Preclinical Skills Research Articles

Effectiveness of virtual simulation and jaw model for undergraduate periodontal teaching

BackgroundThe current study explored the effect of virtual simulation and jaw model on development of preclinical periodontal skills in undergraduate students. The study also sought to explore effectiveness of VR in periodontal preclinical training and determine adequate performance mode in basic periodontal education to improve future preclinical training strategies.MethodsSixty volunteer sophomores and juniors from the stomatology department in Lanzhou university were enrolled to the current study. Participants were randomly assigned into four groups (each group, n = 15) including the traditional jaw model group (Group J) which was the control group, virtual reality group (Group V), virtual-jaw group (Group V-J), and jaw-virtual group (Group J-V). Participants received training on uniform basic periodontal knowledge before completing the first theoretical assessment. Participants further underwent a total 8 h of operation training and completed a second theoretical assessment. Performance of participants was evaluated using the supragingival scaling processes, and clinical operation scores were graded by a blinded professional using an established standard scoring system.ResultsThe findings showed no significant difference in the first theoretical outcomes between the four groups (P > 0.05). The scores of the second theoretical assessment were significantly improved for the V-J and J-V groups (60.00 ± 4.47, 58.33 ± 4.35) compared with the scores of the first theoretical exam (49.67 ± 4.81, 48.00 ± 4.93, P < 0.05). The operation process scores of students in Group V-J and J-V (72.00 ± 5.92; 70.00 ± 3.05) were significantly higher compared with the scores in the other two groups (V: 61.67 ± 7.85; J: 60.67 ± 2.58). The scaling process performance of students in Group V-J and J-V (53.00 ± 3.05; 63.40 ± 4.39) was improved compared with that of students in the other two groups (V: 41.90 ± 5.23; J: 47.40 ± 4.31).ConclusionThe findings show that combination of virtual reality and jaw model during periodontal preclinical training increases students’ grades and improves acquiring of professional skills. Findings from the current study indicate that the jaw model should be applied prior to virtual reality to ensure high efficacy.

Outsmarting COVID-19 through rapid 3D printing and flipped learning in fixed prosthodontics

This paper describes the transformation of pre-Covid 19 educational practices in Fixed Prosthodontics at the School of Dentistry, University of Pretoria. The sudden need for social distancing limited access to the main preclinical skills laboratory, which was overcome by 3D-printed phantom heads that were rapidly produced by the Central University of Technology. This allowed preclinical training to continue in clinical spaces. The educational philosophy also had to be adjusted because contact time became limited. The traditional lecturer-centered approach followed (lectures, notes, demonstrations, practicals and log books) was transformed to a student-centered approach through the production of high quality audio-visual material that allowed students to prepare for practicals in advance. These materials provided learner support at chairside on computer screens and mobile devices and facilitated self-directed learning. Students were formatively assessed using a chairside computer system with the aim of developing competence. This short communication also discusses the lessons learnt from this innovative project and the change in educational philosophy.

Jumping hurdles in achieving preclinical skills during a pandemic‐abbreviated curriculum

Jumping hurdles in achieving preclinical skills during a pandemic‐abbreviated curriculum

Three-dimensional printed model of impacted third molar for surgical extraction training.

Extraction of impacted mandibular third molars is one of the most common surgical procedures performed at dental clinics; however effective training models for teaching oral surgery to dental students are limited. This study aimed to use three-dimension (3D) printing technology to develop an effective training model forimpacted third molar extraction. The data for the 3D model were digitally processed using high-resolution computed tomography, and two common, but different patterns of impacted third molars were simulated using computer-aided design. Thereafter, the model was printed using the 3D-printing technology, and the efficiency of the 3D-printed model and an animal model (pig mandible) were compared using a five-point Likert scale by 35 oral surgeons in the oral surgery department and 208 students of stomatology in the internship stage. The 3D-printed model consisted of three parts: a non-replaceable part (i.e., the body of the mandible and the teeth from the left first molar to the right first molar) and two replaceable parts (i.e., the part of the ascending ramus of the mandible, as well as the second and third molars). It was covered with a layer of rubber-like material to simulate the gingiva. For the comparison between the 3D-printed and animal models, a total of 205 questionnaires were collected. Both oral surgeons and students agreed that the 3D-printed model was better than the animal model in terms of total value and the anatomy of the bone and teeth, simulating the surgical procedure (p<0.05), while the two models achieved similar results for haptic feedback of the soft tissue (p>0.05). The 3D-printed model is realistic and effective for learning impacted third molar extraction and received positive feedback from students and oral surgeons. This model can significantly improve the pre-clinical skill training of dental students.

