Simulation-Based Learning in Oral Radiology: Students' Perceptions of Training in Intraoral Radiographic Techniques Across Two Dental Institutes.

Clinical placements are an essential component of training health professional students, providing them with an opportunity to learn actively and apply their theoretical learning to practice. In the profession of speech pathology, increasing numbers of university programs and students have placed additional burden on the workplace to provide these critical clinical learning opportunities for students. In response, university programs have designed alternative learning experiences. One such example is simulation-based learning which is increasingly being used to support the development of clinical skills in a safe learning environment. Research has shown that simulation-based learning experiences can replace a proportion of clinical placement time for nursing, occupational therapy, physiotherapy, and speech pathology clinical placement students, with no impact on students’ clinical competency outcomes. To date, there has been limited research in speech pathology investigating the use of simulation-based learning focused on adult patients with communication and swallowing difficulties. Therefore, the aim of this thesis was to investigate the use of simulation-based learning in university speech pathology programs to support the development of students’ clinical skills in adult areas of practice. Four studies were conducted with speech pathology students and clinical educators.The first study in Chapter 2 aimed to investigate students’ confidence, skills, knowledge, and perceptions of simulation-based learning experiences focussing on adult areas of speech pathology practice. A pilot group of six final-year undergraduate and graduate-entry masters students engaged in a 1-day simulation-based learning experience. Results indicated a perceived improvement in clinical skills across the domains of foundation knowledge, case history, assessment, intervention, interaction, and clinical reasoning related to adult speech pathology practice. Students reported that the simulation-based learning experience was valuable and assisted in their preparation for clinical placements.Following the positive results of the pilot trial, the second study in Chapter 3 sought to explore the perspectives of 13 undergraduate third-year speech pathology students and five clinical educators after student participation in an extended 5-day simulation-based learning program focusing on adult speech pathology practice. Students attended the simulation-based learning program immediately prior to their clinical placement. Thematic network analysis of students’ and clinical educators’ perceptions of student learning within simulation revealed six organising themes; (1) simulation is different, (2) simulation offers varied learning opportunities, (3) simulation provides an opportunity to prepare students for clinical placements, (4) simulation is valued, (5) perceptions of the simulation-based learning program, and (6) skills learnt in simulation support students on placements. The organising themes highlighted students’ and clinical educators’ perceived value of simulation to assist the development of students’ clinical skills. Additionally, both participant groups perceived that simulation provided different learning opportunities and an opportunity to prepare students for clinical practice. An overarching global theme suggested that simulation offers unique learning benefits to prepare students for traditional clinical placements.The third study in Chapter 5 aimed to (1) evaluate students’ clinical skills in managing stuttering within a simulation-based learning program, (2) develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering), and (3) conduct a preliminary investigation of its validity in measuring students’ performance. Third-year undergraduate and first-year graduate-entry masters students (n=106) participated in this study. Results revealed that students made statistically significant improvements in their stuttering management skills between two separate simulation sessions focussing on the assessment and treatment of adult stuttering as measured by the SPIRS-Stuttering tool. The tool was shown to have good content validity and variable internal consistency, however it had low levels of intra-rater reliability.The final study in Chapter 6 examined speech pathology students’ comfort, anxiety, knowledge, and confidence in stuttering management at the commencement of an academic stuttering course, and prior to and following participation in a stuttering simulation-based learning program. Participants were 96 third-year undergraduate and first-year graduate-entry masters students. Students’ perceptions were gained through a purpose-designed survey administered at three separate time points: pre-course (T1), pre-simulation (T2), and post-simulation (T3). Results revealed that students perceived improvements in their knowledge and confidence from T1 to T2. Statistically significant improvements in students’ perceived comfort levels, knowledge, and confidence were noted from T2 to T3 with a reduction in students’ perceived anxiety levels.Overall, the results of these studies support the use of simulation-based learning in speech pathology programs to develop students’ clinical skills in adult areas of practice and specifically in stuttering. These findings have direct implications for university teaching and learning practices. First, students value simulation as a contributor to their learning and self-efficacy. Second, clinical educators identified a difference in students’ clinical skill development following participation in simulation-based learning experiences prior to attending clinical placement. Third, simulation-based learning experiences can provide clinical learning opportunities such as within stuttering management when access to real-life clinical placement experiences is not possible. Finally, this program of research has produced empirically-designed simulation-based learning programs focussed on adult areas of practice and stuttering.

