Here, students are supposed to treat ALL their patients under the supervision of their professors. I think this applies to all other countries as well, but don't know exactly.

Well the teacher checks every step before being done by the student, gives necessary advice, and once that step was finished, the teacher corrects the student if needed, by telling them how (s)he made a mistake and how to avoid it. Simple as that. Mistakes usually reduce the student's score, so they will be extra cautious to follow the protocols... I think this is the feedback system everywhere.

Thank you for your reply.We meet the problem, that one teacher has to supervise up to 7 students simultaniously. So, we cannot observe the whole treatment session in order to see, if the student does all steps well. We see only the result: e.g. the applied kofferdam or the caries excavation. Very little time is available to actually observe the students work flow. So we see the "mistake" in the result, not in the process. We are looking for ideas, how to improve this situation. One idea is to introduce structured feedback like the mini-CEX, used in medical education. Is there any experience with such evaluations in dental education?

You are so welcome. To my knowledge, there is no mechanism to control and supervise a dental student during the procedure. Actually if not all, any dental procedures cannot be supervised in real time, during the operation, and even if some teacher can supervise a student, it is not quite possible to make rapid corrections. This is because the procedure is taking place rapidly and it is very delicate. So once damage is going to happen, it will happen in a fraction of second and it is difficult to stop it. However, in more sensitive procedures, when the bur is close to the pulp, the teacher can ask the student to use low-speed devices and do it very very slowly so that the teacher can effectively stop the student at the right moment... We face a similar problem, and no teachers can (or even are willing) to supervise a whole procedure during the operation. However, I had fields like endodontics, prosthodontics, and restorative dentistry in mind. In other fields such as orthodontics or periodontics (usually limited only to scaling / root planning in undergrad), etc. it is possible for the teacher to supervise the whole process. However, due to the limitations in the resources, they might do so for a fraction of the treatment, and once made sure the student is on the right track, they just might follow the result (and come to monitor in sensitive steps)...

In France, it is mandatory that all dental treatments undertaken by undergraduate students be done under constant supervision. This is usally quite complicated considering limited resources and personal in public hospitals. Nevertheless it seems essential that first year undergraduate students be able to undertake their first dental treatments with a supervisor assisting during the whole procedure. This is of paramount importance in fields such as oral surgery.

In the case of oral surgery, systematic post operative debriefing of the procedure allows the student to point out the various steps of the intervention in which he feels he hasn't performed adequately and allows the teacher to explain, step by step how to avoid future mistakes and enhance general surgical performance.

Suggest you look up Dr. David Reinhart on the West Coast.

Thank you Nathan for your Input. I agree, that the observing of the whole procedure is as important as difficult (personal resource limitation). Do you use any written "evaluation form" for the systematic post-operative debriefing? Are the results somehow documented, so that they can be recalled later by the student/supervisor?

In some cases, I ask the student to write down 3 things that went well (and why they went well) and 3 things that need improvement (and why they need improving). This practice helps them reflect upon their practice and figure out ways to improve further practice.

Furthermore, every surgical procedure receives a written evaluation from the supervisor, which helps in assessing student level for end term evaluations.

Here, we have adopted a written evaluation form and some other measures for the students undergoing the first semester of clinical practice with patients. They must have a ''clinical portfolio'', which is like a clinical journal. After each patient evaluation, they have to write down key elements on which they have based the diagnosis, and describe the proposed treatment. Then the teacher has to analyse it before the treatment starts. This system is not so time-consuming, and makes easier to notice each student weakness and doubts. Also, before each clinical procedure, the student needs to describe in the journal (homework), each step in detail (advises they will give, burs they'll use, materials' protocol, etc), which we found to be a good way of making sure they will revise all theoretical content in advance. Any changes during the procedure (under the teacher supervision) has to be described, giving the reasons for that. Also, by revising the ''procedures planned for today'', the teachers know in advance in which cases they should be more involved, and the student is told to call the teacher before-during-after each step, for example.

Besides, at the end of each evaluation period (which includes the journal) they must fill an excel file with all performed procedures, materials used, tooth, diagnosis, next recall, etc. The student score is based on several criteria (punctuality, relationship with colleagues, teachers and patients, procedure skills, organization) but we find that really hard to do in a daily basis. Therefore in the end, the journal and remarks (unacceptable mistakes or behavior; as well as positive points) have been used for scoring.

Thank you for your interesting answer. Francoise, your system seem to work really good for advising students. How do you deal with repetitive procedures? Has the student to repeat the descriptions? How many students has a teacer to supervise during one training session? How do you manage the analysis of the prposed treatment mesaures - 4 eyes (only student + teacher) or within s stauents group? I´m quite curious about this system.

The repetitive procedures have to be described all over again if it is a different patient (the more you write, the more you get familiar with). At this stage, they do not have much theoretical classes, so it's a way for them to constantly revise previous contents. But, if they'll perform 2 class 1 cavities, for example, in the same patient, then they should only report on the differences or state that all steps and materials will be the same. Usually we have 5 teachers, and 2 collaborators (such as PhD student and postdoc), so it is about 7 students per teacher. The analysis of the proposed treatments is usually discussed with the students in pairs (they work in pairs) and 2 or more teachers depending on the field (cariology, dentistry and periodontics). During the procedure, usually one teacher is constantly supervising the student. Discussions in group are also performed in seminars, where groups of 6 students have to present a defined clinical case, and after presentation the discussion is open for all. Although we are always trying to improve, it is working quite well.

we have e-learning courses (oral medicine) and dr. Vlaho Brailo is conducting this research mybe you can email him ([email protected]).