Learning from Mistakes—Dental Students’ Learning Experiences from Adverse Clinical Events

Round 1

Reviewer 1 Report

There should be a more detailed description of the adverse event in OS, as in FP and OP. In OS, the description of extraction can be detailed further into the fractured root or crown, etc. 

Author Response

Response

Thank you for the feedback.

We specified the adverse event in OS, in discussion, page 8.

Reviewer 2 Report

The idea of the research is very good and the aim of introducing the presentation of adverse events for collective reflection and learning also appreciated. The paper needs amendments and clarification. My observations/feedback are as follows:

1. The use of the word proficiency is not suitable i feel as it indicates the ability of a learner to complete a task independently without supervision. On the contrary a more apt word that can be used is Competency.

2. The use of the word unexperienced is better to be inexperienced.

3. The study is comparing the adverse events of 3 cohorts retrospectively. The objective was to analyze the frequency, characteristic of the event and causes for which the AD course presentations were examined. The quantitative data analyzed and presented is fine. however, the causes and the characteristics of the events actually are qualitative data analysis and the method of analysis as well as the frequency of the same his not clear.

4. The study finds that for most FP, OP, OS, RP the cause is clinical proficiency which is because the student is still a novice and has not attained clinical competency. This study would be more appropriate on students in Final year who has passed their competency tests for the individual procedures and then going on to do a comprehensive case.

5. The discussion is too elaborative and will need to be reviewed based on the above comments.

Pl. review

Author Response

The idea of the research is very good and the aim of introducing the presentation of adverse events for collective reflection and learning also appreciated. The paper needs amendments and clarification. My observations/feedback are as follows:

1. The use of the word proficiency is not suitable i feel as it indicates the ability of a learner to complete a task independently without supervision. On the contrary a more apt word that can be used is Competency.

Response

Thank you for the feedback.

“Proficiency” was revised with “Competency” throughout the manuscript, including table and figures.

2. The use of the word unexperienced is better to be inexperienced.

Response

Thank you for the feedback.

“unexperienced” was revised with “inexperienced” in page 12, conclusion.

3. The study is comparing the adverse events of 3 cohorts retrospectively. The objective was to analyze the frequency, characteristic of the event and causes for which the AD course presentations were examined. The quantitative data analyzed and presented is fine. however, the causes and the characteristics of the events actually are qualitative data analysis and the method of analysis as well as the frequency of the same is not clear.

Response

Thank you for the feedback.

We added paragraphs for qualitative data analysis in “material and method” section, page 3.

[Qualitative analyses were conducted to characterize adverse events within each discipline. The causes and characteristics of each event presented by students were reviewed and categorized into specific groups within the discipline by three researchers with more> than 30 years of clinical experience.]

4. The study finds that for most FP, OP, OS, RP the cause is clinical proficiency which is because the student is still a novice and has not attained clinical competency. This study would be more appropriate on students in Final year who has passed their competency tests for the individual procedures and then going on to do a comprehensive case.

Response

Thank you for feedback.

The AD course (one of 9 multidisciplinary courses) is placed at the end of the third-year dental curriculum at HSDM. In this course, as one of the contents, students present a comprehensive review of three to four clinical adverse events they have experienced in the last 10 months since starting clinical procedures at the teaching practice. By discussing the event, its causes, and effective prevention methods, 3rd-year students can learn from each other’s experiences and improve upon them in their final year (4th year) of dental school.

As the reviewer commented, it would be interesting to repeat the same session at the end of the 4th year, and we will consider it.  

We made revision in the introduction, page 83, to clarify the purpose of this session in AD course.

By discussing the event, its causes, and effective prevention methods, 3rd-year students can learn from each other’s experiences and improve upon them in their final year of dental school.

5. The discussion is too elaborative and will need to be reviewed based on the above comments.

Response

Thank you for feedback.

Discussion was revised accordingly.

Reviewer 3 Report

The topic is interesting and this type of   research can contribute to the creation of new clinical teaching policies. Perhaps some adverse events are over-critically defined as they are related to the laboratory or dental assistants. In any case, such research helps to identify weak points in clinical exercises.

Author Response

Review #3

The topic is interesting and this type of research can contribute to the creation of new clinical teaching policies. Perhaps some adverse events are over-critically defined as they are related to the laboratory or dental assistants. In any case, such research helps to identify weak points in clinical exercises.

Response

Thank you for feedback.

We added paragraphs in the discussion as limitation of the study.

“Some limitations of the study include adverse events reported that were beyond students’ control, such as laboratory errors. However, we felt it was crucial to include these events since laboratory work is an integral part of dental practice. Teaching dental students to write precise and detailed lab prescriptions is essential, and so is preparing them on how to handle situations where laboratories mistakes occur.”

Round 2

Reviewer 2 Report

Improvements done.

Pl. use the term competency or lacking competency where required as the study is in year 3 DDS students.

Requires some edits

Author Response

Dear reviewer and editorial office,

Thank you very much for your guidance.
In the last revision, we changed "proficiency" to "competency" throughout the manuscript and figures 4 and 5 according to comments. 
We made minor changes this time, on page 1, line 17, and page 4, line 143.
We all hope that this revision will be accepted.

Sincerely,

S Nagai