Dental Students’ Clinical Experience Across Three Successive Curricula at One U.S. Dental School

Abstract

As dental schools continue to seek the most effective ways to provide clinical education for students, it is important to track the effects innovations have on students’ clinical experience to allow for quantitative comparisons of various curricula. The aim of this study was to compare the impact of three successive clinical curricula on students’ experience at one U.S. dental school. The three were a discipline‐based curriculum (DBC), a comprehensive care curriculum (CCC), and a procedural requirement curriculum plus externships (PRCE). Students’ clinic experience data from 1992 to 2013 were analyzed for total experience and in five discipline areas. Clinic experience metrics analyzed were patient visits (PVs), relative value units (RVUs), and equivalent amounts (EQAs). A minimum experience threshold (MET) and a high experience threshold (HET) were set at one standard deviation above and below the mean for the DBC years. Students below the MET were designated as low achievers; students above the HET were designated as high achievers. The results showed significant differences among the three curricula in almost all areas of comparison: total PVs, total EQAs, total RVUs, RVUs by discipline, and number of high and low achievers in total clinical experience and by discipline. The comprehensive care approach to clinical education did not negatively impact students’ clinical experience and in many cases enhanced it. The addition of externships also enhanced student total clinical experience although more study is needed to determine their effectiveness. The insights provided by this study suggest that the methodology used including the metrics of PVs, EQAs, and RVUs may be helpful for other dental schools in assessing students’ clinical experience.

Development of a novel integrated educational relative‐unit value system to assess dental students' clinical performance

“…The development processes of identified systems were evaluated in light of Kane's views of validity 21 . Of these, 3 studies used insurance‐based RUVs to measure students’ performance, 1,16,17 and 5 described systems that were specifically developed for the educational setting 5–7,18,19 . Alignment between the purpose of developing the RUV system and the purpose it was used for, was noted in 2 of the 8 systems 6,7 .…”

“…However, justification of the basis of calculation was provided by 1 study only 7 . Three published systems mentioned involvement of faculty members in the development process 5,7,18 ; however, detailed reporting of how validity was established was not provided. For instance, 1 study identified having “a reasonably organized and efficient dental student should earn roughly 6 CEUs per hour of patient treatment, as a rule of thumb 19 .…”

“…Once validated, this unit can be used to quantify the expected work to be completed to achieve competency, assess case difficulty, and completion of treatment. Having an objective transparent measure can also help students self‐assess their work against previous production data, and help schools evaluate changes in their clinical curricula 5 …”

“…RUVs are typically determined by comparing different procedures relative to each other, hence, providing a standardized unit to compare dissimilar services 4 . In education, RUVs are commonly used to determine student's progress toward achievement of clinical requirements 5 . In fact, some schools have used RUVs to set targets for desired checkpoints, including graduation.…”

“…Some of these practice‐based RUVs have been used by dental educators to assess dental students’ clinical productivity in the educational settings 1,16,17 . Since these systems were not originally developed for use in education, several educational RUVs were developed 5–7,18,19 . A timeline of the usage of RUVs in dentistry is summarized in Figure 1.…”