Building a student learning-focused assessment and grading system in dental school: One school's experience.

PURPOSE/OBJECTIVES: As health professions education moves toward competency-based education, there has been increased focus on the structure of assessment systems that support student competency development and learning. This has been buoyed by a growing body of research supporting assessment for learning processes to promote student growth and learning rather than relying on assessment systems primarily to measure performance. This paper presents the rationale and evidence for moving to an assessment for learning system and the results of a quasi-experimental interrupted time series study using data from 2015 to 2022 to evaluate the impacts of these changes. METHODS: Columbia University College of Dental Medicine faculty voted to implement assessment for learning system changes beginning in 2017 with the graduating class of 2021. These changes included moving from using a grading system for didactic courses with Honors, Pass, and Fail as available grades to a grading system with only Pass and Fail as available grades, as well as creating synthesis and assessment weeks, weekly problem sets, post-exam review sessions, exam remediation opportunities, and formative progress exams throughout the curriculum. The revised assessment and grading system changes were communicated to residency program directors, and programmatic competency data about student performance across the curriculum were shared with programs in Dean's Letters. RESULTS: Once assessment system changes were implemented, it was found that student exam failure rates were lower, course exam scores were the same or higher, and performance on board exams improved compared to the national average. Students reported positive perceptions with regard to well-being and learning climate that they associated with the adoption of Pass/Fail grading. Match outcomes, including student satisfaction and program director ratings, have remained consistently positive. CONCLUSION: As dental educators, our goal is to nurture students to become life-long learners. Adopting a grading structure that is Pass/Fail and an assessment system that fosters learning allows students to shape learning practices that favor long-term retention and application of information, also enhancing the learning environment and student well-being. These system changes may also facilitate the inclusion and support of students whose backgrounds are underrepresented in dentistry.

The utility of a formative one-station objective structured clinical examination for Substance use disorders in a dental curriculum.

Substance use disorders (SUD) are chronic relapsing medical conditions characterised by compulsive substance seeking and use. They constitute a substantial disease burden globally. Labelling of persons with SUD has created barriers to treatment but there are effective management strategies. The dental profession has embraced reforms designed to address the SUD epidemic by promoting continuing education for practitioners and initiating curriculum changes in dental schools. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with SUD. The use of a formative 1-station Objective Structured Clinical Examination (OSCE) for learning and assessment in SBIRT, operationalised with the MD3 rating scale is presented in this study. In 3 years of implementation, the SBIRT OSCE successfully integrated into the curriculum of the College of Dental Medicine, Columbia University. Mean score of total adherent behaviours was 11.80 (SD =4.23) (range: 2 - 24) and Cronbach's coefficient alpha for across-items reliability in adherent behaviours was 0.66. Adherent behaviours correlated with the global ratings (r = 0.66). Mean of global rating scores were 2.90 (SD =1.01) for collaboration and 2.97 (SD =1.00) for empathy and the global rating scores correlated with each other (r = 0.85). Histograms of global rating scores resembled normal distribution. The 1-station OSCE is a good model for learning about SBIRT. Psychometric analysis was useful in understanding the underlying construct of the MD3 rating scale and supported its reliability, validity and utility in dental education.

Innovations in pre-doctoral dental education: Influencing attitudes and opinions about patients with substance use disorder.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based model for managing patients with substance use disorders (SUD). Historically, SUD were seen as a criminal issue and access to treatment was limited, but that paradigm is shifting and substance abuse is now being recognized as a disease state and the management of patients with SUD is increasingly within the healthcare system starting with primary healthcare settings including dental facilities. In a new training initiative, first-year dental students (DDS1) attended a 90-minute SBIRT training. An Attitudes and Opinion Survey (AOS) consisting of 8 questions that separately assesses DDS1 attitudes toward alcohol and drug use disorders was utilized to evaluate the training. Assenting DDS1 anonymously completed the AOS before and following the training. Over 3 years, we analyzed changes in the AOS of 230 DDS1 using Chi-squared test for bivariate comparison. We then applied a Bonferroni correction to the P-values. Response rate was 95.5%. The SBIRT training improved DDS1 attitudes and opinions toward patients with SUD with respect to all AOS questions. There was a statistically significant improvement (P < 0.003) in DDS1 attitudes and opinions with respect to whether other patients care suffers because of time and resources spent on patients with SUD and whether the SBIRT training provided adequate education to prepare DDS1 to manage patients with SUD. SBIRT training is relevant to dental education. It fills an important educational gap and is a suitable model for other dental schools.

