Corne Postma - Academia.edu (original) (raw)

Papers by Corne Postma

Research paper thumbnail of Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures

SA Orthopaedic Journal, 2018

Background: The Schatzker classification is the most widely accepted system used to classify tibi... more Background: The Schatzker classification is the most widely accepted system used to classify tibial plateau fractures. The presence of posteromedial fragments in the more severe fracture types is known, but the presence of posteromedial fragmentation in the less severe fracture types is unknown. The ability of the Schatzker classification to predict posteromedial fragmentation was evaluated. Methods: Two hundred patients were reviewed of which only 67 met the inclusion criteria. The X-rays were reviewed by three independent orthopaedic surgeons and classified according to the Schatzker classification. A radiologist reviewed the CT scans and noted the presence or absence of a posteromedial fragment and if present, the largest diameter of the fragment was measured. Results: The mean age of the sample was 44.79 (SD: 14.03) years. Seventy-five per cent of the females (n=33) presented with posteromedial fragmentation compared to 65.20% of the males (n=44) (chi²-test, P=0.399). The incidence of posteromedial fragmentation varied between 15.8 and 26.3% for Schatzker 1 and 2 fractures and 73.7 and 84.2% for Schatzker 3 to 6 (chi 2-test, p<0.001) based on the three independent assessments. The mean length of the posteromedial fragmentation ranged from 41.87 to 47.77 mm for Schatzker 1 and 2 fractures, and 44.74 to 46.12 mm for Schatzker 3 to 6 for the three assessors (statistically not significant [T-test, P=0.536, P=0.551 and P=0.652]). Conclusion: The Schatzker classification by itself is not adequate to identify all fractures with posteromedial fragmentation. There is a higher association of posteromedial fragmentation with fracture types 3 to 6. There is a high probability of missing a significantly sized posteromedial fragment in Schatzker type 1 and 2 fractures if a CT scan is not performed which might influence and compromise fracture stability, joint congruency and the ability to rehabilitate optimally.

Research paper thumbnail of Second-year dental students’ perceptions about a joint basic science curriculum

African Journal of Health Professions Education, 2015

Globally, medical and dental university students share basic science curricula, [1-6] promoting c... more Globally, medical and dental university students share basic science curricula, [1-6] promoting cost-effectiveness of student training. [7] This strategy ensures that dental students develop a solid medical background. The approach has historical roots, [8] and remains a current teaching and learning requirement for a dentist. [9] The University of Pretoria, South Africa (SA) utilised a joint basic science curriculum for first-and second-year medical and dental students from the late 1940s to 2014. A recent article by Ajjawi et al. [1] identified the marginalisation of dental students in a combined medical curriculum at a university in Australia. Similarly, a US study showed that dental students felt like 'second-class citizens' in their joint curriculum and that its relevance was based on the needs of the medical student; it also contained too much irrelevant information from a dental perspective. [3] Ajjawi et al. [1] suggest that prejudice and stereotyping may be prevalent in joint basic science curricula. These factors may possibly be present from a social and psychological perspective, [10] when two distinct groups have to interact in a joint curriculum. Medical and dental students sharing a joint curriculum may therefore pose undesired risks with regard to student learning. [1] Despite the identification of these problems, no studies or reports could be traced in the literature that describe how such problems are actively being addressed in terms of medical and dental students. There are no studies in SA that investigate dental students' perceptions of their social and peer relationships with medical students in a shared medical curriculum. With the marginalisation of dental students being reported elsewhere, [1] one should investigate this issue in SA. Further evidence in this regard may indicate the need to reconsider the use and management of generic joint programmes locally in terms of the effect on learning and interprofessional collaboration. Based on this assessment, our study investigated whether dental students at the University of Pretoria perceive the joint curriculum to be relevant and useful and if marginalisation is prevalent.

Research paper thumbnail of Retention of Self-etching versus Conventional Sealants in a Community-based Project

Objective: The objective of this study was to compare the retention rate of a self-etching sealan... more Objective: The objective of this study was to compare the retention rate of a self-etching sealant with a conventional fissure sealant in a community-based project. Methods: The sample comprised 26 children of the Boschkop Primary School between the ages 10 and 14 years. Of these children, 140 posterior permanent teeth, which satisfy the criteria for fissure sealant placement, were sealed. A split mouth technique, where the two techniques were randomly allocated to either the right or the left side of the mouth was used. On the one side, a self-etching light cured fissure sealant, Prevent Seal (Itena, Paris, France) was used and on the other side, a conventional light-cured fissure sealant UltraSeal XT plus (Ultra Dent Products, Utah USA) was used. Trained final year oral hygiene students placed the fissure sealants and for both materials the manufacturers' instructions were followed. Moisture control was obtained using cotton rolls and suction. At the follow-up visits after one...

Research paper thumbnail of Dental Caries Experience of Children in the North West Province

Objective: The purpose of this study was to determine trends in dental caries experience of child... more Objective: The purpose of this study was to determine trends in dental caries experience of children in the North West Province (NWP) of South Africa (SA). Method: A two-staged cluster sampling technique was used to select 2900 children randomly from children in the age groups 4-5-, 6-, 12- and 15 years in the Province. WHO methods were used for the collection of data. Prior to the survey all examiners were trained and calibrated. Consent to conduct the survey was obtained from the relevant authorities. Results: When comparing the 1999-2002 survey with the 2008-2010 survey, the results show a significant increase (p<0.05) in caries severity in the primary dentition from 1.62 and 2.22 to 2.28 and 2.65 for 4-5- and 6-year-olds respectively. Significant decreases (p<0.05) in caries severity in the permanent dentition 0.79 to 0.47 and 1.42 to 1.10 were observed for 12- and 15-year-olds respectively. Analysis of the data for the 15 year-old group show that caries is more prevalent ...

Research paper thumbnail of On being self-ish, self-less or well-balanced (other-ish), and how this may relate to practicing dentistry

South African Dental Journal, Oct 10, 2022

It has been said that people are driven by either selfinterest or caring for others. In extreme c... more It has been said that people are driven by either selfinterest or caring for others. In extreme cases, the former selfishly seek self-fulfilment, often at the expense of others, while the latter selflessly and altruistically strive to please others, many times with personal costs. This paper will explore the issues of selfish versus selfless behaviour with regard to the practice of dentistry, and offers dialogue on how practitioners could pursue a more balanced option that will serve the best interest of both parties.

Research paper thumbnail of Buccal and palatal alveolar bone dimensions in the anterior maxilla: A micro‐CT study

Clinical Implant Dentistry and Related Research

Research paper thumbnail of Outsmarting COVID-19 through rapid 3D printing and flipped learning in fixed prosthodontics

African Journal of Health Professions Education, 2021

This paper describes the transformation of pre-Covid 19 educational practices in Fixed Prosthodon... more This paper describes the transformation of pre-Covid 19 educational practices in Fixed Prosthodontics at the School of Dentistry, University of Pretoria. The sudden need for social distancing limited access to the main preclinical skills laboratory, which was overcome by 3D-printed phantom heads that were rapidly produced by the Central University of Technology. This allowed preclinical training to continue in clinical spaces. The educational philosophy also had to be adjusted because contact time became limited. The traditional lecturer-centered approach followed (lectures, notes, demonstrations, practicals and log books) was transformed to a student-centered approach through the production of high quality audio-visual material that allowed students to prepare for practicals in advance. These materials provided learner support at chairside on computer screens and mobile devices and facilitated self-directed learning. Students were formatively assessed using a chairside computer sys...

