Experiences Of Dental Students Research Articles

Experience and perceptions of nigerian undergraduate dental students to virtual learning during the COVID-19 pandemic.

COVID-19 outbreak impacted negatively on teaching globally with traditional face-to-face teaching mostly affected. This study evaluated the experiences and perceptions of Nigerian undergraduate dental students to virtual learning (VL) including perceived institutional challenges during the COVID-19 pandemic. This was a cross-sectional survey of 346 dental students from all 13 Nigerian dental schools. Data collection was done using an open/close-ended online questionnaire. The level of awareness and understanding of dental students to virtual learning was high (93.6%) and good (84.7%), respectively. About two-thirds (62.4%) of the students had a virtual learning classroom experience before the COVID-19 pandemic. Clinical students spent more time on the Internet and reported more confidence in the use of VL platforms than their pre-clinical counterparts during the lockdown (p < 0.05). More male students than their female counterparts felt that VL had less quality than traditional classroom teaching (p < 0.05). Similarly, male students showed more confidence in the use of VL online tools (p < 0.05). Institutional and self-perceived preparedness to VL was ranked low and moderate by the students, respectively. The high cost of data subscriptions, unstable Internet connectivity, and lack of other institutional facilities were perceived as challenges to effective VL by students. None of the identified variables predict effective VL. Experiences of dental students and their preparedness to VL were moderate. The high cost of Internet subscriptions, unstable Internet connectivity, and low institutional facilities were major challenges to students' VL. None of the socio-demographic factors could successfully predict effective VL.

Financial assessment of the community-based dental education program at the Indiana University School of Dentistry.

There is a gap in access to oral health services for millions of Americans residing in health professional shortage areas. The community-based dental education program at the Indiana University School of Dentistry is an innovative model that aims to improve access to oral health services in rural underserved Indiana. With this study, our goal was to assess the financial implications of the program over a period of 3 years (2018-2021). Proxy estimates for the revenue generated by students at the community clinic sites were calculated and compared against the implementation costs of the program as well as revenue lost by the school during the rotation period. Descriptive statistics were used to assess the quantitative impact of the program over the 3 years. The total of 7460 patients who were offered care as part of this program were mostly from the uninsured group or were covered under Medicaid. According to our cost-benefit analysis which was conducted during the peak of the coronavirus disease 2019 (COVID-19) pandemic, the total revenue of $1,777,097 was generated by students at the community sites through the 3-year period. The revenue generated was still more than the dollar amount invested in running the program, given the timeline of the study was when elective services were mostly suspended. We conclude community programs like these have an impact beyond the dollar value; they can be modeled to be cost-effective, improve access to oral health services for millions of Americans in underserved settings and at the same time provide a great learning experience for dental students.

Assessing the experience of dental students with an asynchronous online course about racism, cultural competence.

University of Pennsylvania School of Dental Medicine and the University of Pennsylvania School of Social Policy and Practice (SP2) designed an asynchronous online course about racism and cultural competence to address student concerns about harmful interactions with peers across race/ethnicity. The Penn Experience Course establishes common language and concepts to facilitate difficult conversations about racism in the classroom and clinical spaces. The course included six modules addressing the history of racism in the Philadelphia area and at the University of Pennsylvania: implicit bias and microaggressions; racism and other forms of oppression; gender identity and sexuality; construction of whiteness and white supremacy ideology; cultural humility, disparities, and equity; and access in healthcare. Students completed pre- and post-course surveys about their likelihood of engaging with the neighborhood surrounding Penn, confidence discussing the topics covered, and general experience with the course. Four hundred forty-nine students completed post-course surveys, 220 of which could be linked to precourse survey responses. Overwhelmingly, students reported a positive experience with the course, an increase in their likelihood to engage with the Penn neighborhood, and increased confidence in discussing course topics with peers. Many students suggested incorporating synchronous discussion, while a smaller group expressed resentment about the focus on whiteness, white fragility, and anti-Black racism. Several students of color expressed concern that the course centered the learning needs of white students. Asynchronous online content offers an effective and efficient way of teaching dental students about the basics of cultural competence. Educators should anticipate resistance from some white students and the distinct learning needs of students of color.

