Dental Traumatology 2015; 31: 482–486; doi: 10.1111/edt.12198
What do dental students know about trauma? Fahad AlZoubi1, Francesco Mannocci2, Tim Newton2, Andiappan Manoharan2, Serpil Djemal2 1
Ministry of Health, Kuwait City, Kuwait; 2King’s College London Dental Institute, London, UK
Key words: dental trauma; knowledge; knowledge retention; dental undergraduates; UK Correspondence to: Serpil Djemal, King’s College Hospital Dental Institute, Bessemer Road, London SE5 9RW, UK Tel.: +44 203 299 5282 Fax: +44 203 299 5678 e-mail: [email protected] Accepted 4 April, 2015
Abstract – Aim: To assess the baseline knowledge, knowledge acquisition and retention of dental undergraduate students in dental trauma, and the impact of a lecture on their level of confidence in managing traumatic dental injuries. Material and methods: A total of 145 dental undergraduate students from King’s College London were invited to attend a lecture on dental trauma. The participants were asked to complete a questionnaire on dental trauma before (T0), immediately after (T1) and 6 months (T2) following a 1-h lecture. Results: Seventy of the 145 students participated in the study. The level of knowledge at T0, T1 and T2 was 64.9%, 83.2% and 69.5%, respectively. The increase in score was statistically significant between T0 and T1, and between T0 and T2. A significant decrease in score was also found between T1 and T2. Sex, level of education and whether or not the participants received previous teaching in dental trauma were not significant in predicting a change in score. The level of confidence increased significantly from 2.14 at T0 to 3.13 at T2. Participants who received teaching in dental trauma previous to the lecture were significantly more confident at T0. Conclusions: Lectures are effective at improving the knowledge and retention of knowledge of dental undergraduate students in dental trauma. However, retention of the knowledge is time limited suggesting that education should be repeated after a certain period of time to ensure that a high level of knowledge is maintained.
Dental trauma is a public health problem with the prevalence of traumatic dental injuries (TDIs) being high around the world. In the USA, two large surveys showed that one in six adolescents and one in four adults had experienced dental trauma (1, 2). Data from Britain showed that one in five children had suffered from a TDI before leaving school (3). Additionally, TDIs constitute 5% of all injuries that patients seek help for in hospitals and dental clinics (4). Such victims expect competent management from their dentist to minimize their suffering and improve the prognosis of the injured teeth. Furthermore, inadequate management can lead to serious consequences on the immediate outcome and the long-term prognosis of the dentition, general health and the psychosocial wellbeing of the patient. Without adequate knowledge, the dentist would not be able to provide the best treatment options available to the injured patient. From this perspective, one can postulate that the clinician’s level of knowledge in the management of dental trauma can have a direct bearing on the prognosis of the tooth or teeth. The dental undergraduate curriculum in the UK is governed by the requirements set out in the General Dental Council’s (GDC) document ‘Preparing for Practice’ (5). The GDC learning outcome 1.9.3 states that 482
dentists should be able to recognize and manage dento-alveolar and mucosal trauma. Despite this, there seems to be very little evidence, if any, on the knowledge of dental trauma in undergraduate dental students. Dental trauma is not regarded as a separate specialty, and as a result, it is often included in the undergraduate curriculum from a paediatric, surgical or an endodontic point of view. One study compared the perceived levels of confidence in various procedures in paediatric dentistry in final year dental students from 3 British universities. The students reported that dento-alveolar trauma was the field they felt least confident in managing (6). Several studies have looked into the effectiveness of different educational interventions in improving dental trauma knowledge. Levin et al. (7) assessed the effectiveness of a 60-min lecture among a high-risk population. The control group (137 participants) were asked to complete a questionnaire on first-aid management of dental avulsion without any form of teaching, while the interventional group (199 participants) filled the same questionnaire following a 60-min lecture on body injuries, facial and oral injuries delivered by a military dental practitioner. The authors showed that the knowledge in first-aid management of tooth avulsion in the interventional group was significantly higher. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Dental trauma knowledge and knowledge retention in the UK The effect of a single lecture on avulsion of a permanent tooth was assessed in different groups of professionals including elementary school teachers, physical education professionals, bank employees, dentists and paediatricians (8). Following attendance at a lecture on tooth avulsion, their knowledge had significantly improved, but knowledge retention was not investigated. Despite these attempts, no studies have looked at dental trauma education at the undergraduate level and explored the effectiveness of a certain educational intervention on the students’ short- and long-term knowledge acquisition. This study aims to provide a starting point to plan and think about the delivery of dental trauma teaching to dental professionals in the future. The aims of this study were therefore to: 1 Assess the baseline knowledge in dental trauma of undergraduate dental students 2 Assess the effectiveness of a single lecture on dental trauma in knowledge acquisition 3 Assess the effectiveness of a single lecture on dental trauma in knowledge retention 4 Assess the impact of a lecture on the students’ level of confidence in managing dental trauma. Material and methods
