Title Dental Students Can Benefit by Starting to Learn Indirect Vision (Mirror) Skills Early in Preclinical Studies with The Aid of a Training Device
Clinical Question In dental students, does use of a training device lead to improved mirror-inverted motor functions?
Clinical Bottom Line Mirror-inverted motor function can be learned and improved by repetition with a training device.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
21890859Rau/2011Seventy–eight dental studentsRandomized Controlled Trial
Key resultsAll students were tested on a Mirroprep training device. The device forced students to use a large mirror placed on the back of the device to trace patterns with a pencil held by a replica of a drill. Students were asked to trace the track and blacken various outline forms within 6 minutes without crossing the boundaries. If a student crossed over the line or didn’t fill the forms by more than .5 mm, it was considered to be an error. Post-hoc Games-Howell tests were used to determine which group differences were statistically significant. The student's number of errors decreased significantly from first-year students to graduates. On average the first-year students made 15.4 errors (SD = 7.9; range 4-39), advanced students made 4.4 errors (SD = 5.7; range 0-30), and graduates made only 1.8 errors (SD = 1.9; range 0-5). Therefore ANOVA for number of errors was highly significant (P<0.001). Post-hoc Games-Howell tests showed that first-year students made significantly more errors than both advanced and graduate students (P < 0.001). The difference in errors between advanced and graduate students was significant, but only marginally so (P = 0.07).
Evidence Search ("education, dental"[MeSH Terms] OR ("education"[All Fields] AND "dental"[All Fields]) OR "dental education"[All Fields] OR ("dental"[All Fields] AND "education"[All Fields])) AND Indirect[All Fields] AND ("vision, ocular"[MeSH Terms] OR ("vision"[All Fields] AND "ocular"[All Fields]) OR "ocular vision"[All Fields] OR "vision"[All Fields])
Comments on
The Evidence
The high number of errors (15.4 on average) found in the untrained dental students from the first pre-clinical semester showed consistency with similar studies (Kunovic RS, J Dental Educ 1987;51(12):716-719 and Diaz MJ, Eur J Dent Educ 2001;5:120-126). The study did not represent a full spectrum of dental students. International students have practiced in their own countries, in some cases, for several years and have progressed to have advanced/graduate level mirror skills. The criteria for each final diagnosis were explicit and credible. The diagnostic workup was comprehensive and consistently applied. There was no follow-up after the preclinical and clinical sessions. The author apparently demonstrated no conflict of interest. This study is consistent with other studies that have demonstrated a significant reduction of errors with only one practice session. First-year students obviously had no previous experience working in patients' mouths or on mannequins. It is plausible to assume that the significant difference in the reduction of errors demonstrated by the first-year students was due in part to the one-time use of a training mirror device. One possible criticism of the study might be in its inability to assess which share of advancement is due to curriculum, time spent practicing, or the use of a training device. An additional criticism should be noted. The results of this study were generated from a two-dimensional motor skill model. Clinical success depends upon movement in a patient’s mouth, which is three-dimensional. The dental mirror is held in various positions and different pressure is applied.
Applicability One of the primary values of testing as described would be to identify weaknesses in mirror skills early in the educational process. The subjects were representative of first-year, advanced and graduate dental student. This type of testing is certainly feasible in the typical dental school setting. The evidence would lead to the conclusion that learning indirect motor skills early in a student’s curriculum can only be beneficial in the long run. Dental schools should consider taking these findings into account when preparing curriculum. Dental schools can have first-year students practice with a two-dimensional training device in the preclinical lab and continue practicing three-dimensionally on a dental mannequin and finally in a patient’s mouth.
Specialty (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Dental Education, Indirect Vision
ID# 3133
Date of submission 01/20/2017
E-mail Ronald.brown@ucdenver.edu
Author Ronald N. Brown, DDS
Co-author(s) e-mail
Faculty mentor
Faculty mentor e-mail
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