Predoctoral Students Research Articles

Access to Interpreter Services at U.S. Dental School Clinics

The number of Americans with limited English proficiency (LEP) is growing, and legal protections mandate that LEP individuals have equal access to health care services. The aim of this study was to determine the availability of interpretation services in U.S. dental school clinics and the kinds of instruction dental students are given regarding treatment of LEP patients. A survey was distributed to the academic deans of all U.S. dental schools; 35 completed the survey for a response rate of 58%. Respondents were asked to report on the number of LEP patients treated in their student clinics, the resources available to students working with LEP patients, and the extent of instruction offered. Descriptive statistics were calculated. The results indicated that the proportion of LEP patients treated at U.S. dental schools was perceived to be higher than that of the general population. The availability of interpreter services and the extent of student education about LEP individuals varied widely. Among the responding schools, the most common language spoken by LEP patients was Spanish, followed by Chinese (Mandarin and Cantonese) and Russian. Most of the responding dental schools reported offering fewer than two hours of instruction to their predoctoral students on treating LEP patients. Although almost 90% of the respondents indicated believing LEP patients received care equal in quality to that of non-LEP patients in their clinics, only 61.9% indicated that their students were adequately prepared to manage LEP patients following graduation. These findings suggest that dental schools should consider curricular innovations that will prepare students to work with LEP populations and improve the ability of LEP patients to receive care in the teaching clinic setting.

Improving the Fiscal Sustainability of Teaching Clinics at Dental Schools

Educational patient care clinics are becoming an increasingly important source of revenue for dental schools. Revenue from clinics can help offset the rising cost of dental education. In addition, those clinics represent a source of income over which the schools have reasonably direct control. Recently, a group of nine U.S. dental schools conducted a detailed financial survey of their clinics and shared the confidential results with each other. The purpose of their analysis was to develop benchmarks for key factors related to clinical financial productivity and expenses and to define best practices to guide improvements at each school. The survey found significant variations among the nine schools in revenue produced by predoctoral students and by postdoctoral residents. There were similar variations for levels of clinical staffing. By sharing the results of the survey with each other, the individual schools gained a strong understanding of the business strengths or weakness of their own clinical programs. That information gave each school's leaders the opportunity to investigate how they might improve their clinical fiscal sustainability.

Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting

Statement of problemScientific evidence is lacking regarding the clinical effectiveness of digital complete removable dental prostheses (CRDP). PurposeThis prospective clinical study was conducted to compare clinical treatment outcomes, patient satisfaction, and dental student preferences for digitally and conventionally processed CRDP in a predoctoral setting. Material and methodsThis clinical study rated and compared CRDP fabricated by predoctoral students, using a 2-appointment digital prosthesis fabrication process as opposed to the conventional 5-appointment process. Fifteen completely edentulous patients were treated in the predoctoral clinic at Loma Linda University School of Dentistry. Fifteen predoctoral (third- and fourth-year) dental students fabricated 2 sets of maxillary and mandibular CRDP for each patient. Each patient received 1 conventional set and 1 digital (AvaDent) set of CRDP. Faculty and patient ratings, patient and student preferences, and perceptions of the conventional versus digital prostheses were recorded and analyzed. The average treatment time for the fabrication of each type of prostheses was analyzed. ResultsSignificantly higher average scores were observed for digital dentures than for conventional dentures according to criteria evaluated by faculty (P=.007). Patients reported significantly higher overall average satisfaction scores with digital dentures (P=.001). Patients preferred the digital dentures (P<.01). Significantly higher scores were observed for the retention of the digital maxillary complete denture (P=.001) compared with that for the digital mandibular and conventional complete dentures. Students preferred digital prostheses compared with conventional prostheses (P<.05). The conventional process required significantly more clinical time for each patient than with the digital process of fabrication (P<.01). ConclusionsThe digital process proved to be an equally effective and more time-efficient option than the conventional process of prosthesis fabrication in the predoctoral program. The digital denture process was preferred and effectively used by predoctoral dental students under faculty supervision.

