|Year : 2021 | Volume
| Issue : 1 | Page : 30-38
Self-assessment of preclinical denture setup using a validated, structured, self-designed questionnaire by undergraduate students: A repeated cross-sectional survey
Pavankumar Ravi Koralakunte1, Sunitha Naveen Shamnur1, Nandeeshwar Doddabasavaiah Basavapura1, Usha G Venkatesh2
1 Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
2 Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Submission||26-Dec-2019|
|Date of Acceptance||25-Oct-2020|
|Date of Web Publication||25-Mar-2021|
Dr. Pavankumar Ravi Koralakunte
Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Our aim was to determine if students who perform well on an initial preclinical examination are more accurate on self-assessments with successive examination.
Materials and Methods: This was an observational, descriptive, cross-sectional survey. Ninety-one 2nd year dental students completed two consecutive preclinical examinations on ideal teeth arrangement and two self-assessments. Self-assessment was done using a validated, structured, self-designed questionnaire named “prosthetic denture setup–self assessment questionnaire.” The examinations involved artificial teeth arrangement in Class I jaw relation on maxillary and mandibular ideal edentulous casts mounted on a mean value articulator simulating the clinical procedure of a complete denture patient. Students' and their instructor's assessments were evaluated separately, and statistical results were obtained using t-test and Pearson's product moment correlation coefficient test. Regression analysis was done to predict the student self-assessment and validated self-assessment scores on examination outcomes for both indexed and nonindexed values.
Results: The results indicated a significant increase in the examination and student self-assessment mean scores. Regression analysis indicated changes in student self-assessment scores, explained 11.9% of the variation in examination scores.
Conclusion: Improvement in student self-assessment also showed improvement in successive examination assessments among dental students completing a preclinical denture setup procedure.
The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
Keywords: Dental education, faculty evaluation, prosthetic teeth setting, self-assessment, self-designed structured questionnaire, self-directed learning, student evaluation
|How to cite this article:|
Koralakunte PR, Shamnur SN, Basavapura ND, Venkatesh UG. Self-assessment of preclinical denture setup using a validated, structured, self-designed questionnaire by undergraduate students: A repeated cross-sectional survey. Int J Acad Med 2021;7:30-8
|How to cite this URL:|
Koralakunte PR, Shamnur SN, Basavapura ND, Venkatesh UG. Self-assessment of preclinical denture setup using a validated, structured, self-designed questionnaire by undergraduate students: A repeated cross-sectional survey. Int J Acad Med [serial online] 2021 [cited 2022 Jun 27];7:30-8. Available from: https://www.ijam-web.org/text.asp?2021/7/1/30/311881
| Introduction|| |
The primary mission of dental school is to produce general practitioner who has the capacity to function independently without supervision. The cornerstone of professional practice is the application of thought processes that allows a dentist to recognize pertinent information in a patient presentation, make accurate decisions based on deliberate and open-minded review of available options, evaluate outcomes of therapeutic decisions, and assess their own performances.
Self-assessment is often advocated as a way to share educational responsibility and to develop patterns of reflective learning in students. The advantages of self-assessment are said to be especially valuable informative learning by helping students' efforts toward information and/or skills that they have not yet developed. There has been increasing interest in self-assessment because students should have a realistic sense of their own strength and weakness and should be guided toward responsible self-directed learning. Although self-evaluation skills are integral to the life-long learning process, self-assessment has not been a significant part of curriculum in health-care education.
We are especially keen to be accurate in predicting how they will perform in clinic based on what they do in laboratory and how they will perform in practice based on their performance in dental school.
Current assessment practices in higher education do little to encourage lifelong learning. As Boud says that “assessment is a unilateral act conducted by teachers on students,” students may be outstandingly successful in their teacher assessed achievements without learning how to assess themselves.
Boud defines self-assessment as “the involvement of students' identifying standards and/or criteria to apply to their work and making judgments about the extent to which they have met these criteria and standards.” It is difficult for the students to practice self-assessment unless the criteria and levels of performance used by their teachers are made explicit.
The studies comparing student to faculty evaluations include methodological inconsistencies such as lack of reliability, students and faculty using different criteria or scales for assessment, or students rating their effort while faculty rate that product of effort.