A questionnaire was developed that looked at dental trauma to the permanent dentition as a whole and was tailored to meet the requirements of the undergraduate curriculum. The questionnaire was refined after the lecture slides were finalized to ensure that all the questions asked were covered in the lecture. Prepiloting and piloting of the questionnaire was carried out on hospital dental staff and postgraduate students. Questions on sex, level of education and whether or not participants had received previous teaching in dental trauma were asked. Answers to those questions were used as predictor variables in the analysis of the results. The second part of the questionnaire asked questions related to the participants knowledge of dental trauma. The third and final part of the questionnaire ascertained the participant’s level of confidence in the management of dental trauma. Participants were asked the following question: ‘How confident do you feel in dealing with dental trauma as a clinician? They were asked to rank their level of confidence from 0 to 10, where 0 = no confidence at all and 10 = fully confident. One hundred and forty-five third year dental undergraduate students were invited to attend a lecture and participate in a study on dental trauma. The invitation was sent via email 3 months before the lecture with reminders 1 week and 1 day before. The students were under no obligation to participate in the study but were still welcome to attend the lecture. Ethical approval for the study was granted by King’s College London Biomedical Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittees (BDM RESC Health) BDM/12/13-2. Written consent was not required. On the day of the lecture, the participants were given 15 min to complete a questionnaire on dental trauma. This questionnaire was used to assess the base© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
483
line knowledge of the participants before the lecture was delivered (T0). A 1-h lecture using the IADT guidelines (9, 10) was delivered by a consultant in restorative dentistry with a series of slides showing patient photographs and radiographic images of the full range of TDIs to permanent teeth including fractures and luxation injuries. The participants were asked to complete the same questionnaire at the end of the lecture (T1) to allow assessment of knowledge acquisition as a result of the lecture. Six months after the lecture, the participants, who were by that time 4th year students, were given the same questionnaire to complete (T2). This questionnaire was used to assess the retention of knowledge at 6 months after the lecture. Descriptive statistics were used to summarize various outcome measures and demographic variables. The percentage of questions answered correctly (total marks for each student) at three different time points were tested for normality assumption. This assumption was tested using Shapiro–Wilks test, Histogram and normal QQ plot. All the three tests showed the data did not follow a normal pattern. Hence, Wilcoxon’s matched rank test was used to test the median difference in scores between any two time points. The P values were then adjusted for multiple testing. The mean levels of confidence at baseline (T0) and after 6 months (T2) were compared using paired t-test after confirming the normality assumption. Regression analyses were carried out to find whether any of the variables were significant at predicting a change in the mean percentage of correct answers or the level of confidence. Sex, level of education and previous teaching in dental trauma were entered as predictor variables whereas change in mean percentage of correct answers and level of confidence as dependent variables. A P-value of 0.05 was set as the level of significance for all statistical tests. All the analyses were carried out using Statistical Package for Social Sciences (SPSS) version 20.0. Results
A total of 70 students of 145 participated in the study (48.3%). There were 41 females (59%) and 29 males (41%). All 70 participants completed the questionnaire at T0, T1 and T2 giving a response rate of 100%. The level of education was categorized under either secondary school certificate equivalent to a high school diploma or ‘A’ level 65.7% (n = 46), Bachelors degree or higher which largely comprised mature students 28.6% (n = 20) or unknown 5.7% (n = 4). Six (8.6%) of the 70 students who participated in the study had received teaching in dental trauma prior to attending the lecture. The samples were grouped according to sex, level of education and whether the participants received previous teaching in dental trauma. The mean percentage of correct answers was analysed according to these variables. Table 1 summarizes these findings. The mean percentage of correct answers for all the questions asked in the questionnaire at T0 was 64.86
484
AlZoubi et al.