Orthodontic simulation system with force feedback for training complete bracket placement procedures

BackgroundA virtual system that simulates the complete process of orthodontic bracket placement can be used for pre-clinical skill training to help students gain confidence by performing the required tasks on a virtual patient. MethodsThe hardware for the virtual simulation system is built using two force feedback devices to support bi-manual force feedback operation. A 3D mouse is used to adjust the position of the virtual patient. A multi-threaded computational methodology is adopted to satisfy the requirements of the frame rate. The computation threads mainly consist of the haptic thread running at a frequency of >1000Hz and the graphic thread at >30Hz. The graphic thread allows the graphics engine to effectively display the visual effects of biofilm removal and acid erosion through texture mapping. Using the haptic thread, the physics engine adopts the hierarchy octree collision-detection algorithm to simulate the multi-point and multi-region interaction between the tools and the virtual environment. Its high efficiency guarantees that the time cost can be controlled within 1 ms. The physics engine also performs collision detection between the tools and particles, making it possible to simulate paint and removal of colloids. The surface-contact constraints are defined in the system; this ensures that the bracket will not divorce from or embed into the tooth during the adjustment of the bracket. Therefore, the simulated adjustment is more realistic and natural. ResultsA virtual system to simulate the complete process of orthodontic bracket bonding was developed. In addition to bracket bonding and adjustment, the system simulates the necessary auxiliary steps such as smearing, acid etching, and washing. Furthermore, the system supports personalized case training. ConclusionsThe system provides a new method for students to practice orthodontic skills.

Current perspectives of 3d printing in dental applications

Objective: To evaluate the applications of 3d printing /additive manufacturing (AM) in dental education &amp; clinical dentistry and elaborate various 3d printing technologies, its benefits, limitations and future scope. Methods: Research papers on the application of 3d printing in dentistry were searched in Scopus and Pubmed and studied using bibliometric analysis. This review briefly describes various types of 3d printing technologies with their accuracy, use of different materials for 3d printing and their respective dental applications. It also discusses various steps used to create 3D printed dental model using this technology. Furthermore, the application of this technology in dental education and various clinical procedures are discussed. Results: 3d printing is an innovative technology making a paradigm shift towards treatment customization. It helps in customized production of dental implants, surgical guides, anatomic models etc. using computer-aided design (CAD) data. This technology coupled with state-of-the-art imaging techniques and CAD software has enabled, especially oral surgeons to precisely plan and execute complex surgeries with relative ease, high accuracy and lesser time. 3d printing is also being utilized in other disciplines of dentistry to prepare aligners, crown and bridge, endodontic guides, periodontal surgery guides, surgical models for treatment planning and patient education. Alongside its possibilities have also been explored in preclinical skills in operative, endodontics etc. KEYWORDS 3D printing; Additive manufacturing; Dental applications of 3d printing.

