The Evaluation of a High-Fidelity Simulation Model and Video Instruction Used to Teach Canine Dental Skills to Pre-Clinical Veterinary Students
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Study Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Appendix A.1. OSCE Rubric
- Does not choose a lead gown or a thyroid protector.
- Chooses lead gown and thyroid protector but puts them on incorrectly with/without disposable gloves.
- Chooses lead gown and thyroid protector and puts them on correctly. Does not choose disposable gloves.
- Chooses lead gown, thyroid protector, and disposable gloves. Hesitates to put them on correctly.
- Chooses a lead gown, thyroid protector and disposable gloves and puts them on correctly and confidently.
- Does not choose the plastic sheath and/or the cohesive wrapping bandage tape and/or does not identify the sensor.
- Correctly chooses plastic sheath and cohesive bandage but applies them in the wrong order.
- Applies the plastic sheath and cohesive bandage in the correct order but poorly so that the sensor is insecurely or incompletely covered.
- Correctly chooses a disposable plastic sheath and cohesive wrapping bandage tape. Applies them correctly but hesitantly.
- Correctly chooses disposable plastic sheath and cohesive wrapping bandage tape. Confidently applies them to the radiography sensor with the wrap over the sheath so that the sensor is completely and securely covered.
- The head is not placed in dorsal recumbency.
- The head is placed in dorsal recumbency. The mandible is not parallel with the table because towels, or any other form of support, are not used.
- The head is placed in dorsal recumbency. Towels, or other forms of support, are used to position the head, but the mandible is not parallel with the table.
- The head is placed in dorsal recumbency. Towels or other forms of support are used to position the head. The mandible is parallel with the table. This is performed hesitantly.
- The head is placed in dorsal recumbency. Towels or other forms of support are used to position the head. The mandible is parallel with the table. This is performed confidently.
- The sensor is not placed against the crowns of the incisors and/or the X-ray tube is remote from the mandibular incisors.
- The sensor is not in the correct orientation but is placed against the crowns of the incisors AND the tube is not placed at 45° but is directed at the mandibular incisors.
- The sensor is not in the correct orientation but is placed against the crowns of the incisors OR the tube is not placed at 45° but is directed at the mandibular incisors.
- The sensor is correctly placed and in the correct orientation but the student struggles to support it well and/or the X-ray tube is directed at the mandibular incisors at 45° but is touching the head.
- The sensor is placed in the mouth, resting against the crowns of the mandibular incisors and lingual mucosa, in the correct orientation. The sensor is supported appropriately with gauze/bandage material/props. The X-ray tube is directed at the mandibular incisors, positioned at 45° and close to the mandible but not touching it.
- The sensor is not placed against the crowns of the correct teeth and/or the X-ray tube is remote from the correct teeth.
- The sensor is not in the correct orientation but is placed against the crowns of the correct teeth AND the tube is not in parallel with the sensor but is directed at the correct teeth.
- The sensor is not in the correct orientation but is placed against the crowns of the correct teeth OR the tube is not in parallel with the sensor but is directed at the correct teeth.
- The sensor is correctly placed and in the correct orientation but the student struggles to support it well and/or the X-ray tube is directed in parallel to the sensor, but it is touching the head.
- The sensor is placed in the mouth, resting against the crowns of the teeth and lingual mucosa in the correct orientation. The sensor is supported appropriately with gauze/bandage material/props. The X-ray tube is directed in parallel to the sensor; close to the mandible, but not touching it.
- Only chooses goggles OR only chooses a mask without visor OR only chooses gloves.
- Chooses disposable gloves and a mask without visor or goggles.
- Does not choose disposable gloves but does choose a mask with visor or a mask with goggles.
- Chooses disposable gloves and a mask with visor or mask with goggles. Struggles to put them on correctly.
- Chooses disposable gloves and a mask with visor or mask with goggles and puts them on correctly and confidently.
- Does not identify the correct machine and/or does not identify the correct handpiece.
- Is unable to switch the machine on.
- Does not apply the tip to a metal surface.
- Does not identify the correct machine and/or the handpiece initially.
- Confidently identifies the ultrasonic scaler machine and switches it on. Holds the handpiece in the dominant hand, pushes the metal ring on the handpiece to verify that water is flowing from the scaler tip and applies the tip to a metal surface to verify it’s working correctly.
- Does not identify the correct machine and/or does not identify the correct handpiece.
- Is unable to switch the machine on.
- Does not demonstrate water and air flow separately and together.
- Does not identify the correct machine and/or handpiece initially.
