Saudi Journal for Health Sciences

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 11  |  Issue : 1  |  Page : 10--16

Dental interns' perceptions of their training experiences at different training centers


Ali Alenezi 
 Department of Prosthodontics, College of Dentistry, Qassim University, Buraydah, Saudi Arabia

Correspondence Address:
Ali Alenezi
Department of Prosthodontics, College of Dentistry, Qassim University, P.O. Box: 6700, Burydah
Saudi Arabia

Abstract

Background: Investigating dental interns' perceptions of their learning experience is important for properly understanding potential difficulties and obstacles in training. Aims: The aim of this study was to explore dental interns' perceptions on their learning environment and supervision. Settings and Design: This survey was in a form of a questionnaire that includes 20 items and was divided into three main parts: The first part of the questionnaire evaluated the intern's perception toward the learning outcomes obtained from the field experience. The second part of the study assessed the interns' perceptions toward their supervisors. The third part of the questionnaire investigated the interns' perceptions toward training centers facilities. Methods: This questionnaire was presented in a Likert-type format. Respondents stated their agreement or disagreement with each item on a four-point scale; strongly agree (4), agree (3), disagree (2), and strongly disagree (1). Statistical Analysis Used: Descriptive analysis was conducted to illustrate the sample characteristics using Chi-square Test. The Mann–Whitney U-test was used test the differences between male and female interns. Results: A total number of 234 questionnaires were filled and submitted by interns in which 134 from male interns (57.3%) and 100 from female interns (42.7%). In general, the interns from both genders appeared very satisfied with their training experience. With all the questionnaire 20 items, more than 75% of the obtained answers were either agree or strongly agree with similarly obtained from both male and female interns. Conclusions: High level of satisfaction can be obtained when the field experience outcomes are clearly explained. In addition, the availability of supervisors with full awareness of learning outcomes will improve the learning experience of dental interns.



How to cite this article:
Alenezi A. Dental interns' perceptions of their training experiences at different training centers.Saudi J Health Sci 2022;11:10-16


How to cite this URL:
Alenezi A. Dental interns' perceptions of their training experiences at different training centers. Saudi J Health Sci [serial online] 2022 [cited 2022 May 23 ];11:10-16
Available from: https://www.saudijhealthsci.org/text.asp?2022/11/1/10/344484


Full Text



 Introduction



Globally, the dental education system varies at different levels. In most places, however, it combines theoretical, practical, and clinical training. In general, the traditional dental undergraduate curriculum focuses on building knowledge during the 1st year of education.[1] These 1st year are known as preclinical instruction, with an emphasis on didactic education, while later years (clinical instruction) feature a gradual increase in clinical training.[2] After graduation, new dentists will face work reality and their own challenges in the daily dental practice. The transition of dental graduates from supervised undergraduate education to unsupervised practice represents an important step in dental education throughout the world.[3]

Thus, in many countries, new graduate dentists are required to spend a certain amount of time doing internship training after graduation. The main purpose of this is to prepare them for daily dental practice and to improve their clinical and research skills. For instance, new dental graduates in the United Kingdom (UK) are required to complete a mentored year, known as foundation training.[4] Conducted in general dental practice settings, this foundation training aims to prepare new graduates to practice dentistry without supervision. In China, the last year of undergraduate dental education, known as an intern year, includes comprehensive clinical training.[1] Meanwhile, in Saudi Arabia, students who gain admission to the dental college must complete a year of basic science studies followed by 5 years of undergraduate education in dental college. Dental school graduates are then required to complete an internship year, training at different hospitals, before receiving their licenses.

For new dental graduates, self-confidence and preparedness to work independently are essential in the transition from student to dental practitioner. Many new graduates believe they require supervised training with an experienced dentist until they develop greater confidence and skills that may not have been taught during their undergraduate education.[5] In addition, increased clinical exposure for interns beyond what they receive during undergraduate education could improve professionalism and confidence in clinical procedures.[6] Nevertheless, there is insufficient literature on the most effective methods for dental intern training with regard to improving confidence and developing clinical and research skills. Some reports highlight the significance of the learning environment at training centers for developing dental interns' professional and intellectual skills.[7]

It has been suggested that the ideal learning environment should seek to improve not only trainees' professional aspects but also their personal and social wellbeing.[8] Some studies show that effective learning experiences can provide students with academic success and progression.[9],[10] The ideal learning environment should include supervision by experienced doctors, adequate exposure to clinical work with a sufficient number of patients, and introduction to modern techniques and applications.[5],[11] Digital methods like computer-aided design and computer-aided manufacturing, could significantly improve the quality of dental prostheses using standardized production processes.[12] Work environments should also offer support and guidance for staff and promote constructive feedback to maintain a positive atmosphere and proper student-staff relationships.[2]

For dental interns, clinical supervision is believed to serve many roles, including assisting the trainee to develop competency.[13] Indeed, most skills and treatment methods that interns learn during internship training are gained mainly through interactions with clinical supervisors. However, the clinical supervisor's main task may be to reduce the risk of errors and poor clinical practice. Graham et al. revealed that the presence of a good supervisor also promotes practice-based learning with a degree of junior doctor autonomy.[14] In fact, some studies show that increased supervision can improve intern performance and treatment outcomes.

