Competence, competency-based education, and undergraduate dental education: a discussion paper.

INTRODUCTION: The aim of undergraduate dental education is to provide competent dentists to serve societal needs and improve population oral healthcare. Competency-based education has influenced the development of dental education for decades but this term is problematic. This article explores components of competency-based undergraduate health professional education in order to help the dental profession have a better understanding of the context and purposes of undergraduate dental education. METHODS: This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on competency-based undergraduate education. RESULTS AND DISCUSSION: Competence comprises an integration of knowledge, skills and attitudes indicating a capability to perform professional tasks safely and ethically. The process of becoming a competent practitioner is complex. Four characteristics of competency-based education are: curriculum components and content shaped by societal needs; focused on student-centred learning; learning achievement; and limited attention to time-based training and numerical targets. Alongside a competency-based approach, undergraduate dental education can be influenced by institutional features and external factors but these receive little consideration in the literature. CONCLUSION: Understanding competence, competency-based education, and institutional and external factors will help to improve educational quality, define roles and professional development for the dental educator, and inform further research.

Roles and competences for educators of undergraduate dental students: a discussion paper.

INTRODUCTION: Dental educators are important people who contribute to the development of every aspect of dental education. In part due to the lack of understanding of their roles and competences, dental educator development has so far received little consideration. With the aim of enhancing the dental profession's contribution to the development of undergraduate dental education, this article explores common roles of educators of undergraduate dental students and the competences needed to be effective educators. METHODS: This is a discussion paper based on a wide reading of the literature on the education of health professionals with a specific focus on roles and competences of educators. RESULTS AND DISCUSSION: Roles of educators of undergraduate dental students typically encompass four areas: teaching, research, administration and providing healthcare. Educators may not be involved in every role; they normally perform the roles relevant to their work contexts. Competences for dental educators based on the four main roles comprise 12 domains: educational theories and principles; modes of education; learner issues; educational materials and instructional design; assessment and feedback; curriculum matters; evaluation; educational research; educational management; quality assurance; patient care and healthcare system and professionalism. Not all competences are required by all educators although educators need to be competent in the areas related to their roles and duties. CONCLUSION: Understanding the roles and competences for educators of undergraduate dental students can help individual educators to improve their personal effectiveness and institutions to tailor staff development programmes appropriate to the needs of their staff. Faculty development contributes to sustained enhancement of undergraduate dental education.

Culture and its influences on dental education.

INTRODUCTION: Culture is an important factor influencing how students develop learning and how educators provide support to students. The aim of this paper is to explore a concept of national European cultures, and relationships between culture and educational practice with the intention of helping the dental profession gain a better understanding of effective teaching and learning in dentistry. CONTENT: Culture represents the collective behaviours, values and beliefs of people in a society. How people react to education is partly explained by culture. Students utilise different culturally based strategies to develop learning. We apply Hofstede's model to explore European cultures and implications for dental education and educational practice. Most Western students possess assimilating learning styles enabling them to learn effectively in student-centred contexts while most Eastern students have accommodating learning styles and are more familiar with teacher-centred learning. Eastern students may need to adapt their approach to learning to better benefit from student-centred learning. CONCLUSION: Culture influences students' learning and educational practice. Dental educators should be aware of such influences and provide support that acknowledges students' different cultural backgrounds. Cultural competence is fundamental for effective teaching and learning in dentistry.

Developing educators of European undergraduate dental students: Towards an agreed curriculum.

INTRODUCTION: Recent developments in European dental education are student-focused, concerned with competency-based and problem-based learning. The development of dental educators has so far received little consideration. This study aimed to agree curriculum content for developing dental educators so that they are better able to support changing undergraduate dental education. METHODS: Adopting consensus methodology, a 2-round Delphi was conducted in 2012. Fifty-three dental educators and 39 dental students across Europe volunteered to take part. The Delphi questionnaire was developed based on literature, piloted and sent to participants to gather opinions and seek consensus on educational content using rating scales and open-ended questions. Numeric data were analysed using descriptive statistics, and qualitative data were analysed thematically. RESULTS AND DISCUSSION: This study revealed 7 domains of curriculum content for dental educators. Four of these domains were considered essential: educational principles; educational practice in dentistry; curriculum, quality and improvement; and educational professionalism. Three domains were viewed as optional and could be tailored to local needs: educational principles in relation to specific contexts, educational research, and educational and healthcare management. When developing training for dental educators, factors which need consideration were identified as the academic position and teaching experience of educators, and the nature of clinical dental education. CONCLUSION: The results are beneficial for individual educators to inform professional development plans; institutions to devise faculty developments; ADEE to inform policies on developing European dental educators; and other disciplines to inform training for their educators.

Long-term experiments to investigate irreversibility in sorption of pesticides to soil.

