Comparison of Dental Students’ PAT Scores with Their Performance in Preclinical Technique Courses: Identifying the Need for Early Interventions

• dental education
• educational assessment
• assessment
• academic performance
• operative dentistry
• school admission criteria
• Dental Admission Test
• Perceptual Ability Test

To consider a career in dentistry, it is not unreasonable that students interested in this field have skillful use of their hands since the ability to combine artistry using manual dexterity and science helps make for a successful dentist.¹ Criteria for dental school admission differ among schools but usually involve some combination of total undergraduate grade point average (GPA), undergraduate science GPA, Dental Admission Test (DAT) scores, interviews, service hours, letters of recommendation, and measures of manual dexterity. Through the admissions process, candidates are selected who will hopefully be successful in navigating the rigors of the dental curriculum.

Prior to introduction of the Perceptual Ability Test (PAT) on the DAT, predental students were required to take the Chalk Carving and Spatial Relations Tests, which provided information related to manual dexterity as well as the ability to visualize in three dimensions.² In 1972, the Chalk Carving Test was replaced by the Perceptual-Motor Ability Test— now the PAT. The underlying factor that permitted replacement was that visual perception, when measured reliably through a pencil-and-paper test, was found to be a valid predictor for judging probability of success in the technique courses in dental curricula. The PAT portion of the DAT currently consists of 90 items, including problems in block counting, angle size, form development, orthographic projections, paper folding, and comparison of shapes and objects with apertures. The test is graded from 1 to 30 (lowest to highest).

The American Dental Association (ADA) regularly publishes correlation studies of admissions data and students’ dental school performance at the national level. For 2009, the mean score on the PAT was 18.19 (standard deviation 2.92), based on results of the 13,691 DAT exams taken that year, and 63% of participating dental schools had significant correlations between their students’ PAT scores and performance in preclinical operative technique courses.²

Aside from those national data, it is important for individual dental schools to know how the PAT correlates with their own students’ performance in preclinical technique courses. Among recent studies of the relationship between the PAT and student performance, results have been mixed. Ballard et al. found no difference among PAT scores of students in the top 10%, bottom 10%, and repeating or dismissed members of ten graduating classes and found a negative correlation among PAT scores, predental GPA, and predental biology, chemistry, and physics GPA.¹ These findings led the authors to speculate that possibly the “strong emphasis placed on an applicant’s ability to demonstrate perceptual ability or hand skills prior to dental school is unfounded. Perhaps students are able to develop sufficient manual dexterity while in dental school.” Carroll and Schuster compared DAT scores to performance on a fourth-year competency exam that consisted of three written sections testing patient assessment and treatment planning, periodontics, and prosthodontics and three clinical patient care sections involving endodontics, operative dentistry, and periodontics.³ They found the PAT component score of the DAT was the only statistically significant predictor (p<0.05) of clinical performance at their school. Their explanation was that the PAT tests spatial visualization skills and ability to interpret two-dimensional representations of three-dimensional models, which are analogous to use of two-dimensional radiographs to analyze clinical scenarios and mental construction of three-dimensional images of teeth students are restoring or replacing.

In another study, Sandow et al. examined the relationship between multiple admission criteria and dental school performance for six recent classes at the University of Florida College of Dentistry.⁴ They found that undergraduate science GPA correlated most strongly and consistently with dental school performance and that the DAT Academic Average, the PAT, and the admissions interview score were also associated to a lesser degree with academic success. On the other hand, Curtis et al. found a significant difference between the PAT scores of students categorized into “underachieving” and “normally tracking” groups,⁵ while Gray and Deem found that students with PAT scores of 19 or better had better grades in preclinical technique courses than those with PAT scores of 16 or lower, but that PAT grouping did not predict grades in years three and four.⁶

The aim of our study was to determine if lower scores on the PAT predicted which dental students required remediation in three preclinical restorative dentistry courses at Rutgers School of Dental Medicine. Specifically, the study tested whether the PAT scores of those who required remediation were statistically significantly different from the PAT scores of students in good standing. By reviewing PAT scores from the Rutgers School of Dental Medicine Classes 2010 through 2015, we sought to determine if lower PAT scores increased the probability of students’ requiring remediation in the preclinical technique courses of Preclinical General Dentistry I, Preclinical General Dentistry II, and Preclinical Fixed Prosthodontics.