Keywords
oral surgery - dental undergraduate studies - confidence - competence - clinical skills
- dentoalveolar surgery
Introduction
Oral surgery is an integral part of dentistry that deals with the diagnosis and management
of pathology of the mouth and jaws that requires surgical intervention.[1] The majority of European Union member states recognize oral surgery as a dental
specialty, which comprises at least 3 more years of full-time training after completion
of basic dental training.[2] However, the presence of recognized oral surgery specialists does not limit the
range of activities of the general dental practitioners, who undertake many common
oral surgical procedures.[2]
[3]
[4] The role of the specialist is considered to be a properly trained dentist who can
carry out the more difficult and advanced procedures that may be beyond the abilities
of the average general dental practitioner.[4] In this sense, a dental graduate must possess proper knowledge and skills to provide
surgical management of the most common and basic cases in daily practice of general
dentistry.
In 2010, the Association for Dental Education in Europe (ADEE) published the “Profile
and competences for the graduating European dentist,” where the basic levels of professional
behavior, theoretical knowledge, and clinical skills that a dentist must obtain upon
graduation are described.[5] In this article, competences that fall within the scope of oral surgery are also
described adequately. In the 2017 ADEE review[6] of these competences for the graduating European dentist, although oral surgery
competences appear to have been limited, ADEE adopts and refers to the article of
Macluskey et al,[7] in which a proposed curriculum for undergraduate oral surgery is more thoroughly
described.
Competence is the ability to provide safe and reliable care on a consistent basis,
which presupposes good theoretical knowledge and understanding of the subject along
with sufficient clinical experience to treat, independently or without assistance,
the clinical problems that arise.[8] The acquisition of competence is based on the gradual shifting of the treatment
responsibility from the instructor to the learner, and it has been proposed that the
learner passes through three stages, starting from “novice,” shifting to “beginner”
and finally to “competent.”[9]
[10] In the “novice” stage, the learner is characterized by unconscious disability. In
the “beginner” stage, although inexperienced, the learner is conscious of his or her
impotence, while in the “competent” stage, the learner is able to independently perform
treatments. After going through these three stages, the self-confidence of the learner
increases.
Self-confidence is defined as an individual's own perception of performing a specific
action. Although not necessarily representing the practitioner's actual ability, self-confidence
strongly affects his or her decision to undertake a treatment or not.[11] Thus, as newly graduated dentists are required to perform procedures with limited
clinical experience, boosting of self-confidence should be an integral aim of dental
education. However, it is important to note that self-confidence should be mitigated
by knowledge of personal limitations, weaknesses, and abilities so that the graduate
dentist practices dentistry within safe limits.[12]
The aim of the present study was to evaluate senior dental students' self-confidence
and self-perceived competence to undertake cases within the scope of oral surgery.
Evaluation of clinical experience gathered during training and self-perceived confidence
and competence in generic oral surgery skills is included. Although similar studies
have been conducted in several countries, to the best of our knowledge, this is the
first to involve the two dental schools of Greece.
Materials and Methods
The present study was a questionnaire survey conducted during the academic year 2018–2019,
addressing the senior students of two dental schools of Greece, namely, Aristotle
University of Thessaloniki (AUTH) and National and Kapodistrian University of Athens
(NKUA). The study protocol was approved by the Institutional Ethical Committee and
the candidate participants were informed that their participation was voluntary and
anonymous.
All participants should have completed the first semester of the fifth year of study,
and subsequently completed all theoretical courses and most of their clinical practice
in the field of oral surgery. In both dental schools, theoretical courses begin in
the third year and they are completed in the first semester of the fifth year. Moreover,
preclinical practical teaching in suturing on models is also provided in both schools.
Clinical training in oral surgery is provided during the fourth and fifth year of
study. In the Dental School of AUTH, the students should complete at least 23 simple
(nonsurgical) dental extractions and 2 cases that need incision and flap raising.