Background: An intra-oral periapical radiograph (IOPA) taken with bisecting angle technique (BAT) exhibits superimposition of zygomatic buttress on apices of maxillary molars usually. This influences the endodontic treatment procedures. Objectives: To compare the efficacy of BAT, modified BAT (MBAT), and the paralleling technique (PT) evading the superimposition of zygomatic arch in permanent maxillary molars. Materials and Methods: This is a cross-sectional and comparative study done on 90 patients (30 patients subjected to each technique). Along with the superimposition, other faults that each technique records while taking the radiograph were also assessed. Statistical Analysis Used: Chi-square test with Fischertechnique records while ta data analysis. Results: Zygomatic superimposition was present in almost all the cases in BAT, 26.7% in PT, and 40% in MBAT. The periapical cut-off was found to be absent, 53.3%, and 33.3% in BAT, PT, and MBAT, respectively. All the three techniques exhibit P < 0.001, which is statistically significant. Distortion was 60%, 33.3%, and 20% in BAT, MBAT, and PT, respectively. Cone-cutting was found to be 33.3%, 26.7%, and 26.6% in BAT, MBAT, and PT, respectively, with no statistically significant difference. Conclusions: MBAT successfully avoided superimposition as well as periapical cut-off in most of the cases.

Background: Intraoral periapical radiographs are reported to show the incisive foramen as a typical anatomical landmark. In order to assess the visibility of the incisive foramen in the bisecting angle and paralleling angle approaches, as well as how visible it is in routine periapical radiographs, the current study was conducted. Methods: This descriptive cross-sectional study evaluated 90 intraoral periapical radiographs of maxillary central incisors. These were scored for visibility of incisive foramen by a radiographic expert using two intraoral radiographic techniques. The data was entered in Microsoft Office Excel sheet 2007 and calculated using SPSS version 20. Results: In both the paralleling and bisecting radiographs, the incisive foramen could be seen in a total of 63.8% and 36.2% of the images, respectively. Conclusions: The dentist must have a thorough awareness of how the incisive foramen appears on standard intraoral radiographs. Our research demonstrates that when compared to the bisecting angle technique, the paralleling technique delivers superior visibility of the incisive foramen. Therefore, it is recommended to use the paralleling technique approach to see the foramen.

Dental radiographs are valuable diagnostic aids for oral healthcare, but exposure to ionizing radiation carries health risks, especially in children due to their high radio-sensitivity. Valid reference values for intraoral radiographs in children and adolescents are still missing. This study aimed to investigate the radiation dose values and underlying justifications of dental, bitewing and occlusal X-rays in children and adolescents. Data from routinely executed intraoral radiographs between 2002 and 2020 with conventional and digital tube-heads were extracted from the Radiology Information System. The effective exposure was calculated from technical parameters and statistical tests performed. A total number of 4455 intraoral (3128 dental, 903 bitewing and 424 occlusal) radiographs were investigated. For dental and bitewing radiographs, the dose area product (DAP) was 2.57 cGy × cm2 and the effective dose (ED) 0.77 µSv. For occlusal radiographs, the DAP was 7.43 cGy × cm2 and the ED 2.22 µSv. Overall, 70.2% of all intraoral radiographs were dental, 20.3% bitewing and 9.5% occlusal radiographs. The most frequent indication for intraoral radiographs was trauma (28.7%), followed by caries (22.7%) and apical diagnostics (22.7%). Moreover, 59.7% of all intraoral radiographs were taken in boys, especially for trauma (66.5%) and endodontics (67.2%) (p ≤ 0.00). Girls were significantly more frequently X-rayed for caries diagnostics than boys (28.1% vs. 19.1%, p ≤ 0.00). The average ED of 0.77 µSv for intraoral dental and bitewing radiographs in this study was within the range of other reported values. The technical parameters of the X-ray devices were found at the lowest recommended levels to best limit the radiation exposure and to assure acceptable diagnostic efficacy. Intraoral radiographs were performed predominantly for trauma, caries and apical diagnostics—reflecting general recommendations for the use of X-rays in children. For improved quality assurance and radiation protection, further studies are necessary to determine the meaningful dose reference level (DRL) for children.