- Confidently identifies the air-driven dental unit and switches it on. Holds the three-in-one syringe in the dominant hand using a palm grip and verifies that it is operating correctly by pressing each of the two buttons separately and together to demonstrate water and air can be delivered at the appropriate pressure, whether separately or together.
- Fails to engage the metal ring and/or fails to identify the correct machine or handpiece.
- Regardless of how the handpiece is held and what areas are de-scaled, the student uses the scaler for longer than 10 s on the tooth and/or does not move the scaler constantly.
- Regardless of how the handpiece is held, the student does not de-scale all these areas: the buccal, mesial, distal aspects and subgingival area.
- Does not use a modified pen grasp and/or uses excessive force and/or is not confident with the action.
- Confidently holds the handpiece with a modified pen grasp. Uses a constant sweeping motion with a light touch to scale the tooth. Scales the buccal, mesial, and distal aspects of the tooth (lingual not essential) and the subgingival area. Does not keep the scaler in contact with the tooth for longer than 10 s.
- Fails to identify the correct handpiece or fails to use the foot pedal.
- Fails to attach a polishing head to the body of the handpiece and/or does not keep the cup in constant motion and/or does not polish the correct tooth.
- Does not polish all these areas: buccal, mesial, distal aspects and subgingival area.
- Does not use a modified pen grasp and/or uses excessive force and/or is not confident with the action. Does not identify the correct handpiece to start with and/or does not assemble the handpiece confidently.
- Confidently identifies and assembles the polisher handpiece by attaching the polishing head. Applies paste to the head. Holds the handpiece with a modified pen grasp. Uses a light touch and keeps the cup in constant motion. Polishes the buccal, mesial, and distal aspects of the tooth (lingual not essential) and the subgingival area.
- Does not select an elevator AND does not select a scalpel blade.
- Does not select an elevator OR does not select a scalpel blade.
- Chooses an elevator over 3 mm and/or chooses a scalpel blade that is not a 15.
- Does not choose a scalpel handle and/or chooses a 1 mm or 3 mm elevator.
- Selects all the following: 15-scalpel blade, scalpel handle, 2 mm elevator.
- Does not select an elevator.
- Does not use a palm grasp.
- The elevator is held in a palm grasp. The index finger is on the stem of the elevator but not close to the tip.
- The elevator is held in a palm grasp. The index finger is on the stem of the elevator and close, but not at, the tip.
- The elevator is held in a palm grasp. The index finger is on the stem of the elevator and close, but not at, the tip.
- Does not select a periosteal elevator AND does not select a scalpel blade.
- Does not select a periosteal elevator OR does not select a scalpel blade.
- Regardless of whether a scalpel handle is selected. Selects a periosteal elevator and a scalpel blade that is not a 15.
- Does not select a scalpel handle.
- Selects all the following: 15-scalpel blade, scalpel handle, periosteal elevator.
- Does not select a bur AND does not select the correct handpiece.
- Does not select a bur OR does not select the correct handpiece.
- Is unable to insert any bur to the handpiece.
- Does not select the correct bur but inserts a bur correctly and/or does not verify that the bur is secure.
- Selects the high-speed handpiece and a #2 or #4 round bur and inserts the bur to the turbine correctly. Verifies that the bur is secure.
Appendix A.2. Pre-Training Questionnaire
- Demographic questions:
- Are you a certified/licensed/registered veterinary technician/technologist/nurse?
- Yes
- No
- Have you completed the elective live animal dental lab in Ross University Veterinary Clinic (RUVC)?
- Yes
- No
- Dental Skills Assessment:
- How do you rate your level of practical experience of canine dentistry skills?
- 1 = not at all experienced; 2 = slightly experienced; 3 = somewhat experienced; 4 = moderately experienced, 5 = extremely experienced.
- How do you rate your confidence with regards to canine teeth polishing skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine teeth de-scaling skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine dental radiographic positioning skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine single-rooted tooth extractions?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine two-rooted tooth extractions?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your level of interest in canine dentistry skills?
- 1 = not at all interested; 2 = slightly interested; 3 = neutral; 4 = interested; 5 = very interested.
- How important do you think canine dentistry skills are to your pre-clinical learning?
- 1 = not at all important; 2 = slightly important; 3 = neutral; 4 = important; 5 = very important.
- How important do you think canine dentistry skills are to a new graduate?
- 1 = not at all important; 2 = slightly important; 3 = neutral; 4 = important; 5 = very important.
- How likely are you to pursue a career in veterinary dentistry?
