Qualitative Analysis of Student Reflections on Preclinical Dental Implant Education
Abstract
:1. Introduction
Conceptual Framework
2. Materials and Methods
2.1. The Simulation Activity under Investigation
2.2. Thematic Analysis
2.3. Reliability
3. Results
3.1. Theme 1: Dental Implant Learning
“I felt like I learned a lot from this course due to the fact that we were able to implement and apply what we learned from the PowerPoint into the projects that we did”.(Participant 29)
“I learned how to place the bone grafting material, collagen matrix disc, and how to secure it all with a figure eight suture”.(Participant 2)
Learning how to suture was also very useful because I was able to implement it in clinic.(Participant 62)
“My suturing abilities improved tremendously through the socket preservation lab”.(Participant 57)
“I learned the importance of paying attention to small details and measuring multiple times prior to proceeding with the procedure to ensure the best results and longest survival rates of implants”.(Participant 65)
“Attending this Implant course was really a great learning opportunity for me to improve both my theoretical as well as practical skills”.(Participant 43)
“I feel that overall I have improved in my knowledge and skill of placing implants, although I know that this is a very basic introduction and there are many more years of experience to be had”.(Participant 11)
“I know I’m not ready to place and restore implants from start to finish, but I certainly feel much more comfortable discussing the process with patients.(Participant 17)
Above all else, the hands-on learning made the experience not only engaging but also memorable”.(Participant 56)
“I am very glad that I had the chance to attend implant course which has expand my knowledge to a level where I can feel confident treating patient”.(Participant 44)
“I was really intrigued in taking implants since my mom is currently in the process of receiving an implant. I was confused as to why her dentist was waiting so long to place the implant when bone loss is such a risk, but I came to find out that he was actually doing socket preservation on my mom”.(Participants 19)
“I really enjoyed being able to get hands-on experience with implant placement, socket preservation, scanning, and open/close tray impressions. Also, being able to have these activities done in class gave me more of an idea of what my strengths and weaknesses are when it comes to implant related lab work”.(Participant 23)
“I could use more practice in placing implants and scanning digitally”.(Participants 19)
“Even though I feel confident and comfortable in my abilities, I have a long way to go to master the art of implants”.(Participant 4)
“Although we have not done so on a living patient, this class has exposed us to enough scenarios that we should feel comfortable working on an implant cases in the future”.(Participant 82)
3.2. Theme 2: Potential Improvements
“Some areas of improvement include trying not to place the grafting material and collagen matrix disc is way below the crest of the bone. The areas I would need more practice in is packing the membrane and executing the figure eight suture”.(Participant 2)
“I need to work on the time it takes me to suture as well as my quality because I don’t want to give patients a bad suture that will also heal badly”.(Participant 4)
“After some more practice, I was able to successfully place the graft material and suture”.(Participant 40)
Prior to this exercise, I had not sutured before. This exercise was good practice for me to practice suturing. From this experience, I was able to place better sutures.(Participant 41)
“I know I’m not ready to place and restore implants from start to finish, but I certainly feel much more comfortable discussing the process with patients and working on a case”.(Participant 17)
“After my 4th try on the typodont, I improved my hand-skill and was more precise in my placement”.(Participant 21)
“My suturing abilities improved tremendously through the socket preservation lab”.(Participant 57)