Quantitative analysis of errors in alveolar crest level caused by discrepant projection geometry in digital subtraction radiography: An in vivo study

Objectives : This study was carried out in order to obtain basic data for students` efficient acquirement and instruction of radiography technology in the future by surveying dental hygiene students` recognition of periapical radiography. Methods : This study carried out a questionnaire survey targeting dental hygiene students from December 2009 to December 2010, and obtained the following results. Results : 1. As a result of examining recognition on periapical radiography, the bisecting angle technique was indicated to be averagely points. The paralleling technique was indicated to be points. 2. As a result of examining about problems given the bisecting angle technique, what had been most difficult given the bisecting angle technique was indicated to be the highest in cone positioning with 34.2%. The most difficulty given deciding on the X-ray vertical-angel irradiation direction was indicated to be the highest with 66.9% in adjusting the cone direction on the virtual bisector. 3. As a result of examining about problems given the paralleling technique, what had been most difficult in the process of the paralleling technique was indicated to be the highest with 56.7% in fixing the film immobilization device inside the mouth. Conclusions : Examining the above results, it is considered that there is a need of understanding morphological and anatomical structure inside the mouth in order to reduce the mistake rate given the periapical radiography, and that it is important to increase skill level by repetitively shooting several times with having enough time.

The maxillary deciduous molar periapical radiograph often presents a diagnostic challenge for the clinician due to the overlapping of their roots with the developing premolar tooth bud. Clear and distortion free images are necessary for decision making while planning the treatment. However, the practical anatomical difficulties discourage the clinician from using the paralleling technique in children. While looking for an alternative technique, it was hypothesized in the literature that the 20 degree paralleling compromise technique suggested by Van Aken (1969), could override the anatomic challenges in children and provide images that are superior compared to those recorded with the bisecting angle technique. To compare the image quality of maxillary deciduous molar IOPAR taken using the “20 degree paralleling compromise technique” with that taken using the “bisecting angle technique”. Parallel double blinded randomized clinical trial. Sixty children who fulfilled the inclusion criteria were randomly split into two groups. In group A, the bisecting angle technique was used and in Group B the 20 degree paralleling compromise technique was used. The radiographs were categorized into three groups according to the quality of the image (1: Foreshortened image of the roots, 2: Elongated Image of the roots, 3: Undistorted well-defined image) by two independent observers who were blinded to the study and then compared. The obtained data was analysed for inter and intra observer agreements using Kappa statistics and analyzed for significance using the Chi square test. The p values obtained for category 1 and 2 were 0.21 and 0.99 for observer 1 and 0.16 and 0.33 for observer 2 respectively. Under the conditions of the study, there was no difference in the image quality of maxillary deciduous molar roots on IOPAR recorded using either the “bisecting angle” or the “20 degree paralleling compromise” techniques.

Intraoral periapical radiographic techniques are mandatory exercises taught to undergraduate students during their training. The key challenges encountered while teaching the bisecting angle technique (BAT) include correctly positioning the X-ray cone and adjusting the central X-ray beam to the tooth of interest. To address this, a custom-designed pointed laser light (CDPLL) was fabricated and attached to the X-ray cone. This study evaluated the effectiveness of CDPLL compared to conventional BAT in acquiring quality radiographs, reducing errors, and evaluating students' perceptions through a questionnaire. Third-year Bachelor of Dental Surgery (BDS) students were divided into two groups of 26 each. Group 1 used Conventional BAT, while Group 2 employed Laser-Assisted BAT on a mannequin. Both techniques were taught through theory and clinical demonstrations. Students took radiographs of incisors, canines, premolars, and molars of both jaws. Group 1 students then transitioned to Laser-Assisted BAT and repeated the radiographs. Inter-group and intra-group comparisons of radiographic quality and errors were analyzed using Chi-Square tests. Group 2 produced more excellent (41.8%) and acceptable (47.6%) radiographs, with fewer unacceptable ones (10.6%) than Group 1 (p<0.001). Transitioning from conventional BAT to Laser-Assisted BAT in Group 1 led to significantly higher excellent (41.8%) and lower unacceptable (7.2%) radiographs (p<0.001). Errors were significantly higher in Group 1 (81.5%) compared to Group 2 (59.5%) (p<0.001). Common errors included cone cut and overlapping while foreshortening was the least frequent error. Over 80% of students felt CDPLL effectively guided the central X-ray beam and expressed interest in using it in the future. The CDPLL affixed to the X-ray cone serves as an effective teaching tool for taking high-quality radiographs, yielding a higher number of excellent and acceptable radiographs while minimizing repetition and errors. It also aids students in adjusting the X-ray cone and central beam to the desired teeth.

