Theses and Dissertations (Dental Management Sciences)

Permanent URI for this collectionhttp://hdl.handle.net/2263/32501

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Assessing undergraduate dental students' exodontia competencies by employing a novel continuous assessment instrument
(University of Pretoria, 2018) Postma, Thomas Corne; u83122738@tuks.co.za; Merbold, Karl-Heinz
Background Universities are obliged to ensure that health professions graduates are competent to render safe and effective treatment. Unfortunately, empirical evidence of competence development is lacking, especially at undergraduate level. Hence, this study aimed to provide empirical evidence of dental students’ development of independence in exodontia (tooth extractions) following task-level feedback in relation to achievable targets. Summary of work This entails the implementation of a novel workplace-based assessment instrument in the Module: Oro-facial Surgery, School of Dentistry, University of Pretoria. Thirteen trained clinical supervisors guided by the primary researcher assessed 28280 tooth extractions performed by fourth and fifth year dental students (2014-2016). Quarterly task-level feedback was provided to students on their ability to independently perform tooth extractions using “Independence ratios” (IR=extractions performed without assistance/total number of extractions) as key performance indicator. A customised Level of Difficulty Index (LDI) (<2=easier than standard; 2=standard; >2=more difficult than standard) was used to control for difficulty level attained. Based on 2014 data, minimum targets of 80% and 90% independence were, respectively set for fourth and fifth year students. Feedback aimed to increase the number of students who achieved targets. Only very low performing students were subjected to targeted intervention. Remaining students were left on their own to progress. Dijksterhuis’ model of progressive independence and Zimmerman’s model of self-regulated learning, served as conceptual models for analysis of structured student narrations (BChD IV 2015-2017) to evaluate the instrument. Summary of results Respective mean IRs (SD), (Ranges: IR; LDI; EC) for the 2014 (n=42), 2015 (n=51) and 2016 (n=62) BChD IV cohorts were 85% (SD: 6%) (Ranges: IR=73-95%; LDI=1.9-3.3; EC=57-232), 85% (SD: 5%) (Ranges: IR=71- 97%; LDI=1.8-3.1; EC=65-261) and 88% (SD: 4%) (Ranges: IR=74-94%; LDI=1.6-3.9; EC=55-140). The 2014 BChD V cohort (n=58) eventually achieved a mean IR of 90% (SD: 5%) (Ranges: IR=79-100%; LDI=2.2 - 4.4; EC=27-168). For the respective 2015 (n=37) and 2016 (n=51) BChD V cohorts these performance indicators increased to mean IRs of 92% (SD: 4%) (Ranges: IR=78-98%; LDI=1.8-4.7; EC=65- 219) and 94% (SD: 3%) (Ranges: IR=86-100%; LDI=1.6-4.3; EC=65-150). Students (BChD IV 2014) who achieved 80% independence increased from 60% after mid-year feedback to 81% at the end of the year. The 2015 and 2016 cohorts respectively improved from 67% to 86% and 56% to 97%. BChD V 2014 students who achieved 90% independence, increased from 40% after mid-year feedback to 48% at the end of the year. The 2015 and 2016 cohorts’ improvements were 57% to 65% and 82% to 88%, respectively. Assessment differences were generally small among assessors and could be explained by operational circumstances. The qualitative analysis using the Dijksterhuis model revealed that trainee factors, supervisor factors, the professional activity and the working environment impacted significantly on assessment results. Another analysis using the Zimmerman model revealed that most students were self-regulated learners who set independence targets for themselves. Only a few students showed limited progression. Discussion & Conclusions IR appears to be a useful indicator of clinical competence as gradients of increased independence were illustrated over time. IR measurement was sensitive enough to distinguish between low and high performing students. Target introduction in 2015/16 coincided with increased independent practice compared to 2014 baseline data, suggesting a catalytic effect of assessment. Achievable objectives should accompany task-level feedback to facilitate competence development. Methods employed may be transferable to other disciplines.
Assessing the need for management and leadership training in Dentistry in South Africa
(University of Pretoria, 2018) Van der Berg-Cloete, S.E.; Postma, Thomas Corne; bunmisnest@yahoo.com; Tukuru, Michelle Olubunmi
The main aim of this study was to assess the need for management and leadership training in dentistry in South Africa (SA). The study also explored stakeholders’ opinion about the most important non-clinical skills to teach dental students and how management and leadership training could best be developed and implemented in dentistry in SA. The design of the study was a qualitative research to understand the participants’ perceptions of leadership and management training. The sample included fourteen senior managers in the dental environment as well as eleven recently qualified dentists in South Africa. One-on-one and telephonic interviews were conducted. Interviews were recorded and data were entered into a Word document and analysed. All ethical requirements were addressed. The study was voluntary and participants signed a consent form to participate in the research. The key findings of the study confirmed that participants were negative about dentistry in SA and agreed that strong leadership was necessary. Management and leadership training in dentistry in SA was therefore seen as utmost important. Participants also agreed that the training should start in the undergraduate level and follow through to the postgraduate level. The results of this study provides valuable information about the need for management and leadership training in dentistry and how it best could be delivered in the South African context.