“For the open tray, I again had a void on the distal side, meaning I did not surround the entire implant coping carefully with PVS before placing the tray. I will also need to work on minimizing air bubbles with the PVS. In the digital impression, An area I could improve on. I was being more steady and thorough with my scanning because I felt like I had to scan over the same area multiple times since I could not get the angulation perfect”.(Participant 26)
“I struggled with the hand coordination for the first few times but ended up picking it up on the last try”.(Participant 4)
“I was confused in the beginning with the many different parts of the implant placement and impression process, but the multiple exposures helped me to become more familiar and comfortable with the pieces”.(Participant 84)
“I felt a little confused about some of the concepts like open and close trays, but when we did them in lab it started to make a lot more sense”.(Participant 29)
“Initially I had trouble recognizing which components to use in open and close tray techniques”.(Participant 44)
“Open tray impressions were harder than close tray, and I need to make sure that the hole around is big enough”.(Participant 49)
“To my surprise, closed and open tray impressions were challenging to capture proper margins and required technique-sensitive awareness”.(Participant 58)
“I do wish we could have made our own surgical guides. It also would have been nice to fabricate some implant crowns”.(Participant 3)
“I also think in the future if we could possibly place implants in an actual pig jag could truly improve the course”.(Participant 77)
“The terminology was the biggest mountain to overcome in the course. Instructions would be given with words like analog, pick up/open tray technique, transfer/closed tray technique, abutment, implant body, locators, torque wrench, driver, etc., and it was very difficult to follow”.(Participant 54)
“My favorite lab session was socket preservation. It taught me how I can preserve the bone volume and prevent bone loss by treating the socket with collagen matrix and muco-graft seal”.(Participant 5)
“My favorite lab session was using the scan body and implementing the digital scanners on the implants”.(Participant 12)
“My favorite part of this course was initially learning how to place the implants using the surgical stent and verifying the placement with radiographs”.(Participant 68)
“My least favorite exercise was implant placement because I think it had very little room for error and it was the most stressful to get correct on the first try”.(Participant 26)
3.3. Theme 3: Digital Trends and Further Implant Education
“Scanning and designing the implant was informative”.(Participant 15)
“The digital impression lab session was also very helpful to see how implant impressions and designing can be done digitally”.(Participant 5)
“I believe it is crucial for us as students to understand the uses of the digital hardware and their supporting software”.(Participant 7)
“Digital Impression: This was probably the easiest impression since we just had to place the scanning body and scan it but I think it would take more technique if it were in an actual patient”.(Participant 30)
“Initially scanning the occlusal surfaces of the teeth was not difficult. However, I was having difficulty trying to capture the interproximal areas of the teeth. One aspect that I noticed to improve on was being able to adapt the scanner at an adequate distance and angle onto the teeth”.(Participant 42)
“Digital Impression were a little more challenging than I thought, but again, more experience will help me improve my technique”.(Participant 21)
“I need more practice with digital scanning”.(Participants 19)
“I believe with additional practice, future courses and experience, I will feel much more confident”.(Participant 21)
“I think the most important takeaway for me was that it is going to take continual practice to get more comfortable with the execution of the implant process”.(Participant 45)
“I’m especially grateful to have got some experience with digital scanning since that’s going to be the future of the industry”.(Participant 81)
3.4. Theme 4: Treatment Planning and Evidence-Based Practice
“What I found most helpful about this class was not placing the implants themselves, but the patient selection process beforehand and the restoration procedures after placement. Careful planning and having the finished product in mind will aid in better outcomes”.(Participant 3)
