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1. A Survey of Recent Dental School Graduates Regarding Care of Pediatric and Special Needs Patients
Matthew J. Madsen, University of Kentucky; Larry L. Cunningham, University of Kentucky; Jeffrey Johnson, University of Kentucky; Davis Potter, Kentucky Injury Prevention and Research Center; Anthony Clark, Private Practice
Purpose: A survey of recent dental school graduates to reflect practice habits. Questions were asked about the treatment of pediatric patients (children under sixteen years of age), medically compromised patients (ASA III or greater), and mentally handicapped patients. Additional questions regarded respondents’ level of confidence during procedures on specific groups of patients, as well as the approximate number of patients seen in the practice. A third section of the survey related to the perceived benefit additional training would be in the areas of medically compromised patients and pediatric patients.
Access to dental care for pediatric and special needs patients continues to be a problem in the United States. Caries in children is rampant in many states, despite recent attention to the problem at the national level. The objective of this study was to attempt to understand practice patterns and availability of care from recent dental graduates. A survey was sent to recent graduates (1997–2001) of five dental schools in the United States. Questions pertained to type of practice, numbers of children and special needs patients seen, acceptance of Medicaid, and assessment of the dentist’s training to meet the needs of these patients. One hundred ninety-four surveys were returned out of 840 for a response rate of 23 percent. Only 52 percent of the responders work in practices that accept Medicaid. Most (91.8 percent) treat children and are confident in their abilities to treat children and special needs patients. Interestingly, the majority indicated that they would have been willing to spend an additional year training in dental school if they were dedicated to pediatrics and special needs patients. The conclusion of the study is that recent graduates from five dental schools generally are confident in their abilities to treat these patients, but many do not accept Medicaid in their practices and the majority would choose additional training in dental school to treat special needs patients.
2. Predental Enrichment Activities of U.S. Colleges and Universities
Lauren E. Mentasti, University of Connecticut; Edward A. Thibodeau, University of Connecticut; David M. Demers, University of Connecticut
Purpose: To examine predental enrichment activities and their impact on the number of applicants from the nation’s top dental school feeder institutions (DSFI).
The DSFI were identified by their total number of applicants to dental schools and by their number of applicants per total student enrollment. A survey consisting of twenty-five yes/no questions on possible predental enrichment activities was administered by phone or sent by email to the top eighty-eight DSFI, with forty-nine responding. Pearson correlation coefficients were used to measure the relationships among the number of applicants, predental activities, and total student enrollment per institution. The total number of applicants/institution was correlated with the total student enrollment/ institution (r=.529) and the number of predental activities/institution (r=.520). No correlation was observed between the number of activities at an institution and applicants per thousand enrolled. The percentages of DSFI with specific enrichment activities were preprofessional health advising programs (96 percent), dental clubs (88 percent), volunteer programs (73 percent), specific predental advising (69 percent), practice interview sessions (61 percent), shadowing program (59 percent), personal statement workshops (53 percent), committee for letters of recommendation (49 percent), clinical observation program (45 percent), oral health outreach to elementary/middle schools (39 percent), on-campus dental care facilities (37 percent), dentistry overview/introduction course (31 percent), DAT review course (27 percent), predental honors society (20 percent), affiliated dental school (20 percent), ASDA chapter (18 percent), special interest/minority dental group (16 percent), scholarships for predental students (10 percent), combined degree program (10 percent), and predentistry as a major (6 percent). Sixteen of the DSFI reported ten or more enrichment activities.
While larger institutions produced more applicants and had more activities, there was no correlation between the number of applicants per 1,000 students enrolled and the number of enrichment activities at an institution. The two activities most common to the top feeder institutions were a preprofessional health advising program and a dental club. Results indicate that there are specific predental enrichment activities common to the top dental school feeder institutions in the United States and that a better understanding of these may assist non-feeder schools in developing or strengthening an interest in dentistry as a career option.
3. Advanced Standing Programs for Foreign-Trained Dentists in U.S. Dental Schools with a Focus on IDP-UCSF
Takashi Komabayashi, University of California, San Francisco; William F. Bird, University of California, San Francisco
Purpose: Foreign-trained dentists who want to practice in the United States are asked to participate in a U.S. dental school for a U.S. D.D.S. degree. However, no previous report has been made regarding advanced standing D.D.S. programs for foreign-trained dentists. Therefore, this study compares U.S. nationwide advanced standing D.D.S. programs for foreign-trained dentists (ASDDS) and results of the International Dentist Program at the University of California San Francisco (IDP-UCSF) (2000–04).
Nationwide distribution of ASDDS differs from state to state. All five California dental schools offer ASDDS, while ASDDS is offered at twenty-four other dental schools throughout the United States. Class size ranges from two to 100. Test of English as a Foreign Language (TOEFL) and National Board Dental Examination, Part I (NBDE I) are mandatory to apply in most cases. The minimum scores required range from CBT 213 (PBT 550) to CBT 250 (PBT 600) in TOEFL, and from 75 to 90 in NBDE I. Technical examination and interview are held. A length of study is two or three years, and some programs fully or partially integrate to the equivalent of the second or third year of the existing domestic dental school program, while others are completely independent. IDP-UCSF is a two-year program that begins in June of each year and culminates in a Doctor of Dental Science (D.D.S.) degree. The program has admitted twenty-two or more foreign-trained dentists yearly since 2000. More than half of the students are from the Republic of India. IDP-UCSF is unique in that it includes 1) complete integration to existing domestic D.D.S. program; 2) various sites for clinical training; 3) 100 percent passing rate in California state board examination and other regional examination boards; and 4) a high percentage of IDP-UCSF graduates has been accepted into postgraduate specialty programs.
Outcomes of this study are useful implications for curriculum development in U.S. dental programs for foreign-trained dentists.
4. Clinical Simulation: Ahead of the Game
Karen M. Gardner, University of British Columbia; Lance Rucker, University of British Columbia
Purpose: To introduce the concept of full clinical simulation in a fast-track curriculum.
The University of British Columbia introduces its clinical dentistry using full clinical simulation. We believe the total integration of students into the complete clinical setting from the outset of their clinical training allows a quicker and smoother transition into clinical dentistry. With the onset of a full problem-based learning (PBL) curriculum in 1994, we were asked to accept that our dental students would receive no clinical training until the final month (June) of the second year in our four-year program. In spite of this restriciton, the operative division was asked to have the students ready to perform Class I, II, III, and IVs on live patients within twelve weeks. Here’s how we did it. 1) In June of the second year, students are launched into a month-long intensive course for introduction of clinical skills, lovingly referred to as Boot Camp I. During this time, the students go from never having picked up a dental handpiece to passing a competency involving a Class I amalgam preparation and a Class II amalgam restoration. The students work in full clinical simulation, receiving lectures and clinical simulation training on rubber dam, matrix systems, hand instrumentation, cavity preparation principles, dental materials (amalgam, composite, glass ionomer, IRM), pediatric dentistry (fissure sealants), and other psychomotor skills. 2) The students return at the end of August to attend Boot Camp II (the first part of the third-year operative dentistry course). Between the end of August and the middle of October, they complete various exercises and clinical quizzes that lead to a competency exam at the end of September during which, in two hours, they complete the following: amalgam Class II preparation, amalgam Class II restoration, composite Class III preparation, and composite Class III restoration. 3) Within the next three weeks, they complete exercises in Class V glass ionomer and Class II composite preparation and restoration. 4) At least half of the class has been deemed competent to perform these procedures on patients by the middle of October (although this is carried out with intense instructor-student supervision ratios). The remainder perform these procedures when their competence dictates. 5) Almost all of the students have achieved complete clinical access to these procedures by early December. 6) Complex procedures are examined by the end of the second month of the second semester of the third year (February). Full clinical simulation allows the teaching to move at this pace because, we feel, students are fully integrated and thus do not have to spend time relearning the procedures when a new environment is introduced. That is, full clinical simulation (in the clinics) optimizes skill transfer from the simulation setting to clincal treatment settings. One concern with any fast-track program is the maturation factor. Students may have the skills to perform a certain set of procedures successfully on one or even a few occasions, but they simply lack confidence in their abilities to consistently produce acceptable results. Experienced instructors, both full- and part-time, report high confidence in the quality of skills displayed by students well trained in full clinical simulation. Advantages are that the program allows full integration into the first two years of the medical curriculum (PBL), a simulation lab is not required (chairs can be used for live patients when not being used in simulation), and it provides for a smooth transition into complete patient care. Disadvantages are that the program lacks maturation time, requires low student instructor ratio throughout the third year, students do not perform any clinical dentistry (in simulation) until the end of second year, and there is intense clinical training from the end of second year until the start of fourth year.
A fast-track approach to clinical training in dentistry is possible. It requires full clinical simulation and exquisite planning.
5. Blood Pressure Changes in Hypertensive Patients During Dental Treatment
Jody F. Schilling, University of Michigan; John P. Gobetti, University of Michigan
Purpose: To measure the changes in blood pressure (BP) of hypertensive patients during dental procedures to provide dentists with guidelines for the safe treatment of hypertensive patients. A literature review yielded limited information on the topic.
A convenience sample of seventy-nine patients at the University of Michigan School of Dentistry was used. Eligible patients had diagnosed/medically treated hypertension as defined in the JNC VII report. A Criticare 506DX electronic cuff remained on the arm to record initial, intraprocedural (specifically during perceived physical/ emotional stress), and final BPs. Additional data included patient demographics, pertinent medical history, and rating of dental anxiety perception. Study participants consisted of thirty-seven women and forty-two men with an average initial systolic (S) BP 148mm Hg (range 114 to >201), diastolic (D) BP 81mm Hg (50 to >113). The average number of BP readings per participant was ten (range two to twenty-eight). Average BP increase for all procedures was S 13mm Hg (range -18 [negative denotes decrease from initial BP] to >49), D 7mm Hg (-15 to >34). Each treatment category showed BP increases. Average increases and ranges of BP changes are as follows: extractions S 23 (0 to >49), D 12 (0 to >29); periodontal surgeries S 15 (–6 to >46), D 10 (–5 to >23); restorative S 15 (–14 to >44), D 5 (–7 to >19); periodontics (maintenance, scaling, root planing) S 12 (0 to >30), D 6 (–4 to >16); treatment plans and/or simple prophylaxis S 10 (–6 to >24), D 8 (–2 to >34); endodontics S 7 (–4 to >23), D 3 (–5 to >11); non-invasive prosthodontics S 3 (–18 to >28), D 5 (–15 to >32). S BP increase for all procedures correlated (p=0.036) with negative dental anxiety perception. BP of thirty-eight patients was measured during injections; the average increase was S 6 (–19 to >44), D 3 (–15 to >29). This study was funded by an NIDCR training grant.
Dentists should determine the risk of treating hypertensive patients based on initial patient BP, type of procedure, and patient perception of dental visits. While the average BP increases were not exceptional, the upper ranges of the BP changes were clinically significant. Although a limited sample, our data show BP increases in hypertensive patients during dental procedures, indicating that BP monitoring of hypertensive patients is essential.
6. Identifying and Teaching Generation X Dental Students
Matthew S. Milliner, University of Kentucky; Judith Skelton, University of Kentucky; Paul Osborne, University of Kentucky; Melody Ryan, University of Kentucky; Frank Romanelli, University of Kentucky
Purpose: To determine the degree to which dental students identify with the characteristics ascribed to Generation X’ers and to describe the implications of these characteristics for teaching and learning.
Cultural experiences and climate affect students’ attitudes, values, and beliefs. These influences have an impact on the learning of students and, therefore, should be taken into consideration by those teaching students. Dental educators are struggling to understand this generation of learners to maximize their professional experiences. Little information is available to determine how closely professional students identify with Generation X characteristics. Two surveys were employed in this study. The first instrument was modeled after a survey administered and described by Peter Sacks in his text, Generation X Goes to College. The survey instrument was meant to ascertain attitudes and beliefs of Generation X students. The second survey is a validated Generation X scale. Sixty-seven percent of dental students surveyed were male. Most students ranked the most important quality of an instructor as being warm and friendly. Most thought grades should be primarily based on knowledge and performance in a subject. The majority of students thought the average grade in their respective college should be a B. Further results will be presented.
Generation X students manifest a collective group of characteristics and traits that may affect learning aptitude. Knowledge and awareness of these traits both by faculty and students may improve teaching and learning.
7. Effective Learning Experiences in Dental School: A Qualitative Study
Sarah Hogan, Case Western Reserve University; Kristin Zakariasen Victoroff, Case Western Reserve University
Purpose: Students’ views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students’ dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method.
All seventy third-year and seventy fourth-year dental students enrolled in one midwestern dental school were invited to participate in this study. During summer 2004, fifty-three dental students (thirty-two third years, twenty-one fourth years; thirty-five male, eighteen female) were interviewed using a critical incident interview technique. Each student was asked to describe 1) a specific, particularly effective learning incident that he or she had experienced in dental school and 2) a specific, particularly ineffective learning incident for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the audiotapes. Data were coded, and themes were generated using techniques from grounded theory. The following are themes generated from the data that describe characteristics of effective learning experiences during dental school: 1) instructor characteristics (enthusiastic attitude, checking-in with students, interactive style), 2) learning format (clear focus, relevance, emphasis on concepts and understanding why), 3) learning process (effective demonstrations, opportunity to apply new knowledge, appropriate and timely feedback, opportunity to see the "big picture"), and 4) learning culture (openness to questions, focus on learning rather than performance).
Common themes emerged across a wide variety of learning incidents. Although further research is needed, these themes may have implications for individual course design and for the curriculum as a whole.
8. Utilization of Dental Students as Faculty to Compensate for Faculty Shortage
Jasmin Steven, University of Missouri-Kansas City; Reem N. Haj-Ali, University of Missouri-Kansas City; Cynthia S. Petrie, University of Missouri-Kansas City; Mary P. Walker, University of Missouri-Kansas City
Purpose: To evaluate whether senior dental students could function as effective educators in preclinical laboratory courses and whether such teaching experience could enhance their interest in teaching as part of their future career.
Five senior dental students and five full-time faculty were selected as instructors in a two-semester Dental Morphology and Occlusion preclinical lab course. The ninety-five first-year dental students (1DS) enrolled in this course were randomly assigned to be instructed by a full-time faculty (FF) in one semester and a student-faculty (SF) in the other semester. At the end of each semester, course evaluation forms were completed by the 1DS. The forms ranked faculty from 1 (poor) to 5 (excellent) in six different categories. The student-reported FF and SF performances were compared. In addition, the performances of the 1DS in the lab examinations were compared in respect to instructor type. The senior students were surveyed for their reactions to this teaching experience. The median (semi-interquartile range) performances of the FF and SF were as follows: contribution to knowledge [4.0 (0.5), 4.0 (0.0)], ability to create a positive learning environment [4.0 (0.5), 4.0 (0.5)], ability to communicate effectively [4.0 (0.5), 4.0 (1.0)], availability [3.5 (0.5), 4.0 (0.5)], fairness in grading [4.0 (0.5), 4.0 (0.25)], and overall teaching effectiveness [4.0 (0.5), 4.0 (0.5)] respectively. A Wilcoxon matched pairs signed rank test showed no statistically significant difference between the performance of SF and FF in all categories evaluated (p>.05). An independent t-test revealed no significant difference between the performances of 1DS that were instructed by FF versus those instructed by SF in both semesters (p>.05). In addition, such classroom teaching experience did not necessarily enhance the senior students’ interest in considering teaching as part of their future career.
Senior students appeared to function as effective educators in preclinical Morphology and Occlusion lab courses. Despite the fact that such experience did not influence students’ decision to consider academics as a future career, it provides a quick means to compensate for faculty shortage.
9. Student Perceptions and Use of Digital Textbooks
William Davenport, University of Nevada, Las Vegas; Matthew R. Wirig, University of Nevada, Las Vegas; William J. Curtis, University of Nevada, Las Vegas; Scott Redlinger, University of Nevada, Las Vegas; Paul Froude, University of Nevada, Las Vegas
Purpose: The concept of digital textbooks has been around for many years; however, the practicality of their use is still a matter of debate. In this study we will determine student perceptions of this technology. We will also determine the amount of time students study using either digital textbooks or traditional ones. By investigating the opinions and study habits of numerous dental students around the nation, we plan to provide evidence that either supports the use of digital textbooks or their removal from existing curricula.
Seven dental schools that currently use digital textbooks on DVD have been paired with seven schools that do not. The matching schools were chosen on the basis of similar demographics using the ASDA Guide to Dental Schools (2003). Criteria used for pairing included class size, entrance GPA, entrance science GPA, and DAT scores. Two surveys, one for the study group (schools that use digital textbooks) and one for the control (schools that use traditional textbooks), were constructed. These surveys were posted on a website, and the link was initially emailed to all students at one of the study schools. Seventy percent of the student body completed the survey resulting in an initial study group of 105 students. The link will be sent to all other participating schools. Preliminary results show that 74 percent of students prefer to have their textbooks on computer and 75 percent use their textbooks only as a supplement to class material or as a reference.
It appears that digital textbooks are a viable option to traditional textbooks. Preliminary results indicate that students prefer digital textbooks. Cost of the technology was not taken into account in this study but may appear to be a major deterrent for both students and administration.
10. General Dentists and Special Needs Patients: The Role of Undergraduate Dental Education
Loan P. Dao, University of Michigan; Samuel Zwetchkenbaum, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To determine the effect of undergraduate dental education on general dentists’ professional behavior, practice characteristics, and attitudes concerning special needs patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health concluded that special needs patients are one of the most underserved patient groups in the United States. The objective of this study was to investigate whether undergraduate dental education about treating special needs patients and patients with mental retardation will affect general dentists’ professional behavior, practice characteristics, and attitudes concerning special needs patients. Data were collected with a self-administered survey mailed to a random sample of 500 general dentists who were members of the Michigan Dental Association. The response rate was 41 percent (N=204). Most respondents were male (84.8 percent). The participants’ ages ranged from twenty-seven to ninety-two years (mean=50.1 years). Only 14.2 percent of the respondents reported that their undergraduate education had prepared them well to treat special needs patients, and only 11.7 percent indicated that they had been well prepared to treat patients with mental retardation. The more the respondents agreed that their undergraduate dental education had prepared them well to treat special needs patients and patients with mental retardation, the higher was the percentage of patients from lower socioeconomic backgrounds (r=.21; p.004; r=.20; p=.005) and patients covered by Medicaid (r=.14; p=.05; r=.16; p=.03). The more they agreed that their undergraduate education had prepared them well to treat special needs patients and patients with mental retardation, the more children with special needs (r=.19; p=.02; r=.18; p=.02) and the more adult and children with different disabilities (such as patients with motion, visual, or hearing impairments) they treated. Concerning their practice, the results showed that the better their undergraduate dental education had prepared them to treat special needs patients and patients with mental retardation, the better their practice was set up to treat these patients (r=.28; p=.000; r=.22; p=.002), and the more comfortable (r=.33; p=.000; r=.31; p=.000) and knowledgeable (r=.44; p=.000; r=.46; p=.000) their staff was concerning treating special needs patients. The degree to which these respondents liked to treat special needs patients and were comfortable treating them was significantly correlated with their perception of the quality of their undergraduate education concerning the treatment of special needs patients (r=.35; p=.000; r=.25; p=.000). This research showed that general dentists did not perceive that their undergraduate dental education had prepared them well to treat patients with special needs or mental retardation. However, the better they had been prepared, the more likely they were to treat these patients, the better their practice was set up to serve these patients, and the more positive their attitudes were towards treating these underserved patients. Given the high percentages of patients with special needs, it seems crucial that undergraduate dental curricula be examined concerning their inclusion of material concerning these patients.
11. Resource Utilization for Clinical Decisions Regarding Posterior Composite Restorations
Tabitha Strain, University of Missouri-Kansas City; Reem N. Haj-Ali, University of Missouri-Kansas City; Mary P. Walker, University of Missouri-Kansas City; Cynthia S. Petrie, University of Missouri-Kansas City; Karen B. Williams, University of Missouri-Kansas City
Purpose: To characterize the dental resource utilization patterns of a national sample of general dentists with respect to clinical decisions regarding posterior composite restorations.
A stratified random sample of dentists (n=2880) was obtained using the Academy of General Dentistry membership list. Members were mailed a questionnaire that elicited information about practice characteristics, resources used for clinical decision making, and CE attendance related to posterior composite restorations. Six hundred and ninety-nine dentists responded for a 24 percent response rate. The average years experience of the respondents was 20.6 years (11.6), with 67 percent being general AGD members, 26 percent Fellow, and 8 percent Master AGD members. AGD Master-level members were significantly more likely to use evidence-based (EB) resources (journals and professional meetings) than their counterparts (p<.05). When considering years of experience, use of EB resources was low for all respondents (14 percent) irrespective of experience. However, more experienced clinicians were more likely to use EB resources than recent graduates. Newer graduates were less likely to use information from manufacturers in clinical decisions (p<.05), but more likely to rely on colleagues as resources (p<.05). Patterns of Internet use for online information was not significantly different among experience groups; however, newer graduates were more likely to use this information source.
Although it is likely that newer graduates are exposed to EB dentistry, current patterns of use elicited in this survey suggest a low reliance on evidence-based resources in the practice of clinical dentistry.
12. Providing Care for Underserved Patients: The Role of Dental Education
Carlos S. Smith, University of Michigan; Todd V. Ester, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To explore the role of dental education for dental students’ attitudes and intentions to treat underserved patients in their future professional lives and practicing dentists’ attitudes and actual behavior concerning treating underserved patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health stressed the importance of providing oral health care to underserved patient groups such as underrepresented minority patients. The objective of this study was to explore whether dental education about underserved patient populations will affect dental students’ attitudes and intentions to treat underserved patients in their future professional lives and practicing dentists’ attitudes and actual behavior concerning treating underserved patients. Data were collected from 328 of the 423 students enrolled during the academic year 2003–04 at a midwestern dental school (response rate: 77.5 percent). In addition, surveys were mailed to 535 dental school alumni (response rate =43.7 percent; N=234). Overall, 67.4 percent of the students and 38 percent of the alumni indicated that their education prepared them well to treat patients from different socioeconomic backgrounds, 71.3 percent of students and 55.2 percent of alumni reported that they had been well educated to treat patients from different ethnicities, and 40.2 percent of students and 34.6 percent of alumni that they were well educated to treat special needs patients. The more the students agreed that their dental education had prepared them well to treat patients from different ethnic backgrounds, the more they intended to treat these patients in the future (r=.12; p=.033); the better their education prepared them to treat special needs patients, the more they intended to treat these patients in the future (r=.23; p=.000). The more the alumni dentists agreed that the dental school had prepared them well to treat patients in different communities and to gain insight into barriers to receiving dental care, the more likely they were to treat patients from different socioeconomic backgrounds (r=18; p=.009; r=.17; p=.01) and patients with disabilities (r=.17; p=.011; r=.22; p=.001). In addition, dentists’ attitudes concerning interacting with patients from different backgrounds, addressing community needs, and making a positive difference on public issues were significantly correlated with the degree to which they perceived they were well prepared by their dental education to treat patients in different communities (r=.16; p=.015). In conclusion, these findings showed that access to oral health care for currently underserved patients could potentially be increased if dental curricula would educate students more inclusively about treating patients from different backgrounds.
13. Younger Versus Older Adults Diagnosed with TMDs: Preliminary Findings
James A. Wysocki, State University of New York at Buffalo; Kimberley Zittel-Palamara, State University of New York at Buffalo; Yoly M. Gonzalez, State University of New York at Buffalo; R. Seiji Ohtake, State University of New York at Buffalo; Jude A. Fabiano, State University of New York at Buffalo
Purpose: Several epidemiological studies have shown that approximately 10 percent of the United States population experiences TMDs. The prevalence of these conditions is higher in younger adults and decreases in prevalence in older adults. To date, limited research examines differences between younger and older adults with TMDs. This study examined biobehavioral characteristic differences in sixty-seven patients who received multidisciplinary TMDs treatment in a university clinic.
This pilot study compared patients who were sixty years of age and older (n=11) to patients who were ages eighteen to fifty-nine (n=52). Each patient with an RDC diagnosis was administered standardized instruments to determine biobehavioral and social demographics. Biobehavioral differences were found, including being a Medicaid recipient, an anxiety diagnosis, taking psychotropic medication, tobacco use, and alcohol use. More young adults had Medicaid (n=14, 51.9 percent) versus those sixty and older. This difference was significant (Mann-Whitney Rank Sum Test [MWRST]: p=.023). Younger patients reported more anxiety (n=15, 53.6 percent) than did those sixty and older (28.6 percent). This difference was significant (MWRST: p=.051). Younger patients reported taking psychotropic medication more frequently (n=15, 55.6 percent) than did those sixty and older (28.6 percent). This difference was significant (MWRST: p=.006). Younger patients reported using tobacco more frequently (37.5 percent) with no patients sixty and older smoking. Patients who were sixty and older reported using alcohol more frequently (50 percent) than did younger patients (n=8, 33.3 percent). Aggregated smoking and alcohol data was significant (MWRST: p=.004). These results point to more financial and mental health concerns in the younger adult TMDs patients than those sixty and older.
It is possible that these observations are due to older adults’ less frequently seeking out mental health professionals, thereby neglecting to report a mental health condition. Instead, those sixty and older may be self-medicating an underlying mental health diagnosis with alcohol. Future research with larger sample sizes needs to be conducted in order to examine specific characteristics of biobehavioral and social issues presenting in older adults being treated for TMDs. Social work professionals are integral to the biobehavioral management of patients with TMDs.
14. Services for Special Needs Persons by African American Dentists in Tennessee
Erin S. Hughes, Meharry Medical College; Edwin H. Hines, Meharry Medical College; James E. Tyus, Meharry Medical College; William B. Butler, Meharry Medical College
Purpose: Special needs persons represent a significant underserved population for professional dental services. An estimated 50 percent or more of this population receives inadequate dental services. The level of services provided for this population by African American dentists is not well known. In this study, the special needs practice patterns of licensed African American dentists in Tennessee was determined.
A survey, designed to be culturally sensitive, including twenty culturally oriented incentives to respond, was mailed to 220 African American dentists in Tennessee. Of those, 125 surveys were completed and returned (56.8 percent). Results of the survey indicate that 75 percent of respondents work in private offices, with 85 percent accepting special needs patients. Of the respondents, approximately 27 percent treat zero to five cases/year, 37 percent treat six to twenty cases, 15 percent treat twenty-one to fifty cases, and 4 percent treat more than fifty special-needs persons/year. No handicap was identified as being not acceptable for treatment. Less than 10 percent of negative respondents indicated a lack of patient demand and/or dentist interest, and 12 percent identified other reasons. Seventy-five percent indicated a special interest in African American services. Some 80 percent were receptive to more information, and 75 percent gave positive responses to being placed on a national register of providers or would like more information. We conclude from the results of this study that African American dentists in Tennessee are outstanding sources for special needs services and these dentists represent an excellent opportunity for increased involvement in services for special needs populations.
15. Complementary and Alternative Medicine Awareness in Dentistry
Michael Capalbo, University of Connecticut; Michael Goupil, University of Connecticut
Purpose: The purpose of the first phase of this study was twofold: 1) to determine if Connecticut general dentists are inquiring about the complementary and alternative medicine (CAM) practices of their patients, and 2) to determine if the Connecticut dentists have knowledge in CAM or have any interest in being further educated in CAM. The next phase of this study was to determine if dental schools are currently teaching or planning to incorporate CAM in their dental curriculum.
The use of CAM is no longer excluded from health care in the United States and has been thrust into the mainstream of health care for many Americans. Between 1990 and 1997, there was a 47 percent increase in visits to alternative practitioners. In 1997, four in ten Americans were using at least one type of alternative medicine, and an estimated 15 million adults in 1997 took prescription medicine concurrently with herbal remedies and/or high-dose vitamins. The growing number of patients choosing to use CAM is evidence that the modern-day dental clinician needs to be aware that alternative medicine is a viable and popular option for many of their patients. It is becoming imperative that dentists are educated in the different types of CAM treatments and the effects that these treatments have on prescription drugs and dental care. Without the proper education about alternative medicine, dentists can not provide the highest quality health care to their patients. The purpose of the first phase of this study was twofold: to determine if Connecticut general dentists are inquiring about the CAM practices of their patients and to determine if they have knowledge of CAM or any interest in being further educated in CAM. The next phase was to determine if dental schools are currently teaching or planning to incorporate CAM in their dental curriculum. In Project 1, a random sample of active Connecticut general dentists was selected from the Connecticut State Dental Association’s 2002 roster. The population size was 1300, and 250 dentists were randomly selected. In Project 2, the population was fifty-two dental schools in the United States, all of which were sent a survey. In Project 1, we conducted our survey by mail between the dates of July 1 and August 30, 2003. The surveys were coded to maintain confidentiality. A cover letter reinforcing the importance of participation and objectives of the study, as well as the purpose of the code, was included along with a prepaid preaddressed return envelope. A second survey was sent to all nonrespondents on September 1, 2003. In Project 2, we conducted our survey by email. A cover letter that reinforced the objectives and importance of our study was included in the email. Data were analyzed using descriptive statistics and nonparametric statistics for frequency distribution. In Project 1, of the 250 surveys mailed, 237 reached the target audience; 190 were returned for a return rate of 80 percent. Of the 190 general dentists who returned the survey, 78.4 percent reported that they did not inquire about the CAM practices of their patients and 74 percent reported being interested in learning more about CAM in the future. In Project 2, of the fifty-two surveys sent out, twenty-seven were returned for a return rate of 52 percent. Of those, 7.4 percent of the schools reported currently incorporating CAM in their dental school curriculum, and none of the other respondents had any plan to incorporate CAM lectures into their curriculum.
In Project 1, survey results indicated that a majority of Connecticut general dentists were not inquiring about the CAM practices of their patients. Although most of the dentists surveyed expressed the desire to learn more about CAM, many were not aware of its prevalence of use among their patients. In Project 2, survey results indicated that a great majority of dental students are not being taught CAM in dental school and there are no plans to add CAM to the curriculum in the future.
16. Dental Student Response to an Oral Health Intake Record for Pediatric Patients: Update
Laurence D. Pfeiffer, Stony Brook University; Fred S. Ferguson, Stony Brook University
Purpose: Determine dental students’ response to the use of a new health intake record.
A pediatric health intake record (Pediatric Oral Health Concerns Record: POHCR) was designed that identifies risk factors to oral health, facilitates dental students’ understanding of pediatric oral health, and provides individualized oral health care and counseling to caregivers. The POHCR has been in clinical use for four years from 2001 to the present. The form has evolved from a concise double-sided paper form to an extensive form presented on clinic computers (Axium). The POHCR serves to present health and behavioral concerns that relate to risk for pediatric oral disease. A multiquestion survey was used to record students’ response concerning the POHCR. From the class of 2002, thirty-four students who had completed 290 hours of children’s dentistry clinic reported on the concise double-sided paper form. A different survey was given to twenty-nine students from the class of 2001 who had completed 290 hours of children’s dentistry clinic without use of the POHCR. In a partial report of the results, 91.3 percent of the class of 2002 reported that the POHCR helped in the interview with the parent/guardian, whereas 88.2 percent reported that the POHCR helped them understand caries risk factors. In the class of 2001 survey, 93 percent state they would have benefited from the POHCR in performing a more complete interview with the caregiver and the patient, while 82 percent reported the POHCR would have helped them perform a more efficient clinical exam and 97 percent reported it would have helped in the selection of proper oral health counseling. Finally, 93 percent of the class of 2001 reported that, with the use of the POHCR, they would have obtained a better understanding of oral health risk factors when interviewing a caregiver. From the class of 2003, thirty-three students who had completed 290 hours of children’s dentistry clinic reported on the more extensive paper form. In a partial report of the results, 100 percent of this class reported that the POHCR helped in the interview with the parent/guardian, and the same percentage reported that it helped them in understanding caries risk factors. From the class of 2004, twenty-seven students who had completed 290 hours of children’s dentistry clinic reported on the edited version of the form. In a partial report of the results, 100 percent reported that the POHCR helped in the interview with the parent/guardian, and the same percentage reported that the POHCR helped them in understanding caries risk factors. From the class of 2005, twenty-nine students who had completed 290 hours of children’s dentistry clinic reported on the new more extensive computerized form. In a partial report of the results, 100 percent reported that the POHCR helped in the interview with the parent/guardian, whereas 96.6 percent reported that the POHCR helped them in understanding caries risk factors. The results of the study support that dental students believed they benefited from the use of the POHCR and that it helped them have a better understanding of the risk factors for dental caries and provide individualized patient care. As pediatric oral health/disease is a multifactorial concern, determination of the risk concerns and recognition of the significance of oral findings are essential in the student’s ability to provide appropriate oral health counseling and care. The POHCR facilitates dental students’ ability to obtain this information, while also enhancing their communication skills.
17. Variations Between Health Care Professionals Regarding Herpes Labialis Management
Winnie Wong, University of Alberta; G. Wayne Raborn, University of Alberta; Michael Grace, University of Alberta
Purpose: To assist in the development of a qualitative analysis study instrument to be administered to patients who suffer with recurrent herpes labialis.
As part of the development of a qualitative analysis study instrument, four health professionals, selected for their varying types and level of expertise relative to patient contact, were interviewed regarding their interactions with herpes labialis patients. The pilot group of health professionals were a pediatric infectious diseases specialist, rheumatologist/allergist, oral pathologist, and pharmacist. The interviews were structured around questions about professional background, patient demographics and immune status, frequent presentation, complications, and treatment, while allowing further discussion into each professional’s area of expertise. Each interview lasted between forty-five and sixty minutes. A content analysis was applied to assess the interview data. The health professionals interviewed agree about the high prevalence of previous herpes infection (90–100 percent) and some form of trauma being a trigger for herpes outbreak. However, substantial variation in clinical philosophies and treatment recommendations arose based on the differing experiences of each health professional. The pharmacist typically interacted with immune competent herpes labialis patients, and recommendations focused on treatment with over the counter medications and prevention through promotion of a healthy lifestyle. Conversely, the medical and dental specialists generally encountered immune compromised patients with atypical presentation. Thus, recommendations focused on treatment and prevention of complications with prescription medications. This range in patient presentation, whether immune competent or compromised, led to differing opinions regarding prevention and treatment of herpes labialis with antivirals. Although this was a small sample size and pilot study, it shows that differences exist among health professionals as the experts to whom the public turns for advice. This variation in perspective and mechanisms is related to interaction with patients, emphasizing the need for coordination of care and continuing education to ensure quality patient service. The results of these interviews are being used to formulate questions for focus groups of herpes labialis patients and, ultimately, a large-scale qualitative analysis instrument to survey herpes labialis patients.
18. General Dentists and Pediatric Dental Patients: The Role of Dental Education
John P. Rich, University of Michigan; Lloyd Straffon, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To investigate the effect of undergraduate dental education on general dentists’ practice characteristics, referral patterns, best practices, and challenges encountered when treating pediatric dental patients.
In the year 2000, the first U.S. Surgeon General’s report on oral health pointed to the importance of increasing access to oral health care for pediatric dental patients. The objective of this study was to investigate whether undergraduate dental education about treating pediatric dental patients affects general dentists’ practice characteristics, referral patterns, best practices, and challenges encountered when treating pediatric dental patients. Data were collected with a survey mailed to a random sample of 500 general dentists who were members of the Michigan Dental Association. The response rate was 48.2 percent (N=241). Only 40.4 percent of the respondents reported that their undergraduate education had prepared them well to treat child patients, and only 33.4 percent that their clinical experiences during dental school had prepared them well. The more the respondents agreed that their undergraduate dental education and their clinical experiences had prepared them well to treat pediatric patients, the more they agreed that their practice was set up to treat child patients (r=.25; p=.000; r=.31; p=.000) and that their staff was knowledgeable (r=.27; p=.000; r=.31; p=.000) and comfortable treating child patients (r=.24; p=.000; r=31; p=.000). The better they were prepared, the more different treatments they performed with pediatric patients (r=.23; p=.012; r=.20; p=.003), the less likely they were to refer these patients (r=20; p=.003; r=.20; p=.003), and the more likely they were to offer special arrangements and accommodations for pediatric patients (r=.14; p=.043; r=.12; p=.09). In conclusion, less than 50 percent of practicing general dentists reported that their undergraduate dental education had prepared them well to treat child patients. However, the better they had been prepared, both in general and during clinical encounters, the better their practice was set up to serve these patients, the less likely they were to refer these patients, and the more likely they were to perform various treatments on pediatric patients and to offer special arrangements. These results point to the significance of exploring how future dental providers can be prepared better for treating pediatric dental patients during their undergraduate education.
19. Use of, Knowledge About, and Attitudes Towards Computers at the National Autonomous University of Mexico Dental School
Miguel H. Torres-Urquidy, University of Pittsburgh; Javier de la Fuente Hernand, National Autonomous University of Mexico
Purpose: To determine the levels of utilization and understanding of computer technology among the student population.
The utilization of computer technology by dental students has not been measured in Mexico. The investigators translated into Spanish and adapted a survey that was previously validated in a measurement study. Then it was pretested with a random group of twenty students who were not part of the final sample. The survey was modified and distributed. The response rate of our sample was almost 100 percent. Of the total of 1569, the responses per year were: first year 24.3 percent (N=381), second year 26.6 percent (N=418), third year 15.5 percent (N= 243), fourth year 14.7 percent (N= 231), fifth year 18.7 percent (N=293); 72 percent were female. The use of computers in number of hours per week was 7.9 on average (median=6, mode=10). The school-related activities where the computer was used more frequently was searching Medline (fifth year, 30 percent once a month) and less frequently emailing patients (first year, 79 percent never); 72 percent of the students responded that self-learning has been part of their training experience in computers. For the students, the capability of computer systems of most importance was that "the system should be always functioning" (83 percent) followed by "the system should allow you to manage all patient information" (73 percent). In general, the study found that the effect of computers on practice is beneficial especially when accessing up-to-date information (55 percent answered highly beneficial). Strong statistical analysis was not used as part of this preliminary report. However, it is reasonable to assume that the use of computers by dental students increases throughout their dental training. A similar trend can be assumed for computer knowledge. Overall, the students’ attitudes were positive.