Evaluating the impact of adjunctive integrated case-based dental teaching and learning on clinical reasoning in a discipline-based teaching and learning environment
(University of Pretoria, 2013) White, John George; Snyman, Willem D.; corne.postma@up.ac.za; Postma, Thomas Corne
Problem-solving and integration of knowledge are key objectives of the undergraduate dental curriculum of the School of Dentistry, University of Pretoria, which aims to develop the clinical reasoning skills of students. For practical reasons the School provides discipline-based teaching and learning, which, according to the literature, might limit a student’s ability to integrate knowledge during clinical reasoning processes. The literature suggests that problem-solving by means of case studies – an active teaching and learning strategy– might be a useful method to develop and integrate knowledge at undergraduate level, and that earlier exposure to clinical cases might assist in the attainment of clinical reasoning skills at an earlier stage. Hence, this action research study describes the planning, design, implementation and evaluation of a “new” Comprehensive Patient Care curriculum over a three-year period (2009 - 2011) based on Kern’s “six-step approach to curriculum development”. The new curriculum employs an adjunctive integrated case-based approach according to the principles described in the “Four Component Instructional Design Model” and a new variant of the so-called “progress test”, starting already in the preclinical (third) year of study, to develop and test students’ clinical reasoning skills over time. The exit-level progress test results of dental students who had been taught by following an adjunctive integrated case-based approach were statistically analysed, using mixed model statistics, and were compared with the clinical decision-making skills of cohorts who had been taught by following the traditional discipline-based approach. These analyses were complemented by bivariate and multivariate quantitative analyses and qualitative student feedback (mixed methods). The validity of the progress test results was also examined by comparing the results of different cohorts. The fifth-year cohort who had been exposed to integrated case-based teaching and learning from their preclinical year performed significantly better in the progress test at exit level than the cohorts who had received only discipline-based teaching and learning, even when controlling for previous academic performance. These findings were supported by the quantitative and qualitative feedback that students gave about the educational processes that were followed. The progress test performed reasonably well as a measurement tool and all the differences that were measured between the different cohorts could be explained logically. Case specificity posed the biggest threat to the reliability of the test. The results suggest that integrated case-based teaching and learning, commencing in the preclinical study years, might be a useful intervention to improve clinical reasoning ability at exit level in dental schools such as the School of Dentistry, University of Pretoria that follow a discipline-based approach. The results of this action research study provided particularly useful information, which will allow further improvements to the educational intervention. The results of this study require further research to substantiate the findings beyond doubt.
Effect of Cyclosporin and Amlodipine on growth and collagen production of human gingival fibroblasts
(University of Pretoria, 2006-04-07) Botha, Stephanus Johannes; upetd@up.ac.za; Varnfield, Marlien
Drug-induced gingival overgrowth is a disfiguring condition that is a side effect encountered in susceptible responder patients common to three groups of drugs - immunosupressants, calcium channel blockers and anticonvulsant agents. The altered overgrown gingiva can be aesthetically displeasing but in severe cases it can cause functional problems and such patients may eventually require excision of excess tissue. The underlying mechanisms that mediate drug-induced gingival overgrowth is uncertain and the various investigations into the pathogenesis of this disease suggest that it is multifactorial. This study investigated the effects of exogenous addition of cycJosporin and amlodipine on the growth and proliferation of human gingival fibroblasts and the production of collagen by these cells. Results showed that these drugs have a direct stimulatory effect on the gingival fibroblasts of responder patients in vitro and there seems to be a synergistic effect between the two drugs. Findings of this study have important relevance as it suggests that fibroblast proliferation and collagen production must play a significant role in the pathogenesis of drug-induced gingival overgrowth.

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