In the Dental School of NKUA, the students should complete at least 25 dental extractions,
while it is not mandatory to perform surgical cases. Moreover, in the Dental School
of AUTH, the students should also observe at least 16 oral surgical operations performed
by oral surgery residents or instructors, while in the Dental School of NKUA at least
2 such observations are mandatory.
The questionnaire of the survey was electronic and based on a similar one used in
the study of Shah et al,[13] which was translated to the Greek language with some minor modifications to be harmonized
with domestic data. Before its use in the present study, the questionnaire had been
validated and piloted on the fourth-year dental students of the Dental School of the
AUTH. The questionnaire comprised three sections. Section 1 included demographic data
and the following four closed-ended questions concerning numerical data about the
procedures that they had already performed or observed in the field of oral surgery
during their clinical training:
-
How many simple (nonsurgical) dental extractions have you already performed? (Answer:
1–5, 6–10, 11–15, 16–20, or >20.)
-
How many surgical cases that needed incision and flap raising have you already performed?
(Answer: 1–5, 6–10, 11–15, 16–20, or >20.)
-
Have many surgical cases that needed osteotomy by using a surgical rotary device have
you already performed? (Answer: 1–5, 6–10, 11–15, 16–20, or >20.)
-
How many oral surgical operations performed by an experienced oral surgeon have you
already observed? (Answer: 1–5, 6–10, 11–15, 16–20, or >20.)
Section 2 included the following four questions concerning their self-perceived competence
to perform basic surgical techniques:
-
How competent do you feel in performing incision and flap raising? (Answer: Not at
all, Slightly, Moderately, Very, or Extremely.)
-
How competent do you feel in performing tooth sectioning during extraction? (Answer:
Not at all, Slightly, Moderately, Very, or Extremely.)
-
How competent do you feel in performing osteotomy by using a surgical rotary device?
(Answer: Not at all, Slightly, Moderately, Very, or Extremely.)
-
How competent do you feel in performing wound suturing? (Answer: Not at all, Slightly,
Moderately, Very, or Extremely.)
Section 3 included 10 clinical case scenarios ([Table 1]) in which participants were asked to respond regarding their self-perceived competence
to perform the necessary treatments with or without assistance, such as the following:
Table 1
Clinical case scenarios of section 3 of the questionnaire
|
Clinical case scenario
|
Photograph/radiograph
|
|
1. A 25-year-old male patient with clear medical history who presents for extraction
of the erupted mandibular third molar
|
|
|
2. A 60-year-old female patient with clear medical history who presents for multiple
extractions and possible alveoloplasty to have complete dentures
|
|
|
3. A 45-year-old female patient with clear medical history who presents for surgical
extraction of retained roots of the mandibular second molar
|
|
|
4. A 66-year-old female patient with osteoporosis and on oral alendronate medication
that started 2 mo ago, who presents for extraction of the mandibular central incisors
|
|
|
5. A 66-year-old female patient with osteoporosis, who has received to IV doses of
alendronate in the past year and presents for extraction of a retained root of the
maxillary canine
|
|
|
6. A 58-year-old male patient with a history of coronary artery stenting who receives
aspirin, clopidogrel, simvastatin, and metoprolol and presents for extraction of the
maxillary lateral incisor
|
|
|
7. A 62-year-old female patient with a history of atrial fibrillation who receives
acenocoumarol (INR = 2.5) and presents for extraction of the retained root of the
maxillary premolar
|
|
|
8. A 37-year-old male patient with a clear medical history who presents for drainage
of the vestibular abscess
|
|
|
9. A 25-year-old male patient with a clear medical history, who presents for apicectomy
of the maxillary central incisor
|
|
|
10. A 62-year-old female patient with a clear medical history, who presents for excision
of the fibrous hyperplasia of the buccal mucosa
|
|
Abbreviations: INR, international normalized ratio; IV, intravenous.
-
I feel competent to undertake the procedure, independently and without supervision
or assistance from an instructor.