A comparative investigation between faculty/student agreements over successive examinations has not been previously undertaken in dental education, which is the rationale for our study. Our aim was as follows: first, to determine if students who perform well on an initial preclinical examination were more accurate on initial self-assessments and second, to determine if students who improve more from the first to second self-assessment also improve more in their clinical judgment skills. We hypothesized that students who perform well on initial preclinical examination would have accurate initial and successive assessments.
| Materials and Methods|| |
Study design, setting, and ethical clearance
The study was designed, analyzed, and interpreted according to the STROBE guidelines. An observational, cross-sectional survey was conducted on 2nd year (n = 91) dental students of 2017–2018 regular batch in the preclinical prosthetic laboratory. Before start of the present survey, ethical approval was obtained from the institutional ethical and research committee. Two preclinical examinations (first and second) spaced 4 weeks apart of 3 h duration each. Students who had completed a total number of 10 denture setups in their preclinical work were included in the study. The assessment was carried out only with the approval that the record bases, occlusal rims, and articulation on a mean value articulator have been verified by the instructor before the preclinical examinations.
First examination and self-assessment
The first preclinical examination required them to do the artificial teeth arrangement (denture setup) in ideal Class I jaw relation using ideal maxillary and mandibular edentulous master casts mounted on a mean value articulator. Students were graded on their ability to do artificial teeth arrangement to an ideal patient setup simulating the clinical equivalent of a maxillary and mandibular complete dentures in maximum intercuspation having class I canine and molar occlusal relationship. A self-designed, structured, and validated questionnaire “prosthetic denture setup-self-assessment questionnaire (PDS-SAQ)” which includes a set of 20 questions framed on the principles of ideal teeth arrangement, waxing, carving, finishing, and polishing was used for evaluating students' and their instructor's assessments. The criteria were familiar to the students as both theoretical and practical information related to the complete denture treatment for edentulous mouth beginning with primary impression making till complete denture fabrication were taught prior. After 6 months of preclinical training period and with a total of ten teeth arrangements, the first preclinical examination was conducted. The students were advised that self-assessment performance would count significantly toward their grade. The PDS-SAQ was provided to the students directly after their first preclinical examination. The students were first asked to grade according to the self-evaluation format PDS-SAQ with specific time interval of 20 mins followed by their instructor. The instructor graded the same self-evaluation format PDS-SAQ using a different color ink which was masked to student identity. The self-assessments were graded separately. The evaluation between students and their instructor were correlated, and the first examination results were shared with the students.
Second examination and self-assessment
After the first preclinical examination assessment, both the students and their instructor had one-to-one interaction related to the differences with their assessment that did not correlate. All necessary doubts of students related to where they went wrong and where they did right in their arrangement were clarified. Later, an interval of 4 weeks was given to reduce the memory/recall of students' first preclinical examination (memory bias). The second preclinical examination was conducted on the same dental students who repeated artificial teeth arrangement in ideal Class I jaw relation. The PDS-SAQ was provided again to the students for grading followed by their instructor. The self-assessments were graded separately, correlated with that of students' and the instructor's evaluations. The second examination results were shared with the students.
The results of both first and second preclinical examinations were tabulated and compared between the students' self-assessment score, instructor score, and the validated self-assessment score. One instructor graded all examinations to establish a measure of reliability. The PDS-SAQ was subjected to face validity and content validity after administering it to five experts in the subject of prosthodontics. The content validity was found to be good (0.80).
The methods of grading scores are as follows:
- Examination score: The total correct points as assessed by the faculty/instructor
- Student score: The total correct points as assessed by the student. The student responses were measured against the examination that was used as a standard, not against the instructor. For example, if the student felt the anterior arch form was ideal, he or she would have circled “ideal” on PDS-SAQ and received a point toward the self-assessment score. If the student felt the anterior arch form was not ideal and circled “too wide” on the questionnaire format, he or she would have received no points as it is wrong when compared with the ideal principles of teeth arrangement. The points were considered binary (correct/incorrect) with the preclinical examinations as the criterion for student comparisons
- Validated self-assessment score: The total number of points on the examination on which both the instructor and a student agreed. The validated self-assessment scores are viewed as an external affirmation of the student self-assessment score because it measures both the correct and incorrect student answers consistent with instructor grading, whereas the student self-assessment score reflects only the correct points a student felt were correctly answered.
The index scores were also calculated that measured change of scores from the first examination to the second as we anticipated that the changes might provide valuable criteria to compare student performance:
- Exam index: Change in the examination score from the first examination to the second
- Student index: Change in the student self-assessment score from the first self-assessment to the second and
- Validated index: Change in the validated self-assessment score from the first self-assessment to the second.
These indices allowed comparisons of improvement, decline, or no change from the first examination to the second examination creating positive index values to facilitate statistical correlation analysis.
