| Abstract|| |
Background: Quality of dental education has seen a major improvement in India, most of the dental graduates opt for practice after their internship in India, and there are no prior studies to assess the preparedness of the interns towards dental practice. Hence, the aim of this study was to describe the level of self-perceived competency towards dental practice among Interns of various dental colleges in India.
Materials and Methods: A cross-sectional questionnaire study was conducted using a standardized and valid measure of self-perceived competencies in dentistry (49 items).
Results: The overall response rate to the study was 71.5% (143/200). 83.9% respondents felt well prepared towards dental practice, most of the respondents felt well prepared about "bread and butter" aspects of dentistry: General patient management and conservative dentistry. However, in certain areas the interns felt poorly prepared towards dental practice, over 60% of the interns felt that they are poorly prepared in management of complications of oral surgery, extraction of impacted third molars and in management of trauma to dento-facial complex, replacement of missing teeth with conventional bridges and implants, and in performing periodontal surgical procedures.
Conclusion: In general, Interns felt well prepared towards dental practice; however, there exists a lacuna in certain areas of training the interns towards dental practice and this lacunae has to be fulfilled by making necessary changes in the undergraduate dental education program and also by conducting continuing dental education program for the dental professionals.
Keywords: Competency, dental education, India, interns
|How to cite this article:|
Prabhu S, John J, Saravanan S. Perceived competency towards dental practice among interns of various dental colleges in India. J Educ Ethics Dent 2012;2:33-9
|How to cite this URL:|
Prabhu S, John J, Saravanan S. Perceived competency towards dental practice among interns of various dental colleges in India. J Educ Ethics Dent [serial online] 2012 [cited 2021 Apr 16];2:33-9. Available from: https://www.jeed.in/text.asp?2012/2/1/33/115154
| Introduction|| |
Dental manpower in India had greatly increased, until 1966, all the dental colleges in India were either run by the government or aided by the government, it was in the same year the first dental college in private sector was established.  Forecasts of shortage of manpower led to an increase in the number of colleges, especially in the private sector and there has been stagnation in the growth of government colleges due to the lower amount of funds provided by the government for oral health care. At present there are nearly four times as many private colleges than government colleges.
With the increase in number of dental colleges there has also been improvement in the dentist:Population ratio. At present the dentist-population ratio in India is 1:30000 and India has one dentist per 10000 people in urban areas and one dentist per 2.5 lakh people in the rural areas.  There exists unequal distribution of the dentists in the country.
This unequal distribution of dentists contributes to emergence of oro-dental diseases as a public health problem in India. According to recent estimates, about 50% of school children are suffering from dental caries and 90% of adults are having periodontal disease, oral cancer is also emerging as a major threat among young generation due to the increased usage of tobacco products.  To bring down the burden of oral diseases, various health education programmes and preventive programmes were organized by the government and private colleges and organizations like IDA. But still the disease burden is high; to bring down the disease burden we need to assess the competency of the young dental graduates toward their preparedness for dental practice.
The level of education and socio-economic status of the people had improved much and as a result the life styles of the people were also changed. Dental treatments which were mainly confined to extractions were gradually transforming towards preventive, therapeutic, aesthetic and rehabilitative dental treatments. Dental education curriculum in India at present is not been changed much to cater the needs of the people. Dental education based on competency followed in developed countries is found to be professionally effective for good clinical practice, , education system in India is different from those methods in USA.
To be competent is defined as having the necessary skill or knowledge to do something successfully,  the aim of the undergraduate dental education has been described as "to produce a caring, knowledgeable, competent and skillful dentist who is able, on graduation to accept professional responsibility for the effective and safe care of patients who appreciates the need for continuing professional development, who is able to utilize advances in relevant knowledge and techniques and who understands the role of the patient in decision making". 
An education based on competency offers several advantages, namely enhancement of the students' performance through active participation in problem-solving learning, encouragement of critical assessment facilities, improvement of interdisciplinary understanding, better research skills, and improved links with practice settings. 
