Article Review:
Effect of Community-Based Clinical Teaching Programs on Student Confidence
Synopsis
Current clinical dentistry must deal with not only continually expanding clinical techniques, but also many administrative challenges needed to properly run a dental office. To address this, the traditional teaching model of developing clinical experience with a variety of techniques needs to expand to include holistic management skills necessary to also run an office. It makes sense that a teaching program should include both. Community-based clinical teaching in a representative environment allows a student to gain experience in not just the clinical techniques necessary, but gaining experience in the practical environment as well. Many previous cases are documented showing overwhelming student popularity for community-based training, as it allows students to utilize their skills in a practical setting, thus, increasing their confidence. However, this study formalizes the effect of a community-based teaching program on a student’s confidence by using statistical methods, not just perspectives and opinions.
As part of the curriculum, students attending the Cardiff University School of Dentistry practiced at an outreach center beginning at the end of their 4th year and continuing periodically through their 5th year to treat patients in a dental care setting. The students completed a questionnaire before and after this community-based training program. The questionnaire covered clinical tasks in 36 total areas and was statistically compared. There was a mean positive difference in 30 of the 36 areas. This study substantiates and gives statistical credibility to other, less formal studies that it is to the student’s advantage to include community-based training in a dental school program as it increases student’s confidence and enthusiasm for the role of general dental practitioner.
Research Methodology/Appropriateness
A possible total of 55 students (1 student class) were to complete the questionnaire of their confidence in a total of 36 areas of clinical tasks. The initial questionnaire was given before starting their community-based training and the final questionnaire was given toward the end of their time in the training. The tasks selected for the questionnaire would reflect the necessary tasks of a qualified dentist. These areas included history-taking, operative dentistry, peridontics, endodontics, prosthodontics, oral surgery, sedation, patient management, restorations, and bridgework. The confidence values were reported on a 5-point scale (0=not confident, 4=very confident). Only paired questionnaires (students that completed the questionnaire both before and after the community based training program) were included in the analysis. Data was analyzed using statistical software (SPSS 16 for Windows). Paired t-tests were used to determine the mean differences between the initial and final questionnaires and if the changes were statistically significant. A significance level of 5% was used.
Although this number of students would allow for significance determination, it does seem like a very low number to be included in the final analysis. Such a low number would mask small changes and allow for less accurate significance determination. Also, only having a 5-point scale (vs a 10-point scale) would also lower the accuracy of the significance determination as small changes couldn’t be determined. The questionnaire itself was extensive and appropriate.
Results
Of the potential 55 students, 47 students completed the paired (before and after) questionnaires and were included in the analysis. For each student, change in confidence levels was calculated (final – initial) for each of the 36 areas. Mean changes were determined across the 47 students. Mean differences >0 indicated an increase in confidence, while a change <0 indicated a decrease in confidence level. Paired t-tests determined if the mean differences calculated were statistically significant.
Two areas (both in restorations) showed the lowest mean confidence level (<1) and the highest variation in initial confidence levels. Six areas showed mean initial confidence levels >3 with 2 of these 6 showing the lowest variation in initial confidence levels. The mean difference was positive for 35 of the 36 areas. Only 1 area showed a slight negative change. Statistical significance was shown for 30 of the 36 areas.
The results do support the original claim of the author. This study was designed to give statistical backing to an already established fact that student confidence is increased through the practical application of community-based training. What the study brings to light are areas of weakness for students even prior to the community based study, as can be seen from the areas of the questionnaires that showed the lowest mean confidence levels and the highest variation in initial confidence levels. These can be areas of future studies to help develop curricula and help students continue to increase their confidence.
Previous studies of community-based programs in the US, specifically at the University of Medicine and Dentistry of New Jersey (UMDNJ) has shown that students involved in the community-based program had higher board scores than students that had not. These students were also more confident in their readiness as a dental practitioner.
References
Lynch, C. D. (2009). Effect of Community-Based Clinical Teaching Programs on Student Confidence: A View from the United Kingdom. Journal of Dental Education, 74 (5), 510-516.