International perspectives on radiography practice education

IntroductionThe radiography profession is built upon strong educational foundations which help ensure graduate radiographers have the required knowledge, skills, and competence to practise safely and effectively. Changing clinical practices, service needs, technological developments, regulatory changes, together with our growing professional evidence-base, all contribute to the need for our curricula to responsive and continually reviewed and enhanced. This study aims to explore similarities and differences in training curricula and follows a 2012 global survey on radiography education and more recent surveys undertaken by the European Federation of Radiographer Societies (EFRS). MethodsAn online questionnaire, based on previous EFRS education and clinical education surveys, which comprised of open and closed questions and consisted of sections designed to ascertain data on: type, level and duration of education programmes leading to an initial or pre-registration qualification in radiography/medical radiation practice, pre-clinical skill development and clinical placement within programmes. The survey was distributed via social media channels and through an international network of professional societies. Descriptive statistics are reported for most analyses while open questions were analysed thematically. ResultsResponses were received from 79 individuals from 28 identified countries across four continents. This represented a total of 121 different pre-registration/entry level programmes offered across these institutions. While dedicated diagnostic radiography programmes were most common (42/121), almost one-third of programmes (40/121) offered two or more areas of specialisation within the curriculum. The average of total hours for clinical placement were 1397 h for diagnostic radiography programmes; 1300 h for radiation therapy programmes; 1025 h for nuclear medicine programmes; and 1134 h for combined specialisation programmes, respectively. Institutions provided a range of physical and virtual systems to support pre-clinical skills development. ConclusionAround the world, radiography programmes vary considerably in terms of their level, duration, programme type, pre-clinical and clinical training, use of simulation, and also in terms of class sizes, student/staff ratios, and graduate employment prospects. The ability of graduates to work independently in areas covered within their programmes varied considerably. While some changes around simulation use were evident, given the impact of COVID-19 it would be beneficial for future research to investigate if pre-clinical and clinical education hours or use of simulation resources has changed due to the pandemic. Implications for practiceThe heterogeneity that exists between radiography programmes presents a significant challenge in terms of the mutual recognition of qualifications and the international movement of the radiographer workforce.

Barriers and promotors in receptivity and utilization of feedback in a pre-clinical simulation based clinical training setting

Objective: Many studies have explored feedback effectiveness using interventions focused on feedback delivery. It is equally important to consider how learners actively receive, engage with and interpret feedback. This study explores how medical students receive and use feedback in pre-clinical skills training.&#x0D; Method: Focus group data from 25 purposively selected thirdyear medical students was thematically analysed. Four major themes and eight sub-themes related to the facilitators and barriers to feedback receptivity and utilisation to feed forward emerged from the data.&#x0D; Results and Discussion: Students were receptive to feedback when its purpose and content aligned with their personal objectives, when it was consistent between tutors, and when it involved developing longitudinal relationships. The clinical skills formative logbook feedback culture with a learning focus was perceived to be predictive of their future performance and they were likely to take feedback on board, emphasising the role of reflection in this process. The depth and timing of actual feedback use varied among students, and language barriers hindered decoding feedback. Students’ self-regulatory focus on the feedback process had a dominant influence on their active use of feedback.&#x0D; Conclusion: Incorporating learner behaviour underlying feedback use should be considered when designing interventions to promote feedback engagement, feedback literacy skills and responsibility sharing in the feedback process. Establishing a learning culture that promotes shared responsibility between clinical educators and learners enable greater control by learners over assessment and feedback processes and a commitment to behaviour change.&#x0D; Bangladesh Journal of Medical Science Vol.20(3) 2021 p.594-607

Do didactics improve clinical skills: A retrospective educational study

Introduction: As predoctoral dental students navigate through the dental curriculum, the knowledge of clinical dentistry is progressively gained from didactic lecture courses. The goal of this study was to evaluate whether there is an association between endodontic didactic knowledge and endodontic preclinical skills. Methods: The study utilized the existing preclinical endodontic assessments of 2nd-year dental students (105 students). Using ExamSoft, the nonclinical questions (e.g., microbiology and pulp biology) were excluded from the final didactic assessment, and a new didactic grade was calculated and assigned to each student. Each endodontic skill (access preparation, instrumentation and obturation, and combined) was matched with corresponding clinically related questions in the didactic assessment. For each student, the matched didactic grade was weighted against the practical grade using Kendall's τ correlation coefficient. To determine the effect of each predictor variable (didactic score and gender), an ordinal logistic regression was used. Results: For all portions of the examination, the correlation between preclinical and didactic grades was significant, P Conclusion: Only a weak association was found between didactic performance and preclinical skills. Lectures on clinical topics should be improved and sequenced accordingly to better link the theory of endodontic technique to the hands-on simulation laboratory.

Faculty perceptions of virtual reality as an alternative solution for preclinical skills during the pandemic.

Faculty perceptions of virtual reality as an alternative solution for preclinical skills during the pandemic.

Effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical dental skills: a systematic review of randomized controlled clinical trials

BackgroundTo investigate the effectiveness of technology-enhanced teaching and assessment methods of undergraduate preclinical skills in comparison to conventional methods.MethodsA comprehensive search strategy was implemented using both manual and electronic search methods, including PubMed, Wiley, ScienceDirect, SCOPUS, and the Cochrane Central Register of Controlled Trials. The search and selection of articles that met the inclusion criteria were carried out in duplicates. A Cochrane data extraction form for RCTs was used to extract the relevant information from all included articles. Risk of bias of all included articles was assessed independently by two authors using the Cochrane risk of bias tool.ResultsA total of 19 randomized controlled clinical trials met the inclusion criteria and were included in this review. The majority of the studies included in this review have a high risk of bias mainly due to incomplete data, lack of blinding of the examiners, and due to other biases, such as small sample sizes, not accounting for additional hours of training, and the lack of calibration of examiners grading the preparations. Conflicting results were reported in the included studies with regards to whether there were differences between the intervention and control groups in the outcome measure of quality of students’ performance. A meta-analysis could not be done for this study due to the heterogeneity among the included studies.ConclusionsTechnology-enhanced teaching and assessment tools used in preclinical skills training of undergraduate dental students have the potential to improve students’ performance. However, due to the conflicting outcomes reported in the 19 studies included in this systematic review and their high risk of bias, better quality studies are required to find a definitive answer to the research question of this systematic review.

Supporting the Development of Clinical Reasoning of Preprofessional Novices in Dysphagia Management.

Proficient clinical reasoning is a critical skill in high-quality, evidence-based management of swallowing impairment (dysphagia). Clinical reasoning in this area of practice is a cognitively complex process, as it requires synthesis of multiple sources of information that are generated during a thorough, evidence-based assessment process and which are moderated by the patient's individual situations, including their social and demographic circumstances, comorbidities, or other health concerns. A growing body of health and medical literature demonstrates that clinical reasoning skills develop with increasing exposure to clinical cases and that the approaches to clinical reasoning differ between novices and experts. It appears that it is not the amount of knowledge held, but the way it is used, that distinguishes a novice from an experienced clinician. In this article, we review the roles of explicit and implicit processing as well as illness scripts in clinical decision making across the continuum of medical expertise and discuss how they relate to the clinical management of swallowing impairment. We also reflect on how this literature may inform educational curricula that support SLP students in developing preclinical reasoning skills that facilitate their transition to early clinical practice. Specifically, we discuss the role of case-based curricula to assist students to develop a meta-cognitive awareness of the different approaches to clinical reasoning, their own capabilities and preferences, and how and when to apply these in dysphagia management practice.

Medical Students’ Perceptions on Skills Laboratory Training for Clerkship preparedness at the University of Rwanda: A Pilot Study

Background: The preclinical and skills laboratory training years of undergraduate medical education provide educational content in a structured learning whereas clerkship provides clinical training in a more experiential manner. Although early clinical skills training is emphasized in many medical schools today, students still feel unprepared about starting their clerkship.Aim: This study explored perceived challenges encountered by early clerkship students performing clinical skills learned in a skills laboratory.Methods: Self-administered questionnaires were distributed to ninety purposely selected medical students from year three to year six of the medical school of the University of Rwanda in the academic year 2012-2013. Questionnaire was answered anonymously by the participants.Descriptive statistics were used. Results were analysed in terms of distribution and percentages.Results: Sixty-eight self-administered questionnaires out of ninety distributed (76%) were returned. The results showed that a simulation exercise for preclinical years may be a valuable tool to increase knowledge and student self-confidence at a key transition period prior to beginning clerkship experience. Preclinical skills-laboratory enhances patients’ safety during medical students’ early clerkship years.Conclusions: Preclinical skills training in a skills laboratory is an important tool to increase knowledge and student self-confidence of medical students before beginning clerkship experience.________________________________________________________________________Keywords: Medical students, clinical skills, clerkship, rotations, transition