Dental student's perceptions and experience treating adults with developmental disabilities.

The objective of this study was to investigate the perceptions and experiences of dental students with regards to treating adults with developmental disabilities (AWDDs). Semi-structured interviews were conducted with three groups of participants: experts who extensively work with AWDDs (n=3), students who had no clinical training to treat AWDDs (n=3), and students who had completed their clinical training to treat AWDDs (n=8). One-on-one interviews were conducted in-person or via video call with each participant. Interviews were transcribed, coded, and analyzed for themes. Experts described their motivations for working with AWDDs. Students in both groups identified the challenges of working with AWDDs and highlighted the impact of the informal curriculum as well as the increased importance of clinical training. Students who had received clinical training described the clinical rotation as a transformative learning experience that instilled a sense of health advocacy. There was alignment of themes between all three groups in terms of skills desired, acquired, and required to work with AWDDs; however, the students who had received clinical training and the experts differed on their opinion of the relative importance of the skills they developed. The alignment of perceptions between students and experts is promising and demonstrates the successes of the existing curriculum. The misalignment between students and experts highlights areas in the curriculum that can be improved through adjustments and augmentation.

Evaluation of distance learning and online exam experience of Turkish undergraduate dental students during the Covid-19 pandemic.

Although distance education has been received as an effective educational method in dentistry, the assessment of distance learning and online-exam methods in instantaneous conditions such as a pandemic has not been completely researched. The purpose of the present study was to assess student satisfaction with the distance learning and online-exam experience of dental students in Turkey during the pandemic. Dental students in selected Turkish universities were invited to participate in the research. As a data collection tool, socio-demographic data and a web-based questionnaire consisting of 23 questions, addressing the problems experienced in education during the Covid-19 pandemic period and questioning the solutions of students regarding these problems were used. Satisfaction and attitudes towards distance education and online exams were examined. A total of 1375 students participated in the study. The percentages of students at the various grades of dental school were as follows: first grade = 11.2%, second grade = 18.2%, third grade = 28.3%, fourth grade = 27%, and fifth grade = 15.1%. There is a significant relationship between classes and all scale expressions (P < 0.05). While 11.2% of the students who responded had not experienced any problems, the most common problem was that practical training could not be performed (45.8%) and the lessons were inefficient (29.7%). Dental students demonstrated a low degree of satisfaction and a negative attitude towards distance learning and the quality of presentation of educational material.

Preclinical to clinical transition experiences of dental students at an Australian Regional University.

Clinical experience is a crucial component of dental education as it prepares students for real-world practice. Our study aimed to investigate the transition from preclinical to clinical training experiences of dental students at a regional Australian dental school. A mixed-methods study was conducted using a survey and focus groups. Participants were dental students who recently transitioned into clinical training. Survey data were analysed quantitatively using descriptive statistics, whilst the qualitative data were thematically analysed using the conceptual framework of organisational socialisation theory (OST). Forty-eight of the 69 students in the cohort completed the survey and 10 participated in the focus groups. The quantitative findings revealed that the transition was perceived to be abrupt and associated with a heavy workload. However, orientation sessions and engaging in chairside teaching made transitioning into clinical studies easier. The qualitative findings revealed that the transition process occurred in three phases. In phase 1, participants navigated the educational and social challenges using developmental characteristics such as resilience and positivity. Lessons learnt in phase 1 were used to make necessary learning adjustments in phase 2 and this subsequently enhanced developmental growth in the final phase, which helped ease the transition. This study confirms that transitioning into clinical training can be complex. However, the educational and socialisation challenges associated with the transition can provide stimulating developmental learning opportunities that advance students' adjustments to the clinical environment with positive, empowering and motivational outcomes that facilitate a smooth transition.

Self-perceived Needs for Orthodontic Retreatment among Dental Students: A Qualitative Study.