“I appreciated how an emphasis was placed on restorative-based treatment planning”.(Participant 39)
“As for my personal progress, I entered 7226 with an adequate understanding of implant basics, but as the lectures and assignments progresses, I feel like I have a clinic-ready understanding of when and how to implement them in treatment planning”.(Participant 9)
“I feel much more confident in discussing implant related treatment with patients and other dental providers”.(Participant 32)
“When I begin planning implant procedures for my patients in the future, I now believe I have the tools to give them the most realistic expectation of their implants in terms of what to expect from the procedures, the procedural timeline, and how implants will function with the rest of their dentition”.(Participant 63)
“I have fulfilled my goal of being able to identify what to look for when planning an implant and how to plan the steps correctly”.(Participant 34)
“As the semester progressed, I became more comfortable with the course assignments and with the overall procedures and treatment planning associated with placing implants”.(Participant 55)
“This class helped me to appreciate the complexities and subtleties of the implant process. I now have a greater understanding of the steps that an implant takes, how long the process to complete one is, and what criteria make a patient a good candidate for implants”.(Participant 78)
“I saw the value of a surgical guide and how critical it would be to correctly placing an implant”.(Participant 6)
“I was using it as a definitive spot for #14 and 15, however I did course correct and aligned my drilling for #5 and 8”.(Participant 11)
“This exercise allowed me to realize how easy it is to be out of alignment despite having a surgical guide”.(Participant 41)
“I discovered that having a guide is often not enough to place an implant on the right position”.(Participant 52)
“The integration of PICO was also extremely helpful in facilitating my learning as I was able to answer many of my own questions”.(Participant 23)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Addy, L.D.; Lynch, C.D.; Locke, M.; Watts, A.; Gilmour, A.S.M. The teaching of implant dentistry in undergraduate dental schools in the United Kingdom and Ireland. Br. Dent. J. 2008, 205, 609–614. [Google Scholar] [CrossRef] [PubMed]
- Cooper, L.F. The Current and Future Treatment of Edentulism. J. Prosthodont. 2009, 18, 116–122. [Google Scholar] [CrossRef] [PubMed]
- Mattheos, N.; Albrektsson, T.; Buser, D.; De Bruyn, H.; Donos, N.; Hansen, E.H.; Lang, N.P.; Sanz, M.; Nattestad, A. Teaching and assessment of implant dentistry in undergraduate and postgraduate education: A European consensus. Eur. J. Dent. Educ. 2009, 13, 10–17. [Google Scholar] [CrossRef] [PubMed]
- Commission on Dental Accreditation. Accreditation Standards for Dental Education Programs; American Dental Association: Chicago, IL, USA, 2023. [Google Scholar]
- Koole, S.; Vandeweghe, S.; Mattheos, N.; De Bruyn, H. Implant dentistry education in Europe: 5 years after the Association for Dental Education in Europe consensus report. Eur. J. Dent. Educ. 2014, 18 (Suppl. S1), 43–45. [Google Scholar] [CrossRef] [PubMed]
- Schweyen, R.; Al-Nawas, B.; Arnold, C.; Hey, J. A cross-sectional survey of attitudes towards education in implant dentistry in the undergraduate dental curriculum. Int. J. Implant. Dent. 2020, 6, 26. [Google Scholar] [CrossRef] [PubMed]
- American Association of Dental Schools Curriculum guidelines for predoctoral implant dentistry. J. Dent. Educ. 1991, 55, 751–753. [CrossRef]
- Hicklin, S.P.; Albrektsson, T.; Hammerle, C.H.F. Theoretical knowledge in implant dentistry for undergraduate students. Eur. J. Dent. Educ. 2009, 13, 24–35. [Google Scholar] [CrossRef]
- Cowpe, J.; Plasschaert, A.; Harzer, W.; Vinkka-Puhakka, H.; Walmsley, A.D. Profile and competences for the graduating European dentist—Update 2009. Eur. J. Dent. Educ. 2010, 14, 193–202. [Google Scholar] [CrossRef]