Research paper thumbnail of The 'Digital Access Divide' at a South African Dental School - A cross-sectional study - Part 1

South African Dental Journal, 2020

This study sought to investigate the digital divide, from an access perspective, of dental studen... more This study sought to investigate the digital divide, from an access perspective, of dental students at the University of Pretoria. Second to final year students (n= 218 (87.2% response rate) completed a custom-designed survey at the end of 2017. The investigation enquired about the digital devices and infra-structure they owned and used for study purposes. They were also asked to reveal the networks and resources they used to access online platforms and to comment on any other related access issues such as the quality of the Internet, speed and reliability, as well as cost and personal implications related to usage. A clear divide could be detected for a minority of students (±1/7). Individually targeted interventions will be required to ensure an equitable and fair online learning experience.

Research paper thumbnail of Dental students' self-perceived competency and usage of the internet for learning and evaluation purposes - Part 2

South African Dental Journal, 2020

Many dental lecturers are moving away from providing hand-out notes to their students and are rat... more Many dental lecturers are moving away from providing hand-out notes to their students and are rather opting for posting lecture material and tutorials on the internet using the various university platforms such as clickUP. At the same time a number of students have queried the need to purchase the prescribed text books due to their high costs, and dated content. The presumption is that all students have unrestricted and equal access to this material, and are competent using digital technology for learning and assessment, however there has been no formal investigation into whether this is so. Student access and usage was reported on in Part I of this study. The present paper investigated students' preferences with regards to the mode of learning material, and their self-perceived competencies in using the internet for various academic purposes. The project took the form of an anonymous, structured questionnaire that was given to all dental students from the second to the fifth ye...

Research paper thumbnail of The capacity of the Oral Health Centre, University of Pretoria, to complete root canal treatments

South African Dental Journal, 2016

Introduction: The University of Pretoria Oral Health Centre (UPOHC) is inundated by patients pres... more Introduction: The University of Pretoria Oral Health Centre (UPOHC) is inundated by patients presenting with toothache, many requiring emergency pulpectomies (EPs). To date, the outcome of these procedures performed at this academic/public health facility, remains unknown. Aims and objectives: To determine the completion rate of treatment of teeth that had received EPs at the UPOHC. Study design: A retrospective survey of data obtained from electronic and paper records of 498 randomly selected teeth from the 1050 that had undergone EPs between 1 July 2012 and 30 June 2013 at the UPOHC, followed to 30 June 2014. Methods: The outcome of treatment was recorded as "no treatment after initial pulpectomy", "pulpectomy repeated", "tooth was removed" or "root canal treatment (RCT) was completed by student or dentist". Results: Of the 498 teeth included, 224 (44.98%) were obturated, 35 (7.03%) were retreated, forty two (8.43%) teeth were referred for e...

Research paper thumbnail of Dentistry in South Africa and the need for management and leadership training

South African Dental Journal, 2021

Dental professionals face many challenges due to a rapidly changing environment, and are acknowle... more Dental professionals face many challenges due to a rapidly changing environment, and are acknowledging the need for essential leadership skills to perform optimally. We assessed key stakeholders’ views about the need for management and leadership training in dentistry in South Africa . The aim of this study, was to assess the need for leadership and management training in Dentistry in South Africa from an industry perspective. A qualitative study. Purposive sampling of 14 Senior Managers in the dental environment and 11 recently qualified dentists in South Africa. We conducted one-on-one and telephonic interviews guided by a semi-structured questionnaire with open-ended questions. Interviews were recorded, transcribed and data was thematically analysed. Participants expressed concerns about dentistry in South Africa. All participants mentioned financial constraints, including the high cost of setting up a practice, high cost of imported consumables and dwindling support from medical...

Research paper thumbnail of South African Dental Students’ Perceptions of Most Important Nonclinical Skills According to Medical Leadership Competency Framework

Journal of Dental Education, 2016

Recent developmental frameworks suggest that dental curricula should focus on developing nonclini... more Recent developmental frameworks suggest that dental curricula should focus on developing nonclinical skills in dental students. The aim of this study was to qualitatively map students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of the most important nonclinical skills against the Medical Leadership Competency Framework (MLCF). A representative sample of second- to fifth-year students (n=594; overall response rate 69%) from all four dental schools in South Africa participated in a cross-sectional survey in 2014-15 enquiring about nonclinical skills and dental practice management. One of the questions required students to list the four most important nonclinical skills required for a dentist. Students (n=541) most frequently noted competencies related to working with others (97.9%), personal qualities (72.3%), and managing services (42.9%) as the most important nonclinical skills. Very few students mentioned competencies related to the improvement of services (14.1%) and the provision of strategic direction (10.9%). The students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attention appeared to be on nonclinical skills generally required for clinical care with some realization of the importance of managing services, indicating a need for a stronger focus on leadership and management training in dental schools in South Africa. The results also helped to unravel some of the conceptual ambiguity of the MLCF and highlight opportunities for leadership research using the MLCF as a conceptual framework.

Research paper thumbnail of The prevalence of second canals in the mesiobuccal root of maxillary molars: A cone beam computed tomography study

Australian Endodontic Journal, 2018

I, Nelson Alexander Fernandes, hereby declare that this dissertation, submitted in partial fulfil... more I, Nelson Alexander Fernandes, hereby declare that this dissertation, submitted in partial fulfilment of the requirements for the degree of MChD (Prosthodontics) at the University of Pretoria, has not previously been submitted for a degree at any other University.

Research paper thumbnail of The influence of storage media on early osseointegration of titanium implants