Traditional didactic teaching approaches fall short of adequately supporting diverse student learning styles. Complementing didactic teaching approaches with simulation-based experiential learning can bridge the gap between theoretical knowledge and practical application. However, few studies have rigorously examined the outcomes of this approach in global health education and training. This study describes participants’ self-reported experiences with the World Health Assembly Simulation (WHA SIM), a complex hybrid simulation consisting of a three-day educational exercise, including a tabletop exercise followed by live-action role play, designed to simulate practical global health governance settings. We conducted a descriptive, sequential exploratory study between September 2022 and July 2023, beginning with an anonymous pre-simulation survey among undergraduate students in the Faculty of Health at York University, followed by qualitative post-simulation interviews. The survey included questions on participants’ background, comfort, and confidence in key practice skills and experiences with simulation-based learning. Data was analyzed using simple descriptive statistics for the quantitative data and a framework analysis for qualitative data. Among 39 survey respondents, 18 were interviewed. Participants for interviews were selected through snowball sampling to ensure diverse perspectives. Participants reported feeling more confident in a range of skills, including research capabilities, critical analysis, time management, and organizational effectiveness. They also described increased confidence in interpersonal communication, public speaking, networking, collaboration, and leadership. Several participants reflected on gaining a deeper appreciation of complex global health issues and noted the simulation provided valuable career-relevant insights. Findings highlight the value of simulation-based experiential learning as perceived by undergraduate students in health and science-related degree programs. While this study does not objectively measure knowledge acquisition or skill mastery, it illustrates how the WHA SIM can support confidence and reflective learning in global health education and training contexts.

Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored. To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme. This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment. Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. What is already known on this subject Simulation is a teaching approach used within speech-language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation-based learning programme. It describes a stuttering simulation-based learning programme that can be embedded into speech-language pathology programme curricula. What are the potential or actual clinical implications of this work? The stuttering simulation-based learning programme detailed in this study can be applied and embedded in speech-language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering.

The use of simulation-based learning as an educational tool in nursing.

A dental radiography unit operating at 70 kV (nominal) and 20 cm focus-skin distance was used to irradiate an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in order to assess the variation in organ absorbed dose with intraoral periapical radiographic view. 14 views using the bisecting-angle technique and four views using the paralleling technique were studied. The results are presented and the doses and dose distributions examined. Doses for the paralleling and bisecting-angle techniques are compared, and the effects of focus-skin distance and beam collimation upon patient dosimetry discussed. Sources of uncertainty in dental dosimetry studies using phantoms are also considered.