Promoting Soft Skill Development in Preprofessional Athletic Training Students

ContextAthletic training programs are required to incorporate the development of many foundational skills and behaviors into the curriculum. Athletic training students must develop soft skills such as effective communication, exhibiting empathy, dependability, and integrity, which are all associated with quality athletic trainers.ObjectiveTo describe a novel approach to promoting the awareness of values and development of the characteristics and soft skills associated with being a successful student and health care professional for students before they enter their clinical experiences.BackgroundGraduate and undergraduate programs typically offer an introductory course to students before their first clinical assignment. The main emphasis of introductory courses is often on learning foundational knowledge and technical skills. However, early adoption of professional values and development of soft skills may benefit students as they start their clinical experiences.DescriptionA course was designed using 11 main themes to guide student learning in values and behaviors important to academics and a career in health care. This article describes how the 11 themes were selected and developed, how the course was delivered, and how various pedagogical strategies were incorporated.Clinical Advantage(s)Development of soft skills may benefit athletic training students as they enter the professional phase of an athletic training program.Conclusion(s)As athletic training education shifts to the master's level, fostering soft skills and necessary preclinical skills for students from varied backgrounds is becoming ever more important so students are all equitably prepared for their first clinical experiences.

Best practices to impart clinical skills during preclinical years of medical curriculum.

Globally, health is regarded as a booming industry with greater stress being laid on high quality, accountability, and transparency. Traditional medical curricula rely primarily on clerkships during the clinical period of study to train clinical skills, while the preclinical period is mainly used to teach the basic sciences. In recent years, the early introduction of clinical skills training has received increased attention. This review aims to identify and summarize teaching approaches of clinical skills for medical students during preclinical years, namely, (1) framing objectives (2) learning activities, and (3) evaluation strategies. Although the clinical tutor's role is to ensure that students receive effective preclinical skills through different modes of learning (lectures, presentations, and problem-based learning), the role of advanced technologies, namely, simulation-based learning platforms and gamification are found to be very successful. To improve the communication skills, there is strong evidence in support of role plays, and similarly, for enhancing observation skills, an introduction of fine arts in clinical skills training was found to be very useful. Medical schools worldwide should give high priority to conduct faculty development programs on various aspects of training and teaching modalities, evaluation strategies, and improving the evaluation of various clinical skills. Students should be provided with sufficient learning opportunities including a well-equipped clinical skills laboratory and individual attention, and constructive feedback should be given to students for building their confidence level during their learning process.

Facilitation of student-staff partnership in development of digital learning tools through a special study module

A student-staff partnership was formed as part of a final year special study module to provide dental students the opportunity to work closely with faculty to produce high-quality e-learning resources in areas of the curriculum identified by the students as particularly difficult. The student-staff team identified the following themes as major influences on the success of the project: student-staff interaction, ownership, managing expectations, time pressures, and co-creation partnership benefits. This partnership resulted in a valuable learning experience for both the students and staff involved. The resource developed was evaluated by junior dental students in second and third year of the five year Bachelor of Dental Surgery (BDS) degree programme at Glasgow Dental School and showed a high degree of acceptability by those in both groups. The quality assurance built into the process has resulted in an e-learning resource that has been incorporated directly into our flipped classroom model for pre-clinical skills teaching.

Force-based learning curve tracking in fundamental laparoscopic skills training

BackgroundWithin minimally invasive surgery (MIS), structural implementation of courses and structured assessment of skills are challenged by availability of trainers, time, and money. We aimed to establish and validate an objective measurement tool for preclinical skills acquisition in a basic laparoscopic at-home training program.MethodsA mobile laparoscopic simulator was equipped with a state-of-the-art force, motion, and time tracking system (ForceSense, MediShield B.V., Delft, the Netherlands). These performance parameters respectively representing tissue manipulation and instrument handling were continuously tracked during every trial. Proficiency levels were set by clinical experts for six different training tasks. Resident’s acquisition and development of fundamental skills were evaluated by comparing pre- and post-course assessment measurements and OSATS forms. A questionnaire was distributed to determine face and content validity.ResultsOut of 1842 captured attempts by novices, 1594 successful trials were evaluated. A decrease in maximum exerted absolute force was shown in comparison of four training tasks (p ≤ 0.023). Three of the six comparisons also showed lower mean forces during tissue manipulation (p ≤ 0.024). Lower instrument handling outcomes (i.e., time and motion parameters) were observed in five tasks (resp. (p ≤ 0.019) and (p ≤ 0.025)). Simultaneously, all OSATS scores increased (p ≤ 0.028). Proficiency levels for all tasks can be reached in 2 weeks of at home training.ConclusionsMonitoring force, motion, and time parameters during training showed to be effective in determining acquisition and development of basic laparoscopic tissue manipulation and instrument handling skills. Therefore, we were able to gain insight into the amount of training needed to reach certain levels of competence. Skills improved after sufficient amount of training at home. Questionnaire outcomes indicated that skills and self-confidence improved and that this training should therefore be part of the regular residency training program.

