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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 163-171

Self-perceived preparedness of dental school graduates and the impact of COVID-19 pandemic on their confidence


1 Department of Conservative, University of Jordan, Amman, Jordan
2 Department of Conservative Dentistry, Intern at Jordan University Hospital, Amman, Jordan
3 Department of Oral and Maxillofacial Surgery, University of Jordan, Amman, Jordan

Date of Submission27-Jan-2021
Date of Decision09-Sep-2021
Date of Acceptance19-Sep-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Dr. Islam Abd Alraheam
Department of Conservative Dentistry, University of Jordan Queen Rania Street, Amman
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjos.SJOralSci_5_21

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  Abstract 


Introduction: Dental education quality is reflected by assessing graduating students' professional preparedness. Coronavirus disease 2019 (COVID-19) has had many challenges for dentistry some of which may have further long-term impacts on clinical practice, dental education, and dental research. Impact on education can be directly reflected on graduates' preparedness.
Aim: The aim of this study is to study self-perceived preparedness of dental school graduates and the impact of COVID-19 on their preparedness.
Materials and Methods: An online survey was designed and sent electronically to 5th year students who were graduating in 2020, dentists who graduated in 2019 and were doing their prelicensure training, and dentists who graduated before 2019. The survey was self-designed and validated by an experienced professor in the school then tested by couple of participants. The survey composed of multiple sections. Four-point Likert scale was used to assess participants' perception in all the survey sections.
Results and Discussion: A total of 209 participants responded to the online questionnaire. The mean total preparedness score (TPS) for the 209 participants was 97.6 (standard deviation ± 9.7) with a range of 69–120. The mean TPS of the different classes of participants was 99.5 for the class graduated before 2019, 98.1 for the 2020 class, and 95.1 for the 2019 class. Participants felt they are confident and extremely confident doing most of the required competencies. Weakness was mainly reported in surgical extraction for 2020 graduates due to the 8 weeks loss of their training. COVID-19 had considerable impact on 59.7% of the participants and marginal to no impact on 40.3%. The highest prevalence of those who thought it had some to severe impact on their confidence was those who graduated in year 2019 (73.4%).
Conclusions: The graduates who participated in the survey felt confident in performing the majority of general dentistry procedures. COVID-19 pandemic negatively impacted the confidence of all the classes of participants even those graduated before 2019.

Keywords: Coronavirus disease 2019, coronavirus disease 2019 pandemic, dental, education, preparedness, teaching, training


How to cite this article:
Alraheam IA, AlAshqar MA, Hattar S, AlHadidi A, Alhaddad A, Sawair F A, Alkayed A. Self-perceived preparedness of dental school graduates and the impact of COVID-19 pandemic on their confidence. Saudi J Oral Sci 2021;8:163-71

How to cite this URL:
Alraheam IA, AlAshqar MA, Hattar S, AlHadidi A, Alhaddad A, Sawair F A, Alkayed A. Self-perceived preparedness of dental school graduates and the impact of COVID-19 pandemic on their confidence. Saudi J Oral Sci [serial online] 2021 [cited 2022 Aug 15];8:163-71. Available from: https://www.saudijos.org/text.asp?2021/8/3/163/334295




  Introduction Top


Dental education is regarded as a complex, demanding, and often stressful pedagogical procedure. Dental educational environment is expected to enable students to acquire the necessary theoretical, clinical experiences, and to expose them to continuous self-assessment opportunities equivalent to the environment in which they are likely to be practicing dentistry.[1],[2],[3] The quality of any dental program is reflected by assessing graduating students' professional preparedness.

The dental school in the university where this study was conducted is a 5-year program qualifying students for the doctor of dental surgery degree. After graduation, the graduates must undergo a prelicensure training for 12 months to get their license to practice general dentistry. The school implemented a problem-based learning curriculum and a competency-based assessment grading tool for each branch of dentistry in 2010. Problem-based learning helps students to improve their problem-solving skills as well as motivates them to learn and participate actively.[4] Competence comprises an integration of knowledge, skills, and attitudes indicating a capability to perform professional tasks safely and ethically.[5] This curriculum and grading tool is focused on the skills of examination and treatment planning to assure students preparedness for comprehensive patient care after graduation. It also helps them define their weakness in specific competency; therefore, work harder to develop themselves in this specific area. Positive feedback regarding this teaching strategy from the teaching faculties was verbally reported, but no studies were done to evaluate the effectiveness of this strategy on the dental students' confidence and preparedness to perform general dentistry after graduation.