- Temmerman, A.; Meeus, M.; Dhondt, R.; Wierinck, E.; Teughels, W.; Naert, I.; Quirynen, M. Oral implant placement and restoration by undergraduate students: Clinical outcomes and student perceptions. Eur. J. Dent. Educ. 2016, 20, 73–83. [Google Scholar] [CrossRef]
- Koole, S.; De Bruyn, H. Contemporary undergraduate implant dentistry education: A systematic review. Eur. J. Dent. Educ. 2014, 18 (Suppl. S1), 11–23. [Google Scholar] [CrossRef]
- Ng, S.L.; Kinsella, E.A.; Friesen, F.; Hodges, B. Reclaiming a theoretical orientation to reflection in medical research: A critical narrative review. Med. Educ. 2015, 49, 461–475. [Google Scholar] [CrossRef] [PubMed]
- Lutz, G.; Scheffer, C.; Edelhaeuser, F.; Tauschel, D.; Neumann, M. A reflective practice intervention for professional development reduced stress and improved patient care–a qualitative developmental evaluation. Patient Educ. Couns. 2013, 92, 37–345. [Google Scholar] [CrossRef] [PubMed]
- Priddis, L.; Rogers, S.L. Development of the reflective practice questionnaire: Preliminary findings. Reflective Pract. 2018, 19, 89–104. [Google Scholar] [CrossRef]
- Mortari, L. Reflectivity in Research Practice: An Overview of Different Perspectives. Int. J. Qual. Methods 2015, 14, 1609406915618045. [Google Scholar] [CrossRef]
- Duffy, F.; Holmboe, E. Self-assessment in lifelong learning and improving performance in practice. JAMA 2006, 296, 1137–1139. [Google Scholar] [CrossRef]
- Powell, J.H. The reflective practitioner in nursing. J. Adv. Nurs. 1989, 14, 824–832. [Google Scholar] [CrossRef]
- Koshy, K.; Limb, C.; Gundogan, B.; Whitehurst, K.; Jafree, D.J. Reflective practice in health care and how to reflect effectively. Int. J. Surg. Oncol. 2017, 2, e20. [Google Scholar] [CrossRef]
- Mann, K.; Gordon, J.; MacLeod, A. Reflection and reflective practice in health professions education: A systematic review. Adv. Health Sci. Educ. Theory Pract. 2009, 14, 595–621. [Google Scholar] [CrossRef]
- Obayashi, T.; Oto, T.; Nagatani, Y.; Taguchi, N.; Kawaguchi, H.; Ogawa, T. Dental trainees reflect more critically on negative experiences: Portfolio analysis using a pragmatic approach and a rubric in Japan. BMC Med. Educ. 2018, 18, 292. [Google Scholar] [CrossRef]
- Dunlap, J.C. Using guided reflective journaling activities to capture students’ changing perceptions. TechTrends 2006, 50, 20–26. [Google Scholar] [CrossRef]
- Kolb, D.A. Experiential Learning: Experience as the Source of Learning and Development, 2nd ed.; Pearson Education, Inc.: Upper Saddle River, NJ, USA, 2015; pp. 50–64. [Google Scholar]
- Ashley, F.; Gibson, B.; Daly, B.; Lygo Baker, S.; Newton, J. Undergraduate and postgraduate dental students “reflection on learning”: A qualitative study. Eur. J. Dent. Educ. 2006, 10, 10–19. [Google Scholar] [CrossRef] [PubMed]
- Subramanian, J.; Anderson, V.R.; Morgaine, K.C.; Thomson, W.M. The importance of ‘student voice’ in dental education. Eur. J. Dent. Educ. 2013, 17, 136–141. [Google Scholar] [CrossRef] [PubMed]
- Wilcox, C.W.; Sheets, J.L.; Nilsson, D.E. Predoctoral implant education: The Creighton experience at 20 years. J. Prosthodont. 2010, 19, 144–149. [Google Scholar] [CrossRef] [PubMed]
- Haffling, A.C.; Beckman, A.; Pahlmblad, A.; Edgren, G. Students’ reflections in a portfolio pilot: Highlighting professional issues. Med. Teach. 2010, 32, e532–e540. [Google Scholar] [CrossRef] [PubMed]
- Thorne, S. Data analysis in qualitative research. Evid. Based Nurs. 2000, 3, 68–70. [Google Scholar] [CrossRef]
- Pope, C.; Ziebland, S.; Mays, N. Qualitative research in health care. Analysing qualitative data. BMJ 2000, 320, 114–116. [Google Scholar] [CrossRef]
- Kiger, M.E.; Varpio, L. Thematic analysis of qualitative data. AMEE Guide No. 131. Med. Teach. 2020, 42, 846–854. [Google Scholar] [CrossRef]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef]
- Roberts, K.; Dowell, A.; Nie, J.B. Attempting rigour and replicability in thematic analysis of qualitative research data; a case study of codebook development. BMC Med. Res. Methodol. 2019, 28, 66. [Google Scholar] [CrossRef]
- Boyatzis, R.E. Transforming Qualitative Information: Thematic Analysis and Code Development; SAGE Publications: Thousand Oaks, CA, USA, 1998. [Google Scholar]
- Bogo, M.; Katz, E.; Regehr, C.; Logie, C.; Mylopoulos, M.; Tufford, L. Toward understanding meta-competence: An analysis of students’ reflection on their simulated interviews. Soc. Work Educ. 2013, 32, 259–273. [Google Scholar] [CrossRef]
- Phelps, R. The potential of reflective journals in studying complexity ‘in action’. Complicity Intl. J. Complex Edu. 2005, 2, 37–54. [Google Scholar] [CrossRef]
- O’Connell, T.S.; Dyment, J.E. The case of reflective journals: Is the jury still out? Reflective Pract. 2011, 12, 47–59. [Google Scholar] [CrossRef]
- Jonas-Dwyer, D.R.; Abbott, P.V.; Boyd, N. First reflections: Third-year dentistry students’ introduction to reflective practice. Eur. J. Dent. Educ. 2013, 17, 64–69. [Google Scholar] [CrossRef] [PubMed]
- Chaturvedi, S.; Elmahdi, A.E.; Abdelmonem, A.M.; Haralur, S.B.; Alqahtani, N.M.; Suleman, G.; Sharif, R.A.; Gurumurthy, V.; Alfarsi, M.A. Predoctoral dental implant education techniques—Students’ perception and attitude. J. Dent. Educ. 2021, 85, 392–400. [Google Scholar] [CrossRef] [PubMed]
- Fischer, T.; Fehlhofer, J.; Kesting, M.R.; Matta, R.E.; Buchbender, M. Introducing a novel educational training programme in dental implantology for pregraduate dental students. Eur. J. Dent. Educ. 2024, 28, 416–429. [Google Scholar] [CrossRef] [PubMed]
- Huebner, G.R. Evaluation of a predoctoral implant curriculum: Does such a program influence graduates’ practice patterns? Int. J. Oral Maxillofac. Implant. 2002, 17, 543–549. [Google Scholar]
- Yuan, J.C.; Kaste, L.M.; Lee, D.J.; Harlow, R.F.; Knoernschild, K.L.; Campbell, S.D.; Sukotjo, C. Dental student perceptions of predoctoral implant education and plans for providing implant treatment. J. Dent. Educ. 2011, 75, 750–760. [Google Scholar] [CrossRef] [PubMed]
- Kido, H.; Yamamoto, K.; Kakura, K.; Morinaga, K.; Matsuura, T.; Matsunaga, T.; Shimizu, H.; Takahashi, Y.; Sato, H.; Matsuura, M. Students’ opinion of a predoctoral implant training program. J. Dent. Educ. 2009, 73, 1279–1285. [Google Scholar] [CrossRef] [PubMed]
- Prasad, S.; Bansal, N. Predoctoral Dental Students’ Perceptions of Dental Implant Training: Effect of Preclinical Simulation and Clinical Experience. J. Dent. Educ. 2017, 81, 395–403. [Google Scholar] [CrossRef]
- Afshari, F.S.; Yuan, J.C.; Quimby, A.; Harlow, R.; Campbell, S.D.; Sukotjo, C. Advance predoctoral implant program at UIC: Description and qualitative analysis. J. Dent. Educ. 2014, 78, 770–778. [Google Scholar] [CrossRef]
- Neville, P. Introducing dental students to reflective practice: A dental educator’s reflections. Reflective Pract. 2018, 19, 278–290. [Google Scholar] [CrossRef]
- Wong, F.K.Y.; Kember, D.; Chung, L.; Yan, L. Assessing the level of student reflection from reflective journals. J. Adv. Nurs. 1995, 22, 48–57. [Google Scholar] [CrossRef] [PubMed]
- Bush, H.; Bissell, V. The evaluation of an approach to reflective learning in the undergraduate dental curriculum. Eur. J. Dent. Educ. 2008, 12, 103–310. [Google Scholar] [CrossRef] [PubMed]
- Tsingos-Lucas, C.; Bosnic-Anticevich, S.; Schneider, C.R.; Smith, L. Using reflective writing as a predictor of academic success in different assessment formats. Am. J. Pharm. Educ. 2017, 81, 8. [Google Scholar] [CrossRef] [PubMed]
Code Label | Characterization | Account Description | Criterion | Example |
---|---|---|---|---|
Learning experience | The learning through the semester | Perception of learning | Can be better learning or no learning | This class allowed me to learn all the different steps required to place dental implants (Particpant 8). |
Challenges and mistakes | Challenging knowledge or skill acquisition | Efficiency in understanding and undertaking tasks | Can be challenging or not or initially challenging and later became neutral | By far the most challenging of exercises was the socket preservation technique, specifically the defective socket. Not only was the suturing difficult, but placing the artificial membrane that would prevent the invasion of epithelial cells in a live patient was very technique sensitive (Participant 83). |