The use of computers can have a positive effect while training dental students; thus, dental educators should further explore the impact of information technology in dental education.
20. A Need for Oral Health Care in a Rural Community
Humaira Yousuf, University of Missouri-Kansas City; Michael McCunniff, University of Missouri-Kansas City; Karen Williams, University of Missouri-Kansas City
Purpose: The goal of this project is to conduct an empirically based, theoretically grounded, and methodologically valid needs assessment in rural Kansas that elicits parents’ attitudes, social norms, and perceived control with respect to their children’s oral health.
Early childhood caries (ECC) is a severe form of tooth decay that affects the primary dentition of young children. It is a national public health problem and also a statewide public health issue in rural Kansas, where children of low-income parents from certain ethnic minority groups are at a high risk for developing ECC. To prevent this chronic childhood disease, it is essential that parents be advised about ways to maintain their children’s oral health and decrease their exposure to risk factors for the disease. The needs assessments were administered in Pittsburgh, KS to a convenience sample of forty-two English-speaking parents of children, ages one day to five years, enrolled in the WIC (women, infant, and children) program, MIC (mother and infant clinic), and the Immunization clinic. The written questionnaire, grounded on the Theory of Planned Behavior (TPB), assessed sixty items based on the following domains: parents’ demographics, parental knowledge about ECC, parental attitudes/beliefs about cariogenic drinks, social norms about people likely to influence them on children’s dental care, control beliefs on how much power they have in preventing tooth decay in their children, and parental behavior towards their children’s dental needs. Using the SPSS Statistical program, we found that the greatest area of deficit lies in parental behavior, such that most children above the recommended age have not had their first dental visit. Overall understanding of the prolonged effect of exposure to sugared drinks was poor. Most parents didn’t comprehend the potential manifestations associated with ECC nor the importance of a primary dentition. Parents elicited positive attitudes with respect to their children’s dental needs. However for some, tooth decay is inevitable, which shows low perceived control in the population assessed. Results show that 55 percent of the participants will most likely follow through with a doctor’s or nurse’s recommendations about their child’s dental needs.
We propose an innovative community-specific intervention trial that will utilize educational programs at the chosen sites in Pittsburgh to counsel parents of high-risk children about ways to prevent ECC and empower them with control over their child’s oral health. Dental training will also be provided to specified pediatricians and health care providers in order to further relay the message to the parents and eventually produce a change in behavior as it relates to their child’s oral health.
21. Qualities of an Effective Teacher: The Dental Faculty Perspective
Diya Talwar, University of California, Los Angeles; Weilin Shih, University of California, Los Angeles
Purpose: To identify the qualities dental educators believe are important in an effective teacher.
Full- and part-time faculty at the UCLA School of Dentistry were asked to rate the importance of teaching traits for didactic, lab, and clinical instructors. Surveys were returned by fifty of the eighty-eight faculty members surveyed (57 percent). Data were analyzed by total faculty independent of gender; full-time vs. part-time status independent of gender; and by gender, independent of full-time status. Faculty rated clear organization as the most important quality for a didactic instructor, clear goals and expectations as most important for a lab instructor, and constructive feedback and availability most important for clinic instructors. Comparing full- and part-time faculty, full-time faculty felt basic lecturing skills were most important, while part-time faculty felt clear organization and knowledge of subject were most important in didactic teaching. In lab teaching, full-time faculty felt that fair standards were most important, while part-time faculty felt constructive feedback, availability, and time allocation were equally important. In clinical teaching, full-time faculty felt being a positive role model was most important, while part-time faculty felt fair standards, enthusiasm, and constructive feedback were most important. Gender differences were found for didactic and clinical teaching. In didactic teaching, women considered basic lecturing skills most important, while men felt that clear organization and knowledge of subject were equally important. For clinical instruction, men felt that a positive role model was most important while women felt that constructive feedback and availability were most important.
Faculty consider different teaching skills important, depending on the academic setting, with variations by full- and part-time status and gender. Recognizing these differences is important in designing interventions to improve teaching effectiveness.
22. Early Childhood Caries Needs Assessment: Focus on Native Americans
Ryan P. Wymore, University of Missouri-Kansas City; Thomas M. Darnall, University of Missouri-Kansas City
Purpose: To conduct a needs assessment in a Native American population in rural Kansas to assess parental knowledge dealing with early childhood caries.
Dental caries in children is a major problem in the United States and has been identified as the most common chronic childhood disease. Decay in young children often happens in a predictable pattern, termed early childhood caries (ECC). Different populations have been shown to be differently affected by early childhood caries, Native American children and children in rural areas being the worst affected. The purpose of this project was to conduct a needs assessment in a Native American population in rural Kansas. A convenience sample of parents were asked to participate in the project at the Prairie Band Potawatomi (PBP) Head Start located on the PBP Indian Reservation. The needs assessment was based on the Theory of Planned Behavior and used Likert-type, categorical, and dichotomous response questions. The instrument solicited information on demographics, knowledge, attitude, behavior, social norms, and perceived control related to ECC. Forty-eight percent of parents thought children’s tooth decay was inevitable. Knowledge about carcinogenicity of milk and information about the importance of baby teeth was low. Additionally, respondents were likely to take oral health advice from physicians and nurses. Results were from an empirically based needs assessment. Preconceived ideas can be deceiving, showing the importance of conducting a needs assessment prior to any intervention. The findings will be used in a theory-based educational program.
The results of this theory-based needs assessment should be utilized to assess the knowledge, perceptions, and behaviors of the parents who were studied and to design an effective education intervention for this particular site.
23. Alternatives to Private Practice After Dental School
Benjamin R. Walder, University of California, Los Angles; Ronald S. Mito, University of California, Los Angeles; Milton Clegg, United States Navy; David Neil, University of California, Los Angeles
Purpose: Comparison of dental school debt repayment options for dental practitioners.
As dental students approach graduation, they are often filled with a sense of uncertainty as to their futures and their need to rid themselves of student loan debts. There are many customary postgraduation options for the new graduate to pursue to achieve debt reduction or elimination of debt through the use of newly acquired skills as a dental practitioner. Such choices include postdoctoral general dentistry training, becoming associates, receiving additional specialty training, entering a practice with a partner or as a solo practitioner, or even joining the uniformed services as a dental practitioner with officer status. This study examines the opportunity afforded an enlisted dentist serving men and women exchanging student loan debt for time served in the uniformed services in the Health Professions Scholarship Program. In addition to picking up the payments for the student loan after graduation, the military also awards the student-candidate a modest cost of living stipend while attending dental school. Income and debt data used for this study were obtained from recent surveys conducted by the ADA, ADEA, and the University of North Carolina. Comparison models for this study were created to represent time required to pay the debt service of student loans using alternative solutions for the dental postgraduate. The income potential of the associate with debt, as compared to the uniformed services officer on scholarship with no debt after four years of military service, has unexpected similar outcomes.
The dental practitioner, in committing the required time in the uniform services and being rendered debt-free, will have a financial advantage over an associate practitioner in private practice with student loans after the same amount of time.
24. The Effect of Different Disinfection Methods on DIAGNOdent Readings
Elaine B. Lam, University of Missouri-Kansas City; Christopher Rice, University of Missouri-Kansas City
Purpose: To compare DIAGNOdent readings with traditional methods of caries detection on teeth that had been disinfected using three different regimens.
The KaVo DIAGNOdent has shown promise in several studies as an adjunct in caries detection. Many of these studies used extracted teeth that had been disinfected in a variety of ways. The effect of different disinfection methods on the accuracy of DIAGNOdent readings is unknown. A total of 161 extracted posterior teeth with intact occlusal surfaces were disinfected by one of three methods: autoclaving, formalin immersion for three weeks, or immersion in a 10 percent bleach solution for forty-eight hours. Each tooth was then independently examined by two experienced clinical faculty for caries using an explorer and conventional bitewing radiographs. One clinician also performed an examination with the DIAGNOdent unit. Each tooth was rated on a 1 to 5 scale for the presence of caries. After the initial examinations, each tooth had a Class I preparation to the DEJ. One clinician then reexamined all the teeth using the visual/ tactile method (the gold standard for this study) and the DIAGNOdent. Comparison of the three methods of caries detection with the post-preparation visual/tactile method reveals that the radiographs had the lowest sensitivity and specificity (36 percent and 59 percent), followed by the visual/tactile method (57 percent and 76 percent) and the DIAGNOdent (55 percent and 89 percent). After opening the occlusal surface, the DIAGNOdent had much higher values (81 percent and 89 percent). DIAGNOdent readings for the autoclaved group had markedly lower correlation values (Spearman rho =.383) than the formalin (rho =.753) or bleach (rho =.815) groups. The autoclaved teeth also generally appeared brittle and dry, while the formalin teeth had a light coat of white powder and the bleached teeth had a blue tint to the root structure.
Autoclaving extracted teeth appeared to adversely affect the accuracy of DIAGNOdent readings. Further studies should be carried out to confirm these preliminary results.
25. Elevated Expression of CXCL5 in a Model of Metastatic Head and Neck Squamous Cell Carcinoma
Ryan Edmunds, Virginia Commonwealth University; Hiroshi Miyazaki, Virginia Commonwealth University; Andrew Yeudall, Virginia Commonwealth University
Squamous cell carcinoma of the head and neck (HNSCC) is the sixth most common malignancy in the developed world. The combined five-year survival rate is extremely low (17 percent) for patients with metastatic disease. However, although metastasis to lymph nodes is a major contributory factor to HNSCC morbidity and mortality, the molecular and biochemical events that enable oral tumor cells to metastasize and survive at sites distant from the primary lesion are not well understood. Using cDNA microarray analysis to study global gene expression in a model of metastatic HNSCC, we identified elevated expression of the CXC-chemokine CXCL5 in HN12 cells, which were derived from highly metastatic HNSCC, but not in HN4 cells derived from the corresponding primary lesion. Using quantitative real-time PCR, we found that metastatic cells expressed CXCL5 transcripts at a level around 200-fold greater than primary tumor cells. In addition, treatment of cells with epidermal growth factor at concentrations that induced invasion of metastatic cells resulted in further enhancement of CXCL5 RNA levels. Western blotting of conditioned media collected from HNSCC cultures showed that metastatic cells secrete CXCL5 protein into the cell microenvironment, providing additional evidence that the elevated CXCL5 expression is functionally significant. Taken together, the data suggest that CXC chemokines are secreted at high levels by metastatic HNSCC cells and potentially play a pivotal role in regulating the metastatic behavior of these cells.
26. Teaching Head and Neck Anatomy Using Reconstructive Modeling: Update
Casey Allman, University of Nevada, Las Vegas; Brent Adams, University of Nevada, Las Vegas; Ray Rawson, Community College System of Southern Nevada; William D. Davenport, University of Nevada, Las Vegas
Purpose: To highlight a different approach to teaching functional Head and Neck Anatomy in a dental school curriculum and assess its validity as an appropriate teaching methodology.
A thorough understanding of head and neck anatomy is crucial to the practice of clinical dentistry. Traditionally, the dental student is first introduced to this information through cadaver dissection. This proven and well-accepted method of teaching this body of information is expensive in terms of dedicated laboratory space; material acquisition, preparation, and storage; and actual curriculum time. One of the goals of the UNLV School of Dental Medicine (SDM) integrated curriculum is the conservation of contact hours to allow for students to engage in enrichment opportunities as well as allow adequate time for independent study. Based on empirical data from the Dental Hygiene Program at the Community College of Southern Nevada (CCSN), UNLV SDM decided to adopt and expand the CCSN method of using reconstructive modeling for teaching functional head and neck anatomy (hygienists in Nevada have expanded duties). After examining nearly a decade of Hygiene National Board scores, we were confidant that this would be an effective and efficient way of teaching head and neck anatomy. Dr. Raymond Rawson, who developed the program for CCSN and serves as a director of our Head and Neck Anatomy course, has expanded it to meet the needs of our dental students. The UNLV course requires reconstructing essential head and neck anatomical structures using dental waxes and museum-grade skull replicas. Each student must model required sets of structures (e.g., muscles of mastication, the distribution of V2 and V3, the distribution of the maxillary artery, etc.) as well as choose specific individual projects (e.g., infratemporal fossa, posterior triangle, brainstem, and circle of Willis). Our use of this teaching methodology was introduced at the 2004 ADEA Annual Session. This presentation further elaborates this methodology and incorporates new data from the first cycle of national board scores at UNLV and student perceptions on preparedness for National Boards. A survey of time spent outside designated curriculum hours is also included. Additional class information will include the second and third cycle of students being taught using this methodology.
The value and success of this program will be fully realized when we have additional substantial data including several cycles of National Board scores (first class took boards in July 2004), grades in the preclinical and clinical courses, and clinical competency evaluations. We recognize the difficulty of evaluating a new program and establishing its precedence. However, we feel that the educational values and novelty of this approach are noteworthy. Long-term assessment will eventually produce sufficient data for reliable statistical predictions.
27. Development of a Parent Education Component in a Smokeless Tobacco Prevention Curriculum
Samuel A. McGuire, Case Western Reserve University; Catherine A. Demko, Case Western Reserve University; Lance T. Vernon, Case Western Reserve University
Purpose: To develop a culturally sensitive, parent-targeted curriculum component for inclusion in a school-based, comprehensive smokeless tobacco prevention program in Appalachian Ohio counties.
The use of smokeless tobacco products has been associated with negative health consequences, including oral cancer, leukoplakia, and other dental-related illnesses. It has been reported that nearly all initial use of tobacco occurs before high school graduation and is associated with social influences such as peer and parental use. Parents can play a key role in preventing uptake of this behavior through education, parental controls, and role-modeling. Educational materials targeting parental knowledge, attitudes, and behaviors about smokeless tobacco are not available. Therefore, the effect of a parental education component within a smokeless tobacco prevention curriculum for children has not been evaluated. We developed an informational brochure about smokeless tobacco for parents as part of a fifth grade school-based smokeless tobacco prevention curriculum implemented in the Appalachian counties of Ohio. The brochure will be taken home by students receiving the prevention curriculum, and responses to several discussion questions with parents will be a homework assignment for extra credit. A similar assignment requiring parental involvement was piloted in a fifth grade classroom with sixteen of twenty-four students returning a completed assignment. Using the framework of the Health Belief Model, the brochure is designed to increase awareness about the negative health consequences of smokeless tobacco (susceptibility and severity), the importance of parental involvement (benefits), specific suggestions for discussion material (self-efficacy), and instructions for a simple oral cancer self-screening. Content experts from the Appalachian region reviewed the brochure for content, readability, format, and cultural relevance. Reviewers prioritized topics for inclusion including the oral cancer screening photos and revised the formatting and visual aspects. Their reviews resulted in producing a more culturally relevant written message as well as the inclusion of a CD component from the Ohio Dental Association’s T.A.C.T.I.C. curriculum that contains an interview with a local family about the impact of smokeless tobacco. Development of this parent-targeted material will allow us to assess the effectiveness of a culturally sensitive parental component within a comprehensive smokeless tobacco prevention curriculum.
The process of developing a relevant health message for a distinct cultural population should include input from the local target audience to ensure effective communication.
28. Ability of the HLD (CALMod) Index to Identify Essential Orthodontic Treatment Need
Jerad L. West, University of California, San Francisco; Mary C. Cooke, University of California, San Francisco; Brian C. Lingg, University of California, San Francisco; Barbara Gerbert, University of California, San Francisco
Purpose: To determine if the HLD (CALMod) index identifies all patients for whom orthodontic treatment need is essential.
The HLD (CALMod) occlusal index is used by the state of California to determine whether Medicaid benefits should be applied to patients requiring orthodontic treatment. For a patient to become eligible for such benefits, a total score of 26 must be achieved based on a review of pretreatment study models or the patient must qualify as an eligible exception. Eligible exceptions generally indicate a severely handicapping malocclusion. The purpose of this study is to determine whether individuals requiring essential orthodontic treatment need, as determined by orthodontists, have access to Medicaid benefits, as determined by the HLD (CALMod) index. A panel of AAO member orthodontists evaluated 110 study models. Each model was rated on a scale of 1 to 12 as follows: 1-3, No Treatment Needed; 4–6, Treatment Elective; 7–9, Treatment Advisable; 10–12, Treatment Essential. Of the models evaluated, twenty-eight patients scored 9.5 or above indicating an essential treatment need. Using the HLD (CALMod) index resulted in five patients of 110 being eligible for Medicaid benefits with three patients scoring 26 or above and two meeting at least one of the eligible exceptions. Of the three patients scoring 26 or above on HLD (CALMod), the panel of orthodontists rated them in a range from 9 to 11, indicating a highly advisable to essential orthodontic need. The two patients meeting eligibility exceptions on HLD (CALMod) were rated at 8.75 (advisable need) and 10 (essential need). The results suggest that use of the HLD (CALMod) index may not provide Medicaid benefits for all patients needing essential orthodontic treatment.
The criteria by which the HLD (CALMod) index awards Medicaid benefits may not provide adequate access for patients requiring essential orthodontic need as determined by a consensus of orthodontists.
29. Dental Hygiene Students’ Preferences for Using Blackboard
Natasha N. Peyton, East Tennessee State University; W. Gail Barnes, East Tennessee State University (now at Forsyth Dental Hygiene)
Purpose: To ascertain the inclination for the use of Blackboard (Bb) in dental hygiene classes.
The profession of dental hygiene, like other professions, is becoming more technically based. This trend is also prevalent in dental hygiene education programs. Innovative dental hygiene programs have a vision that includes Internet-based components of the curriculum. In an effort to determine the students’ preference for the use of Blackboard in their classes, a survey was developed and administered to summer 2004 dental hygiene students (N=23) via one of their course’s Blackboard sites. The survey consisted of nine quantitative and qualitative (open-ended) questions and included a section on demographics. The data sample consisted of nineteen usable responses (82.6 percent response rate). To inform them of the survey, the students were sent a traditional email in addition to a voice email that was generated using WIMBA, a voice management server. The students logged onto a Blackboard course’s Announcement page, which instructed them to access the survey located in the Course Document section. Blackboard provided an analysis for the survey that included the percentage for each response of every question. The results indicated that the most favorable aspect when using Blackboard in dental hygiene courses was the "flexibility of classes, i.e., no specific lecture time or day" (100 percent). On the contrary, the students reported that the Blackboard "testing methods" (66.7 percent) were the least favorable aspect of using Blackboard. "Discussion forum questions," "chat rooms/synchronous communication," and "ability to work in groups/group collaboration" each reported an 11.1 percent response.
In summary, it is speculated from the survey responses that Blackboard, according to the students studied, is favored because of its flexibility with their schedules. However, course directors should consider modifying the testing delivery method by incorporating a more traditional pen and paper testing process.
30. Dental Hygiene Students Informed of the Profession Before Starting the Program
Ronda C. Poland, East Tennessee State University; W. Gail Barnes, East Tennessee State University (now at Forsyth Dental Hygiene)
Purpose: To determine if dental hygiene students were aware of the profession before they enrolled in their program.
The attrition rate for all students seems to be highest during the first term (semester or quarter) of a professional program, suggesting that many students appear to be unaware of the requirements of their chosen profession. Dental hygiene students are no exception. A study was recently developed to ascertain if dental hygiene students were aware of the professional responsibilities of a dental hygienist. A web-based survey was administered to dental hygiene students (N=23) who had recently completed three semesters of professional education. The survey was placed on a course’s Blackboard (Bb) site and consisted of ten quantitative and qualitative questions, including a section on demographics. The data sample consisted of nineteen usable responses (82.6 percent response rate). By means of a voice email (WIMBA, a voice management server on Bb 6.0), students were requested to complete the survey, which was located in the Course Document section of Bb. An analysis for each survey question was generated by Bb. The results indicated that only 33.3 percent of the students felt that they were "aware of what it entails to become a dental hygienist," whereas 56.6 percent were not. More specifically, students reported that they were aware that they would have to perform the following: "use instruments subgingivally" 22.2 percent; "probe patients" 44.4 percent; "polish and selectively polish" 89.8 percent; and "take radiographs" 89.9 percent. However, 55.6 percent of the students reported that they were not aware that "the condition of the oral health affects the entire body."
The present study demonstrates how professionally unprepared some dental hygiene students are before they begin a dental hygiene course of study. As part of the application process, some dental hygiene programs require students to observe a practicing hygienist for a specified number of hours in an effort to prepare them for their future profession. The researchers concur with this requirement.
31. Children’s Oral Health: Application of a Needs Assessment in a Rural and a Native American Community
Thomas M. Darnall, University of Missouri-Kansas City
Purpose: To assess the needs of a Native American population and a rural population and to show how population-specific, theoretically grounded empirical needs assessments inform future planning for meaningful community health interventions.
Early childhood caries (ECC) has been reported to be perhaps the most prevalent infectious disease of our nation’s children. This disease occurs in all racial and socioeconomic groups; however, it tends to be more prevalent in low-income children, in whom it occurs in epidemic proportions. Native American children and children in rural areas have been found to have the highest prevalence of this disease. The purpose of this project is to assess the needs of a Native American population and a rural population and to show how these population-specific, theoretically grounded empirical needs assessments inform future planning for meaningful community health interventions. A convenience sample of parents was asked to participate in the project at the Prairie Band Potawatomi (PBP) Head Start located on the PBP Indian Reservation and at the WIC clinic located in Pittsburg, KS. The needs assessment was based on the theory of planned behavior and used Likert-type, categorical, and dichotomous response questions. The instrument solicited information on demographics, knowledge, attitude, behavior, social norms, and perceived control related to ECC. Data from both sites was entered into the SPSS statistical program and compared on the survey domains. Just under half of the parents from both populations thought children’s tooth decay was inevitable. Knowledge about cariogenicity of milk and the importance of a child’s deciduous teeth was low. Among the WIC population there was a deficit in the parents’ knowledge of the cariogenic potential of juice in a cup or bottle; among the PBP population there was a deficit in the knowledge of the cariogenic potential of breast feeding at will. Additionally, respondents were likely to take advice from physicians and nurses. Community expectations do not always meet the national norm. To have a meaningful community health intervention, you need to know your community. To do this, you need to perform a theoretically grounded, empirical needs assessment for the specific population. These results will be used in future planning for educational interventions at both sites.
32. National Board Dental Examination Part I: Goals and Preparation
Haley Burdette, West Virginia University; Eleisha Nickoles, West Virginia University; Richard Crout, West Virginia University; Stanley Wearden, West Virginia University; Louise Veselicky, West Virginia University
Purpose: To evaluate students’ goals and traditional methods of preparation for the National Board Dental Examination Part I (NBDE I) along with students’ attitudes towards the efficacy of a new optional preparatory review course.
Passing the National Board Dental Examinations (NBDE) developed by the Joint Commission on National Dental Examinations of the American Dental Association is a general requirement for licensure in all states in the United States. The purpose of this study was to evaluate students’ goals and traditional methods of preparation for the National Board Dental Examination Part I (NBDE I) along with students’ attitudes towards the efficacy of a new optional preparatory review course. A twelve-item instrument, primarily Likert-scale questions, was administered to all second-year dental students prior to an elective NBDE I review course, after the course but before the NBDE I, then finally after receiving the NBDE I results. All questionnaires were coded to enable correlated student-wise comparisons at each time of administration. Respondents were asked questions concerning expectations for performance on each part of the exam, ranking preferences for preparation and attitudes toward a new elective review course’s value. Results revealed a response rate of 73.3 percent for the first and second administration followed by 22.2 percent for the final evaluation. Performance goals utilizing excellent as the highest to at least passing as the lowest for each part of the board exam significantly diminished between the first and later administrations. Ranking preferences for preparation revealed the use of Dental Decks as first choice, followed by the Kaplan course, and then a tie between the experimental review course and the board review book. Perceptions of perceived value of the new optional review course statistically significantly declined from the first administration. However, among those who completed the final evaluation, half agreed or strongly agreed that attending one or more sessions of the review course would have helped them prepare for the NBDE I.
In conclusion, performance goals for NBDE I significantly decreased between the first and later administration. Dental Decks were the first choice in the preparation, and the experimental optional review board course did not meet the students’ initial expectations.
33. Chairside Computer Use in Clinical Dentistry
Pedro L. Hernandez, University of Pittsburgh; Thankam Thyvalikakath, University of Pittsburgh; Miguel H. Torres-Urquidy, University of Pittsburgh; Heiko Spallek, University of Pittsburgh; Titus Schleyer, University of Pittsburgh
Purpose: To established a baseline measure of clinical computer use among general dentists.
More than 89 percent of all dentists use computers for administrative functions, yet only 25 percent of general dentists in the United States use computers at chairside. To date, computer use at chairside has not been formally studied. We have conducted a telephone survey with a random sample of 302 dentists who use computers at chairside in order to determine the hardware and software infrastructure, storage, and data entry patterns for patient information and their perceptions of the practice management system in use and clinical computing. As of August 2004, we have completed eighty-four interviews. Our preliminary results show that dentists who use computers at chairside are on average forty-eight years old, 85 percent of them are male, more than half have taken computer courses, and only 10 percent feel uncomfortable with computers. The majority of patient information is entered by dental assistants and hygienists. However, dentists typically record treatment plans, progress notes, and digital images. Information with a strong administrative connotation, such as appointments and treatment plans, is most often stored on the computer. Images and hard/soft tissue charts are stored less often on the computer, and other clinical information, such as the medical and dental history and progress notes, least often. Only 1 percent of the practices studied were completely paperless. Advantages of computers at chairside included fast, organized, and easy access to patient information, patient education, and improved workflow. Barriers for chairside computer use were lack of space, the steep learning curve for staff, infection control, the time required to enter data, cost, and cumbersome user interfaces. While 90 percent of the offices had Internet access, only 22 percent of dentists found it to be very essential for clinical purposes or accessed it at chairside. Final results of this study will be presented at the meeting.
The study showed that, despite rising computerization, much patient information is still stored on paper. The number of truly paperless practices is still very small.
34. Capturing and Integrating Video into a Website to Teach Operative Dentistry Techniques
Christopher Gamble, The Ohio State University; Mary Cliett, The Ohio State University; Pooja Misra, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University; Robert Rashid, The Ohio State University
Purpose: To edit and repurpose video captured during class demonstrations.
The creation of video for teaching operative cavity preparations and rubber dam techniques can be an expensive and time-consuming process. This project looked at using material captured during class demonstrations in a preclinical laboratory course. The video camera was connected to both a monitor output for display to the class and also to a computer video input. Lighting and magnification in this pilot proved to be difficult factors that had to be overcome. Two solutions were attempted: using a small camera mounted in the line of sight of the operator and using a camera with a telephoto lens at a distance. The captured material was then edited using iMovie and Final Cut Pro on a computer to produce two sets of video files. One set was created for use in web pages. This set comprised multiple short clips, each illustrating a small discrete part of the whole procedure. The other set was a complete (edited) movie meant for viewing with instructor commentary during a class session. The first set of small clips was linked with text in web pages for self-paced study independently by the students. It is planned to be included on a CD along with other teaching aides for study at home and in the preclinical laboratory.
When captured at the time of demonstration, video material can be repurposed for web pages and lecture room use.
35. Developing Operative Preparation Learning Assets
Joshua Merrill, The Ohio State University; Christopher Gamble, The Ohio State University; Pooja Misra, The Ohio State University; Mary Cliett, The Ohio State University; Lindsay Pabst, The Ohio State University; Robert Rashid, The Ohio State University
Purpose: To create a computer-based alternative to stone study models of operative preparations.
Virtual reality movie files are capable of relaying 3-D information on a computer screen and can be the foundation for useful learning assets. To be most effective, these assets must be able to be incorporated across different computing platforms and combined with other learning assets to provide learning objects for incorporation into different areas of dental education. Operative cavity preparations that are taught during the first year of preclinical study were cut in both Columbia and Kilgore typodont teeth. Multiple teeth were prepared so that each preparation could be illustrated in a series of steps. Steps were chosen that illustrated distinct steps in the creation of the cavity preparation. Digital images of each of the cavity preparation steps were captured at specific angles and degrees of rotation with the aide of Nikon D1x digital camera and macro lens mounted on a computer-controlled mechanical arm and Motion Control and Image Capture Software for ObjectMaker (Peace River Studios). After the collection of up to 612 photographs for each preparation, VR Worx (VR Toolbox) was used to combine and compress these images to create a QuickTime VR movie file. Each file showed either the separate stages of a cavity preparation viewable from all sides of the tooth or the finished cavity preparation viewable from all angles. Because the user has control of the rotation and different views, these virtual reality teeth are a reasonable substitute on the computer for the hand-held models traditionally used to illustrate operative cavity preparation. Once the capture system is set up for the capture and processing of images, the creation of additional images using different models is a task that can be delegated to non-experts. An example of this type of learning asset can be found at dent.osu.edu⁄operativedent⁄vr following the link 3-D Learning Asset.
Virtual reality tooth models appear to be a good alternative to stone models of cavity preparations.
36. Adding Directed Study to Virtual Study Models
Pooja Misra, The Ohio State University; Christopher Gamble, The Ohio State University; Mary Cliett, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University
Purpose: Creation of learning objects using 3-D models.
Just as having a stone study model is not sufficient for teaching students the concepts of cavity preparation, virtual reality tooth preparation models also lack guidance. A technique of combining the learning asset of a three-dimensional tooth model with text information about the different views was explored to create a learning object for teaching the steps of cavity preparation and the evaluation of the different classes of finished operative cavity preparations. A program (LiveStage Professional, Totally Hip Software) for combining different computer media such as text, graphics, animation, and movie files was used to add text information and instruction to specific views of the different stages of operative cavity preparations. A stage was created that was 640 pixels wide and 670 pixels tall. A virtual reality tooth model (640 by 420) pixels illustrating the different steps of an operative cavity preparation was inserted into the stage at the top. Below it, a 640x250 pixel text field was created. For each rotational step of the cavity preparation, text was added in the box giving instruction on how to proceed with the cavity preparation to the next step. The result was an interactive, rotating, three-dimensional tooth model with specific text associated with each stage of the cavity preparation. The model can be controlled by the computer user using basic click and drag of the mouse. Because the final file is a QuickTime movie, it is playable on different computer platforms and can be played alone or integrated into media such as web pages and PowerPoint slide presentations. Once a format has been determined, combining different learning assets (of varied media) can create a learning object that can be repurposed a variety of ways. An example of this type of learning object can be found at dent.osu.edu?/ operativedent?vr following the link 3-D Learning Object.
Learning objects based on three-dimensional virtual reality teeth can be used in variety of ways across multiple platforms.
37. Creation of an Operative Dentistry Website with Learning Objects
Mary Cliett, The Ohio State University; Christopher Gamble, The Ohio State University; Pooja Misra, The Ohio State University; Joshua Merrill, The Ohio State University; Lindsay Pabst, The Ohio State University
Purpose: Use a variety of learning objects to create a website for teaching cavity preparation.
Creating an operative dentistry site with three-dimensional virtual reality images of cavity preparation steps and finished cavity preparations in Kilgore and Columbia typodont teeth, movies made during the teaching of cavity preparation in the preclinic, and web pages with text and graphics leading the student through the phases of cavity preparation including necessary armamentarium can provide dental students with a resource for directed self-study. Such a site can allow study at the student’s own pace and might help in the reduction of class time devoted to procedural techniques and allow increased efficiency. In addition, such a website could provide calibration and orientation for new faculty, along with resources for other courses within the college. Web pages were created using Macromedia Dreamweaver, Microsoft FrontPage, and PAGEot. Dreamweaver and FrontPage were used to make templates, and most pages for the website and PAGEot provided web page links to regular and virtual reality (VR) movie files. Learning objects prepared previously in the project were linked to multiple areas for use as self-standing teaching tools and in conjunction with other learning assets. A goal of the site is to provide different approaches and styles to teaching cavity preparation techniques so that the different learning styles of the students can be accommodated. Future plans for the site include distribution via CD for use when network access is slow or impossible. It is hoped that the material will be used by the students at the lab bench, providing self-paced instruction for operative cavity preparations.
Multiple learning objects and learning assets can be combined into a website to provide alternative teaching styles for cavity preparation.
38. The Effect of Nutrition Lectures on Dietary Habits of Students at a Midwestern Dental School
Matthew Rohr, University of Missouri-Kansas City; Chris Rice, University of Missouri-Kansas City
Purpose: To survey dental students before and after their exposure to the nutrition material to see if there was any change in their dietary habits and to what they attributed any change.
Nutrition is a standard part of the dental school curriculum. One midwestern dental school recently introduced two hours of introductory nutrition into a first-semester, first-year course in an effort to instill healthy habits early in the dental student’s career. The effect of this early exposure to nutrition was unknown. Students in two classes (n = 197) were given a baseline survey in their first week of school, then again after one or two years of dental school. Responses were received from 92 percent of baseline surveys and from 80 percent of the follow-up surveys. Data were analyzed using the independent t-test. Results indicated that students’ diet stayed relatively stable. Students consumed significantly less (p<.05) cereal, rice, pasta, and sugared carbonated beverages, while they increased their consumption of fast food, diet carbonated beverages, and water. Students attributed any changes to (in order) a lack of time, their exposure to the dietary habits of their peers, the nutritional lectures, and various forms of advertising.
The presentation of nutrition lectures early in the dental curriculum had a minor effect on dietary habits compared with other factors.
39. Factors That Influence Dental Students in Choosing a Residency Program
Richard B. Webster, University of California, Los Angeles
Purpose: To identify the most important factors that influence a dental student’s decision to accept a position at a specific residency or postgraduate program.
At UCLA, a significant number of dental students desire to further their education after graduating from dental school by pursuing postdoctoral training. By surveying fourth-year students who are currently applying to postgraduate programs, we can discern general trends concerning the criteria that students use to select a program. Members of the Class of 2005 at the UCLA School of Dentistry were asked to rank, in order of importance, fifteen factors that could affect their decision. These factors are: 1) quality of teaching, 2) quality of research, 3) quality of clinic program, 4) option of a dual degree (Ph.D., M.D., or M.S.), 5) length of program, 6) minimal research requirements, 7) school facilities, 8) school name recognition, 9) cost (stipend paid), 10) potential for future employment in the area, 11) location/climate, 12) quality of life for family, 13) area is close to family, 14) family member/friend is an alumnus, and 15) other UCLA graduates are currently in the program. Students applying to AEGD/ GPR programs were asked to respond to additional items regarding the reason for their choice, e.g., to gain advanced clinical experience prior to entering general practice or applying to a specialty program in the future. Students were also asked what sources they used to gather information relevant to their decision factors. Demographics of gender, age, and marital status were also gathered. Results were analyzed separately for those applying to AEGD/GPR and specialty programs and by gender, age, and marital status.
The findings from this study will be important to those mentoring students for postgraduate training, as well as for postgraduate program directors.
40. Prophylactic Third Molar Extractions: A Review of Departmental Recommendations
Jason D. Majors, Case Western Reserve University; Lauren A. Wanosky, Case Western Reserve University; Angela Graves, Case Western Reserve University; T. Roma Jasinevicius, Case Western Reserve University
Purpose: To determine the current treatment recommendations regarding the prophylactic extraction of third molars in the departments of oral surgery, orthodontics, and restorative dentistry at U.S. dental schools.
The appropriateness of prophylactic removal of third molars (P-ext) continues to be debated. While studies have examined the decision making process of dentists, few have assessed what is being taught to predoctoral students. In 1998 we surveyed U.S. dental faculty regarding the P-ext of third molars. The goal of this study was to determine whether there continued to be treatment differences among departments. In July 2004 the same survey was sent to the chairs of oral surgery (OS), orthodontics (OR), and restorative/prosthodontics (RD) of all U.S. dental schools. Educators were to characterize departmental philosophy pertaining to P-ext for adolescents (under twenty-one years of age), young adults (twenty-one to thirty-five years), and adults (over thirty-five years) having fully (FE), semi-(SE), and unerupted (UN) third molars. The participants also indicated the rationale for prophylactic extraction. Chi square tests were applied to the data (p <0.05). The first mailing (n=147) elicited forty-five responses (to date). There were significant differences among the OS, OR, and RD in prophylactic extraction recommendations of FE and UN third molars of adolescents (p=0.006 and p=0.017, respectively), and young adults (p=0.013 and p=0.04, respectively). For adolescents and young adults, a majority of OS recommended P-ext of FE and UN, while <10 percent of OR recommended P-ext of FE third molars. There were no differences among the OS, OR, and RD in their P-ext decisions for adults; few recommended prophylactic removal of FE, while most would P-ext SE and UN. There also were no differences in P-ext decisions of SE third molars of adolescents or young adults. These results are similar to those found in 1998, although there has been a slight decrease in the percentage recommending P-ext, especially for FE and UN. The results of the second mailing will be available for the 2005 Annual Session.
The recommendations for nonextraction of fully erupted third molars is consistent with the current literature. However, not all departments had consistent treatment philosophies, especially for the adolescent and young adult age groups. Although a slight decrease in P-ext recommendations was seen in two categories (FE and UN), the controversy will continue until a more uniform approach is adopted.
41. Assessment of Calibration of Dental Students for Grading
Maureen L. Pezzementi, University of Alabama; Katherine L. Fry, University of Alabama
Purpose: To analyze the effect of calibration of dental students on their ability to critique a carving exercise.