In the literature, multiple studies were done to evaluate the self-perceived preparedness of the graduates. Some of these studies used a self-designed survey questions,[6],[7],[8] while others used the Dental Undergraduate Preparedness Assessment Scale.[9],[10] The findings of those studies indicate that dental schools usually succeed in graduating dentists who are prepared for performing most of the simple and basic dental procedures.

Coronavirus disease 2019 (COVID-19) has had many challenges for dentistry some of which may have further long-term impacts on clinical practice, dental education, and dental research.[11] The Occupational Safety and Health Administration in the United States classified dentist in the very high-risk category because of the potential of exposure to coronavirus through aerosol generating procedures.[12],[13],[14] Therefore, this pandemic which affected almost all the countries in the world caused paralysis in clinical education in dental schools and hospitals. Impact on education can be directly reflected on graduates' preparedness. Suspension of educational activities can lead to frustration among students and faculties. Shifting to on-line learning was a good strategy to teach the didactic theoretical courses, but it could not replace the hands-on teaching where the students usually gain and develop their skills and manual dexterity to build their confidence. In addition, the quality of online education is a critical issue that needs proper attention.[15],[16],[17] Some dental educators recommend dental school to invest in haptic technology to improve psychomotor skills and in faculty training for teaching through technology by faculty development programs.[13],[18] The effectiveness of utilizing haptic technology in clinical education is not proven and more research is needed in this area.[15],[19] It is been suggested that the model of dental education should be innovated to suit different situations and novelty intelligent technology should be applied for future dental education.[20] Dental schools around the world tried their best using web-based seminars, lectures, and case discussions on multiple platforms to compensate the students for that lost part of education which could impact their confidence and preparedness.

The COVID-19 outbreak has created a tremendous level of stress among students and dentists. This stress may lead to unfavorable effects on the learning and psychological health of students.[15] Fear of the unknown can develop anxiety in healthy people as in those with previous mental health problems.[21] It might also have a serious impact on the careers of this years' university graduates.[15] Dentists are exposed to a high psychological tension from the fear of getting infected with COVID-19 and the frequent appointment cancellation from patients.[21],[22],[23]

The effect of this pandemic on dental students and dentists in terms of their preparedness and confidence needs to be investigated and reported. This research was designed to study the self-perceived preparedness of dental graduates and the impact of COVID-19 on this preparedness.


  Materials and Methods Top


Ethical approval to conduct the study was obtained from the School of Dentistry and the Academic Research Committee at the University, IRB number 19/2020/325. An on-line survey was designed by the research team in the English language since it is the teaching language in the dental school. The survey [Appendix 1] was self-designed and composed of multiple sections. The demographic section covered information on gender, GPA and status of the participants (student in his/her 5th year, dentist graduated in 2019, and dentist graduated before 2019). The next sections composed of questions about the confidence of performing 28 competencies in examination and treatment planning, restorative (operative, endodontics, and prosthodontics), periodontics, oral surgery, pediatric dentistry, and orthodontics. The last section had questions about communication skills and the impact of COVID-19 on participants' self-perceived confidence and preparedness. Four-point Likert scale was used to assess the student preparedness and confidence (extremely not confident, not confident, confident, and extremely confident). Responses of extremely not confident were allocated a score of one; (not confident) a score of two, (confident) a score of three, and (extremely confident) a score of four. The total score for the preparedness scale ranged from 0 to 120.

The survey was validated by an experienced professor in the school then tested by couple of participants. It was sent electronically through E-mail and other social media website like messenger and WhatsApp in May 2020 to 5th year students who were graduating in 2020 (n = 197) and to the ones who graduated in 2019 and they were doing their prelicensure training (n = 202) and to dentists who graduated between 2010 and 2019 (n = 90). The participation was voluntary and anonymous. The invitation letter was accompanied by a participant information sheet summarizing the aims of the study. Consents of the participants were obtained before they could start answering the survey. The survey was opened for the participants for 6 weeks. A reminder was sent after 3 weeks.

Statistical analysis was performed using the SPSS software for Windows release 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics including total preparedness score (TPS) were generated. Normality of TPS was tested by numerical (skewness, kurtosis, z values, and Shapiro − Wilk test) and visual outputs (Histograms, normal Q-Q plots, and Box plots). These methods showed that TPS was normally distributed, and therefore, Independent samples t-test, one-way ANOVA, and Bonferroni post hoc test were used to compare mean TPS between the different groups. For each competency, Chi-square and Fisher's exact tests were used to examine the differences between the different years of graduation. The significance level was stated as P < 0.05.


