The General Dental Council in its latest educational review placed professionalism at the heart of its education agenda and developed corresponding learning outcomes (GDC, 2015). This interpretivist qualitative study aimed to delineate perceptions about dental students' development of professionalism and explore significant influences on this development by examining the perceptions of dental students, their patients and teachers. Purposive sampling of students, patients and teachers ensured representation of diverse perspectives through focus groups and individual semi-structured interviews. An initial inductive thematic analysis was compared with theoretical perspectives on learning and the Illeris (Illeris, 2004) model of learning was selected for further theoretically driven analysis. Students, patients and teachers identified relational skills as an essential part of professionalism. Differences lay in the emphasis placed by students on being a 'well-rounded professional', patients wanting to be treated as a 'person as well as a patient' and teachers focusing on 'professional values'. As the students' clinical responsibility increased, their perceptions evolved from abstract values to pragmatic reality which mirrors the trajectory of the professionalism literature over the past twenty years. Students were influenced by planned curriculum content and unplanned experiences. Patients motivated students with feedback and reassurance and acted as mentors. Their teachers served as positive and negative role models. Teachers' expressed confusion and identified a gap between the actuality and ideal teaching of professionalism. Learning occurred as a result of simultaneous and multiple interactions within the individual, with the environment and with patients. This study validates the multidimensional intricacy of professionalism. Students identified constructive and adverse experiences which allowed them to develop empathy, take on responsibility for patient care and model themselves on their teachers. The emotional and social interactions involved in these experiences generated a creative 'tension field' of learning leading to the development of professionalism.

Despite the growing number of publications relating to three-dimension (3D) and education, the need for this technology, its usability and educational impact are not clear for dental education with the exception of haptics. The first stage of this doctoral research used a mixed method to examine key stakeholders’ views about those areas of dentistry that would benefit from having a 3D learning resource. Two hundred and five dental students, academics and graduates responded to the survey (134 females and 71 males). Results suggested that several areas of dentistry would benefit from 3D animations or simulations. Anatomy of the Temporomandibular joint (TMJ) was the top priority area from the list of the identified items. After identifying the areas of need, the researcher determined principles for e-learning and instructional design; followed by a feasibility study that identified a suitable authoring tool for the construction of a resource capable of containing 3D interactive models. A multidisciplinary team headed by the researcher developed the first iBook addressing the Tooth Morphology of the permanent dentition. The researcher collected feedback from users of the tooth morphology iBook using a mixed method experimental study, which included a questionnaire and a focus group session. Scottish and Chilean participants (n=138), from the University of Dundee and The Andes respectively, indicated that the iBook was well designed and it was a valuable resource where they could interact with the 3D models provided. These results informed the construction of a second iBook addressing the anatomy of the temporomandibular joint (TMJ) and masticatory system. Two versions of the TMJ iBook were created: a 3D version containing interactive models and a 2D version holding images. The researcher designed a comparative study including a pre-test/post-test intervention and a questionnaire to compare results from the two groups (3D and 2D). Twenty-seven first-year and thirty-two third-year dental students from the University of Dundee participated. The results of the intervention revealed statistically significant improvements in the results of first-years students who used the 3D version iBook compared to those who used the 2D one. The third-year cohort results revealed no significant difference between the 2D and 3D groups. The researcher arranged two focus group sessions to gain a deeper insight into the results. From those who took part in the intervention, eleven volunteered for the focus group sessions (six first years and five third-years). Results indicated that the TMJ iBook was a valuable resource for learning. Regardless the year of study, all participants preferred the use of the 3D interactive models as they had the potential to simplify visualisation and orientation, and enhance motivation for learning. Three key findings arose from this doctoral study. The first one indicates that several areas of dentistry would benefit from 3D resources and they would satisfy dental students’ needs. The second conclusion suggests that iBooks are a powerful, straightforward and valuable resource for creating new e-learning interactive material capable of displaying 3D models. The final finding suggests that the use of 3D interactive models have the potential to enhance learning in novice dental students, while they are capable of motivating and aiding visualisation both in junior and experienced students.