Eleven dental students completed individual precalibration assessment of a wax tooth carving replacing the incisal one-third of the maxillary right central incisor. The carving was evaluated for overall accuracy and perfection of the reproduction to match the model tooth by six categories: labial, lingual, incisal, mesial, and distal views and for overall blending/finish. A grade sheet that lists the presence or absence of 156 separate characteristics was used to make comparisons of the analysis possible. Participants then attended a calibration session to more firmly define the criteria for assessment. Guidelines for assigning a numerical grade were given with examples of carvings of various grades to demonstrate. Each participant successfully passed an exit exam. Following calibration, the same dental students assessed another carving of tooth #8 to apply the criteria as defined. Two separate double-blind faculty evaluations of the same carving by calibrated dental anatomy instructors were used as the standard to which precalibration and postcalibration assessments were compared. Assessments were analyzed by Student’s t-test using pair-wise comparisons. The average percent change in precalibration and postcalibration for each of the six grading categories was calculated as the overall numerical grade as well as the number of incorrect assessments on the 156 characteristics. Overall, the students improved in both their verbal analysis of the critical assessment and their assignment of a numerical grade. On the 156 separate characteristics there was an improvement in the mean from 28.3 incorrect assessments to only 21.5 after calibration. The numerical grade assignment improved from only 4/11 within three percentage points of the instructor assigned grade to 8/11 within 3 percentage points.
The number of participants was low for this preliminary study; however, it shows a significant improvement in students’ ability to critique after calibration training. This study indicates that students may benefit from undergoing calibration prior to taking a competency exam since it appears to improve their critical eye. Further studies are needed to assess the benefit.
BLOCK 2: Monday March 7
2:00–3:30 pm
42. Comparison of National Board Dental Examination Preparation with Performance
Lisa P. Deem, Temple University; Sarah A. Gray, Temple University; Daniel W. Boston, Temple University
Purpose: To compare the study methods used by dental students in preparation for National Board Dental Examinations with their performance.
A survey was designed to compare students’ methods of preparation for National Board Dental Examinations Parts I and II (NBI and NBII) with results on those examinations. Checklist surveys were given to 121 juniors and 103 seniors upon completion of NBI and NBII. Each survey included instructions to rank study materials used (Back Exams, Notes, Books, Dental Decks [Decks], Commercial Preparation) as "most, "some," or "not at all," and preparation time in hours as 0–10, 11–30, 31–60, and 60+. The response rate was 89.2 percent and 82.5 percent for junior and senior classes respectively. Upon receipt of examination scores, a comparison of study methods and time was made for students whose average score was below 75, 75–79, 80–89, and 90–99. Students who scored in the 80–99 range on NBI reported as "most" using Decks (84.0 percent), Back Tests (62.7 percent), Text Books (10.6 percent), Notes (6.3 percent), and Commercial Preparation (7.4 percent). Students who scored 79 and below reported as "most" using Back Tests (78.5 percent), Decks (71.4 percent), Books (21.4 percent), Commercial Preparation (21,4 percent), and Notes (0 percent). Of the students scoring in the 90–99 range, 69 percent reported studying 60+ hours, compared to 54 percent of the students who failed. Students who scored in the 80–99 range on NBII reported as "most" using Decks (84.7 percent), Back Test (39.1 percent), Text Books (13.0 percent), Commercial Preparation (6.5 percent), and Notes (4.3 percent). Students who scored 79 and below reported as "most" using Decks (94.8 percent), Back Tests (43.5 percent), Books (7.6 percent), Commercial Preparation (2.5 percent), and Notes (2.5 percent). Of the students scoring from 80 to 99, 50 percent reported studying 60+ hours, compared to 27.2 percent of the students who failed. Students who scored in the 80–99 range in both NBI and NBII reported using all study materials available more than those scoring below 80 and studying more hours by 55 percent.
The National Board Dental Examination Candidate Guide recommends that candidates use textbooks and lecture notes as primary sources for studying. Notwithstanding these recommendations, students report using Back Exams and Dental Decks as primary sources for preparing.
43. Measuring Blood Glucose Levels in the Patient Population at the University of Illinois College of Dentistry
Gary L. Drahos, University of Illinois at Chicago; Frank W. Licari, University of Illinois at Chicago; Rudolph Burger-Zellinger, University of Illinois at Chicago
Purpose: To identify prediabetics, undiagnosed diabetics, and out of control diabetics in the patient population by relating physical and oral symptoms to measured blood sugar values.
Diabetes is an endocrine disease that has steadily increased in incidence over the last fifty years. It is estimated that as many as 20 million diabetics go undiagnosed in the United States. Uncontrolled, undiagnosed, or prediabetic patients can display oral symptoms or variations in abnormal healing. The following groups were targeted for testing: 1) known diabetics who are on complex, multidrug regimens to control diabetes or diabetics we suspect are not well controlled; and 2) undiagnosed diabetics who display one or more of the following symptoms: increased urination, increased thirst, unexplained weight loss, blurred vision, aged forty-five or older, obesity, gestational diabetes, blood pressure greater than 140/90, increased cholesterol level, inactivity, and patients with a familial history of diabetes (parents, brother, or sister). The technique used to test the patients was as follows: obtain patient consent to test; test blood glucose per directions included with monitor (calibrated daily); and document blood sugar levels in patient’s record. Normal levels are considered to be 110 or lower. Values of 110–140 (on multiple testing) are considered prediabetic. Above 140 (consistently) is considered diabetic. If a random test (taken without regard to fasting) results in a reading above 110, recommend retake in one to two weeks or refer to MD to evaluate. If a diabetic or prediabetic condition is diagnosed, referral to physician is mandatory. During a three-month period of this type of testing, 843 blood glucose tests were performed in the clinic. Three hundred seventy-nine tests were on known diabetics, 252 were on suspected diabetics, and 212 were done at random (on students and staff). Sixty-one percent (231) of the known diabetics were not well controlled (blood glucose over 140). Thirty-four percent (eighty-five) of the suspected diabetics tested high (above 140). Eighteen percent (38) of the at random subjects had blood sugar levels above 140. Blood sugar values for all tests ranged from 54 to 531.
Routine testing of blood glucose for certain diabetics and suspected suspected diabetics in the UIC COD dental clinic can be a useful tool in identifying and aiding the control of diabetes.
44. The Clinic Environment and Patients’ Blood Pressure
Gary L. Drahos, University of Illinois at Chicago; Frank W. Licari, University of Illinois at Chicago
Purpose: To measure variations in the patient’s blood pressure that may occur when the patient is placed in the dental clinic environment just prior to receiving dental treatment.
Blood pressure is routinely measured on patients as they present for dental treatment at the University of Illinois College of Dentistry. It was noted that a significant percentage of patients (18 percent) had elevated blood pressures (diastolic above 95). When these patients were referred to their primary physicians for medical consultations concerning their blood pressure, 74 percent of the consultations were returned with the diagnosis that the patient did not have high blood pressure when measured in the consulting physician’s office. The theory was hypothesized that the undergraduate dental clinics, with their open treatment areas and large amount of activity, could be contributing to this noted increase in blood pressure. An experiment was devised in which the blood pressure of patients was taken prior to treatment while in the relative calmness of the waiting areas and compared to their blood pressures taken after being seated in the dental chair and just prior to receiving planned treatment. For uniformity, a wrist cuff was used to measure the waiting room blood pressure, and the exact same device was used on the same patient in the dental chair. Uniform methods of measurement were used (same wrist, same upright position with feet on the floor) with the only variable being the environment and the proximity to receiving treatment. Six hundred twenty-five tests were conducted. Sixty-nine percent of the patients measured an increase of 5 or more points in the systolic pressure, and 63 percent showed an increase in the diastolic pressure of 5 or more points. Twenty-nine percent showed a change of less than 5 points (higher or lower), and 8 percent measured a decrease in the systolic or diastolic blood pressure. Blood pressure increases as much as 40 points systolic and 20 points diastolic were measured in comparison to the control levels taken in the relative calm of the waiting room.
45. Converting a Dental Jurisprudence Course from Lecture to a Web-Based Format
Mary E. Jacks, University of Texas Health Science Center at San Antonio; Taline Dadian-Infante, University of Texas Health Science Center at San Antonio
Purpose: To convert a dental jurisprudence lecture course to a web-based format to address concerns of accessibility, practicality, limited faculty, and financial resources.
Applicants seeking dental licensure must pass an examination covering state rules and regulations. Further, the Commission on Dental Accreditation competencies #14-01, #14-02 (Dental), and #2.2 (Dental Hygiene) state that graduates must be competent in complying with the codes, rules, laws, and regulations that govern dental practice. Additionally, competency statements require that dental programs prepare students for lifelong learning. Web-based education meets societal trends in the pursuit of lifelong learning and will further assist the graduate in remaining current with ever-changing laws. The purpose of this project is to convert the dental jurisprudence course from a lecture to a web-based format. Through this format, students can access the information at their convenience and learning pace. Further, due to limited departmental financial resources and faculty reassignments, designing an online course provides the solution to these challenges. The web-based course contains three modules pertinent to the rules and regulations for the state of Texas. Each module includes a brief interpretation of the legal issues, electronic links to rules and regulations located on the State Board of Dental Examiners’ website, case scenarios with related questions for online discussion, and sample jurisprudence examination questions. Student feedback indicates a favorable response to the convenience and self-paced format of this online course.
By utilizing the multimedia format and implementing case-based scenarios, students are now better prepared for the newly implemented computerized jurisprudence exam administered in the state of Texas. Web-based learning and knowledge of navigating the web will enable practitioners to remain current with dental laws.
46. Convergence Angles of Tooth Preparation for Complete Crowns Among Dental Schools in Three Different Countries
Mohamed F. Ayad, University of Tanta; Abdulhamid A. Maghrabi, King Abdulaziz University; Stephen F. Rosenstiel, The Ohio State University
Purpose: Convergence angles for complete crown preparations have been recommended at four to twelve degrees. However, practitioners have difficulty meeting these recommendations. This study measured and compared the convergence angles of tooth preparations for complete crowns prepared at three Colleges of Dentistry: the University of Tanta, Egypt, King Abdulaziz University, Saudi Arabia, and The Ohio State University, Columbus, Ohio.
The convergence angles of 499 tooth preparations for complete crowns were evaluated. This group was comprised of a random sample of 262 teeth prepared by third-year dental students at the University of Tanta on extracted molars under normal preclinical conditions, thirty-seven preparations on molar teeth on typodonts done by first-year dental students at The Ohio State University, and 200 molar typodont complete crown preparations done by fourth-year dental students at King Abdulaziz University, Saudi Arabia. The facial-lingual and mesial-distal convergence angles of each preparation were measured with a goniometer microscope. Mean convergence angles were calculated, and differences between groups were tested for statistical significance with analysis of variance (ANOVA) at 5 percent level of confidence. Convergence angle measurements were significantly different between the groups and the dimensions (P<0.001). The greatest convergence value (19.8 ±10.0) was for facial-lingual measurements prepared by Egyptian dental students. The smallest convergence value (14.1±3.8) was for mesial-distal measurements prepared by Saudi dental students.
This study emphasized the difference between what is taught at dental schools (what is theoretically possible) and the results of actual practice. There was a considerable disparity between the convergent angles recorded in this study and the ideal configurations recommended in fixed prosthodontic textbooks and the dental literature. Tooth preparation criteria should define a realistic, measurable goal that dentists can visualize and achieve. However, within the limits of this study, dental students have difficulties meeting recommendations for preparation convergence angle consistently and preparation design routinely exceeds the ideal. Such variations may contribute to excessive tooth removal and a reduction in retention and resistance form.
47. New OMS Rotation at UTHSCSA
Gregory K. Spackman, University of Texas Health Science Center at San Antonio; Stephen B. Milam, University of Texas Health Science Center at San Antonio; Jim L. Burk, University of Texas Health Science Center at San Antonio; Wendell A. Edgin, University of Texas Health Science Center at San Antonio; Ronald C. King, University of Texas Health Science Center at San Antonio; David G. Leibold, University of Texas Health Science Center at San Antonio; James M. Startzell, University of Texas Health Science Center at San Antonio
Purpose: This report documents a new format for teaching dental students oral surgery.
In the summer of 2003, the University of Texas Health Science Center at San Antonio Dental School changed its clinical program to more closely reflect the climate of private practice within the state. This change included the vertical integration of all four classes into eight General Practice Groups (GPGs) and a reorganization of the faculty into core and non-core groups. Faculty assigned to the core group work in the comprehensive care clinic. This group includes faculty from the departments of General Dentistry, Restorative Dentistry, and Prosthodontics. All other faculty members continued to work in discipline-based clinics. The Department of Oral and Maxillofacial Surgery (OMS) took advantage of this reorganization to implement a new and innovative approach to provide oral surgical training to the predoctoral students. Prior to reorganization, all OMS didactic material was presented via traditional lecture format. The didactic material was spaced throughout the sophomore, junior, and senior years. This material was entirely independent and separate from the clinical experience. The junior and senior oral surgery clinical experience consisted of a one-week rotation each semester. Senior students would also perform routine surgery in the general clinic under the supervision of the general dentistry faculty. The new oral surgery program is a concentrated exposure to the specialty via one four-week rotation during the junior year. Approximately ten students are assigned to each rotation. Eight different rotations were scheduled during the 2003–04 academic year. During this rotation the junior student’s only clinical obligation is to work in various oral and maxillofacial surgery clinics. Emphasis is placed on care of the oral surgery patient. More than forty hours of traditional classroom lectures were eliminated. These lectures were replaced with a series of web-based, self-study modules and weekly seminars. Seminar material was tied closely to the clinical experience. As preparation for the DS III OMS rotation, OMS still provides three formal lecture courses during the sophomore year (Local Anesthesia and the Management of Medical Emergencies, Nitrous Oxide, and Introduction to Oral Surgery). Student and faculty surveys were used to assess the new program. In addition, DS III caseload relative to the previous year caseload (OMS cases/DS III student) and gross income were monitored to assess the impact of the new program on DS III OMS clinic activities. Student surveys were very favorable. In response to the statement "Overall, this was a good course," 90.9 percent strongly agreed. The remaining students agreed. In response to the statement "I learned a great deal from this course," 100 percent strongly agreed. Likewise, all students agreed that course materials and seminars presented during the clinical rotation when this material was reinforced with clinical practice provided an exceptional learning experience. OMS faculty-student contact time was reduced with the elimination of the formal lectures. Faculty clinic commitment was two hours less per week. Didactic teaching time actually increased due to the need to repeat seminars for each rotation. Seminars were conducted two hours each week, one hour at the beginning of each Monday and Wednesday afternoon clinic sessions. OMS faculty enjoyed the seminar format and interaction with students. The faculty did not view this increase in student seminar contact negatively. A 137 percent increase in oral surgery caseload for DS III students was realized relative to the previous year. Gross predoctoral Oral Surgery clinic income increased by 62 percent. Issues to address in the future include coordinating schedules for the faculty seminars, faculty staffing for the clinic, and makeup sessions for holidays proved to be time-consuming. In addition, the new rotation coupled with improvements in our operations efficiency enhanced our capacity to provide patient care in the predoctoral OMS clinic. This increased patient care capacity resulted in a demand for more referrals form the comprehensive clinic to assure adequate training material. In addition, core faculty raised concerns that the new format could compromise continuity of care provided in the core comprehensive care units. This issue will be evaluated in the upcoming year.
A coordinated and concentrated exposure to the specialty of Oral and Maxillofacial Surgery is more efficient and effective for teaching the critical skills needed to manage the oral surgery patient.
48. Tobacco Cessation Counseling Among Dentists and Dental Students: How Often Are the 5 As and 5 Rs Implemented in Texas?
Robert A. Kaminski, University of Texas Dental Branch at Houston; Thomas A. Servos, University of Texas Dental Branch at Houston; Gene C. Stevenson, University of Texas Dental Branch at Houston; Unto E. Pallonen, University of Texas School of Public Health at Houston
Purpose: This project assessed dentists and dental students’ involvement in the implementation of the Clinical Practice Guideline of the U.S. Department of Health and Human Services. It recommends the 5 As cessation counseling among patients who are willing to quit and the 5 Rs cessation counseling among patients unwilling to quit.
Tobacco use is the most important preventable health risk, causing over 400,000 annual deaths in the United States. Tobacco use is also a major cause of oral and pharyngeal cancer deaths and adult periodontitis; it worsens the prognosis of periodontal therapy and implants and increases the risk of oral soft-tissue changes. In spite of the American Dental Association endorsement to counsel all tobacco users, fewer than half of dental and dental hygiene schools offer any formal training for tobacco cessation counseling. Two virtually identical surveys assessed tobacco cessation counseling among 783 actively practicing dentists and ninety-eight third- and fourth-year dental students in Texas in 2003–04. The response rates were 54 percent and 79 percent, respectively. Principal component analysis with varimax rotation on fifteen items used to assess the 5 As and 5 Rs of counseling activities produced, according to a scree test, three well-defined and stable factors in both the dentist and student data. The factors explained over 60 percent of the variance. The factors and their internal constancy coefficients in the dentist and student data respectively were: inquiry about tobacco use (two items, Cronbach’s Coefficient Alpha .71 and .72); education about tobacco use (five items, Alpha .89 and .89); and support during a cessation attempt (five items, Alpha .91 and .92). The means of the factor scores were almost identical in both data sets and revealed that 44 percent of the dentists and 42 percent of the students inquired about tobacco use usually or always. The corresponding percentages of these who educated their patients about tobacco use were 36 percent and 43 percent. However, only 2 percent of the dentists and 5 percent of the students assisted smokers during cessation.
These results demonstrated surprising similarity among practicing dentists and the third- and fourth-year dental students in their cessation counseling in spite of obvious differences between the dental office and the training clinic. Involvement in cessation counseling activities is well below the recommended level of the guideline in both groups. This is especially the case in supporting tobacco users who are willing to try quitting.
49. Development and Evaluation of a Pediatric Course for Dental Hygiene Students
Beverly A. McClure, The Ohio State University
Purpose: To develop a pediatric course for dental hygiene (DH) students to prepare them for pediatric clinical experiences
Dental hygiene students have the opportunity to treat patients at an underserved rural pediatric dental clinic, Children’s Hospital, and the Pediatric Dental Clinic at the college. A pediatric course was developed to prepare students for treatment modalities. The course consists of lecture, laboratory, and clinical experiences. Topics include: Behavior Management, Orthodontics/Occlusion, Fluorides, Prevention, Radiology, Trauma, and Sealants. One of the final clinical experiences enables all enrolled students to treat pediatric patients in the college’s pediatric clinic on the same day so that many behavior patterns can be observed. Another clinical experience consists of placing several sealants on classmates. The laboratory experiences include identification of ages and occlusion of study models and radiographs as well as a mock treatment of a pediatric patient. A 4-point Likert survey was given to the thirty-three enrolled students to determine their perception of preparedness to treat various aspects of care for pediatric patients. One hundred percent felt they were prepared or somewhat prepared to 1) utilize behavior management skills effectively, 2) complete head/neck/occlusion exams, and 3) chart mixed dentitions. Ninety-seven percent felt prepared or somewhat prepared to 1) treat pediatric patients, 2) recommend a fluoride regimen to children at risk for caries, 3) administer a topical fluoride to a pediatric patient, 4) place sealants on children’s teeth, and 5) give information to a parent whose child had an avulsed tooth. Comments were also solicited and they were very positive, including "I loved it" and "Liked the hands-on work."
All of the dental hygiene students enrolled in the course felt prepared to treat pediatric patients in various aspects of care. The course was effective in preparing students for treatment modalities.
50. Journal Impact Factor Effectiveness: Where Is the Evidence?
Maged Khedr, Temple University; Amit Chattopadhyay, Temple University; Ivonne Ganem, Temple University; Jeffrey L. Perry, Temple University
Purpose: To determine whether the JIF is a reliable tool for judging significance of the journal in a particular field, such as dentistry.
Journal impact factor (JIF), invented in the 1960s by the Institute of Scientific Information (ISI), USA, is frequently used to determine stature of a journal. JIF is calculated by counting the number of citations made in a particular year for articles published in the previous two years and dividing that count by the number of articles published in that period. JIF ranking data of dental journals were collected for the year 2002 from the ISI website. We used the three top-ranked dental journals: Journal of Dental Research (JDR), Critical Reviews of Oral Biology and Medicine (CROBM), and Journal of Clinical Periodontology (JCP) as our target journals. We then examined all articles from three selected dental journals: Community Dentistry and Oral Epidemiology (CDOE), JDR, and Journal of the American Dental Association (JADA) for citing articles from the target journals. Results: In the year 2002, a total of fifty-seven articles published in CDOE had 1847 references. The respective numbers were 154/3815 for JDR and 128/2885 for JADA. In CDOE, 11.7 percent of the references cited CDOE itself; 4.9 percent cited JDR; 2.1 percent cited JCP; and none cited CROBM. CDOE articles referred to CDOE at a rate of 3.8 references per article, whereas JDR was referred at 1.6 references per article and JCP at 0.7 percent references per article. General trends for citing self and other journals were similar for JDR and JADA.
Though JIF is a widely used tool for ranking journals, it is likely that JIF does not faithfully represent citations of references in different journals. Therefore, a more representative index is needed.
51. Oral Health-Related Quality of Life in Nigeria
Amit Chattopadhyay, Temple University; Christopher Okunseri, Marquette University; Ivan R. Lugo, Temple University
Purpose: To identify oral health-related factors and their effects and impacts on quality of life among adults resident in Benin City, Edo State, Nigeria.
Concepts of health and quality of life are abstract, difficult to define, and refer to multidimensional, complex, and not well-demarcated events. At this time, no study has assessed oral health-related quality of life of the population of Nigeria. This cross-sectional study of 358 adults aged eighteen to sixty-four years used a closed-ended oral health questionnaire administered by trained interviewers to assess sociodemographic information, factors associated with oral health care utilization, and oral health-related quality of life. Oral health-related quality of life factors were measured in two dimensions (effects and impacts) with constituent domains and attributes for each dimension. The overall response rate was 84 percent. Some 62 percent of the participants reported their self-perceived oral health to be good, 26 percent had visited a dentist in the past one year, and 71 percent reported visiting a dentist only if they had a treatment need. More than 50 percent of the participants reported their oral health had a good or very good effect on their quality of life across each attribute of all domains for the two measured dimensions (effects: physical, psychological, and social; impacts: daily activities, social activities, and talking to people). Overall, 82 percent of the participants perceived oral health as affecting their eating or enjoyment of food; sleep or ability to relax (63 percent); and smiling or laughing (77 percent). About 46 percent reported that it did not impact their daily activities, social activities (36 percent), or ability to talk to people (25 percent).
While reporting good effects, participants also reported little/ no impacts of oral health on their quality of life. This along with low oral health care utilization and treatment-oriented health care-seeking behavior reflects cultural attributes of the population and needs to be addressed by policy makers for improving oral health of Nigerians.
52. PBL vs. Traditional Educational Methodology: A Comparison of Preclinical and Clinical Periodontics Performance
Sandra K. Rich, University of Southern California; Robert G. Keim, University of Southern California
Purpose: To compare midterm, final, and clinical exam scores (N = 1,383) of dental students enrolled in a problem-based learning (PBL) vs. a traditional (TRAD) undergraduate periodontics program to determine differences in performance.
PBL has been explored in dental education as an alternative instructional method. To provide formative evaluation of PBL efficacy in preclinical and clinical teaching, scores of 234 students from the TRAD classes of 2003 and 2004 were compared with scores of 274 students from the PBL classes of 2005 and 2006. Midterm (probing/ exploring) and final (curette) exams were performed on student/mock patients. Clinical exams (2003, 2004, 2005 only) required evaluation of the hand skills on a clinic patient. For preclinic, students under both methodologies worked with an instructor in small groups (six to eight students) and practiced skills on typodonts and student partners. TRAD students had required reading assignments, and sessions began with formal lectures. PBL students directed their own learning in pre-session/post-session, instructor-facilitated groups by analyzing cases and determining their own daily learning objectives. Statistical analysis of scores (t test) revealed that PBL students performed significantly better than TRAD students on midterm (p<.000) and final (p<.02) exams. There was no difference in performance on clinical exams for PBL vs. TRAD students. ANOVA comparing the classes with each other showed a sig. F for midterms and finals. Multiple comparison tests (Tukey) revealed that the Class of 2004 (TRAD) performed significantly below all three of the other classes.
Considering narrow differences in mean scores, the educational significance of differences in performance on midterm and final exams must be cautiously interpreted. Ultimately, both methods were determined to be equally effective in teaching nonsurgical periodontics skills to undergraduate dental students as measured by a clinical exam on a patient.
53. Patient Services Liaison: A Necessary Component to Patient Complaint Resolution
Janet B. Markell, Tufts University; David A. Russell, Tufts University
Purpose: To describe a successful process at one dental school that facilitates expeditious patient problem resolution that limits the clinical dean’s involvement to only those cases that are irreconcilable and/or have significant potential for liability.
Within the dental school environment, patient issues arise for various reasons. The clinical dean’s office can easily become the complaint bureau. It is to a dental school’s benefit to resolve the issue to the satisfaction of the patient, and that resolution should be perceived by the student, faculty, and staff as fair. A successful process at Tufts University School of Dental Medicine has been in effect for three years. A "go to person" who demonstrates compassion to the patient and understands the issue is the first step in successful resolution. A patient services liaison should be identified as this "go to person" who demonstrates compassion to the patient and an understanding of the issue. Steps in the resolution process include the development of a form for a brief synopsis of the patient’s issue, information-gathering via the patient record, and brief interviews of those involved. Direction of the complaint to the appropriate individuals is integral for resolution, and the conclusion must be documented. The clinical dean is involved only as the last step in the process if the situation is irreconcilable. At Tufts University School of Dental Medicine, such a process has been in place for over three years with an excellent record of success and patient retention. From September 2001 until September 2004, 252 complaints were registered. The average length of time for resolution was 7.6 days. Seventy-seven percent (n=194) of those patients with complaints stayed on at the school for continuing treatment with their same student; 12.7 percent (n=32) chose to continue treatment but were transferred to another student or department; and 10.3 percent chose not to continue receiving care at the school.
At Tufts University School of Dental Medicine, it has become the culture for the patient services liaison to be the coordinator of patient complaint resolution.
54. Web-Based vs. Traditional Instruction in Gerontology for Dental Hygiene Curriculum
Judith E. Gallagher, University of Pittsburgh; Kathleen A. Vergona, University of Pittsburgh; Robin G. Wingard, University of Pittsburgh
Purpose: To determine if the web-based teaching format was as effective as the traditional classroom style of instruction in a dental hygiene curriculum.
This study compares the student profiles and educational outcomes of a gerontology course offered in a web-based and a traditional classroom format within a dental hygiene curriculum. Questionnaires were sent to both groups of students completing the course. The questionnaire was designed to provide a profile of the students, their familiarity with online instruction, extent of prior training and/or interaction with the elderly, and their evaluations of course effectiveness. The web-based respondents included dental hygiene students (73 percent) and other health care providers (27 percent). All of the traditional classroom respondents were dental hygiene students. Most of the web-based respondents were over twenty-five years of age and had taken an online course in the past. The majority of traditional classroom students was under twenty-five years of age and had never taken a web-based course. The web-based students demonstrated greater motivation and learning success based on final course grades, completion of assignments, and knowledge retention over time. In summary, student characteristics influenced teaching mode selection, as well as learning success in a dental hygiene curriculum.
The web-based format was as effective as traditional classroom instruction. The educational outcomes of the web-based students were more favorable than the traditional classroom students in most areas.
55. PGD Program Alumni Survey: A Useful Outcomes Assessment Instrument
Meredith C. Bogert, Temple University; Daniel W. Boston, Temple University; Eugene J. Whitaker, Temple University
Purpose: To determine whether a survey of practice characteristics and curriculum effectiveness sent to program alumni can be useful for outcomes assessment for fulfillment of program goals in the preparation of its graduates for general practice.
A survey was sent to three classes of recent graduates of a postdoctoral general dentistry program to determine the nature of their current practices and to assess the effectiveness of the program in preparing them for practice. Sixteen of twenty-one surveys were returned, representing 76 percent of the graduates for three program years. All but two (in orthodontics and pedodontics specialty training) were actively engaged in full-time practice of general dentistry at the time of the survey and were performing specialty services in periodontics, endodontics, oral surgery, and pedodontics, but not in orthodontics. They reported that their approach to assessment, diagnosis, and treatment planning remained similar to their training in the program. Ninety-four percent felt that the amount of training in restorative dentistry (including pedodontics and implantology), periodontics, oral surgery, orthodontics, pharmacology, physical diagnosis, and oral pathology/medicine was "about right." All of the graduates from the earliest program year felt they would have liked more training and experience in endodontics, as they were expected to keep as much endodontic treatment in-house as possible. Following the introduction of rotary endodontics courses, additional seminars in endodontics, and additional clinical endodontics instruction in the following program year, 87.5 percent of the respondents from the two subsequent years felt that their endodontics training was "about right." Based on their current experiences, 100 percent of respondents felt they would have liked more training in practice management to better prepare them for the realities of practice. Evaluation of these survey data resulted in substantial modification of the program’s practice management curriculum in order to better prepare program graduates for practice.
An alumni survey can be a very effective outcomes assessment instrument to identify opportunities for improvement in a PGD program’s curriculum.
56. Second Phase of Clinical Integration of Dental and Dental Hygiene Students
Lorilei Kirby, New York University; Eva Lupovici, New York University; Eric Studley, New York University; Cheryl Westphal, New York University
Purpose: The second phase of clinical integration of dental and dental hygiene students has been initiated by curriculum enhancement in the discipline of practice management and increase of productivity and income.
Two years ago a new, integrated, multidisciplinary approach to teaching was initiated to enhance the competencies of comprehensive patient management and effective utilization of allied dental personnel through clinical integration of dental and dental hygiene students in patient care. This enabled third-year dental and second-year dental hygiene students to work as co-therapists in health promotion and disease prevention with a defined role for each provider. The objectives of the initial phase have been met. The second phase of the integration is the increased emphasis on practice management and benefits derived through increase in clinical experiences, production, and income. A group practice clinic was used as a model for measurement of outcomes of the second phase. The integration has resulted in an increase in the number of patients treated and income. Patient appointments have increased 27 percent, with an income increase of 19 percent. The increase in patient appointments was the result of increases in the number of providers available for patient care, clinical experiences, productivity, and clinic income. The integration provided the opportunity for each student to increase his or her productivity in patient care and income by emulating the private practice setting through defined roles of each practitioner with maximized time utilization.
The second phase of the integration of dental and dental hygiene students as co-therapists has resulted in improved practice management skills and increased number of services provided, clinical experiences, and clinic income. Due to the success of the integration, the curriculum format will be continued.
57. Obturation of Rotary-Prepared Root Canals
Patricia A. Bauer, University of Michigan
Purpose: To introduce an efficient and practical technique that undergraduate dental students can use to obtain consistently well-obturated canals in teeth prepared using nickel titanium rotary instruments.
Cleaning and shaping of root canals using a nickel titanium rotary instrumentation were introduced into the undergraduate clinic in fall 2003 as a result of a growing trend in their use by practicing general dentists. The technique was enthusiastically embraced by students and faculty, and there was improvement in the cleaning and shaping of the root canal system as demonstrated by established, measurable criteria. The obturation of canals had remained the same, yet with the widened, more thoroughly cleaned canals, the quality of the final fill had decreased. Errors such as extruded accessory cones and overfills were occurring more frequently. So, in spring 2004, a new means of obturating the canals was introduced using standardized 0.04 tapered gutta percha cones instead of the standardized 0.02 cones used in the past. The technique applied the cold lateral methodology of filling the canal. Early results from the application of the new technique in the preclinic reflected a decrease in certain filling errors by as much as 50 percent with an additional benefit of a decrease in time required to fill the canal. Implementation began on patients in the subsequent clinic session in summer 2004. Data collected at the completion of the session demonstrates an increase in the obturation score by an average of 20 percent as compared to scores achieved in the same time frame in 2003, using the old technique. Total canals obturated increased in summer 2004 (seventy-eight) as compared to 2003 (fifty-three). The technique will be presented along with a table comparing the quality and quantity of obturated root canals in 2003 versus 2004, based on specific criteria such as the following: 1) fill extends to established working length, 2) homogenous, dense fill, and 3) absence of core material beyond apex.
Obturation of rotary instrumented root canals is better and more efficiently filled with wider 0.04 taper cones as compared to standardized 0.02 taper cones used in the past in canals prepared with nickel titanium 0.04 taper rotary instruments.
58. Preclinical Dental Students’ Perception of the Implementation of VR-Based Technology
Riki Gottlieb, University of Pennsylvania; Judith A. Buchanan, University of Pennsylvania; Peter Berthold, University of Pennsylvania; Margrit P. Maggio, University of Pennsylvania
Purpose: To compare D1 and D2 students’ perception of the implementation of virtual reality-based technology (VRBT) in the dental curriculum at the University of Pennsylania School of Dental Medicine during the academic year 2003–04.
VRBT was implemented into the D1 curriculum at the beginning of the academic year 2003–04. This VRBT allows for students’ self-learning of the basic manual skills needed for cavity and crown preparations. Fifty-four percent of the D2 students evaluated VRBT as a better teaching tool than traditional lab as compared to 21 percent of the D1 students. More than 80 percent of D1 and D2 students would not completely substitute traditional teaching by faculty with VRBT and would like to have a faculty member as part of the procedure evaluation. The preferred option of instructional feedback differentiated between D1 and D2 students: 58 percent of D1 students preferred feedback from faculty to VRBT, in comparison to 46 percent of D2 students; 56 percent of D1 students felt less stressed when getting feedback from faculty, in comparison to 43 percent of D2 students. The majority of both groups evaluated the instant feedback, the contribution to correct positioning and posture, and the consistency and 3D evaluation to be the main advantages of working with VRBT. Seventy percent of D1 students would like to practice in the advanced simulation lab at least once a week, compared to 21 percent of D2 students. These results show that D2 students, who had more experience in traditional dental training, preferred computerized feedback to human feedback more than did D1 students. D1 students had limited experience with faculty evaluation, but the radical shift from computerized feedback had a big impact on their attitude (hence favoring the human feedback). Students perceive computerized evaluation to be more stressful than human evaluation, but are aware of the advantages that VRBT training has in improving their clinical skills.
The findings support the implementation of VRBT training as an integral part of the curriculum of D1 and D2 preclinical training. Following these evaluations, the University of Pennsylvania School of Dental Medicine will continue to use VRBT as part of D1 and D2 preclinical curriculum on a daily basis (some changes will be made based on feedback from students). The effect of VRBT on students’ dental qualities and grades in preclinical and clinical settings is currently being evaluated.
59. Faculty Evaluations and Expectations of VRBT and Non-VRBT Trained D1 Students
Riki Gottlieb, University of Pennsylvania; Judith A. Buchanan, University of Pennsylvania; Peter Berthold, University of Pennsylvania; Margrit P. Maggio, University of Pennsylvania
Purpose: To compare faculty expectations and evaluations of first-year dental students who used virtual reality-based technology (VRBT) as an integral part of their first preclinical year curriculum.
Thirteen preclinical faculty instructors were asked to evaluate the finishing D1 class (ninety-seven students), at the end of the preclinical course, in various qualities (e.g., psychomotor skills, confidence level, operative procedures). The faculty attended a review lecture and hands-on session on the VR Dental Simulator, after which they answered questions regarding their expectations of the incoming D1 class (105 students) who had an average of thirty-eight hours of VRBT training. These faculty members were surveyed again at the end of the traditional preclinical D1 course and evaluated the same qualities in these students who had about sixty VRBT hours at that time. D1 VRBT-trained students’ qualities rated higher than non-VRBT students in fifteen out of sixteen qualities checked. Faculty expectations were higher than students’ qualities in VRBT-trained students in fourteen out of sixteen qualities checked. The faculty rated the students’ use of hand instruments in evaluation of preps to be lower in the VRBT group, but higher than what was expected (using the computer as the main source for feedback, there is less emphasis on the use of hand instruments to evaluate the dimensions of a preparation). The students’ stress level was evaluated as higher in the VRBT group, possibly because of the faculty’s higher expectations. According to the literature, VRBT helps students acquire clinical skills more efficiently. In this study, we showed that students’ dental qualities, as perceived by faculty, are better in VRBT-trained students ithan in non-VRBT-trained students. Nevertheless, preclinical instructors had higher expectations of students’ qualities (with VRBT training), in comparison to the levels shown in their evaluations.
Following the impact of VRBT on dental students, their improved dental qualities, and higher daily grading, we think that VRBT-trained students will have an advantage in a dental clinical setting, in comparison to non-VRBT-trained students. These results support the use of VRBT as an integral part of the preclinical dental curriculum.
60. Skill Progression and Licensure Examination Preparation of First Professional Students in the Discipline of Fixed Prosthodontics
Antonio R. Charneco, University of Pittsburgh; Daniel P. Ratkus, University of Pittsburgh; Marnie Oakley, University of Pittsburgh
Purpose: Numerous dental institutions struggle to address a trend that appears to suggest a difficulty for students to access patients whose accepted treatment plan includes a fixed partial denture. Of equal concern, student performance statistics on regional licensure examinations are under continuous scrutiny in any given institution.
The innovative approach of the Simulated Patient Treatment course appears to have positively affected the students’ performance on licensure examinations as well as raised their ability to progress clinically in the discipline of fixed prosthodontics. It can be argued that the following factors of this course helped influence these outcomes: the repetition of procedures performed by students, the students’ self-assessment of their performance on each project, and the continuous interaction of highly calibrated faculty offering feedback to the students. Assuming these positive trends continue, further investigation may prove to be beneficial in implementing these key factors in other disciplines throughout the School of Dental Medicine.
61. Mock Clinical Boards: Effective Board Preparation?
Carolyn H. Ray, Texas Woman’s University
Purpose: To determine if the administration of a mock clinical board helped determine performance on the actual clinical board examination.