  Results Top


A total of 209 participants responded to the online questionnaire yielding 43% response rate. The study sample was composed of 82 (39.2%) dental students who were graduating in 2020 with a response rate of 42%, 64 (30.6%) dentists who graduated in 2019 and were doing their prelicensure training with a response rate of 32%, and 63 (30.2%) dentists who graduated before 2019 with a response rate of 70%. They were composed of 171 (81.8%) females and 38 (18.2%) males.

The mean TPS for the 209 participants in this study was 97.6 (standard deviation ± 9.7) with a range of 69–120. The mean TPS was not significantly affected by gender or GPA of the participants (P > 0.05). The mean TPS of the different classes of participants is shown in [Table 1]. The mean TPS was significantly affected by class of participants (P = 0.032); graduates before 2019 had the highest TPS followed by those graduated in 2020 and the lowest TPS was for graduates of 2019. However, this effect was mainly noticed when graduates of 2019 were compared with graduates before 2019 (P = 0.031). The differences in mean TPS between those who graduated in 2020 and who graduated in 2019 (P = 0.20) and between those who graduated in 2020 and who graduated before 2019 (P = 1.0) were not statistically significant.
Table 1: Descriptive statistics of total preparedness score according to class of participants

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The response of the different graduates to each competency is shown in [Table 2]. The response as four grades (extremely not confident, not confident, confident, and extremely confident) was compared. Graduates before year 2019 had significantly higher level of extreme confidence compared with other graduates in skills of examination, simple treatment planning, direct restorations, profound local anesthesia, examination and treatment planning on a pediatric patient, oral hygiene instructions and dietary advice for a pediatric patient, and extraction of a primary tooth. In contrast, graduates of 2020 had significantly higher level of extreme confidence compared with other graduates in skills of rubber dam isolation, root canal treatment for a molar tooth, secondary impression for complete denture patient, and bite registration for complete denture patient.
Table 2: The response of the different graduates to each competency

Click here to view


A significant percentage of graduates, regardless of the year of graduation, thought they were not confident in performing some competencies. These include surgical extraction (58.9%), clinical remount and insertion of a removable prosthesis (55.5%), oral cancer screening (54.1%), surveying and designing of a Co-Cr RPD (34%), comprehensive treatment planning including indirect restorations, removable prosthesis and implants (30.1%), suturing (29.7%), root canal treatment for a molar tooth (26.8%), bite registration for complete denture patient (24.4%), and crown preparation (20.1%).

The different graduates were also asked if COVID-19 impacted their level of confidence in performing general dentistry procedures. Of the respondents, 17.5% thought it had a severe impact, 42.2% thought it had some impact, 20.9% thought it had a marginal impact, while 19.4% thought it had no impact. The different years of graduation are compared, as shown in [Figure 1]. Of the graduates before year 2019, 55.7% thought it had some to severe impact on their confidence in performing general dentistry procedures. The highest prevalence of those who thought it had some to severe impact on their performance were those who graduated in year 2019 (73.4%), while the lowest prevalence of those who thought it had some or severe impact on their performance were graduates of the year 2020 (51.9%) (P = 0.024). This opinion was not significantly affected by gender or GPA of the graduates.
Figure 1: The impact of coronavirus disease 2019 pandemic on graduates' confidence in performing general dentistry procedures

Click here to view



  Discussion Top


In this study, three different classes were targeted; the 5th year dental students who were graduating in 2020, dentists graduated in 2019 and they were doing their prelicensure training, and dentists who graduated before 2019. All the groups had similar dental school curriculum except that the classes graduated before 2019 had 10% more clinical sessions in their training because the number of students per class was less compared to the graduates of 2019 and 2020 classes.

The design of the survey was extracted from the required competencies for graduation of students from the school of dentistry where this study was conducted.

The range of the TPS for all the participants is 69–120 with a mean of 97.2 is considered satisfactory. Differences in TPS were noticed between the classes. The highest TPS was found for the dentists who graduated before 2019. One of the reasons could be that neither their pregraduation clinical training nor their prelicensure training was affected by COVID-19.