Enhancing Health Care Student Inter-Professional Learning Through a Pilot Simulation Ward Experience Using Mask-Edtm(KRS Simulation)

Pre-clinical training is traditionally conducted in ‘siloed’ disciplines limiting inter-professional learning (IPL) opportunities. A pilot using Mask-EdTM technology was used to simulate an authentic IPL experience for health-care students and enhance the IPL experience of students in a preclinical simulation-training program. A multidisciplinary, simulated ward experience was conducted using Mask-EdTM. Students completed pre- and post-pilot Interprofessional Collaborative Competencies Attainment Surveys (ICCAS). A focus group was conducted to explore participant IPL experience and pre-clinical skill development. Statistically significant improvements were found in all six domains of the ICCAS (collaboration, roles and responsibilities, patient centred approach, conflict management and team functioning). Focus group analysis generated three themes: authenticity, mistakes are ok and learning. This pilot study suggests that Mask-Ed™ simulation is an effective method to teach IPL to health students.

Stress Perception of Second-year Dental Undergraduate Students - A Cross-Sectional Study

Background and Objective: The dental undergraduate students are trained intensely on preclinical skills in their second year added to the regular academic workload. A study on the perception of the stress by these students will provide feedback for the faculty members to do necessary curricular modifications if needed. The aim of this study was to assess the overall stress of the students and the contributing factors. Material and Methods:The modified dental environmental stress questionnaire was administered to 55 second-year undergraduate dental students. The questionnaire had 25 items with the responses on a Likert scale of 0 to 4 for each item. Data analysis was done by descriptive statistics with frequencies and one-way ANOVA with posthoc analysis using SPSS. Results: Majority of the students were having no stress (21.8%) to mild stress (70.9%). Only 7.3% had moderate stress and none were highly stressed in the study population. The academic factors, personal life issues, and professional identity were contributing equally and the faculty relations were significantly less stressful than other factors. The fear of facing parents after failure was perceived to be the top stressor with a mean stress score of 2.1 ±1.5. The difficulty in learning precision manual skills contributed lesser stress (1.25 ± 0.7) and was not in the top five stressors. Conclusion: Within the limitations of the study, the second year dental students were not highly stressed. Milder grades of stress cannot be prevented completely. Stress is not always bad as eustress motivates positive functioning of the students

The use of virtual reality simulation to improve technical skill in the undergraduate medical imaging student

ABSTRACTIn recent years, simulation has increasingly underpinned the acquisition of pre-clinical skills by undergraduate medical imaging (diagnostic radiography) students. This project aimed to evaluate the impact of an innovative virtual reality (VR) learning environment on the development of technical proficiency by students. The study assessed the technical skills of first year medical imaging students. The learning experience by each student was either via traditional laboratory-based simulation or VR simulation, for two specified anatomical protocols. Following the learning experience, the students performed role-plays and were assessed on their technical proficiency. The type of learning environment, laboratory-based or VR simulation, was recorded for each radiographic procedure, as well as demographic data. Data demonstrated an improved total role-play skill score for those students trained using VR software simulation compared with the total role-play skills score traditional laboratory simulation. Demographic multivariable analysis demonstrated no statistically significant association of age, gender, gaming skills/activity with the outcome. The novel medical imaging VR simulation learning tool facilitated technical skill acquisition, equal to, or slightly better than traditional laboratory training. Ongoing data collection will evaluate the impact this VR software has on the undergraduate medical imaging student.Abbreviations: QUT: queensland university of technology; VR: virtual reality; SLE: simulated learning environment; PA: posterio-anterior; DP: dorsi-plantar; CP: central point; CR: central ray; SID: source image distance; HWA: health workforce Australia