ABSTRACTAims:The aims of this research were to explore perceptions of Mahidol dental students toward orthodontic retreatment and to examine whether there were any influential factors in a dental school toward their decision to receive the retreatment.Materials and Methods:Mahidol dental undergraduates who were requesting orthodontic retreatment were recruited into this research. A semi-structure interview with a topic guide was conducted to collect in-depth information. All responses were recorded using a digital voice recorder and transcribed using a verbatim transcription technique. The data were then analyzed using a framework analysis.Results:The common reasons for requesting orthodontic retreatment among dental students were self-perceived esthetic and functional concerns. Knowledge and experiences of dental students could raise awareness of dental problems, so they were likely to detect even a small defect of their teeth. The students also worried if their dental problems were presented to patients or other dental students. In addition, although they were requesting for orthodontic retreatment, they felt quite worried with the complications they had learned from the dental program. The students also reported that these concerns could affect their psychological well-being.Conclusion:Dental knowledge and experiences as well as surrounding people such as their peers and patients in a dental school seemed to have impact on awareness of dental problems and a decision to receive orthodontic retreatment.

Prevalence of Vitality in Fixed Partial Denture Done by the Undergraduates - A Retrospective Study

Fixed partial denture is any dental prosthesis that is luted, screwed, or mechanically attached or otherwisesecurely retained to natural teeth, tooth roots, and/or dental implants/abutments that furnish the primarysupport for the dental prosthesis and restoring teeth in a partially edentulous arch; it cannot be removed bythe patient. This study is aimed to evaluate prevalence of vitality of pulp before and after tooth preparationdone by undergraduates for fixed partial denture. A retrospective study was done in which 955 teeth wereprepared for fixed partial denture from 1 June 2019 till 1 March 2020 were included. Data was reviewedfrom the patients records of 86,000 patients documented in a private institution. Statistical analysis wasperformed to assess the vitality of pulp before and after tooth preparation done by undergraduates for fixedpartial denture. There was a statistically significant difference when postoperative vitality was compared indifferent age groups (p&lt;0.05). Out of 200 abutments that were non vital postoperatively only 48% of theabutment had indication for endodontic therapy. Lack of experience of dental students can be the reason forpulpal exposure during preparation. It might be difficult for students to get the parallelism of the abutmentsmainly in the multiunit fixed dental prosthesis. Treatment planning should be done carefully along with thestudents and a beforehand mock preparation should be done on plaster models instead of direct preparationof the vital abutments, this can also help students to perform different types of treatments adequately.

Dental Education With the COVID-19 Pandemic: Ghanaian Dental Students' Experience.

Introduction: Due to the COVID-19 pandemic, all Ghanaian tertiary institutions were closed down and resorted to online teaching. This posed a challenge for dental education due to requirements of clinical tutoring and patient handling. This study explored the experiences of dental students with the change in teaching methods during the pandemic with the aim of assessing their effectiveness and explore measures for their improvement.Materials and Methods: This was an online survey involving undergraduate dental students in the two dental schools in Ghana. An e-questionnaire was sent out to all the students, exploring their knowledge of and response to the pandemic and assessing the impact of measures implemented during the pandemic to assist them complete their education.Results: Two hundred out of 412 students participated in the study giving a response rate of 48.5%; however, completed responses were available for 195 students, 123 (63.1%) from the University of Ghana Dental School and 72 (36.9%) from the Kwame Nkrumah University School of Medicine and Dentistry. There were 106 (54.4%) females;108 participants (54.4%) were pre-clinical students. One hundred and sixty-four (84%) respondents believed dental professionals had a higher risk of contagion because of proximity to patients during treatment and 115(59.0%) reported being fearful of performing clinical procedures. The students demonstrated adequate knowledge of the disease and a positive attitude towards the required changes instituted because of the pandemic. They however, highlighted technical obstacles and distraction as some of their challenges. The quality of internet was acceptable, but the volume of data was inadequate to meet their needs. Also, though both Universities had their own recommended learning management systems, Zoom was the preferred online learning platform.Conclusions: Generally, the students demonstrated a positive attitude towards the required changes. A blended educational approach may continue to be ideal for dental education as we adapt to this pandemic. Innovative ways may need to be sought to improve the online experience and the University approved online learning management systems enhanced to make them more user friendly.

How dental students' course experiences and satisfaction of their basic psychological needs influence passion for studying in Chile.