Introduction: Competence has been a term subject to many interpretations over the years. This discrepancy in agreement is not due to the clash of minds but mostly the fruit of differences in expectations and legal requirements of local healthcare systems. As a result, the assessment of competence has been subject to dynamic changes with abundance of literature published to address its properties from different angles. This research project is designed to explore a number of unknowns: firstly, we aim to explore what it is meant by competence and compare it to how it is defined by the regulators. Once this is established, such expectations are to be compared to the expectations of the Educational Supervisors (ESs): the trainers who are in charge of training the newly qualified dentists. The next goal of this project is to shed light on how students perceive competence and explore the assessment methods that reflect such competencies best. Once known, these assessment methods will be explored in the national level to understand how they are implemented. The project also aims to explore if such assessment methods could be improved and finally, to examine if new assessment methods can be introduced to the field of medical and dental education with significant benefits and advantages. Methodology: A mixed-method approach was chosen, consisted of qualitative, quantitative and descriptive statistics. Results: Profile of a competent newly qualified dentist as described by the regulatory bodies, ESs and students was discussed. The most reflective assessment methods to illustrate students' competencies were identified and their use at national level explored. We looked at the bench marking of the OSCEs and where the line of competence is drawn, and finally, we developed a new mathematical model that can predict competence after observing a number of clinical encounters. Conclusion: Several conclusions and recommendations were drawn and discussed at their relevant chapter.

To examine the pediatric dentists’ perspective on level of care to children 0-3 years old by general dentists, an electronic survey was sent out to 5185 AAPD members and 769 responded (response rate: 14.8%). Forty-six percent agreed with a general dentist providing a dental home to children 0-3 years old. Only 24% agreed that general dentists could perform complex restorative and behavior management procedures for 0-3 years old. Younger respondents, pediatric dentists who practice in rural areas or teaching pediatric dentistry, and those who perceived adequate exposure during dental school were more likely to agree on general dentists proving a dental home (p values ranged from <0.0001 to 0.022). This study finding can help guide what level of care general dentists may provide and when a referral to a pediatric dentist is recommended and the appropriate competency level of entry-level general dentists to care for 0-3 years old.

Due to the increasing demand from teaching institutions and the General Dental Council to provide dental students with accurate assessment and feedback, the focus of this thesis is to evaluate and improve assessment and feedback at Dundee Dental School. The aim is to determine and appraise assessment tools used in evaluating the clinical skills of dental students in laboratory setting. In addition, the purpose of this thesis is to further develop the assessment tools to provide valid and reliable assessment and feedback on students’ performance. Dental students practise clinical procedures in clinical skills laboratories which are evaluated by qualified staff. Effective evaluation should be valid (accurate and reliable) and produce consistently useful feedback. In this thesis, assessment of experienced (senior) examiners demonstrated, unrepeatable (intra-examiner) and reproducible (inter-examiner) evaluation of class II amalgam cavity and full veneer gold shell crown preparations in a clinical skills laboratory (Chapters 3 and 4).Further assessment of a wider group of additional teaching staff also demonstrated poor levels of intra-examiner reliability (repeatability) and inter-examiner reliability (reproducibility) (Chapter 4). Concentrating on the senior examiners, consistent methods, including the use of novel tools, were then devised and tested to improve intra-examiner repeatability and inter-examiner reproducibility. These methods also included feedback sheets which served to provide feedback for students (Chapter 5). Grades awarded from the best senior examiner who had the highest level of intra- and inter-examiner repeatability and reproducibility, respectively, were then tested against known developed standard criteria as well as actual preparations to establish the validity of these grades (Chapter 6). The checklist is the most common assessment method which is used within the Clinical Skills Laboratory in Universities. From five consistent methods, new checklists and reliable tools were established and tested again to demonstrate improved validity and reliability of awarded grades as well as feedback consistency (Chapter 7). This process now requires further testing with another cohort of preparations to affirm its usefulness. The new cohort should include tooth preparations by both novice and expert operators to reflect a greater range of abilities and thus test the assessment process more rigorously.