Veneered zirconia crowns as abutment teeth for partial removable dental prostheses: A clinical 4-year retrospective study

Statement of problemThe mechanical properties of zirconia suggest that it might serve as a material for abutment crowns for partial removable dental prostheses (RDPs). Only limited clinical evidence is available for the use of ceramics as abutment crowns. PurposeThe purpose of this retrospective clinical study was to evaluate the outcome of veneered zirconia single crowns in abutment teeth for RPDs in participants treated by predoctoral students. Material and methodsThirty-seven veneered zirconia single crowns in 17 participants (9 men and 8 women; mean age 62.5 years) were prepared as abutment teeth for a clasp-retained RDP with a metal framework: 22 crowns with an occlusal rest seat and 15 crowns with both an occlusal rest seat and retentive clasps. The mean follow-up time was 4.2 years (2.9 to 5.4 years). In a clinical examination, the anatomic form of the crown, marginal fidelity (the border between the crown and the tooth was felt with an explorer), wear of the ceramic surface in the rest seat, and fracture of the veneering porcelain were examined and assessed as good, acceptable, or unacceptable. The retention and stability of the RDPs were recorded as good, moderate, or poor. ResultsThe complications found were fracture of the veneering porcelain (11%) and fracture of the occlusal rest seat (3%). Wear of porcelain at the occlusal contact point was found in 24% of the zirconia single crowns. Wear of the ceramic surfaces of the rest seats for the RDPs was not found. The retention was good in all RDPs. The stability was good in 73% and moderate in 23% of the RDPs. ConclusionsVeneered zirconia single crowns are suitable in abutment teeth for RDPs with a metal framework. Fracture in the veneering porcelain remains a problem with veneered zirconia, although the zirconia surface in the rest seats for RDPs showed no wear.

Adequacy of Patient Pools to Support Predoctoral Students’ Achievement of Competence in Pediatric Dentistry in U.S. Dental Schools

The aim of this study was to characterize the current status of predoctoral pediatric dentistry patient pools in U.S. dental schools and compare their status to that in 2001. A 2014 survey of school clinic-based and community-based dental patient pools was developed, piloted, and sent to pediatric predoctoral program directors in 57 U.S. dental schools via SurveyMonkey. Two follow-up contacts were made to increase the response rate. A total of 49 surveys were returned for a response rate of 86%. The responding program directors reported that their programs' patient pools had declined in number and had changed in character with more diversity and fewer procedures. They attributed the changes to competition, cost, and location of the dental school. The respondents reported that community-based dental education clinical sites continued to provide additional service experiences for dental students, with contributions varying by the nature of the site. A large number of the respondents felt that their graduates lacked some basic pediatric dentistry clinical skills and were not ready for independent practice with children. The results of this study suggest that the predoctoral pediatric dentistry patient pool has changed and general dentists may be graduating with inadequate experiences to practice dentistry for children.

Electronic laboratory quality assurance program: A method of enhancing the prosthodontic curriculum and addressing accreditation standards

Statement of problemAn electronic quality assurance (eQA) program was developed to replace a paper-based system and to address standards introduced by the Commission on Dental Accreditation (CODA) and to improve educational outcomes. This eQA program provides feedback to predoctoral dental students on prosthodontic laboratory steps at New York University College of Dentistry. PurposeThe purpose of this study was to compare the eQA program of performing laboratory quality assurance with the former paper-based format. Material and methodsFourth-year predoctoral dental students (n=334) who experienced both the paper-based and the electronic version of the quality assurance program were surveyed about their experiences. Additionally, data extracted from the eQA program were analyzed to identify areas of weakness in the curriculum. ResultsThe study findings revealed that 73.8% of the students preferred the eQA program to the paper-based version. The average number of treatments that did not pass quality assurance standards was 119.5 per month. This indicated a 6.34% laboratory failure rate. Further analysis of these data revealed that 62.1% of the errors were related to fixed prosthodontic treatment, 27.9% to partial removable dental prostheses, and 10% to complete removable dental prostheses in the first 18 months of program implementation. ConclusionsThe eQA program was favored by dental students who have experienced both electronic and paper-based versions of the system. Error type analysis can yield the ability to create customized faculty standardization sessions and refine the didactic and clinical teaching of the predoctoral students. This program was also able to link patient care activity with the student’s laboratory activities, thus addressing the latest requirements of the CODA regarding the competence of graduates in evaluating laboratory work related to their patient care.