Simulation-based learning can be used in university programmes to provide speech-language pathology students with essential clinical experiences. However, limited research has explored the use of simulation to support students' development of skills in clinical practice with people who stutter. (1) To evaluate students' clinical skills in managing stuttering within a simulation-based learning programme; (2) to develop an assessment tool, the Standardised Patient Interview Rating Scale for Stuttering (SPIRS-Stuttering); and (3) to conduct a preliminary investigation of its validity in measuring students' performance. Speech-language pathology students (n = 114) participated in a simulation-based stuttering programme in addition to academic coursework in fluency disorders. Students' clinical skills were assessed over two simulation sessions using the SPIRS-Stuttering tool, adapted from an earlier iteration of the SPIRS tool. Content validity, intra-rater reliability and internal consistency of the SPIRS-Stuttering tool were also explored. Students demonstrated a statistically significant improvement in stuttering clinical skills between sessions 1 and 4 of the simulation-based stuttering programme. Good content validity was achieved for the SPIRS-Stuttering tool with a low level of intra-rater reliability and variable internal consistency. This study identified that students' clinical skills in stuttering improved during participation in a simulation-based programme undertaken in conjunction with an academic course on fluency disorders. The results of this study support the inclusion of this learning modality in university programme curricula. Whilst the SPIRS-Stuttering tool enabled assessment of speech-language pathology students' clinical skills in stuttering management, further exploration of reliability is required. What is already known on this subject Within speech-language pathology, simulation-based learning is a teaching approach used in university clinical programme curricula. Simulation-based learning is used as an opportunity for students to gain specific clinical skills, particularly if clinical experiences are readily not available. Research in speech-language pathology has revealed that students value simulation because it provides a safe learning environment. What this study adds to existing knowledge There are fewer opportunities for students to gain clinical experience in the management of stuttering in adults. This study explored students' clinical skill development within a stuttering simulation-based learning programme. Additionally, it detailed the development and preliminary investigation of validity of the SPIRS-Stuttering, an assessment tool used in a simulation-based learning environment. What are the potential or actual clinical implications of this work? Students' clinical skills in the assessment and management of stuttering in adults, as measured by the SPIRS-Stuttering, improved during participation in the stuttering simulation-based learning programme. Further investigation of validity of the SPIRS-Stuttering tool is required to confidently measure students' performance. The stuttering simulation-based learning programme can be used to provide students with an opportunity to develop their clinical skills in stuttering, a practice area in speech-language pathology that is not always available to students.

Background: Basic science subjects are usually taught during the first and second academic years of the Undergraduate training with minimum or no integration with the clinical subjects, thereby creating a compartmentalization within the curriculum. The students have difficulty in understanding the concepts and depend on their ability to memorize facts for diagnosing various disease conditions. Aims and Objectives: To evaluate and compare the Effectiveness of Integrated teaching on diagnostic accuracy in Oral radiology among dental students. Material and Methods: A total of 46 students were randomly divided into 2 groups – Integrated basic science group (BSG) and segregated group (SG). Learning materials included sets of intraoral periapical radiographs and lecture based classes on radiographic features of a normal tooth, periapical abscess, periapical granuloma and periapical cyst. BSG students were taught regarding the radiographic appearance and the cause for such appearance in the radiograph. SG students were only explained regarding the radiographic features of these entities. Following the discourse, two tests - Diagnostic test (multiple-choice questions) on the day of lecture, followed by a memory test (spot diagnosis and match the following) one week later - were done to assess the level of understanding among the students. Statistical analysis was done using Students's t – test. Results: BSG students outperformed both in diagnostic test and memory test when compared to SG students. Conclusions: Integrated teaching has been found to be an effective method in enhancing diagnostic accuracy in Oral radiology and also improving the ability to memorize concepts among dental students.

In Taiwan, seven dental schools, three national and four private schools have formal certified dental programs. Among the undergraduate courses, oral and maxillofacial radiology is a compulsory subject for all the dental students. In clinical dentistry, oral radiology may not be an independent department, depending on the different policies of each hospital. For example, the oral radiology section is part of the oral diagnostic department in the Kaohsiung Medical College Hospital. The main role of the oral diagnostic department is to make the diagnosis and to plan the treatment for all new patients. The names of the oral radiology departments are different in each hospital but they possess similar functions, including the basic intra-oral and extra-oral radiographic examinations. Modern new image machines such as Digora (Soredex) and PM 2002 CC (Planmeca) are also available in our department. Some special radiographic examinations including CT, MRI, angiography and scintigraphy can be ordered and performed by the general radiology department in our hospital. In the future, we are planning, to use a computer to scan the images and filling. Modern transmission of radiographic images is also our planned. This will help the related specialists to have phone discussions from different hospitals, even international consultations.