clinical procedures in paediatric dentistry in a UK dental school during 1997–2001. Eur. J. Dent. Educ. 2004, 8, 172–176.
[9] Przystanowicz A., Rębała L.: Preparation for the job of a dentist, as evaluated by the graduates from the division of dentistry of the University of Medical Sciences in Poznań. Pozn. Stom. 1999, 26, 193–199 [in Polish].
[10] Results obtained by a questionnarie on undergraduate training in paediatric dentistry in Europe, 1998. Institute of
Dentistry, University of Helsinki.
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M. Kruszyńska-Rosada et al.
[11] Alaluusua S., Frankenmolen F., Holm A.K., Marks L., Papagiannoulis L., Danhllof G.: Undergraduate
teaching in paediatric dentistry – a European perspective. Abstracts 5th Congress of EAPD – Bergen June 7–11,
2000. Eur. J. Pead. Dent. 2000, 3, 1, 24.
[12] Burchardt D., Bręborowicz A., Borysewicz-Lewicka M.: Stomatological issues in curriculum of pediatrics
– surveying medical students. Pol. Prz. Nauk Zdr. 2010, 1 (22), 7–12 [in Polish].
[13] Schulte A.G. et al.: European Core Curriculum in Cariology for undergraduate dental students. Eur. J. Dent.
Educ. 2011, 15, Suppl. 1, 9–17.
Address for correspondence:
Tamara Pawlaczyk-Kamieńska
Department of Pediatric Dentistry
Poznan University of Medical Sciences
Bukowska 70
60-812 Poznań
Poland
E-mail: [email protected]
Received: 19.06.2012
Revised: 4.09.2012
Accepted: 28.05.2013
Praca wpłynęła do Redakcji: 19.06.2012 r.
Po recenzji: 4.09.2012 r.
Zaakceptowano do druku: 28.05.2013 r.