Competencies of Performance Appraisal in a Dentistry School: A 6-Year Study

Competencies’ Importance

Students ranked application of interpersonal and communication skills (3.1), practicing within one’s scope of competence and consultation with or referral to professional colleagues (2.2), evaluation of outcomes of comprehensive dental care (6.26), making alternative treatment planning for individual patients by incorporating many parameters (6.9) and demonstration for effective business, and financial management and human resource skills (5.4) as the top 5 most important competencies. It is noteworthy that students generally ranked competencies related with collaborative, interpersonal and interdisciplinary skills, and comprehensive dental care as important acquisitions. One reason for this may be that Dental Faculty has an integrated clinic that allows the student to evaluate and manage patients with a holistic approach. This facilitates students’ awareness of working in a collaborative attitude and capturing the significance of practicing in an interdisciplinary manner. Similarly, the holistic approach and comprehensive patient management provide the student with the opportunity to follow-up patients and evaluate treatment outcomes. The collaborative dental work also better implements the concept of taking patients individually and drawing a treatment plan including many variables. Koole et al. (2017) reported that differences existed in responses depending on the gender of the dentist. For example; female respondents scored obtaining and recording a complete history; identifying and managing anxiety and abnormal patient behavior; obtaining and interpreting radiography and awareness of own limitations and when to refer as the top important competencies significantly higher compared to males. These responses also show similarity with our study, although parameters such as gender or age were not recorded to confirm the anonymity. Our findings also show similarity to the results of Schönwetter et al. (2011) in which interpersonal-communication and basic clinical skills were ranked as the most important competencies.

Business, financial management, and human resource skills were also among the most important competencies. Furthermore, a discrepancy existed with respect to this parameter as students also reported it as a competency in which they feel low confidence. This issue was recently taken into consideration and the content of the “Practice management” course was modified. The course includes a wide range of issues related with the functioning of a dental clinic such as financial and legal issues, patient and staff interactions etc. It is coordinated by a renowned dentist and another unique aspect is the invitation of leading names in dentistry as guest lecturers. This enables the students to capture key points for successful management of a dental office by firsthand delivery of knowledge by individuals of proven experience and success.

Making clinical decisions taking into consideration clinical expertise, patient values, best research results, systematic reviews and evidence-based dental applications (6.10), ability to apply the knowledge and understanding of basic biological, medical and clinical sciences to every day real life and clinical situations (7.6), making suggestions regarding national oral and dental health system and health policies (4.6), having knowledge of the science of dental biomaterials and their limitations (7.5), and developing a catastrophe preparedness plan for the dental practice (5.7) were the competencies regarded as of lowest importance. Gerrow et al. (2006) reported that managing growth and developmental abnormalities received the lowest score. The authors further indicated that ranking of competency “ evaluation of the literature” was rather disappointing, and this should be an alarming sign for educators to focus more on the delivery of evidence-based dental education. Their results show similarity to ours in which best research results, systematic reviews, and evidence-based dental applications were among the competencies ranked as having relatively lower scores. These results suggest that further attempts should be made to emphasize the significance of evidence-based dentistry and the implementation of evidence-based knowledge into clinical practice. Currently, some departments assign students with different evidence-based topics pertaining to their discipline and ask them to make presentations by further literature search. This type of approach encourages the student to search and better assimilate established information. We anticipate that these attempts will be disseminated further within the dental school. In addition, although evidence-based information is continuously delivered through individual courses, there is not a single course dedicated to evidence-based dentistry only. A collaborative course with the contribution of all clinical departments can be planned to address this issue. One reason for students’ ranking basic medical sciences as of relatively lower importance might be the fact that they do not encounter patients with uncontrolled medical issues at the clinics. Only patients within a specific range of medical scale are admitted, thus students’ experience on the correlation between medical and dental issues is relatively limited. Consequently, they may not have adequate fundamental experience to capture the significance of this competency. Furthermore, correlation of basic and clinical sciences is a topic that has recently been focused in detail by the educators. Some attempts have been made in that respect such as the participation of clinical faculty in some basic sciences courses to give lectures during which they can assist students in comprehending the clinical relevance of the basic science course they received.

Making suggestions regarding national oral and dental health system and national health policies (4.6) was also regarded as having relatively lower importance. This might be due to the lack of student interaction with related governmental organizations. Future attempts to address this issue might include invitation of individuals associated with such organs to the dental school to deliver information regarding national health policies. Having knowledge of the science of dental biomaterials and their limitations (7.5) was also ranked as of relatively lower importance. The reason for such a consideration might be related with the fact that students select materials under the supervision of instructors, leading them not to have a full comprehension of the significance of this topic. Developing a catastrophe preparedness plan (5.7) was also underscored in terms of importance. Even though this is a very crucial issue, it is a topic that is not directly related with the dental profession itself; thus, students may have ranked it relatively lower and given more priority to professional and scientific competencies. To enhance students’ awareness, regular practices and operations are being carried out where students and staff practice the evacuation plan in the presence of a catastrophic incidence.

Students ranked adoption of lifelong learning and acquisition of the ability to make and execute plans for continuous professional development (2.3) as the competency in which they felt the highest confidence. In the study by Razak et al. (2008), professional development skills were also among the high-ranked competencies, similar to the results of our study. One of the major reasons for this finding might be that students are continuously encouraged to participate in scientific activities during their education, an example of which is the annual International Students Research days where students are assigned with a research topic to present at the annual congress. Meanwhile, periodically organized hands-on courses and seminars might also have contributed to students’ confidence in lifelong professional development.