Dental education today must ensure that professionals are equipped to deal with the challenges of tomorrow, and in an increasingly globalized scenario, how we educate our future professionals will decide the future of oral health of our country. Hence this study was conducted with the aim to assess the perceived competency of interns towards dental practice among various dental colleges in India.
| Materials and Methods|| |
At present in India there are 294 dental colleges, the state of Tamil Nadu was chosen at random. From this state the city of Chennai was chosen at random and the capital city of the state has 14 dental colleges of which 3 dental colleges were chosen at random. The state attracts health care consumers all over the world; it also provides dental education to students from rest of India, South East Asian countries like Malaysia and Singapore, and Sri Lanka. Interns of these dental colleges in the academic year 2011-2012 constituted the study population.  Interns who are willing to take part in this study and those interns in the verge of completion of their internship (last 1 month of internship) were included as they were equally exposed to all the branches of dentistry by this time period and Interns who had already participated in any previous studies of such kind were excluded.
Prior to the start of the study ethical approval was obtained from the Institutional Review Board, Saveetha University. An approval from the concerned dental college authorities and written informed consent from the interns were obtained. Sample size required for the study was calculated to be N = 123, with 80% power at 5% α-error, based on the studies conducted by Rafeek - error, based on the studies conducted by Rafeek et al.,  and Arena et al., Self-perceived competencies of graduates were assessed by employing a pre-tested, validated, self-administered questionnaire containing 49 closed ended questions, previously used to assess dental competencies among dental graduates in Canada, Australia, and Hong Kong was used.  Items cover eight aspects of dental practice: 'General patient management', 'periodontology and dental public health', 'conservative dentistry', 'oral rehabilitation', 'orthodontics', 'managing children and special needs patients', 'oral and maxillofacial surgery' and 'drug and emergency management'. Questions about each intern's personal characteristics like age and sex were included.
After a brief introduction on the purpose and intent of the study with the help of intern's information sheet, the informed consent was obtained from the interns and questionnaire was distributed through the interviewer with the help of department of public health dentistry in each of the selected colleges and filled questionnaires were collected using a drop box placed at a common place. Only completely filled forms were considered for analysis.
The data collected was analysed and tested for significance using statistical software packages, SPSS software for windows (version 16.0). Frequency tables were computed, mean competency scores were calculated for each domain and Independent samples t - test was used to test if there is differences for various parameters were statistically significant across gender. For all the tests, (P < 0.05) is considered statistically significant.
| Results|| |
A total of 200 questionnaires were distributed among the interns of the three dental colleges. Of which 143 (71.5%) questionnaires were returned and free from errors and considered for further analysis, among the respondents 73 (51%) were males and 70 (49%) were females. [Table 1] shows the self-perceived competency of the interns towards various domains of dental practice.
|Table 1: Self-perceived competency of the interns towards various domains of dental practice|
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91 (63.6%) interns perceived well prepared in taking and interpretation of medical, social, and dental history. 79 (55.2%) interns perceived well prepared in effective communication with patients. 75 (52.4%) interns felt well prepared in discussing treatment plans and to get informed consent from the patient, 82 (57.3%) interns felt well prepared in discussing fess and payment options with the patient. 103 (72%) interns felt well prepared to develop sequential treatment plan for the patient. 106 (74.1%) interns felt well prepared in interpreting tests and history to make a diagnosis. 47 (32.9%) interns felt very well prepared in addressing patients chief complaints and 85 (59.4%) interns felt well prepared in addressing patients' chief complaint.
96 (67.1%) interns felt that they were well prepared to treat early stages of periodontal disease and 62 (43.4%) interns perceived they were well prepared for scaling and root planning procedures. 89 (62.2%) interns felt well prepared in giving oral hygiene instructions and dietary analysis for the patient.
63 (44.1%) interns felt that they were very well prepared in restoring the teeth with amalgam restoration and 80 (55.9%) interns felt very well prepared in restoring the teeth with composite resin. 80 (55.9%) interns felt well prepared in single rooted teeth root canal treatment, whereas only 61 (42.7%) interns felt well prepared in root canal treatment of multi rooted teeth.
