A study to evaluate the effectiveness of competency-based training program for the dental interns of a tertiary care center in Jaipur city

Kopal Sharma; Amit Sharma; Kanu Neemawat

doi:10.4103/cjhr.cjhr_60_19

ORIGINAL ARTICLE

Year : 2020 | Volume : 7 | Issue : 2 | Page : 110-114

A study to evaluate the effectiveness of competency-based training program for the dental interns of a tertiary care center in Jaipur city

Kopal Sharma¹, Amit Sharma², Kanu Neemawat³
¹ Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
² Department of Oral and Maxillofacial Surgery, Rajasthan Dental College, Jaipur, Rajasthan, India
³ Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India

Date of Submission	25-May-2019
Date of Decision	07-Jul-2019
Date of Acceptance	22-Nov-2019
Date of Web Publication	8-Oct-2020

Correspondence Address:
Amit Sharma
Department of Oral and Maxillofacial, Rajasthan Dental College, Jaipur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/cjhr.cjhr_60_19

Abstract

Background: The purpose of our study was to ascertain the effectiveness of competency-based training model for dental interns. Materials and Methods: This competency-based integrated training program was conducted for the dental interns of a dental college in Jaipur city. Clinical vignettes, interactive video lectures, webinar sessions, group discussions, and multiple-choice questions were the components of our training module. The whole program was divided into five modules, which were planned meticulously to achieve five different learning objectives. Before starting each module and at its completion, the students were evaluated for their performance by the same multiple-choice questions and the feedback of the students was taken. Results: The respondents included 8 (16.67%) males and 40 (83.33%) females, with a mean age of 22.34 ± 0.78 years. An increase in overall mean score was found in the posttest for all the five modules, and this was statistically significant with P < 0.001 using the Wilcoxon signed-rank test. Conclusion: Competency-based training program for the dental interns was very effective in training them various skills and knowledge that cannot be merely achieved by traditional teaching methodology. More integrated programs are warranted for dental undergraduates to train them to become a skilled practitioner.

Keywords: Competency-based modules, dental interns, integrated teaching

How to cite this article:
Sharma K, Sharma A, Neemawat K. A study to evaluate the effectiveness of competency-based training program for the dental interns of a tertiary care center in Jaipur city. CHRISMED J Health Res 2020;7:110-4

How to cite this URL:
Sharma K, Sharma A, Neemawat K. A study to evaluate the effectiveness of competency-based training program for the dental interns of a tertiary care center in Jaipur city. CHRISMED J Health Res [serial online] 2020 [cited 2020 Dec 1];7:110-4. Available from: https://www.cjhr.org/text.asp?2020/7/2/110/297582

Introduction

Contemporary dental curriculum in India is deviating from its goal of imparting practical skills alongside the boosting of theoretical knowledge in the students.^[1] As a results, every year we are producing mere cramming parrots which are lacking competence and facing redundancy.^[2] Dental curriculum till date is not sufficiently at par when it comes to either integrating medical participants with the clinical dentistry or implementation of comprehensive patient care as a model of clinical education.^[3] Few noteworthy characteristics which differentiate competency-based education from traditional teaching techniques include integral curriculum components planned to meet the societal needs, student-driven learning, and minimal focus on time-based training and numerical targets.^[4]

The irony is that we keep on teaching the students about various oral diseases and their management from the 2^nd year onward in pharmacology and even in oral medicine during the final year; still, we face the challenges of wrongly prescribed antimicrobials for various dental conditions. Antibiotics resistance, medication errors, and undue hospitalizations due to serious drug interactions are all the aftermaths which ensue.^{[4],[5],[6],[7]}

To overcome these shortcomings, we devised and tested a new module for the interns for the initial 1 month of entering followed by routine chair-side intern training emphasizing evidence-based dentistry.

Materials and Methods

This competency-based training program was designed for the intern students of a tertiary care center in Jaipur city for the year 2018.

Ethical approval to design and implement the same was conducted by the Institutional Ethics Committee of the institute. The students were explained the objectives of the program and how it could benefit them. Only those students who volunteered to participate and gave their informed consent were recruited. The following steps were followed:

Step 1: Revamping the shortcomings

Determining the learner needs

An in-depth analysis of the summative performance of the final-year dental students of the college was done, and the students were approached in groups to identify the major areas where they face the deficiency of knowledge and skills. Thereafter, an intensive program was planned to bridge the gap in the areas where the knowledge of the students' needs to be enriched further.

Step 2: Laying out various competencies for the training program and defining the learning objectives

The primary focus of our study was building the expertise of the interns for various competencies such as:

Rational prescribing practices for common dental conditions
Dealing with medical emergencies in dental practices
Considerations regarding the dental treatment of special patients
Drug interactions commonly encountered in dental clinics.

Upon completion of this training program, the participants should be able to write a rational prescription for the common oral diseases for a healthy patients as well as for the patients with associated diseases, choose an appropriate generic drug for the patient from the list of P-drugs, manage the medical emergencies if encountered in clinics, should be able to perform the dental treatment of patients with associated diseases, and should be able to identify the potential drug interactions and avoid prescribing such combinations. Furthermore, the participants should develop a continuing learning-based approach.

Step 3: Learning strategies

Clinical vignettes, interactive video lectures, webinar sessions, and group discussions were all the components of this training program [Appendix 1]. The whole program was divided into five modules which were planned meticulously to achieve each learning objectives [Table 1]. Each module was allotted a time of 1 week.