SPSS (Version 20) descriptive statistics was done to express students' self-assessment scores, instructor scores, and validated scores in mean and standard deviation on their first and second preclinical examinations. The inferential statistical analysis was done using t-test for comparing the mean differences between students' and instructors' examination assessments and Pearson's multiple correlation coefficient test for association between students' and instructors' examination scores.
Regression modeling using SPSS (Version 20) software IBM SPSS statistics for windows version 20 (Armonk, NY:IBM Corp) was used to predict the individual effects of student self-assessment and validated self-assessment scores on preclinical examination outcomes for both indexed and nonindexed values. Indexed and nonindexed regression models were also used to predict the individual effects of student self-assessment scores on validated self-assessment scores. This technique measures the predictive power of both self-assessment instruments on individual examination performance and change in examination performance over time. Similarly, the indexed and nonindexed approach was also useful for predictions of student self-assessment scores with validated self-assessment scores individually and between examination periods. Nine models were formulated to evaluate these characteristics.
Regression models using indexed scores (examination/instructor, student self-assessment, and validated self-assessment) were also developed to evaluate changes in student performance. Regression models evaluated change in examination scores as the dependent variable and change in student self-assessment and change in validated self-assessment as independent variables. Because the variables such as student self-assessment scores and validated self-assessment scores exhibited a high degree of multicollinearity, these independent variables could not be combined in a multiple regression model; therefore, all models are simple regressions.
| Results|| |
Descriptive measures comparing mean and standard deviation between first and second preclinical examination scores [Table 1] show increased mean scores and statistically highly significant (P = 0.00) among student self-assessment scores (15.68 ± 1.527 vs. 17.44 ± 1.024), instructor-graded scores (12 ± 1.606 vs. 16.52 ± 1.205), and validated self-assessment scores (15.01 ± 2.479 vs. 18.27 ± 1.136).
|Table 1: Descriptive statistical measures for variables and t-tests comparing mean differences between first and second preclinical examination scores (n=91)|
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The multiple correlation matrix [Table 2] shows moderately strong and highly significant correlation between the first and second instructors scores (r = 0.741), moderately strong and highly significant correlation between the first and second students' self-assessment scores (r = 0.673), and weak but statistically significant correlation between the first and second validated self-assessment scores (r = 0.244).
The correlations between variables were stronger on the second examination when compared with the first examination [Table 2] between the first and second preclinical examinations; correlations for instructor scores with student self-assessment scores increased from r = 0.635 to 0.741, respectively, and for instructor scores with validated self-assessment scores from r = 0.673 to r = 0.930, respectively.
The multiple correlation matrix [Table 2] shows moderately strong and highly significant correlation between the exam (instructor) and student index (r = 0.345), moderately strong and highly significant correlation between the exam and validated index (r = 0.533), and moderately strong and negative correlation between the student and validated index (r = −0.610).
Of the nine regression models, three predicted from 11.8% to 23.7% of the variance in examination scores with self-assessment variability, while the remaining six explained from 25.4% to 54.4% of the variance in validated self-assessment with variability in student self-assessment. Similarly, six models explained relationships among examination scores and both measures of self-assessment individually (nonindexed models), and three predicted change across examination periods (indexed models) predicting from 11.8% to 54.4% of the variability in the nonindexed models and from 11.9% to 36.4% of the variance in the indexed models [Table 3].
|Table 3: Regression analysis of student self-assessment and validated self-assessment scores on preclinical examination outcomes for both indexed and nonindexed values (n=91)|
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The graphs [Figure 1] and [Figure 2] illustrate increasing association between instructor-graded examination scores with student self-assessment scores across examinations. As a measure of reliability of single faculty/instructor who completed all grading, the correlation for a single rater's evaluation between two preclinical examinations was r = 0.7.
|Figure 1: Graph showing association between students’ self-assessment and instructor/exam scores on the first preclinical examination|
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|Figure 2: Graph showing association between students’ self-assessment and instructor/exam scores on the second preclinical examination|
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| Discussion|| |
Dental education is the institution whereby future dental health professionals become equipped with the knowledge and training necessary to meet the oral health needs of the public.
It is widely accepted in dental schools that repetition of clinical procedures is necessary to achieve clinical competence. First, it is assumed that students learn from experience and that it is found andragogical practice to promote sufficient practice to ensure learning. Second, it is sometimes held that practice per se, without regard for quality of outcomes, is a necessary if not sufficient condition for learning. The skills and techniques that students develop during their clinical education are heavily contingent on their interactions with the faculty who serve as their coaches, mentors, and evaluators.