49 (34.3%) interns felt that they were very well prepared in replacing teeth with partial dentures, 68 (47.6%) interns felt well prepared replacing teeth with complete denture. Only 9 (6.3%) interns perceived that they were well prepared in replacing the teeth with implants, Only 32 (22.4%) interns felt well prepared in replacing teeth with conventional bridges while 69 (48.3%) interns perceived that they were poorly prepared in replacing teeth with conventional bridges.
11 (7.7%) interns felt very well prepared towards orthodontic treatment planning and 65 (45.5%) interns felt well prepared towards orthodontic treatment planning. 31 (21.7%) interns felt well prepared in full-arch alignment, while 65 (45.5%) interns felt poorly prepared in full arch alignment.
86 (60.1%) interns perceived that they were well prepared in management of anxious dental patients, 104 (72.7%) interns felt well prepared in management of child patients. 95 (66.4%) interns felt well prepared in management of elderly patients. Only half of the interns 72 (50.3%) were well prepared in management of medically compromised patients, while 58 (40.6%) interns perceived that they were poorly prepared in management of medically compromised patients.
27 (18.9%) interns felt very well prepared in management of acute pain/infection, 68 (47.6%) interns felt very well prepared in performing simple extraction, and 63 (44.1%) interns were well prepared in performing simple extraction. Only 46 (32.2%) interns felt well prepared in extraction of third molars, 42 (29.4$) interns felt well prepared in management of complications of oral surgery, while 65 (45.5%) interns felt poorly prepared in management of complications of oral surgery.
82 (57.3%) felt that they were well prepared in prescribing drugs to the patient. Only 62 (43.4%) interns felt well prepared in prevention and management of complications of local anesthesia and 52 (36.4%) interns felt poorly prepared in prevention and management of complications of local anesthesia. 79 (55.2%) interns felt well prepared in management of medical emergencies in dental practice and 44 (30.8%) interns felt poorly prepared in management of medical emergencies in dental practice.
[Table 2] shows the self-perceived competency of interns according to gender; there is no significant difference between gender (P > 0.05) in self-perceived competency of the interns across various domains of dental practice.
[Figure 1] shows interns self - perceived preparedness across various domains of dental practice. Overall preparedness across various domains was found to be greater than 50%, Interns overall competency was highest for the domain general patient management (78.2%), and it is lower for oral rehabilitation (59%) and orthodontics (55%).
|Figure 1: Interns self-perceived preparedness across various domains of dental practice|
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[Figure 2] shows interns overall preparedness towards dental practice. Among the 143 interns none of them felt very poorly prepared towards dental practice, 6 (4.2%) interns felt poorly prepared toward dental practice, 120 (83.92%) interns felt well prepared toward dental practice, and 17 (11.88%) interns felt very well prepared towards dental practice.
| Discussion|| |
Appraisal of graduate's competency 'at' graduation is routinely assessed through their academic performance; there is a dearth of information on the competency of graduates 'in' dental practice. Starting up a clinical dental practice is the most common 'step-forward' by the interns. There exists no prior study on the perceived competency of the interns towards dental practice in India.
This study was conducted with an aim to assess the competency of the interns toward dental practice. The questionnaire used in the present study was previously used in the studies conducted in Canada, Australia and Hong Kong. 
Most of the interns felt well prepared in most aspects of general patient management, taking and interpreting medical, social and dental histories, communicating effectively with the patients, identifying and addressing patients' chief complaints and formulate a sequential treatment plan. Nonetheless, approximately 17% of the interns felt poorly prepared in getting informed consent from the patient. Informed consent serves as a tool to safeguard from medico-legal issues and also it increases the level of trust between the patient and dentist.  Dental education program and clinical practice at a dental institution should encourage the dental students to take informed consent from the patient for the dental treatment procedures as in the present study only one-third of the study participants were well prepared in getting informed consent from the patients this was similar to the study conducted by McGrath et al. in Hong Kong. 