-
I feel competent to undertake the procedure, but I may need some guidance or assistance
from an instructor.
-
I do not feel competent to undertake the procedure and I would refer the patient to
an experienced dentist or oral surgeon.
Statistical analyses were performed by using SPSS (IBM SPSS Statistics 25.0). All
answers of the questionnaire were categorical variables and they are presented as
absolute and relative (%) frequencies. Comparison of frequencies between subgroups
was performed with the chi-squared test, and when expected frequencies were lower
than 5, comparison was performed with Fisher's exact test. Statistical significance
was determined at p < 0.05 level.
Results
One hundred and twenty-seven students participated in the study, representing over
60% of the final year students in two dental schools in Greece. Seventy-five (59.1%)
were students of AUTH Dental School and 52 (40.95%) of NKUA Dental School. The mean
age of the participants was 24.26 ± 1.6 years and the majority were females (74%).
Regarding answers of section 1 ([Table 2]), most students had already performed over 20 simple (nonsurgical) dental extractions
in both schools, without significant differences between them. Moreover, most students
had already performed one to five surgical cases that needed incision and flap raising,
although a significant difference was recorded between students from the two schools.
Regarding osteotomy by using a surgical rotary device, most students had never performed
any in both schools, without significant differences between them. Finally, great
heterogeneity was recorded concerning the number of oral surgical operations that
the students had observed, where the students of AUTH had observed marginally more
operations than those of NKUA.
Table 2
Answers in questions of section 1 of the questionnaire
|
Question
|
Answers
|
Total n = 127 (%)
|
AUTH n = 75 (%)
|
NKUA n = 52 (%)
|
p-value
|
|
Q1. How many simple (nonsurgical) dental extractions have you already performed?
|
1–5
6–10
11–15
16–20
> 20
|
1 (0.8)
1 (0.8)
1 (0.8)
22 (17.3)
102 (80.3)
|
1 (1.3)
0 (0.0)
0 (0.0)
10 (13.3)
64 (85.3)
|
0 (0.0)
1 (1.9)
1 (1.9)
12 (23.1)
38 (73.1)
|
0.114
|
|
Q2. How many surgical cases that needed incision and flap raising have you already
performed?
|
1–5
6–10
11–15
16–20
> 20
|
110 (86.6)
10 (7.9)
6 (4.7)
1 (0.8)
0 (0.0)
|
72 (96.0)
3 (4.0)
0 (0.0)
0 (0.0)
0 (0.0)
|
38 (73.1)
7 (13.5)
6 (11.5)
1 (1.9)
0 (0.0)
|
< 0.001
|
|
Q3. How many surgical cases that needed osteotomy by using surgical rotary device
have you already performed?
|
1–5
6–10
11–15
16–20
> 20
|
39 (30.7)
40 (31.5)
34 (26.8)
13 (10.2)
1 (0.8)
|
21 (28.0)
22 (29.3)
22 (29.3)
10 (13.4)
0 (0.0)
|
18 (34.6)
18 (34.6)
12 (23.1)
3 (5.8)
1 (1.9)
|
0.366
|
|
Q4. How many oral surgical operations performed by an experienced oral surgeon have
you already observed?
|
1–5
6–10
11–15
16–20
> 20
|
13 (10.2)
26 (20.5)
45 (35.4)
16 (12.6)
27 (21.3)
|
6 (8.0)
11 (14.7)
27 (36.0)
14 (18.7)
17 (22.7)
|
7 (13.5)
15 (28.8)
18 (34.6)
2 (3.8)
10 (19.2)
|
0.044
|
Abbreviations: AUTH, Aristotle University of Thessaloniki; NKUA, National and Kapodistrian
University of Athens.