- 1 = extremely unlikely; 2 = unlikely; 3 = neutral; 4 = likely; 5 = extremely likely.
- How likely are to pursue a career in small-animal practice?
- 1 = extremely unlikely; 2 = unlikely; 3 = neutral; 4 = likely; 5 = extremely likely.
Appendix A.3. Post-OSCE Questionnaire
- How do you rate your level of practical experience of canine dentistry skills?
- 1 = not at all experienced; 2 = slightly experienced; 3 = somewhat experienced; 4 = moderately experienced; 5 = extremely experienced.
- How do you rate your confidence with regards to canine teeth de-scaling skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine teeth polishing skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine dental radiographic positioning skills?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine single-rooted tooth extractions?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your confidence with regards to canine two-rooted tooth extractions?
- 1 = not at all confident; 2 = slightly confident; 3 = somewhat confident; 4 = moderately confident; 5 = extremely confident.
- How do you rate your level of interest in canine dentistry skills?
- 1 = not at all interested; 2 = slightly interested; 3 = neutral; 4 = interested; 5 = very interested.
- How important do you think canine dentistry skills are to your pre-clinical learning?
- 1 = not at all important; 2 = slightly important; 3 = neutral; 4 = important; 5 = very important.
- How important do you think canine dentistry skills are to a new graduate?
- 1 = not at all important; 2 = slightly important; 3 = neutral; 4 = important; 5 = very important.
- How useful do you think the lab was in improving the acquisition of canine dentistry
- 1 = not at all useful; 2 = slightly useful; 3 = neutral; 4 = useful; 5 = very useful.
- How likely are you to pursue a career in veterinary dentistry?
- 1 = extremely unlikely; 2= unlikely; 3 = neutral; 4 = likely; 5 = extremely likely.
- How likely are to pursue a career in small-animal practice?
- 1 = extremely unlikely; 2= unlikely; 3 = neutral; 4 = likely; 5 = extremely likely.
- Which dental laboratory did you participate in?
- Videos.
- High-fidelity models.
- Please provide further details regarding your experience of the lab:
Appendix A.4. Questionnaire Statistical Analysis
Group A (HFM) | Group B (Video Instruction) | p Value Baseline between Groups 2 | p Value Evolution between Groups 2 | |||||
Before | After | p Value 1 | Before | After | p Value 1 | |||
How do you rate your level of practical experience of canine dentistry skills? | 1 (1–2) | 3 (2–4) | <0.001 * | 1 (1–2) | 1.5 (1–2) | 0.4 | 0.8 | <0.001 * |
How do you rate your confidence with regards to canine teeth de-scaling skills? | 1 (1–1) | 4 (3–4) | <0.001 * | 1 (1–2) | 2 (1–3) | 0.008 * | 0.4 | <0.001 * |
How do you rate your confidence with regards to canine teeth polishing skills? | 1 (1–1) | 4 (4–4.25) | <0.001 * | 1 (1–2) | 2 (1.75–3) | <0.001 * | 0.4 | <0.001 * |
How do you rate your confidence with regards to canine dental radiographic positioning skills? | 1 (1–2) | 3 (2–3) | <0.001 * | 1 (1–2) | 2 (1–2.25) | 0.01 * | 0.7 | <0.001 * |
How do you rate your confidence with regards to canine single-rooted tooth extractions? | 1 (1–1) | 3 (2.75–4) | <0.001 * | 1 (1–1) | 2 (1–2) | <0.001 * | 0.4 | <0.001 * |
How do you rate your confidence with regards to canine two-rooted tooth extractions? | 1 (1–1) | 3 (2–3) | <0.001 * | 1 (1–1) | 1 (1–2) | 0.01 * | 0.2 | <0.001 * |
How do you rate your level of interest in canine dentistry skills? | 4 (4–4.25) | 4 (3–5) | 0.5 | 4 (3–5) | 4 (3–4) | 0.7 | 0.7 | 0.7 |
How important do you think canine dentistry skills are to your pre-clinical learning? | 5 (5–5) | 5 (5–5) | 0.2 | 5 (4.75–5) | 5 (5–5) | 0.6 | 0.8 | 0.7 |
How important do you think canine dentistry skills are to a new graduate? | 5 (5–5) | 5 (5–5) | 0.1 | 5 (5–5) | 5 (5–5) | 0.6 | 0.7 | 0.2 |
How likely are you to pursue a career in veterinary dentistry? | 3 (2–3) | 3 (2.75–3) | 0.4 | 3 (2–3) | 3 (2–3) | 0.9 | 0.7 | 0.7 |
How likely are to pursue a career in small-animal practice? | 5 (4–5) | 5 (4–5) | 0.8 | 5 (4–5) | 5 (5–5) | 1 | 0.6 | 0.4 |
How useful do you think the lab was in improving the acquisition of canine dentistry skills? | 5 (5–5) | 3.5 (2–5) | - | <0.001 * | ||||
