Title Predoctoral Dental Students Are More Clinically Confident And Efficient In A Community-Based Clinical Education Program
Clinical Question In pre-doctoral dental education, are students more clinically confident and efficient in a community-based clinical education program compared to a traditional educational program in an on-campus dental school clinic?
Clinical Bottom Line Dental students trained in a community-based clinical education program had more positive educational outcomes than traditionally-trained dental students. This is supported by a retrospective and a cohort study of two different groups of dental graduates and dental students who scored higher on the North East Regional Board (NERB), had a 100% on-time graduation rate, and higher clinical productivity compared to students in a traditional educational program.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
16352768DeCastro/2005457 students in a traditional predoctoral dental curriculum and 50 seniors in a community-based program.Case Control Study
Key resultsFrom 1996 to 2003, 572 students graduated from the University of Medicine and Dentistry of New Jersey (UMDNJ)-New Jersey Dental School (NJDS) traditional program. 457 students released their NERB scores. From the CODE program, 63 students graduated, but only 50 released their NERB scores. CODE students performed significantly better than traditional students on the restorative section of the NERB exam (94.92; sd. 14.03 vs. 88.23; sd. 26.37 respectively, p=0.006). There was no significant difference in scores between either group on the written, simulated patient and periodontics portion of the NERB exam. Clinical production was analyzed for 284 students from the classes of 2001 through 2004: 260 on the traditional curriculum and 24 CODE students. CODE students accumulated roughly three times as many points in the areas of oral diagnosis, prevention, and oral surgery and approximately double in operative. Total clinical points generated by the CODE curriculum were 1,946.54, with a mean of 472.18. Traditional curriculum totaled 1,082.45 clinical points, with a mean 187.58; P<.001. Overall, the students in the CODE program had an average of 80 percent higher clinical points compared to the students in the traditional program. From 1996 – 2004, the overall on-time graduation rate for CODE was 100%; traditional program was 72.03%; Chi-Square P<.001. The on-time graduation rate for the traditional program had a low of 58.67 percent in 1997 and a high of 82.35 percent in 2004.
17687084Bean/2007102 senior dental students assigned to treat patients on different sites: community-based clinics and school clinic-base clinic.Prospective Cohort Study
Key resultsOne (1) year study of 102 senior dental students from the Ohio State University College of Dentistry averaged 42 days treating patients in different community-based sites (clinics). The students performed a total of 26,882 procedures by treating a total of 11,808 patients. This is equivalent to treating 116 unduplicated patients and 264 procedures per student. Procedures accomplished per day and average utilization rate was 655.7 and 99.0%, respectively. Revenues billed for the top 25 procedure and dollars generated per student was $997,762 and $9,782, respectively. The same students averaged 93 days treating patients in the school-based clinic. The students completed 28,680 procedures by treating 19,344 patients. This is equivalent to each student treating 190 patients and completing 281 procedures. Procedures accomplished per day and average utilization rate was 308.4 and 94.7%, respectively. Revenues billed for the top 25 procedure and dollars generated per student was $1,039,218 and $10,188, respectively.
Evidence Search ((("Community Dentistry"[Mesh] AND "Dental Clinics"[Mesh]) AND "Education, Dental"[Mesh]) AND "Educational Measurement"[Mesh]) AND "Clinical Competence"[Mesh]
Comments on
The Evidence
Validity: Both studies were completed utilizing a community-based learning program with a large overall population of students (n>100). DeCastro/2005 provides statistical and Chi-Square analysis with p-values. On the other hand, Bean/2007 provides results utilizing a business approach of productivity, demographics, procedures performed, billed and collected, and revenues generated per student. Perspective: Although both studies analyze the effectiveness of a community-based learning program in dental education, the studies differ with the population of students, years of data analyzed and the overall execution in the comparison of programs. DeCastro/2005, retrospectively compared the performance of 457 students exclusively in a traditional-learning school based clinic curriculum versus 50 students exclusively in a community-learning based curriculum program in the following categories: scores and pass/fail rates on the NERB, clinical production, passage of competencies, and on-time graduation rates. NERB scores were collected from 1996-2003. Clinical production was collected from 2001-2004 and it was only available for 284 students, 260 traditional curriculum and 24 CODE students. Graduation rates were analyzed from the years 1996-2004. On the other hand, Bean/2007 analyzed the information obtained in a one (1) year study of 102 senior students who all participated in both, a 42-day community-based educational experience and a 93 clinic days at the school’s dental clinic. The evidence provided in both articles is creditable and compelling. The evidence provided demonstrate the importance of a new dental curriculum, which includes a community-based learning environment for students. Such program not only benefits the students with their confidence in treating patients, but also allows the student to treat a wider population; thus decreasing dental and oral health care disparities.
Applicability Dental education in the United States remained practically unchanged during the twentieth century. By the mid-2000s, reports and articles from the Institute of Medicine and the American Dental Education Association stated that the curricula followed by dental schools around the country was in great need for a change. The transformation needed to provide a better dental education that would allow students to graduate highly proficient to work in the fast changing industry of health care; and at the same time, provide care for the people with limited access and resources for care. In order to address the issues, many traditional schools around the country have added community-based educational programs to their dental curricula. The reviewed articles by DeCastro (New Jersey) and Bean (Ohio State) indicate that community-based programs achieve the same or better educational outcomes that a student would get in a traditional school-based clinic program, but with the added benefits that students obtain a higher level of confidence through increased opportunity to apply their clinical skills. These factors translate to an increase in student performance, student clinical productivity and revenue to the schools. Furthermore, community-based programs provide access to care and reduce dental and oral health care disparities.
Specialty (General Dentistry) (Interprofessional CATs)
Keywords Predoctoral Dental Education, Community-Based Learning, Traditional Curricula, Dental Education, Clinical Competence
ID# 3079
Date of submission 04/26/2016
E-mail Dominguezd3@livemail.uthscsa.edu
Author Daniel Dominguez
Co-author(s) e-mail
Faculty mentor William D. Hendricson, M.A., M.S.
Faculty mentor e-mail Hendricson@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available