Teacher attributes associated with effective clinical teaching in dental school include providing specific feedback about performance, demonstrating an interest in teaching, making an effort to motivate students, knowing how to translate didactic information into patient care situations, explaining difficult concepts clearly, showing compassion, and approaching treatment in a proactive manner.
For teachers, evaluation is a mean of making educational decisions: are students prepared for the course as planned; at what level should the material be presented; is the progress of the course too rapid or too slow? Evaluation provides insight into course and teaching effectiveness. Effective evaluation provides valuable information, which contributes to both student and course success.
Students in clinical dentistry must learn sufficient skills to be able to self-assess their performances very accurately, because after graduation, the nature of dental procedures means that others are seldom in a position to evaluate the quality of their work. The present study was thus aimed at thorough preclinical training for students by creation of sound self-assessment and judgment to become effective clinicians later.
According to Gordon, limitations of self-assessments are as follows:
- Self-assessment just lets me know how good/bad I have done – it doesn't tell me how I can improve
- In my culture, it is strongly appreciated to be modest giving me a higher grade is not modest
- Self-assessment does not work when there are inadequate guidelines or insufficient feedback from the tutor
- Sometimes, there is insufficient time to do it properly.
To overcome these limitations, in the present study, we included:
- Didactic interaction between instructor and student, which showed improvement among students' assessment skills and judgment
- Both theoretical and practical guidelines related to ideal principles of teeth arrangement were taught to the students' prior assessment
- A new self-designed, structured, and validated questionnaire PDS-SAQ was formulated for both students and instructor to evaluate in a simple way
- Students' self-assessment to provide better opportunity for faculty members to understand both product and process.
The mean differences of students, instructor, and validated self-assessment scores between first and second preclinical examinations [Table 1] on denture setup in the present study (15.68 ± 1.527 vs. 17.44 ± 1.024, 12 ± 1.606 vs. 18.93 ± 1.511, and 15.01 ± 2.479 vs. 18.27 ± 1.136) are in correlation with the previous study (122.97 ± 27.0 vs. 126.07 ± 27.6) and (124.71 ± 17.4 vs. 128.67 ± 17.4) except for instructor/exam score being (130.79 ± 17.2 vs. 130.71 ± 18.8).
The mean scores for instructor, students' self-assessment, and validated self-assessment in the present study [Table 1] changed on a statistically significant basis (P = 0.00), which in contrast with previous study did not change on a statistically significant basis (P > 0.05) from first to second examination. Thus, in the present study, the association of instructor/examination scores, students' self-assessment scores, and validated self-assessment scores strengthened between preclinical examination periods.
The mean scores of two self-assessment groups changed between examination periods; individual initial assessment scores were associated with subsequent performance. It means that the groups improved on average that students who did not score well on the first assessment performed well on their second assessment. This clearly shows overall students' improvement in their performance level.
These stronger associations in the second preclinical examination indicate that students' self-assessment skills became a more accurate predictor of examination performance and instructor-validated self-assessment. At the second examination, while group mean scores improved significantly that became an even stronger indicator of success. In the previous study, poor self-assessment skills were more associated with poorer performance in the subsequent period, which is in converse with the present study.
In the second preclinical examination, the student self-assessment scores (17.44 ± 1.024) are nearer with the instructor assessment scores (18.93 ± 1.511), which is in correlation with the study done by Geissler, who found that student self-assessment scores were more closely aligned with faculty assessments over time. Geissler also suggested an increased willingness to award marks outside the middle range and a closer faculty/student agreement resulted, which was in correlation with the present study where instructor/student agreement improved on successive examinations.
When comparing correlations between two examinations for student self-assessment scores (r = 0.673) and validated self-assessment scores (r = 0.244) in the present study [Table 2] were in correlation with the previous study (r = 0.592 and r = 0.216, respectively). This indicates that for self-assessment evaluations, there exists a moderately strong relationship between students' performances on successive assessments.
The index scores in the present study [Table 2] between examination index and student index (0.291), examination index and validated index (0.553), and student index and validated index (0.605) are not in agreement with the previous study that showed correlation of 0.404, 0.377, and 0.564, respectively.
The examination index and student index (0.291) in the present study [Table 2] is almost in correlation with the previous study between examination scores and students' self-assessment scores (r = 0.225 and 0.370, respectively).
The instructor and validated self-assessment scores (r = 0.673 and 0.930) and the examination index and validated index (0.533) in the present study [Table 2] are higher than the previous study that showed scores of r = 0.34 and 0.429 and 0.377, respectively.
