An educational evaluation of learner experiences in dentistry open-book examinations.

Introduction The COVID-19 pandemic resulted in substantial global disruptions, with many universities restructuring their examinations to open-book assessments. In this format, learners are allowed to use revision notes, textbooks and other permitted material during their examination. Traditionally, dentistry is assessed using closed-book examinations where the use of such materials is prohibited. Learners will have limited or no prior experience of open-book examinations in dentistry, hence this educational evaluation aimed to explore their experiences and assess suitability for continuity of this examination.Methods A retrospective anonymous survey was conducted on all undergraduate dentistry and oral health sciences learners on completion of their examination and once they received their results. The questionnaire was designed to contain both qualitative and quantitative data items, validated through previous published studies. All authors independently analysed the data through tallying quantitative parameters and thematically analysing qualitative free text.Results In total, 210 learners participated in the survey, with 52.4% strongly agreeing a preference for open-book examinations. In addition, 42.9% of learners either agreed or strongly agreed that less preparation was required for open-book examinations; however, 80.5% reported learning new information. Furthermore, 85.2% disagreed or strongly disagreed that open-book examinations were stressful. Thematic analysis highlighted four core themes: stress, memorisation of facts, motivation to learn and unfairness.Conclusions There were several learning points for both educators and learners that can be actioned for future open-book examinations, including tailoring exam questions to foster application of knowledge rather than resource-searching skills, intended learning objective mapping against curriculum requirements and learner preparation.

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 2: consequences of withholding dental care.

As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm.In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care.The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses.

The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 1: clinical.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols.The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management.It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes.