Longitudinal assessment of undergraduate dental students: Building evidence for validity.

PURPOSE: To investigate the content and criterion validity, and reliability of longitudinal clinical assessment of undergraduate dental student clinical competence by determining patterns of clinical performance and comparing them with validated standalone undergraduate examinations. METHODS: Group-based trajectory models tracking students' clinical performance over time were produced from LIFTUPP© data for three dental student cohorts (2017-19; n = 235) using threshold models based on the Bayesian information criterion. Content validity was investigated using LIFTUPP© performance indicator 4 as the threshold for competence. Criterion validity was investigated using performance indicator 5 to create distinct trajectories of performance before linking and cross-tabulating trajectory group memberships with a 'top 20%' performance in the final Bachelor of Dental Surgery (BDS) examinations. Reliability was calculated using Cronbach's alpha. RESULTS: Threshold 4 models showed all students followed a single upward trajectory in all three cohorts, showing clear progression in competence over three clinical BDS years. A threshold 5 model produced two distinct trajectories, and in each cohort a 'better performing' trajectory was identified. Students allocated to the 'better performing' trajectories scored higher on average in the final examinations for cohort 2 (29% vs 18% (BDS4); 33% vs. 15% (BDS5)) and cohort 3 (19% vs. 16% (BDS4); 21% vs. 16% (BDS5)). Reliability for the undergraduate examinations was high for all three cohorts (≥0.8815) and did not change appreciably when longitudinal assessment was included. CONCLUSIONS: There is some evidence to support that longitudinal data have a degree of content and criterion validity for assessing the development of clinical competence in undergraduate dental students, which should increase confidence in decisions based on these data. The findings also provide a good foundation for subsequent research.

Adaptation to Virtual Assessment during the COVID-19 Pandemic: Clinical Case Presentation Examination.

BACKGROUND: Case presentation assessment is common in both medicine and dentistry and is known under various names depending on the country and institution. It relates mainly to aspects of diagnosis and treatment planning and is considered highly authentic and useful. The COVID-19 pandemic necessitated the movement of this assessment from face-to-face to online. The aim of this investigation was to explore the students' impressions of the two different examination modalities. With this information, a decision on future diets of this examination can be made to accommodate the students' perspectives. METHODS: Quantitative and qualitative data were gathered using an online, self-administered survey. RESULTS: The students were split 50/50 regarding which assessment modality they preferred. Overall, they considered the online examination to be fair, and the majority agreed that the online format allowed them to display their knowledge as well as face-to-face. CONCLUSIONS: The delivery of case presentation examination is possible online. An online case presentation is a fair, useful, and authentic assessment that is appropriate to the needs of the faculty and students. Satisfaction with the two possible methods of conducting this assessment suggests it would be reasonable to conduct this examination online in the future.

Virtual objective structured clinical examination during the COVID-19 pandemic: An essential addition to dental assessment.

INTRODUCTION: COVID-19 has profoundly affected dental undergraduate teaching and assessment. The pandemic resulted in cessation of face-to face teaching and assessment in many countries, with an associated move online. Objective structured Clinical Examination (OSCE), an important modality for clinical assessment in dentistry and medicine, is not possible with pandemic restrictions in place. As a result, interest in virtual objective structured clinical examination (VOSCE) has been revived. Student and staff evaluation of any assessment process is important, where the views of all involved are required in establishment of authenticity. This papers aims to explore and describe the views of undergraduate dental students and staff in relation to VOSCE MATERIALS AND METHOD: Qualitative methods utilising online focus groups and video recording were used in this study. Five focus groups, involving 24 participants were undertaken. RESULTS: Thematic analysis following a deductive semantic approach was carried out resulting in the identification of six themes relating to the VOSCE: VOSCE preconceptions, examination preparation, examination process, fairness, comparison with OSCE and possible improvements. Consideration of these themes, and their interaction, is likely to prove important for optimisation of this assessment modality. CONCLUSIONS: Overall, both staff and students considered the VOSCE a useful and fair examination and a suitable alternative to OSCE. The potential for a number of improvements in the assessment process was identified.

COVID-19 Adaptations for Biomedical Teaching and Assessment Within the Undergraduate Dental Curriculum.

The COVID-19 pandemic has profoundly affected the provision of teaching and assessment on the undergraduate dental programme in many institutions worldwide, and for a prolonged period resulted in the cessation of face-to-face teaching. This resulted in significant changes in the way that didactic and preclinical skills have been taught and required novel thinking to overcome the issues that COVID-19 restrictions presented.Dentistry is a very practical subject and at this institution, the University of Glasgow Dental Hospital and School, we had to quickly develop new ways of teaching that allowed us to cover teaching and assessment of the required Intended Learning Outcomes. This chapter highlights some specific case studies of how adaptations were made to the undergraduate dental teaching program within our institution utilising technology and visualisation to promote this during this turbulent time. These included teaching of head and neck anatomy, teaching of pre-clinical skills in placement of local anaesthetic and dental extraction forceps, communication skills as well as describing a raft of modifications to our assessment programme.Many of these innovations, utilising blended learning methodologies with the use of visualisation, have been transferred into other areas of teaching within the curriculum and will replace older material as we transition out of the pandemic, undoubtedly significantly improving the student experience.