PurposeThis study aimed to determine how the general course experiences of dental students in Chile and the satisfaction or frustration of their basic psychological needs influenced their passion for studying, and how passion influenced students’ study strategies.MethodsA correlational cross-sectional study was conducted at 3 Chilean dental schools between April and June 2018, in which 935 undergraduate students participated. Students responded to Spanish-language versions of 4 psychological scale tools: the Course Experience Questionnaire, the Basic Psychological Needs Satisfac¬tion and Frustration Scale, the Passion Scale, and the Revised Study Process Questionnaire. Data were analysed with bivariate correlations and structural equation modelling, controlling for age, gender, year of study, and type of university.ResultsStudents’ general course experiences (i.e., good teaching, clear goals and standards, appropriate assessment, and appropriate workload) positively predicted basic need satisfaction and negatively predicted need frustration. Need satisfaction positively predicted passion in students, with stronger scores for harmonious passion. Basic need frustration positively predicted obsessive passion and negatively predicted harmonious passion. Harmonious passion positively predicted deep study strategies and negatively predicted surface study strategies, while obsessive passion positively predicted both deep and surface study strategies.ConclusionDental students’ optimal course experiences positively influenced the satisfaction of their basic psychological needs, which favoured harmonious over obsessive passion. In turn, harmonious over obsessive passion positively influenced deep study strategies. Therefore, efforts should be made to provide course experiences that support students’ basic needs and harmonious passion for studying, both in classroom and chair-side teaching.

Awareness of Removable Prosthodontics on Clinical Experience of Dental Students - A Survey

Awareness of Removable Prosthodontics on Clinical Experience of Dental Students - A Survey

An Evaluation of Dental Student Experiences with the Medicaid Application Process.

Applying for Medicaid can be a barrier to health care services. Most health science students are unaware of the Medicaid application process. First-year students at the University of Washington School of Dentistry (N=170) completed the Washington state Medicaid application as part of an introductory dental public health course and completed a 20-item survey about their experiences. About 54.7% and 41.8% of students encountered some difficulty in understanding the instructions and completing the application, respectively. Students reported lack of Internet access as a significant barrier to completing the online application. Suggested revisions included making it easier to access and submit the application, simplifying instructions, and shortening the application. Most first-year dental students reported difficulties completing the Medicaid application, which underscores the need to simplify the process for potential beneficiaries. Early experiential learning activities have the potential to expose trainees to the barriers to care that vulnerable populations encounter.

Experiences during the execution of emergency endodontic treatment and levels of anxiety in dental students.

This study aims to evaluate the experience of dental students and assess their anxiety levels when performing emergency endodontic treatments. Undergraduate students completed the STAI-Trait/State and a questionnaire to assess their confidence level to perform each step of an emergency endodontic procedure. They also answered a numerical scale (NRS) for anxiety before and after emergency care. Ten randomly selected students from the same sample further participated in a focus group aimed at obtaining qualitative data on their perception of endodontic treatments' conduction and the learning process necessary to perform them. A total of 23 students joined the study. The majority of the participants reported feeling "confident" when performing local anaesthesia (57.6%), rubber dam placement (57.6%) and coronal sealing (72.7%). However, a small number reported feeling "little confident" to perform access cavity (15.2%) or pulpotomy/pulpectomy (24.2%). Students who scored above the 3rd quartile of STAI-Trait/State were classified as "highly anxious," and comprised 26.1% of the sample. The values of NRS scale were higher in the preoperative when compared with the post-operative assessment. All students classified as "highly anxious" reported low confidence in performing "access cavity" and "pulpotomy/pulpectomy." Both quantitative and qualitative analysis showed different anxiety levels in dental students. It can possibly contribute to a reduction in confidence prior to emergency endodontic procedures. The current findings suggest it might be important to rearrange activities in order to allow for more practical classes in Endodontics.