Experiments investigated irreversibility in pesticide sorption to soil. Sorption behaviour under abiotic conditions was quantified for chlorotoluron, prometryn and hexaconazole in three soils over periods of up to 274 days. An isotope-exchange procedure was used whereby sorption of (12)C- and (14)C-pesticide isotopes in shaken suspensions of three soils (56-168 days shaking) was followed by substitution of the isotopes in the liquid phase and a 14-day exchange phase. This was followed by forced isotope exchange where the sorbed (14)C material was exchanged by adding an excess of non-radiolabelled compound. Experiments were concluded with solvent extraction and soil combustion to determine remaining radioactivity. Under conditions of continuous shaking, the pesticide-soil systems took around four months to approach sorption equilibrium, resulting in strong asymmetry between the profiles of exchange for isotopes of all three compounds. Physically entrapped residues were released back into solution under the steep concentration gradient of forced isotope exchange and small amounts of radioactivity were still being released at the termination of the experiment. The profiles of exchange did not deviate markedly from ideal behaviour based on the assumption that sorption is fully reversible. Whilst the timescales for release of sorbed residues back into solution were very long, soil combustion at study termination only yielded <1-2% of applied radioactivity; this confirms that sorption processes under abiotic soil conditions were overwhelmingly reversible for this set of compounds and soils.

Acceptability of a reflective e-portfolio instituted in an orthodontic specialist programme: a pilot study.

AIM: The purpose of the study was to highlight students' and mentors' acceptability of a reflective e-portfolio instituted in a postgraduate orthodontic programme in the UK. METHODS: A reflective e-portfolio was developed on the basis of principles provided by a literature search and was piloted for 2 months with six students and seven mentors. At the end of the experience, mentors' and students' acceptability of the e-portfolio with a reflective component was studied using questionnaires. The data were analysed using basic quantitative and qualitative methods. RESULTS: Students' response highlighted acceptability issues related to each aspect of the e-portfolio derived from the literature: relevance of the e-portfolio reflective part; time required for the process; support and mentoring; the implementation method; and the electronic medium. Mentors showed a more positive attitude towards the e-portfolio, expressing only some concerns about the time involved in using it. Furthermore, the analysis of the data highlighted some other acceptability matters: the specificity of the e-portfolio, the communication amongst students and the relationship between students and mentors. CONCLUSIONS: The future successful implementation of the reflective e-portfolio will depend on the productive management of the acceptability issues identified by students and mentors, in particular:(i)the specificity of the e-portfolio that would avoid its overlapping with other part of the programme;(ii)the increasing communication amongst students to improve their knowledge of the reflective writing process; and (iii)the development of a relationship between students and mentors helping to create the appropriate environment for reflection.

Evaluation of a reproduction technique for the study of the enamel composite/bracket base area.

The objective of the study was to evaluate a reproduction method that would enable the study of the enamel/ bracket/composite interface in vivo, and consisted of in vitro assessment of two different impression materials to compare reproduction of brackets bonded to extracted teeth followed by in vivo assessment of the superior material. In vitro standard edgewise brackets were bonded to two extracted teeth and impressions were taken using two different types of low viscosity silicone-based impression materials. A medium viscosity silicone impression material was used to support the original impression. Three impressions of both the gingival and occlusal aspect of the bracket base region were obtained using each of the impression materials. Replicas were then prepared for SEM viewing and these compared to SEMs of the real teeth for reproduction of detail. A 3-point Reproducibility Index was used to compare the SEM photographs of the comparable replicas. One impression material was clearly superior to the other and produced an acceptably accurate representation of the true clinical situation in three out of four samples. This material also performed well in the in vivo situation. The technique described is satisfactory for the production and analysis of SEM pictures of the enamel/composite/ bracket base interface in vivo.

Case report: treatment of the late eruption of an ectopic maxillary canine.

A case is documented which presents an unusual sequence of events that led to the eruption of a previously impacted tooth. Treatment using fixed appliances and restorative measures achieved an acceptable result for the patient.

Deformation of the palate in preterm infants.

AIM: To investigate the effect of gestation, postmenstrual age, and orotracheal intubation on palate morphology. METHODS: A prospective study was made of 76 newborn infants of 25 to 41 weeks' gestation. Palate dimensions were measured on plaster models produced from serial palatal impressions. Palate size relative to that of the mouth was assessed using a ratio of palate depth to palate width (Palatal Index). RESULTS: Palate depth and width were related to postmenstrual age and gestation. Palatal Index ranged from 0.15 to 0.57, indicating a wide variation in palate shape, but gestation and postmenstrual age had no effect. Prolonged intubation had a small effect, equivalent to an increase in palatal depth of less than 2 mm at 32 weeks' postmenstrual age. The effect was transient. CONCLUSION: Prolonged orotracheal intubation (> 10 days) leads to a small and temporary increase in palatal depth. However, this is unlikely to account for palatal grooving, which is probably caused by an overgrowth of the lateral palatine ridges.

The Family Atherosclerosis Risk Intervention Study (FARIS): risk factor profiles of patients and their relatives following an acute cardiac event.