Dental Caries is still considered one of the most prevalent chronic diseases that affect children in the US. Access to oral care problems could be due to the limited availability of services or unwillingness of people to seek services. As a proposed solution to those challenges, Atraumatic Restorative Technique (ART) was developed in the 1980s as an affordable, patient friendly caries management procedure that does not need extensive operator training or special skills. ART was originally developed to be conducted in field settings; however, after initial evidence of effectiveness, the World Health Organization (WHO) and the International Dental Federation (FDI) promoted the use of ART in modern clinical settings worldwide. In the US, the practice of ART is not believed to be widely used. This may be a result of little attention given to (ART) in dental education and advanced training. This dissertation is comprised of three separate studies that investigated the extent and the factors related to the didactic and clinical instruction on ART in US pre- and post-doctoral pediatric dentistry programs and the factors related to the willingness of pediatric dentists to use ART with their child patients. survey post-doctoral pediatric dentistry program directors and pre-doctoral pediatric dentistry program directors. In study III a different instrument was used to survey pediatric dentists in the US. The survey instruments were tested for content and face validity by cognitive analysis interviews and pilot testing. Using web-based survey methodology, two questionnaires were sent out in May 2010 to investigate self-reported use of ART in educational training institutes (study I and II) and in April 2011, a third questionnaire was sent to a random national sample of pediatric dentists (study III). Using a conjoint design, the third questionnaire asked pediatric dentists to rate their willingness to use ART for 9 patients' scenarios. Eighty eight percent of Pediatric Dentistry Residency programs and 66 % of pre-doctoral pediatric dentistry programs in the US provided clinical training on ART; however only 30% of post-doctoral programs and 14 % of pre-doctoral programs used ART "Very Often/ Often" as a caries management technique for their pediatric patients. Pediatric Dentistry residency programs and pre-doctoral pediatric dentistry programs used ART mainly in primary, anterior, single surface cavities and as an interim treatment. Attitudes toward ART alone and after controlling for other variables explained 35% of the level of training on ART in post- doctoral program and 23% in pre-doctoral pediatric dentistry programs. For study III, conjoint analysis showed that being very young and/or uncooperative were the most important reasons practitioners reported a higher likelihood of using ART. Although insurance coverage was the least important factor overall, not having any insurance was identified as an additional important factor in decisions to use ART. Collectively, our results suggest that that the use of ART is not widespread in the US. In addition, ART is viewed by some as a sub optimum treatment and needs to be modified to conform to the US standards of care. On the other hand, educators and pediatric dentists who had positive views of ART thought it could be a valuable treatment for very young, uncooperative children and children with no insurance.

Background: Cognitive processing in diagnostic oral radiology requires a solid foundation in the basic sciences as well as knowledge of the radiologic changes associated with disease. Although it is generally assumed that in dentistry, students must acquire both knowledge sets, little is known about the role or impact of the basic sciences on clinical reasoning because the two have traditionally been taught separately in the curriculum. Objectives: This dissertation investigates the role of basic sciences in oral radiology and its effects on diagnostic accuracy. The studies were designed to satisfy the following research aims: 1) to examine and compare the effects of integration and segregation of the basic and clinical sciences on diagnostic accuracy; 2) to examine the effects of basic science instructional methodology and diagnostic strategy on diagnostic outcomes; 3) to explore the potential interactions between instructional methodologies used to teach disease categorization and diagnostic strategies; and 4) to examine the effects of testing the basic sciences on diagnostic accuracy in an integrated instructional methodology. Methods: We conducted three quantitative studies, all of which involved a learning phase and an immediate testing phase that assessed diagnostic performance and memory. In each of the studies, learning strategies, and or testing frequency were varied. We also included performance assessment of diagnostic ability and memory, one week after the initial learning phase. Results: Our results show that students who learned basic sciences explanations had higher diagnostic accuracy when using a holistic System 1 type diagnostic strategy than those who did not. We also demonstrated that basic science knowledge was the most effective when directly integrated with the clinical sciences, and this result is further enhanced with testing. Conclusions: We conclude that integrated basic science learning provides a coherent framework that has the potential to significantly improve the diagnostic accuracy of training dentists.