Formação em saúde bucal e Clínica Ampliada: por uma discussão dos currículos de graduação

Na perspectiva de compreender percursos de formação e suas interfaces com os processos de trabalho no Sistema Único de Saúde (SUS), este artigo objetiva analisar as experiências vividas por estudantes de Odontologia em um estágio extracurricular no serviço de saúde no município de São Paulo. Trata-se de estudo descritivo-exploratório de abordagem qualitativa, cujos sujeitos foram três estudantes de graduação em Odontologia, inseridos em um estágio em Clínica Ampliada que registraram suas experiências em diários de pesquisa. O material coletado foi trabalhado por análise de conteúdo temática. No período de maio a dezembro de 2015, foram atendidos - na Clínica Ampliada de saúde bucal da Unidade Básica de Saúde (UBS) - em média, 16 usuários por estagiário, número aproximado à quantidade de pacientes que um aluno de Odontologia da mesma Instituição de Educação Superior (IES) comumente atende durante sua graduação. A partir do conteúdo dos diários dos estagiários, percebe-se a existência de uma forte dissociação entre as vivências dos estudantes no espaço da pesquisa e suas experiências nos ambulatórios da IES. Apesar de passada mais de uma década desde a homologação das Diretrizes Curriculares Nacionais (DCN) para os cursos da área da saúde, e dos esforços para mudar o perfil profissional, persiste o distanciamento entre conteúdos e abordagens da graduação em saúde e os processos de trabalho no SUS. Por certo, o desafio reside também na efetividade da integração curricular, na diversificação de cenários de aprendizagem e na articulação com o SUS. As experiências vividas pelos estagiários revelam as diferenças profundas e arraigadas da prática odontológica nos cenários de ensino e no SUS

Training experience and attitudes towards safeguarding children reported by dental students in Saudi Arabia

Introduction: Dental practitioners have ethical and legal responsibilities toward protecting children from child abuse and neglect (CAN). Training the dental team in safeguarding children is recommended, to be able to detect and report suspected child maltreatment. Therefore, the purpose of this study was to assess training experience of dental students in CAN and assess their attitudes towards the importance of safeguarding children.Methodology: A self – administered structured questionnaire was distributed by hand to both fourth and fifth year students in the College of Dentistry, King Saud University in Riyadh. The questionnaire included demographic questions, questions related to previous training in CAN, and attitudes of dental students towards CAN.Results: Only 141 dental students participated in this study. Around 7% of participants have had previous training in child protection. Only 5.5% from male students and 9% from female students had previous training in CAN. There were no significant differences between genders or between academic years in terms of having previous CAN training. However, 80.4% of dental students agreed that more training is required in this field.Conclusion: The results of this study show that there is an insisting need to include CAN training in undergraduate University courses for dental students.

Implementation of an Outcome-Based Longitudinal Pharmacology Teaching in Undergraduate Dental Curriculum at KSAU-HS Experience

Purpose/objectivesThe aim of this study is to present a modification of the structure of the pharmacology educational experience for dental students as a result of the early introduction of a pharmacology course into the pre-professional curriculum. MethodsThree courses of professional dental pharmacology were modified before and/or after delivery by developing general course learning outcomes, lecture-by-lecture learning outcomes and theme mapping to align topics taught within these courses and with those taught in the pre-professional dental program. ResultsFinal proposals for three professional dental pharmacology courses, which are distributed over three professional years, were prepared based on teaching experience and theme mapping. Topics were added, deleted, transferred from one course to another to afford courses that are fully aligned, relatively comprehensive, longitudinal, with focus on topics relevant to the dental practice without redundancy. In addition, the design of these courses took into consideration the level of coverage of the pre-professional dental pharmacology course. ConclusionsThis longitudinal inclusion of pharmacology courses form the second pre-professional year to the third professional year is expected to improve dental students’ pharmacology education experience. Although the last of these courses is a pharmacotherapeutic course, more courses with clinically oriented therapeutic approach are recommended.

