J Dent Educ. 71(9): 1217-1222 2007
© 2007 American Dental Education Association
International Dental Education |
Western Australian Dental Graduates’ Perception of Preparedness to Practice: A Five-Year Follow-Up
Gina Arena, B.A. (Hons), M.A., Ph.D.;
Estie Kruger, B.Ch.D., M.Ch.D.;
David Holley, B.Hlth.Sc.;
Samantha Millar, B.B.Sc. (Hons);
Marc Tennant, B.D.Sc, Ph.D.
Key words: dental education, perceptions, Australia
Submitted for publication 12/11/06;
accepted 05/18/07
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Abstract
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The School of Dentistry in Western Australia developed a pregraduation intern year in which final-year students, having completed their didactic education, undertook a focused clinical experiential program (CEP) over an extended year. This program was implemented for the first time in 2002. The aim of this study was to identify the strengths and weaknesses of the curriculum as perceived by graduates and to compare the perceptions of those graduates who did the CEP to those who did not. A survey with questions based on the graduate outcomes of the dental school was mailed to all graduates from 2000, 2001 (did not complete CEP), and 2004 (completed CEP). The response rate was 66 percent (n=57) and included twenty-nine respondents who graduated before implementation of the CEP and twenty-eight who completed the CEP. Most respondents (80 percent) were in the twenty to twenty-nine age group, and there were slightly more males (53 percent). Learning outcome items with the highest mean scores were practicing universal precautions (4.2), behaving ethically (4.2), and demonstrating a satisfactory level of core dental knowledge (4.2). Practical skills outcomes with the highest scores were amalgam restorations (4.3), anterior endodontics (4.3), and single crowns (3.9). When comparing the respondents who did CEP (51 percent) with those who did not (49 percent), there were few significant differences. The general findings from this survey were that most graduates, whether completing the CEP or not, perceived themselves to be prepared, competent, and confident to practice as dentists and were most confident in managing problems that they most frequently encountered during training.
As in other nations, there has been a significant evolution in dental education in Australia over the last five to ten years.1 The challenge for dental schools worldwide has been to design and implement clinical curriculum models in which patient-centered, comprehensive care is the norm, but, at the same time, ensure that each student has an appropriate mix of patient care experiences that are part of general practice.2 During the mid-1990s, the School of Dentistry in Western Australia was an early change agent. These changes were focused on capital and staff renewal, but also included a significant redevelopment of the core curriculum underpinning its educational activities. One of the key changes was the development and implementation of the pregraduation intern year, first implemented in 2002, in which final-year students, having completed their didactic education, undertook a focused clinical experiential program (CEP) over an extended year (the fifth year of training). This year is in many ways similar to the Advanced Education in General Dentistry training model in the United States,3 although it is a pregraduation year.
The traditional dental school curriculum in Australia has been five years, with the first year consisting of basic sciences. Without this basic sciences year, the whole curriculum was adapted to accommodate the fifth (CEP) year. The academic year length of three of the first four years was also increased to ensure that appropriate levels of didactic teaching have occurred before the fifth (CEP) year. The CEP program was developed to provide highly active clinical participation. In summary, it runs over some forty weeks, and students are rostered to various clinical settings for terms within the year. Each rostered term provides a different experience, from community-based practice through hospital-based practice and some private practice experience. The opportunity to undertake some specialist options within the year-long program is also provided for students.
Clinical experiences in dental school encompass a wide variety of learning opportunities, and students prefer more opportunity to work in many patient care settings, not just the dental school clinic.4 The Western Australian school was the first in Australia to implement such a program, and it is now becoming more common through the country. Since its implementation, the students have been followed through a schema of evaluation processes. This study is part of an ongoing series to examine the outcomes of this change. Evaluation processes included a year evaluation, evaluation of the unit, evaluation of teachers, and evaluation of tutors. It is acknowledged that changes in outcomes cannot be associated with specific changes in the educational process, as over the period many changes occurred that may have had an effect. One outcome widely used to assess the effectiveness of curricular changes is to measure the perceptions of graduates regarding their competence and confidence and obtain their opinions about the strengths and weaknesses of a curriculum and the importance of its various components. The aim of this study was to identify the strengths and weaknesses of the curriculum as perceived by graduates and to compare the perceptions of those graduates who did the CEP to those who did not.