An important goal of dental hygiene education is graduating clinically competent practitioners. Much of the clinical curriculum includes process and product evaluations that monitor and assess dental hygiene students’ clinical abilities. The purpose of this study was to determine if the administration of a mock clinical board helped determine performance on the actual clinical board examination. A mock board was administered to twenty-five dental hygiene students during their last semester before graduation. The criteria for the mock board matched that of the regional board. Students were responsible for selecting their own patients. Patients had to meet the specified criteria and were not pre-approved prior to the mock exam. The time frame of the mock board matched that of the regional board, allowing two hours and thirty-five minutes to complete the procedures being tested. Scores were calculated based on 10 points for intra/extra oral exam, 15 points for probing, and 75 points for calculus removal. Upon completion of the procedures, three examiners (dental hygiene faculty) examined and recorded areas of calculus. Areas that had two examiners agreeing on them were counted as an error. Six points were deducted for each calculus error. All twenty-five students took the regional board two weeks later. The mock board scores were compared with the results from the regional board. A paired samples t-test showed there was no significant difference between the mock board calculus removal scores and the regional board calculus removal scores (t=.154, p=.879). There was also no significant difference between the mock board total scores and the regional board total scores (t=.189, p=.852). While the mock board did not predict success on the regional board, results were similar. In conclusion, the mock board may be an effective practice exam that prepares students to take their actual board examinations. More data would need to be collected to determine whether the mock board examination predicts students’ performance on their actual boards.
62. The Concordance of Faculty and Student Learning Styles
Joseph H. Murphy, Dalhousie University; Helen A. Ryding, Dalhousie University
Purpose: The study had two purposes: first, to determine the preferred learning styles of clinical faculty members and undergraduate dentistry students; and, second, to consider the implications of matches and mismatches between the two groups’ learning preferences.
In 2001, Valachovic cited "transgenerational learning style differences" as a major issue facing dental education. If dental students and faculty share similar orientations to learning, then dental education is likely to be relatively harmonious, but, if not, then the road to graduation may be quite bumpy. The objective of this study was to ascertain the degree of concordance between the learning styles of dental students and educators. The Gregorc Style Delineator was completed by all students (N=136) in five entering classes during their first month in the D.D.S. program. The Gregorc was also completed by forty-three faculty members. The Gregorc instrument is derived from Jungian psychology and suggests that differences in the way people approach a learning task can be explained by their use of "perception" (abstract or concrete) and "judgment" (sequential or random). Results are expressed in terms of a person’s strength along each of four dimensions: Concrete Sequential (CS), Abstract Sequential (AS), Abstract Random (AR), and Concrete Random (CR). Results: CS (emphasizing the "practical" and preferring an environment that is ordered, linear, discrete, and stable) was chosen as first or second choice by 78 percent of students and 70 percent of faculty. The second most popular for students was CR (with an emphasis on the "possible" in a stimulus-rich, competitive, restriction-free environment); but CR was least often selected by faculty. Students were least likely to endorse the AR orientation (emphasizing "potential" and preferring an environment that is rich, active, colorful, and emotionally and physically free), with only 35 percent selecting it as a first or second choice; yet this AR style was second most popular among faculty members. The AS orientation ranked third for both groups.
Current dental students’ learning styles are quite similar to those of their instructors. However, there are sizeable numbers of students for whom the match is poor, suggesting that their dental education experiences may be difficult. In light of these inconsistencies, faculties must explore ways to broaden the educational experiences to accommodate better the increasingly diverse student population.
63. Influencing Underrepresented Minorities’ Attitudes Regarding Dentistry Through Exploration and Mentoring
Canise Y. Bean, The Ohio State University; Michael L. Rowland, The Ohio State University
Purpose: To introduce and expose underrepresented minority high school students to dental assisting and the dental profession as viable career options.
The Ohio State University College of Dentistry enrolled eight junior and senior high school students in an intensive summer dental assisting program. Students were recruited from local area high schools, particularly two high schools with a health careers academy. Selection into the program was based on high school grades, letters of recommendation, and interest in the health profession. The seven-week program introduced students to the dental profession, including all specialties, dental hygiene, and the vocations of dental assisting and dental laboratory technology. The program trained the students through didactic learning packages as well as clinical and laboratory experiences. Students were exposed to oral anatomy, infection control procedures, equipment and instrument identification, instrument transfer, moisture control, radiology, patient charting, tray set-up, identification and mixing of dental materials, and assisting dental students with restorative procedures. The textbook Essentials of Dental Assisting by Ehrlich and Torres was used for the program. During the seven-week program, students were in class Monday through Thursday. On Fridays, participants spent time observing and working in minority-owned general practice dental offices. Participation in the summer program should foster an understanding and interest in dental practice on all levels and open doors of opportunity for immediate employment in the dental field. The students were given a pre-test to determine their knowledge of, interest in, and attitudes toward the dental profession the first week of the program and a post-test the last week of the program. At the conclusion of the program, participants and their parents attended a special dinner to commemorate the experience.
Participants’ knowledge of the dental profession increased on the post-test examination. Students scored 60 percent on the pre-test questions while scoring 100 percent on the post-test questions. Participants noted the most valuable aspects of the program included working in private practice dental offices, hands-on experiences, and learning about the profession from guest speakers. One participant noted, "I believe I would like to become an Oral Pathologist." Thirty-eight percent of the students thought the seven-week program was too short.
64. Students’ Perception of Learning Utilizing a Double-Entry Journal
JoAnn C. Scofield, Baylor College of Dentistry
Purpose: To assess dental hygiene students’ perception of learning using double-entry journals as a learning tool for reading assignments.
Standards for dental hygiene (DH) education are guided by core competencies, which include critical thinking and problem-solving skills. The use of a double-entry journal (DEJ) was instituted at Baylor College of Dentistry as a teaching tool to encourage reflective reading as a learning strategy. Students enrolled in Gerontology and Theory of Dental Hygiene I were required to complete assignments using a DEJ to engage students in active learning. Using two columns, students wrote objective information on the left and subjective information on the right, creating an interactive dialog with the reading. Students were asked to make comments regarding each objective statement such as: How did this change your understanding of this topic? How will this relate to patient care? What is your interpretation? They were to include examples of application, discuss solutions, and/or relate to personal experience. All DH students (Gerontology n=26, Theory of DH n=28) were given a Likert-like survey regarding their perceived value of the DEJ as a learning tool. There was a 100 percent response rate. More than 80 percent in both classes either strongly agreed or somewhat agreed to the following: 1) the DEJ helped me connect the subject matter with patient care; 2) writing the DEJ encouraged me to think for myself; and 3) writing the DEJ helped me gain a better understanding of the material. To the statement, "Overall, the DEJ enhanced my critical thinking skills," those that somewhat agreed or strongly agreed ranged from 64 percent in Theory of Dental Hygiene I to 88 percent in Gerontology.
As a faculty member using this method, I observed that the students were better prepared for class as exhibited by discussion and the types of questions posed. According to student perceptions, the use of a double-entry journal as a learning tool appears to be a viable method that enhances critical thinking skills.
65. Prevalence and Severity of Hypertension in a Dental Hygiene Clinic
Ana L. Thompson, Medical College of Georgia; Marie A. Collins, Medical College of Georgia; Mary C. Downey, Medical College of Georgia; Wayne W. Herman, Medical College of Georgia; Joseph L. Konzelman, Medical College of Georgia
Purpose: To document the prevalence and severity of hypertension in a dental hygiene clinic.
This study assessed the prevalence and severity of hypertension in a dental hygiene clinic. Records of 615 patients, treated by dental hygiene students during 2003, were reviewed. Data collected included systolic and diastolic blood pressure, presence of diabetes and renal disease, non-modifiers (race, gender, age), and modifiers (marital status, smoking habits, and occupation). According to the JNC7 Classification, 154 (25 percent) of the subjects had normal blood pressure readings, 374 (60.8 percent) had prehypertension, and 87 (14.1 percent) had Stage 1 hypertension. Statistical analysis showed a significant difference in the JNC7 Classification between groups when considering the non-modifier race (p = .02) and the modifiers smoking habits (p = .03) and occupation (p = .01). A statistically significant difference in the JNC7 Classification existed between groups with diabetes (p = .00). Several recommendations were made to align the dental hygiene clinic policy for assessing and diagnosing hypertension with the 2003 JNC7 Classification.
In conclusion, there were significant differences in the prevalence and severity of hypertension between groups when considering race, smoking habits, occupation, and diabetes. The majority of patients had blood pressure readings in the prehypertension stage. Based on these results, the researchers recommend clinical policy modifications that include additional documentation for blood pressure readings in the prehypertension stage, lowering the systolic reading from 160 mmHg to 140 mmHg when adding hypertension alert labels, and noting prehypertension/ hypertension on the dental hygiene care plan with the appropriate interventions.
66. What Determines Student Perceptions of Extramural Clinical Rotations? An Analysis Using ADEA Senior Survey Data
Amardeep Thind, University of California, Los Angeles; Kathryn Atchison, University of California, Los Angeles; Ronald Andersen, University of California, Los Angeles
Purpose: We used the ADEA 2003 Senior Survey to understand graduating dental students’ perceptions about their extramural rotations.
Extramural clinical rotations are an integral part of many dental school curricula. As part of the Robert Wood Johnson Foundation/ California Endowment "Pipeline, Professions, and Practice" program, schools are increasing student extramural opportunities to expose students to patients of different needs, cultures, and dental delivery modes. However, to date, there has not been a national level analysis of the determinants of students’ perceptions of their extramural rotations. The American Dental Education Association and the National Evaluation Team added a series of questions to the 2003 survey that ascertained students’ perceptions of their extramural clinical rotations. The present study was designed to determine the factors associated with a student’s perception of the extramural clinical rotations being a positive experience in his or her dental education and improving the student’s ability to provide care for racially, ethnically, and culturally diverse groups. The respondents included 2950 graduating seniors who reported at least one week of extramural rotation experience. Controlling for other factors, race/ethnicity, a stronger socially conscious attitudes score, number of weeks spent in extramural rotations, and the student’s rating of time spent in extramural rotations were significant determinants of those rotations being reported as positive experiences. With respect to improving a student’s ability to provide care to racially, ethnically and culturally diverse groups, more positive student socially conscious attitudes, a greater number of weeks spent in the rotations, a stronger service orientation for selecting dentistry as a career, and the student’s rating of their time spent in extramural rotations were significant determinants.
This study presents evidence that time spent in extramural rotations may be positive dental school experiences, but it is unclear whether students perceive their value in training them to handle culturally diverse patients by the time of their graduation.
67. Student Perception of Dentoform Teeth Containing Simulated Carious Lesions
Charles K. Hill, University of Nevada, Las Vegas; Stanley J. Nelson, University of Nevada, Las Vegas; Thomas P. Nowlin, University of Nevada, Las Vegas
Purpose: Measure student perception of learning operative dentistry techniques in a preclinical setting using both standard dentoform teeth and dentoform teeth containing simulated carious lesions.
Minimal research has been completed regarding student perception of dentoform teeth with simulated carious lesions as an operative dentistry teaching tool. One hundred forty-nine dental students at the University of Nevada, Las Vegas School of Dental
Medicine participated in preclinical courses this year that utilized both standard Kavo dentoform teeth and Kavo dentoform teeth with simulated carious lesions. Ten of the eighteen exercises covered in both courses used the carious teeth. The simulated caries was fabricated and placed into the teeth by an attending faculty member. Seventy-four first-year students and seventy-five second-year students were represented. At the conclusion of the courses, students completed a nine-question survey regarding their learning experience having performed procedures on both types of teeth. Six questions related to the carious teeth as an aid for learning principles and techniques of operative dentistry. Three questions covered student preferences regarding the use of both standard dentoform teeth and those with simulated caries in future courses. The survey had an 88 percent rate of return, with 132 respondents. Ninety-eight percent of responses were positive for the six questions regarding the usefulness of teeth with simulated caries in learning operative dentistry principles. One hundred percent of respondents favored the continued presence of the carious dentoform teeth in future courses, and 97 percent agreed they would like to increase their usage. But response to whether or not the teeth with simulated caries should be the only dentoform teeth utilized in future courses was much less favorable with 46 percent positive responses and 54 percent negative.
Increased use of teeth with simulated caries was highly favored by the students in this study, although the majority of students also preferred the continued use of standard dentoform teeth as part of their learning experiences.
68. Therapeutic Communication Skills for Dental Hygiene Students
Valerie A. Orlando, University of Colorado; Terri S. Tilliss, University of Colorado
Purpose: In order to improve the therapeutic communication skills of dental hygiene students, an experiential curricular module was developed, and a communication assessment tool was constructed and utilized for self- and peer evaluation.
Communication skills are fundamental to the practice of dental hygiene. Effective communication facilitates the development of trust within the helping relationship, positively influencing health beliefs and behaviors. The art of therapeutic communication is traditionally challenging to teach and objectively evaluate. A curricular module was developed to help senior baccalaureate dental hygiene students develop therapeutic communication skills in an experiential manner. Initially, students were presented with six scenarios portraying frequently encountered consultation interactions. Each student selected one of the scenarios and prepared a videotaped roleplay with a mock client. Before viewing the videotapes, two classroom discussion sessions clarified principles of therapeutic interaction. In small groups, the videotapes were viewed and self- and peer-critiqued after introduction of a competency-based therapeutic communication tool. Students reviewed their tape at home and prepared an improved live roleplay to present at the next session, with classmates participating in the roleplay and assessment of the improved interactions. After this session, students retaped the original scenario with the same mock client. Meeting again in small groups, the second videotapes were assessed using the communication assessment tool. Major improvements in communication skills were generally noted between the first and second videotapes. Each small group selected the pair before and after videotapes that demonstrated the most improvement; these were presented in the final wrapup session with the entire class. Students and faculty observed application of better communication skills within the clinical setting. The development of the therapeutic communication assessment tool was an important outcome of this curricular module, with applications for self-, peer, or instructor evaluation in the laboratory or clinical setting.
A therepeutic communication teaching module and accompanying assessment tool were developed and successfully utilized for improving communication skills of dental hygiene students.
69. Assessment of Patient Satisfaction with the OSU Outreach Geriatric Mobile Dental Program in Appalachia
Abdel R. Mohammad, The Ohio State University
Purpose: To assess patient satisfaction with the goals of the OSU geriatric dental program including broadening the educational experiences of its students and reaching underserved low-income people who are lacking access to dental care.
In 2001, an Appalachian Outreach Program was launched. This weekly program visits community senior centers of ten participating Appalachian counties in southeastern Ohio where at least fifteen patients are treated each visit. A questionnaire was used utilizing a Likert 5-point scale to evaluate patient satisfaction with the goals of this program. Demographics data pertaining to age, gender, race, and employment status of these patients were collected. A total of 455 questionnaires were completed. Sixty-five percent were females and 35 percent were males. Forty-six percent of the patients were between the ages of sixty and seventy, and only 6 percent of the patients were eighty-six or older. Eighty-six percent were retired, and 14 percent were employed. Eighty-one percent of the patients were Caucasian. When patients were asked reasons why they would not or had not seen a dentist, 55 percent reported financial reasons, and 22 percent said that they did not perceive a need for dental treatment. Other reasons for not visiting the dentist were lack of transportation, no dentist in the area, or fear. Seventy-five percent of patients strongly agree or agree with statements that the area is underserved by dentists. Sixty-eight percent replied that they only go to the dentist when they feel pain or have a problem. When patients were asked if the dental students addressed their chief complaint, 97 percent strongly agreed or agreed. Lastly, when the patients were asked if they were pleased with the dental care they received from the OSU dental students, 97 percent strongly agreed or agreed that they were satisfied
The result of this questionnaire indicates a very high degree of satisfaction with the goals and services rendered in this program.
70. A Patient-Instructor Module to Promote Cross-Cultural Communication Skills
Julie Wagner, University of Connecticut; Joseph A. D’Ambrosio, University of Connecticut; Sarita Arteaga, University of Connecticut; Cynthia Hodge, University of Connecticut; Effthimia Ioannidou, University of Connecticut; Carol Pfeiffer, University of Connecticut; Susan Reisine, University of Connecticut
Purpose: To evaluate a patient-instructor learning module to enhance students’ interviewing skills with diverse patients.
A cultural competence patient-instructor (PI) module was developed to address potential student-patient differences that can hinder communication. PIs were individuals from the community trained to portray specific fictional patients. Forty third-year students interviewed four PIs in simulated clinical encounters. Students were evaluated by PIs and faculty using two criteria: 1) ability to elicit and provide essential information as measured by percentage of previously determined items on a content checklist, and 2) interviewing skills as measured by the Arizona Clinical Interview Rating scale (ACIR; 25-items scored 1-5, 5=better skills). Students also assessed the module’s relevance and appropriateness and reported changes in diversity-related behaviors and attitudes. Across students and counterbalanced cases, content checklist scores significantly improved as students progressed through cases (first encounter M=69 percent, SD=17 percent; fourth encounter, M=78 percent, SD=16 percent), F(3,151)=4.24, *p<.01. The overall mean score for case content checklists was normally distributed, slightly negatively skewed, with substantial variability, M=76, SD=16 percent. There was a trend for improved ACIR scores as students progressed through cases, p=.09. The overall mean score for the ACIR was normally distributed and slightly negatively skewed, M=3.7, SD=0.6. Students reported significant positive changes in their diversity-related attitudes and expected behaviors (*p’s<.01). They also reported that the module improved their skills, provided useful feedback, and indicated room for improvement in their own cross-cultural communication skills.
Results suggest that the PI model effectively promotes cross-cultural student-patient communication. Plans include expansion of the module for incoming third- and fourth-year students.
71. Evaluation of a Novel Dental Course Redesign Project
Sandra D. Challman, University of Kentucky; Michael C. Herren, University of Kentucky
Purpose: Selected dental faculty participated in a year-long, multi-institutional, collaborative effort to examine how instructional technology, workload sharing, and an innovative course redesign process can recreate courses that are competency-based, modular, deliverable online, and student-centered.
Dental education programs face the same budget woes as other programs in higher education. High technology costs, increasing class sizes, decrease in state funding, and faculty workload constraints place stress on institutional effectiveness. New models must be created to enhance the efficiency of our teaching while improving student learning. One statewide faculty development initiative has introduced dental faculty to a course redesign paradigm, based on that of the Center for Academic Transformation at Rensselaer Polytechnic Institute. Proposals were solicited from faculty willing to engage in innovative reform to promote new models of efficient, learning-centered courses that apply instructional technology and sound pedagogy. Key features were a retreat, web-based self-study, distance learning opportunities, and a series of workshops. Seventy-four faculty participated across a full spectrum of undergraduate to professional level programs from community colleges through Research I state universities. A critical mass of eight dental faculty participated in over thirty hours of instruction and twenty-two topics in the application of good pedagogy (learner-centered teaching, active learning, computer-based instruction); effective formative/summative assessment methods; and educational costs and efficiencies. Evaluation strategies included analysis of pre/post tests, homework assignments, a final redesign plan, and satisfaction surveys comparing dental faculty to the broader group. From the retreat, faculty reported varying levels of satisfaction in regards to new knowledge acquisition. Dental faculty (DF) compared to all faculty (AF) rated the extent to which the retreat expectations were met regarding knowledge on student learning (AF=93 percent; DF=100 percent) teaching efficiency (AF=91.8 percent; DF=80 percent) and integrating instructional technology (AF= 90.4 percent; DF=100 percent). As a baseline, reliance on instructional technology use was reported from "occasionally" to "entirely" (AD=73.5 percent; DF=80 percent). At mid-course, faculty will be evaluated on their ability to apply the principles to course redesign.
There is significance and merit to dental faculty exposure to broad-based, campus-wide approaches to teacher training. Dental faculty who attended the collaborative course redesign training were satisfied with the exposure to new knowledge about teaching and learning and were able to develop course redesign plans in fundamental, innovative, and meaningful ways. Other dental schools should look into ways of leveraging university resources to provide similar faculty development opportunities.
72. Assessment of Personality Preferences via MBTI and Performance in Dental School and on Licensure Examinations
Carol M. Stewart, University of Florida; Robert E. Bates, University of Florida; Gregory E. Smith, University of Florida; Linda Young, University of Florida; Gail S. Mitchell, University of Florida
Purpose: To determine if knowledge of dental students’ personality preferences via Myers-Briggs Type Indicator (MBTI) could be useful in predicting performance during dental school and on dental licensure examinations.
Data from 416 University of Florida College of Dentistry graduates from eight successive classes, 1996–2003, were assessed using logistic regression and general linear regressions models to determine relationships between personality preferences, performance in dental school, and success on the state licensure exam. The main study group consisted of 416 students who had completed the MBTI during the first two semesters and the senior mock board exam before graduation and attempted the Florida dental licensure examination immediately upon graduation. Variables in the retrospective analysis included the MBTI, performance on the National Board I (NB- I), National Board II (NB-II), Dental Aptitude Test (DAT), the senior mock board examination, entering and graduating GPA, clinical productivity, and performance on the state dental licensure examination. If the analysis identified "at risk" students, the information would be used to modify the curriculum or construct individual enrichment programs to maximize their potential for successful outcomes. Results suggested that MBTI personality preference was correlated with success on the following traditional academic benchmarks: DAT academic average, DAT total science, National Board I and II, entering GPA, and graduating GPA. Graduating GPA was higher for judging than perceiving students. Myers-Briggs Personality Indicators demonstrated no significant differences in overall personality types and performance (pass vs. fail) on the state dental licensure exam, clinical productivity, or performance on the senior mock board exam, with the exception of the Class II amalgam procedure.
While MBTI is helpful in understanding personality preferences, this study did not identify a personality type that would require significant curricular modification to ensure students’ success.
73. A Novel Three-Dimensional Multimedia Approach to Teaching the Pterygopalatine Fossa
Jennifer K. Brueckner, University of Kentucky; Tom Dolan, University of Kentucky
Purpose: To facilitate student mastery of a conceptually challenging anatomical topic, the pterygopalatine fossa.
The pterygopalatine fossa is a deep region of the head that is small and inaccessible, making its anatomy difficult for students to envision. To create a multimedia product that would effectively supplement classroom instruction on this fossa, first- and second-year dental students were surveyed to better understand which aspects of this topic are most confusing to them. The results indicated that the majority of students struggle with visualizing the osseous anatomy of the fossa. Therefore, we storyboarded and authored an image-rich, highly structured multimedia tutorial designed to elucidate the three dimensional structure of the pterygopalatine fossa. A variety of graphic and multimedia software tools were used to create a modular tutorial, including Adobe Photoshop, Adobe Illustrator, Macromedia Flash, and Lightwave 3D. The program’s first module is an introduction to the fossa, including its key neurovascular contents and their clinical relevance to the dental practitioner. Module two focuses on the position and boundaries of the fossa, which were illustrated from six different anatomical perspectives. Each of these views is presented in a stepwise, "peel away" fashion to simulate an anatomical dissection approach. Module three assimilates all of the views introduced in the prior module using an interactive three-dimensional model of the fossa, highlighting key bony landmarks and foramina. Preliminary student evaluation data suggest that this product serves as an effective, efficient independent study program by addressing and remedying common student questions and misperceptions about the anatomy of the fossa.
In summary, the goal of this tutorial is to focus and direct student study of the pterygopalatine fossa, resulting in an improved student understanding of this clinically important region of the head.
74. Leadership Seminar Series
Ronald S. Mito, University of California, Los Angeles; Terrence E. Steyer, Medical University of South Carolina; Stewart Babbott, Tufts University; Shadia Garrison, American Medical Student Association Foundation; Paul Duncan, University of Florida; Colleen Porter, University of Florida; Shannon Davis, American Medical Student Association Foundation
Purpose: This project trains faculty and resident pairs in primary care medicine and dentistry to be future leaders in public health service and advocacy.
The Leadership Seminar Series (LSS) is a five-year contract funded by the Division of Medicine and Dentistry, Bureau of Health Professions, Health Resources and Service Administration. The contract is managed by the American Medical Student Association Foundation. The nation has seen a decline in the numbers of physicians and dentsts pursuing advanced training or careers in public health. This runs contrary to the ever-expanding need for services and the federal goals established in Healthy People 2010 and the Surgeon General’s report on oral health in America. The LSS trains primary care resident and faculty physicians and dentists with a goal of building future leaders in public health service and advocacy. Twenty resident-faculty pairs participate in three three-day training sessions over the course of one year. In total, the LSS will train sixty pairs. Each year the LSS discusses a different public health theme. The first year, 2003, focused on the health of ethnic minorities. Year two focuses on rural health, and the third year on people living in poverty. Each series begins in Washington, DC, by providing a basic overview of health policy, health care financing, advocacy, and leadership. Subsequent sessions are held in locations that represent the issues underscoring the annual theme. In 2003, the LSS held session 2 in Miami, FL and session 3 in San Antonio, TX. For 2004, session 2 will be in Phoenix, AZ and Session 3 in Memphis, TN. The multidisciplinary, primary care mix of LSS participants learn from experts and share personal experiences related to their specific discipline. In 2003, seven of the twenty pairs were dental (two GPR, one Public Health, and four Pediatric Dentistry), and thirteen were physician (six Family Medicine, two Internal Medicine, and five Pediatric).
The LSS is a novel approach to training a cadre of primary care public leaders of the future.
75. Puerto Rico Infant Caries Prevention Program
Lydia M. Lopez, University of Puerto Rico; L.C. Ocasio, University of Puerto Rico
Purpose: To present and develop educational and treatment strategies and community activities to prevent early childhood caries (ECC) in Puerto Rican children through dental health promotion and specific education to children, parents/caretakers, and communities.
The vision of this prevention program is the optimal health and care of the infants and children of Puerto Rico. Its mission is to advocate and develop public policies and community activities to promote optimal oral health and oral health care for these infants and children. Early childhood caries (ECC) is a serious problem in the primary dentition of the children with disastrous consequences for the primary and secondary dentition of the child. The consequences of dental disease included a very high risk for the development of further dental decay, an unaesthetic appearance of the mouth, which contributes to low self-esteem and confidence, orthodontic problems, and dental fear. The treatment of dental caries condition in young children is costly. Although health reform was implemented in Puerto Rico in 1994, many dental care services for young children are not being met due to lack of insurance coverage for complex procedures and preventive services and lack of participation of general dentists in the treatment of young children. The program included the following: 1) educational activities for children in preschool age every week; 2) educational activities for parents and caregivers of children at the week education is started for children; 3) fluoride varnish clinics and dental health fairs; 4) screening at preschool centers, both private and public preschools; 5) foundation of sealants clinic at the University of Puerto School of Dentistry; 6) educational activities for pregnant women every month about prenatal dental care, breast feeding, and ECC prevention in children; 7) education for dentists and other health professionals; and 8) media advertisement for these specific themes: breast feeding and caries prevention, diagnosis of ECC, dental health during pregnancy, and traditions about nutrition in babies. The target population was from Puerto Rico private daycare centers, early Head Start centers, Head Start centers, prekinder and kinder at private and public schools, WIC programs, and Department of Health, Adolescent, and Pregnant Women Program in Puerto Rico. Results: The prevalence of ECC has been reduced from 53 percent in 1990 to 33 percent at the present time. Parents’ awareness of ECC condition has been increased in 75 percent in the last years. The community activities of the program have engaged university dental students in community and pediatric prevention programs in an innovative way.
Community prevention programs sponsored by dental schools serve as a vehicle for dental students’ motivation and leadership development and promote increases in dental prevention in community settings
76. Variation in Periodontal Diagnosis and Treatment Planning Among University Faculty
Sharon K. Lanning, Virginia Commonwealth University; Scott D. Pelok, University of Michigan; Philip S. Richards, University of Michigan; Sarment P. David, University of Michigan; Tae-Ju Oh, University of Michigan; Brent C. Williams, University of Michigan; Laurie K. McCauley, University of Michigan
Purpose: To examine variation among faculty in diagnosis and management of common periodontal diseases.
Consistency in clinical decision making is necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. Twenty-three faculty members with varying backgrounds and experience reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Case studies represented predoctoral clinic patients in terms of disease type and severity. Response rates for the three cases ranged from 62 percent to 70 percent. Faculty members’ rating of percent bone loss in the majority of cases varied among three descriptive categories for the same tooth. Diagnoses offered for one patient included gingivitis and chronic and aggressive periodontitis. Greater consistency in periodontal diagnosis was noted within the periodontal resident group as compared to periodontal and dental hygiene faculty groups. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter-faculty variation was more prevalent than intra-faculty variation.
To our knowledge, this is the first study to document substantial variation among faculty in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student learning and patient care can be made but as yet remains unknown. Consistent utilization of accepted practice guidelines and greater consensus-building opportunities may decrease variation among faculty and enhance dental education.
77. An Assessment of African American Dentists’ Career Satisfaction and Practice Location
Michael L. Rowland, The Ohio State University; Shereen M. West, The Ohio State University
Purpose: To explore the practice location habits of the patient demographic pool of African American dentists. The study sought to determine African American dentists’ level of satisfaction with career choice and with their dental school experience.
Recruitment of underrepresented minorities to the dental profession has faced numerous legal challenges and issues that will affect the oral health care of the nation. The role of the practicing dentist can play a critically important role in the recruitment of other minorities entering the dental profession. A thirteen-item questionnaire was designed to find out more about African American practicing dentists. The eighty-nine respondents to the questionnaire represented a total of twenty-nine different U.S. dental schools. The year of graduation from dental school ranged from those who graduated in 1946 to those who graduated in 2004. The years of experience for the practicing dentist ranged from one month to fifty-five years of practice. The mean number of years in practice was 20.3 years. The questionnaire asked African American dentists to identify where their practice was located given the following options: urban area, suburban, rural, or other. Sixty-one (73 percent) of these dentists indicated they practiced in an urban community, while twenty-two (26 percent) indicated they practiced in a suburban environment. Only one (1 percent) indicated practice in a rural area, and none of the respondents chose "other" as a practice location. Participants were asked, "How would you rate your dental school experience?" According to the responses given, five (6 percent) rated their dental school experience as usually not pleasant, twenty-six (29 percent) rated it as sometimes not pleasant. While nine (10 percent) rated their dental school experience as neither unpleasant nor pleasant, forty-nine (55 percent) indicated it was usually pleasant. Finally, participants were asked to indicate if they would choose dentistry as a profession again. Of the eighty-nine respondents, seventy-five (84 percent) said they would choose dentistry again, while fourteen (16 percent) said they would not.
Results of this study are important to the recruitment of African American students to the dental profession. Having African American dentists who are largely satisfied with their career choice and would make the same choice again can assist in recruitment to the profession from the private practices. The data suggest that African American dentists are practicing in urban locations where there is a significantly higher proportion of potential African American dental students. Recruitment literature should be devised specifically for African American dental offices to promote the dental profession. These professionals are working in the urban areas of our country, largely providing general dental services to the public. The outcomes of this study are important also because most of the African American dentists who participated in the survey would choose dentistry if they had an opportunity to choose again.
78. Characteristics, Role, and Responsibilities of Principal Admissions Officers at U.S. Public and Private Dental Schools
Michael L. Rowland, The Ohio State University
Purpose: To understand what are the personal characteristics of those individuals serving as principal dental admissions officers; the academic and experiential characteristics of principal dental admissions officers, such as the academic degrees they hold and their major area of study in their highest academic degree awarded; and the activities of importance to principal dental admissions officers such as admissions, recruitment, marketing, or office administration.
The admissions office is often the first contact applicants/ prospective students have with an institution. Studies have been conducted on almost every aspect of the dental admissions process, yet very little is known about the characteristics, roles, and responsibilities of the principal dental admissions officer. A web-based survey research design was selected to investigate and obtain information about the personal characteristics, roles, responsibilities, and areas of importance to principal dental admissions officers (PDAOs). The questionnaire contained fifty-eight questions. After fifty-six email invitations and email reminders and additional telephone calls to ensure respondents received the questionnaire, a total of forty (71 percent) principal dental admissions officers responded to the online survey. However, two of the participants chose to answer fewer than ten of the questions on the survey, so their responses were excluded from the overall findings and the response rate yielded was n=38 or 67 percent. The first section of the survey focused on an analysis of demographic data such as age, gender, race, educational background, professional background, faculty rank, number of years in the position, public or private dental schools, total predoctoral enrollment, average salary, title of supervisor, number of staff under the supervision of PDAOs, and number of hours spent working in admissions. The second section asked PDAOs the frequency with which they performed certain tasks. The third and final section asked PDAOs to rate the importance of certain activities and their importance to their job. Descriptive statistics such as the mean, frequencies, ranges, and percentages were used to identify characteristics of the data.
The following conclusions have been developed based upon the data collected. There is wide variability of principal dental admissions officers in terms of age, academic, and experiential characteristics. The ethnic background of most principal dental admissions officers is white, which can have a major impact on the recruitment of underrepresented minoritiy students. Much variation exists among the characteristics of principal dental admissions officers, including title, title of immediate supervisor, size of staff, admissions operations, and importance of activities as perceived by the principal dental admissions officer. The results of this survey will provide dental school administrators with a baseline of information about PDAOs’ roles, responsibilities, and opinions that could be used to facilitate admissions change or to ensure a more standardized approach among dental schools.
79. Faculty and Student Use of the VitalBook DVD at NYUCD
Andrew I. Spielman, New York University; Elise S. Eisenberg, New York University; Gretchen S. North, New York University
Purpose: The present survey was done to assess the extent of use of the VitalBook (VB), its acceptance, and changing attitudes among faculty and students at NYU College of Dentistry.
Three years ago, New York University College of Dentistry was among the first five dental schools that introduced into the D.D.S. curriculum the VitalBook, a digital reference library. A total of 507 students (39.7 percent) and seventy-eight faculty (68.5 percent) responded to our sixteen to twenty-question surveys administered between June and July 2004. When asked how frequently they used the VB, 31.8 percent of the students and 26.9 percent of the faculty responded they never use it. However, this number shows a marked drop when students are analyzed by class. Among the current freshmen, 8.8 percent never use it, compared to 11.4 percent of the sophomores and 36.2 percent of the juniors. When asked where the VB is most utilized, 34.6 percent of the freshmen use it before lectures, while 34 percent of the juniors use it before clinics. There were fewer students (32.8 percent) than faculty (60.3 percent) who felt this was a good investment in student education. Conversely, more students (43.5 percent) than faculty (21.8 percent) felt this was a bad investment. Approximately the same percentage of the students say they will (30 percent) or will not (31 percent) use it after graduation. Almost a quarter of the students and 62.8 percent of the faculty would recommend it to students or faculty at another school, while 48.9 percent of the students and 20.5 percent of the faculty would not. Finally, 21 percent of the students and 26.9 percent of the faculty have a more favorable view of the VB after one to two years of use. One quarter of the students and 11.5 percent of the faculty have a less favorable opinion.
Overall, there is still a significant amount of resistance to this technology in replacing printed material among a segment of the student population and faculty. Nevertheless, the trend among incoming students is toward more acceptance and higher use. This is encouraging news in a climate of declining sales and publishing of medical textbooks.
80. Rater Agreement with a Gold Standard: Short- and Long-Term Effects of Calibration Training
Reem N. Haj-Ali, University of Missouri-Kansas City; Brian Williams, University of Missouri-Kansas City; Philip Feil, University of Missouri-Kansas City
Purpose: The purpose of this investigation was twofold: a) evaluate the immediate effect of calibration to a gold standard on interrater agreement on criteria, and b) determine whether the effects of calibration training can be sustained over a ten-week period.
Faculty who instruct students in preclinical labs must be calibrated so that the feedback they offer is consistent and accurate. Most calibration studies have been short term and have relied on assessing reliability, which implies consistency in rankings but not necessarily agreement with a valid standard. These attempts have yielded reliability estimates ranging from almost 0 to over .90. Another approach is to calibrate with a valid gold standard (GS) and to calculate percent agreement across raters with each criterion. Valid criteria (fourteen) for a Class II amalgam preparation, a three-point rating scale, and a grade form were developed. GS preparations representing the ideal and error forms of varying magnitude for each criterion were identified. Calibration training consisted of a) an explanation of each criterion, how each is observed and evaluated, and presentation of the ideal and errors and their assessment; then, b) faculty (n=9), working in pairs and then larger groups, independently graded preparation examples, compared ratings, and checked the key to ensure accuracy and resolved discrepancies. Three tests were administered: prior to training (pretest), immediately following training (posttest), and ten weeks later (delayed test). Each test consisted of faculty independantly evaluating ten new teeth randomly selected from a large supply of student work on practical exams. Results: Agreement across criteria having a GS score of 2 (ideal) for the pretest, posttest, and delayed test was 57, 75, and 74 percent respectively; a GS score of 1 (acceptable) was 53, 57, and 55 percent respectively; and a GS score of unacceptable was 38, 53, and 56 percent. Agreement with GS scores for most of the fourteen criteria also improved and did not deteriorate over time with very few resisting improvement. Finally, in spite of improvements, there were still too many faculty ratings of 1 (acceptable) on the posttest and delayed test (33 percent and 35 percent) when the GS score was unacceptable.
With training, raters can improve agreement with a gold standard. The outcomes of calibration are reasonably resistant to deterioration after ten weeks. Future training ought to consider the use of mastery requiring a higher level of agreement for each rater following training.
BLOCK 3 (WORKS IN PROGRESS): Monday, March 7
4:00–5:00 pm
WIP 1. The Effectiveness of Infrared Technology as an Adjunctive Instructional Medium
Joy Phipps-Gall, Weber State University; Kami M. Hanson, Weber State University; Cami Gorringe, Weber State University
WIP 2. Creating a Combination Program for a General Dentistry Residency and Continuing Education
Thomas C. Porter, University of Florida; Shannon Johnson, University of Florida; Krista Schobert, University of Florida
WIP 3. The Use of a Computerized, Interactive Learning Tool in Dental Anatomy
Judith A. Porter, University of Maryland
WIP 4. Dental Hygiene Admissions Criteria: A Predictor of Success?