Interns felt well prepared in treatment of early stages of periodontal disease and in performing deep scaling and root planing procedures. However, 19% of the interns felt poorly prepared in performing dietary analysis and in giving oral hygiene instructions, but this observation is higher than the results of the study done by McGrath et al. in Hong Kong  Diet analysis and oral hygiene instructions are basic dental procedures taught early in dental training but often neglected in clinical practice.  It is essential that interns are well trained in health promotion procedures. Interns felt poorly prepared in carrying out periodontal surgeries for home care (70%) and in crown lengthening procedures (73.4%). This is similar to the studies done by McGrath et al. in Hong Kong  and Greenwood et al. in Canada.  This was due to the questionable merits of surgical over non- surgical approaches to periodontal management have led to greater emphasis on non-surgical periodontal care teaching among undergraduates. 
Interns felt well prepared in restorative procedures like amalgam and composite restorations, single crowns, and single-root endodontics, which are the most common procedures in dental practice, similar to the findings of study by McGrath et al. in Hong Kong.  In performing multi-rooted teeth, endodontic treatment 44.8% interns felt less well prepared in contrast to the study by McGrath et al. in Hong Kong,  as poor access and variation in root morphology causes practical difficulties for the dental students. With the increased intention of people to save their own teeth, emphasis should be given either in undergraduate educational curriculum or through continuing education programs to improve their competency.
Interns felt well prepared in replacement of missing teeth with both partial and complete dentures. Almost 90% of the interns felt they were poorly prepared in replacing the tooth with implants. This is in contrast to the studies done by McGrath et al. in Hong Kong,  Greenwood et al. in Canada  and Greenwood et al. in Toronto  and 76% interns felt poorly prepared in replacement of teeth with conventional bridges. With the increased demand for conventional bridges and implants for replacement of missing teeth, the dental curriculum should be modified to solve these issues.
Only 53% of the interns felt well prepared in performing orthodontic treatment planning and 78% of the interns felt less well prepared in performing full-arch alignment, which is similar to the study by McGrath et al. in Hong Kong.  This was due to the lack of practical support offered to the dental students in their undergraduate curriculum.
Interns felt well prepared in management of elderly and child patients; however, 42% of the interns were not well prepared in managing medically compromised patients. With an increase in the elderly population there is also an increase in the medical diseases suffered by them. Interns should be competent in this domain and ensure dental health or dental treatment does not affect patients' general health, which can be improved by proper guidance provided by the physicians on treating patients who are medically compromised at a dental school.
Practically all of the interns felt well prepared in performing simple extraction, administration of local anesthesia and in managing acute pain/infection. 61% of the interns felt not well prepared in performing extraction of impacted third molars. Interns also felt less well prepared in the management of complications following oral surgery, management of chronic orofacial pain, identification and management of oral pathology, in performing soft tissue biopsies and in the management of trauma to dentofacial complex. These findings concur with studies carried out by McGrath et al. in Hong Kong,  Greenwood et al. in Canada  and Greenwood et al. in Toronto. 
One quarter of the respondents were not well prepared in prescribing drugs for the patient and nearly half (43%) of the interns were poorly prepared in prevention and management of complications arising from local anesthesia administration, such problems were lower in the studies conducted by McGrath et al. in Hong Kong  Greenwood et al. in Canada  and Greenwood LF et al. in Toronto.  There needs to be a special emphasis given to the dental students on local anesthesia complications and their management. About 40% of the interns felt not well prepared in management of medical emergencies. This too appears to be a common problem in studies by similar to studies by Arena et al. in Western Australia  and Rafeek et al. in West Indies.  A risk of medical emergency accompanies every dental procedure and it is of utmost importance that dental graduates feel prepared for dealing with such events. 
