an evaluation of the preclinical prosthodontic training at the faculty of dentistry, university of...

An evaluation of the preclinical prosthodontic training at theFaculty of Dentistry, University of Bergen, NorwayJana Ingebrigtsen, Edvard Røynstrand and Morten E. Berge

Department of Oral Sciences – Prosthodontics, Faculty of Dentistry, Arstadveien 17, N-5009 Bergen, Norway

Introduction

The graduate teaching in dentistry is under revision in manydental schools, both with regard to organisation, curriculumand educational principles. In this context, the shift from tech-nology to biology is an international trend (1, 2). Furthermore,it is maintained that the curriculum has to reflect the localcommunity needs, which vary within and between countries(3).

In agreement with this, the Faculty of Dentistry at the Uni-versity of Bergen, Norway, was reorganised in 1996 and is cur-rently divided into a Department of Oral Science (research andtheoretical teaching) and a Clinic of Dentistry (clinical teachingand clinic administration). In March 1998, the Board of theFaculty decided to complete the reorganisation by appointing acommittee, for the purpose of revising the dental curriculum.The committee was to consider the professional challenges andrequirements dentists have to meet for the next 20 years. Neweducational methods such as problem-based learning and web-based teaching should be considered. In addition, availableresources, economic framework and the existing building facili-ties had to be taken into account in the process of planning thenew curriculum.

The curriculum in dentistry in Bergen consists of a fiveyear full time study. In the present curriculum, the first twoyears of the dental course is mainly concerned with the

preclinical disciplines: biochemistry, anatomy, physiology, oralbiology, general pathology and immunology. These subjectsare taught by the medical faculty. During the last trimester ofthe second year, the students are taught the theory related todirect restorative techniques (cariology, filling techniques andbiomaterials) and receive practical training in the same. Inthe third year, the prosthodontic preclinical course and theclinical parts of the study commence. Clinical training andcommunity dentistry dominate the curriculum in fourth andfifth year.

As a consequence of the major principles laid down in thenew curriculum (the macro plan) (4) decided by the Board ofthe Faculty, it became appropriate to revise the teaching ofprosthodontics. The main intention was to integrate the teach-ing of this subject with that of other subjects.

A comparison with the previous curriculum showed thefollowing specific changes in the preclinical teaching:1. Integration of cariology, dental biomaterials and prostho-dontics.2. The above subject teachers co-operate in tuition of thestudents in the fourth and fifth semesters.3. The number of lectures and seminars in cariology, prostho-dontics and biomaterials was markedly increased, and closelycoordinated with the progression of the laboratory course.

The intention was to present a tuition package to the stu-dents which should furnish them with sufficient background

Keywords

education; preclinical; prosthodontics.

Correspondence

Morten Berge

Department of Oral Sciences – Prosthodontics

Faculty of Dentistry

Arstadveien 17, N-5009 Bergen

Norway

Tel: +47 555 866 36

Fax: +47 555 864 89

e-mail: [email protected]

Accepted: 4 October, 2007

doi:10.1111/j.1600-0579.2007.00489.x

Abstract

The curriculum of the dental faculty at the University of Bergen was revised and a newcurriculum was implemented in 2000. The first candidates graduated in 2003. In thenew curriculum the theoretical teaching consists of an extended integrated lectureseries in prosthodontics and biomaterials. The revised laboratory course includes anincreased number of tooth preparations performed on phantom heads solely. Newertypes of preparations based on bonding technique, such as ceramic crowns, veneersand inlays, have also been introduced. As a consequence of the reduced time allocatedto the course, the amount of dental technical work has been considerably reduced.Demonstrations of practical procedures are video-based. Several theoretical and practi-cal tests are carried out during the course. The purpose of this study was to assess theoutcome of the alterations made, by comparing former students’ opinions on differentaspects of the two curricula. A questionnaire was mailed to the students graduated in2003 with the new curriculum and graduates in 1997 and 2000 with the ‘old’ curricu-lum. The results indicate that the alterations tended to improve the students’ evalua-tions of some aspects of the course. In addition, the new curriculum appeared to bemore relevant for the succeeding work in the clinic.

European Journal of Dental Education ISSN 1396-5883

80 Eur J Dent Educ 12 (2008) 80–84 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Munksgaard

knowledge and technical skills, both for the preclinical practicalwork and prepare them for patient treatment at a later stage.

