The present study explored self-reported competence by new dental graduates in Saudi Arabia. While preparedness of dental graduates from several countries is reported, there is limited data to gauge the preparedness of Saudi Dental graduates. A safe dental practitioner recognises their limitations and seeks assistance upon encountering them [15]. Thus, ascertaining attributes of low competence could then be used to highlight areas that need improvement in a dental curriculum to conduct safe dental practice [3]. Examples include adopting a student-based learning approach (e.g. flipped and problem-based learning), providing a supportive environment for learning (e.g. counselling and feedback/feedforward), and promoting the lifelong learning skills of students/future dentists (e.g. critical thinking), training staff and mentors [3, 16, 17].
In comparison with other similar studies, the participants presented similar mean self-reported preparedness (DU-PAS) total score of 79 to that found among final-year dental students in Malaysia [79] [18], but slightly higher than reported by a similar study in Pakistan [65] [19]. Also, the mean score given by participants for clinical skills items (DU-PAS part A) was similar to that reported in Mat Yudin et al. [2020] study. Similar to other studies [18–20], a high self-reported competence noted in conducting basic dental work independently (e.g. obtaining medical history, prescribing and interpreting radiographs, caries control and using tooth coloured fillings). Similarly, a lower competence was noted presently as well as in these studies with more complex clinical tasks such as performing endodontic treatment of multirooted teeth, assessing orthodontic treatment needs, prescribing medications
However, other studies noted lower independence scores for undertaking periapical and bitewing radiographs [19] and interpreting radiographic findings [20].
A general dental practitioner's low confidence in formulating a treatment plan may act as a deterrent to providing specific interventions [21], which might be encountered among the 35% of present participants who indicated no experience or needed help to formulate a comprehensive treatment plan. This was demonstrated by participants in the present study, who indicated improving treatment planning skills as a goal for the internship year [P27 and 31]. Furthermore, around 35% of 106 dental graduates in Malaysia noted a low level of preparedness regarding oral rehabilitation [17]. This is likely to be mirrored presently with 45 and 51 out of the 82 study participants indicating no experience or need help to provide sound partial or complete dentures, respectively.
The reported low-competent tasks and procedures can be addressed by employing case and simulation-based training using virtual reality and physical simulation exercises to improve psychomotor skills in the pre-clinical courses. Examples include using hardware simulators and stereoscopic 3-dimension glasses and augmented reality headsets for complex operative and surgical procedures and software simulations like that used for aviation safety exercises [22, 23]. For medication prescription, there is a need to implement the generic [24] and dental [25] or antimicrobial-related [26] prescription guidelines and checklists within the curriculum and electronic health systems to maintain a practical usage and safe and error-free dental prescriptions.
Regarding the behavioural and cognitive attributes (DU-PAS part B), self-reported preparedness scores were notably lower than those presented to clinical skills. None of these attributes was scored as "always" by 80% or more of study participants presently and among other studies [18, 19]. Although, some attributes obtained slightly higher "always" scores compared to a recent study that included 245 final-year dental students [18]. For instance, communicating with colleagues, referring patients with complex treatment needs and recognising personal limitations (> 77% and < 70). Both studies indicated similar areas of low preparedness for managing children's behaviour and anxious individuals, evaluating new dental materials, and interpreting new research findings. Accordingly, the participants indicated their goals of the internship to improve both clinical and research skills [P04], learn about interpreting [P82] and implement research findings [P13].
Other studies also suggest that many dental graduates may find difficulties in implementing evidence-based clinical practice [18, 27]. This might be attributed to the limited ability to search, access and critically appraise the literature [28, 29]. Barriers to implementing an evidence-based care approach could be related to patient factors (e.g. access to health information and financial aspects), health care service team and provider (e.g. availability of clinical decision-making tools) and literature (e.g. complexity and actionability of clinical guidelines) [30].
Dental schools may therefore consider using big data analysis to analyse the student's performance and present predictive conclusions to provide efficient patient care tailored to needs and expectations [31]. Examples can include clinical information data repositories, such as BigMouth Dental Data Repository [32], accessed and analysed by dental students to maintain evidence-based dental care. Nevertheless, using these data sets to inform dental practice and optimise clinical outcomes is presently limited due to their inadequate availability for oral health research [31]. Thus, dental educators could reduce this gap by developing interdisciplinary information technology courses or assignments to support the student's capacity to access and appraise oral health research needed to solve the day-to-day clinical queries [29].
Moreover, around 30% of respondents of both studies indicated no experience referring patients with suspicious oral lesions, which could affect the early detection of these lesions and their malignant transformation [33]. Thus, dental educators may consider integrating the evidence from systematic reviews regarding the diagnostic accuracy of clinical assessments for oral suspicious lesions [34] with new trends in oral cancer risk calculation to recognise high-risk individuals. Based on the demographics and clinical information these tools can assist risk stratification by dental students and graduates to avoid "false alarm" and the unnecessary use of health care resources [34, 35]. Image classification algorithms and tele-diagnosis tools of oral mucosal suspicious lesions, which can inform clinicians when to refer or not refer [36, 37], can also be incorporated into dental curricula.
The present study is limited by using self-reported views of preparedness with no objective assessment of competence, performance, or knowledge. However, the instrument used (DU-PAS) was developed using qualitative methods. The Rasch model demonstrated its adequate construct validity and test-retest reliability [18–20]. Moreover, the relatively low response rate of 65% was comparable to those reported in similar quantitative studies of 60% [17] and 66% [5]. Another limitation was the lack of items assessing the competence to manage patients with dental/medical emergencies and special needs and report neglect, as noted in a mixed-method study to determine the preparedness for dental practice in Australia [2].
Dental educators may consider qualitative methods (e.g. in-depth interviews) and the available measures along with DU-PAS to gain a deeper understanding about the perceptions, experiences and recommendations by relevant stakeholders. For instance, a 11-item trainer-rated instrument (rated by 10 cm visual analogue scale) was develop and validated specifically to assess the dental student's performance for dental extraction [7]. Also, researchers at the University of Liverpool have recently developed a 19-criteria tool to assess the complexity of root canal treatment based on three tiers: class I (complicated), class II (moderately complicated) and class III (highly complicated) [38]. The competence of dental graduates/students to implement evidence-based practice specifically can be assessed using generic measures such as Berlin Questionnaire or its revised version for evidence-based dentistry [39]. Future studies may also consider comparative analysis between self-assessment, trainer assessment and peer assessment of performance, which is another reliable quality assurance of learning and professional development as autonomous trainee and practitioner [40].