ORIGINAL PAPERS. Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education Opinion of Students

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1 210 ORIGINAL PAPERS Dent. Med. Probl. 2013, 50, 2, ISSN X Copyright by Wroclaw Medical University and Polish Dental Society Maria Kruszyńska-Rosada 1, Maria Borysewicz-Lewicka 1, Tamara Pawlaczyk-Kamieńska 1, Aleksander Przystanowicz 2 Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education Opinion of Students Nabycie umiejętności praktycznych w stomatologii dziecięcej w kształceniu przeddyplomowym w opinii studentów 1 Department of Paediatric Dentistry, University of Medical Sciences, Poland 2 Department of Medical Education, University of Medical Sciences, Poland 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, ). 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

2 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, ). 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

3 212 & 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 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.

4 Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education 213 Table 1. Acquiring practical skills in paediatric dentistry (the questionnaire) Tabela 1. Nabycie umiejętności praktycznych ze stomatologii dziecięcej (ankieta) Name Date: No. Practical skills (Umiejętności praktyczne) 1. Varnishing (Lakierowanie) 2. Pit and fissure sealing (Uszczelnianie bruzd) Questions The level of mastering the practical skill (Poziom opanowania umiejętności praktycznych) The expected level of usefulness of particular skills in professional practice (Spodziewany poziom wykorzystania poszczególnych umiejętności praktycznych w praktyce zawodowej) 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. Primary teeth restoration (Odbudowa zębów mlecznych) 4. Young immature permanent teeth restoration (Odbudowa zębów stałych niedojrzałych) 5. Impregnation directly application silver nitrate to carious lesion (Impregnacja bezpośrednia aplikacja azotanu srebra na zmianę próchnicową) 6. Stainless steel crown restoration (Odbudowa za pomocą koron stalowych) 7. Direct pulp capping permanent teeth (Bezpośrednie pokrycie miazgi zęby stałe) 8. Indirect pulp capping primary teeth (Pośrednie pokrycie miazgi zęby mleczne) 9. Indirect pulp capping permanent teeth (Pośrednie pokrycie miazgi zęby stałe) 10. Pulpotomy primary teeth (Pulpotomia zęby mleczne) 11. Pulpotomy permanent teeth (Pulpotomia zęby stałe)

5 Pulpectomy permanent teeth (Pulpectomia zęby stałe) 13. Root canal obturation primary teeth (Wypełnienie kanału korzeniowego zęby mleczne) 14. Root canal obturation permanent teeth (Wypełnienie kanału korzeniowego zęby stałe) 15. Traumatic injury management primary teeth (Leczenie urazów - zęby mleczne) 16. Traumatic injury management permanent teeth (Leczenie urazów zęby stałe) 17. Primary tooth extraction (Ekstrakcja zębów mlecznych) 18. Permanent tooth extraction (Ekstrakcja zębów stałych) 19. Topical anaesthesia (Znieczulenie powierzchniowe) 20. Infiltration anaesthesia (Znieczulenie nasiękowe) 21. Tooth vitality testing (Badanie żywotności zęba) 22. Using a rubber dam (Zastosowanie koferdamu)

6 Acquiring Practical Skills in Paediatric Dentistry During Pregraduate Education 215 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 undergraduate 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 4 th year and continued on the 5 th year. The total number of hours devoted to clinical training in paediatric dentistry varied between (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), [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, [4] Fugill M.: Teaching and learning in dental student clinical practice. Eur. J. Dent. Educ. 2005, 9, [5] Kells H.R.: Self-study processes. A guide to self-evaluation in higher education. Wyd. UMCS, Lublin [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, [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, [8] Seddon R.P.: Undergraduate experience of clinical procedures in paediatric dentistry in a UK dental school during Eur. J. Dent. Educ. 2004, 8, [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, [in Polish]. [10] Results obtained by a questionnarie on undergraduate training in paediatric dentistry in Europe, Institute of Dentistry, University of Helsinki.

7 216 [11] Alaluusua S., Frankenmolen F., Holm A.K., Marks L., Papagiannoulis L., Danhllof G.: Undergraduate teaching in paediatric dentistry a European perspective. Abstracts 5 th Congress of EAPD Bergen June 7 11, 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, Address for correspondence: Tamara Pawlaczyk-Kamieńska Department of Pediatric Dentistry Poznan University of Medical Sciences Bukowska Poznań Poland klstomdz@ump.edu.pl Received: Revised: Accepted: Praca wpłynęła do Redakcji: r. Po recenzji: r. Zaakceptowano do druku: r.