The preclinical prosthodontic course, presently shortened by67 h, now contains approximately 280 h. The profile of thecourse is altered so that more emphasis is on fixed prosthodon-tics and tooth preparation and less on removable prosthodon-tics and production of crowns, fixed partial dentures and fullremovable dentures. Emphasis is primarily on training in toothpreparation, which is currently performed on phantom headssolely. The preparations were earlier performed mostly on teethnot mounted in a jaw on the bench top.

In addition, a new video-based teaching programme hasbeen introduced, demonstrating practical procedures of toothpreparations performed on the bench top and some technicalprocedures. This facility is used when teaching the entire classof students, and is also accessible for the students for individualuse. The available financial resources did not allow for theprovision of electronic simulators for the students, which arein use in numerous dental schools.

The format of assessment of the ‘old’ curriculum was byexamination of the work handed in by the students at the endof the course. An external censor carried out the assessment.The present preclinical course includes several theoretical andpractical tests conducted during the course. The main objec-tives of these tests are two-fold: To ensure that the undergradu-ates are able to carry out the preparations precisely and to givefeedback to the students on their own learning progress. In thepractical tests, the students are trained in evaluating their ownpreparations in order to develop self-assessment skills. Thetutor gives an individual evaluation on their performance sub-sequently. At the end of the course, there is a main theoreticaltest. The undergraduates must obtain the grade ‘passed’ fortheir performance in the course, and in the final theoretical testto be certified to proceed to the treatment of patients. The firstclass with the new curriculum graduated in 2003.

Limited written information is available about preclinicaltraining in dentistry. However, some publications have latelydescribed new developments in preclinical training with someemphasis on the use electronic simulators (5–7).

The aim of the present study was to was to assess the out-come of the alterations made, by comparing former students’opinions on different aspects of the two curricula.

Material and methods

Sample

The study groups comprised the total number of candidatesgraduating from the Faculty of Dentistry, University of Bergen,Norway in the years 1997, 2000 and 2003. The graduates receivedan envelope by mail, containing a questionnaire together with astamped and addressed envelope for the response, and a writtenenclosure outlining the purpose of the study. The deadline forthe response was 14 days. Those who did not respond receiveda second questionnaire. In order to secure anonymity of theparticipants, their names were substituted with registration num-bers. The students graduating in 1997 and 2000 studied underthe old curriculum. The students graduating in 2003 were thefirst class who studied under the new one.

Gender, occupational condition and the graduates’ opinionsconcerning the preclinical and clinical prosthodontic trainingwere collected from these questionnaires. This first part of thestudy is about the preclinical curriculum. The specific questionsasked are quoted in the legends of the figures. There was alsoan opportunity for additional comments. The participants wererequested to propose changes/improvements regarding theprosthodontic education if they wanted to.

Statistical analyses

Results were analysed statistically using of the SPSS 11.0 (Statis-tical Package for the Social Sciences) statistical software. Differ-ences between the groups on gender, occupational status andresponse rate were tested by means of a chi-squared test. Dif-ferences between the groups on the responses to questions weretested using the Mann–Whitney rank sum test for comparisonof two populations. The chosen a-level was 5%.

Results

Questionnaires

Out of 114 questionnaires, 90 were completed and returned,constituting a response rate of 78.9 %. The rates for the differ-ent years of graduation were 80.1 % for 2003 (n = 29, $ = 16,# = 13), 78.8 % (n = 26, $ = 14, # = 12) for 2000, and 77.8% for 1997 (n = 35, $ = 20, # = 15). With regard to the year1997, 23 graduates were working in private practice, six in pub-lic health practice, and six in a combination of private andpublic practice. The corresponding numbers for the year 2000-graduates were: 11 in private practice, eight in public healthpractice, four in a combination of private and public practiceand three were not in practice.

One of the graduates of year 2003 did not answer one of thequestions. This questionnaire was nevertheless included in thestudy. All the other questionnaires were complete. There wereno statistically significant differences related to the rates ofresponses for the groups of different years of graduation(P > 0.05).