Outcome of zirconia single crowns made by predoctoral dental students: A clinical retrospective study after 2 to 6 years of clinical service

Statement of problemZirconia has established its role as a reliable ceramic material for fixed prostheses. PurposeThe purpose of this retrospective study was to evaluate the outcome of zirconia single crowns made by predoctoral students after 2 to 6 years of clinical service. Material and methodsA cohort of 88 patients treated with zirconia single crowns (mean 3 crowns per patient, range 1 to 12 crowns) from 2007 to 2010 by predoctoral dental students was identified. The patients were invited to attend a clinical examination. ResultsSixty-six participants (75%) took part in the clinical follow-up (30 women and 36 men; mean age 60.4 years, range 19 to 81 years). Altogether, 190 teeth with single crowns were examined, and the mean follow-up time was 3.88 years (1.85 to 6.04 years). The most common complications were chipping of veneering porcelain (4%) and loss of cementation (4%). The success rate of the zirconia single crowns after 2 to 6 years was 80% and the survival rate 89%. ConclusionsZirconia crowns can be successfully used in predoctoral dental education. The success rate of zirconia single crowns after 2 to 6 years was 80% and the survival rate was 89%, in accordance with previous studies.

Prosthodontic Implant Club at UIC, Program Description and Survey Analysis.

This study aims to (1) describe the Predoctoral Implant Club at UIC (PIC-UIC) mentoring model while providing a rationale for the program and (2) investigate PIC members' perception about the club and prosthodontics in general via a questionnaire and focus group discussion. A survey to investigate PIC members' perception regarding the club was distributed at a meeting. The survey consisted of questions about the members' prior exposure to prosthodontics, faculty, and residents; current exposure to and perceptions of prosthodontics; future outcomes from membership; and possible improvements to PIC-UIC. Four student members of PIC-UIC participated in a focus group discussion about their exposure to prosthodontics during each year of their training, their exposure to prosthodontics following PIC-UIC membership, including rotations in the advanced prosthodontic clinic, mentorships by prosthodontic faculty and residents, and attendance at the American College of Prosthodontists Annual Session. Following PIC-UIC membership, students indicated an increased exposure to prosthodontics and prosthodontic faculty. More than a third of the respondents indicated that they are "likely" to consider a prosthodontic residency after having joined PIC-UIC. Almost two-thirds of the respondents indicated that they would recommend PIC to students at other universities and believed their understanding of the prosthodontic specialty has increased. Students who participated in the focus group agreed they had little exposure to prosthodontics, prosthodontic faculty, and advanced restorative procedures in the beginning of their dental education. They felt that involvement in PIC-UIC was a valuable experience that helped them consider or reinforced their decision to pursue prosthodontics as a career. PIC-UIC increased predoctoral students' interest in prosthodontics. Involving prosthodontic faculty and residents in mentoring and educational activities was evaluated positively by students. PIC-UIC may serve as a pipeline program for predoctoral students at other dental schools.

The Tennessee study: factors affecting treatment outcome and healing time following nonsurgical root canal treatment.

To determine factors that may influence treatment outcome and healing time following root canal treatment. Root filled and restored teeth by pre-doctoral students were included in this study. Teeth/roots were followed-up regularly, and treatment outcome was evaluated at every follow-up appointment (healed, healing, uncertain or unsatisfactory). Host (age, immune condition, pulp/periapical diagnosis, tooth/root type, location and anatomy) and treatment factors (master apical file size, apical extension, voids and density of root filling) were recorded from patient dental records. Univariate, bivariate and multivariate analyses were performed to determine the impact of the factors on treatment outcomes and healing times. A total of 422 roots from 291 teeth met the inclusion criteria with a mean follow-up period of 2 years. The preoperative pulp condition, procedural errors during treatment, apical extension and density of root fillings significantly affected the treatment outcome. The average time required for a periapical lesion to heal was 11.78 months. The healing time increased in patients with compromised healing, patients older than 40 years, roots with Weine type II root canal systems, root canal systems prepared to a master apical file size <35, and roots with overextended fillings (P < 0.1). Multiple host and treatment factors affected the healing time and outcome of root canal treatment. Follow-up protocols should consider these factors before concluding the treatment outcome: patient's age, immune condition, as well as roots with overextended fillings, root canal systems with smaller apical preparations (size <35) or roots with complex canal systems. Intervention may be recommended if the treatment quality was inadequate or if patients became symptomatic.