1 Wilcoxon Signed-Rank Test (paired). 2 Wilcoxon Rank-Sum Test. * Statistically significant p values. N = 84. |
Appendix A.5. Cronbach α by Station, Cohort and Rater
Cohort 1 | Cohort 2 | Cohort 3 | All Cohorts | |
Station 1 (3 Items) | 0.52 (Rater A) | <0 (Rater B) | 0.03 (Mixed Raters) | 0.003 |
Station 2 (2 Items) | 0.51 (Rater C) | 0.51 | ||
Station 3 (3 Items) | <0 (Rater D) | 0.24 (Mixed Raters) | 0.19 | |
Station 4 (2 Items) | 0.63 (Rater E) | 0.85 (Rater F) | 0.47 (Mixed Raters) | 0.59 |
Station 5 (4 Items) | 0.59 (Rater G) | 0.55 (Rater H) | 0.56 | |
All stations | 0.74 | 0.64 | 0.64 | 0.66 |
Cohort 1: January 2020, n = 18; Cohort 2: October 2020, n = 21; Cohort 3: January 2021, n = 66. |
Appendix A.6. Sensitivity Analysis: Cronbach α Calculated without each Station or Item
Cronbach α | |
Station 1 | 0.69 |
Put on the necessary personal protective equipment to obtain dental radiographs. | 0.67 |
Prepare the digital radiography sensor to obtain dental radiographs. | 0.67 |
Place the canine head on the table and in the correct position to obtain a dental radiograph of the mandible. Indicate verbally to the examiner once you have completed this task. | 0.67 |
Station 2 | 0.62 |
Position the radiography sensor and the tube head of the radiograph generator to obtain a radiograph of the mandibular incisors at 45°. Indicate verbally to the examiner once you have completed the task. | 0.65 |
Position the radiography sensor and the tube head of the radiograph generator to obtain a radiograph of the mandibular premolar tooth 4 and molar tooth 1 in quadrant 3. Indicate verbally to the examiner once you have completed the task. | 0.62 |
Station 3 | 0.64 |
Put on the necessary personal protective equipment to perform a canine cleaning and polishing procedure. | 0.67 |
Switch on the ultrasonic scaler machine and verify that it is working correctly. | 0.62 |
Switch on the air-driven dental unit and verify the three-in-one syringe handpiece is working correctly. | 0.66 |
Station 4 | 0.58 |
All teeth in the cadaver head have had all tartar removed. Demonstrate a scaling procedure on the left mandibular canine tooth. | 0.63 |
Assemble the polisher handpiece so that it is ready to use and then polish the left mandibular canine tooth. | 0.62 |
Station 5 | 0.53 |
Select the necessary items to perform an incisor extraction. Place on Card A. | 0.66 |
Select any elevator and use it to demonstrate how to hold this tool correctly when in use. | 0.63 |
Select the necessary instruments to perform a gingival flap, instruments for suturing are not necessary. Place on Card B. | 0.65 |
Assemble the high-speed handpiece so that it is ready to remove alveolar bone from around a tooth root. | 0.61 |
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Grade HFM Laboratory Group A | Grade Video Instruction Group B | Wilcoxon Rank-Sum Test p Value | |
---|---|---|---|
Median (IQR) | Median (IQR) | ||
Overall OSCE (denominator = 100) | 80.6 (72.4–85.8) | 67.1 (56.7–71.3) | <0.001 * |
Station 1 | |||
Put on the necessary personal protective equipment to obtain dental radiographs. | 4 (3–4) | 2 (2–4) | 0.008 * |
Prepare the digital radiography sensor to obtain dental radiographs. | 4 (2–4) | 3 (2–4) | 0.2 |
Place the canine head on the table and in the correct position to obtain a dental radiograph of the mandible. Indicate verbally to the examiner once you have completed this task. | 3 (1–4) | 2 (1–4) | 0.6 |
Station 2 | |||
Position the radiography sensor and the tube head of the radiograph generator to obtain a radiograph of the mandibular incisors at 45°. Indicate verbally to the examiner once you have completed the task. | 3 (2–4) | 3 (2–4) | 0.8 |
Position the radiography sensor and the tube head of the radiograph generator to obtain a radiograph of mandibular premolar tooth 4 and molar tooth 1 in quadrant 3. Indicate verbally to the examiner once you have completed the task. | 2 (1–3) | 1 (1–2) | 0.006 * |
Station 3 | |||
Put on the necessary personal protective equipment to perform a canine cleaning and polishing procedure. | 4 (4–4) | 4 (3–4) | 0.3 |
Switch on the ultrasonic scaler machine and verify that it is working correctly. | 4 (2–4) | 2 (2–3) | <0.001 * |