Sandra Z. Zagar, Harrisburg Area Community College; Joan G. Ellison, Harrisburg Area Community College
WIP 5. The Gross Anatomy Professor’s Guide to Oral Local Anesthesia
Pamela Stein, University of Kentucky; Jennifer Brueckner, University of Kentucky; John Mink, University of Kentucky
WIP 6. A Preclinical Diagnosis and Treatment Planning Course Utilizing the Axium Dental Information System
Kenneth Gehrke, University of Illinois at Chicago; Eva Sabaitis, University of Illinois at Chicago; G. William Knight, University of Illinois at Chicago
WIP 7. Use of Computer-Based Self-Study Learning Materials in an Elective Sports Dentistry Course
Michael C. Herren, University of Kentucky; Sandra D. Challman, University of Kentucky
WIP 8. Graduate Certificate in Geriatric Dentistry
Kathleen A. Vergona, University of Pittsburgh; John G. Hennon, University of Pittsburgh
WIP 9. Graduate and Degree Completion Students’ Precourse and Postcourse Perceptions Concerning Web-Based Courses
Tanya Villalpando Mitchell, University of Missouri-Kansas City; Cynthia C. Gadbury-Amyot, University of Missouri-Kansas City; Kimberly Bray, University of Missouri-Kansas City
WIP 10. Clinical Collaboration of Dental and Dental Hygiene Students
Elizabeth A. Hughes, Indiana University; George P. Willis, Indiana University; Steven E. Dixon, Indiana University
WIP 11. Pediatric Dentistry Digital Image Library: A Community of Scholarship
Jeffrey T. Johnson, University of Kentucky; David A. Nash, University of Kentucky; Sandra D. Challman, University of Kentucky
WIP 12. Developing Calibration Workshops for Periodontal and Dental Hygiene Faculty
Elizabeth A. Hughes, Indiana University; Vanchit John, Indiana University
WIP 13. Endodontic Followup Utilizing Computer Tracking in a Dental School Setting
Nader A. Nadershahi, University of the Pacific; Fred J. Fendler, University of the Pacific
WIP 14. Early Clinic Experiences to Enhance Dental Student Preparedness
Hilary A. Soller, The Ohio State University; Lewis Claman, The Ohio State University; Beverly McClure, The Ohio State University; Janet Uldricks, The Ohio State University
WIP 15. Introducing In-Office or Chairside Tooth Bleaching Concepts in the Undergraduate Dental Curriculum
Richard A. Mahevich, University of Medicine and Dentistry of New Jersey
WIP 16. A Dental School Interpreter Services Policy: Cost Versus Cause
Melissa S. Monner, Oregon Health & Science University, Lynnette J. George, Oregon Health & Science University; Megan Smith, Oregon Health & Science University; Brandy Eurto, Oregon Health & Science University; Denice Stewart, Oregon Health & Science University
WIP 17. Pediatric Risk Assessment Questionnaire for Dental Students
Fred S. Ferguson, Stony Brook University; John F. Chaves, Stony Brook University; Laurence D. Pfeiffer, Stony Brook University
WIP 18. Generalist Model Cross-Training
Brian J. Kenyon, University of the Pacific; Kenneth G. Louie, University of the Pacific; Russell G. Woodson, University of the Pacific; Nader A. Nadershahi, University of the Pacific; Terry E. Hoover, University of the Pacific
WIP 19. A Dental School Curriculum That Integrates Limited Orthodontics Using a Clear Esthetic Appliance System
Mitchell J. Lipp, New York University
WIP 20. The Accelerated Dental Program of the University of Detroit Mercy School of Dentistry
Leyvee Cabanilla, University of Detroit Mercy; Michael Magtoto, University of Detroit Mercy; Pamela Zarkowski, University of Detroit Mercy
WIP 21. Non-Traditional University Credit for Dental Hygiene Degree Completion Students
Marge Reveal, Northern Arizona University
WIP 22. Pediatric Dentistry Curricula: A Survey of Departments
Jeffrey T. Johnson, University of Kentucky; Tyler Albrecht, University of Kentucky; Heather H. Wise, University of Kentucky
WIP 23. Competency Assessment in Comprehensive Patient Care
Thomas A. McConnell, University of Kentucky; Timothy M. Armentrout, University of Kentucky; Barbara L. Theiss, University of Kentucky; Michael C. Herren, University of Kentucky
WIP 24. Development of Guidelines for Teaching Women’s Health in Dental Schools
Wendy S. Hupp, Nova Southeastern University
WIP 25. International Outreach Programs, Phase II: Charity, Education, or Both?
Ralph P. Cunningham, New York University; Kristen Gualtieri, New York University; William Maloney, New York University; Ivy D. Peltz, New York University
WIP 26. Use of a Personal Digital Assistant to Review Clinical Techniques in Restorative at Chairside
Howard E. Strassler, University of Maryland
WIP 27. Implementation of Computerized Prescriptions in a Paperless Chart via Axium
Marina C. Lazzara-Jimenez, University of Southern California
WIP 28. Multidisciplinary Training in Bioterrorism: Dental Students as an Untapped Resource
Theresa G. Mayfield, University of Louisville; F. John Firriolo, University of Louisville; John N. Williams, University of Louisville
WIP 29. Access to Post-Diploma Degree Completion Education for Dental Hygienists
Sharon M. Compton, University of Alberta; Sandra J. Cobban, University of Alberta; Catherine Gramlich, University of Alberta
WIP 30. A Periodontal Surgical Elective for Dental Students: A Didactic, Hands-On, and Clinical Approach
Swati Y. Rawal, The Ohio State University; Lewis J. Claman, The Ohio State University; Fred Alger, Private Practice; Lisa Palermo-Edwards, Private Practice; Christine Halket, The Ohio State University; Dimitris N. Tatakis, The Ohio State University; Charles W. Solt, The Ohio State University
WIP 31. Usability of Practice Management Systems in Clinical Dentistry
Thankam P. Thyvalikakath, University of Pittsburgh; Larsen Bryce, University of Pittsburgh; Benjamin Lin, University of Pittsburgh; Titus Schleyer, University of Pittsburgh
WIP 32. Student Profit and Loss Tracking Reports
Nader A. Nadershahi, University of the Pacific; Richard Fredekind, University of the Pacific; Russell Woodson, University of the Pacific; Terry Hoover, University of the Pacific
WIP 33. Using the Standardized Client to Practice Tobacco Cessation Interventions
Barbara J. Gitzel, University of Alberta; Steve Patterson, University of Alberta
WIP 34. An Integrated Clinical Simulation System
Michael D. Dougherty, Medical Center of Aurora
BLOCK 4: Tuesday, March 8
12:00 noon to 1:30 pm
81. Student Response to a Web-Enhanced Laboratory Manual and Streaming Video Used in a Preclinic Technique Course
Kenneth G. Boberick, Temple University
Purpose: Evaluate student response to a web-enhanced laboratory manual containing high-quality still images and embedded hyperlinks allowing interactivity with streaming video and web-based resources.
The manual was created in Microsoft Word, converted to PDF format and made available as a web-interactive resource using Blackboard. Integrated hyperlinks embedded in the manual text provided interactivity with video streaming files created from HI-8 and VHS tapes using a video capture card. Project success was evaluated using a post-course survey that evaluated enabling criteria (technical support and flexibility of access to the technology), process criteria (the actual experience and usability), and outcome criteria (acquisition and successful use of the knowledge and skills learned). Students responded favorably to sections in the manual called "slide galleries" where color images of ideal and non-ideal projects could be viewed. Possible causes, appropriate corrective measures, and tips to prevent future occurrence of the errors were provided. Sections called "slide series" provided students with detailed instructions allowing for self-paced, student-directed learning. Students reported less stress and fewer laboratory errors. Regarding the streaming video, 99 percent of the students found the quality adequate to excellent. Regarding Internet connections and video viewing, 59 percent of students successfully viewed the videos from a remote site. Cable connections were most reliable, dial-up connections inadequate, and DSL connections variable. Seventy-three percent felt the videos were an effective substitute for in-class demonstrations; 37 percent of students preferred video with sound and 18 percent with subtitles while 45 percent felt the two were equally effective. Eight percent preferred a compilation video, 43 percent preferred short clips embedded in the text, and 49 percent felt the two were equally effective. Fifty-five percent of the students reported owning a laptop computer, and 72 percent of those students reported they would bring the laptops to the laboratory if wireless connectivity was available.
The results show it is possible to develop and implement a web-enhanced interactive type format of dental education in a preclinical restorative technique course successfully delivering information beyond the textual format. A library of video materials provided the student with choice and control by providing on-demand viewing with the ability to start, stop, pause, skip, and review the material. The PDF format allows selected sections of the manual to be printed and provided as hardcopy to the students for reference during the laboratory session.
82. Teaching Patient-Centered Care Through Experiential Learning
Eunice M. Edgington, University of Alberta
Purpose: To increase students’ understanding of the illness experience in the context of the patient’s lifestyle.
Understanding the illness experience in the context of a patient’s life is fundamental to patient-centered care. During the assessment process the emphasis is often on exploring the signs and symptoms of a disease, and little attention is directed toward exploring the patient’s experience. To maximize dental hygiene students’ awareness of the patient’s illness experience, an interactive experiential learning workshop was developed. The focus was on diabetes mellitus because it has many metabolic and vascular components and it requires many changes in lifestyle. An interdisciplinary team presented information on all aspects of diabetes. Nutritional counselling enabled students to perform diabetic diet conversions. Students were provided a glucose blood sugar meter, lancets, and strips. They were required to adhere to a diabetic meal plan and a blood sugar testing schedule for three days and journal the experience. During the debriefing session the students identified and discussed the many challenges they faced, including time management, dealing with others, remembering to take blood sugar readings, recording what was eaten, cost of the lancet and strips, and understanding the impact of exercise, drinking alcohol, and illness on insulin intake. Students expressed a deeper understanding of the meaning of the illness experience in the context of lifestyle changes and discussed its application to the diverse needs of their patient population.
Experiential learning is an effective teaching method to increase students’ understanding of the illness experience in the context of the patient’s lifestyle changes. The skills learned have application to the diverse needs of the patient population.
83. Improved Treatment Planning Teaching Materials Through Personal Publishing
Daniel W. Boston, Temple University
Purpose: To enhance case-based teaching materials for a comprehensive treatment planning course, a newly designed case book was created using an inexpensive, rapid commercial personal publishing service. Objectives were to improve the following attributes compared to digital projector presentation: ease of navigation, organization, and quality of images.
Highly functional case-based teaching materials are essential to conducting an effective course in comprehensive treatment planning for general dentistry. The range of materials required (clinical images, radiographs, charting, study casts, and narrative), the quality of information necessary, and the need for student-controlled navigation present particular challenges for current slide, paper, or digital presentation approaches. A twenty-four-page, 8
x 11, full-color case presentation book was created using the Personal Publishing system (Xlibris, Philadelphia, PA 19106). The book contained images of clinical views, radiographs, charting, study casts, and a narrative for three complex cases arranged with color-coded organizational aids. Digitized images and a hand-drawn mock-up were submitted to the publishing company (four hours’ work). Three weeks later, the completed book and requested number of copies was delivered ($24.90 each). In class, cases were first presented using digital projection of the same images contained in the book, and then cases were considered by students (N=21) and discussed using the new books. At the end of the course, students completed a survey comparing the book to digital projection using a 5-point scale (5=much better, 4=somewhat better, 3=same, 2=somewhat worse, 1=much worse). Results: general presentation: 4.3; ease of navigation: 4.7; organization: 4.6; clinical images: 4.2; charting images: 4.2; radiographic images: 3.9; study cast images: 4.4.
The Personal Publishing book was a rapid and inexpensive means to provide improved quality case-based materials for teaching comprehensive treatment planning in general dentistry and is easily adaptable to other disciplines/programs. Disclosure: The author has no affiliation with or financial interest in Xlibris.
84. Three-Year Trends in a New Clinical Restorative Dentistry Program
Daniel W. Boston, Temple University; Klara Alpertstein, Temple University; David Appleby, Temple University; Juan Arocho, Temple University; Sarah Gray, Temple University; Sheldon Winkler, Temple University
Purpose: To develop competency in the disciplines of restorative dentistry and treatment planning, a new program of skill examinations, competency assessments, and integrated flexible clinical requirements was implemented. Student outcomes were assessed for the Classes of 2002, 2003, and 2004 to determine trends in competency assessment, clinical experience, and overall quality performance.
This new program consists of skill assessments in treatment planning, operative dentistry, fixed prosthodontics, and removable prosthodontics, followed by demonstration of competency in each discipline. Required mock board examinations and a flexible minimum clinical experience requirement complement the program. The minimum clinical experience requirement provides flexibility for attaining 27 percent of the 600 point requirement, while defining specific essential experiences such as 50 points Cl II amalgam (MO=4 pts), 11 CD or RPD arches (12 pts each), 1 FxBr, etc. Summary data for the Classes of 2002, 2003, and 2004 were analyzed for junior and senior years combined. Results: All students in all years completed the full complement of skill exams prior to taking competency examinations. Error analysis of initial performance (critical and noncritical combined) on competency examinations ranged from 3.57 percent on provisional fixed restoration, 0.8 percent for open contact on Cl II amalgam, 14 percent for centric relation, and 17 percent for integration of caries risk assessment in treatment planning. The three-year trend showed a general decrease in errors, with stability in most fixed prosthodontic criteria. Overall, clinical experience remained very stable over three years with each class performing 15–16 percent above the minimum requirement. The top one-third of each class performed most (55–59–72 percent) of flexible experience in operative dentistry, an increasing trend from 2002 to 2004. The bottom 10 percent of each class performed almost none of the flexible experience in removable prosthodontics (9–3–4 percent), a decreasing trend from 2002 to 2004. Daily quality average increased 2 percent from 2002 to 2003 and 2 percent from 2003 to 2004 (3.39–3.46–3.52).
Over the three years analyzed, the new program provided a stable and effective means for attaining competency in restorative dentistry and treatment planning, in spite of considerable flexibility for minimum clinical experiences. Similar flexibility can be considered for other schools/disciplines while maintaining desired outcomes.
85. A Problem-Based Learning (PBL) Preclinical Periodontics Program
Sandra K. Rich, University of Southern California; Robert G. Keim, University of Southern California
Purpose: To develop and evaluate a PBL preclinical periodontics program that motivates students to learn through problem-solving.
A problem-based learning (PBL) program has been presented to third trimester D.D.S. students and first trimester ASPID (Advanced Specialty Program for International Dentists) over a three-year period. Two years of PBL student performance has been compared to two years of a traditional program (TRAD) along with PBL student evaluation of the program. To date, the program has enrolled students from D.D.S. Classes of 2005, 2006, and 2007 (n = 418) and ASPID Classes of 2005 and 2006 (n = 62). The course is designed such that students practice clinical skills initially on typodonts in a simulation laboratory, then on student partner/mock patients in the clinic. Sessions begin with a pre-session and end with a post-session. All learning emanates from cases presented in instructor-facilitated groups of six to eight students. Students direct their own learning by analyzing cases, which center on patient problems related to daily exercises. They determine facts and hypotheses and develop learning needs to be investigated and reported upon. Additionally, they devise personal learning objectives for the day’s clinic/lab exercises in order to comply with faculty-predetermined, daily program goals. Some problems/ topics include probing, exploring, scaling and root-planing technique, medical history review, measurement of vital signs, patient education, subgingival irrigation, use of fluorides, and management of periodontal abscesses. OSCEs (Objective Structured Clinical Examinations) are individually administered on a student partner/ mock patient at mid-term, and the final examination tests hands skills on probes and explorers (mid-term) and curettes.
Mean scores for OSCE examinations showed superior performance of PBL students (p<.02) when measured against TRAD. Over a two-year period, PBL students highly rated the program at a mean of 4.41 on a 5-point scale. The program provides a successful model for other dental schools.
86. Meeting the Changing Needs of Tomorrow’s Students Today
William K. Lobb, Marquette University; Timothy J. Creamer, Marquette University; Lawrence J. Schnuck, Kahler Slater Architects
Purpose: Through a post-occupancy evaluation of the now three-year-old Marquette University School of Dentistry, ADEA participants will discover the school’s successes and lessons learned related to their new curriculum, culture, facilities, and overall productivity.
Research authors from Marquette University and Kahler Slater Architects will share proven results of how the Marquette University School of Dentistry (MUSoD), in Milwaukee, Wisconsin, successfully responded to the Institute of Medicine report Dental Education at the Crossroads and set the standard for how dental schools can meet the changing needs of tomorrow’s students today. Results, gathered from a post-occupancy evaluation completed on the school over a six-month period, will illustrate how the vision and goals used to create Marquette’s benchmark dental facility have been realized and experienced by students, faculty, and patients during the past three years. Results include the successes and lessons learned related to MUSoD’s newly developed curriculum, "real world" clinical environments and experiences, enhanced patient care and accessibility for the surrounding underserved community, attraction and retention of top students and faculty, and overall productivity.
ADEA members also will have the opportunity to discuss with the authors, in greater detail, how their schools and universities can vision the future, implement "real world" learning, clinical environments, and experiences, and maintain positive results.
87. Oral Health Providers and Secondary Prevention of Disordered Eating: An Application of the Transtheoretical Model
Rita D. DeBate, Old Dominion University; Lisa Tedesco, University of Michigan; Wendy Kershbaum, University of Michigan
Purpose: Despite the crucial role oral health providers have in early identification, referral, and case management of eating disorders, little is reported regarding current secondary prevention practices. The purpose of this study was to assess readiness among dentists and dental hygienists pertaining to secondary prevention of disordered eating.
This study employed a randomized cross-sectional study. Data were collected from 576 dentists and dental hygienists via a self-administered paper-pencil questionnaire. The questionnaire included constructs from the Transtheoretical Model in addition to demographic information. Five criterion-specific secondary prevention behaviors were assessed with regard to eating disorders: identification of oral manifestations, addressing concerns, prescribing oral treatment, client referral, and case management. The results of this study indicate that, in general, the majority of oral health practitioners are not practicing behaviors associated with secondary prevention of eating disorders. Over half of the oral health practitioners were in the pre-contemplative/contemplative stages. Fewer than 45 percent of the practitioners currently assessed clients for disordered eating and prescribed specific home dental care instructions. Fewer than 25 percent of practitioners arranged a more frequent recall program and referred clients for treatment. Only 12.6 percent of dentists and 7.3 percent of hygienists reported communicating with the client’s primary care provider. Statistically significant differences were observed among oral health practitioners with regard to assessing clients for disordered eating (p=.006) and currently communicating with the clients’ primary care providers (p<.001). In general, more dental hygienists indicated assessing clients for oral manifestations of disordered eating while more dentists said they communicated with the primary care provider. It is evident from the current study that although some oral health practitioners are assessing and providing client-specific home dental care, the bridge from assessment to referral and case management is not yet occurring.
Improvements regarding secondary prevention practices among dentists and dental hygienists are warranted. Increasing the consistency of practitioners who practice secondary prevention will necessitate increasing: 1) knowledge of oral and physical manifestations of disordered eating behaviors and understanding of the complexities of this multifaceted illness, 2) perception of the severity of disordered eating regarding systemic health issues and well-being, 3) belief in the crucial role they play in the secondary prevention of disordered eating, 4) belief in the value of secondary prevention of disordered eating, 5) skill and self-efficacy in identification of oral manifestations of disordered eating, client approach, and communication with primary care provider, 6) providing dental practitioners with prepared resource lists in addition to prepared eating disorder specific home dental care instruction handouts, and 7) establishing practice protocol for those identified with oral manifestations of disordered eating behaviors.
88. An Assessment of Oral Health Practitioners’ Knowledge of Oral and Physical Manifestations of Disordered Eating
Rita D. DeBate, Old Dominion University; Lisa Tedesco, University of Michigan; Wendy Kershbaum, University of Michigan
Purpose: The role of the dental practitioner in the screening and diagnosis of systemic health problems by way of oral and maxillofacial manifestations is well established. Although considered a psychological disorder, the oral problems associated with eating disorders have been well reported in the literature. Given that oral health practitioners may be the first health care provider to assess the oral and physical effects of disordered eating behaviors, they may be the key health care provider in the secondary prevention of disordered eating. In spite of this, little is known regarding their knowledge of oral and physical complications of eating disorders. The purpose of this study was to determine the extent to which oral health practitioners are knowledgeable of the oral and physical manifestations of disordered eating behaviors.
Employing a randomized cross-sectional study, data were collected from 576 randomly selected dentists and dental hygienists. The self-administered questionnaire included constructs from the Health Belief Model in addition to demographic information. Results indicate low to moderate knowledge of oral and physical cues of disordered eating among oral health practitioners. The mean scores with regard to oral manifestations of disordered eating among dentists and dental hygienists (4.73±1.75 and 5.51±1.56 respectively) both fell slightly above the midpoint of the range for scores (scores ranged from 0–9 with higher scores indicating a larger number of correct responses). A greater number of dental hygienists correctly identifed oral manifestations as compared to dentists (p<.001). With regard to knowledge of physical cues among dentists and dental hygienists fell below the midpoint of the range (1.79±1.62 and 2.66±1.48 respectively); scores ranged between 0 and 6, higher scores indicating a greater number of correct responses for physical cues of disordered eating. A statistically significant difference was revealed between practitioners with more dental hygienists correctly identifying physical manifestations (p<.001). The results of this study support previous studies indicating many oral health practitioners are knowledgeable with regards to erosion and dentin hypersensitivity as oral manifestations of disordered eating. However, few are aware of the following oral and physical signs: xerostomia, parotid enlargement, parotid dysfuntion, lanugo, and Russel’s finger.
Early detection and intervention play a key role in the recovery of eating disorders. The dental practitioner is instrumental in the recovery process as they are often the first health professionals to identify oral and physical manifestations of disordered eating. The appropriate assessment of possible disordered eating behaviors among patients involves knowledge of both oral and physical manifestations. The dental practitioners must triangulate oral and physical manifestations with information from the patients’ health history in addition to establising and maintaining open communication with the patient. Once appropriately identified as oral manifestations of disordered eating, the oral health practitioners’ role is crucial in delivering prerestorative care, restorative care, and referral for treatment to decrease further damage in the oral cavity as well as improving the quality of life of the patient.
89. Readability Levels of Oral Health Education Materials
Kathleen M. Jordan D’Ambrisi, Harrisburg Area Community College; M. Elaine Parker, University of Maryland
Purpose: Literacy is a national problem. Studies show that many Americans aged sixteen and older are unable to read above the fifth-grade level. The purpose of this study was to utilize four readability formulas to determine the grade reading level of oral health patient education materials obtained from professional dental associations, commercial organizations, and government agencies. This study also compared readability scores to determine if oral health patient education materials are written at the recommended eighth-grade reading level.
Patient education materials are frequently implemented in patient care. If patients cannot understand materials, they are of little value in the education process. The dental field is lacking research on the readability of dental education materials. Thirty printed brochures and twenty-five websites containing over 200 words in length relating to oral health patient education were tested for readability. Readability of these materials was assessed using the Flesch, Flesch-Kincaid, FOG, and SMOG readability formulas. Results: The reading level ranged from third grade to sixteenth grade. The overall mean for printed materials was 57.46 reading ease for Flesch, 9.13 grade for Flesch-Kincaid, 11.08 grade for FOG, and 10.86 grade for SMOG. Seventy-seven percent were written above the recommended eighth-grade reading level. The overall mean for educational materials on the World Wide Web was 59.98 reading ease for Flesch, 8.54 grade for Flesch-Kincaid, 10.51 grade for FOG, and 10.34 grade for SMOG. Eighty-eight percent were written above the recommended eighth-grade reading level.
This study concluded that both printed and website oral health education materials are written higher than the recommended eighth-grade reading level, making patient comprehension more difficult. Dental professionals should be aware of this limitation when providing educational materials to their patient population as an adjunct to oral health and self-care instructions.
90. Enhanced Generalist Model for Senior Clinics at the University of the Pacific School of Dentistry
Russell G. Woodson, University of the Pacific; Terry E. Hoover, University of the Pacific; Nader A. Nadershahi, University of the Pacific; Brian J. Kenyon, University of the Pacific; Kenneth G. Louie, University of the Pacific
Purpose: To describe the development of a system of improved patient care and mentoring of dental students.
In 1995 the University of the Pacific School of Dentistriy’s third-year clinical teaching model was reorganized to provide our patients with superior service and our students with an improved clinical education. The model utilized a combination of specialist faculty in Fixed and Removable Prosthodontics, Periodontics, and Endodontics working in concert with generalists who would provide teaching in Operative Dentistry, Oral Diagnosis, and very limited Fixed Prosthodontic procedures. The system remained in existence until July 2004 when an improved version of the generalist model was implemented in response to inefficiencies in delivery of care, supervision, and inequality of case loads among clinical faculty. The new clinic model divides the third-year D.D..S and international classes (a total of 156 students) into four teaching groups. Teams of three faculty are assigned to each of these teaching groups on a daily basis. Faculty team members have academic appointments in the Restorative Department and are designated group practice mentors (GPM). A designated member of each team is the team leader and is responsible for the direction of patient care and overall management of the team. A GPM coordinator oversees all faculty training, and two group practice administrators under the direction of the associate dean for clinical affairs oversee the general operation and management of the third-year clinics and students. With the supervision of their mentor team, students treat their patients’ diagnostic, restorative, emergency, and routine periodontal needs as they would in a general practice. Advanced periodontal, endodontic, oral surgery, removable prosthodontic, and orthodontic treatment is referred to other areas of the clinic under the direction of specialist faculty. This enhanced teaching model is designed to improve efficiency of patient care, accountability for all stakeholders, communication and feedback with students, monitoring and documentation of student progress, and modeling of professionalism and patient management.
Although this model has been functioning for a short period of time, the initial feedback and data suggest that there has been an increase in chair utilization, procedures completed per student, and average productivity in the senior clinic as compared with the same time period last year. Outcomes of this change will be monitored through our clinic management system and presented in the following months.
91. Test Length and Score Reliability: A Study of the Reduction in the Length of Part II
Chien-Lin Yang, American Dental Association; Gene A. Kramer, American Dental Association; Robert L. Bailey, American Dental Association; Laura M. Neumann, American Dental Association
Purpose: To investigate the possible impact of reducing the number of items on score reliability on a sample of 3,186 candidates who took the written version of Part II of the National Board Dental Examinations in December 2003.
Two conditions were employed to control for the adequate coverage of test content during the item reduction process. The first condition was to randomly remove the items from the 400 case-independent items proportionally from each of the dental disciplines, and the second condition was to retain all of the 100 case-dependent items from the entire set of 500 items administered. Specifically, twenty case-independent items were removed consecutively until the shortest length of the test was achieved at 300 items. A total of ten different test lengths for Part II were generated. The traditional test theory and an IRT-based Rasch analysis were conducted to examine the effect of ten different test lengths for Part II on the stability of score reliability. Three types of study results are reported: 1) the measures of test reliability that include reliability correlation coefficient (KR-20) and standard error of measurement and Raschi’s person separation reliability; 2) the measures of candidate ability that include mean of raw score, mean of scaled score, and mean of measure on person ability; and 3) the measures of the outcomes of candidate performance that include percentage of decision changes on pass/ fail status and percentage of fail rate with respect to candidate background. In this study, the overall results indicated that 1) the reliability of 0.90 (both KR-20 and Raschi’s person separation reliability) was obtained when the test was reduced to a 420-item test; 2) means of raw score and of scaled score were compatible when the test was reduced to a 380-item test; and 3) the measures on candidate ability and on the outcomes of candidate performance were not affected at all as the test was reduced to a 300-item test.
The next step is to replicate this study using another sample (e.g., the candidates who took the written version of Part II in December 2001) before generalizing the impact of shortening the test on score reliability. Aside from the issue of reliability, there are other factors that must be considered before a decision can be made regarding test length. One factor relates to adequate coverage of essential content.
92. Training Faculty for the Design and Development of Multimedia Instructional Materials
Kathleen E. Crespo, University of Puerto Rico; Jose E. Torres, University of Puerto Rico; Gloria Alvarez, University of Puerto Rico
Purpose: The University of Puerto Rico School of Dentistry received a grant in 2003 to establish a Hispanic Center of Excellence. One of the goals of this center is to improve students’ performance and train faculty in innovative instructional methodologies.
One of the strategies to achieve these goals has been the development of instructional materials using multimedia technology to promote independent learning and cultural competence. This has been accompanied by faculty training in strategies that promote independent learning, such as problem- and case-based learning, evidence-based practice, and standardized patients. A bank of twenty cases in topics related to Hispanics’ health and computerized interactive instructional materials emphasizing cultural and socioeconomic aspects related to oral health are being developed. Four faculty members have received hands-on training by an instructional technologist, on a one-to-one basis for the development of the materials. Case-based learning has been used as the methodology to guide the design of these materials. A facility is available for faculty with computers and digital imaging equipment. Materials were produced using software such as PowerPoint, Adobe Acrobat, and Photoshop. Cases in pediatric dentistry and cases to prepare students for the NBDE Part II have been developed. Also, two modules using multimedia have been developed: "The Role of the Health Professional in the Prevention of Tobacco Use" and "Topics in Periodontal Surgery." These materials are available to students for independent learning as part of specific courses. Faculty evaluated the experience as highly positive, and materials were produced in a relatively short period of time. The curriculum committee evaluated content and relevance of materials, prior to their implementation.
The use of hands-on and one-on-one training, as well as the availability of software, equipment and a computer lab facility, has proved to be a highly effective strategy for faculty’s development of skills in the use of multimedia technology.
93. New Curriculum Influence on Acquiring Early Skills in Intraoral Radiology
Sherry L. Ortiz, Marquette University; Rodney D. Daering, Marquette University
Purpose: To determine if there was a significant difference in the scores of first-year dental students who had patient contact prior to starting radiology and anatomy courses, compared to second-year dental students who had completed didactic courses first.
A new dental curriculum for Marquette University School of Dentistry was initiated during the 2001–02 academic year. Under the old radiology curriculum, third-semester, second-year students (sophomores) completed two years of didactic courses before any clinical work on patients. In the new curriculum, first-semester, first-year students (freshmen) start performing clinical radiographic exams the first week of dental school. Mean scores of seventy-seven first-year dental students were compared to seventy-two second-year dental students using ANOVA through SPSS Inc. (Chicago, IL). Students demonstrate proficiency in obtaining intraoral full-mouth radiographs on patients during their freshman year prior to completing the anatomy and radiology didactic courses. It is hypothesized that freshman students who obtain hands-on clinical instruction prior to didactic radiology and anatomy courses will have a rudimentary understanding of radiology and anatomy; therefore, the midterm and final course grades should exceed those of the sophomore class. The first manikin and first patient scores were compared between the first- and second-year students, as well as midterm and final grades of the radiology course. First-year dental students’ scores did not exceed second-year dental students’ scores. The radiology mean scores of first- and second-year students’ national boards Part II will also be compared in December 2004.
Comparing mean scores did not demonstrate that earlier exposure to patients improved students’ scores. However, short-term evidence does indicate a positive effect on early contact with patients, as data showed no statistical differences in radiology mean scores of first- and second-year students.
94. Employment Characteristics of Recent National Board Dental Hygiene Examination Candidates
Laura M. Neumann, American Dental Association; Gene A. Kramer, American Dental Association
Purpose: To describe the employment characteristics of recent National Board Dental Hygiene Examination (NBDHE) candidates and confirm the assumptions of the job analysis for the NBDHE.
Current testing standards recommend the validation of examination content through the conduct of a job analysis. Information on the tasks and responsibilities of a particular job is usually gathered by surveys of individuals working in the field. This study examined the employment characteristics of dental hygienists surveyed for the 2003 practice analysis for the NBDHE. The purpose of the exam is to assist state boards in determining qualifications of individuals who seek licenses to practice dental hygiene. This study involved a stratified random sample of 4,078 (16.5 percent) of 24,675 dental hygiene candidates who participated in the NBDHE between 1997 and 2001. A written survey completed in January 2003 included ten items requesting information regarding candidate demographic characteristics and practice environment. One multipart item asked candidates to rate the importance of fifty-six competencies to their practice of dental hygiene. The competencies had been selected for their relevance to entry-level dental hygiene practice from the ADEA Competencies for Entry into the Profession of Dental Hygiene and the Accreditation Standards for Dental Hygiene Education. The adjusted response rate was 68 percent, and 96.9 percent of respondents reporting being in practice for five years or less. Of the 1841 respondents, 1284 or 69.7 pecent practiced full-time; 491 or 26.7 percent practiced part-time; 3.3 percent indicated they were not in practice as a dental hygienist; 82.4 percent of respondents were employed in general dental practice; 3.2 percent were involved in periodontics practice, and 1.9 percent were in pediatric dentistry practice. Other dental specialties were indicated by less than 1 percent of respondents. Less than 2 percent of respondents were involved in public health, education, or other institutional practice settings.
The results of this study confirm that the job analysis is reflective of perceptions of new dental hygiene practitioners involved in clinical dental hygiene practice and supports the linkage of selected practice competencies to the content of the NBDHE.
95. Trends Related to Dental School Satellite Clinics
Diane M. Boehm, American Dental Association; Judith A. Nix, American Dental Association; Laura M. Neumann, American Dental Association
Purpose: To identify trends in the use of satellite clinics by dental schools.
The ADA’s Council on Dental Education and Licensure (CDEL) conducted an electronic survey of dental schools to collect current data on dental school satellite clinics for comparison to data collected in 1998. A link to an electronic survey was sent to all fifty-six dental schools in the United States on January 8, 2004. Follow-up notices were emailed to nonrespondents on January 23 and February 12, with data collection ending on March 12, 2004. Forty-four dental schools responded, for a final response rate of 78.6 percent. The survey questions addressed the following topics: the school’s use of satellite clinics; the number of satellite clinics that treat non-indigent patients; the number of indigent patients served by satellite clinics; communication with the state associations regarding satellite clinics; and perceptions of local dentists’ attitudes toward the school’s satellite clinics. The responses indicate that dental schools continue to increase their use of satellite clinics for training dental students in providing oral health services to underserved populations, especially those schools that have received a grant from the Robert Wood Johnson Foundation (RWJF): Pipeline, Profession, and Practice: Community-Based Education Project or the California Endowment. A comparison of the results of the 1998 survey and the 2004 survey indicate the following. There has been an increase in the mean number of satellite clinics per dental school from three in 1998 to 9.5 in 2004. The mean number of new satellite clinics per dental school since 1998 is 3.5. Most of the current clinics are independent, affiliated clinics rather than school-sponsored clinics. In 1998, respondents indicated that 49.9 percent of patients treated in dental school satellite clinics were covered by public assistance; in 2004, 81.5 percent of the patients were categorized as indigent. 2004 survey data reflects greater interaction of dental schools with local dental societies in planning community-based sites. In 2004, 68.4 percent of the respondents indicated that their perception of the surrounding community dentists’ attitudes toward their dental school’s current satellite clinics is very favorable, and another 18 percent indicated the attitude is somewhat favorable.
Satellite clinics expand and support the schools’ role in providing access to care and in preparing students to provide culturally competent patient care to diverse populations. Survey responses and narrative comments indicated that there is more communication between dental schools and the local dental community and more understanding of issues that have been problematic in the past, such as the perception of competition, quality of patient care, and supervision of students.
96. Improving Older Adults’ Access to Dental Care in a University-Based Dental Clinic: Interdisciplinary Collaboration with Social Work Professionals
Kimberley Zittel-Palamara, State University of New York at Buffalo; Jude A. Fabiano, State University of New York at Buffalo; Elaine L. Davis, State University of New York at Buffalo; Deborah P. Waldrop, State University of New York at Buffalo; Louis J. Goldberg, State University of New York at Buffalo
Purpose: The Surgeon General and the National Institute of Dental and Cranial Research have indicated that older adults in the United States have difficulty accessing oral health care. Limited access to dental care in older adults negatively impacts general health, oral health, and psychosocial well-being. This project examines how a university-based dental clinic is attempting to improve access to oral health care for older adults by collaborating with social work professionals.
A social work (CARES) program was established in 2001 to address oral health needs of older adults and retention rates in the university clinic. Since then, 178 individuals aged sixty and over (range=60–96) have been provided social work assistance to access oral health care. Patients spent an average of fifty minutes with a social worker. Number of contacts per patient ranged between one and twenty. Social workers contacted or referred patients to an average of three community resources for assistance and advocacy. Approximately eight in ten patients who received social work assistance between 2001 and 2004 were able to receive dental treatment within the past year. The most common types of assistance offered to older adults were: financial (n=85, 47.8 percent), transportation (n=59, 33.1 percent), health-related (n=104, 58.4 percent), mental health (57, 32.2 percent), and housing (n=10, 5.6 percent). Insurance-related barriers to care were significant in this population for oral health with only 3.9 percent (n=7) having dental insurance and 5.6 percent (n=10) having Medicaid insurance. Additionally, only 30.3 percent (n=54) had health insurance, and 46.1 percent (n=82) had Medicare insurance. Twelve (14.3 percent) older adults reported experiencing anxiety, and seven (8.3 percent) reported experiencing depression or manic depression. Caregiver responsibilities were cited by seventeen patients (9.6 percent) as possible barriers to the receipt of dental care. Six (3.4 percent) individuals reported experiencing problems in the family.