Regarding answers of section 2 ([Table 3]), most students felt “slightly” to “moderately” competent to perform incision and
flap raising, and the students of AUTH were feeling significantly more competent than
those of NKUA. Similarly, most students felt “slightly” to “moderately” competent
and low percentage of students felt “very” competent in performing tooth sectioning
during extraction, and the students of AUTH were feeling significantly more competent
than those of NKUA. Regarding performing an osteotomy using a surgical rotary device,
most students were more or less equally divided in feeling “not at all,” “slightly,”
or “moderately” competent to perform it in both schools, without significant differences
between them. Finally, most students felt “moderately” to “very” competent and a considerable
number of students felt “extremely” competent in performing wound suturing, although
the students of NKUA were feeling significantly less competent to perform this task
than those of AUTH.
Table 3
Answers in questions of section 2 of the questionnaire
|
Question
|
Answers
|
Total n = 127 (%)
|
AUTH n = 75 (%)
|
NKUA n = 52 (%)
|
p-value
|
|
Q1. How competent do you feel in performing incision and flap raising?
|
Not at all
Slightly
Moderately
Very
Extremely
|
15 (11.8)
40 (31.5)
53 (41.7)
17 (13.4)
2 (1.6)
|
7 (9.3)
17 (22.7)
38 (50.7)
12 (16.0)
1 (1.3)
|
8 (15.4)
23 (44.2)
15 (28.8)
5 (9.6)
1 (1.9)
|
0.027
|
|
Q2. How competent do you feel in performing tooth sectioning during extraction?
|
Not at all
Slightly
Moderately
Very
Extremely
|
9 (7.1)
42 (33.1)
46 (36.2)
25 (19.7)
5 (3.9)
|
8 (10.7)
21 (28.0)
32 (42.7)
13 (17.3)
1 (1.3)
|
1 (1.9)
21 (40.4)
14 (26.9)
12 (23.1)
4 (7.7)
|
0.031
|
|
Q3. How competent do you feel in performing osteotomy by using a surgical rotary device?
|
Not at all
Slightly
Moderately
Very
Extremely
|
39 (30.7)
40 (31.5)
34 (26.8)
13 (10.2)
1 (0.8)
|
21 (28.0)
22 (29.3)
22 (29.3)
10 (13.3)
0 (0.0)
|
18 (34.6)
18 (34.6)
12 (23.1)
3 (5.8)
1 (1.9)
|
0.366
|
|
Q4. How competent do you feel in performing wound suturing?
|
Not at all
Slightly
Moderately
Very
Extremely
|
2 (1.6)
14 (11.0)
26 (20.5)
60 (47.2)
25 (19.7)
|
2 (2.7)
3 (4.0)
11 (14.7)
43 (57.3)
16 (21.3)
|
0 (0.0)
11 (21.2)
15 (28.8)
17 (32.7)
9 (17.3)
|
0.002
|
Abbreviations: AUTH, Aristotle University of Thessaloniki; NKUA, National and Kapodistrian
University of Athens.
Regarding answers of section 3 ([Table 4]), more than one-third of the students felt competent to perform extraction of an
erupted mandibular third molar, multiple dental extractions with minor alveoloplasty,
or surgical extraction of the retained root (clinical cases 1, 2, and 3) independently.
Approximately half of them would prefer to have an instructor's guidance or assistance
while operating, and very few students said they would refer these cases to a specialist.
Regarding the cases of dental extractions in patients on oral or intravenous (IV)
bisphosphonate medication (clinical cases 4 and 5), about one-third of the students
felt competent to undertake the cases independently, one-third believed that they
would need an instructor's guidance to undertake the cases, and about one-third would
refer those cases. A small shift toward the need for an instructor's guidance or referring
was recorded in case of patients on IV bisphosphonate medication in comparison with
the case of patient on oral bisphosphonate medication. Regarding the cases of dental
extractions in patients on antithrombotic medication (clinical cases 6 and 7), answers
were similar. While a little less than one-third of the students felt competent to
undertake the case independently, more than one-third of the students felt that they
would need an instructor's guidance to undertake the cases, and a little less than
one-third of the students would refer the cases. No statistically significant differences
were recorded in the answers between students of the two dental schools, concerning
the above clinical case scenarios.
