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Purpose/objectives To investigate dental students’ perceptions and concerns regarding the COVID‐19 pandemic, their coping strategies and support resources, and their perceived stress levels. Methods A customized 19‐item survey and the perceived stress scale (PSS) were applied to undergraduate dental students from the US, Spain, Ireland, Chile, India, and Brazil between April 10 and July 5, 2020. Linear modeling and mediation analysis were used to explore the relationships among demographics, stressors, coping mechanisms, social support, and stress Results A total of 4475 students responded to the survey. The majority (72.4%) were women, and 52.3% had no COVID‐19 training at the time of the survey. The students reported that they had to accommodate to changes in patient care (96.6%) and didactic learning (95.2%) activities, while 88.5% of the respondents indicated at least one of their courses moved online. Transition to online courses went “smoothly with some troubles” for 51.8% of the respondents, and 48.3% perceived the faculty as prepared for the online transition; however, 45.9% reported feeling extremely concerned about the impact of COVID‐19 on their education. The average PSS score was 21.9 of 40 (moderate stress). Multivariate models were built for participants with full data (n = 3899). Being male, having completed more dental coursework, and perceiving a smoother transition were associated with lower PSS scores; more concern about academic progress was associated with higher PSS. Faculty support mediated the relationship between a smoothness of transition and concern about academic progress and PSS scores Conclusion Stress caused by the pandemic may be alleviated by smoother transition and good faculty support.

Purpose/objectives The aim for this study was to identify important factors influencing patient satisfaction in a university dental clinic, through qualitative analysis. Methods From June 1, 2014 to January 30, 2018, 7827 patient satisfaction surveys were collected. A thematic analysis was conducted on the 10,956 patient responses to 3 open-ended questions. A thematic coding dictionary was inductively developed using thematic analysis managed with MAXQDA 2018 Standard, a qualitative data management software program. Results The thematic dictionary included 12 categories, developed from 48 working codes, and enabled the patient annotations to be grouped and sorted based on common themes to highlight significant aspects of the patient experience. Four notable themes that emerged from patient comments include: (1) satisfaction with the emotional care felt during their appointments; (2) satisfaction with skills and treatment provided and the connections made with various personnel; (3) the importance of establishing and maintaining patient expectations throughout their care; and (4) the high value patients place on clear communication with the patient, as well as the communication between departments, dental student and faculty, providers, and front desk. Conclusion The results of this study highlight 12 key themes related to the patient experience at the College of Dentistry from the patients' perspective. These data provide insight into aspects of the dental experience that have a large effect on patient satisfaction. With this knowledge, steps can be taken to enhance the patient experience and, therefore, help dental schools move further in the direction of person-centered care.

Purpose/objectives Silver diamine fluoride (SDF) is a promising therapy for arresting and preventing caries in difficult to treat, high-risk populations, including institutionalized older adults. This study investigates the knowledge and perceptions about SDF of graduating dental students in multiple U.S. dental schools, as well as their willingness to use SDF in their practices. Methods A survey was designed consisting of 21 total questions: 6 questions regarding students' demographic information and their SDF content exposure contextualization, 8 questions tailored to investigate 2 domains regarding students' knowledge about SDF (properties and indication), and 7 questions aiming to investigate 3 domains regarding students' perceptions about SDF (SDF usefulness, appropriateness of using SDF, and willingness to use SDF when in private practice). The survey was then distributed to graduating dental students at 7 U.S. dental schools. Results A total of 386 surveys (response rate of 55%) was collected from 7 schools in the Spring of 2019. The median score resulting from the SDF content exposure questions was 3 (SD = 1.43) from a range of 0-5. The median score from knowledge about SDF properties was 4 (SD = 1.18) from a range of 0 to 6. In the multivariate analysis, a linear model found that the covariates "SDF Usefulness", "SDF Appropriateness" and "SDF Patient Willingness to Use" were significantly associated with higher student willingness to use SDF (R2 = 0.395). Conclusion The results indicated that the graduating students have a positive perception of SDF regarding its usefulness and appropriateness. Graduating students appear inclined to utilize SDF upon entering private practice.