Peer-assisted Learning Associated with Team-based Learning in Dental Education

Peer-assisted learning is one of many educational strategies that can assist students׳ learning and their professional development. Its value could be enhanced if combined with a student centered learning strategy such as team-based learning. PurposeThe aim of this pilot study is to evaluate the impact of peer-assisted learning associated with team-based learning on the learning experience of dental students. MethodForty-two dental students participated in peer-assisted learning associated with team-based learning activities and 6 of them took the role of tutors in the team-based learning sessions. A structured on-line questionnaire was sent to 42 students to evaluate their perception regarding the impact of peer-assisted learning associated with team-based learning on their learning experience. Thirty-eight (90.5%) participants out of 42 answered the questionnaire. Sixteen students volunteered to participate in focus-group interviews for verification of the questionnaire responses. ResultsThirty-two participants (84%) agreed that peer-assisted learning associated with team-based learning improved the way they study and increased their interest in the subject. Thirty-five students (94%) indicated that they enjoyed this learning experience. In addition, they would recommend this program to their colleagues. Thirty-one (82%) agreed that peer-assisted learning associated with team-based learning improved their teaching skills. Furthermore, thirty-one students (82%) indicated that it increased their communication skills. All participants agreed that they were satisfied with the overall program. The results obtained from both students׳ survey and focus-group interviews were consistent. DiscussionOur findings suggested that peer-assisted learning associated with team-based learning was a valuable strategy to enhance learning among students. It can also provide these students with teaching experience which could help their professional development.

Cultural competency and communication skills of dental students: clinical supervisors' perceptions.

This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught. Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software. A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience. For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well.

Dental Students’ Clinical Expectations and Experiences Treating Persons with Disabilities

Persons with disabilities (PWDs) have a disproportionate level of dental disease relative to the general population. Access to care is a cause along with dentists' willingness to treat PWDs. The aim of this study was to investigate the expectations and experiences of dental students in providing treatment to these patients in a hospital-based dental clinic for PWDs. Senior dental students at the Faculty of Dentistry, University of Toronto (n=92) were surveyed prior to (Phase I) and at the end of (Phase II) mandatory clinical rotations at the Mount Sinai Hospital's Dentistry Clinic for Persons with Special Needs. Response rates were 88% for Phase I and 58% for Phase II. Before the rotations, 70% of the respondents reported little or no experience with PWDs, and 46% said they did not feel comfortable providing basic dental treatment to PWDs. However, in Phase II, significantly more students reported being comfortable than in Phase I (p=0.001). Overall, the majority of respondents (Phase I 95%; Phase II 98%) indicated they would at least attempt to provide basic dental care to PWDs after graduation. The majority also identified the opportunity to provide care and interact with PWDs as the most enjoyable aspect of their experience at the clinic. They reported that the experience helped reduce their concerns about treating PWDs including being more realistic about the time required and ideal quality of the treatment they could provide. These results suggest that their experience in the clinic significantly increased students' comfort in treating PWDs. The respondents expressed a willingness to treat PWDs once graduated and generally identified their experience as being more positive than their expectations.

Dental students' experiences of treating orthodontic emergencies - a qualitative assessment of student reflections.

IntroductionProfessional regulatory bodies in the UK and Europe state that dental graduates should be able to manage orthodontic emergency patients. Therefore, the aim of this study was to explore dental student experiences of treating orthodontic emergencies within a teaching institution.Materials and methodThis study was designed as a single‐centre evaluation of teaching based in a UK university orthodontic department. The participants were fourth‐year dental students who treated orthodontic emergency patients under clinical supervision as part of the undergraduate curriculum. Student logbook entries for one academic year detailing the types of emergencies treated and structured, reflective commentaries for each procedure were analysed using thematic analysis methods. The total numbers and types of orthodontic emergencies treated by students were presented. Overall, self‐reported student confidence in managing orthodontic emergencies was calculated. Themes, which represented student reflections, were identified.ResultsSeventy‐two students participated in the study. Overall, 69% of students stated they were confident in managing orthodontic emergencies. Students treated a range of emergencies, of which the most frequent was debonded brackets (38%). Reflections from student commentaries were housed under a primary theme of building procedural confidence. Three subthemes were identified: (i) theory‐practice integration; (ii) expanding clinical experience; and (iii) importance of a supportive clinical learning environment.ConclusionThe majority of dental students were confident in managing orthodontic emergencies. Theoretical knowledge supplemented by exposure to a range of clinical problems within a supported learning environment made students feel more confident.