Table 4
Answers in clinical case scenarios of section 3 of the questionnaire
|
Clinical case scenario
|
Answers
|
Total n = 127 (%)
|
AUTH n = 75 (%)
|
NKUA n = 52 (%)
|
p-value
|
|
1. Extraction of the erupted mandibular third molar
|
a
b
c
|
44 (34.6)
73 (57.5)
10 (7.9)
|
32 (42.7)
37 (49.3)
6 (8.0)
|
12 (23.1)
36 (69.2)
4 (7.7)
|
0.056
|
|
2. Multiple extractions with minor alveoloplasty
|
a
b
c
|
40 (31.5)
73 (57.5)
14 (11.0)
|
26 (34.7)
38 (50.7)
11 (14.6)
|
14 (26.9)
35 (67.3)
3 (5.8)
|
0.118
|
|
3. Surgical extraction of the retained root
|
a
b
c
|
54 (42.5)
59 (46.5)
14 (11.0)
|
35 (46.7)
35 (46.7)
5 (6.6)
|
19 (36.5)
24 (46.2)
9 (17.3)
|
0.142
|
|
4. Extraction in a patient on oral bisphosphonate medication
|
a
b
c
|
48 (37.8)
39 (30.7)
40 (31.5)
|
24 (32.0)
24 (32.0)
27 (36.0)
|
24 (46.2)
15 (28.8)
13 (25.0)
|
0.234
|
|
5. Extraction in a patient on IV bisphosphonate medication
|
a
b
c
|
26 (20.5)
50 (39.4)
51 (40.2)
|
11 (14.7)
29 (38.7)
35 (46.6)
|
15 (28.8)
21 (40.4)
16 (30.8)
|
0.083
|
|
6. Extraction in patient on dual antiplatelet medication
|
a
b
c
|
35 (27.6)
60 (47.2)
32 (25.2)
|
19 (25.3)
39 (52.0)
17 (22.7)
|
16 (30.8)
21 (40.4)
15 (28.8)
|
0.434
|
|
7. Extraction in a patient on coumarin anticoagulant medication
|
a
b
c
|
35 (27.6)
58 (45.7)
34 (26.7)
|
22 (29.3)
33 (44.0)
20 (26.7)
|
13 (25.0)
25 (48.1)
14 (26.9)
|
0.851
|
|
8. Incision and drainage of the vestibular abscess
|
a
b
c
|
53 (41.7)
56 (44.1)
18 (14.2)
|
40 (53.3)
27 (36.0)
8 (10.7)
|
13 (25.0)
29 (55.8)
10 (19.2)
|
0.006
|
|
9. Apicectomy of the anterior tooth
|
a
b
c
|
7 (5.5)
16 (12.6)
104 (81.9)
|
6 (8.0)
14 (18.7)
55 (73.3)
|
1 (1.9)
2 (3.8)
49 (94.3)
|
0.008
|
|
10. Excisional biopsy of mucosal fibrous hyperplasia
|
a
b
c
|
15 (11.8)
45 (35.4)
67 (52.8)
|
12 (16.0)
33 (44.0)
30 (40.0)
|
3 (5.8)
12 (23.1)
37 (71.1)
|
0.002
|
Abbreviations: AUTH, Aristotle University of Thessaloniki; IV, intravenous; NKUA,
National and Kapodistrian University of Athens.
Regarding incision and drainage of the dentoalveolar abscess (clinical case 8), most
students felt competent to undertake the procedure, although approximately half of
them would prefer to have an instructor's guidance or assistance while operating and
a relatively low proportion of students said they would refer the case. Regarding
apicectomy of the anterior maxillary tooth (clinical case 9), a vast majority of students
would refer the case. Very few students said they would undertake the procedure independently
or with an instructor's supervision or assistance. Finally, regarding excision of
the mucosal fibrous hyperplasia (clinical case 10), approximately half of the students
would refer the case, while a few students said they would undertake the procedure
with an instructor's guidance or assistance, and even fewer students said they would
undertake the procedure independently. Considering the above three cases, the students
of AUTH, although fewer in number, were feeling significantly more competent to undertake
these procedures than the students of NKUA.