Table 1. Mean percentage (%) of correct answers according to variable T0
T1
Mean (SD) Sex Male 60.74 (14.17) Female 67.78 (8.65) Level of education Secondary 64.88 (12.65) Higher 65.77 (9.35) Previous teaching received Yes 64.66 (11.50) No 66.99 (14.87)
T2
Median (min–max)
Mean (SD)
Median (min–max)
Mean (SD)
Median (min–max)
63.46 (17.31–78.85) 69.23 (48.08–86.54)
78.58 (21.59) 86.44 (6.02)
84.62 (0.00–96.15) 86.54 (75.00–98.08)
68.04 (9.13) 70.50 (8.82)
69.23 (40.38–84.62) 71.15 (42.31–88.46)
67.31 (17.31–86.54) 65.39 (38.46–78.85)
85.74 (10.03) 77.79 (22.91)
86.53 (28.85–98.08) 82.69 (0.00–96.15)
70.10 (8.44) 68.56 (10.92)
71.15 (48.08–86.54) 70.19 (40.38–88.46)
65.39 (17.31–86.54) 73.08 (38.46–76.92)
84.29 (11.54) 71.47 (35.36)
84.62 (28.85–98.08) 84.62 (0.00–90.38)
69.41 (8.16) 70.19 (16.44)
70.19 (42.31–86.54) 72.12 (40.38–88.46)
SD, standard deviation.
(SD 11.7), T1 83.19 (SD 15.0) and T2 69.48 (SD 8.97). Using the Wilcoxon’s matched pair rank test, there was a significant increase in knowledge from T0 to T1 (P =
What do dental students know about trauma? Fahad AlZoubi1, Francesco Mannocci2, Tim Newton2, Andiappan Manoharan2, Serpil Djemal2 1
Ministry of Health, Kuwait City, Kuwait; 2King’s College London Dental Institute, London, UK
Key words: dental trauma; knowledge; knowledge retention; dental undergraduates; UK Correspondence to: Serpil Djemal, King’s College Hospital Dental Institute, Bessemer Road, London SE5 9RW, UK Tel.: +44 203 299 5282 Fax: +44 203 299 5678 e-mail: [email protected] Accepted 4 April, 2015
Abstract – Aim: To assess the baseline knowledge, knowledge acquisition and retention of dental undergraduate students in dental trauma, and the impact of a lecture on their level of confidence in managing traumatic dental injuries. Material and methods: A total of 145 dental undergraduate students from King’s College London were invited to attend a lecture on dental trauma. The participants were asked to complete a questionnaire on dental trauma before (T0), immediately after (T1) and 6 months (T2) following a 1-h lecture. Results: Seventy of the 145 students participated in the study. The level of knowledge at T0, T1 and T2 was 64.9%, 83.2% and 69.5%, respectively. The increase in score was statistically significant between T0 and T1, and between T0 and T2. A significant decrease in score was also found between T1 and T2. Sex, level of education and whether or not the participants received previous teaching in dental trauma were not significant in predicting a change in score. The level of confidence increased significantly from 2.14 at T0 to 3.13 at T2. Participants who received teaching in dental trauma previous to the lecture were significantly more confident at T0. Conclusions: Lectures are effective at improving the knowledge and retention of knowledge of dental undergraduate students in dental trauma. However, retention of the knowledge is time limited suggesting that education should be repeated after a certain period of time to ensure that a high level of knowledge is maintained.