A community-engaged cardiovascular health disparities research training curriculum: implementation and preliminary outcomes.

To overcome cardiovascular disease (CVD) disparities impacting high-risk populations, it is critical to train researchers and leaders in conducting community-engaged CVD disparities research. The authors summarize the key elements, implementation, and preliminary outcomes of the CVD Disparities Fellowship and Summer Internship Programs at the Johns Hopkins University Schools of Medicine, Nursing, and Bloomberg School of Public Health. In 2010, program faculty and coordinators established a transdisciplinary CVD disparities training and career development fellowship program for scientific investigators who desire to conduct community-engaged clinical and translational disparities research. The program was developed to enhance mentorship support and research training for faculty, postdoctoral fellows, and predoctoral students interested in conducting CVD disparities research. A CVD Disparities Summer Internship Program for undergraduate and preprofessional students was also created to provide a broad experience in public health and health disparities in Baltimore, Maryland, with a focus on CVD. Since 2010, 39 predoctoral, postdoctoral, and faculty fellows have completed the program. Participating fellows have published disparities-related research and given presentations both nationally and internationally. Five research grant awards have been received by faculty fellows. Eight undergraduates, one postbaccalaureate, and two medical professional students representing seven universities have participated in the summer undergraduate internship. Over half of the undergraduate students are applying to or have been accepted into medical or graduate school. The tailored CVD health disparities training curriculum has been successful at equipping varying levels of trainees (from undergraduate students to faculty) with clinical research and public health expertise to conducting community-engaged CVD disparities research.

Self-reported comfort treating severe mental illnesses among pre-doctoral graduate students in clinical psychology

Background: One possible explanation for the dearth of psychologists working in severe mental illness (SMI) areas is a lack of training opportunities. Recent studies have shown that while training opportunities have increased, there remain fewer resources available for SMI training compared to other disorders.Aim: Examines whether students express discomfort working with this population and whether they are satisfied with their level of training in SMI.Methods: One-hundred sixty-nine students currently enrolled in doctoral programs in clinical psychology in the United States and Canada were surveyed for their comfort treating and satisfaction with training related to a number of disorders.Results: Results indicate that students are significantly less comfortable treating and finding a referral for a patient with schizophrenia as well as dissatisfied with their current training in SMI and desirous of more training. Regression analyses showed that dissatisfaction with training predicted a desire for more training; however, discomfort in treating people with SMI did not predict a desire for more training in this sample. This pattern generally held across disorders.Conclusions: Our results suggest general discomfort among students surveyed in treating SMI compared to other disorders.

Are Predoctoral Students Able to Provide Single Tooth Implant Restorations in the Maxillary Esthetic Zone?

The objective of this study was to assess the ability of the University of Illinois at Chicago College of Dentistry (UIC-COD) predoctoral students to provide single tooth implant (STI) prostheses in the maxillary esthetic zone. The patient's esthetic satisfaction and the correlation between prosthodontists' and patients' perspectives were examined. Twenty-seven patients were recruited for recall examinations at the UIC-COD predoctoral implant program and underwent clinical and radiographic examination with clinical photographs of the implant sites. The patients completed a semantic differential scale questionnaire. The collected information was formulated into a PowerPoint presentation for two Diplomate of the American Board of Prosthodontists to use the Pink/White Esthetic Score (PES/WES) to evaluate the esthetic outcome. Descriptive analyses, Cohen kappa test, and Spearman rank correlation coefficient test were performed. The average PES/WES were above 6.0 (out of 10). The median for the patient satisfaction and esthetic outcome questionnaires were 10 and 9, respectively, on a scale with 10=highest. There was a medium and positive correlation between prosthodontists' and patients' perspectives in esthetic outcome. This study found that, with strict guidance and proper selection criteria, predoctoral students were able to provide esthetically acceptable STI prostheses in the maxillary esthetic zone and patients were satisfied with the treatment provided.