Discussion
Acquisition of clinical competence and self-confidence is a primary objective of the
curricula in dentistry, although standards of undergraduate teaching and extent of
clinical training largely defer among dental schools worldwide. Oral surgery is considered
a discipline in which dental students have lower levels of self-confidence upon graduation
in comparison with other disciplines of dentistry.[14] To the best of our knowledge, this is the first study to evaluate self-perceived
confidence and competence in oral surgery among final year undergraduate dental students
in Greece. In general, the results of the study indicate acceptable levels of self-confidence
to undertake simpler oral surgical procedures and lower levels of self-confidence
to undertake more difficult or complex cases, which may be considered an expected
finding.
Achieving the competence to perform simple (nonsurgical) exodontia by using forceps
and root elevators is considered a primary target of undergraduate training in oral
surgery.[15] The majority of final-year Greek dental students had already approached the minimum
mandatory dental extractions (>20), although this represents a relatively low number
in comparison to other similar studies[16]
[17]
[18]
[19]
[20]
[21] reporting 20 to 60 dental extractions in the final year. However, a great heterogeneity
in the total number of extractions (1–200) that the graduates finally perform is recorded
in these studies. Although a minimum target number of dental extractions is usually
applied in undergraduate training in oral surgery, it is considered difficult to define
a universal number of cases that would ensure undergraduate students' competence and
confidence, as some students feel capable after a small number of dental extractions,
while others felt incompetent even after a large number of dental extractions.[22]
[23] Considering this, the achievement of learning objectives and the acquisition of
surgical skills in all students may not be possible with the generalized quantification
of the minimum number of cases. This could be achieved with the early identification
of students with increased learning needs and the creation of a supportive environment
with individualized assignment of appropriate cases.
The competence in surgical extractions or other more advanced oral surgical procedures
is considered more difficult to be delivered due to limited undergraduate exposure.[15]
[16] These procedures prerequire adequate training in generic elementary surgical skills
such as incision and flap raising, tooth sectioning, bone removal with surgical rotary
devices, and wound suturing. The majority of Greek dental students reported low to
moderate levels of self-confidence to perform incision and flap raising or tooth sectioning,
lower levels of self-confidence to perform osteotomy, but high levels of self-confidence
in suturing. These findings are probably due to the fact that most students had already
undertaken one to five cases that needed incision, flap raising, and consequently
wound suturing, while very small students had undertaken at least one case that needed
osteotomy with a surgical rotary device. Moreover, preclinical training on models
in both Greek dental schools included in the study includes only training in wound
suturing and not in incisions, flap raising, or osteotomy. The finding of higher level
of self-confidence in wound suturing compared with other generic elementary surgical
skills is consistent in most similar studies.[13]
[19]
[20]
[24]
The clinical cases of this study's questionnaire represent cases in which graduates
are expected to demonstrate a sound theoretical knowledge and understanding of the
subject, according to the curriculum proposals adopted by the ADEE. Furthermore, the
first three scenarios represented cases in which graduates are expected to have adequate
clinical experience to be competent to undertake them independently or without assistance,
while the rest of the scenarios represent cases in which graduates may have only limited
clinical/practical experience. A similar study including similar case scenarios was
conducted by Shah et al[13] in 2015 on final-year dental undergraduate students at King's College London, from
which the present study's questionnaire was obtained and modified with similar cases.