The changing landscape of dental education - Glasgow Dental School.

Glasgow Dental School was set up in 1879, and since that time, dental education has been changing and evolving into the current landscape we recognise today. Changes in demographics and numbers of dental students have led to a more diverse community of students from wide and varied backgrounds. The years have also seen the development of educational theory and practice, and in more recent times, the introduction and expansion of digital and technology-enhanced learning and teaching have revolutionised the delivery of the dental curriculum. One of the most notable changes in the dental programme is the incorporation of student support, health and wellbeing. The modern dental course takes a more holistic approach to education, with the provision of training in generic and life skills, as well as the clinical skills required in an ever-expanding field. The demands and pressures of studying dentistry in the setting of modern, fast-paced life cannot be underestimated and the course must be ever-changing to reflect this. However, the one thing that has not changed is the enduring Glasgow Dental School community.

Management of patients at risk of adrenal crisis in the dental setting: a review of current practice in UK dental teaching hospitals.

Introduction Patients with impaired corticosteroid response due to Addison's disease or systemic glucocorticoid use are at risk of adrenal crisis when undergoing dental treatment. There is a lack of conclusive evidence to support dental teams in identifying patients at risk and their management to prevent an adrenal crisis.Aim To review the current practice in UK dental teaching hospitals regarding the management of patients at risk of adrenal crisis in the dental setting.Methods An electronic survey focused on patients who may be at risk of adrenal crisis due to systemic glucocorticoid therapy was sent to all 18 UK dental teaching hospitals. Information on the use of a policy or guidance was requested. Responses were evaluated for clinical decision-making, patient risk assessment and steroid cover dosing regimens.Results A 78% response rate was achieved. Only 29% of institutions had a written policy or guidance document. Variation exists in the threshold of steroid dose and duration of treatment in identifying patients at risk of adrenal suppression. Furthermore, the dose regime for steroid cover varied.Conclusion Further evidence on the management of patients at risk of adrenal crisis is required to inform national guidance and reduce variation in patient management.

The impact of wrong-site surgery on dental undergraduate teaching: a survey of UK dental schools.

INTRODUCTION: Patient safety within dental education is paramount. Wrong-site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools' undergraduate experience of NEs, safety interventions implemented and the impact on student experience. METHODS: All 16 UK dental schools were surveyed via email. RESULTS: The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre-operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus. DISCUSSION: This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre-operative briefings. CONCLUSION: UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre-operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

A pilot of a Virtual Objective Structured Clinical Examination in dental education. A response to COVID-19.

INTRODUCTION: The outbreak of COVID-19 necessitated a move to online teaching and assessment. The objective structured clinical examination (OSCE) has been an integral part of dental examinations for several decades. The COVID-19 pandemic stopped face to face examinations around the world. An Online Virtual OSCE (VOSCE) was developed and piloted for dental undergraduate assessment. MATERIALS AND METHODS: This initial report outlines the steps required to run an OSCE online. Planning and preparation required in adaptation of an OSCE for the online environment is dreported. The necessity for familiarisation sessions is addressed, and VOSCE logistics described. RESULTS: With careful planning, the VOSCE is a useful assessment method in difficult times. Feedback from staff and students was favourable. CONCLUSION: Although significant organisation was required, the examination process worked well for both students and examiners. Despite limitations in relation to technical dental procedures, the VOSCE could be a viable alternative to face to face clinical examination.

An Innovative Assessment of the Dynamics of Facial Movements in Surgically Managed Unilateral Cleft Lip and Palate Using 4D Imaging.

OBJECTIVE: Assess facial asymmetry during maximum smile in patients with surgically managed unilateral cleft lip and palate (UCLP), using a dynamic 3-dimensional (3D) imaging (4-dimensional) system. DESIGN: Prospective 2 cohort comparative study. METHODS: Twenty-five surgically managed UCLP cases and 75 controls at 8 to 10 years of age were recruited. Facial movements during maximum smile were recorded using video stereophotogrammetry at a rate of 60 3D facial images per second. Maximum smile took approximately 3 seconds and generated 180 3D facial images for the analysis. A generic facial mesh which consists of more than 7000 quasi landmarks was used for the assessment of facial asymmetry at 5 key 3D frames representing the pattern of maximum smile. RESULTS: Statistically significant differences were seen regarding the magnitude of facial asymmetry between the UCLP group and the noncleft controls. Higher average asymmetry in the UCLP group was seen in the 3D frame midway between maximum smile and rest (frame 4) followed by the frame at peak expression of maximum smile (frame 3). The average magnitude of nasolabial asymmetry of the control group was within 0.5 mm in comparison with the UCLP cases which was about 1.8 mm. CONCLUSION: This study provided for the first time, an objective tool for analysis of the dynamics of muscle movements which provided an unprecedented insight into the anatomical basis of the residual dysmorphology. The research demonstrates the limitations of the primary lip repair in achieving symmetrical results and underpins the required refinements to improve the quality of surgical repair of cleft lip.