Self–Perceptions of Cultural Competence Among Dental Students and Recent Graduates

This study assessed self-perceptions of cultural competence in dental students and recent graduates of the University of British Columbia. The sample consisted of 106 predoctoral students (response rate 98 percent) and thirty-three recent graduates (response rate 43 percent). The two cohorts completed similar questionnaires. Over 80 percent of responding predoctoral students reported encountering patients from culturally different groups, 50 percent of them admitted that their communication is not effective, two-thirds were not confident in caring for patients from diverse cultural groups, and over 60 percent perceived that sociocultural differences affect the provision of care. Some significant differences between the genders and study years were observed. Exploratory Factor Analyses validated multiple indicators in five domains: 1) encountering culturally diverse patients, 2) communication challenges in sociocultural situations, 3) cultural competence-related skills, 4) cultural competence related to diagnosis and patient treatment, and 5) training in cultural competence. Through qualitative assessments, important culturally relevant topics and interactive training methods preferred by students for developing cultural competence were identified. This study concluded that cultural competence was perceived as important by both dental students and recent graduates but also as partly deficient, particularly by predoctoral students. For teaching cultural competence, participants recommended various topics and interactive teaching modalities.

Implementation of a Laboratory Quality Assurance Program: The Louisville Experience

Remakes, or the refabrication of dental prostheses, can occur as a result of inherent inaccuracies in both clinical and laboratory procedures. Because dental schools manage large numbers of predoctoral dental students with limited familiarity and expertise as related to clinical prosthodontic techniques, it is likely these schools will experience an elevated incidence of laboratory remakes and their ramifications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both fixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identified as variables associated with the high percentage of remakes documented. The purpose of this study was to introduce the implementation of a new multidepartmental quality assurance program designed to increase consistency and quality in both information provided to commercial dental laboratories and the prostheses returned. The program has shown to be advantageous in terms of cost-effectiveness and treatment outcomes. A statistically significant decrease in remake percentages has been recorded from inception of this program in December 2010 until December 2012. Furthermore, this program has resulted in more consistent communication between the dental school and commercial dental laboratories, among faculty members, and between faculty and students.

Training in clinical geropsychology: Predoctoral programs, professional organizations and certification.

Nearly 35 million Americans are 65 years of age and over. Over the next 40 years, the number of people 65 and older is expected to double and the number of people 85 and older is expected to triple. Graduate training in professional psychology continues to be under pressure to respond to the growing number of older adults and their mental health needs. Moreover, in order to meet the American Psychological Association Commission on Accreditation aspiration of truly broad and general training, inclusion of didactic information regarding the mental health needs of older adults, and, ideally, exposure to this clinical population are necessary. This article describes training of predoctoral geropsychology graduate students and others interested in geropsychology in the United States. Basic information regarding the requirements for obtaining a doctoral degree in clinical psychology is reviewed, along with specifics about the breadth of mentorship students experience during graduate training in geropsychology. An explanation about different training models with a focus on the Pikes Peak training model for clinical geropsychology is provided. Clinical training opportunities within a long-standing clinical geropsychology training program are discussed as an example of a specialty, predoctoral graduate training program within the United States. This is followed by a description of resources provided by various professional organizations affiliated with adult development and aging, and information regarding the potential for student involvement. Finally, a brief overview of the current debate regarding credentialing in clinical geropsychology within the United States is provided.

Evaluating the students' perspectives of a clinic mentoring programme

The purpose of this article is to describe and examine the effectiveness of a mentoring program for third and fourth year clinical dental students. This is an educational intervention for the pre-doctoral students at the Schulich School of Dentistry. We have recently instituted this program and have developed a questionnaire to assess the student perspectives using a SWOT analysis of the strengths, weaknesses, opportunities and threats of this intervention by analyzing the quantitative and qualitative responses of the students towards their clinical education and patient management. Our findings, both quantitative and qualitative, indicated that the mentoring program was well received by most students who would like to see the program expanded. The majority of students felt that the mentoring program aligned well with comprehensive care of their patients while enhancing their clinical experience. One of the strongest areas of agreement involved the ability to discuss cases in a non-threatening environment. The SWOT analysis identified key areas for future improvements. We offer steps to successfully implement a similar program based on our findings. It is our hope that our results might be instrumental for other schools wishing to adopt a similar model which supports patient-based comprehensive care.