Journal of Dental Implants, 2016

Introduction: Marketing of implants stored in different media other than air could improve implan... more Introduction: Marketing of implants stored in different media other than air could improve implant wettability resulting in a favorable implant bone interface with subsequent optimized early osseointegration. The effect that the different storage media, such as saline, air and argon, have on the early osseointegration of plasma treated, titanium dental implants was investigated and was compared to conventional implants stored in air, in an ovine pelvis model. 96 implants were inserted in the iliac crests of four sheep and tested for osseointegration by comparing insertion torque values and removal torque values at 4 and 6 weeks postinsertion. Twelve implants were inserted in each ovine iliac crest (24 per sheep representing six implants from each experimental group). Saline demonstrated the highest increase in torque values with argon demonstrating a linear decrease. The average percentage gain for each of the storage media at 4 weeks were plasma/air = +2%, plasma/saline = +30.4%, air = +9.6% and plasma/argon = −30.4%. The results were only statistically significant for the saline group at 4 weeks and the argon group at 2 weeks. All storage media demonstrated an initial decrease in torque value of 14.25% at 2 weeks before a strong rise in torque value could be observed. Saline as a storage media has great potential for improving early osseointegration. An interesting observation made was that the majority of the dental implants tend to demonstrate an initial decrease in osseointegration before demonstrating a strong rise in torque values. Further studies are recommended for the periods of 6 and 8 weeks after implant placement. Context: Research protocol. Aims: The purpose of the study was to compare the early osseointegration potential of plasma-enhanced implants stored in different storage mediums, to conventional implant stored in air. Settings and Design: The experiment consisted out of a comparative in vivo pilot study in which the early osseointegration potential of implants stored in four different storage media was compared. These implants were inserted in the iliac crest of four sheep, and the degree of osseointegration of the different groups was compared at 2 and 4 weeks after insertion. The osseointegration potential of the implants was evaluated by measuring and documenting the insertion torque and comparing it to the removal torque values of each implant. Subjects and Methods: A total of 96 (n = 96) dental implants (3.75 mm in diameter and 10 mm in length), including 24 plasma-enhanced dental implants stored in air; 24 plasma-enhanced dental implants stored in argon; 24 plasma-enhanced dental implants stored in saline and 24 conventional dental implants stored in air; were inserted into the iliac crests of 4 sheep. The insertion torque values were measured and documented on insertion. Two sheep were euthanized after a period of 2 weeks postinsertion, and the maximum removal torque value of each implant was measured and documented. The remaining two sheep were euthanized at 4 weeks postinsertion and the maximum removal torque of each implant measured and documented. The torque values measured on insertion, after 2 weeks, and after 4 weeks postinsertion were then compared and used to determine the level of osseointegration as well as the potential for further osseointegration. Statistical Analysis Used: Comparative graphical analysis was performed. Significance was determinant at P < 0.05. Results: Saline demonstrated the highest increase in torque values with argon demonstrating a linear decrease. The average percentage gain for each of the storage media at 4 weeks were plasma/air = +2%, plasma/saline = +30.4%, air= +9.6%, and plasma/argon = −30.4%. The results were only statistically significant for the saline group at 4 weeks and the air group at 2 weeks. All storage media demonstrated an initial decrease in torque value of 14.25% at 2 weeks before a strong rise in torque value could be observed. Conclusion: Saline as a storage media has great potential for improving early osseointegration. The majority of the dental implants tend to demonstrate an initial decrease in osseointegration before demonstrating a strong rise in torque values. Further studies are recommended for periods of 6 and 8 weeks after implant placement.

Research paper thumbnail of Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence

European Journal of Dental Education, 2015

Introduction: This study provides empirical evidence of the development of integrated clinical re... more Introduction: This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the fourcomponent instructional design model for complex learning. Methods: Progress test scores of third-to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth-and fifth-year cohorts. These fourth-and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions. Results: Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions. Conclusion: The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.

Research paper thumbnail of Socio-demographic and academic correlates of clinical reasoning in a dental school in South Africa

European Journal of Dental Education, 2015

Introduction: There are no empirical studies that describe factors that may influence the develop... more Introduction: There are no empirical studies that describe factors that may influence the development of integrated clinical reasoning skills in dental education. Hence this study examines the association between outcomes of clinical reasoning in relation to differences in instructional design and student factors. Materials and Methods: Progress test scores, including diagnostic and treatment planning scores, of fourth and fifth year dental students (2009-2011) at the University of Pretoria, South Africa served as the outcome measures in stepwise linear regression analyses. These scores were correlated with the instructional design (lecture-based teaching and learning (LBTL=0) or case-based teaching and learning (CBTL=1), students' grades in Oral Biology, indicators of socioeconomic status (SES) and gender. Results: CBTL showed an independent association with progress test scores. Oral Biology scores correlated with diagnostic component scores. Diagnostic component scores correlated with treatment planning scores in the fourth year of study but not in the fifth year of study. "SES" correlated with progress test scores in year five only, while gender showed no correlation. 2 Conclusion: The empirical evidence gathered in this study provides support for scaffolded inductive teaching and learning methods to develop clinical reasoning skills. Knowledge in Oral Biology and reading skills may be important attributes to develop to ensure that students are able to reason accurately in a clinical setting.

Research paper thumbnail of Developing students’ clinical reasoning skills: correlates of perceived relevance of two teaching and learning approaches

European Journal of Dental Education, 2015

Introduction: "Relevance" is a key concept in adult learning. Hence this study sought to examine ... more Introduction: "Relevance" is a key concept in adult learning. Hence this study sought to examine students" perceptions of relevance of the teaching and learning in relation to different instructional designs employed in a Comprehensive Patient Care (CPC) course that aims to develop integrated clinical reasoning skills. Methods: Third to fifth year students (2009-2011) were asked to anonymously rate the relevance of the CPC instructional design (RELID) they participated in by means of visual analogue scales at the School of Dentistry, University of Pretoria. They were also asked to rate their perceptions of the alignment between teaching and learning and outcomes (ATLO), assessments" contribution to learning (ACL), course organisation (CO) and lecturer competence (LC). RELID served as the outcome measure in stepwise linear regression analyses. ATLO, ACL, CO, LC and the instructional design (case-based learning (CBL)=1 and discipline-orientated lecture-1 based teaching (DOLBT)=0) served as the co-variables for each of the years of study. Results: The analysis showed positive correlations between RELID and ATLO and between RELID and ACL for all the years of study. RELID was associated with LC in year three and four and CO was associated with RELID in year four and five. CBL outperformed DOLBT in terms of perceived relevance of the teaching and learning. Conclusion: The results suggest that there are correlations between RELID and indicators of constructive alignment, LC and CO. The teacher"s philosophy appears to have a distinct influence on students" perceptions of the relevance of teaching and learning.

Research paper thumbnail of Dental students’ perceptions of practice management and their career aspirations

African Journal of Health Professions Education, 2015

The inclusion of 'management' competencies in medical curricula is widely propagated. [1-3] Partl... more The inclusion of 'management' competencies in medical curricula is widely propagated. [1-3] Partly based on this requirement, Dental Practice Management (DPM) is part of the undergraduate curriculum in the School of Dentistry, University of Pretoria, South Africa (SA). In recent years, DPM has been presented in the fourth and fifth years of study and can be considered a major study unit in the undergraduate dental curriculum. Teaching and learning in DPM typically include leadership, strategic management, financial management, personnel management, patient management, dentist-patient communication and marketing. [4] To date, from a student perspective, no information is available regarding the need for DPM as a subject in undergraduate dental curricula in SA. There is, however, some evidence in the literature that undergraduate dental students do not regard the development of management skills to be as important as the attainment of clinical skills. [5] DPM is likely to be relevant to those who aspire to become dental practice owners or managers in the private or public sector. It is debatable whether extensive teaching and learning in DPM will be perceived to be relevant by those who aspire to follow a career as employees only. The literature shows that the majority of dental graduates in SA aspire to enter private practice. [6] These trends may, however, be affected by the transformation in dental education during the past two decades. During this time, the profile of dental students changed from being male dominated to female dominated. [6] Furthermore, social redress in correcting racial profiles at universities is actively being pursued. [6] It would therefore be valuable to investigate whether these demographic changes affect the career aspirations of dental students and if DPM is perceived to be relevant and necessary as a major subject in the undergraduate dental curriculum. This study sought to investigate students' perceptions regarding the need for DPM as a subject in the undergraduate dental curriculum at the University of Pretoria and to relate these perceptions to their future career aspirations. The study also aimed to identify perceptions of the students regarding the most important skills (other than clinical skills) they have to learn in the undergraduate dental curriculum. Methods A cross-sectional survey was conducted in 2012 by means of an anonymous questionnaire among second-, third-, fourth-and fifth-year dental students (N=228) at the

Research paper thumbnail of Self-regulation – the key to progress in clinical reasoning?