Dental trauma is a public health problem with the prevalence of traumatic dental injuries (TDIs) being high around the world. In the USA, two large surveys showed that one in six adolescents and one in four adults had experienced dental trauma (1, 2). Data from Britain showed that one in five children had suffered from a TDI before leaving school (3). Additionally, TDIs constitute 5% of all injuries that patients seek help for in hospitals and dental clinics (4). Such victims expect competent management from their dentist to minimize their suffering and improve the prognosis of the injured teeth. Furthermore, inadequate management can lead to serious consequences on the immediate outcome and the long-term prognosis of the dentition, general health and the psychosocial wellbeing of the patient. Without adequate knowledge, the dentist would not be able to provide the best treatment options available to the injured patient. From this perspective, one can postulate that the clinician’s level of knowledge in the management of dental trauma can have a direct bearing on the prognosis of the tooth or teeth. The dental undergraduate curriculum in the UK is governed by the requirements set out in the General Dental Council’s (GDC) document ‘Preparing for Practice’ (5). The GDC learning outcome 1.9.3 states that 482
dentists should be able to recognize and manage dento-alveolar and mucosal trauma. Despite this, there seems to be very little evidence, if any, on the knowledge of dental trauma in undergraduate dental students. Dental trauma is not regarded as a separate specialty, and as a result, it is often included in the undergraduate curriculum from a paediatric, surgical or an endodontic point of view. One study compared the perceived levels of confidence in various procedures in paediatric dentistry in final year dental students from 3 British universities. The students reported that dento-alveolar trauma was the field they felt least confident in managing (6). Several studies have looked into the effectiveness of different educational interventions in improving dental trauma knowledge. Levin et al. (7) assessed the effectiveness of a 60-min lecture among a high-risk population. The control group (137 participants) were asked to complete a questionnaire on first-aid management of dental avulsion without any form of teaching, while the interventional group (199 participants) filled the same questionnaire following a 60-min lecture on body injuries, facial and oral injuries delivered by a military dental practitioner. The authors showed that the knowledge in first-aid management of tooth avulsion in the interventional group was significantly higher. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Dental trauma knowledge and knowledge retention in the UK The effect of a single lecture on avulsion of a permanent tooth was assessed in different groups of professionals including elementary school teachers, physical education professionals, bank employees, dentists and paediatricians (8). Following attendance at a lecture on tooth avulsion, their knowledge had significantly improved, but knowledge retention was not investigated. Despite these attempts, no studies have looked at dental trauma education at the undergraduate level and explored the effectiveness of a certain educational intervention on the students’ short- and long-term knowledge acquisition. This study aims to provide a starting point to plan and think about the delivery of dental trauma teaching to dental professionals in the future. The aims of this study were therefore to: 1 Assess the baseline knowledge in dental trauma of undergraduate dental students 2 Assess the effectiveness of a single lecture on dental trauma in knowledge acquisition 3 Assess the effectiveness of a single lecture on dental trauma in knowledge retention 4 Assess the impact of a lecture on the students’ level of confidence in managing dental trauma. Material and methods
A questionnaire was developed that looked at dental trauma to the permanent dentition as a whole and was tailored to meet the requirements of the undergraduate curriculum. The questionnaire was refined after the lecture slides were finalized to ensure that all the questions asked were covered in the lecture. Prepiloting and piloting of the questionnaire was carried out on hospital dental staff and postgraduate students. Questions on sex, level of education and whether or not participants had received previous teaching in dental trauma were asked. Answers to those questions were used as predictor variables in the analysis of the results. The second part of the questionnaire asked questions related to the participants knowledge of dental trauma. The third and final part of the questionnaire ascertained the participant’s level of confidence in the management of dental trauma. Participants were asked the following question: ‘How confident do you feel in dealing with dental