Caring for patients who are deaf or hard of hearing.

Patients who are deaf and hard of hearing often find the American healthcare system to be inaccessible due to communication barriers. This article describes facilities' and providers' requirements under the Americans with Disabilities Act to provide qualified interpreters and other assistive devices to patients who are deaf or hard of hearing. Removing communication barriers can protect healthcare providers from potential legal action and lets them deliver consistent, quality healthcare to all patients.

Three-dimensional assessment of facial appearance following surgical repair of unilateral cleft lip and palate.

BACKGROUND AND OBJECTIVE: Objective assessment of postsurgical facial asymmetry can be difficult, but three-dimensional (3D) imaging techniques have made this possible. The objective of this study was to assess residual asymmetry in surgically repaired unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP) patients and to compare this with noncleft controls. DESIGN: Retrospective multicohort comparative study. PATIENTS AND METHODS: Fifty-one 10-year-old children with surgically managed UCLP and 44 children with UCL were compared with a control group of 68 ten-year-olds. The 3D facial models at rest and with maximum smile were created using a 3D imaging system. Asymmetry scores were produced using both anatomical landmarks and a novel method of facial curve analysis. RESULTS: Asymmetry for the whole face was significantly higher in both cleft groups compared with controls (P < .001). UCLP asymmetry was higher than UCL (P < .001). In cleft patients, the upper lip and nasal rim were the most asymmetric (P < .001 to .05). Control subjects also displayed a degree of facial asymmetry. Maximum smile did not significantly affect the symmetry of the whole face, but it increased asymmetry of the vermillion border and nasal rim in all three groups (P < .001). CONCLUSIONS: Despite surgical intervention at an early age, asymmetry remains significant in cleft patients at 10 years of age. Three-dimensional imaging is a noninvasive objective assessment tool that identifies specific areas of the face responsible for asymmetry. Facial curve analysis describes the face more comprehensively and characterizes soft tissue contours.

Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate.

Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P  =  .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

3D assessment of lip scarring and residual dysmorphology following surgical repair of cleft lip and palate: a preliminary study.

OBJECTIVE: To evaluate lip scarring and the three-dimensional (3D) lip morphology following primary reconstruction in children with unilateral cleft lip and palate (UCLP) relative to contemporaneous noncleft data. DESIGN: Retrospective, cross-sectional, controlled study. SETTING: Glasgow Dental Hospital and School, University of Glasgow, U.K. PATIENTS AND PARTICIPANTS: Three groups of 10-year-old children: 51 with UCLP, 43 UCL (unilateral cleft lip), and 68 controls. METHODS: Three-dimensional images of the face were recorded using stereo cameras on a two-pod capture station, and 3D coordinates of anthropometric landmarks were extracted from the facial images. A novel method was applied to quantify residual scarring and the associated lip dysmorphologies. The relationships among outcome measures were investigated. RESULTS: Residual lip dysmorphologies were more pronounced in UCLP cases. The width of the Cupid's bow was increased due to lateral displacement of the christa philteri left (cphL) in both UCL and UCLP patients. In the upper part of the lip, the nostril base was significantly wider in UCLP cases when compared with UCL cases and controls. Scar redness was more pronounced in UCL than in UCLP cases. No relationship could be identified between lip scarring and other measurements of lip dysmorphology. CONCLUSIONS: Stereophotogrammetry, together with associated image analysis, allow early detection of residual dysmorphology following cleft repair.

Dentoalveolar trauma in Glasgow: an audit of mechanism and injury.

Traumatic dental injuries in children often require multiple follow-up visits to the dentist and may have long-term consequences for the developing dentition. The aim of this audit was to examine age, gender, location, time of year, mechanism of injury and type of injury sustained in relation to dentoalveolar trauma in children attending the paediatric dental trauma clinic at Glasgow Dental Hospital from 2002 to 2004, and to compare our findings with data in the published literature. Males suffered 60% of all dental trauma, 79% of sporting injuries and 85% of assaults. The injuries in males were more severe, representing 65% of enamel dentine and pulp fractures, 100% of crown root fractures and 66% of crown root and pulp fractures. A peak for trauma was seen in the 8-11-year-old group (43%). The majority of injuries in the under four age group resulted from falls (87%). Taken as a whole, falls accounted for 49%, sports related injuries 18%, bicycle and scooter 13%, assault 7%, and road traffic accidents 1.5% of all injuries. They also accounted for a far higher percentage of intrusive luxations (67%). The largest proportion of injuries occurred during the summer months (33%). Sixty-four percent of children suffered trauma to more than one tooth. Fifty-eight percent of injuries involved the dental hard tissues and pulp and the majority of these (82%) were crown fractures. Most subjects (82%) suffered trauma to their periodontal tissues, (26% concussion or subluxation, 26% lateral luxation and 23% avulsion). Injuries to the supporting bone were uncommon. Sixty-six percent of all injuries occurred outdoors. Our findings were similar to a number of published studies, but in contrast to several others. More consistency is required in the collection and reporting of trauma data to be able to draw meaningful conclusions by comparison.