African Journal of Health Professions Education, 2015

In 2009 the School of Dentistry, University of Pretoria, South Africa implemented a novel integra... more In 2009 the School of Dentistry, University of Pretoria, South Africa implemented a novel integrated case-based approach during the third (preclinical) year of the undergraduate dental curriculum in a subject called Comprehensive Patient Care (CPC). [1-4] The purpose was to scaffold the transfer from the preclinical year to clinical teaching and learning. [5] The case-based intervention was adopted in pursuit of relevance [5-7] and integration [8] through active learning [9] and problem-solving approaches [2,10]. in the undergraduate dental curriculum. [3] The novel intervention aimed to improve the assessment of clinical reasoning [11,12] and the provision of formative feedback during the teaching, learning and assessment processes. [5,12] Teaching and learning in the third year of study were designed to focus on tracer conditions (common oral diseases or conditions) [5,13,14] and were generally administered through scaffolded simulation activities. [5] The assessment plan included a test on the completion of patient administration forms used in the School. This was followed by three communication role-play exercises, simulating the communication during a clinical encounter [15,16] based on context-rich case studies, and a comprehensive clinical examination on a peer. The formative assessment contained 5 integrated clinical reasoning portfolio case-study exercises that simulate typical clinical cases dental students would encounter in their fourth year of study. These exercises included diagnostic and treatment planning decisions and required descriptions of the student's reasoning. The final assessment comprised a progress test containing 32 multiple-choice questions (MCQs) based on a context-rich integrated case study covering the selected tracer conditions and formulated to test the ability of the students to diagnose and make decisions with regard to treatment planning. Students wrote the same test at the end of the third, fourth and fifth years of study to monitor their progress in their clinical decision-making ability. The progress test was the only standardised assessment entity that measured the outcome of clinical reasoning over time. The other assessments had a pertinent formative purpose and may have varied; they could therefore not be used to measure the development of clinical reasoning over a period of time. All of the abovementioned activities have been integrated into clinical teaching and learning in a clinical setting during the fourth and fifth years of study. The problem An analysis of progress test data for 2009-2011 showed that some students improved their progress test scores while some did not. It should be noted that the non-progression group included students who obtained high, moderate, as well as low scores at baseline. This observation led to the investigation of possible reasons for progression and non-progression in clinical reasoning decision-making. A literature review revealed that psychological attributes such as 'self-regulated' learning and 'self-handicapping' behaviours may influence the learning of individual students. The concept of self-regulated learning Self-regulated learning may be defined as a proactive way of acquiring knowledge, skills and competence. [17] Those who engage in self-regulated learning set goals for themselves, display strategic thinking, and monitor their own academic performance and effectiveness. This is in stark contrast to students who merely react to what the environment enforces on them. [17] Zimmerman and Campillo [18] adapted a model of self-regulated learning from a publication titled 'The nature of problem solving'. There is increasing empirical evidence to support the validity of the components of the model and the interactions. Fig. 1 demonstrates the three phases of the model. The forethought phase precedes the performance phase, which is followed by a self-reflection phase. Self-reflection is often followed by a new forethought stage for further or enhanced learning. [17] Background. In 2009 a new case-based instructional design was imple mented during the preclinical year of study of the undergraduate dental curriculum of the University of Pretoria, South Africa. The objective of the educational intervention was to improve the development of clinical reasoning skills. To achieve this, systematic scaffolding, relevance, integration and problem-solving were actively promoted as part of teaching and learning. A student's clinical reasoning was measured by a progress test containing 32 multiple choice questions (MCQs), formulated on a knowledgeapplication level. In 2011 it became clear that some students showed progression while others did not. Objectives. This study was conducted to gauge the value of the case-based intervention with the aim of determining the need for further scaffolding and support, especially for non-progressing students. Methods. The 2011 BChD IV cohort (N=48) was identified for the study. Two semi-structured focus group discussions were conducted. Group 1 (n=8) consisted of students who progressed ≥9%, while group 2 (n=8) comprised students who did not progress to the same extent. Results. Both groups lauded the scaffolding that the case-based curriculum provided. Strategic thinking, goal orientation and self-regulation ability were identified in group 1. A lack of diligence, poor data-processing ability and a possible lack of interest were identified in group 2 students, who were unaware of learning opportunities. Conclusion. There is a need for early identification of students lacking self-regulated learning and for providing timely feedback and support to progressively develop their clinical reasoning skills.

Research paper thumbnail of Students’ perceptions of vertical and horizontal integration in a discipline-based dental school

European Journal of Dental Education, 2016

Introduction: Integration is a key concern in discipline-based undergraduate dental curricula. Th... more Introduction: Integration is a key concern in discipline-based undergraduate dental curricula. Therefore, this study compared feedback on integration from students who participated in different instructional designs in a Comprehensive Patient Care course. Methods: The study was conducted at the University of Pretoria (2009-2011). Third year cohorts (Cohorts A, B and C) participated in preclinical case-based learning, while fourth year cohorts (Cohorts D and E) received didactic teaching in Comprehensive Patient Care. Cohorts A, D and E practiced clinical Comprehensive Patient Care in a discipline-based clinic. Cohort B conducted their Comprehensive Patient Care patient examinations in a dedicated facility supervised by dedicated faculty responsible to teach integration. Students had to indicate on visual analogue scales whether the way they were taught at the school helped them to integrate knowledge from the same [horizontal integration] and preceding [vertical integration] year of study. The end-points of the scales were defined as "definitely" and "not at all". Analysis of Variance (ANOVA) was employed to measure differences between cohorts according to year of study. Results: Third year case-based learning cohorts rated the horizontal integration close to 80/100 and vertical integration ranging from 64 to 71/100. In year four Cohort B rated vertical and horizontal integration 9-15% higher (ANOVA, P<0.05) than Cohorts A and D. In year five Cohort A rated vertical and horizontal integration 11-18% higher (ANOVA, P<0.05) than Cohorts D and E. 2 Conclusion: Preclinical case-based learning and Comprehensive Patient Care supervised by dedicated faculty were associated with more favourable perceptions about integration in the discipline-based undergraduate dental curriculum.