BACKGROUND: Relatives of patients with coronary heart disease have a heightened risk of cardiovascular disease. Attendance at a family-based screening clinic after an acute cardiac event could motivate patients and relatives to modify their lifestyles. AIMS: The Family Atherosclerosis Risk Intervention Study (FARIS) aimed to determine (i) whether a high proportion of patients and relatives would attend a special screening and prevention programme; (ii) whether the risk factor profiles of relatives would be worse than those in the general community; and (iii) whether ongoing management of patients and families together in a special clinic would improve risk factor profiles. METHODS: Consecutive patients, together with spouse, siblings and offspring, aged 18 to 69 years, were randomly allocated three months after an acute cardiac event to attend a special outpatient clinic, a screening and advice group, or a control group. Risk factor measures were total cholesterol, HDL cholesterol (HDLC), systolic blood pressure (SBP), body mass index (BMI) and smoking behaviour. This paper presents the risk factor profiles of all FARIS attenders and compares those of family members, age adjusted, with risk factors measured in a multicentre urban cross-sectional survey conducted in the same period. Differences between groups were compared using t-tests for numerical variables and ANOVA and chi-square for categorical variables. RESULTS: Six hundred and twenty-eight patients and 1723 family members were enrolled, representing 85.9% and 82.7% of eligible patients and relatives respectively. Risk factors were significantly worse amongst family members than among those in the population survey.

A combined orthodontic/restorative clinic. Rationale, evolution, and experience.

The rationale for running combined clinics between orthodontics and restorative dentistry is given, together with the history of the development and experience of such a clinic at the Dental School and Hospital in Cardiff. Brief details of the organization of the combined clinic and possible future developments are also given.

Morphology of anterior teeth associated with displaced canines.

This clinical study compared tooth dimensions of maxillary central and lateral incisors on the same side as a palatally impacted maxillary canine with those of the contralateral side with a normally erupted canine, in a group of 33 consecutively referred patients. The dimensions recorded were the mesio-distal width, labio-palatal depth, obtained from models of the four upper anterior teeth and total tooth length obtained from an orthopantomographic radiograph. The results showed that there was no statistically significant evidence to support the view that palatally impacted maxillary canines are associated with diminutive maxillary lateral incisors.

Student and staff opinion of electronic capture of data related to clinical activity.

OBJECTIVE: To seek the opinion of staff and students of a new electronic method for collection of data related to student clinical activity. DESIGN: Questionnaire survey. SETTING: Staff and students in the Department of Child Dental Health, Dental School, Cardiff, and staff in the Community Dental Service who undertake clinical supervision. METHOD: A questionnaire was circulated to all 2nd and 3rd clinical year dental undergraduate students seeking their opinion on a range of issues associated with the recently introduced bar code system of data gathering of their clinical activity and achievement. A similar questionnaire was circulated to staff who have responsibility for clinical supervision of these students. RESULTS: A total of 102 replies were received. With the exception of 2 aspects, there was no disagreement between staff and students. An overall majority preferred the use of bar codes to other methods of data collection; bar codes were perceived to be more accurate and reliable than other methods; students were satisfied with the method of quality assessment; staff were dissatisfied (P < 0.05). Staff were strongly in favour of extension of the use of bar codes to other clinics, whereas students were less strongly in favour (P < 0.001); there was little enthusiasm to extend bar codes for recording attendance at lectures, seminars and other such activity. CONCLUSION: The new system has been accepted by staff and students alike. It has proven to be satisfactory for its intended purpose. As a result of this survey, minor adjustments to procedures will take place, and the method of assessment of clinical work will be reconsidered.

Patient and parent opinion of the use of recycled orthodontic brackets: an international comparison.

The aim of this study was to determine the opinion of patients and parents to the use of recycled orthodontic brackets. The design consisted of a questionnaire survey, which took place in the orthodontic departments of two teaching hospitals (Cardiff, Wales, and Dunedin, New Zealand). The subjects were patients (and parents of those under 18 years) undergoing active fixed appliance treatment and similar groups of those on the waiting list for fixed appliance treatment. There were no significant differences of opinion between gender, patient, parent, or centre. There were significant differences of opinion between those under treatment and those on the waiting list; those under treatment were less concerned about wearing recycled brackets than those waiting for treatment. All respondents felt that they should be told if recycled brackets were to be used, and any savings arising from their use passed on to the consumer.

Neonatal feeding of infants born with cleft lip and/or palate: parental perceptions of their experience in south Wales.

OBJECTIVE: This paper describes the responses of 100 parents of children born with cleft lip and/or palate in South East Wales to a postal questionnaire survey of their experiences of the services available to help with the feeding of their children in the immediate postnatal period. RESULTS & CONCLUSIONS: Prior to birth, the majority of mothers intended to breast feed their child; after birth, the majority of infants were bottle fed. The majority of mothers felt that they had been a part of the decision to change methods. Advice on feeding was obtained from a variety of sources, both in hospital and on discharge. Mothers of cleft children who were first born in the family were less critical of the support offered in hospital than were mothers whose cleft child was a second or subsequent child. Isolated clefts of the palate were associated with a high proportion of feeding via nasogastric tube both on discharge from hospital and at home. The major criticism of the service offered to parents and their children was the poor quality of advice on feeding their children, both in hospital and on discharge. A variety of mechanisms for service improvement are suggested.