trauma as a clinician? They were asked to rank their level of confidence from 0 to 10, where 0 = no confidence at all and 10 = fully confident. One hundred and forty-five third year dental undergraduate students were invited to attend a lecture and participate in a study on dental trauma. The invitation was sent via email 3 months before the lecture with reminders 1 week and 1 day before. The students were under no obligation to participate in the study but were still welcome to attend the lecture. Ethical approval for the study was granted by King’s College London Biomedical Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittees (BDM RESC Health) BDM/12/13-2. Written consent was not required. On the day of the lecture, the participants were given 15 min to complete a questionnaire on dental trauma. This questionnaire was used to assess the base© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
483
line knowledge of the participants before the lecture was delivered (T0). A 1-h lecture using the IADT guidelines (9, 10) was delivered by a consultant in restorative dentistry with a series of slides showing patient photographs and radiographic images of the full range of TDIs to permanent teeth including fractures and luxation injuries. The participants were asked to complete the same questionnaire at the end of the lecture (T1) to allow assessment of knowledge acquisition as a result of the lecture. Six months after the lecture, the participants, who were by that time 4th year students, were given the same questionnaire to complete (T2). This questionnaire was used to assess the retention of knowledge at 6 months after the lecture. Descriptive statistics were used to summarize various outcome measures and demographic variables. The percentage of questions answered correctly (total marks for each student) at three different time points were tested for normality assumption. This assumption was tested using Shapiro–Wilks test, Histogram and normal QQ plot. All the three tests showed the data did not follow a normal pattern. Hence, Wilcoxon’s matched rank test was used to test the median difference in scores between any two time points. The P values were then adjusted for multiple testing. The mean levels of confidence at baseline (T0) and after 6 months (T2) were compared using paired t-test after confirming the normality assumption. Regression analyses were carried out to find whether any of the variables were significant at predicting a change in the mean percentage of correct answers or the level of confidence. Sex, level of education and previous teaching in dental trauma were entered as predictor variables whereas change in mean percentage of correct answers and level of confidence as dependent variables. A P-value of 0.05 was set as the level of significance for all statistical tests. All the analyses were carried out using Statistical Package for Social Sciences (SPSS) version 20.0. Results
A total of 70 students of 145 participated in the study (48.3%). There were 41 females (59%) and 29 males (41%). All 70 participants completed the questionnaire at T0, T1 and T2 giving a response rate of 100%. The level of education was categorized under either secondary school certificate equivalent to a high school diploma or ‘A’ level 65.7% (n = 46), Bachelors degree or higher which largely comprised mature students 28.6% (n = 20) or unknown 5.7% (n = 4). Six (8.6%) of the 70 students who participated in the study had received teaching in dental trauma prior to attending the lecture. The samples were grouped according to sex, level of education and whether the participants received previous teaching in dental trauma. The mean percentage of correct answers was analysed according to these variables. Table 1 summarizes these findings. The mean percentage of correct answers for all the questions asked in the questionnaire at T0 was 64.86
484
AlZoubi et al.
Table 1. Mean percentage (%) of correct answers according to variable T0
T1
Mean (SD) Sex Male 60.74 (14.17) Female 67.78 (8.65) Level of education Secondary 64.88 (12.65) Higher 65.77 (9.35) Previous teaching received Yes 64.66 (11.50) No 66.99 (14.87)
T2
Median (min–max)
Mean (SD)
Median (min–max)
Mean (SD)
Median (min–max)
63.46 (17.31–78.85) 69.23 (48.08–86.54)
78.58 (21.59) 86.44 (6.02)
84.62 (0.00–96.15) 86.54 (75.00–98.08)
68.04 (9.13) 70.50 (8.82)
69.23 (40.38–84.62) 71.15 (42.31–88.46)
67.31 (17.31–86.54) 65.39 (38.46–78.85)
85.74 (10.03) 77.79 (22.91)
86.53 (28.85–98.08) 82.69 (0.00–96.15)
70.10 (8.44) 68.56 (10.92)
71.15 (48.08–86.54) 70.19 (40.38–88.46)
65.39 (17.31–86.54) 73.08 (38.46–76.92)
84.29 (11.54) 71.47 (35.36)
84.62 (28.85–98.08) 84.62 (0.00–90.38)
69.41 (8.16) 70.19 (16.44)
70.19 (42.31–86.54) 72.12 (40.38–88.46)
SD, standard deviation.
(SD 11.7), T1 83.19 (SD 15.0) and T2 69.48 (SD 8.97). Using the Wilcoxon’s matched pair rank test, there was a significant increase in knowledge from T0 to T1 (P =