Research paper thumbnail of Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures

SA Orthopaedic Journal, 2018

Background: The Schatzker classification is the most widely accepted system used to classify tibi... more Background: The Schatzker classification is the most widely accepted system used to classify tibial plateau fractures. The presence of posteromedial fragments in the more severe fracture types is known, but the presence of posteromedial fragmentation in the less severe fracture types is unknown. The ability of the Schatzker classification to predict posteromedial fragmentation was evaluated. Methods: Two hundred patients were reviewed of which only 67 met the inclusion criteria. The X-rays were reviewed by three independent orthopaedic surgeons and classified according to the Schatzker classification. A radiologist reviewed the CT scans and noted the presence or absence of a posteromedial fragment and if present, the largest diameter of the fragment was measured. Results: The mean age of the sample was 44.79 (SD: 14.03) years. Seventy-five per cent of the females (n=33) presented with posteromedial fragmentation compared to 65.20% of the males (n=44) (chi²-test, P=0.399). The incidence of posteromedial fragmentation varied between 15.8 and 26.3% for Schatzker 1 and 2 fractures and 73.7 and 84.2% for Schatzker 3 to 6 (chi 2-test, p<0.001) based on the three independent assessments. The mean length of the posteromedial fragmentation ranged from 41.87 to 47.77 mm for Schatzker 1 and 2 fractures, and 44.74 to 46.12 mm for Schatzker 3 to 6 for the three assessors (statistically not significant [T-test, P=0.536, P=0.551 and P=0.652]). Conclusion: The Schatzker classification by itself is not adequate to identify all fractures with posteromedial fragmentation. There is a higher association of posteromedial fragmentation with fracture types 3 to 6. There is a high probability of missing a significantly sized posteromedial fragment in Schatzker type 1 and 2 fractures if a CT scan is not performed which might influence and compromise fracture stability, joint congruency and the ability to rehabilitate optimally.

Research paper thumbnail of Second-year dental students’ perceptions about a joint basic science curriculum

African Journal of Health Professions Education, 2015

Globally, medical and dental university students share basic science curricula, [1-6] promoting c... more Globally, medical and dental university students share basic science curricula, [1-6] promoting cost-effectiveness of student training. [7] This strategy ensures that dental students develop a solid medical background. The approach has historical roots, [8] and remains a current teaching and learning requirement for a dentist. [9] The University of Pretoria, South Africa (SA) utilised a joint basic science curriculum for first-and second-year medical and dental students from the late 1940s to 2014. A recent article by Ajjawi et al. [1] identified the marginalisation of dental students in a combined medical curriculum at a university in Australia. Similarly, a US study showed that dental students felt like 'second-class citizens' in their joint curriculum and that its relevance was based on the needs of the medical student; it also contained too much irrelevant information from a dental perspective. [3] Ajjawi et al. [1] suggest that prejudice and stereotyping may be prevalent in joint basic science curricula. These factors may possibly be present from a social and psychological perspective, [10] when two distinct groups have to interact in a joint curriculum. Medical and dental students sharing a joint curriculum may therefore pose undesired risks with regard to student learning. [1] Despite the identification of these problems, no studies or reports could be traced in the literature that describe how such problems are actively being addressed in terms of medical and dental students. There are no studies in SA that investigate dental students' perceptions of their social and peer relationships with medical students in a shared medical curriculum. With the marginalisation of dental students being reported elsewhere, [1] one should investigate this issue in SA. Further evidence in this regard may indicate the need to reconsider the use and management of generic joint programmes locally in terms of the effect on learning and interprofessional collaboration. Based on this assessment, our study investigated whether dental students at the University of Pretoria perceive the joint curriculum to be relevant and useful and if marginalisation is prevalent.

Research paper thumbnail of Retention of Self-etching versus Conventional Sealants in a Community-based Project

Objective: The objective of this study was to compare the retention rate of a self-etching sealan... more Objective: The objective of this study was to compare the retention rate of a self-etching sealant with a conventional fissure sealant in a community-based project. Methods: The sample comprised 26 children of the Boschkop Primary School between the ages 10 and 14 years. Of these children, 140 posterior permanent teeth, which satisfy the criteria for fissure sealant placement, were sealed. A split mouth technique, where the two techniques were randomly allocated to either the right or the left side of the mouth was used. On the one side, a self-etching light cured fissure sealant, Prevent Seal (Itena, Paris, France) was used and on the other side, a conventional light-cured fissure sealant UltraSeal XT plus (Ultra Dent Products, Utah USA) was used. Trained final year oral hygiene students placed the fissure sealants and for both materials the manufacturers' instructions were followed. Moisture control was obtained using cotton rolls and suction. At the follow-up visits after one...

Research paper thumbnail of Dental Caries Experience of Children in the North West Province

Objective: The purpose of this study was to determine trends in dental caries experience of child... more Objective: The purpose of this study was to determine trends in dental caries experience of children in the North West Province (NWP) of South Africa (SA). Method: A two-staged cluster sampling technique was used to select 2900 children randomly from children in the age groups 4-5-, 6-, 12- and 15 years in the Province. WHO methods were used for the collection of data. Prior to the survey all examiners were trained and calibrated. Consent to conduct the survey was obtained from the relevant authorities. Results: When comparing the 1999-2002 survey with the 2008-2010 survey, the results show a significant increase (p<0.05) in caries severity in the primary dentition from 1.62 and 2.22 to 2.28 and 2.65 for 4-5- and 6-year-olds respectively. Significant decreases (p<0.05) in caries severity in the permanent dentition 0.79 to 0.47 and 1.42 to 1.10 were observed for 12- and 15-year-olds respectively. Analysis of the data for the 15 year-old group show that caries is more prevalent ...

Research paper thumbnail of On being self-ish, self-less or well-balanced (other-ish), and how this may relate to practicing dentistry

South African Dental Journal, Oct 10, 2022

It has been said that people are driven by either selfinterest or caring for others. In extreme c... more It has been said that people are driven by either selfinterest or caring for others. In extreme cases, the former selfishly seek self-fulfilment, often at the expense of others, while the latter selflessly and altruistically strive to please others, many times with personal costs. This paper will explore the issues of selfish versus selfless behaviour with regard to the practice of dentistry, and offers dialogue on how practitioners could pursue a more balanced option that will serve the best interest of both parties.

Research paper thumbnail of Buccal and palatal alveolar bone dimensions in the anterior maxilla: A micro‐CT study

Clinical Implant Dentistry and Related Research

Research paper thumbnail of Outsmarting COVID-19 through rapid 3D printing and flipped learning in fixed prosthodontics

African Journal of Health Professions Education, 2021

This paper describes the transformation of pre-Covid 19 educational practices in Fixed Prosthodon... more This paper describes the transformation of pre-Covid 19 educational practices in Fixed Prosthodontics at the School of Dentistry, University of Pretoria. The sudden need for social distancing limited access to the main preclinical skills laboratory, which was overcome by 3D-printed phantom heads that were rapidly produced by the Central University of Technology. This allowed preclinical training to continue in clinical spaces. The educational philosophy also had to be adjusted because contact time became limited. The traditional lecturer-centered approach followed (lectures, notes, demonstrations, practicals and log books) was transformed to a student-centered approach through the production of high quality audio-visual material that allowed students to prepare for practicals in advance. These materials provided learner support at chairside on computer screens and mobile devices and facilitated self-directed learning. Students were formatively assessed using a chairside computer sys...

