In recent years, there has been an increase in the number of dental schools around the world with differing standards of undergraduate teaching, the number of years in training, and the numbers of qualified teaching faculty members [4, 7, 8]. This makes it difficult to compare graduates from these dental schools. A study by Lee et al. demonstrated that undergraduate grades and scores on the standardised dental admission test are poor predictors of performance in examinations used for residency admission in OMFS [11]. A major part of any dentistry curriculum relies on helping 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, clinical competency and self-confidence in one’s abilities are the primary objectives of any dental school curriculum [3]. Self-assessment of students’ knowledge and confidence to complete clinical skills have previously been used in the field of dentistry and oral surgery [1-4, 7-10, 12-15].
Given that the department of OMFS at Kuwait University is a relatively new one (established in 2002), feedback from students is of paramount importance to improve the quality of teaching delivered in the department. The high response rate seen in this study reflects the interest of students to voluntarily assess their undergraduate OMFS teaching in preparation for their entry in the dentistry practice. 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%). This is even greater (78.9%) when considering just those in their final year of university.
Overall, when assessing readiness to undertake private practice and perform extractions with forceps and minor oral surgery procedures, confidence scores were favourable and similar to previous studies utilising the same survey instrument [3, 4, 7-10].
Both the 7th and 6th year students reported confidence in extracting an upper single-rooted tooth with an intact crown (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 study by Burdurlu et al., in which the older class reported being more confident than those in lower year groups [8]. This may be due to the fact that dental students at Kuwait University undergo a more extensive teaching curriculum with a longer study period, where dentistry studies take seven years (with the last 2 and ½ years as clinical years), compared to the study by Burdurlu et al., where the study program was of five years duration. Nevertheless, the responses of 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, sectioning of teeth, bone removal, wound closure and suturing (Table2). This 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, differentiating pain origins, or writing detailed referral letters to other specialists (Table 2). Similar findings were also demonstrated in the studies by Cabbar, Burdurlu, and Macluskey [7-10]. One explanation to why most students score relatively low in confidence in conducting surgical extractions is that they are considered the most invasive procedure that students are exposed to during their dental school training, and even if they are clinically competent as dentists, they may feel intimidated by it [9, 16].
When assessing anatomical knowledge, the responses from the students indicate that their teaching was sufficient to prepare them for OMFS clinical scenarios, and the responses were not significantly different between 6th and 7th year students. This maybe is because the students receive extensive didactic OMFS teaching in their clinical years with a strong emphasis on head and neck anatomy. The importance of instilling constant anatomical knowledge during dental education to help with consolidation and retention of the clinical knowledge was 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.
Just 59% of students reported that they had the opportunity to gain experience in dental centres off-campus. This gave students the chance to perform more simple extractions with some being allowed to perform surgical extractions. The role of off-campus learning needs to be emphasised in our teaching, in order 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 year groups 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 hands-on training sessions, utilising phantom heads in oral surgical education, assisting in 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.
A limitation encountered in this study was that dental students have different performance and academic caliber, and this were not adequately assessed by our methodology. Given the nature of the dental curriculum, students were evaluated mostly through institution-based didactic examinations and through grading supervised competency in performing limited numbers of procedures. The true caliber and performance level of the students could thus be under-evaluated. Further detailed and standardized didactic and clinical assessment tools need to be introduced to better understand and evaluate the students’ performance in OMFS.