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Materials and Methods
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All research protocols were approved by the Ethics Committee of the University of Western Australia prior to commencement of the study. During 2003, a survey was developed to evaluate dental graduates’ self-assessment of their skills and abilities. Survey respondents used a six-point Likert scale to indicate their assessment of level of preparedness in various areas including learning outcomes and clinical practice. The Likert scale ranged from 1 (Don’t know), 2 (Very poorly), 3 (Poorly), 4 (Neutral), 5 (Well), to 6 (Very well). Respondents had to provide their perceptions of their preparedness to practice as they would have at the time of graduation. In addition, the survey provided an opportunity for participants to provide open-ended feedback. The survey was developed by medical educators from the university, and the survey questions were based on the Graduate Outcomes of the Dental School, which indicate what knowledge, skills, and values students should acquire by the time of graduation and thus provide a benchmark for ongoing assessment of graduates’ perceptions of their readiness for unsupervised dental practice. Results of the open-ended feedback were not analyzed in this study and will be used in future research.
This survey was mailed to all graduates of the School of Dentistry, University of Western Australia from 2000, 2001, and 2004, as identified through registration with the Dental Board of Western Australia (n=86). The classes of 2000 and 2001 were surveyed as they did not participate in the CEP. In 2002, the CEP was introduced for the first time. The classes of 2002 and 2003 were not included because the program was still too new and some changes were still being introduced. The class of 2004 was then included as the CEP was in its third year at that stage and initial problems were solved.
All surveys were coded prior to mailing so that all responses remained confidential. Registration numbers were removed and replaced with a code number by an independent person not associated with dentistry or dental education who is also not associated with the project. The code numbers were created randomly so that they could not be traced back to the graduate. Follow-up contacts were made over three months following the original survey. All the 2004 graduates did the CEP year, whilst graduates from the earlier years did not. All survey data were analyzed using SPSS, and the Mann Whitney U analysis was applied to test for significance where appropriate.
Individual survey components were cumulated into themes through consensus discussion among the researchers. The learning outcomes were divided into general skills (GS), which are listed in Table 1
; general clinical skills (GCS), listed in Table 2; and specific clinical skills (SCS), which appear in Table 3. The practical/clinical skills were also clustered under the same three groupings and are indicated in Tables 1–3.
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Table 1. Self-perceptions regarding general skills for all respondents and by clinical experiential program (CEP) exposure
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Table 2. Self-perceptions regarding general clinical skills for all respondents and by clinical experiential program (CEP) exposure
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Table 3. Self-perceptions regarding specific clinical skills for all respondents and by clinical experiential program (CEP) exposure
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Results
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A total of fifty-seven graduates responded to the survey (66 percent response rate). Most respondents were in the twenty to twenty-nine age group (80 percent), with 17 percent aged thirty to thirty-nine and 3 percent aged forty to forty-nine. There were slightly more males (53 percent) than females. The majority of respondents were working in private general practice (74 percent), with 24 percent working in the public sector and 2 percent not working at the time of the survey. Half of the respondents (n=29, 51 percent) did the CEP, and twenty-eight (49 percent) did not.
Table 1
shows the mean scores for the self-rated competency regarding general skills, listed from highest to lowest. The highest scoring item was "behave ethically in my work" (4.2), and the lowest scoring item in the general skills category was "balance my work and personal life" (2.5). When comparing those undertaking CEP with those who did not, significant differences were found for "cope with stress related to my work" (
=–2.51, p=0.012) (Mann Whitney U analysis) with CEP students rating their coping skills more positively (3.2) than non-CEP students (2.6).
Table 2 shows the mean scores for self-rated competency regarding general clinical skills, listed from highest to lowest for learning outcomes and for practical skills. The highest scoring item was "amalgam restoration" (4.3), and the lowest scoring item was "gold in/onlays" (1.9). Significant differences between those undertaking CEP and those who did not were only found for "gold in/onlays" (=2.19, p=0.029) with the results favoring the non-CEP group.
Table 3 shows the mean scores for self-rated competency regarding specific clinical skills, listed from highest to lowest. The highest scoring item was "practice universal precautions" (4.2), and the lowest was "management of challenging paediatric situations" (2.9). There were no significant differences for any of the items between those who did and did not do the CEP.