Table 1: List of activities and sessions undertaken to achieve various learning objectives

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Step 4: Evaluation

The test-centered approach was adopted for evaluating the participant's performance and program effectiveness. Before starting each module and at its completion, the students were evaluated for their performance by the same multiple-choice questions. After the posttest, the facilitators discussed the correct answers to the multiple-choice questions and the feedback of the students about the module was also taken.

The collected data were analyzed using (SPSS for Windows, version 16.0 SPSS Inc., Chicago, USA), Excel 2007. Statistical significance was evaluated using two-sided P value at a 5% level of significance.

Results

A total of 50 interns were approached for the study. There were two dropouts, so the sample size of 48 was used for the statistical analysis. The respondents included 8 (16.67%) males and 40 (83.33%) females, with a mean age of 22.34 ± 0.78 years. An increase in overall mean scores was found in the posttest for all the five modules, and this was statistically significant with P < 0.001 using the Wilcoxon signed-rank test [Table 2].

Table 2: Comparison of mean scores of the participants before and after each module

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The analysis of the scores for different modules separately reflected that the highest increase in scores was observed in the fifth module, which trained the students about different drug interactions pertinent to dentistry. The responses of the students were in agreement for most of the items in the feedback and 93.75% of them feel that such programs should be conducted in future for dental interns [Table 3].

Table 3: Distribution of the students according to their responses in the feedback of the program

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Discussion

The current system of medical and dental undergraduate training in India is designed on a summative pattern and also lacks the opportunity for student's feedback. The students often face a dilemma to apply their knowledge for practical implications to provide health needs of society.^[8] The pharmacology is taught to the students as system-wise pharmacotherapy, with a result, the training on rational drug use in clinical settings remains untouched.^[9] Many previous studies have reported irrational prescribing practices in dentistry and have claimed it as the root cause of wide spreading antimicrobial resistance presently.^[10],[11] This justifies the reason for training the students about rational prescribing practices and prescription writing for common dental diseases. The positive impact of our training module for prescription writing is evident by the refined posttest performance of the students.

Fixed-dose combinations (FDCs) are part and parcel of prescriptions even in dental settings. However, it is a harsh fact that irrational FDCs have flushed the dentist's prescriptions as well.^[12] To train the interns about the irrationality of various FDCs is, therefore, justified. Reinforcing the P-drug concept in interns through clinical vignettes exercises will generate logical thoughtfulness and will help them in future preparedness.^[13] Learning by clinical vignettes, the students were able to correlate the pharmacotherapy of disease to the signs and symptoms in clinical settings. This could be appreciated by the higher scores of the students in posttest for these objectives.

Medical emergencies occur more frequently in dental practices with the increasing rate in the elderly and medically compromised patients.^[14] Previous studies suggest that dental undergraduates lack the skills of handling medical emergencies due to inadequate training.^[15],[16] Our program trained the students in skills required to implement the treatment of patients with systemic diseases and to deal with common medical emergencies in dental practices. Drug interactions often occur in dentistry, and hence, educational strategies such as drug interactions knowledge and pharmacovigilance of drug interactions are very essential components of undergraduates training.^[17] The module on drug interactions greatly improved the knowledge of the participants about common drug interactions. The positive feedback of the students for the program further suggests that such competency-based teaching programs boost the confidence in the students and provide a common platform to them to develop practical and rational approach for the treatment planning before they face real challenges as practitioner.

If students are trained through such competency programs in India, the quality of dental education will be uplifted as in Western countries. Although the Medical Council of India has already approved such competency-based training for medical students,^[18] so the same could be planned for dental students as well. The limitation of this study is that only interns were allowed to participate in this training program. The reason was to train the interns first to imply the knowledge acquired in all the undergraduate years of their training for better patient care. More of such competency-based programs integrating the medical and dental participants can be designed for each semester students so that they learn to develop logical thinking and diagnostic approach.

Conclusion

Although this study was just an elementary step to evaluate the success and effectiveness of competency-based program for the dental interns, the students had positive feedback for it. The mean scores of the students improved significantly after each training module. By conducting more of such programs, the students could be trained to strive for successful, skilled dental practitioner.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Appendix

Exemplar clinical vignette:

Q1. A twenty five year old male patient with non contributory medical history attended a dental OPD. She complained of pain and progressive swelling in the lower right jaw. On clinical examination facial asymmetry was observed in the right cheek region. Lower right first molar had a painful response to percussion and was nonresponsive to the pulp vitality test. Periodontal probing was within the normal limits. Radiographic examination revealed periapical radiolucency.

1) What could be the diagnosis this patient?

a) Acute periapical abscess b) Chronic periapical abscess c) Pericoronitis d) Acute periodontitis

2) What will be the line of treatment for this patient?

a) Start antimicrobial therapy b) Prescribe Non-steroidal anti-inflammatory drug for this patient

c) Endodontic management only d) Endodontic management with antimicrobial therapy

3) Is the combination of Diclofenac and Paracetamol rational for this patient?

a) Yes b) No c) Can't say

4) Is the combination of Diclofenac and Serratiopeptidase rational for this patient?

a) Yes b) No c) Can't say

5) Prepare a list of P-drug for this patient.

Q2. A 39 year old female patient becomes unwell and apprehensive, holding her chest and complaining of palpitation during crown preparation on her lower first molar. She had been given an infiltration of 1 ml Lignocaine 2% with adrenaline 1:80 000 and further a 2 ml cartridge to give an inferior alveolar and lingual nerve block before to complete the procedure. Medical history of the patient didn't show any records of allergies.

a) What will you do?

b) Is this a vasovagal attack. Explain why?

c) Is this myocardial infarct?

d) What is your differential diagnosis and why?

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