Comparisons between 1997 and 2000(‘old’ curriculum graduates)

Data were collected from the responses of both the graduatesof years 1997 and 2000 in order to see if the two groups dif-fered in terms of gender, occupation and responses to the ques-tions. None was demonstrated, strengthening the argument thatthe year 2000-graduates were representative for the ‘old’ curric-ulum. Accordingly, only this group was used in the followinganalyses because they graduated nearest in time to the 2003-group. The intention was to make the comparisons betweenthe current and previous programs more meaningful and valid.

Question 1

The results indicated that most of the graduates were of theopinion that the number of crown and abutment preparationin the preclinical course was adequate.

Ingebrigtsen et al. Evaluation of the preclinical prosthodontic training

Eur J Dent Educ 12 (2008) 80–84 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Munksgaard 81

However, the responses showed that a statistically signifi-cantly smaller proportion of the graduates in the 2003-groupthan in the 2000-group thought that the number was too low(P = 0.039) (Fig. 1).

Question 2

When asked about the amount of teaching of removable pros-thodontics, differences in responses from the graduates of 2000and 2003 did not reach statistical significance. A substantialpart of the graduates in both groups considered this part of thecourse to be too limited. (P = 0.144) (Fig. 2).

Question 3

The amount of dental technical work was markedly reduced inthe new curriculum. Nevertheless, the majority of the respon-dents of both groups thought that the amount was too high.

There was no significant difference between the responses ofthe two groups (P = 0.289) (Fig. 3).

Question 4

The number of teachers available (ratio students/teacher 8:1)for the two groups of students was unchanged. For both groupslarge proportions of the respondents thought that the numberof instructors was too low. There was no statistically significantdifference between the groups regarding this question(P = 0.239) (Fig. 4).

Question 5

Teaching of biomaterials is now integrated in the prosthodonticpreclinical course. Most of the graduates in both groupsconsidered the teaching of biomaterials to be relevant for thepreclinical prosthodontic work. The graduates of 2003 appeared

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Year of graduation 2000


Far too many Too many

Suitable numberToo few

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Fig. 1. The opinions of the two groups of graduates regarding the number

of crown and bridge preparations in the preclinical course (P = 0.039).

Question asked: What is your opinion on the number of crowns and

abutment preparations in the preclinical training course?

0

10

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30

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Far too much Too much Suitable Too little Much too little


Per

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Fig. 2. The opinions of the two groups of graduates regarding the

amount of teaching of removable prosthodontics in the preclinical course

(P = 0.144). Question asked: Do you think there was too much or too

little removable prosthodontics in the preclinical training course?

0

10

20

30

40

50

60

70

80



Much too much

Too much

Suitable

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Much too little

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amount of dental technical work in the preclinical prosthodontic course

(P = 0.289). Question asked: What is your opinion on the amount of

dental technical work in the preclinical training course?

0

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Much too few Too few Suitable Too many Much too many

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Fig. 4. The opinions of the two groups of graduates regarding the num-

ber of instructors (dentists/ dental technicians) participating in the course

(P = 0.239). Question asked: Do you think there were sufficient instruc-

tors (dentists/ dental technicians) in the preclinical training course?

Evaluation of the preclinical prosthodontic training Ingebrigtsen et al.


to have a more favourable opinion on the relevance of bioma-terials than the graduates of 2000. However, this tendency onlyapproached statistical significance (P = 0.061) (Fig. 5).

Question 6

The great majority of the graduates found the preclinical teach-ing relevant, but to varying extents. However, there was astatistical difference that the 2003-graduates were more positiveto the clinical relevance of the course than their 2000-counter-parts (P = 0.045) (Fig. 6).

Gender differences and proposed changes/improvements

No statistically significant differences between the opinions ofthe genders for any of the questions were shown (P > 0.05).No comment from the graduates were received regardingproposed changes or improvements of the preclinical course.

Discussion

The present survey indicates that the changes made in the pre-clinical programme have improved its quality significantly intwo different areas: The altered teaching associated with prepa-rations of fixed restorations performed by students was foundmore consonant with the requirements (Fig. 1), and the rele-vance of the course was enhanced (Fig. 6). These results appearvalidated due to the high response rate of the survey (78.9 %)with one reservation: It has been pointed out that students areunable to judge the significance of their education until sometime after they graduate and have practised dentistry on theirown (8). While the 2000-group had approximately 3 years expe-rience as practicing dentists, the 2003-group made their evalua-tions based almost solely on their experience as recentlygraduated candidates. Nevertheless, the 2003-group had at leastbeen able to evaluate the relevance of their preclinical trainingas it applied to their subsequent undergraduate clinical practice.