Selecting, obtaining, and interpreting patient/medical data, including a thorough intra/extra oral examination and using these findings to accurately assess and manage all patients (6.4) was another competency in which students felt confident. It can again be speculated that the integrated clinic is the major contributing factor to this result as students are assigned with patients and complete all procedures in a comprehensive manner. Effective communication with pediatric patients considering every stage of their mental and emotional development and provision of necessary behavioral management (3.4) was also among the top-ranked competencies. Once again, the integrated pediatric clinic provides the students with the opportunity to gain experience by the completion of all dental procedures of the child patient. Keeping and protecting patient records, respect of patient privacy (2.4), and adherence to infection guidelines (6.12) were also ranked as highly important. Joint Commission International (JCI), a renowned organization for hospital quality and management, regularly audits YUFD; thus, the Faculty of Dentistry has very strongly established guidelines and policies for the maintenance of patient service quality on which students continuously receive education. Consequently, topics such as patient privacy, informed consent, and infection control are concepts that are firmly instilled and students’ high level of confidence is clearly reflected in the findings of the present study.

In the study by Honey et al. (2011), final year students were found to be most confident in simpler procedures and procedures in which they had most clinical experience and least confident in more complex procedures in which they were not experienced. Our findings show similarity with their results as students tend to display more confidence in clinical practices where they have adequate experience. Our results are also concurrent with the results of Rafeek et al. (2004) who determined taking an adequate medical history and oral examination among the highly ranked competencies and the report by Razak et al. (2008) where participants ranked treatment planning as one of the topics they felt highly competent.

One of the competencies in which students reported the lowest confidence was effective communication with individuals from diverse populations (3.3). One reason for this result might be the characteristics of our country’s population, which does not have many ethnical varieties. Despite this, attempts are made to evenly distribute patients with different medical conditions so that concept of diversity can be addressed from a different perspective. Prevention, identification, and management of oral trauma, oral diseases, and other disorders (6.3) were also reported as topics with relatively lower confidence. A similar result was reported by Schönwetter et al. (2011).

Lack of adequate knowledge and experience in the diagnosis and correct management of trauma among dental practitioners is actually a well-known and universal problem stated by some authors previously (Cınar et al., 2013; Krastl et al., 2009; Zhao & Gong, 2010). It is therefore not surprising that students report their self-confidence to be relatively lower due to the small possibility of encountering complicated traumatic incidences in their years of education. To compensate this, a multidisciplinary course entitled “Dental Trauma” has been integrated and conducted by the participation of different departments, which deliver the concept from their own perspectives. It is undeniable that reminder courses should be continuously taken following graduation so that knowledge will not be forgotten and dental practitioners will be well-prepared and at least have fundamental knowledge on emergency interventions during traumatic cases.

Demonstration of effective business, financial management, and human resource skills (5.4) was not only ranked as a highly important topic but controversially as one where students felt low confidence. Although the practice management course has been modified to address this issue, lack of experience in a real practice setting might be a reason why students do not feel prepared. Rotation of students in real dental clinics is not a common practice in our country but might be one strategy to enhance students’ self-esteem in practice management by witnessing the real atmosphere and functioning of a dental care delivery unit.

Prevention, diagnosis, and management of pain and anxiety (6.14) as confidence was also reported as relatively lower in terms of confidence. Recently, a multidisciplinary course entitled “Urgent treatment and pain management in dentistry” was implemented and covered emergency treatment approaches as well as topics focusing on the alleviation of pain.” Furthermore, students take rotations at the emergency cubicle at the student clinic to provide first aid for patients presenting with painful and urgent symptoms. Considering the lower result in terms of confidence despite these attempts, it is obvious that further action should be taken to address this important issue as management of pain and anxiety is one of the fundamental responsibilities of the dental practitioner and frequently an ability by which patients judge dentists. Management of orofacial pain was also rated as having relatively low confidence by Schönwetter et al. (2011).

Finally, having knowledge of the biological processes in the body to be able to exploit emerging biological technologies in clinical practice, especially in regenerative medicine (7.2) was a competency scored as relatively low compared to others. Newly emerging information is continuously integrated in the undergraduate curriculum with the efforts of the curriculum management committee, and regenerative procedures constitute a very significant proportion of innovative information implemented in various courses. On the other hand, methodologies such as regenerative procedures are generally delivered theoretically by the inclusion of case presentations during undergraduate years, whereas actual clinical practice is generally a part of post-graduate program. It is therefore expected that students might feel less confident in that respect. Meanwhile, it is also emphasized that challenging cases requiring innovative biological methods should be referred to a specialist who is more intensively involved with these procedures.

This study comprises information gathered from participants extending over a 6-year period and reflects the opinion of a group of individuals receiving dental education from a private institution. Some authors commented that although surveys in dental education are easy and practical means of collecting information, multiple factors might influence findings (Chambers & Licari, 2009). Thus, results of this study should definitely be interpreted with caution and must be regarded as a summary of the views of students in an international dental program over 6 years. It is equally obvious that further contributing studies performed in other dental schools in the country would contribute to making more concrete statements regarding the views of students on the existing dental educational model. It should also be kept in mind that competency-based education is a rather recently established concept in our country and not all dental schools might yet have defined their own competencies for the graduating dentist. Consequently, it may take some time for competency-based dental education to be established before we can draw comparisons between dental schools. Nevertheless, this study highlights the views of the recent graduates of the first private dental school in our country and it is anticipated that it will serve as a guide to other institutions in determining the competencies they wish to implement in their students before graduation.