Geriatrics Education in U.S. Dental Schools: Where Do We Stand, and What Improvements Should Be Made?

The number of adults above sixty-five years of age in the United States will expand considerably over the next thirty years. However, many dentists believe that their dental education did not adequately prepare them to treat an older adult population. Consequently, it is important to review dental curricula to determine where these gaps in education may occur and what can be done to address them in order to improve access to care. In this study, information was gathered from the websites of sixty-two U.S. dental schools in order to understand the types of geriatric courses offered. This review revealed that while most schools (89 percent) provide their predoctoral students with some education in geriatrics, only fourteen (22.6 percent) offer clinical training specifically for older adult care. In addition, forty-three schools (69 percent) include a geriatric component in either their General Practice Residency or Advanced Education in General Dentistry programs or have a certificate program in geriatric dentistry. Only about 23 percent of the schools offer a continuing education course in geriatrics at any one time. Previous studies have shown that clinical training is the most effective method of increasing students' confidence in treating older patients. Consequently, dental schools should work to incorporate clinical experience into geriatric education to prevent widening an existing gap in older adult oral health care.

Training the Translational Research Teams of the Future: UC Davis—HHMI Integrating Medicine into Basic Science Program

There is a need for successful models of how to recruit, train, and retain bench scientists at the earliest stages of their careers into translational research. One recent, promising model is the University of California Davis Howard Hughes Medical Institute Integrating Medicine into Basic Science (HHMI-IMBS) program, part of the HHMI Med into Grad initiative. This paper outlines the HHMI-IMBS program's logic, design, and curriculum that guide the goal of research that moves from bedside to bench. That is, a curriculum that provides graduate students with guided translational training, clinical exposure, team science competencies, and mentors from diverse disciplines that will advance the students careers in clinical translational research and re-focusing of research to answer clinical dilemmas. The authors have collected data on 55 HHMI-IMBS students to date. Many of these students are still completing their graduate work. In the current study the authors compare the initial two cohorts (15 students) with a group of 29 control students to examine the program success and outcomes. The data indicate that this training program provides an effective, adaptable model for training future translational researchers. HHMI-IMBS students showed improved confidence in conducting translational research, greater interest in a future translational career, and higher levels of research productivity and collaborations than a comparable group of predoctoral students.

Predoctoral Dental Implant Education at Creighton University School of Dentistry

The purpose of this report is to describe the dental implant education that predoctoral students receive and to characterize the patient population receiving implants at Creighton University School of Dentistry (CDS). CDS has no postdoctoral residency programs. Therefore, clinical management of diagnosis, treatment planning, surgical aspects, restoration, complications, and maintenance of dental implants requires significant involvement by predoctoral dental students. CDS implant education involves radiology diagnostic assets of the General Dentistry Department (including the use of Cone Beam Computed Tomography), as well as faculty and equipment from the Departments of Oral and Maxillofacial Surgery, Periodontics, and Prosthodontics, with a majority of students satisfied with their didactic preparation for their clinical experiences. Focusing on a three-year window from August 2007 to August 2010 and using electronic health records, this study found that a total of 242 implants were placed, out of which six failed within one year of placement and had to be removed. The average age of the population of 153 patients was found to be 53.3 years, with a range of eighteen to eighty-nine. Treatment outcomes compared very favorably with those published in the literature.

Electronic Health Records: A Valuable Tool for Dental School Strategic Planning

The objective of this study was to investigate if electronic patient records have utility in dental school strategic planning. Electronic health records (EHRs) have been used by all predoctoral students and faculty members at Nova Southeastern University's College of Dental Medicine (NSU-CDM) since 2006. The study analyzed patient demographic and caries risk assessment data from October 2006 to May 2011 extracted from the axiUm EHR database. The purpose was to determine if there was a relationship between high oral health care needs and patient demographics, including gender, age, and median income of the zip code where they reside in order to support dental school strategic planning including the locations of future satellite clinics. The results showed that about 51 percent of patients serviced by the Broward County-based NSU-CDM oral health care facilities have high oral health care needs and that about 60 percent of this population resides in zip codes where the average income is below the median income for the county ($41,691). The results suggest that EHR data can be used adjunctively by dental schools when proposing potential sites for satellite clinics and planning for future oral health care programming.