Graduates before 2019 had higher level of confidence in multiple competencies compared to the other two classes. That could be related to the fact that those dentists have been practicing dentistry for multiple years. Their responses might have been influenced by their clinical experience in clinical practice. The concept of students considered themselves competent based on their previous experience of the task was mentioned previously in the literature.[24] In addition, the classes graduated before 2019 had 10% more clinical sessions in their training which could have slightly increased their level of confidence and preparedness. In the study conducted by Manakil, the authors found that 71.4% of students suggested that an increase of the number of clinical sessions would enhance their educational experience and yield more confidence.[25]

The results of this study showed that 12.2% of 2020 class, and around 6% of the other two classes perceived themselves as extremely not confident performing surgical extraction. This is one of the procedures which is considered complex and the new graduates usually do not have adequate confidence to perform.[7],[8] Those findings agree with D. J. Scho ̈Nwetter's findings where he reported that recent graduates were least confidence in implantology, orofacial pain, trauma, and surgical management and C. K. Y. Yiu findings where he concluded that there is an apparent deficiencies of training in oral and maxillofacial surgery in the institution where the study was conducted.[7],[26] Although the 2020 class lost 8 weeks of their clinical training due to COVID-19 pandemic and could not continue their surgical extraction competency, 32.9% of them felt confident and extremely confident performing such procedure, which could indicate students over estimating their abilities.

When reviewing the results on oral cancer screening, most of our graduates reported being not confident and extremely not confident performing this task. Fortunately, by the time, this manuscript was being prepared, the diagnostic science department introduced a special module in their curriculum to enhance the upcoming students' skills in oral cancer screening. Participants' low confidence level in oral cancer screening was also reported in a national study done in the UK and on another study done in Saudi Arabia.[10],[27]

Concerning removable prosthodontic tasks our students demonstrated lower level of confidence compared to restorative procedure tasks. That could be due to the lower number of clinical sessions of removable prosthodontic clinics compared to operative and fixed prosthodontic clinics. The high students' confidence in making secondary impression for a complete denture patient is most probably because it is the required task for the final exam of the removable prosthodontic clinic. Students tend to focus on this competency in particular to ensure doing it correctly in the final examination.

More than 90% of the participants of this survey reported being confident and extremely confident in the following modules: examination and treatment planning, restorative dentistry (profound local anesthesia, rubber dam isolation, direct restorations, and root canal treatment for a single root tooth), prevention and pediatric dentistry, periodontics, and communication skills. Those results suggest that dental graduates are prepared to perform the basic general dentistry procedures.

Around 60% of the participants reported that COVID-19 had some to severe impact on the level of confidence in performing general dentistry procedures. The lockdown that happened due to COVID-19 lead to almost 2 months loss of performing general dentistry. The impact affected all the classes of the participants with the highest impact on the dentists who graduated in 2019 and they were doing their prelicensure training (73.4%) and the lowest on the students who were graduating in 2020 (51.9%). The lower level of impact on 2020 class might be related to the possibility that students might be unaware of their proper level of clinical expertise. In addition, psychological impact of this pandemic on students' well-being and the stress of graduation during COVID-19 might also create a psychological defensive response from the participants who were graduating in 2020 affecting the accuracy of their answers about their confidence level. On the other hand, graduates with experience can better identify their strengths and weaknesses and could give more accurate answers regarding what they know and what they do not know. According to medical education literature, the process of oneself assessment is complicated, and by its very nature can never be objective or free from the beliefs and values individuals hold about themselves.[24] Therefore, self-evaluation instruments are best used to help individuals analyze their work practices and to promote reaction on performance. They should not be used to judge the accuracy of the individual's evaluation.[24] A good example on that is a study reported that graduates perceived their competency to be excellent in the four areas (treatment planning, community-based skills, management, administrative skills, and personal management; and professional development skills), on the other side, employers of those graduates felt that these are the areas that are of concern and needed attention.[28]

The highest level of impact reported by the 2019 class. Those participants might have been felt that the interruption which happened in their training did not allow them to work on their weaknesses as they planned.