When learning outcomes and the practical/ clinical skills questions were analyzed together under the three thematic clusters (GS, GCS, and SCS), no significant differences were found between those students undertaking CEP versus those who did not. When comparing genders, a difference was found between males and females for the theme SCS (= –2.04, p=0.02); for specific clinical skills, males were significantly more confident than females.
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Discussion
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The assessment and evaluation of a curriculum are necessary to validate outcomes, and as no curriculum ever remains static, continuous quality control monitoring is essential for ongoing development.5 In this study a survey of dental graduates was used to provide information on the effects of a curriculum change, as well as the strengths and weaknesses of the curriculum as perceived by graduates. Several quantitative tools have previously been used to evaluate curricula, including competency examinations, board examinations, oral comprehensive examinations, surveys, student surveys, alumni surveys, evaluation by instructors, patient satisfaction surveys, and clinical productivity.6 The advantage of the alumni survey, however, is that alumni are in a position to give significant information on the strengths and weaknesses of a curriculum and the importance of its various components.6,7 Surveys of alumni can also reveal practice patterns, learning behaviors, and levels of satisfaction with the profession; this is important because the role of the dental curriculum is not only to develop competence but also confidence and the other attributes of a health care professional.6,8
In terms of general skills, graduates felt most confident about behaving ethically in their work, completing documentation appropriately and accurately, asking colleagues for help when necessary, knowing their own clinical limitations, and applying medico-legal principles. They were least confident in coping with stress related to work, using computers competently in the health care setting, and balancing work and personal life. In terms of general clinical skills, graduates were most confident about their level of core dental knowledge and applying and understanding basic and clinical sciences to the care of patients. In terms of practical skills, they were most confident with amalgam restorations, anterior endodontics, and single crowns, but least confident about gold in/onlays and occlusion-related problems.
In terms of specific clinical skills, they were most confident about the practicing of universal precautions and least confident about the management of challenging pediatric situations. These results, which indicate more confidence and competence in the more common aspects of general dentistry and less confidence in less frequent aspects, were similar to previous findings among dental graduates.7,9–11
There were few significant differences between the respondents who completed the CEP (n=29, 51 percent) and the students (n=28, 49 percent) who did not. This might, however, be explained by the limitations of this survey, as graduates were asked to recall their perceptions at the time of graduation. It becomes difficult to separate the effects of curriculum from those of experience if the length of time between end of training and data gathering is too long.5,6 This is a cognitive bias that results from disproportionate salience of stimuli or observations. It is recommended that these surveys be limited to individuals who have graduated in the past ten years,6 and that was achieved in this survey. The graduates who did the CEP (compared to those who did not) scored higher in 72 percent of all the Learning Outcomes items, but scored higher on only 40 percent of the Practical Skills items. This is most probably an indication of the difference in practical experience between the two groups. The level of interest or lack of interest of graduates for certain aspects of practice can also introduce biases into their responses to questions about university programs.6 Qualitative studies have also shown that self-evaluation is a complex process that can never be objective.12
Students are not provided with a barrier exam during their fifth-year clinical experience, and perhaps they do not treat it as an educational opportunity but more like a work experience opportunity.
The general findings from this survey were that most graduates perceived themselves to be prepared, competent, and confident to practice as dentists. As previous studies have also indicated,7,9–11 students were most confident in managing problems that they most frequently encountered during training. Less confidence in other aspects and skills is probably a reflection of the deficiency of practical experience in those aspects of the curriculum.
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Acknowledgments
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The authors would like to thank Sandra Carr, the Evaluation Committee, Alice Evans, and Jill Evans for their valuable contributions to this project.
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Footnotes
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Dr. Arena is Lecturer in Medical Education, Education Centre, Faculty of Medicine, Dentistry, and Health Sciences; Dr. Kruger is Research Fellow, Centre for Rural and Remote Oral Health, Faculty of Medicine, Dentistry, and Health Sciences; Mr. Holley is Research Assistant, Centre for Rural and Remote Oral Health; Ms. Millar is Administrative Officer (Curriculum), School of Dentistry; Dr. Tennant is Professor and Director, Centre for Rural and Remote Oral Health—all at the University of Western Australia. Direct correspondence and requests for reprints to Dr. Estie Kruger, Centre for Rural and Remote Oral Health, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Australia; 61-8-9346-7248 phone; 61-8-9346-7237 fax; ekruger{at}crroh.uwa.edu.au.
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Abstract
Materials and Methods