Investigating dental interns' perceptions of their learning experience is important for properly understanding potential difficulties and obstacles in training.[9],[15] Few published works discuss this topic, focusing mainly on the US and UK.[16] Still, various studies concur that interns' feedback about their training experience provides significant value for the continuous development of training programs and the learning environment. Subramanian et al. reported that students' perceptions of their learning environments could be a great reflection of their undergraduate education performance.[16] Other studies employed quantitative and qualitative methods to investigate the effects of training environments on interns' professional education.[17],[18],[19]

Most studies that discussed new dental graduates were based on predesigned questionnaires to mainly evaluate clinical performance. Few publications have investigated the transition experience from undergraduate education to graduation level.[20],[21] Thus, the aim of the present study was to explore dental interns' learning experiences at the training center during their internship, including their perceptions of their learning environment and supervision.

 Methods



The research protocol of this study was approved by (Blinded for reviewers). All methods were performed in accordance with relevant guidelines and regulations.

This survey was in form of a questionnaire in which interns were asked to fill and submit at the end of each training rotation. All interns were then invited to sign a consent form acknowledging their willingness to participate in the study. The sample size in this survey includes all dental interns from governmental dental schools in Saudi Arabia, between 2016 and 2021.

The questionnaire includes 20 items and was divided into three main parts: The first part of the questionnaire evaluated the interns' perception toward the learning outcomes obtained from the field experience and their development. This part had eleven questions to analyze the interns' feedback regarding the amount of requirements assigned to them during their training and questions about the learning experience and satisfaction.

The second part of the study assessed the interns' perceptions toward their supervisors. This part had six questions to evaluate how much the interns consider their supervisors were available and facilitating their clinical and research work.

The third part of the questionnaire investigated the interns' perceptions toward training centers facilities. This part had three questions to investigate to the interns' opinion regarding the resources at the training center and the availably of modern technology to improve their learning experience.

This questionnaire was presented in a Likert-type format. Respondents stated their agreement or disagreement with each item on a four-point scale; strongly agree (4). Agree (3), disagree (2), and strongly disagree (1). All interns received copy of the questionnaire by email at the end of each training rotation at requested to fill it and submitted to the intern's affair unit at collage of dentistry at Qassim University.

Descriptive analysis was conducted to illustrate the sample characteristics using Chi-square Test. The Mann–Whitney U-test was used test the differences between male and female interns. Mean rank scores were considered to be statistically significant if P ≤ 0.05.

 Results



A total number of 234 questionnaires were filled and submitted by interns in which 134 from male interns (57.3%) and 100 from female interns (42.7%). In general, the interns from both genders appeared very satisfied with their training experience. With all the questionnaire 20 items, more than 75% of the obtained answers were either agree or strongly agree with similarly obtained from both male and female interns [Figure 1].{Figure 1}

[Table 1] represents interns' perceptions toward the field experience outcomes that include the knowledge and skills obtained during the field experience. Most of the interns perceived that the requirements for the successful completion of field experience, including the assessment criteria were clearly explained. They believe that the amount of work they had to do was reasonable and will be useful to practice dentistry independently. Around 17% of the Interns said they were not satisfied with the quality of my field experience.{Table 1}

For the Interaction with supervisor, interns reported answers with positive feedback (agree and strongly agree) for all items [Table 2]. More than 85% of the responders revealed that their supervisors were fully committed and enthusiastic to impart the best possible training during the field experience. They also believe were fully aware of the learning outcomes, format, and contents of the field experience program.{Table 2}

With regard dental resources and modern technology, around 76% of the interns agreed that the dental materials and equipment available in the training centers were the latest and fulfilled my clinical requirements [Table 3]. A similar percentage reported that the modern technology was used effectively to enhance their learning experience.{Table 3}

 Discussion



Obtaining a dental degree and a license to practice dentistry are recognized as great achievements. However, the transition from undergraduate student to an independent clinical practitioner is considered a major challenge, especially initially. Most new graduate dentists faced common challenges, including a higher level of responsibility when treating patients compared to the undergraduate level. At the same time, new graduates are supposed to be learning and grasping new information during this process. Some studies report that it requires several years of clinical practice to develop skills and knowledge. Meanwhile, a limited number of studies offer qualitative research on dental interns' learning experiences.