Preparation of teeth for fixed restorations is the main practi-cal topic of the course. It is an important and technicallydemanding clinical procedure for obtaining an adequate pros-thodontic treatment result (9). In order to improve the stu-dents’ competence in this field, not only were the number ofpreparations increased from nine in the old curriculum to 11in the new one, but a number of supplementary endeavourswere introduced. Important in this respect, unlike the old cur-riculum, the preparations were performed solely on phantomheads using indirect mirror vision, which is considered morerelevant to the clinical requirements (10). Also, newer types ofpreparations for inlays, veneers and bonding technique wereadded. The analysis of the results indicates that the new pre-clinical programme was more relevant for future work than theprevious one (Fig. 6). The purpose of the course was to teachnot only psychomotor skills, but also to train students in deci-sion-making, problem-solving and self-evaluation, which areessential in treatment of patients in the clinic (11). The prosth-odontic lectures and video presentations elucidated the criteriaand background for the practical work for the students; all ofwhich are important for training of the students’ self-assess-ment (12). There were no statistically significant differencesbetween 2003-group and 2000-group related to questions of theamount of dental technical work and removable prosthodon-tics, despite the significant reduction in these aspects for the2003-group (Figs 2, 3). This is most likely caused by the factthat students find dental technical work difficult and bothgroups felt they have had too little experience in doing remov-able prosthodontics also in the clinic.

Teaching of biomaterials was integrated in the prosthodonticcourse in the revised curriculum. The present results show thatapproximately 70% of the 2003-respondents were of the opin-ion that the teaching of biomaterials was relevant to the courseand thus indicated a positive view on the integration. However,the difference between the curricula in this respect (Fig. 5)for all intents and purposes was probably not of decisiveimportance, explaining why the groups were not statisticallydiscernible.

Several evaluation tools, including a student directed ques-tionnaire survey, are needed in order to evaluate the effective-ness of a new curriculum (8). Consequently, supplementary

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Not relevant at all Not sufficiently relevantSomewhat relevant Relevant Very relevant

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relevance of the teaching of biomaterials for the prosthodontic work in

the preclinical course (P = 0.061). Question asked: Was the teaching of

biomaterials in the preclinical training course relevant for the clinical

practice?

0

10

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30

40

50

60

70

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Not at all relevant

Not sufficiently relevant

Somewhat relevant

Relevant

Very relevant

Per

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Fig. 6. The opinions of the two groups of graduates regarding the rele-

vance of the course for their work in the succeeding prosthodontic clini-

cal course (P = 0.045). Question asked: Was the preclinical training

course relevant for the work in the clinic?

Ingebrigtsen et al. Evaluation of the preclinical prosthodontic training

Eur J Dent Educ 12 (2008) 80–84 ª 2008 The Authors. Journal compilation ª 2008 Blackwell Munksgaard 83

studies should be carried out to complete the picture. Somekind of study aiming at presenting an assessment of thecourse by the teachers should be performed. However, it is ademanding and complex matter developing relevant and validmeasures for evaluation of the whole range of aspects relatedto the running of- and outcome of a course. The presentresults indicate that to some degree the attempts at improvingthe preclinical course have succeeded, thus better preparingthe students for their clinical work. The results also indicatethat there is a potential for further improvement. Eventhough there is an international trend towards reducing thefocus on laboratory training in favour of an early holistic andbiological approach to patients (3), the present authors stillmaintain that students should have a solid base in terms oftheoretical and manual competence before clinical training onpatients commences. Therefore the preclinical course in pros-thodontics is important. In line with Bothelho and O’Donnell(11) we will claim that high quality preclinical teachingshould be maintained with a sufficient number of teachers,allowing for individual guidance for the students (Fig. 4), thussecuring subsequent competent patient treatment. In fact, thedevelopment of new prosthodontic materials and newadvanced technical procedures require an even higher techni-cal skill of the future dentists.

For those reasons further attempts will be made to improvethe preclinical course, thereby heightening the competenceof the dental student and in consequence increasing the skill ofthe dentist and thus of the quality of the treatment offered tothe patients.

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