ORIGINAL PAPERS
Maria Kruszyńska-Rosada
1,
Maria Borysewicz-Lewicka
1,
Tamara Pawlaczyk-Kamieńska
1, Aleksander Przystanowicz
2Acquiring 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 perma-nent 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 cor-rect 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 master-ing 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
umie-jętności 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 umiejęt-ności porównywano z liczbą wykonanych poszczególnych zabiegów podczas zajęć klinicznych. Celem była również
Dent. Med. Probl. 2013, 50, 2, 210–216
Paediatric dentistry is the science of the sto-matognathic system of the developmental age. It is concerned with assessment of the stomatog-nathic system, taking the account of the anatom-ic and physiologanatom-ic standards, working out preven-tion standards for most frequent oral diseases and dental treatment methods with respect to the basic dentistry specializations.
The teaching of paediatric dentistry mainly fo-cuses on prevention, diagnosis and treatment of den-tal 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 develop-mental 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 develop-mental age.
4. Based on the medical history and clinical examination, be able to recognize symptoms of disorders and diseases of the stomatognathic sys-tem 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 paedodon-tist depends on the knowledge of paediatric denpaedodon-tistry 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 par-ticular tasks without any help or advice.
The skills (psychomotor skills), which lead to achieve competent clinical goals in a profes-sional practice of paedodontist are created dur-ing a long period of traindur-ing because there is a ne-cessity to establish a proper relationship between a person’s perception and the motor reaction [3]. What is more, the effects of performing profes-sional tasks are influenced by individual features of persons. They cause that some people, especial-ly 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 crite-ria, 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 train-ing and the necessary number of repetitions is dif-ferent for difdif-ferent students. It is also important that not only “teacher – student” interaction but al-so “patients – students” and “patient – teacher” in-teractions 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 assess-es 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 regen-eration” [5]. Self-assessment can become a part of ed-ucational quality control and its result can be help-ful in the self-regulation of university unit i.e. a clinic or department. The use of the self-assessment meth-od to define the level of a performed task is charac-teristic for studies on “student’s opinion on teaching
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 stu-diów.
Wyniki. Badania wykazały przewagę opinii pozytywnych. Nie stwierdzono zależności między poziomem
opanowa-nia przez studenta umiejętności praktycznych a liczbą wykonanych zabiegów podczas zajęć klinicznych.
Wnioski. Badania wykazały, że w ocenie studentów poziom opanowanych umiejętności, możliwość ich
wykorzy-stania w praktyce oraz poziom nauczania umiejętności praktycznych był wysoki. Nie stwierdzono zależności mię-dzy stopniem opanowania poszczególnych umiejętności praktycznych a liczbą wykonanych zabiegów podczas zajęć klinicznych (Dent. Med. Probl. 2013, 50, 2, 210–216).
& 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 opin-ion 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 stu-dent should be able to solve certain clinical prob-lems without any help [7].
2. The expected level of usefulness of particu-lar practical skills in professional practice.
3. The extend to which teaching the paediat-ric dentistry influenced the correct performance the examined skills.
The opinions made by students express a sub-jective evaluation of mastering practical skills and the teaching quality and depend on their self-as-sessment ability.
Students’ opinions, concerning the level of acquir-ing practical skills, were confronted with the frequen-cy of performing particular procedures during class-es. 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 fi-nal exam. Data concerning the mastery of prac-tical skills in paediatric dentistry by students was obtained during two academic years. They were given the questionnaire where the students ex-pressed their opinion on the level of acquiring the practical skills: varnishing, pit and fissure seal-ing, primary teeth restoration, young immature permanent teeth restoration, impregnation – di-rect application of silver nitrate to carious lesion, stainless steel crown restoration, direct pulp cap-ping (permanent teeth), indirect pulp capcap-ping (primary teeth), indirect pulp capping (perma-nent teeth), pulpotomy (primary teeth), pulpot-omy (permanent teeth), pulpectpulpot-omy (permanent teeth), root canal obturation (primary teeth), root canal obturation (permanent teeth), traumatic in-jury management (primary teeth), traumatic inju-ry management (permanent teeth), primainju-ry 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-de-gree scale, where point “1” showed extreme negative
opinion – “a very low level of mastering the skill” or “expected very low level of usefulness of particu-lar skills in professional practice” or “very low lev-el 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 dentist-ry 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 master-ing and teachmaster-ing the skill is very low. They also claimed that the level of mastering the skill of “us-ing 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 par-ticular 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 lev-el 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 per-manent teeth)” and “traumatic injury treatment of primary teeth”; and “root canal obturation of pri-mary teeth” (Me = 4) and “traumatic injury treat-ment 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 statistical-ly significant.