Social workers are able to assess and provide interventions for the global health, psychological, and social barriers that prevent older adults from accessing dental care. By providing social work assistance in a university-based dental clinic, close to 80 percent of older adults were able to receive dental care. This is dental care that might otherwise not have been obtained if social work intervention was not provided. The 20 percent that were unable to receive dental care fell into several categories (not listed in order of significance): passed away, no longer needed care, changed dental providers, or moved. Integrating social workers as part of an interdisciplinary team to reach at-risk populations in dental clinics is a successful method to address oral health care disparities.
97. Mind Mapping and Learning Anatomical Concepts
Kami M. Hanson, Weber State University; Joy Phipps-Gall, Weber State University
Purpose: A long-standing conundrum in education has been on how to make learning real for the student. How can synergistic connections be made in the learning process between knowledge and application? Today’s graduate needs to possess knowledge that can be structured or restructured and deployed as necessary and appropriate in a variety of clinical situations. Now, more than ever, instructional strategies need to be utilized that promote meaningful learning, that provide opportunities for discussion and reflection, and that lead to interconnected, coherent and articulated frameworks for understanding. The purpose of this research was to employ the instructional strategy of mind mapping in a classroom setting to identify the impact on cognition. More succinctly put, does constructing and using mind maps affect the meaningful learning of anatomy concepts of orofacial structures by university level dental hygiene students? In order to get at this question, two guiding questions were probed: does mind mapping impact student cognition, and does mind mapping aid in memory retrieval in an assessment situation?
This research investigated the impact of mind mapping on student cognition and on memory retrieval in an assessment situation. The impact on student cognition was referred to as research question 1 (RQ1), and the aid in memory retrieval was referred to as research question 2 (RQ2). It was hypothesized that mind mapping would enhance the encoding process of information for the learner and would aid in the retrieval of material in an assessment situation. The research was an experimental, treatment-control group, comparison design using thirty dental hygiene students taking a course on the anatomical features of orofacial structures. The group was divided equally into experimental and control groups. The experimental group was instructed on mind mapping and asked to create mind maps on concepts taught related to the muscles of facial expression, mastication, and the temporomandibular joint. The methodology included post-treatment interviews, mind map analysis, and post-treatment examination. The exam included a multiple choice section (quantitative data) and a short answer section (qualitative data). Qualitative data was presented in a data collection matrix, and quantitative data was evaluated using a t-test to assess for statistical significance in the results of both groups. The analysis of data revealed the following for RQ1: 98 percent (n=15) of the post-treatment interview responses were "yes" that mind mapping impacted cognition; 56 percent (n=45) total components expected on mind maps for analysis were present. This demonstrated the impact on cognition and that the experimental group had a higher combined score than that of the control on the examination for those questions that probed for RQ1. For RQ2, 83 percent (n=15) of the post-treatment interview responses were "yes" that mind mapping impacted memory retrieval, and 73 percent (n=45) total components expected on mind maps for analysis were present. This demonstrated the impact on memory retrieval and that there was a nonsignificant difference in examination scores on those questions that probed for RQ2. Overall, the results supported the research questions with a percentage in all cases of at least 56 percent above and higher.
Evidence suggested that mind mapping did impact student cognition and aid in memory retrieval in an assessment situation. Therefore, future research is recommended to seek out the use of educational materials and methodologies that support the use of mind mapping.
98. Students’ Attitudes Towards Case-Based Seminars at the Beginning and End of the Class
Phil S. Richards, University of Michigan; Won-Seok Chung, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To explore how second-year dental students’ attitudes towards different aspects of case-based seminars develop from the beginning to the end of the class.
Dental students are required to take a case-based seminar in the second term of their second year in dental school. The objectives of this educational research project were to assess how interested the students were at the beginning of the seminar in various aspects of this class and how these interests would change over the course of the seminar. Key features are a) a general introduction and modeling of the case analysis required from the students by the instructor, b) a group activity in which the students had to analyze patient information given to them and come up with a diagnosis and treatment planning, and c) attendance of the third- and fourth-year student case presentations. Questionnaire data were collected in the first and the last class of the term concerning the students interest in the class overall (two items), their own group-based activities (five items), and attending the older students’ seminar sessions (three items). Ninety-two of the 101 students in the class responded to both surveys (response rate=92 percent). The results showed that at the beginning of the term the students were rather interested in taking the seminar (on 5-point scales: mean=3.74) and attending their own class session (mean=3.57). They were also interested in their own group work (mean=4.02), learning from the third- and fourth-year students (mean=4.38), and listening to their presentations (mean=4.28). While, at the end of the term, the students were still interested in taking the seminar (on 5-point scales: mean=3.82), attending their own class session (mean=3.61), and their own group work (mean=4.02), their interest in learning from the third- and fourth-year students and in listening to their presentations had significantly decreased (mean=4.38 vs. 4.20; p=.026; 4.28 vs. 4.06; p=.007). In conclusion, these data showed that students valued case-based seminars overall as well as their own group activities consistently high throughout the term, while their interest in attending more advanced students’ seminars decreased over the term. Curricular efforts should therefore aim at getting students directly involved in case-based learning.
In conclusion, these data showed that students valued consistently highly case-based seminars overall as well as their own group activities throughout the term, while their interest in attending more advanced students’ seminars decreased over the term. Curricular efforts should therefore aim at getting students directly involved in case-based learning.
99. An Interdisciplinary Approach to Case-Based Seminars: A Quasi-Experimental Analysis
Phil S. Richards, University of Michigan; Won-Seok Chung, University of Michigan; Marita R. Inglehart, University of Michigan
Purpose: To explore whether having a behavioral scientist participate in a second-year, case-based seminar would affect student learning.
Dental students are required to take a case-based seminar in the second term of their second year in dental school. The objective of this educational research project was to assess whether the participation of a behavioral scientist in such a seminar would affect the students’ learning. Key features of this study were a) that the 101 students were randomly assigned to one of two conditions (behavioral science instructor present=Tuesday class vs. not present=Thursday class), and b) that their evaluations of the importance of various factors for diagnosis and treatment planning were assessed in self-administered questionnaires during the first and the last class of the term. Ninety-two of the 101 students in the class responded to both surveys (response rate=92 percent). The results showed that, at the beginning of the term, the students in the Tuesday class with the behavioral science instructor present evaluated the importance of the psychological factors such as the patient’s mental health status, dental fear, and patient expectations as more important than the students in the Thursday class (means on 5-point scale: 4.40 vs. 4.06; p=.03; 4.29 vs. 3.72; p=.001; 4.33 vs. 4.00; p=.033). In addition, they evaluated the importance of sociocultural factors such as the importance of the patient’s socioeconomic background, and race/ ethnicity as higher than the students in the Thursday class (3.90 vs. 3.43; p-.013; 3.27 vs. 2.87; p=.05). A comparison of the student evaluations at the end of the term showed that the students in the Tuesday class again rated psychological as well as sociocultural factors as significantly higher than the students in the Thursday group. In addition, the students in the Tuesday group indicated that the medical history and knowing the patient’s medications were more important than did the students in the Thursday session.
In conclusion, these data showed that interdisciplinary teaching of case-based seminars can increase students’ evaluations of the complexity of factors that contribute to diagnosis and treatment planning, thus contributing to a more patient-centered and culturally sensitive approach to patient care.
100. Introducing a Senior Course on Catastrophe Preparedness Studies into the Curriculum
David L. Glotzer, New York University; E. Dianne Rekow, New York University; Walter Psoter, New York University; Frederick G. More, New York University
Purpose: To determine the value, effectiveness, and level of student interest in a senior level course on catastrophe preparedness, with an emphasis on bioterrorism, in the dental school curriculum.
Initially, at New York University College of Dentistry, the material on bioterrorism was put into modules that were "dropped" into existing courses in the Basic Sciences and in Oral Medicine and Diagnosis during the first three years of the dental student’s education. In their senior year it was decided to present an independent twelve-hour course, exercise-driven, by chemical, biological, and radiological scenarios. The course objectives include having the students develop an individual prototype plan to support patients, staff, and family in the event of a public health emergency. Also included will be basic tabletop exercises intended to generate discussion on required actions to be taken and a point of distribution (POD) exercise, based on the NYC model, for the widespread distribution of antibiotics. Before the course begins, the senior students will be asked to fill out a short (ten-item) IRB-approved questionnaire, posted online, that rates on a scale of 1 to 5 how important they believe certain issues are that relate to bioterrorism preparedness, and then on a scale of 1 to 5 how prepared (confident) they feel they are to respond to those issues. We also ask the students’ gender and what type of practice they envision for themselves in five years. We will then give them the same questionnaire to complete after the interactive twelve-hour senior presentations to try to assess any significant changes in their attitudes and sense of preparedness.
In summary, the two significant questions confronting dental education in the dangerous world we live in today are: 1) what should dental students learn about bioterrorism (learning objectives)? and 2) what kind of educational experiences would best allow students to achieve those learning objectives?
101. Improving Multiple-Choice Examinations in an Undergraduate Dental Hygiene Program
Nancy T. Keselyak, University of Missouri-Kansas City; Pamela Overman, University of Missouri-Kansas City
Purpose: Determining that dental hygiene students are competent to graduate requires reliable means of evaluation throughout the curriculum. The objective of this project was to improve the reliability of a multiple-choice examination in an undergraduate dental hygiene course as determined by the Kuder Richardson 20 (KR 20) score for the overall examination and discrimination index scores on distracters.
All multiple-choice examinations in the Introduction to Dental Hygiene Practice course are evaluated using a NCS Pearson Exam SYSTEM II program to determine item analysis (Kuder Richardson 20 scores and discrimination index scores). Each test item from the 2002 final examination was reviewed to identify distracters that performed poorly. Modifications were made to those distracters, or the distracter was eliminated. The revised examination was given to students in 2003 and analyzed using the same NCS Pearson Exam SYSTEM II program. Results: Overall examination reliability was measured by KR 20. The KR 20 score improved from 0.45 in 2002 to 0.82 in 2003. Single item discrimination indices improved overall (correct answer discrimination index score improvements ranged from 0 to .5).
Courses in a dental hygiene program are intended to develop specific knowledge and skills essential to the practice of dental hygiene. Reliable examinations are needed to ensure that dental hygiene students are competent for graduation. By applying a few simple steps, educators can make significant improvements in multiple-choice examinations and increase confidence that students are competent for graduation.
102. Success Factors for Computer-Based, Student-Centered Clinic Management
Lynn A. Johnson, University of Michigan; Mark Fitzgerald, University of Michigan; Don Heys, University of Michigan; Mary Garrelts, University of Michigan; Jean Thompson, University of Michigan; Rick Getchell, University of Michigan; Roger Gillie, University of Michigan
Purpose: The University of Michigan School of Dentistry is implementing a computer-based patient management system into the dental and dental hygiene clinics. The first task was to identify and pilot implementation strategies. The successful strategies will be used to implement new functions of the clinic management system.
The pilot focused on sixteen D4 students scheduling their patients using the scheduling module of a dental information management program, axiUm. Initial concerns were the amount of time required to train the class of 107 to operate the software and the students’ acceptance of the added responsibility. Training materials were developed that contained step-by-step instructions for scheduling activities and a competency exam listing three routine patient scheduling scenarios that had to be completed at 100 percent success rate. A Participant Perception Indicator (PPI) was developed on which students rated their knowledge, experience, and confidence on a scale of 1–5 (5 being the highest) on fourteen different items related to computer-based scheduling. The pilot consisted of the pre-PPI, the training in groups of four or less, the post-PPI, and the competency exam. Student PPI scores increased from a Pre-PPI average of 1.28 to 3.74 on the Post-PPI, demonstrating high student acceptance of the task and confidence that they could independently and correctly perform the task. Two-thirds of the students passed the competency exam on the first attempt, and one-third of them successfully started computer-based patients scheduling with no staff assistance. The rest had to repeat the exam, but not the training. Additionally, it was observed that the time required for student training is approximately half of that required for staff. A follow-up evaluation will investigate the nature of appointment errors so that interventions can be incorporated into the training and exam.
Careful planning of training combined with a competency exam is a two-part strategy that ensures successful student use of a computer-based clinical management system.
103. Academic Dentistry: A Descriptive Analysis of Leadership Among Women Deans, Department Chairs, and Program Directors
Susan J. Kowalewski, University at Buffalo
Purpose: To bettter understand what leadership skills are held by women who become leaders in the field of dental academics. The information gained through this research can be utilized to increase numbers/improve the environment of quality of worklife of women in academic dentistry. Undertanding the leadership practices that female administrators utilize and possess within dental schools is imperative to increase access for females as students, as well as leaders. This study can be utilized for understanding strengths, weaknesses, and opportunities for women in academic dentistry.
Improving and increasing leadership opportunities for women in academic dentistry are integral to achieve a diverse workplace and gender equity. The specific purpose of this study is to better understand leadership skills held by women who have become leaders in the field of dental academics. A database comprised of the 184 female deans (ten deans, thirty assistant deans, forty-nine associate deans), thirty-three program directors, and sixty-two chairs from the fifty-six dental schools in the United States provide data identifying leadership skills using the Leadership Practices Inventory (LPI) developed by James Kouzes and Barry Posner. The control group consists of 100 males holding the same titles. The survey is made up of two parts: a demographic section and the LPI, comprised of thirty statements on a 10-point Likert scale. Responses to the survey will be analyzed using descriptive statistics, which include percentages and frequency distribution. The research questions being addressed include the following: 1) what leadership skills, utilizing the LPI, do female dental administrators with the titles of dean, program director, or chair possess? 2) which leadership skills are important to perform their jobs? 3) how do female dental school deans, program directors, and chairs differ in leadership skills? what similarities do the titles have and what dissimilarities do they exhibit? The results of this study can be used to make decisions regarding hiring, but more importantly implementing mentoring and leadership programs for individuals to obtain the necessary leadership skills for advancement. Preliminary results from 160 respondents show that 95 percent of the respondents are Caucasian, with less than 1 percent African American, Hispanic, and international administrators. Based on these limited results to date, this study provides data that although the percentage of women in academic administration in dental schools has increased over the last thirty years, there are still significant shortfalls related to diversity.
Although there has been an increase over the last thirty years in the number of both female administrators and dental students, a large percentage of women in leadership roles are not dentists or hold titles at a lower rank than their male counterparts. This would lend itself to additional mentoring and leadership opportunities for female dentists to obtain the same opportunities as male dentists. This study also provides pertinent information related to faculty holding positions in administration and retirement numbers. This study is a Ph.D. thesis; the survey is currently in process with an end date of 9/1/04. The dissertation is scheduled for completion 1/05.
104. Dental Hygiene Student Experience with Ethically Problematic Situations
Sandra J. Cobban, University of Alberta; Margaret P. Wilson, University of Alberta; Patricia Covington, College of New Caledonia; Bess Miller, John Abbott College; Diane Moore, SIAST; Susan Rudin, George Brown College; Van Tran, University of Alberta
Purpose: To identify how often dental hygiene students encounter ethically problematic situations and their actions and feelings at the time of encounter.
Anecdotal evidence has suggested that dental hygiene students are faced with ethically problematic situations particular to their clinical education and that the students do not feel that these problems are adequately resolved. The purpose of this study was to identify how often students encounter ethically problematic situations and their actions and feelings at these times. One hundred and eighty-eight completed survey questionnaires were received from students enrolled in five dental hygiene programs in Canada. Of these respondents, nearly half (44.6 percent) had witnessed unethical behavior by a dental hygiene instructor/other instructor, and over half (51.7 percent) had witnessed unethical behavior by another dental hygiene student. Those witnessing unethical behavior were most likely to feel bad or guilty (29.8 percent) or confused (28.2 percent). Fewer than 10 percent felt comfortable challenging the individuals involved and discussing it with them. To provide our graduates with strong skills to address ethical dilemmas in practice, educators may wish to begin developing these skills when student issues emerge.
Dental hygiene students do experience ethically problematic situations during their education, but few feel confident and comfortable enough to challenge the individuals involved and discuss it with them
105. Case-Based Teaching of Patient and Practice Management: An Integrated Approach
Carol A. Bibb, University of California, Los Angeles; Kathryn A. Atchison, University of California, Los Angeles
Purpose: To describe a novel educational program to integrate teaching of patient management skills and quality assurance (QA) methodology within the predoctoral student dental clinic.
A fourth-year course entitled "Clinical Applications of Quality Assurance" uses a case-based format in which students work in teams with a faculty coach to conduct a structure and process evaluation of a UCLA School of Dentistry clinic using a standardized evaluation instrument provided by Delta Dental, three chart reviews of randomly selected patient records, and an investigation of a team-selected quality issue. Recommendations related to quality are provided to the clinic administration and relevant committees for action, and the students are notified of the outcomes of these recommendations. For example, the Health and Safety Committee developed and implemented operational guidelines for collection and disposal of scrap amalgam in response to student concerns. The second component of this integrated program is a quarterly review of the records of all active patients within a vertical team conducted by the clinic group directors. Several criteria are evaluated under the categories of documentation, professional communication, and patient-centered care. Performance is considered in the context of the student’s level of experience with progress toward competency expected. Identified deficiencies are discussed, and a plan for corrective action is developed. The most common deficiencies are in the areas of timeliness of treatment and required signatures in the record. Overall, the frequency of criteria in need of improvement has decreased, indicating that our students are meeting our patient management expectations.
Participation in the clinic QA process in combination with hands-on mentoring in patient management strategies by experienced clinicians has improved patient care and facilitated the transition from student dentist to independent professional.
106. Classroom Instructional Practices at a U.S. Dental School
Linda S. Behar-Horenstein, University of Florida; Gail S. Mitchell, University of Florida; Teresa A. Dolan, University of Florida
Purpose: A qualitative evaluation strategy was used to assess the impact of the curricular change on classroom instructional practices.
The University of Florida College of Dentistry adopted an educational philosophy in 1997 and implemented a new integrated basic and behavioral sciences curriculum in 2000. A qualitative evaluation strategy was used to assess the impact of the curricular change on classroom instructional practices. Unstructured observations were used to document the instructors’ teaching behaviors related to the context of what the teacher said, asked, or directed students to do. Behaviors were recorded using running notes. Data were analyzed inductively guided by Spradley’s scheme of domain analysis and by the constant comparative method proposed by Glaser and Strauss. Fifteen medical and dental school faculty who taught in first- and second-year D.M.D. courses were observed by two of the authors. Courses included Biochemical, Molecular, and Cellular Biology; Structure and Function of the Body Systems; Disorders of the Body Systems; and Oral Medicine. Classroom observations revealed that instruction was predominantly teacher-directed. Teaching consisted of didactic methods, dissemination of facts and content, teacher talk, and little to no opportunity for students to demonstrate comprehension. Opportunities for students to think aloud, explain their conceptions, or alter misconceptions were infrequent. Course goals as stated in the syllabi were revised to meet the institutional expectations of the curriculum revision process. However, most instructional practices observed were inconsistent with the college’s educational philosophy and goal of providing more active and authentic learning experiences within these courses. Likewise, the revised curriculum did not consistently meet the curriculum revision goal of integrating basic and behavioral science content with oral health and patient care concepts. The findings call attention to the need to raise faculty awareness about acquiring evidence-based educational skills, aligning instruction with course goals and objectives and formatively assessing teaching, and providing authentic learning experiences that promote active learning and critical thinking. Findings from this study will be used to support the process of continuous curriculum improvement endorsed by this college.
107. A Comparison of Dentists’ State of Origin to State of Practice
Carol F. Weller, American Dental Association; Karen Schaid Wagner, American Dental Association; L. Jackson Brown, American Dental Association
Purpose: A common access to care issue is the distribution of dentists in the United States. When discussing reasons for the unequal distribution, the state that a dentist originally comes from is often overlooked. The purpose of this study is to look at where dentists are practicing in relation to their state of origin. Dentists’ likelihood of moving from their state of origin to practice dentistry is examined. We also consider whether dental school location affects the movement of dentists between states.
The American Dental Association conducts an annual census of dentists and reports its findings in the report "Distribution of Dentists in the United States." From this self-reported data, we are able to identify and compare a dentist’s state of origin to a dentist’s state of practice. The first three digits of the social security number are used to identify the state of origin. Only dentists who were in private practice in 2001 and who graduated in 1990 or later are considered in this analysis. The percentage of dentists who moved out of their state of origin to practice in another state varies from 18.1 percent to 90.0 percent per state. Dentists from the New England region were most likely to move, and dentists from the East North Central and West South Central regions were least likely to move. States without a dental school were more likely to have dentists leave their state of origin to practice dentistry than states with a dental school. However, enough dentists move into states without dental schools so that those states without schools are no more likely than other states to have a net loss of dentists.
There is no correlation between states with high population-to-dentist ratios and the state of origin of dentists. In general, states with a higher population-to-dentist ratio are equally likely to change states as those with lower ratios. However, some individual states such as Arkansas and West Virginia are likely to have dentists return to their state of origin for practice. Such states might be a possible target for dental school recruitment.
108. Student Outcomes from a Combined Medical-Dental Curriculum
G. Wayne Raborn, University of Alberta; Hussein Parani, University of Alberta; Michael Grace, University of Alberta
Purpose: To determine if the combination of the first two years of dental education with that of medicine had measurable effects on dental students.
Major changes occurred in the Faculty of Dentistry throughout the 1990s including a reduction in class size from fifty-two to thirty-two, curriculum revisions, and a merger into the Faculty of Medicine. Curriculum revisions resulted in a sharing by dental students of the initial two years of the program with medical students. Revisions have also made summer programs compulsory. Identifying particular changes to the program that have been beneficial and/or detrimental on student outcomes can aid in planning dental education. In addition, identifying predictors of success as measured by student outcomes can improve the selection process of candidates for admission into the dental program for long-term success of students entering dental education. The purpose of this study was to determine whether changes in the program affected measurable student outcome scores by analyzing qualifying data of students entering dentistry, marks obtained on examination in clinical courses in the fourth year of dental school, and those obtained on Canadian National Board Exams. Three groups were delineated. Group A (traditional) consisted of students graduating in 1998 and 1999 who were part of a standard four-year dental program; Group B (transitional) consisted of students graduating in 2000 and 2001 who went through the process of the Faculty of Dentistry being collapsed and merged with the Faculty of Medicine; and Group C (merged) which consisted of students graduating in 2002 and 2003 from a combined curriculum with the M.D. program. Incoming measures (demographic and qualifying grades) were assessed to determine whether student groups were the same at entry into dentistry and for their predictability of success in completing dental school. Comparison between groups on baseline information was done by chi-square and analysis of variance. Tests of comparisons were set at p<.01.
There was a significant difference at the start of dental school between groups in overall and prerequisite GPAs with average entrance grades increasing over time. There was a significant difference between the three groups in the clinical part of the Canadian National Board Exams (NDEB) with Group C having the highest score. There was no significant difference in the written part of the NDEB, although there was a trend over time for scores to become higher. No significant differences were found between the three groups in their fourth-year final grades.
109. First-Professional Students’ Perception of Clinical Preparedness: Impetus for Curricular Change
Jean A. O’Donnell, University of Pittsburgh
Purpose: Anecdotal reports from students and faculty at the University of Pittsburgh School of Dental Medicine (UPSDM) suggest that as students complete their preclinical curriculum they may not be as well prepared for initial patient care activities as expected. In support of this theory, detailed investigation into the concepts relating to student preparedness and confidence in the delivery of patient care was addressed by means of a survey administered to first-professional students. This method of questioning was intended to identify areas of the preclinical curriculum that may require modification.
A faculty focus group was convened to identify areas of concern that formed the basis of the survey. In April 2003 and 2004, a survey was administered to first-professional students who had completed two years of preclinical courses as well as to those students who had completed one year of clinical experience. In 2004 the survey was also administered to the class who had now completed two years of clinical experience. Specifically, the survey asked students to rate, on a scale of 1–5, how well prepared they thought they were to enter the clinic in eight different categories. They were also given open-ended questions that asked them to omment on other specific areas of the curriculum. The UPSDM classes of 2004, 2005, and 2006 were involved in the study. Student responses were anonymous. Preliminary results indicate a trend in three areas (results from the first-year survey and the second-year survey are listed, respectively, after each class): 1) students feel they should have had more exposure to patients prior to their official assignment into the clinic (Class of 2004, 36 percent and 31 percent; Class of 2005, 59 percent and 42 percent; Class of 2006, 54 percent); 2) students feel they needed more training in radiographic and clinical detection of caries (Class of 2004, 26 percent and 15 percent; Class of 2005, 35 percent and 32 percent; Class of 2006, 52 percent); and 3) a course in dental materials was requested by those classes who had not had exposure to this course (Class of 2004, 40 percent and 61 percent; Class of 2005, 61 percent). Final results will be analyzed comparatively and descriptively to assess group change from pre- to post-survey administration. During the course of the 2002–03 academic year and prior to the implementation of the formal survey, a new course in dental materials was introduced to entering first-year students (Class of 2006). Preliminary results of the survey seem to validate these modifications to the curriculum.
Through these surveys, first-professional students were able to express their concerns regarding the curriculum and its impact on their perceived readiness to administer patient care. Student comments relating to early increased exposure to patients as well as additional training in the areas of radiographic and clinical identification of caries will be presented to the curriculum committee to further investigate the need for curricular revisions. Further data will be needed to identify whether the changes implemented have effectively addressed the students’ concerns.
110. A Novel Approach to Scheduling New Patients in a General Practice Residency
Todd E. Thierer, University of Rochester; Bridgette Rees, University of Rochester; Diane Chiesa, University of Rochester
Purpose: To increase patient access, improve chair utilization, and maximize resident efficiency in the scheduling of new patients.
Access to dental care for underserved populations has come to the forefront recently as a major issue facing our profession. Our hospital-based dental service is one of the few to accept Medicaid insurance in our region. As a result, we have many more patients who desire our services than we can provide care for. To compound this problem, our new patient no show rate (NSR) for the calendar year 2003 was 52 percent. To attempt to address these two issues, we decided to take an innovative approach to overbooking new patients. Traditionally, we have booked thirty-minute new patient appointments per provider. We calculated the NSR for each month of the year to determine the percentage overbooking we would do. We took the number of providers and overbooked new patients by that percentage. Instead of simply overbooking each provider, we took the total number of new patients per thirty minutes (incorporating the overbooking percentage) and booked them on thirty-minute intervals. The patients were not booked with an individual provider; rather as each provider finished a patient, they took another one. In this way, a provider who had a "quick" edentulous exam did not have to wait for their next patient to arrive. We began this program in July 2004 and have had eight new patient sessions. Two hundred ninety-five patients have been scheduled and the NSR was 35 percent. Under our old system, 169 patients would have been scheduled. At the current NSR, 109 new patients would have been seen versus the 193 that actually arrived, a 77 percent increase.
This novel approach to scheduling new patients has significantly increased access, improved chair utilization, and maximized resident efficiency in a hospital-based general practice residency program. This was achieved without increasing the number of providers or support staff.
111. Testing a Domestic Violence Tutorial with Dental Students and Dentists
Nancy Kwon, University of California, San Francisco; Karen Herzig, University of California, San Francisco; Dale Danley, University of California, San Francisco; Stuart Gansky, University of California, San Francisco; Barbara Gerbert, University of California, San Francisco
Purpose: Our goal was to test the effectiveness of a brief, interactive, multimedia tutorial, designed to educate dentists to identify and respond to domestic violence (DV), through the AVDR (Ask, Validate, Document, Refer) Model. We tested our tutorial separately with dental students and dentists.
To help dentists learn the AVDR model, we created an interactive, multimedia tutorial that takes approximately fifteen minutes to complete. Next, we developed an instrument that included a series of twenty-four questions, delivered by computer, to assess the participant’s knowledge, attitudes, and practice behaviors related to DV. Finally, we conducted two randomized, controlled trials: one with dental students (n=161), one with dentists (n=174), in which the intervention groups took the tutorial and the control groups did not. Results: Using resampling-based multiple comparison t-tests, in both studies experimental groups demonstrated significantly greater improvement in scores on most items, including knowledge, attitudes, and behaviors, relative to control subjects (Bonferroni p-values all <.005 for dental students; all <.001 for dentists).
The domestic violence multimedia tutorial is equally effective in helping dental students and dentists learn how to identify and help patients who are victims of abuse. Given these findings, we believe our tutorial could be disseminated to help dentists and their patients across the country.
112. Value of a National Board Dental Hygiene Review Course: A National Survey
Chris F. Beatty, Texas Woman’s University; David D. Marshall, Texas Woman’s University; Heather O. Mapp, Lanier Technical Institute
Purpose: To evaluate the value of a nationally based National Board Dental Hygiene (NBDH) review course offered by Dental Hygiene Seminars, Inc. (DHS).
Dental hygiene (DH) students have access to a variety of highly publicized and costly NBDH review courses. DH educators are called on to recommend their appropriateness. Following IRB approval, a questionnaire was mailed to 1648 individuals who attended the 2002 DHS review course. Response rate was 29 percent, and data analysis was completed on 415 valid responses. Data was self-reported. Results included the following: 89 percent graduated from a two-year program, and 11 percent from a bachelor’s degree program; 89 percent spoke English as their first language; 96 percent passed on first attempt, 2 percent on second attempt, and 2 percent on third or greater attempt; 48 percent scored above 85; 86 percent rated the course as good to excellent relevance to NBDH content; 94 percent would recommend it to other students; 85 percent rated it as beneficial to very beneficial; 61 percent rated it as having excellent monetary value; and 53 percent relied on faculty recommendation to select this course to attend. Canonical correlations analysis revealed a statistically significant relationship between NBDH achievement and personal and opinion variables (.61 [F(28, 748)=7.598, P<.001]). The high factor loadings were passing on first attempt for NBDH achievement (.994) and GPA (.917) for personal and opinion variables. Cross-tabulation chi-square analysis revealed a statistically significant (P<.001) relationship between type of program and success on first attempt (Cramer’s V = .230). Funding for this project was provided through DHS.
The DHS review course was relevant and beneficial, students from two-year programs are more likely to pass NBDH on first attempt, and GPA is the only factor significantly related to pass rate.
113. Use of Computer Technology to Modify Objective Structured Clinical Examinations
Lavern J. Holyfield, Baylor College of Dentistry; Kenneth A. Bolin, Baylor College of Dentistry; Kathleen V. Rankin, Baylor College of Dentistry; Jay D. Shulman, Baylor College of Dentistry; Daniel L. Jones, Baylor College of Dentistry; Becky Eden, Baylor College of Dentistry
Purpose: To describe a modification of the OSCE concept that is more logistically manageable and less resource intensive.
An objective structured clinical examination (OSCE) is a multistationed clinical examination shown to be effective in testing students’ ability to integrate the knowledge, skills, and attitudes acquired during their preclinical and clinical training and experiences. Moreover, the OSCE provides a means by which the educational process and the curriculum can be evaluated in order to identify areas that may require modification. The OSCE for the third-year Preventive Dentistry course at Baylor College of Dentistry used four sections of ten stations each, through which the forty-three students (one-half of the third-year class) rotated over a period of ninety minutes. The second half of the class did the exam on a separate day. To reduce the disruption caused by the students’ moving from station to station, we modified the traditional concept by "moving" the stations to the students through the use of computer technology. All test questions, radiographs, graphics, and materials were transferred to electronic format and incorporated into PowerPoint slides, which were advanced based on designated times presumed necessary for students to successfully assess and respond to information. The overall atmosphere was less chaotic, more organized. Each student was given the exact instructions and explanations and received the same amount of time to respond to the information presented. The ratio of faculty to students required to monitor the exam was lower than required for the traditional format. Additionally, since there was no need to allow time for student transition, less time was required to administer the exam.
We were able to accomplish our objectives assessing the entire class at one setting using fewer faculty, in less time, with less disruption.
114. Teaching Patient-Centered Care Through Experiential Learning
Eunice M. Edgington, University of Alberta
Purpose: To increase students’ understanding of the illness experience in relation to lifestyle changes.
Understanding the illness experience in the context of a patient’s life is fundamental to patient-centered care. During the assessment process the emphasis is often on exploring the signs and symptoms of a disease, and little attention is directed toward exploring the patient’s experience. To maximize dental hygiene students’ awareness of the patient’s illness experience, an interactive experiential learning workshop was developed. The focus was on diabetes mellitus because it has many metabolic and vascular components and it requires many changes in life style. An interdisciplinary team presented information on all aspects of diabetes. Nutritional counselling enabled students to perform diabetic diet conversions. Students were provided a glucose blood sugar meter, lancets, and strips. They were required to adhere to a diabetic meal plan and a blood sugar testing schedule for three days and journal the experience. During the debriefing session the students identified and discussed the many challenges they faced including: time management, dealing with others, remembering to take a blood sugar readings, recording what you ate, the cost of the lancet and strips, and understanding the impact of exercise, drinking alcohol, and illness on insulin intake. The students expressed a deeper understanding of the meaning of the illness experience in context to lifestyle changes and discussed its applcation to the diverse needs of the patient population.
Experiential learning is an effective way to increase students’ understanding of the illness experience in the context of the patient’s lifestyle changes. This understanding can be applied to the diverse needs of the patient population and will enhance patient-centered care.
115. Incidence Reports of Percutaneous Injuries in a Dental School: A Two-Year Overview
Richard S. Callan, Medical College of Georgia; W. Frank Caughman, Medical College of Georgia; Michael L. Budd, Medical College of Georgia
Purpose: Monitor the effectiveness of existing quality assurance programs and improve workplace safety.
Quality Assurance Programs dictate continued effort towards the reduction of accidental injury in the workplace. Such programs should have the ability to both monitor compliance and evaluate effectiveness. In addition, the Centers for Disease Control has begun to emulate many of the OSHA guidelines as the Standard of Care for all health care workers indicating the possibility of medical/legal consequences for noncompliance. An analysis of data collected over a two-year period shows some interesting results concerning various aspects of the reported incidences of percutaneous injuries. The data were complied over a two-year period (academic years) from individual incidence reports encompassing the entire school of dentistry. The categories of interest for the incidences were as follows: source, recipient, time of day, specific clinic, instrument involved, and body part involved. The population examined in this study consisted of predoctoral and postdoctoral dental students, dental hygiene students, staff, and patients. The results of our data analysis indicate that the overall number of injuries is relatively small considering the total number of patient visits recorded (thirty-six percutaneous injuries reported for the 111,831 patient visits). The majority of injuries occur in the predoctoral clinic (54 percent) between 3:30 and 4:00 pm (36 percent). The instrument most likely involved was a needle (50 percent) followed by a bur (23 percent). The body part most commonly injured was a finger, which includes the thumb (75 percent). There was an overwhelming preponderance for the predoctoral student to be the recipient of the injury (74 percent) and the patient to be the source of exposure (97 percent).
The collection and analysis of the incidence reports over the past two years have shown a high success rate in the prevention of percutaneous injures. Additional reinforcement of needle capping protocol should prove beneficial in improving workplace safety.
116. Web-Based Faculty Calibration in Predoctoral Endodontics
Ashraf F. Fouad, University of Maryland; Elaine Romberg, University of Maryland; Omar J. Jones, University of Maryland
Purpose: This presentation will describe a new program for web-based calibration in predoctoral endodontics and show the characteristics and evaluation patterns of endodontics instructors who did or did not participate in this program
Four full-time, eleven part-time faculty, and six postgraduate (PG) endodontics students at the University of Connecticut, were encouraged to participate in a web-based teaching calibration program. All instructors could take the exercise any time and from personal or school computers, throughout the 2003–04 academic year. The program consisted of ten illustrated clinical scenarios, for which the instructors made decisions on the evaluation of the students. Immediate feedback was provided on what the syllabus had determined to be the expected answers. A database tracked who took the program and when they took it. Data on the evaluations made by all instructors during the year (including only data after calibration for those who took the program) were obtained from a clinic information system. Two full-time and four part-time faculty did not take the program. The mean number of years of teaching of faculty (excluding PG students) who took the program was 11.6 compared with 22.5 for those who didn’t take it (t-test; p=0.047). A total of 473 visit evaluations (335 from calibrated instructors, including PG students, and 138 from uncalibrated instructors) were analyzed. The average rank of calibrated faculty rank was lower than that of non-calibrated faculty (Mann-Whitney U; p=0.008). The calibrated instructors gave negative evaluations in 16.7 percent of the visits, whereas the non-calibrated instructors gave negative evaluations in only 3.6 percent of the visits (Chi-square with Yates Correction; p=0.0001).
We conclude that faculty with more years of experience in teaching are less likely to take a calibration program. Clinical instructors who have not taken a calibration program are more likely to display higher average evaluations and fewer negative evaluations.
117. Interdisciplinary Training of Pediatric Dental Residents in Developmental Disabilities
Fouad S. Salama, University of Nebraska; Patricia A. Gromak, University of Nebraska
Purposes: To develop knowledge and acquire and/or sharpen clinical skills and abilities of pediatric dental residents in interdisciplinary training in developmental disabilities as well as to develop a family-centered care of children with disabilities and their families.
Approximately 15 percent of all children in the United States have some special health care needs, including developmental and physical disabilities. Any pediatric dental resident who cares for children will deal with children who have special educational or physical needs. Understanding the ability of other health professionals and valuing their input will be important in developing a competent pediatric dentist. The program allows each resident to rotate in different departments that include evaluative and therapeutic services, such as developmental medicine, nutrition, physical therapy, occupational therapy, augmentative and alternative communication service, and autism program. Advisors are assigned to each resident during their training experience. Based upon data from outcome measures and resident evaluations by the advisor systematic evaluation of the program was conducted to determine whether the goals of the project are being met. The preliminary results showed that the program achieved most of its goals and acquaints the pediatric dental resident with multiple specialties available to care for children with special health care needs and each resident develop an understanding of the interdisciplinary concept. The pediatric dental residents reported that there is a need for sufficient time with some disciplines and advisors.
The program demonstrated both the need for and the effect of interdisciplinary training in developmental disabilities and that teaching and clinical experiences centering around developmental disabilities can provide a natural setting for such training. The pediatric dental residents showed positive perceptions of interdisciplinary training in developmental disabilities.