The student index and validated index (0.605) in the present study [Table 2] is almost in correlation with the previous study between students' self-assessment and validated assessment scores (r = 0.510 and 0.672) and is higher when compared between student index and validated index (0.564).
The consistency of students' and instructor's assessment evaluation on specific questionnaire criteria for denture setup in the present study (r = 0.29) is similar with the previous study (r = 0.262).
Our findings in the present study, along with the previous studies,, support the concept that self-assessment practice can modestly improve self-assessment scores, which improves examination scores.
Regression analysis [Table 3] showed the predictive value of student self-assessment improved from the first examination to the second (R2 from 0.396 to 0.544). We noted similar improvement in predicting validated self-improvement (R2 from 0.372 to 0.254). This improvement is consistent with previous study where they found improvement in student self-assessment from 1st to 2nd examination (R2 from 0.051 to 0.137) and improvement in the prediction of validated self-improvement (R2 from 0.116 to 0.184).
Limitations of the present study:
- Evaluating preclinical denture setup for students' assessment between examination periods was short
- One should conduct frequent assessments for long duration of time to understand the maintenance level of student performances
- Denture setup was done on a mean value articulator, so this cannot be reflected in clinical practice where we often use semiadjustable articulators.
| Conclusion|| |
Improvement in student self-assessment also showed improvement in successive examination assessments among dental students completing a preclinical denture setup procedure. Self-assessment is most effective when students are able to be honest with them, able to admit mistakes and to record what they have learned from the experience, and to give themselves a realistic grade.
From the present study, it can be inferred that the self-assessment protocol such as PDS-SAQ to be introduced into the dental curriculum. This process was not designed to denigrate the student, but to focus the learning experience and encourage students to accept the need for change. This could only happen in a trusting environment as the confidence of the student is critical to the success of any self-assessment procedure.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Research quality and ethics statement
The authors of this manuscript declare that this scientific work complies with reporting quality, formatting and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation required Institutional Review Board/Ethics Committee review, which was granted by their institution. As this study is not a clinical trial, it has not been registered in clinical trial registry.
| Prosthetic Denture Setup - Self Assessment Questionnaire (PDS-SAQ)|| |
- Midline Relation (Maxillary Teeth To Mandibular Teeth and To Cast Midline)
a) Centered b) Left shift c) Right shift
- Anterior Arch Form (Bonwill Circle)
a) Ideal b) Wide c) Narrow
- Maxillary Anterior Teeth Inclination In Relation To Midline (Frontal View)
a) Ideal b) More inclination c) Less inclination
- Mandibular Anterior Teeth Inclination In Relation To Midline (Frontal View)
a) Ideal b) More inclination c) Less inclination
- Anterior Teeth Inclination (Sagittal View)
a) Ideal b) More proclined c) Retroclined
- Overjet/Horizontal Overlap (Ideal is 2mm)
a) Ideal b) More than ideal c) Less than ideal
- Overbite/Vertical Overlap (Ideal is 2mm)
a) Ideal b) More than ideal c) Less than ideal
- Maxillary Anterior and Posterior Teeth Arrangement In Relation To Horizontal Relation (Glass Plate Relation)
a) Present b) Absent
- Maxillary Posterior Teeth Arrangement In Relation To Lateral Scale Relation
a) Approximating b) Non-approximating
- Relation of Maxillary Functional Cusps In Relation To Mandibular Crest of The Ridge
a) Approximating b) Buccally placed c) Lingually placed
- Interchanging of Right And Left Tooth/Teeth (If Any)
a) Present b) Absent
- Interchanging of Maxillary And Mandibular Tooth/Teeth (If Any)
a) Present b) Absent
- Curve of Spee/Anterio-Posterior Curve
a) Ideal b) Shallow c) Steep
- Lingual Occlusion (Lingual View)
a) Present b) Absent
- Intercuspation of Teeth (Buccal View)
a) Present b) Absent
- Canine And Molar Key of Occlusion In Class I Relation
a) Present b) Absent
- Wax Carving of Gingival And Root Morphology
a) Ideal b) Over carving c) Under carving
- Any wax residues remain on the tooth/teeth crown surface area after finishing and polishing of waxed up dentures?
a) Yes b) No
- Is the incisal rod of mean value articulator in contact with the incisal guide table after teeth arrangement?
a) Yes b) No
- Is the incisal pin of mean value articulator in midline and in contact with the incisal edges of maxillary central incisor teeth?
a) Yes b) No
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]