Discussion
The study showed the predominance of a high level of students’ opinion about the level of par-ticular practical skills mastery. This opinion was confronted with the number of procedures per-formed during classes. There was no correlation between them.
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) Questions 1 2 3 The level of mastering the practical skill (Poziom opanowania umiejętności praktycz -nych) Th e e xp ec te d lev el of u se fu ln es s o f particular skills in professional practice (Spodziewany poziom wykorzystania poszczególnych umiejętności prak -tycznych 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) 1. Varnishing (Lakierowanie) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 2. Pit and fissure sealing (Uszczelnianie bruzd) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 3. Primary teeth restoration (Odbudowa zębów mlecznych) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 4. Young immature permanent teeth restoration (Odbudowa zębów stałych niedojrzałych) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 5. Impregnation – directly application silver nitrate to carious lesion (Impregnacja – bezpośrednia aplikacja azotanu srebra na zmianę próchnicową) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 6. Stainless steel crown restoration (Odbudowa za pomocą koron stalowych) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 7. Direct pulp capping – permanent teeth (Bezpośrednie pokrycie miazgi – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8. Indirect pulp capping – primary teeth (Pośrednie pokrycie miazgi – zęby mleczne) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 9. Indirect pulp capping – permanent teeth (Pośrednie pokrycie miazgi – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 10. Pulpotomy – primary teeth (Pulpotomia – zęby mleczne) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 11. Pulpotomy – permanent teeth (Pulpotomia – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
12. Pulpectomy – permanent teeth (Pulpectomia – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 13. Root canal obturation – primary teeth (Wypełnienie kanału korzeniowego – zęby mleczne) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 14. Root canal obturation – permanent teeth (Wypełnienie kanału korzeniowego – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 15. Traumatic injury management – primary teeth (Leczenie urazów - zęby mleczne) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 16. Traumatic injury management – permanent teeth (Leczenie urazów – zęby stałe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 17. Primary tooth extraction (Ekstrakcja zębów mlecznych) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 18. Permanent tooth extraction (Ekstrakcja zębów stałych) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 19. Topical anaesthesia (Znieczulenie powierzchniowe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 20. Infiltration anaesthesia (Znieczulenie nasiękowe) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 21. Tooth vitality testing (Badanie żywotności zęba) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 22. Using a rubber dam (Zastosowanie koferdamu) 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7
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 stu-dents 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 on-ly 80–90% of the group and less frequenton-ly per-formed procedures would only have been experi-enced by a minority of graduates. To first category come administering a local analgesic and fissure sealing, to second: amalgam restoration in prima-ry teeth, preventive resin restoration and assessing an emergency patient, and to third category: pri-mary molar pulp treatment or preparing and fit-ting a performed crown [8].
The aim of study of dental students complet-ing the undergraduate education, made in Uni-versity 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 stu-dents 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 conserv-ative 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 den-tistry 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-graduate education and training in paediatric den-tistry in European dental schools. The aim of the study was twofold, first to promote an exchange of information regarding the curriculum in pae-diatric dentistry between dental schools in the EU countries; secondly, to provide baseline data for the development of curriculum guidelines for under-graduate education in paediatric dentistry. A ques-tionnaire was sent out to 140 dental schools in the 15 EU countries. Questionnaires were returned from 61 EU dental schools, resulting in a 44% re-sponse rate. In 67% of the schools, paediatric den-tistry was taught in separate departments devot-ed only to padevot-ediatric 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 Med-ical 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 ex-tremely between dental schools in Europe [10–13]. This study demonstrated that the level of mas-tering, usefulness and teaching of most of the par-ticular 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 Uni-versity 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 learn-ing. 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 dur-ing 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 divi-sion 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
[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: klstomdz@ump.edu.pl 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.