Background: Cognitive processing in diagnostic oral radiology requires a solid foundation in the basic sciences as well as knowledge of the radiologic changes associated with disease. Although it is generally assumed that in dentistry, students must acquire both knowledge sets, little is known about the role or impact of the basic sciences on clinical reasoning because the two have traditionally been taught separately in the curriculum. Objectives: This dissertation investigates the role of basic sciences in oral radiology and its effects on diagnostic accuracy. The studies were designed to satisfy the following research aims: 1) to examine and compare the effects of integration and segregation of the basic and clinical sciences on diagnostic accuracy; 2) to examine the effects of basic science instructional methodology and diagnostic strategy on diagnostic outcomes; 3) to explore the potential interactions between instructional methodologies used to teach disease categorization and diagnostic strategies; and 4) to examine the effects of testing the basic sciences on diagnostic accuracy in an integrated instructional methodology. Methods: We conducted three quantitative studies, all of which involved a learning phase and an immediate testing phase that assessed diagnostic performance and memory. In each of the studies, learning strategies, and or testing frequency were varied. We also included performance assessment of diagnostic ability and memory, one week after the initial learning phase. Results: Our results show that students who learned basic sciences explanations had higher diagnostic accuracy when using a holistic System 1 type diagnostic strategy than those who did not. We also demonstrated that basic science knowledge was the most effective when directly integrated with the clinical sciences, and this result is further enhanced with testing. Conclusions: We conclude that integrated basic science learning provides a coherent framework that has the potential to significantly improve the diagnostic accuracy of training dentists.

The extent of the application of the strategic planning process on dental education institutions was the problem in this descriptive study. The specific purpose was to describe the status of strategic planning based on the perceptions of the respondents. The organization, the characteristics and the impact of the strategic planning process would be investigated and described by this research. The total population of the doctoral and post-doctoral dental education institutions were included in the study. A specifically developed research instrument was used to elicit the perceptions of the respondents, both experts and chief executive officers (deans). All the experts (100 percent) completed and validated the research instrument and 65 percent of the dental education institutions completed the research instrument. The research instrument evaluated three areas of strategic planning: organization, characteristics, and the impact of strategic planning on their institutions. It was concluded that all dental education institutions participate in the strategic planning process and that the organization in the strategic planning process and that the organization and characteristics are generally similar to those in higher education institutions. The application of the strategic planning process has been proven beneficial in higher education institutions and there are perceived benefits in dental education. The study also concluded that there were conflicting perceptions that showed differences between dental and higher education institutions. These differences demonstrated that the dental education^institutions were not using the strategic planning process at the same functioning level as higher education institutions.