In this study, the interns' perceptions of their training experience from different aspects, mainly the work environment and level of supervision were evaluated. The method used to evaluate interns' perceptions was a 20-item questionnaire, which was mailed to interns with instructions to complete and submit at the end of each rotation. Submitted questionnaires were to be read-only by the interns' affair unit, allowing interns to provide honest answers without being influenced. The questionnaires are based on a Likert-type format, a commonly used method in dentistry to explore students' and graduates' perceptions of their education.[22],[23] Other methods used for this purpose include interviews,[17] anecdotal evidence,[24] and close-ended questionnaires.[25] Manague et al. reported that most evaluation tools in dental school are mainly based on daily observations and exams.[26] A low response rate is believed to be one limitation of questionnaire-based methods.[27] In this study, however, participants were informed that filling out and submitting questionnaires was a requirement; as a result, all participants submitted completed questionnaires.

In this evaluation, interns were very satisfied with their training experiences and supervisors. The assumption that male interns would rank preparedness higher than female interns was not evident in this study as both genders gave similar responses. Nearly all evaluated areas were deemed excellently covered by the training centers. The fact that interns were able to choose their training center and research area of interest provided them great satisfaction from the start, facilitating their training experience and reducing the risk of conflicts.

Meanwhile, interns' satisfaction regarding the work required of them may be based on the fact that they were not asked to complete a certain number or type of clinical cases. In fact, most training centers only assigned walk-in patients or patients presenting to the clinic for pain treatment. Most patients requiring advanced treatment that can involve several visits were treated in specialists' clinics. Thus, most of the interns' clinical work involved the first stages of treatment, such as pulp extirpation or tooth extraction. This differs from undergraduate training where they are required to complete a certain number and type of dental cases as they need approval and evaluation during each step. In addition, assessment criteria at the end of each training rotation are based mainly on interns' attitudes and their integration with staff. All these findings were somewhat similar to those reported in other studies regarding dental students' and graduates' perceptions of their learning experiences during undergraduate and postgraduate periods.[15],[28] In their study, Kuit et al., reported that this type of learning experience is a recognized teaching method, which allows experiences to be considered not only by thought but also through action.[29]

The high satisfaction reported by interns may be attributed to the fact that all training centers are government institutes, which typically have good facilities and supplies, as well as a high number of clinics and staff members. Thus, this may help establish good training programs for interns, focusing more on skill improvement than requirements. The training experience is believed to be somewhat similar across different centers since the internship program is standardized for dental interns. As such, all interns are asked to be observers at the clinic, or mainly perform first-stage dental treatments such as operative or endodontic therapy. Interns may be allowed to treat more advanced cases if they have demonstrated sufficient ability and ask to lead such cases.

Regarding supervision, it has been noted that the role of clinical supervisor in interns' learning experience has a greater influence in the clinic compared to classroom settings.[30] To ensure an effective learning experience for interns, the clinical instructor or supervisor should exhibit theoretical and clinical knowledge while engaging trainees as a teacher.[2],[15] In this study, interns reported that clinical supervisors were always present. This may be due to the high number of available supervisors who, in general, are qualified and experienced, thereby enabling close relationships between interns and supervisors.[16] This relationship allows more time for interns to improve their clinical and research skills. Such improvement may be the main factor for interns' high satisfaction, along with not having specific requirements for completing their internship. Meanwhile, increased stress caused by the surrounding needs and requirements was reported to be a major factor for decreased level of satisfaction among interns.[31]

The interns seemed satisfied with the cooperation they received from supervisors. This is important since conducting research projects may be a goal for interns seeking to improve their resumes for future job applications or postgraduate programs.[16] The interns' daily work with supervisors at the training center may help facilitate research work. Several studies revealed the importance of supervisor characteristics, such as availability, encouragement, and providing feedback to trainees.[14],[30] Moreover, there appeared to be no issues regarding deficiencies in dental materials and equipment. This may be of great importance to interns since it allows a smooth training experience. In addition, introducing interns to modern technology, such as digital dentistry, will teach them the latest updates in the field.[2] Completing training at institutes with such facilities may ensure high satisfaction levels, as reported in this survey.

While this survey contained 20 items, it was mainly designed to determine if interns believed their training experience improved their ability to think, solve problems, and develop skills as a team member. Such improvements are a main outcome expected from the internship year and may facilitate the transition to practice. Thus, receiving interns' feedback is essential to evaluate this outcome. Along with intern questionnaires, supervisors had a form to evaluate interns, allowing us to obtain feedback from all parties involved in the training process.

Constructive feedback is believed to be an assistive tool for an effective learning experience. Interns revealed that encouragement was beneficial for communication with supervisors and enabled a stronger commitment to learn.[13],[32] Furthermore, while many interns reported that critical feedback is important in developing clinical skills, it should be delivered in a respectful manner to avoid causing embarrassment, particularly in the presence of patients or other interns.

 Conclusions



This qualitative study evaluated dental interns' perspectives on the learning experiences with regard to the work environment and supervision. A high level of satisfaction can be obtained when the field experience outcomes are clearly explained to the dental interns. In addition, the availability of supervisors with full awareness of learning outcomes will improve the learning experience of dental interns.

Acknowledgement

The researcher would like to thank the Deanship of Scientific Research, Qassim University for funding the publication of this project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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