Research paper thumbnail of The 'Digital Access Divide' at a South African Dental School - A cross-sectional study - Part 1

South African Dental Journal, 2020

This study sought to investigate the digital divide, from an access perspective, of dental studen... more This study sought to investigate the digital divide, from an access perspective, of dental students at the University of Pretoria. Second to final year students (n= 218 (87.2% response rate) completed a custom-designed survey at the end of 2017. The investigation enquired about the digital devices and infra-structure they owned and used for study purposes. They were also asked to reveal the networks and resources they used to access online platforms and to comment on any other related access issues such as the quality of the Internet, speed and reliability, as well as cost and personal implications related to usage. A clear divide could be detected for a minority of students (±1/7). Individually targeted interventions will be required to ensure an equitable and fair online learning experience.

Research paper thumbnail of Dental students' self-perceived competency and usage of the internet for learning and evaluation purposes - Part 2

South African Dental Journal, 2020

Many dental lecturers are moving away from providing hand-out notes to their students and are rat... more Many dental lecturers are moving away from providing hand-out notes to their students and are rather opting for posting lecture material and tutorials on the internet using the various university platforms such as clickUP. At the same time a number of students have queried the need to purchase the prescribed text books due to their high costs, and dated content. The presumption is that all students have unrestricted and equal access to this material, and are competent using digital technology for learning and assessment, however there has been no formal investigation into whether this is so. Student access and usage was reported on in Part I of this study. The present paper investigated students' preferences with regards to the mode of learning material, and their self-perceived competencies in using the internet for various academic purposes. The project took the form of an anonymous, structured questionnaire that was given to all dental students from the second to the fifth ye...

Research paper thumbnail of The capacity of the Oral Health Centre, University of Pretoria, to complete root canal treatments

South African Dental Journal, 2016

Introduction: The University of Pretoria Oral Health Centre (UPOHC) is inundated by patients pres... more Introduction: The University of Pretoria Oral Health Centre (UPOHC) is inundated by patients presenting with toothache, many requiring emergency pulpectomies (EPs). To date, the outcome of these procedures performed at this academic/public health facility, remains unknown. Aims and objectives: To determine the completion rate of treatment of teeth that had received EPs at the UPOHC. Study design: A retrospective survey of data obtained from electronic and paper records of 498 randomly selected teeth from the 1050 that had undergone EPs between 1 July 2012 and 30 June 2013 at the UPOHC, followed to 30 June 2014. Methods: The outcome of treatment was recorded as "no treatment after initial pulpectomy", "pulpectomy repeated", "tooth was removed" or "root canal treatment (RCT) was completed by student or dentist". Results: Of the 498 teeth included, 224 (44.98%) were obturated, 35 (7.03%) were retreated, forty two (8.43%) teeth were referred for e...

Research paper thumbnail of Dentistry in South Africa and the need for management and leadership training

South African Dental Journal, 2021

Dental professionals face many challenges due to a rapidly changing environment, and are acknowle... more Dental professionals face many challenges due to a rapidly changing environment, and are acknowledging the need for essential leadership skills to perform optimally. We assessed key stakeholders’ views about the need for management and leadership training in dentistry in South Africa . The aim of this study, was to assess the need for leadership and management training in Dentistry in South Africa from an industry perspective. A qualitative study. Purposive sampling of 14 Senior Managers in the dental environment and 11 recently qualified dentists in South Africa. We conducted one-on-one and telephonic interviews guided by a semi-structured questionnaire with open-ended questions. Interviews were recorded, transcribed and data was thematically analysed. Participants expressed concerns about dentistry in South Africa. All participants mentioned financial constraints, including the high cost of setting up a practice, high cost of imported consumables and dwindling support from medical...

Research paper thumbnail of South African Dental Students’ Perceptions of Most Important Nonclinical Skills According to Medical Leadership Competency Framework

Journal of Dental Education, 2016

Recent developmental frameworks suggest that dental curricula should focus on developing nonclini... more Recent developmental frameworks suggest that dental curricula should focus on developing nonclinical skills in dental students. The aim of this study was to qualitatively map students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of the most important nonclinical skills against the Medical Leadership Competency Framework (MLCF). A representative sample of second- to fifth-year students (n=594; overall response rate 69%) from all four dental schools in South Africa participated in a cross-sectional survey in 2014-15 enquiring about nonclinical skills and dental practice management. One of the questions required students to list the four most important nonclinical skills required for a dentist. Students (n=541) most frequently noted competencies related to working with others (97.9%), personal qualities (72.3%), and managing services (42.9%) as the most important nonclinical skills. Very few students mentioned competencies related to the improvement of services (14.1%) and the provision of strategic direction (10.9%). The students&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; attention appeared to be on nonclinical skills generally required for clinical care with some realization of the importance of managing services, indicating a need for a stronger focus on leadership and management training in dental schools in South Africa. The results also helped to unravel some of the conceptual ambiguity of the MLCF and highlight opportunities for leadership research using the MLCF as a conceptual framework.

Research paper thumbnail of The prevalence of second canals in the mesiobuccal root of maxillary molars: A cone beam computed tomography study

Australian Endodontic Journal, 2018

I, Nelson Alexander Fernandes, hereby declare that this dissertation, submitted in partial fulfil... more I, Nelson Alexander Fernandes, hereby declare that this dissertation, submitted in partial fulfilment of the requirements for the degree of MChD (Prosthodontics) at the University of Pretoria, has not previously been submitted for a degree at any other University.

Research paper thumbnail of The influence of storage media on early osseointegration of titanium implants