Prosthetic outcomes and survival rates of implants placed with guided flapless surgery using stereolithographic templates: a retrospective study.

Recent technologic advances allow clinicians to place dental implants using computer-generated templates. However, there are limited data regarding treatment outcomes for implants placed using these techniques. The purpose of this retrospective study was to report the 2- to 4-year prosthetic outcomes and survival of dental implants placed by postdoctoral residents with a flapless surgical protocol using computer-based planning and stereolithographic surgical templates. Thirty-six patients were treated using the NobelGuide concept, comprising an image-based three-dimensional implant planning software and flapless implant surgery with stereolithographic templates.

Infection patterns in chronic and aggressive periodontitis.

BACKGROUND: We revisited the postulate that localized aggressive periodontitis (LAP) patients have robust serum antibody (ab) responses to periodontal pathogens while patients with generalized aggressive periodontitis (GAP) show weak responses. We also studied ab responses in localized chronic (LCP) and generalized chronic periodontitis (GCP). METHODS: Fifty-seven patients (14-74 years, 25% male, 70% Hispanic, 26% African American) were studied (15 LAP, 19 GAP, 11 LCP, 12 GCP patients). Three plaque samples/subject were analysed with respect to 15 species, and serum immunoglobulin G (IgG) responses to the same bacteria were determined. Ab responses were expressed as log-transformed titres, and "infection ratios", i.e., log-transformed ratios of ab titre over the subject-based mean bacterial load for the homologous species. RESULTS: The results failed to corroborate the postulate that LAG patients have robust responses to infecting agents while GAP subjects exhibit weak responses. This held true for ab to "red complex", "orange complex", and health-associated species, and for both titres and infection ratios. Similarly, no differences were found between ab titres or infection ratios in chronic and aggressive periodontitis, or their extent-based subdivisions. CONCLUSIONS: A distinction between the two principal categories of the current periodontitis classification cannot be established by the study of infection patterns.

Gene expression signatures in chronic and aggressive periodontitis: a pilot study.

This pilot study examined gene expression signatures in pathological gingival tissues of subjects with chronic or aggressive periodontitis, and explored whether new subclasses of periodontitis can be identified based on gene expression profiles. A total of 14 patients, seven with chronic and seven with aggressive periodontitis, were examined with respect to clinical periodontal status, composition of subgingival bacterial plaque assessed by checkerboard hybridizations, and levels of serum IgG antibodies to periodontal bacteria assayed by checkerboard immunoblotting. In addition, at least two pathological pockets/patient were biopsied, processed for RNA extraction, amplification and labeling, and used to study gene expression using Affymetrix U-133 A arrays. Based on a total of 35 microarrays, no significantly different gene expression profiles appeared to emerge between chronic and aggressive periodontitis. However, a de novo grouping of the 14 subjects into two fairly robust clusters was possible based on similarities in gene expression. These two groups had similar clinical periodontal status and subgingival bacterial profiles, but differed significantly with respect to serum IgG levels against the important periodontal pathogens Porphyromonas gingivalis, Tannerella forsythensis and Campylobacter rectus. These early data point to the usefulness of gene expression profiling techniques in the identification of subclasses of periodontitis with common pathobiology.

Maxillary canine impactions: orthodontic and surgical management.

With the exception of the maxillary and mandibular third molars, the maxillary canine is the most commonly encountered impaction. In North America, palatally located impactions appear to predominate over labially impacted canines and occur more frequently in women. Because of the common nature of this phenomenon, the general dentist should know how to properly diagnose and manage potential disturbances in the eruption of the maxillary canine. If diagnosed early, and when clinically and radiographically indicated, extraction of the deciduous canine may help correct the eruption path of the permanent tooth and prevent impaction. This article reviews the etiology, prevention, and surgical and orthodontic management of impacted cuspids. Because the general dentist is often the first dental care provider to come in contact with patients with impacted canines, knowledge about this common dental anomaly is essential to provide proper comprehensive therapy.