In the present study, however, three additional cases have been added regarding the
drainage of a dental abscess, performing an apicoectomy of the anterior tooth, and
removing a fibrous hyperplasia. In general, students at King's College show significantly
more confidence than students in Greek universities in almost all cases, probably
due to the increased clinical exposure of the former (mean number of nonsurgical and
surgical extractions performed was 64 and 9, respectively). Moreover, Shah et al[13] included more older age students (29–40 years) than our study, who generally report
higher levels of self-confidence according to the same study.
In clinical case 1 of the present study, which may be considered a difficult extraction
although it is nonsurgical, half of the students report that they would need some
guidance or assistance from an instructor to undertake the procedure. This finding
is consistent with previous studies,[18]
[19] which also report that final-year students feel more confident to undertake a single
rooted tooth extraction than a posterior multirooted tooth. This indicates that generally
undergraduate students may need more training in posterior multirooted teeth nonsurgical
extractions than in anterior single rooted tooth extractions. Considering clinical
cases 2 and 3, almost half of the students also report that they would need some guidance
or assistance from an instructor to undertake the procedure. This finding may be the
result of students' limited experience and lower self-confidence in generic elementary
surgical skills.
The following four case scenarios of the present study represent cases of nonsurgical
extractions in patients on common medication (antithrombotics or bisphosphonates).
The medical complexity of these cases demands sound theoretical knowledge on the management
of medically compromised patients. In general, it seems that Greek dental students
feel more confident to perform dental extractions in patients on antithrombotic medication
than on bisphosphonate therapy, which is also reported in the study of Shah et al[13] conducted at King's College. However, students at King's College report much higher
self-confidence to independently treat patients on antithrombotic medication, while
Greek students report higher self-confidence to treat patients on IV bisphosphonates.
These differences may be explained by differences not only in both clinical exposures
but also in the extent of theoretical courses on proper management of medically compromised
dental patients.
The last three case scenarios of the present study represent the cases in which the
students have limited clinical experience and exposure. In total, Greek students feel
more confident to perform incision and drainage of the dentoalveolar abscess than
to perform an apicectomy of the anterior tooth or excisional biopsy of the mucosal
fibrous hyperplasia. In these case scenarios, the students of AUTH seem to feel significantly
more confident to undertake these cases than the students of NKUA. Interestingly,
the students of AUTH in comparison with those of NKUA had observed significantly more
operations performed by an experienced oral surgeon, but they had performed significantly
lesser cases that needed incision and flap raising. Thus, it may be assumed that when
the number of cases to perform is small and cannot provide competency and confidence,
regular observation and assistance in corresponding procedures performed by a skilled
instructor can significantly help gain confidence and improve skills. The important
role of observing surgical operations performed by seniors and outreach in teaching
of oral surgery has also been proposed by previous studies.[19]
[24]
[25]
Admittedly the present study bears the limitation of evaluating the self-perceived
confidence of the students. Although it is considered that there is a positive correlation
between reported confidence and clinical experience,[26] self-assessment of surgical skills may be inaccurate,[27] particularly in those who perform poorly.[28] Moreover, overconfident graduates can put their patients at risk when carrying out
surgical procedures without actual competency. Thus, objective assessment tools for
surgical skills should be adopted to evaluate the graduates' competency in daily dental
practice.
Conclusion
Greek graduate dental students report moderate levels of self-confidence in oral surgery.
Although there are several factors affecting the confidence of dental students, the
structure of the training program can be considered to have an important role. Traditional
teaching methods for increasing self-confidence would suggest increasing the clinical
experience by increasing the number and complexity of clinical cases undertaken by
the students. However, this would be difficult to apply in the undergraduate training
of oral surgery, as the students' clinical training should be balanced between several
other disciplines of dentistry. Thus, another approach in increasing self-confidence
and actual competence in oral surgery would be to focus on observational sessions
of oral surgery procedures or outreach training, together with achieving proficiency
in generic elementary surgical skills. These skills are part of a complete surgical
procedure and, in combination with the growing clinical experience, will allow the
general dentist to undertake surgeries of varying difficulty over the years.