Switch on the air-driven dental unit and verify the three-in-one syringe handpiece is working correctly. | 4 (4–4) | 4 (4–4) | 0.5 |
Station 4 | |||
All teeth in the cadaver head have had all tartar removed. Demonstrate a scaling procedure on the left mandibular canine tooth. | 3.5 (3–4) | 2 (2–4) | 0.001 * |
Assemble the polisher handpiece so that it is ready for use and then polish the left mandibular canine tooth. | 4 (3–4) | 3 (2–4) | 0.003 * |
Station 5 | |||
Select the necessary items to perform an incisor extraction. Place on Card A. | 3.5 (3–4) | 3 (2–4) | 0.052 |
Select any elevator and use it to demonstrate how to hold this tool correctly when in use. | 4 (4–4) | 3 (2–4) | <0.001 * |
Select the necessary instruments to perform a gingival flap—instruments for suturing are not necessary. Place on Card B. | 3 (1–4) | 1 (1–3) | 0.03 * |
Assemble the high-speed handpiece so that it is ready to remove alveolar bone from around a tooth root. | 4 (3.75–4) | 3 (1–3) | <0.001 * |
Comments from Group A |
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The high-fidelity models were really nice to learn on. I enjoyed getting the feel of how it is actually done on a live patient. I am amazed at what stuck with me after learning about it once for three hours two weeks ago. |
As someone who has never been exposed to dentistry, I believe the lab helped me out a tremendous amount, I feel much more confident than I did prior to the in-person labs. I hope every vet student gets the chance to learn using the models, my confidence in dentistry has significantly improved after only one day of training. |
I really enjoyed the models, I felt like it was a really good experience to feel and handle a model that’s similar to real life. The models were very helpful for getting a good understanding of accurate canine dental anatomy. |
The high-fidelity models were extremely helpful for me because I could visualize and assess all procedures with all my senses. It was a great learning experience. I got very interested in dentistry because of the models. |
Comments from Group B |
Being assigned to the videos, I like the fact that I could review the material prior to the OSCE and rewatch them. However, I don’t think they are as helpful as a hands-on lab. There are many questions I wish I could have asked and even with watching the videos multiple times I don’t feel prepared to perform these skills on a live patient by myself. |
I felt like I learned a lot watching the videos but not nearly as much as if I had done the lab in person. It’s hard to assess your understanding without being able to do something with direct instruction and immediate feedback. |
I did not find the videos very helpful in learning how to perform the tasks demonstrated. However, I do feel that they would be a good to refer to after completing the lab on the models, should any questions come up after the lab. |
Felt videos were good quality. However, online was able to slack off. There is also no feedback or possible corrections made to your skills with online videos and no live instructor. |
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Share and Cite
Fairs, J.; Conan, A.; Yvorchuk-St. Jean, K.; Gingerich, W.; Abramo, N.; Stahl, D.; Walters, C.; Artemiou, E. The Evaluation of a High-Fidelity Simulation Model and Video Instruction Used to Teach Canine Dental Skills to Pre-Clinical Veterinary Students. Vet. Sci. 2023, 10, 526. https://doi.org/10.3390/vetsci10080526
Fairs J, Conan A, Yvorchuk-St. Jean K, Gingerich W, Abramo N, Stahl D, Walters C, Artemiou E. The Evaluation of a High-Fidelity Simulation Model and Video Instruction Used to Teach Canine Dental Skills to Pre-Clinical Veterinary Students. Veterinary Sciences. 2023; 10(8):526. https://doi.org/10.3390/vetsci10080526
Chicago/Turabian StyleFairs, James, Anne Conan, Kathleen Yvorchuk-St. Jean, Wade Gingerich, Nicole Abramo, Diane Stahl, Carly Walters, and Elpida Artemiou. 2023. "The Evaluation of a High-Fidelity Simulation Model and Video Instruction Used to Teach Canine Dental Skills to Pre-Clinical Veterinary Students" Veterinary Sciences 10, no. 8: 526. https://doi.org/10.3390/vetsci10080526