118. Students’ Evaluation of a Preclinical Course in Periodontics After One Year of Clinical Training
Alexandra Tsami Pandi, University of Athens; Phoebus N. Madianos, University of Athens; Ioannis K. Karoussis, University of Athens; Ioannis A. Vrotsos, University of Athens
Purpose: There is a need for evaluation of modern didactic approaches incorporated in the preparation of dental students for their clinical training. The aim of this study was to evaluate the preclinical course in periodontics at the University of Athens, based on a questionnaire answered by the students.
One hundred and twenty-eight students who attended the preclinical course in periodontics in the sixth semester answered anonymously and returned a questionnaire, at the end of the eighth semester, after having completed two semesters of clinical training. The questionnaire included questions regarding the course content, the use of audiovisual and computer-assisted educational methods (video projection preceding hands-on practice, e-learning, etc.), evaluation tests, and the effectiveness of the course as a whole to prepare them for the clinic. Each question/statement had five possible, preselected answers coded from 0 to 4 (0=no opinion, 1=totally disagree to 4=totally agree). Although 84.4 percent of the students thought that the course had efficiently prepared them for the clinic, 60 percent felt that the difficulties they encountered in the clinic were only due to lack of experience, while the rest felt that it was also related to certain aspects of their preclinical preparation. While 72.67 percent believed that the course content was sufficient, 62.5 percent had proposals for modification or addition of certain subjects, and 92.18 percent preferred the use of computer assisted educational methods (video projections, e-learning, etc.) to the traditional slide-based presentation. Finally, 72 percent thought that more frequent interactive evaluation tests would motivate more effort for studying.
Within the limits of this study, it was concluded that a preclinical course incorporating the use of audiovisual and computer-assisted educational methods is effective in preparing students for clinical training and that frequent interactive evaluation tests may motivate more effort for studying.
119. Outreach Learning and Serving an Underserved Population
Wendy J. Moore, The Ohio State University
Purpose: A new program was developed to include service learning to dental hygiene (DH) students and to provide preventive and restorative needs to an underserved pediatric population.
In this project, supported by the Center for Healthy Communities, students utilized a dental public health clinic to place dental sealants. The students with the Expanded Function Dental Auxiliary (EFDA) specialization worked with a dentist to place restorations. Seventy-four children (229 teeth) were treated during this project. An assessment was conducted of dental hygiene students to measure student perceptions of community service learning as a result of treating this population. Students completed an identical pre- and post-evaluation of personal attitudes concerning community outreach learning, utilizing a Likert scale. The significance is based on a paired t-test statistic (p). Eighty-three percent of the students felt they gained unique knowledge from this clinical experience. Students felt better prepared to practice in an underserved area. The students noted an increased interest in working with patients of various cultural backgrounds (p=.02). Students gained knowledge in the types of community resources available for underserved populations (p=.01) and how health care delivery systems impact their work in a community (p=.01). The students better understood the health care needs of an underserved community (p=.02). Students discovered patient barriers to receiving health care in an underserved community and the impact of socioeconomic status on health and illness (p=.01). Working with patients who have various levels of health care knowledge had a significant effect on student knowledge (p=.01). When asked if they felt they had acquired new skills, one student comment was "I feel much more equipped to deal with people from different backgrounds with different needs."
In conclusion, the community involvement activity helped to reach an underserved population while facilitating improvement in student understanding of the many facets of treating an underserved population.
120. Survey of Special Patient Care Programs at U.S. and Canadian Dental Schools
Daniel C. Stoeckel, Southern Illinois University; Susan E. Rieken, Southern Illinois University; Debra M. Schwenk, Southern Illinois University
Purpose: To obtain information regarding special patient care clinics at U.S. and Canadian dental schools to assist the Southern Illinois University School of Dental Medicine (SIU/SDM) in revising its method of providing dental care to patients with developmental disabilities (DD).
It is anticipated that a designated special patient care (SPC) clinic will allow more patients with DD to be seen, thus providing better service to this patient population and a more cohesive and consistent experience for predoctoral students. It is hoped that more extensive experience with patients with DD will encourage these students to treat such patients upon graduation. A two-page survey was designed. The survey was mailed to sixty-six dental schools in the United States and Canada. Thirty-five surveys were returned (53 percent). Fifteen respondents (43 percent) indicated that their schools had an SPC clinic. All see patients with DD, and all but one include medically compromised patients in their SPC clinics. Fourteen of the clinics involve predoctoral dental students in treatment with each spending from three days to one month. Ten of the clinics offer general anesthesia to their patients, providing a range of services to special patients including fixed and removable prosthodontics. Schools without special patient care clinics tend to mainstream the majority of these patients, referring severe cases to various hospital-based residency programs.
Most respondents are treating special care patients whether or not they have a designated clinic. The schools with SPC clinics were more likely to involve predoctoral students. Based upon the information gathered in this survey, the SIU/SDM will develop an SPC clinic in conjunction with our Advanced Education in General Dentistry (AEGD) program. Year III and Year IV students will work with the AEGD residents to treat these underserved patients.
121. Predictive Value of Subjective Evaluations in Timely Graduation of Students
Vicky Evangelidis-Sakellson, Columbia University; Richard M. Lichtenthal, Columbia University
Purpose: To assess the predictive value of "subjective" (based on written criteria) evaluations of students in their timely graduation.
The Columbia University School of Dental and Oral Surgery clinical program operates as a comprehensive care program. Subjective faculty evaluations are not used as prerequisites for graduation. Students qualify for graduation upon completion of all competencies and completion of care for assigned patients; however, faculty group leaders are asked to evaluate students in the early fall of the academic year. In this study, all students in the class of 2002 and 2004 (n=142) were evaluated by their group leader in October of their academic year in the areas of technical skill, clinical judgment, patient management, and attitude. Faculty rated the students as "above expectations (ae)," "meets expectations (me)," or "below expectations (be)." Faculty evaluations were analyzed with the following results: 1) clinical judgment seemed to be the highest predictor of graduation: 97 percent of students rated "ae" graduated on time compared to 83 percent and 13 percent for those rated as "me" and "be" respectively; 2) in technical skill, 95 percent of students rated "ae" graduated on time compared to 80 percent and 40 percent of those rated "me" and "be" respectively; 3) in attitude, 92 percent of students rated "ae" graduated on time compared to 77 percent and 25 percent for "me" and "be" respectively; and 4) in patient management, 91 percent of students rated "ae" graduated on time compared to 90 percent and 37 percent of those rated "me" and "be" respectively. Finally, when this data was analyzed by the faculty group leader (evaluator), it revealed that timely graduation for students rated as "ae" ranged from 92 percent to 100 percent while for those rated "me" and "be" it ranged from 92 percent to 81 percent and 0 percent to 43 percent respectively.
In conclusion, subjective evaluations of students by faculty are highly predictive of student behavior and the student’s ability to graduate on time.
122. A Vertically Integrated Comprehensive Care Clinical Teaching Model: A Seven-Year Summary
Mark Fitzgerald, University of Michigan; Donald R. Heys, University of Michigan; Ronald J. Heys, University of Michigan
Purpose: To describe a unique patient-centered comprehensive clinical program and present the challenges encountered and benefits derived over its seven-year existence.
The Clinical Design Task Force at the University of Michigan School of Dentistry was charged with successfully implementing a patient-centered comprehensive care clinic that would integrate all levels of dental and dental hygiene clinical education and provide comprehensive, patient-centered care. The vertically integrated clinic (VIC) model that resulted has been successfully functioning for seven years and consists of four similar thirty-six-chair clinics on two floors of the building. Approximately one-fourth of the students from each dental and dental hygiene class are assigned to each clinic and remain assigned to their clinic for their full tenure in the program. Patients are assigned to students based on anticipated patient treatment needs and student experience. Students are responsible for providing or arranging for their patients’ total treatment needs. Each clinic has one faculty clinic director (FCD) and one patient care coordinator (PCC), who work together to ensure students have the proper treatment profiles in their patient families and the patients are being treated in a timely and appropriate fashion. The thirty-six-chair clinics are each staffed with five or six faculty. With the exception of oral surgery and pediatric dentistry, all aspects of dental treatment are provided in the VICs. On average, first-year (D1) students have one clinic session a week of patient contact experience, D2 students have two clinic sessions a week, D3 students have four, and D4 students six. Challenges encountered include switching from a procedures-based to a competency-based clinical program; transitioning from a discipline-based to a comprehensive care-based treatment model; increased responsibility of tracking patient assignment and treatment progress; and cross-training faculty for teaching across disciplines in the clinic. Benefits derived as a result of this clinic model include 1) high patient satisfaction (over 90 percent); 2) D1 student familiarization with clinic procedures and increased patient contact; 3) consistent increase in patient treatment experiences for all students at all levels; 4) ability to shift pediatric dental experiences from the D3 and D4 years to the D2 and D3 years thus freeing time in the D4 year for a new external outreach program; and 5) over 40 percent increased clinic production.
The Vertically Integrated Clinic program at the University of Michigan School of Dentistry has been very successful for patients, students, and the educational program. It has allowed earlier and greater opportunities for patient contact and treatment in conjunction with creating opportunities for providing new clinical programs in the curriculum. It is anticipated that as student clinical experience continues to increase in the earlier years of the curriculum, opportunities for other more advanced clinical experiences, such as mini external residencies, can be added.
123. Project HEARTS: Humanitarian Efforts and Research of Tomorrow’s Scientists
Norbert R. Myslinski, University of Maryland
Purpose: Project HEARTS was created to coordinate humanitarian efforts in the community that supports the University of Maryland dental school.
Tutoring grade school children, serving at soup kitchens, and collecting for the poor do not sound like activities of scientists or dentists. However, they are the activities of high school students who aspire to be future scientists and dentists. Through Project HEARTS: Humanitarian Efforts and Research of Tomorrow’s Scientists, students in the Baltimore-Washington Metropolitan Area give back to the community that ultimately supports the University of Maryland dental school. Students learn that altruistic and humanitarian activities should be part of everyone’s life no matter what career they enter. The program is coordinated and run by dental students under the guidance of a faculty member. This year the high school students tutored inner-city fourth and fifth graders in math and English. Many of these elementary school students are at a disadvantage because of large class sizes in their schools and inadequate training at home. This experience is unique for these grade school children because it involves one-on-one instruction over a number of weeks by young men and women who are knowledgeable and motivated. The young tutors are excellent role models. They also volunteered as servers at Our Daily Bread and Paul’s Place Soup Kitchens. These are valuable experiences in teaching and service. Since Operation HEARTS began, students have donated over 1600 hours and have made an immediate difference in the lives of thousands of people. Evaluations by the students, community leaders, and unbiased outsiders indicate a beneficial effect on all parties involved. This is such a positive experience for the students that many of them continue these activities on their own and become interested in dental careers. Any dental school can create such a program to improve community relations, enhance recruitment, and instill humanitarian values. This program is supported in part by a grant from the Maryland Higher Education Commission.
Humanitarian efforts coordinated by dental students can increase community relations, enhance recruitment, and instill human values.
BLOCK 5: Tuesday, March 8
2:00 to 3:30 pm
124. Evaluation of Medical Consultations for Dental School Patients
Rose Y. Geist, University of Detroit Mercy; James R. Geist, University of Detroit Mercy
Purpose: Evaluate effectiveness of consultation requests.
Consultation requests (CR) are sent to physicians regarding patients’ systemic conditions pertinent to dental care. Some physicians do not provide the requested information or offer inaccurate suggestions regarding dental care, and consultations are occasionally requested for conditions that have no significance for dental management. We reviewed 329 patients for whom CR were sent for 344 conditions. Most letters (eighty) requested information regarding hypertension. The majority of responses regarding HTN (64/80, or 80 percent) were appropriate. The physicians evaluated the blood pressure and indicated their findings regarding the presence of HTN. Six responses (7.5 percent) were inadequate because no diagnosis or evaluation of the patient was reported. No response was received for ten patients. Requests for information regarding heart murmurs (sixty-five) yielded adequate responses in thirty-five cases (53.8 percent). These replies included a diagnosis of the murmur, with or without correct recommendations for antibiotic prophylaxis. Of the twenty-four inadequate responses (36.9 percent), sixteen did not list a diagnosis but recommended the use of AP, while seven had no diagnosis but recommended against AP. One reply suggested an improper AP regimen for the diagnosis listed. There was no response to six letters. Unnecessary letters requested advice on the use of AP for eleven patients with remote, uncomplicated joint replacements; seven responses incorrectly recommended AP. Eight requests concerned coronary artery surgery or stent placement, with two responses inappropriately recommending AP.
We concluded that many consultation requests were lengthy, poorly worded, and vague. As a result, consultation letters have been changed to a format including targeted questions for physicians’ responses and requests for specific data. Oral Diagnosis faculty now review the need for consultation letters. Research is ongoing to evaluate the improvement in responses with the new consultation format.
125. Assessment of Dental Hygienists Certified to Administer Local Infiltration/Nitrous Oxide
Lisa Stefanou, New York University; Eva M. Lupovici, New York University; Elina Fudiman, New York University; Judy Kreismann, New York University; Cheryl Westphal, New York University
Purpose: A questionnaire was administered to participants who completed a course for Dental Hygiene Certificate to Administer and Monitor Local Infiltration Anesthesia/Nitrous Oxide Analgesia in the Practice of Dental Hygiene in the State of New York, to determine why registered dental hygienists were adding knowledge and skills to their scope of practice and their demographics.
The scope of practice of dental hygiene has advanced to add Dental Hygiene Certificate to Administer and Monitor Local Infiltration Anesthesia/Nitrous Oxide Analgesia in the Practice of Dental Hygiene in the State of New York. A twenty-one item questionnaire was administered via the telephone to 39 percent of registered dental hygienists who earned the certificate in the first course offered by a college of dentistry. The results of the questionnaire are as follows. Seventy-seven percent graduated in the past five years from a two-year dental hygiene program. An associate degree was the highest degree earned by 71 percent, baccalaureate by 25 percent, and master’s degree by 4 percent. All the dental hygienists participating in the course are currently practicing dental hygiene, while 83 percent were employed in a general dental practice and 17 percent in periodontal or prosthodontics specialty dental practice. Since taking the course, 52 percent administer local infiltration anesthesia daily, 30 percent weekly, and 18 percent less than once a week. The fee for the certificate course was self-paid by 45 percent of participants, 45 percent by the employer, and 10 percent shared cost with employer. The participants felt that the certificate enhanced their ability to provide dental hygiene services greatly, somewhat, or did not enhance at 75 percent, 22 percent, and 3 percent respectively. All the respondents stated that they enrolled in the course to enhance their scope of practice, stay current with the practice of dental hygiene, and apply the knowledge and skill in providing comprehensive dental hygiene care to their patients.
The registered dental hygienists earning the certificate graduated in the past five years from the two-year dental hygiene program, who would apply their added scope of practice in promoting and providing comprehensive dental hygiene services to their patients.
126. Multipurpose Facility: A Center for Reducing Minority Oral Health Disparities
Donna B. Grant-Mills, Howard University; Ruth A. Anderson, Howard University; Judith L. Neely, Howard University
Purpose: To utilize a school-based dental facility as a model to increase access to oral health care for a minority pediatric population, enhance oral health literacy in the community, and train dental and dental hygiene students in diverse settings.
The 2000 Surgeon General’s report Oral Health in America and the subsequent "Call to Action" in 2003 recommend "partnerships at all levels of society to engage in programs to promote oral health and prevent disease." The dental facility at Gage Eckington Elementary School operated by Howard University has served as a center for oral health care for underserved minorities of Washington, DC, since 1982, though with limited expansive capacity. Grants from the Robert Wood Johnson Foundation and Tom’s of Maine Natural Care Products Company have been pivotal in redesigning the center with concomitant structural adjustments to increase the capacity of the facility and sustain its uniqueness as an environment conducive for the delivery of pediatric oral health care for underserved minority populations, off-site training for dental and dental hygiene students, and an instructional facility in oral health for parents, teachers, and other community health care providers. This partnership has resulted in an increase in 1) the number and types of services being rendered; 2) the number of rotation days and clinical experiences for dental and dental hygiene students; 3) parental involvement due to enhanced oral health literacy in the community; and 4) oral health collaborative efforts among local dental societies, the academic institution, the departmentof health, parents, and community leaders.
The multipurpose utilization of an elementary school-based dental facility is a cost-effective way of creating a synergy among the various factors necessary in reducing oral health disparities in underserved minority communities.
127. The Relationship Between Body Mass Index and Early Eruption of Premolars
Toshiki Matsui, Howard University; George P. Thomas, Howard University; Garnett Henley, Howard University
Purpose: Determine that there is a difference in body mass index of children with early eruption of permanent premolars compared to children with normal eruption time of permanent premolars. Determine that body mass index of African American pediatric population is different than the body mass index used by the CDC growth charts according to the NHANES study.
Careful attention needs to be given to the process of measuring, recording, and evaluating body weight in relation to the mass of the body. The body mass index (BMI)-for-age is the recommended method for screening overweight and underweight. For children, BMI is age- and gender-specific; for adults, there are fixed cut points. In addition, the effect of race and ethnicity on BMI-for-age is unclear. Presently, the literature shows that the early eruption of premolars is due to a pathological condition of a previous primary tooth, and subsequent exfoliation of that tooth. Risinger has reported eruption could be due to secretion of growth hormone and thyroid hormone. The purpose of this study was to determine whether body mass index is associated with the early eruption of permanent premolars. In addition, body mass index of African American individuals was compared to the CDC growth charts, which were obtained from the NHANES study. The sample obtained was from pediatric dental patients of Howard University College of Dentistry. The race composition was African American individuals without gender preference. Body mass index was evaluated from normal eruption timing of permanent premolar patients. This group was compared to another group composed of individuals with early eruption of the premolars. The hypothesis was that the individuals with early eruption of premolars would have higher body mass indexes than individuals with normal eruption of premolars due to an underlying hormonal increase in growth and thyroid hormone. The following variables were obtained during the study: age, height, weight, erupted premolar in normal range, early-erupted premolar, and gender. Twenty premature eruptions of premolars and twenty normal eruption premolars were analyzed. The two groups were compared using a t-test. Logistic regression was used to determine if the eruption dichotomy is a predictor of height or weight. Linear regression was used to associate height with weight and age, if moderate to strong relationships exist between those variables. All tests were performed within the 95 percent confidence interval, with a=.05. The results showed no difference in BMI between the two groups (p=.084). There was weak spearman rho’s correlation between gender and weight (-.366). The whole group lay between the 85th and 97th percentiles BMI growth chart standard developed from the third NHANES study. No conclusions could be made concerning BMI’s effect to the premature eruption of premolars.
Difference in body mass index of premature eruption of premolars versus normal eruption of premolars were not statistically significant. There is significantly weak correlation between gender and weight, gender and body mass index, and gender and height. The body mass index of African American children are much higher than the body mass indexes of the standard growth curves used by the CDC.
128. Free Oral Health Care for Disadvantaged Children
Karen S. Wagner, American Dental Association; Bradford C. Petersen, American Dental Association; Joan M. Hansen, American Dental Association; Clay Mickel, American Dental Association
Purpose: In 2002 the Board of Trustees of the American Dental Association (ADA) authorized staff to plan and implement a campaign to provide free dental care to underserved children during National Children’s Dental Health Month. The first ADA Give Kids a Smile (GKAS) National Children’s Dental Access Day event took place on February 21, 2003.
On July 28, 2003, the ADA Survey Center sent a web-based survey to all fifty-three state and 108 staffed local dental societies to assess the GKAS event. After one reminder notice to nonrespondents on August 4, data collection ended on August 22, 2003. A total of sixty-five dental societies completed the survey, for an adjusted response rate of 41.9 percent. In addition, an extensive database was developed to measure access to care activities. Dentists and their dental team members, dental societies, program directors, and others were offered the opportunity to "register" their GKAS event activities. Through the web-based survey, 73.8 percent of the responding dental societies reported that they sponsored a GKAS event. Forty of the societies responded that they provided actual treatment to children, and thirty-five provided dental screenings. In addition to the dental societies, individual members of the ADA provided free dental care for children. The online registration recorded almost 5,000 programs and individuals who indicated they would be sponsoring an event. It was estimated that some $100 million in dental education, screening, treatment, and products were delivered to a million children through those programs.
Though not all dental societies responded nor did all GKAS event organizers provide information on their event activities, through the use of the web-based survey and the online registration database, GKAS was partially measured. The first GKAS event was a successful campaign since it augmented the nation’s oral health care system in addressing the unmet needs of the nation’s children. Event activities also highlighted for policy makers the ongoing challenges that low-income and disabled children face in accessing dental care.
129. DAT Test Preparation for Students from Disadvantaged Backgrounds: A Ten-Year Analysis
Marilyn Woolfolk, University of Michigan; Marita R. Inglehart, University of Michigan; Todd V. Ester, University of Michigan; Charlita Daniels, University of Michigan; Patricia Katcher, University of Michigan; Thomas G. Green, University of Michigan
Purpose: This educational research project investigated whether a summer program for students from disadvantaged backgrounds would increase their DAT scores and their confidence in doing well on the DAT and in the dental school admission process.
Starting in 1994, a summer program for students from disadvantaged backgrounds was conducted annually at the University of Michigan School of Dentistry. This Profile for Success (PFS) Program is for junior/senior undergraduates who plan to attend dental school. The objectives of this study are to explore whether the PFS program helped the participants to increase their DAT scores and their confidence to perform well on the DAT and in the dental school admission process. Key features of the program are a) intensive DAT preparation sessions conducted by a commercial test preparation organization (Kaplan), b) interactions with dental students and faculty, and c) didactic and experiential sessions concerned with various aspects of the dental school admission process (such as writing an essay and interviewing). Data were available from 187 students who participated in the PFS program between 1994 and 2004. The participants took the mock DAT and, starting in 1998, responded to surveys before and at the end of the program. The results showed that the students improved their DAT scores significantly over the course of the program (perceptual score: 13.77 to 17.94; quantitative score: 12.75 to 14.41; reading score: 15.23 to 16.88; academic average: 13.11 to 15.13). The students indicated at the end of the program that they felt on average more confident about taking the DAT (5 point scale: 3.73). Compared to the beginning of the program, they felt more confident in their ability to do well on the perceptual part of the DAT (2.71 vs. 3.63), the natural science part (3.03 vs. 3.33), and in writing a personal statement/admission essay (3.16/3.50).
In conclusion, the data suggest that dental school preparation programs can make a difference in students’ test scores and their confidence in their ability to do well in the admission process. Preparing students from disadvantaged backgrounds for gaining access to professional training will contribute to creating more diverse dental school classes and, ultimately, a more diverse workforce nationwide.
130. Utilizing Step-by-Step Laboratory Procedures in Teaching Predoctoral Fixed Prosthodontics
Ahmad Maalhagh-Fard, University of Detroit Mercy; Leila Emari, Private Practice; Arthur Nimmo, University of Florida
Purpose: To incorporate pertinent aspects of prosthodontics into treatment planning of fixed restorations.
Teaching fixed prosthodontics procedures to predoctoral students is challenging because every step of the procedure is based upon previous steps. Typically, students focus on details of the process and do not get an overall view of the prosthodontic procedures. By having each critical step of the procedure including wax-up, die with die relief, metal substructure, metal cutback, and opaque and porcelain application available, the student can see how every step of crown fabrication depends on previous steps. For example, students have better appreciation of why more facial reduction is needed for a PFM crown than a metal crown. At the University of Detroit Mercy, in addition to didactic courses, step-by-step laboratory procedures are used in fixed prosthodontics. There are models of restorations at every critical step of laboratory fabrication. Even though students do not fabricate a fixed restoration, they are taught the criteria for tooth preparation as displayed by a series of models from the beginning of lab procedures to the completion. Prior to the tooth preparation simulation, the course director presents a thirty-minute lecture and fifteen-minute videotape to the students. Then, a criteria sheet for evaluation of tooth preparation is reviewed, highlighting critical steps such as occlusal reduction and margin design. There are several master casts demonstrating removable dies, dies with cement relief, a complete wax-up with cutback for porcelain application, and a metal casting showing the metal substructure. Porcelain application is shown on other models with opaque, dentin, and enamel layers over the metal substructure. The final restoration is displayed in cross section so the student can appreciate why a certain amount of tooth reduction is needed for a fixed restoration. Therefore, students are able to observe all the steps necessary to complete a fixed restoration at the tooth preparation stage.
This approach helps students to incorporate pertinent aspects of prosthodontics into treatment planning of fixed restorations. This approach also trains students to have an overall view of fixed prosthodontic procedures and a better appreciation of preparation phase criteria.
131. Assessing Information Technology Skills in Incoming Predoctoral Dental Students
Daniel W. Emmer, University at Buffalo; Joseph J. Zambon, University at Buffalo
Purpose: To summarize lessons learned and consider future directions in assessing information technology skills in new dental students.
Competency in a basic set of information technology (IT) skills is a clear prerequisite for students enrolling in a modern predoctoral dental program. Use of technology in our D.D.S. program has increased markedly in recent years, particularly with our school’s commitment to DVD-based electronic curriculum support, so deficiencies in basic IT skills could seriously jeopardize students’ academic progress. Given first-year students’ heavy courseload and their immediate need to access electronic course materials, it is essential to assess these skills as early as possible and identify potential problems. The first revision of our basic IT skills test was administered as a part of incoming students’ general orientation in August 2001. Beginning in 2002, the skills test became part of a new information management course that begins during the orientation period and runs into the start of the fall semester. Students use their own notebook computers connected to the school’s wireless network to perform several exercises involving a word processor, presentation software, and web navigation and search skills. The initial version of the test also included basic email and Medline search skills, but these were moved to other sections of the information management course. Students who fail to perform adequately on any section of the test are required to attend review sessions and re-test on the relevant skills. In our 2001 IT skills tests, only 36 percent of students passed on their first attempt. The remaining 74 percent were required to attend training seminars and take an additional test. In subsequent years, due in part to refinements in the skills test and its delivery, failure rates have dropped considerably. The percentage of students passing the revised IT skills test on their first attempt increased to 89 percent in 2002, 91 percent in 2003, and 97 percent in 2004. Changes in the content of the skills tests make direct quantitative comparisons between years difficult. However, based on qualitative observations, our IT skills tests have effectively identified students who were lacking in some basic IT skills, albeit with many "false positives" in the first version of the test.
Basic IT skills testing as part of our introductory information management course provides an effective means of identifying students with potential technology skills problems. Regular review and modification of the IT skills testing process will ensure that it remains an appropriate measure of relevant skills.
132. Outcomes of Bite Splint Treatment: A Function of the Student Provider’s Communication Skills?
Marita R. Inglehart, University of Michigan; Sven Widmalm, University of Michigan
Purpose: To explore whether the communication skills of undergraduate dental students affect the patient’s acceptance vs. non-acceptance of bite splint treatment, as well as the patient’s quality of life when using bite splints.
Bruxism is a not uncommon phenomenon in the adult U.S. population. Dental students in many schools learn to treat this disease with bite splints. The objective of this research project was to explore whether the communication skills of undergraduate dental students affect the patient’s acceptance vs. non-acceptance of bite splint treatment, as well as the patient’s quality of life when using bite splints. Data were collected with a survey mailed to the 563 adult patients of an undergraduate dental clinic who had received bite splints between January 2001 and December 2003 (sixty-seven surveys were returned due to mailing problems; response rate: 47 percent; N=233). Most of the respondents were female (66.4 percent). They ranged in age from sixteen to eighty-seven years (mean: 42.78 years). Of the respondents, 79.5 percent agreed with the statement that their student provider had explained the bite splint use well, and 79.4 percent that they were satisfied with the student provider. Those patients who agree that their provider had explained the bite splint use well were significantly more likely to actually use the splint (chi square=.012). In addition, those respondents who were satisfied with their provider were more likely to use the splint (chi square=.012). The more the patients agreed that their student provider had explained the bite splint use well and that they were satisfied with their provider, the more helpful they thought the bite splint was (r=.170; p=.042; r=.280; p=.000), the more they believed their general status had improved (r=.241; p=.001; r=.367; p=.000) and agreed that the bite splint had a positive effect (r=.226; p=.002; r=.334; p=.000).
In conclusion, this research demonstrates that undergraduate students with good communication skills may achieve better patient outcomes when treating patients with bite splints. The results point to the significance of revisiting dental curricula with the goal to ensure that undergraduate students receive solid communication skills training.
133. Annual Faculty Evaluation as Data Warehouse and Outcomes Assessment Tool
Larry Eisenberg, University of Southern California; Eileen Suffet, University of Southern California; Charles Shuler, University of Southern California
Purpose: To create a web-based application that will automate annual faculty evaluation and store data for optimal reporting of outcomes measures.
At the end of each fiscal year and as part of budget planning for each new cycle, the University of Southern California School of Dentistry’s five divisions conduct a rigorous evaluation of core faculty. Individual faculty members are required to document their activities of the previous year and verify effectiveness of their teaching, research, and service activities. In preparing for our 2001 ADA accreditation site visit, it became clear that many of the standards could be supported by material gleaned from past faculty evaluations but that an organized mechanism for collection and storage was missing. It was decided at that time to build a database application that would house results of all future evaluations. Now in its fourth consecutive year, we find ourselves with a huge body of readily accessible information that is constantly mined to create reports required by our outcomes assessment committee and to serve as measurements for elements of the school’s strategic plan. The breadth and scope of our evaluation form has grown dramatically and now includes elements of faculty development as well as daily clinical evaluation. There is an accountability process section that tracks and monitors individual faculty members’ stated academic and professional goals. Currently, our application resides full-time on the worldwide web. It is linked to various local data sources from our dentistry network and collects a wide range of material, including CE, PBL case facilitation, daily evaluation, committee membership, time profile, and all sorts of other information. Each faculty member has a username and password. They logon at their convenience, verify material warehoused, then edit, add, delete, or revise as needed. At the end of each calendar year the updated data is harvested and becomes part of our permanent datastore.
We began this process to improve efficiency of our faculty evaluation process. In addition, at the push of a button, we are now able to generate reports detailing teaching-research-service profiles, faculty-student ratios, publications, presentations, PBL credentialing, faculty development activities, grant activity, national academies, specialty training, clinical disciplines, faculty mentorship, research collaboration, honors and awards, intellectual property, daily clinical evaluation, PBL evaluation, committee and community activities, and on and on. Now, into our fourth year, we can also chart all these elements over time and measure our progress towards stated goals and objectives.
134. National Survey of Dental Hygiene Programs Regarding Health Behavior Education
Susan M. Bauchmoyer, The Ohio State University; Robert Rashid, The Ohio State University; Marilyn Hicks, The Ohio State University; Consuelo Hamm
Purpose: To gather data regarding methods of utilization of health behavior concepts in clinical settings and perceptions of need and/or barriers to teaching these concepts.
One of the primary goals of the dental hygienist is to facilitate positive changes in a patient’s health behavior. However, previous studies suggest that dental professionals do not consistently follow principles of effective instruction. The purpose of this study was to gather data regarding methods of utilization of health behavior concepts in clinical settings and perceptions of need and/or barriers to teaching these concepts within dental hygiene programs across the country. A previously piloted survey instrument was mailed to the director of all accredited dental hygiene programs in the United States (n=266), with a total response rate of 60 percent (n= 160) following a second mailing. Results reveal that 53 percent of the respondents feel there is adequate emphasis placed on health behavior education within their respective dental hygiene program. Pearson Chi-square analysis indicated a positive relationship between the emphasis on health behavior education and the student learning of health behavior research concepts (i.e., health belief model or transtheoretical model of health behavior) ranging in p-value from .0004 to .0525 with the exception of information on the stages of change (p=.06114). The greatest barriers identified by the respondents to implementing a behavioral science component within the program are lack of time and lack of curricular time (61 percent) and lack of faculty skills/expertise (29 percent), with 24 percent of respondents perceiving no barriers. The survey also communicates that although the majority (92 percent) of the responding programs feel it is appropriate for the dental hygiene profession to become expert in knowledge and skills associated with health behavior change, nearly half (47 percent) of the responding schools feel more emphasis is needed.
In conclusion, these results suggest dental hygiene programs must continue to seek opportunities to advance changes within the curriculum and utilize concepts from health behavior research.
135. Faculty Attitudes Toward Accommodating Students with Disabilities
Diane L. Bourque, Independent Consultant
Purpose: To examine factors that influence postsecondary faculty members’ decision making in the provision of academic accommodations to students with disabilities.
The theory of reasoned action (TRA) is a predictive model that incorporates the effects of both personal and social factors on behavior. In an expansion of the TRA model, faculty knowledge of disability legislation was added as an independent variable. The sample consisted of full-time faculty members from three public institutions in Rhode Island. Participants (n=306) completed a questionnaire developed according to Ajzen and Fishbein’s guidelines. The TRA model provided a conceptual framework to identify factors that influence faculty members’ intent to accommodate; correlations between all constructs of the model were found to be significant (p=.01). Strong positive relationships were found between behavioral beliefs and attitude and between attitude and intent to accommodate. Moderate positive relationships were found between normative beliefs and subjective norm (perception of social pressure to engage or not engage in the behavior) and between subjective norm and intent to accommodate. Consistent with the theory, faculty attitude and subjective norm were found to be significant predictors of intent to accommodate (R2=.30). Significant predictors of faculty attitude were identified as faculty beliefs about accommodation as sound pedagogy weighted by their evaluation of the likely outcome of student preparedness (p<.01). Knowledge of disability legislation was also found to be a significant predictor of attitude (p<.05). The normative influences of the office of disability services, department chairpersons, and other faculty members were significant in predicting subjective norm (p<.01).
Study results suggest that faculty members’ intent to accommodate is influenced by their underlying attitudes, beliefs, and knowledge of their legal role in the provision of accommodation. Faculty development activities designed to increase knowledge and foster change in behavioral beliefs are recommended. A paradigm shift from the deficit model of disability to recognition of disability within diversity is suggested to change the beliefs and attitudes currently held by faculty members.
136. Changes in Reflective Judgment During the First Year of the Dental Clinical Curriculum
Linda D. Boyd, Georgia Perimeter College; Joanne Weir, Georgia Perimeter College; Virginia Dunn, Oregon Health & Science University
Purpose: This exploratory study used reflection in the form of clinical journals and interviews to assess the development of reflective judgment in dental students during their initial exposure to clinical practice.
The Institute of Medicine has suggested that dental education does not adequately develop critical thinking in its dental graduates. Because of the uncertain and ambiguous nature of clinical care, the development of the reflective judgment aspect of critical thinking in order to provide quality dental care to patients is essential. Study participants consisted of a convenience sample of sixteen third-year dental students at Oregon Health & Science University who maintained clinic journals and participated in interviews at three time points. The data was coded independently by three investigators using a coding scheme developed from the reflective judgment model of intellectual development. The Cronbach alpha generated was 0.76. The change in reflective judgment during the year for the intervention group was +0.50 (Stage 4.98 to Stage 5.48) or half a stage of change in reflective judgment. A one-way repeated measures ANOVA was conducted to compare the RJ scores generated from the data at Time 1 (summer-fall term), Time 2 (winter term), and Time 3 (spring term). There was a significant effect for time, Wilks’ Lambda=.437, F(2, 9)=5.80, p<.05, multivariate eta squared=.56. The eta squared statistic (.56) indicates the differences in means was large, suggesting that time had a large effect on the change in reflective judgment. The change over time was significant at the p<.05 level.
This exploratory study found that reflection in the form of clinic journals and interviews was able to identify significant growth during the first year of clinical training. This information is important in demonstrating the desired outcomes in relation to the Commission on Dental Accreditation standards regarding critical thinking.
137. A Self-Paced, DVD/Video-Facilitated (Endodontics) Laboratory Course
Cheryl L. Biber, University of Medicine and Dentistry of New Jersey; Gerald Fishelberg, University of Medicine and Dentistry of New Jersey; Richard Merkel, University of Medicine and Dentistry of New Jersey
Purpose: To investigate the receptivity and productivity of students in a self- paced learning environment
Faculty at New Jersey Dental School (Endodontics and Restorative Dentistry and Office of Academic Affairs) created a series of endodontic technique instructional videos. These videos have been transferred to DVDs and distributed to each student prior to the second-year course in preclinical endodontics. The required student armamentarium includes a laptop computer. Students could view the videos prior to, during, and after each session and also have a manual, lecture, and laboratory instructor to utilize for input and assistance. They could progress independently, with any combination of the four resources, until all six assignments were completed. At the end of the course, the students (n=60) completed surveys. Questions related to the quality and usefulness of the videos indicated a good level of satisfaction (96 percent: sufficient to thorough coverage of information; 80+ percent: approval of length and narration; 93 percent: easy to very easy to navigate; 94 percent: helpful for procedure). A large degree of variability was seen with the ways the DVD was utilized. The students indicated that their assigned area instructors were almost equally loyal to the techniques on the videos versus occasionally not (45 vs 54 percent). This may have accounted for the decreased use of the DVD as the course progressed; the students were eager to please the instructor. When tracking utilization per exercise, it was initially used either alone or in conjunction with other resources 75 percent of the time but declined to 30 percent by the last project. However, the course director indicated this class accomplished more and produced a higher quality of work than the previous classes and anticipates that they will be completing more endodontic procedures, including rotary-based, in fewer appointments.
This study suggests that a self-paced, DVD/video-enhanced curriculum has great potential in the teaching of psychomotor skills but requires the mandated calibration of all participating faculty.
138. A Survey of Best Management Practices of Amalgam Waste among U.S. and Canadian Dental Schools
John H. Purk, University of Missouri-Kansas City; Steven Raphael, University of Missouri-Kansas City; Harvey C. Eplee, University of Missouri-Kansas City; Karen Williams, University of Missouri-Kansas City
Purpose: To assess compliance of schools with the best management practices (BMP) for amalgam waste published by the ADA in April 2004.