Journal of Dental Implants, 2016

Introduction: Marketing of implants stored in different media other than air could improve implan... more Introduction: Marketing of implants stored in different media other than air could improve implant wettability resulting in a favorable implant bone interface with subsequent optimized early osseointegration. The effect that the different storage media, such as saline, air and argon, have on the early osseointegration of plasma treated, titanium dental implants was investigated and was compared to conventional implants stored in air, in an ovine pelvis model. 96 implants were inserted in the iliac crests of four sheep and tested for osseointegration by comparing insertion torque values and removal torque values at 4 and 6 weeks postinsertion. Twelve implants were inserted in each ovine iliac crest (24 per sheep representing six implants from each experimental group). Saline demonstrated the highest increase in torque values with argon demonstrating a linear decrease. The average percentage gain for each of the storage media at 4 weeks were plasma/air = +2%, plasma/saline = +30.4%, air = +9.6% and plasma/argon = −30.4%. The results were only statistically significant for the saline group at 4 weeks and the argon group at 2 weeks. All storage media demonstrated an initial decrease in torque value of 14.25% at 2 weeks before a strong rise in torque value could be observed. Saline as a storage media has great potential for improving early osseointegration. An interesting observation made was that the majority of the dental implants tend to demonstrate an initial decrease in osseointegration before demonstrating a strong rise in torque values. Further studies are recommended for the periods of 6 and 8 weeks after implant placement. Context: Research protocol. Aims: The purpose of the study was to compare the early osseointegration potential of plasma-enhanced implants stored in different storage mediums, to conventional implant stored in air. Settings and Design: The experiment consisted out of a comparative in vivo pilot study in which the early osseointegration potential of implants stored in four different storage media was compared. These implants were inserted in the iliac crest of four sheep, and the degree of osseointegration of the different groups was compared at 2 and 4 weeks after insertion. The osseointegration potential of the implants was evaluated by measuring and documenting the insertion torque and comparing it to the removal torque values of each implant. Subjects and Methods: A total of 96 (n = 96) dental implants (3.75 mm in diameter and 10 mm in length), including 24 plasma-enhanced dental implants stored in air; 24 plasma-enhanced dental implants stored in argon; 24 plasma-enhanced dental implants stored in saline and 24 conventional dental implants stored in air; were inserted into the iliac crests of 4 sheep. The insertion torque values were measured and documented on insertion. Two sheep were euthanized after a period of 2 weeks postinsertion, and the maximum removal torque value of each implant was measured and documented. The remaining two sheep were euthanized at 4 weeks postinsertion and the maximum removal torque of each implant measured and documented. The torque values measured on insertion, after 2 weeks, and after 4 weeks postinsertion were then compared and used to determine the level of osseointegration as well as the potential for further osseointegration. Statistical Analysis Used: Comparative graphical analysis was performed. Significance was determinant at P < 0.05. Results: Saline demonstrated the highest increase in torque values with argon demonstrating a linear decrease. The average percentage gain for each of the storage media at 4 weeks were plasma/air = +2%, plasma/saline = +30.4%, air= +9.6%, and plasma/argon = −30.4%. The results were only statistically significant for the saline group at 4 weeks and the air group at 2 weeks. All storage media demonstrated an initial decrease in torque value of 14.25% at 2 weeks before a strong rise in torque value could be observed. Conclusion: Saline as a storage media has great potential for improving early osseointegration. The majority of the dental implants tend to demonstrate an initial decrease in osseointegration before demonstrating a strong rise in torque values. Further studies are recommended for periods of 6 and 8 weeks after implant placement.

Research paper thumbnail of Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence

European Journal of Dental Education, 2015

Introduction: This study provides empirical evidence of the development of integrated clinical re... more Introduction: This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the fourcomponent instructional design model for complex learning. Methods: Progress test scores of third-to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth-and fifth-year cohorts. These fourth-and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions. Results: Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions. Conclusion: The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.

Research paper thumbnail of Socio-demographic and academic correlates of clinical reasoning in a dental school in South Africa

European Journal of Dental Education, 2015

Introduction: There are no empirical studies that describe factors that may influence the develop... more Introduction: There are no empirical studies that describe factors that may influence the development of integrated clinical reasoning skills in dental education. Hence this study examines the association between outcomes of clinical reasoning in relation to differences in instructional design and student factors. Materials and Methods: Progress test scores, including diagnostic and treatment planning scores, of fourth and fifth year dental students (2009-2011) at the University of Pretoria, South Africa served as the outcome measures in stepwise linear regression analyses. These scores were correlated with the instructional design (lecture-based teaching and learning (LBTL=0) or case-based teaching and learning (CBTL=1), students' grades in Oral Biology, indicators of socioeconomic status (SES) and gender. Results: CBTL showed an independent association with progress test scores. Oral Biology scores correlated with diagnostic component scores. Diagnostic component scores correlated with treatment planning scores in the fourth year of study but not in the fifth year of study. "SES" correlated with progress test scores in year five only, while gender showed no correlation. 2 Conclusion: The empirical evidence gathered in this study provides support for scaffolded inductive teaching and learning methods to develop clinical reasoning skills. Knowledge in Oral Biology and reading skills may be important attributes to develop to ensure that students are able to reason accurately in a clinical setting.

Research paper thumbnail of Developing students’ clinical reasoning skills: correlates of perceived relevance of two teaching and learning approaches

European Journal of Dental Education, 2015

Introduction: "Relevance" is a key concept in adult learning. Hence this study sought to examine ... more Introduction: "Relevance" is a key concept in adult learning. Hence this study sought to examine students" perceptions of relevance of the teaching and learning in relation to different instructional designs employed in a Comprehensive Patient Care (CPC) course that aims to develop integrated clinical reasoning skills. Methods: Third to fifth year students (2009-2011) were asked to anonymously rate the relevance of the CPC instructional design (RELID) they participated in by means of visual analogue scales at the School of Dentistry, University of Pretoria. They were also asked to rate their perceptions of the alignment between teaching and learning and outcomes (ATLO), assessments" contribution to learning (ACL), course organisation (CO) and lecturer competence (LC). RELID served as the outcome measure in stepwise linear regression analyses. ATLO, ACL, CO, LC and the instructional design (case-based learning (CBL)=1 and discipline-orientated lecture-1 based teaching (DOLBT)=0) served as the co-variables for each of the years of study. Results: The analysis showed positive correlations between RELID and ATLO and between RELID and ACL for all the years of study. RELID was associated with LC in year three and four and CO was associated with RELID in year four and five. CBL outperformed DOLBT in terms of perceived relevance of the teaching and learning. Conclusion: The results suggest that there are correlations between RELID and indicators of constructive alignment, LC and CO. The teacher"s philosophy appears to have a distinct influence on students" perceptions of the relevance of teaching and learning.

Research paper thumbnail of Dental students’ perceptions of practice management and their career aspirations

African Journal of Health Professions Education, 2015

The inclusion of 'management' competencies in medical curricula is widely propagated. [1-3] Partl... more The inclusion of 'management' competencies in medical curricula is widely propagated. [1-3] Partly based on this requirement, Dental Practice Management (DPM) is part of the undergraduate curriculum in the School of Dentistry, University of Pretoria, South Africa (SA). In recent years, DPM has been presented in the fourth and fifth years of study and can be considered a major study unit in the undergraduate dental curriculum. Teaching and learning in DPM typically include leadership, strategic management, financial management, personnel management, patient management, dentist-patient communication and marketing. [4] To date, from a student perspective, no information is available regarding the need for DPM as a subject in undergraduate dental curricula in SA. There is, however, some evidence in the literature that undergraduate dental students do not regard the development of management skills to be as important as the attainment of clinical skills. [5] DPM is likely to be relevant to those who aspire to become dental practice owners or managers in the private or public sector. It is debatable whether extensive teaching and learning in DPM will be perceived to be relevant by those who aspire to follow a career as employees only. The literature shows that the majority of dental graduates in SA aspire to enter private practice. [6] These trends may, however, be affected by the transformation in dental education during the past two decades. During this time, the profile of dental students changed from being male dominated to female dominated. [6] Furthermore, social redress in correcting racial profiles at universities is actively being pursued. [6] It would therefore be valuable to investigate whether these demographic changes affect the career aspirations of dental students and if DPM is perceived to be relevant and necessary as a major subject in the undergraduate dental curriculum. This study sought to investigate students' perceptions regarding the need for DPM as a subject in the undergraduate dental curriculum at the University of Pretoria and to relate these perceptions to their future career aspirations. The study also aimed to identify perceptions of the students regarding the most important skills (other than clinical skills) they have to learn in the undergraduate dental curriculum. Methods A cross-sectional survey was conducted in 2012 by means of an anonymous questionnaire among second-, third-, fourth-and fifth-year dental students (N=228) at the

Research paper thumbnail of Self-regulation – the key to progress in clinical reasoning?

