Concordance between undergraduate dental students and their lecturers in their attitudes towards difficult patients.

The 'difficult' patient syndrome is caused by an imbalance in the dentist-patient relationship which may be influenced by human, cultural and psychosocial factors. The aim of this study was to compare the concordance between undergraduate dental students and lecturers in the degree of difficulty assigned to vignettes describing 'difficult' patients and to describe the extent to which ratings are influenced by gender, place of study and experience of specific 'difficult' patients. A questionnaire with 21 patient-stereotypes identified as difficult from the specialized literature was prepared. Both students and lecturers had to determine the degree of difficulty of each stereotype on a Likert-like scale. The students selected were in the final 2 years before graduation in Santiago de Compostela (Spain) and Porto (Portugal) Dental Schools. Lecturers were selected by simple random sampling method. Both lecturers and undergraduate students found more difficulty in those patients classified as aggressive, manipulative help-rejecters or patients with invasive companions. On the other hand, drug abusers and HIV-positive patients were ranked as presenting low levels of difficulty. Our results seem to point to the need of improving undergraduate teaching and learning of specific procedures for the management of aggressive or stubborn patients and those with invasive companions.

Assessment of dental students' ability to recognise precancerous lesions and conditions.

The role of dentists in both primary (promoting a healthier lifestyle) and secondary (early diagnosis) prevention of oral cancer is undeniable, and becomes particularly important as oral cancer is thought to be preceded by premalignant lesions or conditions in about one half of the cases. In these situations, there is the possibility for an early diagnosis which will definitively influence the survival rate. Thus, it is an undergraduate educational objective related to secondary prevention of oral cancer to increase the efficacy of screening of precancerous lesions/conditions. A questionnaire with 38 clinical cases including 16 benign lesions, 9 malignant lesions and 13 precancerous lesions or conditions was applied voluntarily to 3rd, 4th and 5th year University of Santiago de Compostela dental students on April 1996. The participation rate was 90% of the 3rd-year students, 60% in 4th-year class, and 50% of the 5th-year group. The agreement in the diagnosis with a panel of experts reached 81.45% for 5th-year students. Students of 3rd- and 4th-year scored lower percentages, probably due to the rarity of some of the conditions in our area. 5th-year students scored significantly higher values than 3rd- and 4th-year students.