Hands on experience | The impact of simulated hands on activities | How helpful or not the hands on exercises on psychomotor skill development | Helpful in skill development or neutral | It was very helpful to have some hands-on experience to supplement the didactic portion of the course as I can relate more with hands-on activities than I typically would with just didactic/ppt presentations Also, being able to have these activities done in class gave me more of an idea of what my strengths and weaknesses are when it comes to implant related lab work. Thus, giving me an idea of what I should practice before taking on an implant case (Participant 23). |
Areas of Improvements | Initially struggled but eventually improved | Students perception of their struggles | The room for improvement in skill | The impressions were moderately difficult with the open tray being more difficult than the closed tray. However I see now how to get a good open tray impression, although my first one was not ideal and took multiple attempts (Participant 71). |
The course | The effectiveness of learning and the expectation | The perception of how course facilitate learning | Expectation may or not be fulfilled | This course amply fulfilled all my expectation and beyond. I did not just learned how to place implants but also learning how to restore them and actual being able to take analog impressions with both techniques open and close tray plus learning it the digital way with a scan body (Participant 50). |
Practical activities | The favourite exercises in psychomotor skill development | Students‘ perceptions of how much the found one activity or more enjoyable | The experience can be enjoyable or not enjoyable | The socket preservation exercise was also an experience I enjoyed and probably something I will do a lot more of as a general dentist (Participant 21). |
Confidence | Acknowledged of increase in confidence | Students’ voice of their confidence levels | The ability to apply knowledge to real-life scenarios, | In regard to implants, I feel much more confident in discussing implant related treatment with patients and other dental providers (Participant 32). |
Interest in further implant education | Given the knowledge and experience, how students perceive the need for future implant education | Student’s perception of the need for further dental implant education | The need for more practice to build on the learned techniques | I believe with additional practice, future courses and experience, I will feel much more confident on placing implant at the right location and angle (Participant 21). |
Digital dentistry in implantalogy | The opportunity to learn and practice digital implant dentistry | Students perception of using digital technology in implant dentistry | The learning opportunity can be positive or negative | As the field of dentistry is moving towards the digital trend at a rapid pace, I believe it is crucial for us as students to understand the uses of the digital hardware and their supporting software (Participant 7). |
Treatment Planning in implant dentistry | The importance of treatment planning | Students’ perception the importance of treatment planning | The treatment planning ability has or has not been fullfield | I entered 7226 with an adequate understanding of implant basics, but as the lectures and assignments progresses, I feel like I have a clinic-ready understanding of when and how to implement them in treatment planning (Participant 9). |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ziada, H.; Webberson, M.; Sharma, R.; Abubakr, N.H. Qualitative Analysis of Student Reflections on Preclinical Dental Implant Education. Dent. J. 2024, 12, 293. https://doi.org/10.3390/dj12090293
Ziada H, Webberson M, Sharma R, Abubakr NH. Qualitative Analysis of Student Reflections on Preclinical Dental Implant Education. Dentistry Journal. 2024; 12(9):293. https://doi.org/10.3390/dj12090293
Chicago/Turabian StyleZiada, Hassan, Michael Webberson, Rassilee Sharma, and Neamat Hassan Abubakr. 2024. "Qualitative Analysis of Student Reflections on Preclinical Dental Implant Education" Dentistry Journal 12, no. 9: 293. https://doi.org/10.3390/dj12090293
APA StyleZiada, H., Webberson, M., Sharma, R., & Abubakr, N. H. (2024). Qualitative Analysis of Student Reflections on Preclinical Dental Implant Education. Dentistry Journal, 12(9), 293. https://doi.org/10.3390/dj12090293