African Journal of Health Professions Education, 2015

In 2009 the School of Dentistry, University of Pretoria, South Africa implemented a novel integra... more In 2009 the School of Dentistry, University of Pretoria, South Africa implemented a novel integrated case-based approach during the third (preclinical) year of the undergraduate dental curriculum in a subject called Comprehensive Patient Care (CPC). [1-4] The purpose was to scaffold the transfer from the preclinical year to clinical teaching and learning. [5] The case-based intervention was adopted in pursuit of relevance [5-7] and integration [8] through active learning [9] and problem-solving approaches [2,10]. in the undergraduate dental curriculum. [3] The novel intervention aimed to improve the assessment of clinical reasoning [11,12] and the provision of formative feedback during the teaching, learning and assessment processes. [5,12] Teaching and learning in the third year of study were designed to focus on tracer conditions (common oral diseases or conditions) [5,13,14] and were generally administered through scaffolded simulation activities. [5] The assessment plan included a test on the completion of patient administration forms used in the School. This was followed by three communication role-play exercises, simulating the communication during a clinical encounter [15,16] based on context-rich case studies, and a comprehensive clinical examination on a peer. The formative assessment contained 5 integrated clinical reasoning portfolio case-study exercises that simulate typical clinical cases dental students would encounter in their fourth year of study. These exercises included diagnostic and treatment planning decisions and required descriptions of the student's reasoning. The final assessment comprised a progress test containing 32 multiple-choice questions (MCQs) based on a context-rich integrated case study covering the selected tracer conditions and formulated to test the ability of the students to diagnose and make decisions with regard to treatment planning. Students wrote the same test at the end of the third, fourth and fifth years of study to monitor their progress in their clinical decision-making ability. The progress test was the only standardised assessment entity that measured the outcome of clinical reasoning over time. The other assessments had a pertinent formative purpose and may have varied; they could therefore not be used to measure the development of clinical reasoning over a period of time. All of the abovementioned activities have been integrated into clinical teaching and learning in a clinical setting during the fourth and fifth years of study. The problem An analysis of progress test data for 2009-2011 showed that some students improved their progress test scores while some did not. It should be noted that the non-progression group included students who obtained high, moderate, as well as low scores at baseline. This observation led to the investigation of possible reasons for progression and non-progression in clinical reasoning decision-making. A literature review revealed that psychological attributes such as 'self-regulated' learning and 'self-handicapping' behaviours may influence the learning of individual students. The concept of self-regulated learning Self-regulated learning may be defined as a proactive way of acquiring knowledge, skills and competence. [17] Those who engage in self-regulated learning set goals for themselves, display strategic thinking, and monitor their own academic performance and effectiveness. This is in stark contrast to students who merely react to what the environment enforces on them. [17] Zimmerman and Campillo [18] adapted a model of self-regulated learning from a publication titled 'The nature of problem solving'. There is increasing empirical evidence to support the validity of the components of the model and the interactions. Fig. 1 demonstrates the three phases of the model. The forethought phase precedes the performance phase, which is followed by a self-reflection phase. Self-reflection is often followed by a new forethought stage for further or enhanced learning. [17] Background. In 2009 a new case-based instructional design was imple mented during the preclinical year of study of the undergraduate dental curriculum of the University of Pretoria, South Africa. The objective of the educational intervention was to improve the development of clinical reasoning skills. To achieve this, systematic scaffolding, relevance, integration and problem-solving were actively promoted as part of teaching and learning. A student's clinical reasoning was measured by a progress test containing 32 multiple choice questions (MCQs), formulated on a knowledgeapplication level. In 2011 it became clear that some students showed progression while others did not. Objectives. This study was conducted to gauge the value of the case-based intervention with the aim of determining the need for further scaffolding and support, especially for non-progressing students. Methods. The 2011 BChD IV cohort (N=48) was identified for the study. Two semi-structured focus group discussions were conducted. Group 1 (n=8) consisted of students who progressed ≥9%, while group 2 (n=8) comprised students who did not progress to the same extent. Results. Both groups lauded the scaffolding that the case-based curriculum provided. Strategic thinking, goal orientation and self-regulation ability were identified in group 1. A lack of diligence, poor data-processing ability and a possible lack of interest were identified in group 2 students, who were unaware of learning opportunities. Conclusion. There is a need for early identification of students lacking self-regulated learning and for providing timely feedback and support to progressively develop their clinical reasoning skills.

Research paper thumbnail of Students’ perceptions of vertical and horizontal integration in a discipline-based dental school

European Journal of Dental Education, 2016

Introduction: Integration is a key concern in discipline-based undergraduate dental curricula. Th... more Introduction: Integration is a key concern in discipline-based undergraduate dental curricula. Therefore, this study compared feedback on integration from students who participated in different instructional designs in a Comprehensive Patient Care course. Methods: The study was conducted at the University of Pretoria (2009-2011). Third year cohorts (Cohorts A, B and C) participated in preclinical case-based learning, while fourth year cohorts (Cohorts D and E) received didactic teaching in Comprehensive Patient Care. Cohorts A, D and E practiced clinical Comprehensive Patient Care in a discipline-based clinic. Cohort B conducted their Comprehensive Patient Care patient examinations in a dedicated facility supervised by dedicated faculty responsible to teach integration. Students had to indicate on visual analogue scales whether the way they were taught at the school helped them to integrate knowledge from the same [horizontal integration] and preceding [vertical integration] year of study. The end-points of the scales were defined as "definitely" and "not at all". Analysis of Variance (ANOVA) was employed to measure differences between cohorts according to year of study. Results: Third year case-based learning cohorts rated the horizontal integration close to 80/100 and vertical integration ranging from 64 to 71/100. In year four Cohort B rated vertical and horizontal integration 9-15% higher (ANOVA, P<0.05) than Cohorts A and D. In year five Cohort A rated vertical and horizontal integration 11-18% higher (ANOVA, P<0.05) than Cohorts D and E. 2 Conclusion: Preclinical case-based learning and Comprehensive Patient Care supervised by dedicated faculty were associated with more favourable perceptions about integration in the discipline-based undergraduate dental curriculum.