The limitations of the present study are that the interns were not exposed to providing dental care without any supervision, so the results give an overview of the competency of the interns towards dental practice, and the results showed that more than 80% of the interns felt well prepared in dental practice. Further studies are required to assess the competency of interns across various dental schools in India to make necessary changes in the undergraduate dental education curriculum for increasing the competency of interns across various domains of dental practice.
| Conclusion|| |
Interns had high self-perceived competency in most dental aspects such as identification and treatment of chief complaints, treatment of early periodontal disease, restoration of teeth with composite or amalgam restorations, replacement of missing teeth with partial or complete denture, performing simple extraction under local anesthesia and in management of children and elderly patients.
Self-perceived competency of the interns is low in certain treatment areas like periodontal surgery, orthodontic treatment, multi-rooted teeth endodontics and in the management of complications of oral surgery and medical emergencies in dental practice. These deficiencies should be addressed by making necessary modifications in the under graduate dental education curriculum and by conducting continuing dental education with these aforementioned deficits as the main topic of discussion for general dental practitioners.
| References|| |
|1.||Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68(7 Suppl):28-33. |
|2.||Nanda Kishor KM. Public health implications of oral health inequality in India. J Adv Dent Res 2010;2:1-10. |
|3.||Prakash H, Duggal R, Mathur VP. Final report and recommendations "Formulation of guidelines for meaningful and effective utilization of available manpower at dental colleges for primary prevention of oro-dental problems in the country." A GOI-WHO Collaborative Programme, New Delhi: 2007. |
|4.||Marchese TJ. Contexts for competency-based curricula in dental education. J Dent Educ 1994;58:339-41. |
|5.||Chambers DW. Competencies: A new view of becoming a dentist. J Dent Educ 1994;58:342-5. |
|6.||Rafeek RN, Marchan SM, Naidu RS, Carrotte PV. Perceived Competency at graduation among dental alumni of the University of the West Indies. J Dent Educ 2004;68:81-8. |
|7.||The first five years, the undergraduate dental curriculum. 2 nd edition. London: General Dental Council; 2002. |
|8.||Yip H.K, Smales R.J. Review of competency-based education in dentistry. Br Dent J 2000;189:324-6. |
|9.||Dental colleges in India. Accessed from: http://www.dciindia.org/search.aspx. [last cited on 2012 Apr 5]. |
|10.||Arena G, Kruger E, Holley D, Millar S, Tennant M. Western Australian dental graduates' perception of preparedness to practice: A five-year follow-up. J Dent Educ 2007;71:1217-22. |
|11.||Seldin LW. Informed consent. The patient's rights. Dent Today 2003;22:86-8;quiz 89. |
|12.||McGrath C, Cobert EF. Do dental graduates of the University of Hong Kong (1997-2001) perceive themselves prepared for dental practice? Hong Kong Dent J 2005;2:84-91. |
|13.||Gift HC, Hoerman KC. Attitude of dentists and physicians towards the use of dietary fluoride supplements. ASDC J Dent Child 1985;52:265-8. |
|14.||Greenwood LF, Lewis DW, Burgess RC. How competent do our graduates feel? J Dent Educ 1998;62:307-13. |
|15.||Corbet EF. Future directions in periodontology. Hong Kong Dent Assoc Yearbook 1989;34-6. |
|16.||Greenwood LF, Townsend GC, Wetherell JD, Mullins GA. Self-perceived competency at graduation: A comparison of dental graduates from the Adelaide PBL curriculum and the Toronto traditional curriculum. Eur J Dent Educ 1999;3:153-8. |
|17.||Arena G, Kruger E, Holley D, Millar S and Tennant M. Western Australian dental graduates' perception of preparedness to practice: A five- year follow- up. J Dent Educ 2007;71:1217-22. |
|18.||ADA council on scientific affairs. Office emergencies and emergency kits. J Am Dent Assoc 2002;33:364-5. |
Department of Public Health Dentistry, Saveetha Dental College and Hospital, No, 162, Poonamallee High Road, Velappanchavadi, Chennai - 600 077
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2]