Sixty-six U.S. and Canadian dental schools were surveyed anonymously about their best management practices (BMP) for amalgam waste. Twenty-seven (41 percent response rate) schools answered the survey. A total of twenty-three questions were asked. Survey questions were organized into four areas: amalgam usage, amalgam disposal, amalgam recycling, and institutional characteristics. Ninety-six percent use precapsulated alloys as recommended by BMP. Eighty-five percent of schools reported placing non-contact amalgam (scrap) according to BMP. Only 48 percent of schools reported compliance with the disposal of contact amalgam as recommended by BMP. Virtually all schools reported using chairside traps to retain amalgam during the suctioning, and 44 percent of schools reported changing the traps weekly and 37 percent monthly. Sixty-seven percent of schools reported having a filter on the central vacuum pump, and when the filter was cleaned or changed only 36 percent reported doing it according to BMP. Twenty-two percent of schools reported disposing of extracted teeth containing amalgam according to BMP. Twenty-two percent of schools also reported using bleach or chlorine as a line cleaner for wastewater lines, which is not recommended according to BMP. Sixty-four percent of schools reported recycling empty amalgam capsules according to BMP. Only 19 percent of schools reported using an amalgam separator. Seventy-seven percent of schools reported using a recycler; 7 percent of schools reported not being regulated in any way for amalgam disposal. Eighty-nine percent of schools currently have none or don’t know of any pending legislation regarding amalgam waste in their state.
Many of the reported schools have knowledge of the newly published BMPs of amalgam waste and are attempting compliance. An area that needs improvement is the handing of contact amalgam waste. Organized dental education should continue its mission of informing, encouraging, and complying with the BMPs of amalgam waste as recommended by the ADA.
139. Senior Professor Program
Birgit J. Glass, University of Texas Health Science Center at San Antonio; Cynthia L. Alford, University of Texas Health Science Center at San Antonio
Purpose: To give dental students an opportunity to interact with the elderly and with their medical colleagues.
Elderly patients were recruited for the senior professor program. The objectives were to provide students an opportunity to 1) practice interviewing and listening skills; 2) learn about an age cohort and the history that has shaped them; 3) generate appreciation and compassion for elders; 4) provide an opportunity for elders to help educate young physicians and dentists; and 5) provide a vehicle for developing a relationship with their elders. In Session 1, medical and dental students received a lecture on aging, then interviewed the senior professors about their life history. In Session 2, dental students received a lecture on the history of dentistry, then interviewed their senior professors about their experiences with dentistry over their lifetime. Students received a guide on the type of questions to ask. They wrote a report on what they learned and evaluated the program. On a scale of 1–5 (poor to outstanding), the average for the responses were as follows: aging lecture, 2.7; experience with medical students, 3.0; first interview with elder, 3.6; history of dentistry lecture, 4.25; and second interview with elder, 3.55.
Results indicated it was a positive experience that should be continued.
140. Bioethical Debates
Norbert R. Myslinski, University of Maryland
Purpose: The bioethical debates were created as an opportunity for students to think deeply and discuss openly issues of ethics that will influence their future careers.
Ethical behavior is critical for the field of dentistry and society. However, making the right decisions regarding matters of the biological and clinical sciences can be difficult and complex. That is why the Bioethics Debate Series was created. It is an opportunity to think deeply and discuss openly about issues of behavior important to all of us. During the summer, students gather at the University of Maryland Dental School in Baltimore to debate bioethics. Each week two students square off on opposite sides of an issue. Under the guidance of dentists and scientists, they do all the research ahead of time and distribute a one-page summary of their arguments to the other students, faculty, and staff who are attending the debate. Each has fifteen minutes to argue their side and a chance for a rebuttal. Some of the topics debated are: Is a dentist ever justified in denying treatment to an AIDS patient? Should insurance dictate treatment? Should animals be used for medical research? How about fetal stem cells? Are we overmedicating our children to control their behavior? After each debate, the floor is open for discussions led by faculty and staff who are experienced in ethical issues, such as clergy, members of the human and animal experimentation committees, and others who have special training in ethics. The discussions are invariably heated and energetic. Pre-debate and post-debate surveys are taken of the audience to determine which of the debaters was the most persuasive. At the end of the series of ten debates, an award is given to the most convincing debater. Last year the debate that changed the most opinions was the one concerning the Love Canal incident in Western New York State. After three years, this innovative series has demonstrated that the use of debates is an effective way to engage the attention and interest of students and to teach the principles of bioethics. It can be easily duplicated at other dental schools.
Open debates are an effective way to teach bioethics, expose students to a variety of ethical views, and motivate them to think deeply about behavioral issues important to all of us.
141. High School Biomedical Research Program
Joel Greenspan, University of Maryland; Norbert R. Myslinski, University of Maryland
Purpose: Our goal is to capture the hearts and minds of high school students and inspire them to pursue careers in dental research, dentistry, and other dental-related careers.
A prime time to introduce the basic dental sciences to young people is during their high school years. The program’s primary focus is the student-scientist relationship. Each student is matched with a different scientist and works in his or her laboratory for eight weeks in the summer. The program is significantly different from other scholastic experiences. Training is intense and focused, in a highly scientific environment, concentrating on scientific methods, scientific writing, and oral communication. The students spend approximately 40 percent of their time on other activities including science seminars, career seminars, field trips, survival skills workshops, student presentations, bioethical debates, humanitarian activities, group competitions and classes on lab safety, biomedical informatics, scientific methods, ethical conduct, and communicating scientific data. The program has been approved for high school credit in at least one school district. Eighty-two Maryland high schools and eighty-four mentors have participated. Participants have won many local, state, and national awards. This innovative program has been a significant source of applicants for our dental and other campus schools. This program could be easily duplicated at other dental schools, and parts of it have already been used at local high schools. The evaluation process consists of seven parts that are a modified version of the recommendations in the National Science Foundation publication, User-Friendly Handbook for Project Evaluation. Improvements in test scores; positive evaluations by students, mentors, and outside evaluators; and follow-up applications and admissions of these students to our campus all point the effectiveness of this program. This project was supported in part by the Maryland Higher Education Commission.
This program demonstrated its effectiveness to attract high school students to the dental professions.
142. Web-Based Clinical Evaluation System for a Dental Hygiene Program
Lynn Tolle, Old Dominion University; Deanne Shuman, Old Dominion University; Jyotsna Talla, Old Dominion University
Purpose: To share information regarding a browser-based computerized evaluation system for dental hygiene education using a wireless network
Clinical evaluation systems for dental hygiene programs are labor-intensive for faculty as many variables must be evaluated and monitored to ensure student competency. Moreover, accreditation standards require documentation of patient care competencies, clinical hours, and students’ experiences. In order to better meet the evaluation needs of both faculty and students in a baccalaureate dental hygiene degree program, a web-based clinical evaluation system was designed and implemented in the fall of 2003. Created for use in a wireless environment, the system provides secure data access with appropriate access rights preventing unauthorized use. The web-based system allows faculty and students instant availability of information twenty-four hours a day with an easy to use interface. Faculty members use laptop computers to enter data from anywhere in the clinical setting while students can view performance assessments and patient requirements from any computer with Internet access. The system allows recording of patient tracking data, student skill performance, and faculty comments, thus providing an instant, automated assessment report. Advantages of the system include improved accuracy of grading, data management, and security; immediate identification of student problem areas; timely feedback; and elimination of paper forms. Disadvantages include a large faculty learning curve and network and hardware challenges. An eight-item survey completed by faculty after the first year of use revealed that 90 percent of the respondents preferred the web-based evaluation system over the paper-based grading system, but were frustrated with the unreliability of the wireless connection. Faculty unanimously agreed that the web-based system provided superior communication of students’ clinical progress and competence.
This web-based system could meet the needs of a wide variety of dental hygiene programs looking for a paperless system that is efficient and effective for student clinical evaluation. This is in line with the push by many large health care organizations towards a paperless system.
143. A Pilot Program to Introduce High School Students to Career Options Associated with the Doctor of Dental Medicine (D.M.D.) Degree
Jeanette E. DeCastro, University of Medicine and Dentistry of New Jersey; Rosa Chaviano-Moran, University of Medicine and Dentistry of New Jersey; Kim E. Fenesy, University of Medicine and Dentistry of New Jersey; George Jenkins, University of Medicine and Dentistry of New Jersey
Purpose: The overall goal of the program is to introduce high school students to career options associated with the doctor of dental medicine (D.M.D.) degree. The objectives of the High School Decision for Dentistry Program are to offer high school students an informative, hands-on experience at NJDS to shed light on the dental school experience; assist high school students in understanding the requirements to enter dental school and what they must do presently to prepare to meet those requirements; and link high school students with a dental student and/or NJDS faculty to serve as a mentor/role model.
In 2003–04, "Decision for Dentistry" was piloted by UMDNJ-New Jersey Dental School as a three-phase program involving nine students recruited from high schools in Newark, New Jersey. Dr. George Jenkins, coauthor of The Pact: Three Young Men Make a Promise and Fulfill a Dream, described his experiences as a young man attending school in Newark who set his sights on becoming a dentist. Later, the group took dental impressions on manikins, overseen by faculty and student mentors. During luncheon, a panel moderated by Dr. Rosa Chaviano-Moran that included general practitioners and specialists from Oral Surgery, Pediatric Dentistry, Orthodontics, Oral Pathology, and Endodontics described what attracted them to their various specialties. High school students returned to the dental school for one half day of chairside clinical observations with their assigned student mentors. During the third and final phase of the program, participating students, their parents, and career/guidance counselors attended the NJDS admissions symposium which provided information about what is required to enter dental school, as well as an overview of the admissions process. At the end of each phase, student feedback was collected and shown to be unanimously positive.
The pilot program to introduce high school students to various disciplines associated with the D.M.D. degree was well received and should be further developed.
144. Gateway to Dentistry: A Program to Expose Potential Applicants to Dental School and the Dental Profession
Jeanette E. DeCastro, University of Medicine and Dentistry of New Jersey; Kim E. Fenesy, University of Medicine and Dentistry of New Jersey; Rosa Chaviano-Moran, University of Medicine and Dentistry of New Jersey
Purpose: The overall goal of the program is to inform potential applicants about dental school and the dental profession. The objectives of the Gateway to Dentistry (GTD) program are to introduce undergraduate students and recent graduates to the wide range of career options associated with the doctor of dental medicine (D.M.D.) degree; offer potential applicants an informative hands-on experience at UMDNJ-New Jersey Dental School (NJDS) within this two-week intensive internship; assist students in the critical decision making process with regard to future educational and career planning; introduce undergraduate students to student life; and create opportunities to bond with the senior dental students that have been chosen to be mentors or "buddies" with these students.
First piloted with five students in June 2000, GTD is a two-week program offered to thirty undergraduates or recent graduates biannually and consisting of approximately ten full days of activities. Nearly forty faculty, three staff, and fifteen senior "buddies" are involved in introducing participants to dental disciplines through numerous lectures, demonstrations, and hands-on experiences. Examples of activities include lectures on treatment planning, hands-on activities such as taking impressions, and observation of oral and maxillofacial surgery. Evaluation by participants is constant, with students submitting daily evaluations of each activity in which they participate and final, summative evaluations. Student evaluations are used in debriefing and planning future GTD sessions. In addition, program effectiveness is evaluated based on how many participants apply to dental school. Of the 205 participants to date, 114 (55.6 percent) have applied to NJDS. Between 20.0 and 76.7 percent of participants from each GTD session have applied to NJDS, and 29.3 percent of the NJDS class of 2007 are GTD graduates.
A two-week internship providing exposure to various disciplines or career paths available with a D.M.D. degree is an effective means of developing well-informed applicants to dental school.
145. Students’ Performance After Training in Various Preclinical Simulation Settings
Alice Urbankova, Columbia University; Mark J. Graham, Columbia University; Richard M. Lichtenthal, Columbia University; Farhad Hadavi, Columbia University
Purpose: In research by LeBlanc et al. and Urbankova et al., overall preclinical exam performance differences were reported for students trained in computerized dental simulation (CDS) when compared to students trained in a more traditional laboratory setting. Nevertheless, not reported in that research was the question of whether differences were found in individual tooth performance level.
Dental students participating in this study (n=75) were randomly assigned to two groups: traditional group and CDS-computerized dental simulator group. All students received the same standard training in the traditional Operative Dentistry course in Columbia University’s dental curriculum. In addition to regular course activities, the CDS group participated in an eight-hour CDS training environment in the beginning weeks of the Operative Dentistry course, while the control group trained only in the traditional preclinical dental laboratory setting. During the three operative practical exams, conducted in the conventional preclinical laboratory, students perform between two and three cavity preparations. Each tested preparation was evaluated independently by any two of the seven course instructors. On Exam 1 and Exam 2, significant main effects were found between the CDS group and the traditional group (Exam 1: F=10.8, p=.002, and Exam 2: F=8.9, p=.004). On Exam 3, no overall performance differences were found between the two groups, F=2.56, p=.11. However, significant differences were found among students’ Exam 3 scores when assessed at the individual tooth level (#13MO and #14MO). Specifically, for tooth #14MO significant differences were found between the CDS group (M=77.2) and the traditionally trained group (M=74.9), F=4.75, p=.032. In contrast, for tooth #13MO, there were no significant differences found between the two training groups (p=.85). For these additional two tests, the finding for #14MO was also nearly significant at the more stringent Bonferroni-adjusted alpha of p=.025.
At a point where differences in skill level associated with CDS training or traditional training appeared to be leveling off (Exam 3), a subsequent analysis found at least one significant difference at the individual tooth preparation level. Specifically, the CDS group performed significantly better on both tasks in Exam 1 (tooth preparation of 12 O, 30 MO) and on Exam 2 (tooth preparation of 4 MO, 5 MO). On Exam 3, however, the CDS group performed almost the same as the traditional group on 13 MO tooth preparation, yet on 14 MO the CDS group significantly outperformed traditional group. This finding begins to address the question of whether CDS training is only beneficial at certain points in the preclinical operative course or whether it possesses a distinct performance advantage throughout this important year of training. The current findings indicate that on certain teeth preparations, the advantage of CDS training appears to be beneficial. However, precise measures of what constitutes a "difficult" preparation or an "easy" preparation are difficult to obtain. Future research should begin to address the tooth difficulty question and relate it specifically to CDS training.
146. Student Decision Making and Practice Locations
Joseph M. Holtzman, University of Medicine and Dentistry of New Jersey; Cheryl L. Biber, University of Medicine and Dentistry of New Jersey; Jeffrey R. Backstrand, University of Medicine and Dentistry of New Jersey
Purpose: This study investigated factors that enter into dental students’ evaluations of communities as future practice locations.
This study tested the hypothesis that dental students use data rationally in evaluating the practice potential of communities. It is assumed that newly trained dentists will distribute themselves rationally, filling in geographic areas within the state that are currently underserved. Using data derived from dental students’ course projects in community dentistry and data from the U.S. census, the investigators studied the demographic and social characteristics of communities identified by second-year students as possible future practice locations. The investigators focused on the responses of the 128 students selecting communities in New Jersey for evaluation. Students extracted data regarding their selected communities from census summary files SF3 and SF4, using a protocol provided by the instructor. Based upon the data, students were required to rate the community as a potential practice location using a five-point scale. Student-selected communities were coded by county. The age structure and economic characteristics of these counties were investigated. The investigators focused on the percentage of county populations ages fifty and over in five-year age cohorts, and the median household income of the counties was compared both to the national median household income and to mean New Jersey household income. The mean percentage of county population ages fifty and over was directly and significantly (p<.05) related to student ratings of suitability. Student ratings were also directly and significantly (p<.01) related to median county household income. This study demonstrated that second-year students employ rational criteria in assessing the suitability of future practice sites.
These data suggest that it is important to educate students regarding key demographic variables to consider when making decisions about potential practice sites and to train them to access and systematically evaluate these data.
147. PBL Assessment Instruments Utilized in a Hybrid Curriculum: A Comparative Study
Melinda L. Meadows, Indiana University; Lawrence P. Garetto, Indiana University
Purpose: To examine two student assessment tools, the Triple Jump Examination (TJE) and the Individual Assessment of Group Performance (IAGP), used in the problem-based learning (PBL) courses at Indiana University School of Dentistry (IUSD) and determine the correlation between the two instruments.
Dental education seeks to produce graduates with complex content knowledge, clinical and self-assessment skills, and the habit of self-directed, lifelong learning. To address these goals, the Indiana University School of Dentistry introduced a hybrid curriculum incorporating problem-based learning (PBL), along with traditional instructional methods. In this PBL environment, outcomes are assessed using both the content and process skills assessment of the IAGP and the individual assessment of the TJE. These instruments assess student outcomes that support course and institution goals and are intended to improve student learning. This study was a retrospective, correlational investigation of student scores obtained on these two evaluation instruments during the 2001–02 and 2002–03 academic years. A total of 778 IAGP scores and 585 TJE scores were analyzed utilizing Mantle-Haenszel chi-square, Spearman correlation, and multiple-variable logistic regression analysis to determine the character and strength of relationships. Results indicated that all items of the TJE were predictive of the summative score (p<0.0001). Examples of low scores in multiple categories with a "Pass" summative score were also found, potentially linked to rater leniency or faculty interpretation of scoring criteria. The overall Pass/ Fail of the TJE and the IAGP were weakly correlated (rs = 0.05–0.22, p<0.05), indicating that they may be assessing different skills.
Positive correlations between some, but not all, aspects of TJE and IAGP assessing the same constructs suggest variations among raters or a variation in interpretation of assessment criteria. The difference in same and next period correlations suggests tutor feedback positively influences student performance in the group sessions following a TJE. Finally, high scores on both instruments suggest the need for ongoing faculty development in refining and applying performance assessments.
148. Enhancing Dental Student Research at Non-Research-Intensive Schools
Warren Nesbitt, Meharry Medical College; Oluwole Ajagbe, Howard University; Reuben Warren, Centers for Disease Control; Cynthia Hodge, University of Connecticut; Roosevelt Brown, National Dental Association Foundation; Earl Kudlick, Howard University
Purpose: To describe a unique collaboration between a dental research foundation and an industry leader in oral health care and to stimulate and enhance research efforts at two minority-serving dental schools.
Dental schools not considered to be research-intensive (as defined by the lack of significant extramural funding and by the relatively small number of faculty actively engaged in research activities) face a serious challenge in educating students with respect to the important role that science plays in the advancement of the dental profession. Two dental schools that fit this description, Meharry Medical College School of Dentistry (MMCSOD) and Howard University College of Dentistry (HUCD), accept and train students largely from underrepresented minority groups. It is even more critical, therefore, to see that students at these institutions that emphasize traditional didactic and clinical training receive exposure to the research process as part of their education as dental health care providers in the twenty-first century. To this end, a partnership was developed among several entities (National Dental Association Foundation, National Dental Association, and Colgate Palmolive Co.) to provide resources to promote and increase research efforts at MMCSOD and HUCD. Among the reasons for undertaking this initiative are to provide 1) financial support to supplement short-term research training at the home as well as other institutions, 2) travel support so that students have the opportunity to present their research findings, and 3) incentives through awards for recognition of their accomplishments. An intangible benefit is realized by the creation of a research atmosphere among the students who have participated, their peers and the faculty at these schools. Since 2001, sixty-one students at both MMCSOD and HUCD have been participants in short-term training programs and other faculty-mentored projects. A total of eighty-four student presentations have been given at various local, national, and international scientific meetings. Evaluation of the progress to date indicates that this partnership among the stakeholders has been successful in supporting an increase in research activities among interested dental students. The long-term benefit of this partnership is to familiarize the students with the scientific process so that they may appreciate its relevance to dentistry and provide a foundation for making more informed decisions concerning a career in dental research.
Partnerships among research foundations, corporations, and academic institutions appear to be useful in leveraging resources to promote student research at non-research-intensive dental schools.
149. Attitudes of Ohio Dentists and Dental Hygienists on the Use of Automated External Defibrillators
Diane P. Kandray, Youngstown State University; Jennifer Pieren, Youngstown State University; Randall W. Benner, Youngstown State University
Purpose: To assess Ohio dentists’ and dental hygienists’ attitudes toward the use of automated external defibrillators (AEDs) in the dental office setting.
The American Heart Association (AHA) reports that approximately 220,000 people die each year of sudden cardiac arrest. In ventricular fibrillation (VF), the most common abnormal heart rhythm that causes cardiac arrest, the heart’s electrical impulses suddenly become chaotic, often without warning. Death will follow within minutes if the victim is not treated appropriately, and the only known treatment is defibrillation (applying an electrical shock to restore normal heart rhythm). If the electrical shock is delivered within a few minutes, it can save that person’s life. Emergency medical services can defibrillate an individual, but response times vary. An automated external defibrillator (AED) can restore a victim’s normal heart rhythm by providing defibrillation. AEDs are relatively inexpensive ($2100–$3000), lightweight, effective, and safe and do not require extensive medical training to operate. The AHA and the American Red Cross support the placement of AEDs in doctor’s offices and public places. The next logical place to find an AED is dental offices, which are seeing an increasing number of medically compromised and geriatric patients, a trend that will lead to an increased number of cardiac emergencies. Currently, the state of Ohio does not mandate the presence of an AED in the general dental office. Six percent of Ohio dentists and dental hygienists were randomly selected to receive a twenty-three question survey. Thirty-three percent (244) of the surveys were returned; 41 percent of the respondents were dentists, and 59 percent were dental hygienists. Six percent said they have had to administer nitroglycerin to a patient during a dental visit; 5 percent have performed CPR on a patient in the dental office; 78 percent said their last CPR training course included training on an AED. Ninety-eight percent have not used an AED in the dental office setting, and 11 percent said there was an AED at their dental office. Cross-tabulation of data using SPSS resulted in the following: 21 percent feel that AEDs should be mandated in the dental office while 48 percent of dental hygienists feel they should; 81 percent of both dentists and dental hygienists said that they would use an AED on a patient if one were available; 54 percent of dentists and 79 percent of dental hygienists said they felt it was important to have an AED on the premises.
Results suggest that most dental professionals do not have an AED available in the work setting to deal with cardiac emergencies. With the increased likelihood of dealing with a cardiac emergency in the dental office setting and the willingness of dental professionals to use an AED, it is worth further consideration of the importance of an AED in the dental office setting.
150. Incorporation of Service Learning into the Dental Hygiene Curriculum
Joyce C. Hudson, Indiana University
Purpose: To allow students to define a role for themselves as community-minded health care professionals with a keen awareness of citizens in need.
Dental hygiene educators are challenged to provide an educational program that will enable graduates to meet the ever-changing needs of the communities they serve. Our goal is to educate students so they are able to meet the needs of a more diverse population with a wider range of disease conditions and to become sensitive to the values and beliefs of this population. Incorporating service learning activities into the dental hygiene curriculum can provide opportunities for dental hygiene students to achieve these goals. The objectives of this project were to incorporate service learning into the dental hygiene curriculum to provide opportunities for students to achieve specified program and campus competencies and also to foster a greater understanding of the population they will serve. Service learning became a component of our dental hygiene curriculum in the fall of 2003. Students were given a choice of three community sites where the service learning activity could be completed. This allowed students to select an agency that would best enable them to meet the objectives of the assignment. Prior to completing service learning activities, the students were given an in-service presentation that outlined the goals and objectives of the program. Following each service learning experience, students completed a self-evaluation and a reflection paper. During the fall 2003 semester, forty-three second-year dental hygiene students completed service learning. Information collected from self-evaluations indicated the majority of students felt this experience strengthened their interpersonal and communication skills, exposed them to diverse populations, enhanced their sense of civic responsibility, and promoted their leadership development.
This project is continuing, and the program is considering expanding the list of community partners who support our objectives of service learning. This project may also expand to incorporate service learning into the first-year dental hygiene curriculum.
151. Determining Access to Care Barriers at a Local Community Center
Joyce C. Hudson, Indiana University
Purpose: To provide dental health education and access to preventive care for clients at a local community center.
In the United States not all citizens have equal access to dental care. Monetary reasons, lack of dental insurance, transportation, and perceived need for dental care all play a significant role in the utilization of dental services. Dental professionals have an obligation to assist citizens within their community in overcoming these barriers to care. This project was designed and implemented by the Dental Hygiene Program at Indiana University School of Dentistry (IUSD) to assist clients at a local community center in obtaining dental services. Hawthorne Community Center (HCC) in Indianapolis, Indiana, serves diverse individuals who have limited access to dental care. Objectives of this program were to 1) assess the dental needs, knowledge, and utilization of dental services among clients at HCC; 2) identify and provide preventive dental treatment for periodontally involved clients; and 3) provide dental health education to prevent further dental disease. Surveys were designed to assess the dental utilization and knowledge of clients that frequent HCC. Oral screenings were performed to assess unmet dental needs. Results: Fifty-five percent of the adults screened had visible signs of decay, and 31 percent had gingival/periodontal needs. Forty-seven percent of the children screened had visible signs of decay, and 16 percent had gingival and periodontal needs. Monetary issues, lack of dental insurance, lack of transportation, and parents’ work schedule played a significant role in the utilization of dental services. Dental health education programs were implemented and recommendations were made to the director of HCC to assist clients in obtaining access to care. Adults with gingival and periodontal needs were referred to the dental hygiene clinic at IUSD for treatment. Eligible clients had specified services paid for by grant money.
This project is continuing, and HCC will soon be evaluated to determine the success of the program thus far. Changes in the programs at HCC may be recommended based upon the data collected.
152. Validating the National Board Dental Hygiene Examination
Gene A. Kramer, American Dental Association; Laura M. Neumann, American Dental Association
Purpose: Describe the process of validating the dental hygiene examination, which includes analyzing dental hygiene practice, forging a link between practice and examination content, and modifying the content to reflect actual practice.
Validity refers to the evidence and theory that support the interpretation and use of scores for particular purposes. For examinations involved in credentialing, validity is primarily based on the relevance of the content to practice. One source of this validity evidence is the demonstrated relationship between the content and the competencies involved in practice. To gather evidence for the dental hygiene examination, a process was used that involved several phases. These phases included developing competencies, conducting a practice analysis, linking content to competencies, and obtaining final confirmation of the findings. The findings were expected to either confirm the existing content specifications or support adjustments. The Joint Commission on National Dental Examinations’ Committee on Dental Hygiene developed fifty-six competencies deemed to be necessary for successful practice. A practice analysis survey was conducted to determine the importance of these competencies to dental hygiene patient care. The survey was distributed to a stratified random sample of 3,941 dental hygienists. Of these, 1,841 responded, of which 1,284 were full-time practitioners. The importance ratings provided by the full-time practitioners were converted to numbers of items necessary to support the competencies. Using a two-dimensional model, an ad hoc review committee met and distributed the items devoted to individual competencies to the content elements that involve the knowledge and problem solving skills that support the competencies. The outcomes of the validation process supported the inclusion of two new categories of items in the areas of dental hygiene treatment strategies and professional responsibilities.
The content specifications resulting from the validation process were largely consistent with the existing specifications, showing 89 percent agreement between the two. While the findings of the validation process largely confirmed the existing specifications, some revisions were supported. The revised specifications will go into effect as of January 2005.
153. Validating the Restructured Part I National Board Dental Examination
Gene A. Kramer, American Dental Association; Laura M. Neumann, American Dental Association
Purpose: Describe the process of validating the pilot restructured comprehensive Part I National Board Dental Examination, which includes examining its internal structure, comparing the performance on the traditional and comprehensive examinations, and summarizing the reaction of candidates to the pilot examination.
As a part of the process of validating Part I, the Joint Commission on National Dental Examinations determined that its validity might be enhanced if it was restructured so that it would be comprehensive, interdisciplinary, and more clinically relevant than the traditional four-part, discipline-based format. To evaluate the validity of a restructured Part I, a pilot was developed and administered to a sample of currently enrolled students. The pilot consisted of 400 multiple-choice items. The items in the traditional Part I disciplines were intermingled; of the 400 items, 20 percent were associated with testlets. Responses to items and survey questions were available for 1,190 participants at thirty-two schools. Response data were submitted to factor analysis to determine the underlying structure and to item analysis procedures to determine if participants performed equally well on testlet- and non-testlet-based items. Participants’ performance on the traditional Part I and the pilot were compared. The findings of the factor analysis indicated that there was one primary factor and several minor factors most likely reflecting the disciplines. The findings of the item analyses suggested that stand-alone items were somewhat more difficult than testlet items. Participants’ performance on the traditional Part I and the pilot were comparable. Survey responses showed that 49.5 percent of the participants agreed that the pilot represented a reasonable evaluation of their knowledge in the basic biomedical and dental sciences. Also, 54 percent of the participants agreed that the testlets appear to evaluate different skills and abilities than the stand-alone items.
The findings of the validity study of the restructured Part I pilot indicate that it is valid for assessing the ability to understand important information from the basic biomedical and dental sciences and assessing the ability to apply such information in a problem-solving context. Moreover, the presence of testlets suggests that the pilot is superior to the traditional Part I in assessing the ability of candidates to apply information by providing a context related to patient care.
154. Curriculum Changes in Preclinical Laboratory Education with Virtual Reality-Based Technology Training
Margrit P. Maggio, University of Pennsylvania; Judith A. Buchanan, University of Pennsylvania; Peter Berthold, University of Pennsylvania; Riki Gottlieb, University of Pennsylvania
Purpose: To describe the changes and philosophy behind the implementation of virtual reality-based technology (VRBT) training into the D1 curriculum. It is hypothesized that this new curriculum will produce better-trained students and allow the reduction of preclinical course hours.
The University of Pennsylvania School of Dental Medicine (SDM) has conducted research on the use of VRBT to teach preclinical operative procedures for several years. The SDM installed a VRBT laboratory and included this technology in the D1 curriculum based on findings in previous studies. The reasoning for the new curriculum is guided by the following beliefs: 1) the philosophy that if students practice with a handpiece earlier and continuously throughout the curriculum, they will be better prepared for patient care; and 2) students will achieve skill compentency faster with the consistent, visual, comprehensive feedback offered by this technology. The objectives were to create constant practice setting for students with a high speed drill and to reduce preclinical operative dentistry course hours. One hundred and five D1 students started in the VRBT laboratory the first week of school. Thirty-eight hours of VRBT were completed per student prior to entering the traditional operative preclinical course. After entering the traditional preclinical laboratory training, the students simultaneously continued in the VRBT laboratory twenty-two more hours. Class I, II, III, IV, and V preparations were completed in the VRBT laboratory prior to the traditional laboratory course. These topics were not repeated, allowing the course to be reduced by seventy hours. The evaluation of this new D1 curriculum was done by comparing data (time learning skills, number of failed practicals, course failures, remediation required, etc.) from the previous year. Results showed a reduction in course failures by more than half. In some areas, increased performance was shown, while allowing a reduction in course hours. Additionally, preclinical faculty surveys ranking these same students on preparedness and ability were conducted, and the results are currently being presented in other abstracts.
The goals of the implementation of virtual reality based technology training into the D1 curriculum were met. The early, constant acquisition of high-speed handpiece use was established, and results of comparisons to previous years show that students were trained as well or better in the preclinical laboratory course, with a reduction in the course of seventy hours. Based on this experience, VRBT training implementation has followed into the D2 curriculum, training students on crown preparations. A reduction of thirty hours from the fixed prosthodontic course has followed. Plans for implementation into the D3 year is being worked out to serve as preparation refreshment prior to the acutal clinical procedure. Addition of VRBT training to the D4 year is being planned to practice for the Board examinations. This information is important to any school using or considering use of this advanced simulation technology and its possible implementation into their curriculum.
155. Virtual Reality-Based Technology (VRBT) Training Positively Enhances Performance on Preclinical Practical Examinations
Margrit P. Maggio, University of Pennsylvania; Judith A. Buchanan, University of Pennsylvania; Peter Berthold, University of Pennsylvania; Riki Gottlieb, University of Pennsylvania
Purpose: This is a comparative study of preclinical performance between the 2003 D1 class that had VRBT in their curriculum and that of the previous year where VRBT did not take place in the curriculum.
Advanced simulation was incorporated into the D1 curriculum at the University of Pennsylvania. All 105 students rotated through the VRBT laboratory approximately two hours a week. The students completed Class I, II, III, IV, and V preparations. Minimal didactic materials (lectures, handouts) were given to the students at this time. The students completed thirty-eight hours of VRBT training and then entered the traditional preclinical laboratory course. The students worked on the same mannequin head as in the VRBT laboratory to enforce learned ergonomics. This was different from the previous year, where only hinged jaws were used. Grading of the preclinical course was based on practical exams on waxing procedures, operative preparations, and operative restorations. As in years past, the faculty graded the practicals and this was bench top. The criteria were identical. Comparison between the two D1 classes (last year, non VRBT, ninety-seven students) was done. Comparison of students earning grades of A (90 percent), B (80 percent), C (70 percent), and F (below 70 percent) for each practical were made. The same was done with the total grades of practical exams and graded daily lab projects. In the operative practicals, the percentages of students achieving the level of 80 percent or higher increased with the VRBT-trained students. Of these, the gold inlay exam closely matches the VRBT experience with handpiece use. But in these operative practicals, there was an increase in the scores less than 70 percent in the VRBT-trained D1 class. With the waxing technique practicals, the failure rates reduced between 30 and 50 percent in the VRBT-trained students. Overall comparison of laboratory exams and graded daily projects showed a 26 percent increase of VRBT students achieving above 80 percent. VRBT students failing the course decreased by more than 50 percent.
The results show the efficacy of VRBT in the curriculum to enhance psychomotor skills and subsequent performance in preclinical course performance. Comparatively, the VRBT students performed better on the gold inlay preparation #14, encountering more limitations with the mannequin head than previous D1 classes. VRBT does increase the handpiece familiarity, in addition to both psychomotor and indirect vision skills. The decrease in failures of the waxing technique could be because VRBT training allows the student to better visualize form, in addition to gaining psychomotor skills. An explanation for the increased percentage of VRBT-trained students scoring below 70 percent in the operative exams is because although the exams were done in the mannequin with the limitations of the head, cheeks, and demanding posture requirements to contend with, the arches were still graded in hand or bench top by the faculty rather than in the mannequin. In concurrent studies we are conducting, findings (presented in a separate abstract) show faculty expectations of the current VRBT-trained class are high. This may also be a contributing factor to the increased failure rate with the operative procedures. The overall comparison showed a decrease in students failing the course and requiring remediation by more than half. Based on the results, the use of VRBT prior to preclinical courses showed to positively influence the students’ psychomotor performance and reduce the course remediation rate.
156. Measuring Community-Based Dental Education Experience of Predoctoral Students
Oscar Arevalo, Temple University; Amit Chattopadhyay, Temple University; Carlos Echeverri, Temple University; Andres F. Gaitan, Temple University
Purpose: To develop and test a questionnaire-based instrument with a core set of questions to measure students’ experiences of community-based dental education.
Comprehensive care in a community setting has become the preferred method of enhancing clinical dental training programs in the United States. At present no instrument exists to measure this activity. The closed-format questionnaire was developed out of questions selected from the bank of items developed from literature review, focus group meetings, and semistructured interviews with dental professionals. The response was measured as fixed-response measurement scale (Likert scale, yes/no or agree/disagree) with narrative option for some items. Two versions were developed and were modified with item removal and restructuring to eliminate ambiguity and reduce potential nonresponse. The final version of the questionnaire was used in two small pilot studies with samples of convenience for readability, understandability, consistency, reliability, and validity. Results: An eight-domain questionnaire with a total of forty-four response items was developed. The scoring was divided between a 5-point Likert scale, a dichotomous (yes/no; agree/disagree) type response, and selecting the most applicable response from a set of possible responses. These items have a high degree of face validity and, when summed, they show a high degree of construct validity and internal reliability consistency. Levels of internal reliability ranged from reasonable to good, Cronbach’s alpha correlation coefficient exceeding 0.70 for all scales. Content validity was ensured by the process of questionnaire development.
This questionnaire comprises a core set that should be measured in all student community experience surveys. The instrument can be incorporated into student experience surveys in different settings around which further optional modules may be added. Scores are easy to interpret and actionable.
157. Community-Based Comprehensive Care Dental Training Program for Dental Students
Ivan R. Lugo, Temple University; Ivonne Ganem, Temple University; Oscar Arevalo, Temple University; Amit Chattopadhyay, Temple University
Purpose: To describe the process of developing and implementing a community-based dental education (CBDE) within an existing training program at Temple University School of Dentistry (TUSoD).
The paradigm shift of health care towards a health promotion, disease prevention, and health restoration model within a community-based framework demands new approaches and greater integrated activities within dental schools. An infrastructure model to implement a CBDE program was drawn after needs assessment to incorporate community experience into the dental training program. Financial projections were made to estimate program revenues and expenditures and the financial impact on TUSoD. Thereafter, funding was sought through different granting sources. Formative evaluation was used throughout the program implementation. Results: A consortium of more than thirteen agencies were organized into a public/private collaboration including the Robert Wood Johnson Foundation, TUSoD, local and state public health agencies, and private organizations. Barriers to the program included behavioral (faculty and student inertia), curricular (clinical requirement fulfillment and scheduling conflicts), and data collection and transfer issues. Six extramural sites in central PA (one rural, five urban) covering 350 square miles were incorporated in the program and linked through a web-based data collection system stationed in TUSoD. Faculty and student awareness was enhanced through focus groups. A faculty-student advisory committee was established. Outcome assessment tools for the following domains were developed: students’ attitudes towards CBDE (pre- and post-CBDE experience), self-reported improvement in clinical skills, cultural competence, social awareness, and impact on access for underserved populations.
A latent need for CBDE exists to prepare a well-trained future dental workforce. The development of a CBDE requires a systematic approach in which all stakeholders must be involved.
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