More than half of the participants who graduated before 2019 reported that COVID-19 had some to severe impact in their confidence performing general dentistry procedures. This group neither their undergraduates training nor their prelicensure training was affected by the lockdown. The learning opportunity they missed is basically the continuing education practical courses which were cancelled due to the lockdown. The impact on the confidence can be due to the possibility that those dentists are exposed to a high psychological tension from the fear of getting infected with COVID-19 and transmitting the disease to their family members and between their patients and the stress that comes from the financial aspect of their career. In addition, the low level of some personal protection equipment knowledge among dental practitioners was reported. This can significantly increase dentists stress to practice dentistry in COVID-19 era.[29]

Interestingly, GPA of the graduates had no effect on the level of confidence of the participants. That could be explained by the fact that the GPA is cumulative from both of the didactic and clinical courses. As found in the dental literature, the correlation between the student's performance in the didactic and clinical courses is weak.[30] Furthermore, confidence can be directly associated with social skills and intelligence which is usually not precisely covered in the grading criteria.

There are multiple limitations of this study. One of the main limitations is the possibility that graduates before 2019 answers could be highly affected by the clinical experience they gained through their practice and not based on the skills they graduated with from the dental school. One more limitation is the low response rate from the students who were graduating in 2020 and the ones who graduated in 2019. The survey was conducted during the final examinations of the graduating students which could justify the low response rate from them.

According to the authors, the results of this study cannot be generalized on dental school graduates from different institutions because the required competencies for graduation vary between schools. However, the impact of COVID-19 on the preparedness of the graduates might be similar due to the lockdown and strict restrictions on aerosol-generating procedures followed by most of the countries worldwide.


  Conclusions Top


The graduates of the dental school felt confident in performing most general dentistry procedures after COVID-19 lockdown. COVID-19 pandemic negatively impact the confidence of all the classes of participants in performing general dentistry procedures even those graduated before 2019.

Modifications in our dental curriculum might be warranted for the competencies that demonstrated low level of confidence. Dental schools and organization must develop an intensive teaching courses and modules to overcome the impact of COVID-19 on dental students' and dentists' confidence and preparedness.

Acknowledgments

The research team acknowledge all the participants in this survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Appendix 1: The survey modules and questions Top


Demographics

What is your status

  1. Student who are graduating in 2020
  2. Dentist graduated in 2019
  3. Dentist graduated before 2019.


Are you a

  1. Male
  2. Female.


What is your GPA? (If you are student please provide your cumulative GPA)

  1. Excellent
  2. Very good
  3. Good
  4. Acceptable.


Examination and Treatment Planning

  1. Are you confident performing full mouth examination?
  2. Are you confident performing simple straight forward treatment plans?
  3. Are you confident performing comprehensive treatment planning including indirect restorations, removable prosthesis and implants?
  4. Are you confident performing oral cancer screening?


Restorative Procedure

  1. Are you confident performing rubber dam isolation?
  2. Are you confident performing direct restorations?
  3. Are you confident performing full-coverage crown preparation?
  4. Are you confident performing provisional restoration?
  5. Are you confident performing final impression?
  6. Are you confident performing randomized control trial (RCT) (access cavity, cleaning/shaping, and obturation) for a single root tooth?
  7. Are you confident performing RCT (access cavity, cleaning and shaping, and obturation) for a molar tooth?


Removable Prosthodontics

  1. Are you confident performing secondary impression for complete denture patient?
  2. Are you confident performing bite registration for complete denture patient?
  3. Are you confident performing clinical remount and insertion of a removable prosthesis?
  4. Are you confident performing surveying and designing of a Co-Cr RPD?


Oral and Maxillofacial Surgery and Radiology

  1. Are you confident performing profound anesthesia (nerve block and infiltration)?
  2. Are you confident performing simple nonsurgical extraction?
  3. Are you confident performing surgical extraction?
  4. Are you confident performing suturing?


Periodontology

  1. Are you confident giving oral hygiene instructions?
  2. Are you confident performing periodontal examination, diagnoses, and treatment planning?
  3. Are you confident performing supra and sub-gingival scaling?


Pediatric Dentistry

  1. Are you confident performing clinical and radiographic examination and treatment planning on a pediatric patient?
  2. Are you confident performing oral hygiene instructions and dietary advice for a pediatric patient?
  3. Are you confident performing fissure sealant on a first permanent molar?
  4. Are you confident performing restorations on a primary tooth?
  5. Are you confident performing extraction of a primary tooth?


Orthodontics

Are you confident recognizing teeth malalignment problem which needs an orthodontic treatment by an orthodontist?

Others

  1. How do you grade your communication skills?
  2. Are you confident referring your patient to a specialist when the required procedure is beyond your scope of skills and expertise?
  3. How would you rate the impact of coronavirus disease 2019 pandemic on your confidence in performing general dentistry procedures?




 
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