O objetivo deste estudo longitudinal prospectivo foi desenvolver um curso de extensão usando recursos da educação a distância (EAD) e avaliar seu potencial no desenvolvimento das competências necessárias para a execução do Tratamento Restaurado Atraumático (ART) nos cirurgiões-dentistas. O curso aborda filosofia e técnica do ART utilizando diferentes recursos como computação gráfica em três dimensões, filmagens clínicas, imagens de fotografias e radiografias intrabucais e entrevistas com especialistas no assunto. O curso tem aproximadamente 40 minutos e é apresentado em formato de DVD, que em função disso, proporciona alta acessibilidade e baixa interatividade. A amostra consistiu de 68 cirurgiões-dentistas divididos em 2 grupos: Grupo Diadema - 44 profissionais da população de cirurgiõesdentistas da rede pública de Diadema/SP (perda amostral de 38,9%) e Grupo USP- 24 profissionais da rede pública de 7 cidades próximas à São Paulo envolvidos em parceria científica entre as prefeituras e a disciplina de Odontopediatria da FOUSP (perda amostral 7,7%). Inicialmente os cirurgiões-dentistas responderam questionário que abordou conhecimento prévio, credibilidade e interesse na capacitação relativos ao ART. Na seqüência, os participantes foram submetidos ao processo de avaliação que consistiu na aplicação de prova setorizada (setores 1, 2 e 3) em dois momentos distintos: antes e depois dos profissionais terem passado pela capacitação à distância (avaliação inicial e final). A correção das provas foi realizada por 2 pesquisadoras (grau de concordância inter-examinadores CCI=0,970; 95%IC=0,916-0,989 e intraexaminadora CCI=0,991; 95%IC=0,975-0,996). Os 2 grupos apresentavam nível semelhante de conhecimento inicial (teste t de Student p>0,05) e mostraram ganho de conhecimento, após terem sido submetidos ao curso de extensão, para os 3 setores da prova isoladamente e média geral (teste t de student pareado p0,05). No modelo múltiplo de regressão linear, considerando as notas da avaliação inicial, foi observado associação para profissionais acima de 46 anos de idade (= -0,807; p0,01), para os participantes que entendiam o ART como tratamento restaurador definitivo (= 0,581; p0,01) e para os cirurgiões-dentistas com experiência clínica reduzida em ART (= -0,592; p0,05). Quando considerado o desempenho dos cirurgiões-dentistas na avaliação final, houve associação para os profissionais do grupo Diadema (= -0,652; p0,01), para as mulheres (= 0,700; p0,05), para os profissionais acima de 46 anos (= -0,788; p0,05) e para os participantes que consideravam o ART como tratamento restaurador definitivo (= 0,515; p0,05). Concluiu-se que cursos de extensão profissional a distância desenvolvidos adequadamente apresentam potencial para promover, nos cirurgiõesdentistas, as competências necessárias para a correta execução de técnicas odontológicas baseadas em evidências, como por exemplo, o ART. Além disso, adultos jovens, do sexo feminino, que apresentam conhecimento prévio adequado e interesse no aprimoramento tendem a apresentar melhor desempenho frente a esta modalidade de ensino. / The aim of this prospective longitudinal study was to develop an extension course based on distance learning and evaluate its potential in developing necessary skills for Atraumatic Restorative Treatment (ART) implementation. The course teaches philosophy and technique using different resources such as computer graphics in three dimensions, clinical films, photographs and radiographs, and interviews with experts. The course takes approximately 40 minutes and is presented in DVD format providing high availability and low interactivity. The study sample consisted of 68 dentists and was assigned into 2 groups: Diadema Group - 44 professionals from public health system in Diadema / SP (dropout 38.9%) and USP Group - 24 professionals from 7 different cities close to São Paulo involved in a scientific partnership between municipalities and discipline of Pediatric Dentistry from FOUSP (7.7% dropout). Initially the dentists answered a questionnaire focused in baseline knowledge, credibility and interest in receive training in ART. Subsequently, participants underwent an assessment process that consisted of sectorized evaluation (sectors 1, 2 and 3) at two different times: before and after the extension course (baseline and final assessment). The correction of the tests was performed by two researchers (inter-examiner agreement ICC = 0.970, 95% CI = 0.916 to 0.989 and intraexaminer agreement ICC = 0.991, 95% CI = 0.975 to 0.996). The two groups had similar initial knowledge (Student´s t test p> 0.05) and showed knowledge increase, after extension course, for each of three sectors and in the sum (Student\'s paired t test p 0.05). In the multiple linear regression model, considering the grades from initial evaluation, it was observed association for professional over 46 year olds ( = -0.807, p 0.01), for participants that had in mind that ART was a definitive treatment ( = 0.581, p 0.01) and for dentists with reduced clinical experience in ART ( = -0.592, p 0.05). When considering the dentists´ performance in the final evaluation, there was an association for professionals in the Diadema group ( = -0.652, p 0.01), for women ( = 0.700, p 0.05), for professionals over 46 years old ( = -0.788, p 0.05) and for participants who pointed out ART as a definitive restorative treatment ( = 0.515, p 0.05). It was concluded that distance education has the potential to promote the skills to perform correctly evidence based dental techniques, such as ART. Besides that, young adult, female, with appropriate basis knowledge and interest in professional development improve the students´ performances on distance education.