In recent years, there has been an increase in the number of dental schools around the world with heterogenous standards of their undergraduate teaching curriculum, years of training, and numbers of qualified teaching faculty members. [4, 7, 8] As a result, this makes it difficult to have a recognised standardisation across dental schools. A study by Lee et al. demonstrated that the dental students’ undergraduate grades and their scores on the standardised dental admission test were poor predictors of performance on assessment examination that are used for residency admission in Oral and Maxillofacial Surgery.  A major part of any dental school curriculum relies on helping the students acquire predefined clinical competencies and technical skills, and many consider the mastery of these technical skills to be of the highest importance in clinical practice. [3, 6] Thus, one of the major objectives of any dental school curriculum lies in attaining clinical competency and the required self-confidence by the students.  Student self-assessment of their own knowledge and level of confidence and knowledge to complete clinical technical skills has been previously used in the field of dentistry and oral surgery. [1-4, 7-10, 12-15]
Given that the department of Oral and Maxillofacial Surgery at Kuwait University is a fairly young one, and has commenced its teaching activities in 2002, such a feedback from the students is of paramount importance to us to refine our teaching goals and competencies. The response rate seen in the studies reflects the interest of the students to voluntarily assess their undergraduate OMFS teaching in preparation for their entry in the dentistry practice. Table 1. The majority of the dental students were females, which indicates the overall interest of the female students in Kuwait to embark on a career in the field of dentistry. Even though the class sizes are small, the responses of the students were regarded as promising as they feel confident that they have enough knowledge to undertake independent practice (61%). Overall, when assessing their readiness to undertake private practice and perform extractions with forceps and minor oral surgery procedures, the scores were favourable and being in line with previous studies utilising the same survey instrument. [3, 4, 7-10]
When assessing their technical skills to extract an upper single-rooted tooth with an intact crown, both the 7th and 6th-year students felt confident that they could (94.7% and 90% respectively). In addition, both groups were also confident that they could remove visible retained roots of an upper left first molar with elevators or forceps (84.2% and 65% respectively). This finding was different from a previous study by Burdurlu et al., in which the upper class reported being more confident than their counterparts in the year younger.  This could be due to the fact that dental students at Kuwait University undergo a more extensive teaching curriculum due to a longer study period, where dentistry studies take seven years, with the last 2 and ½ years being considered as clinical years, whereas in the study by Burdurlu et al., the study program was of five-year duration. Nevertheless, the responses between the 7th year and 6th year students were statistically different when reporting their level of confidence for performing surgical procedures, ranging from raising of a mucoperiosteal flap, to sectioning of teeth, to bone removal, to wound closure and suturing, Table2. This, however, was in line with other studies which reported relatively less self-confidence in conducting surgical extractions [4, 8, 9, 14]. Responses about the level of confidence in diagnosing and managing acute pericoronitis, assessing impacted third molars, or managing haemorrhage from a socket were more favourable than recognising benign and malignant conditions, or differentiating pain origins, or writing detailed referral letters to other specialists, Table 2. This was also following the same pattern in the previous studies by Cabbar, Burdurlu, and Macluskey. [7-10] One explanation to why most students score relatively low in their confidence to conduct surgical extraction is that it is considered the most invasive procedure across the whole spectrum of dental procedure which the students get exposed to during their dental school training, and even if they are clinically competent as dentists, they feel intimidated by it. [9, 16]
When assessing anatomical knowledge, the responses from the students indicate that their teaching was sufficient to prepare them to face oral surgical clinical scenarios, and the response was not statistically significant between sixth- and seventh-year students. This maybe is because the students receive extensive didactic OMFS teaching in their clinical years with a strong emphasis on clinical head and neck anatomy. The importance of instilling constant anatomical knowledge during dental education to help with the consolidation and retention of the clinical grasp was previously advocated by Thomas et al. [8, 17] The fact that both classes disagreed unequivocally to the item that only anatomical knowledge needed for oral surgery is that of jaw and tooth morphology shows a maturation of their understanding that general anatomy knowledge is of paramount importance when treating patients or performing oral surgical procedures. The role off-campus learning needs to emphasised in our teaching, to increase the exposure of the students to the more complex procedures that are not heavily emphasised in the dental school’s clinic.
In our study we found that students in both junior and senior clinical years have sufficient level of confidence to perform extractions by the use of forceps, and a good higher level of confidence when diagnosing conditions commonly seen in oral surgery practice, such as management acute pericoronitis, manage haemorrhage from a socket, assessing impacted teeth, and recognising the clinical features of potentially malignant and malignant lesions of the oral cavity. However, both classes showed a lower level of self-confidence in performing more invasive procedures such as raising of a flap, sectioning of teeth and bone removal, and wound close with suturing. This prompts us to put more emphasis on our hands-on training sessions, utilising phantom heads in oral surgical education, assisting in the major surgical procedures, and utilising novel models to conduct these surgical procedures which are considered to be essential for dentists wanting to practice the whole spectrum of general dentistry in clinical practice.