PURPOSES/OBJECTIVES Few tools assess the dental school clinical learning environment from students' perspectives. Considering previous efforts to validate the Dental Education Clinical Learning Instrument (DECLEI) in the United States, the goal of this study was to look for the fewest number of items that accounted for the most amount of variability in responses and/or had the highest correlation to the total DECLEI score using a larger, multi-center sample. METHODS The DECLEI was distributed to 286 students in two dental schools (University of Iowa and University of Texas at Houston) during the 2017-2018 academic year. Two alternative methods were applied. In the first approach, all 24-items were regressed on the total composite score using a forward conditional method. In the second approach, the item-total correlation for the full scale was calculated and then items with relatively poor coefficients were eliminated. A cutoff of 0.30 or less was used. RESULTS The first approach, Total R2 by Regression Model, produced a 9-item scale accounting for 90% of the variance in total score and a Cronbach's α coefficient of 0.79. The second approach, Item-Total Correlation, produced a larger scale (20 items), as well as a higher Cronbach's α coefficient of 0.89. The instrument also presented appropriate sensitivity to measure differences between race groups and school of origin. CONCLUSION DECLEI may have the potential to be used as an instrument to measure clinical learning environments for U.S. dental students using either a smaller, concise scale (Mini DECLEI-USA) or a larger (DECLEI-USA), more thorough scale.

The aims of this study were to assess the perceptions of dental students, faculty members, and patients about the benefits and pitfalls of intraoral camera use and to compare the completion rate of treatment planned posterior crowns with and without intraoral camera use in a predoctoral dental clinic. From July 2016 to June 2017, all 60 fourth-year dental students at one U.S. dental school were encouraged to use the intraoral camera in treatment planning with patients in the school clinic. Perceptions of the students, their patients, and the faculty members supervising the treatment planning were assessed with a survey at the end of the treatment planning appointment. The completion rate of treatment planned posterior crowns was determined by recalling all posterior teeth that were treatment planned for a single unit crown at a specific period of time compared to the number of the same crowns completed for the same patients at a specific period of time, using the electronic health record, with and without camera use. Of the 60 students, 51 completed 198 surveys (85% response rate); 35 faculty members completed 64 surveys, and 202 patients completed one survey each (response rates for those groups could not be calculated). The survey results suggested that the students, faculty, and patients viewed intraoral camera use in a positive way. However, faculty perceptions were a little lower than those of patients and students, and a significant number of faculty members were neutral. The completion rate of posterior planned crowns was significantly higher (p=0.0005) when intraoral cameras were used to present images to patients than when cameras were not used. In this study, intraoral camera use in a predoctoral clinic was perceived positively by students and patients but more neutrally by faculty, and it increased the completion rate of planned posterior crowns.

Global disruptions caused by coronavirus disease 2019 (COVID‐19) affects all walks of life, and dentistry and dental education are no exceptions. Dental education uniquely blends didactic courses and hands‐on clinical training seamlessly to prepare oral healthcare providers of the future. Apart from economical and access to care implications, closure of all the dental institutions in the United States affects their educational mission greatly, equally disturbing pre‐doctoral and graduate training. Efforts are ongoing to continue the educational mission in dental institutions by delivering scheduled course content remotely using multiple online tools. In spite of those efforts, since clinical experiences cannot be completely replaced by any available alternative method of instruction that is delivered remotely, students are missing out on valuable patient‐based clinical experiences. In this perspective article, we briefly discuss the several implications of COVID‐19, in the context of dental education. We then highlight some of the lessons we can learn from this pandemic which we hope will have several positive implications, including curricular changes, increased public health awareness and preparedness for future public health emergencies.

The aim of this study was to develop and evaluate a learning strategy using critical thinking to teach dental students how to assess the risk of rapid oral health deterioration (ROHD) among elderly patients. A learning guide was developed using risk factors identified in the literature and the steps that expert faculty members apply in their clinical decision making, summarized in a set of ten steps. A new system of labeling risk was developed for the elderly population, which correlates the level of risk with the amount of disease. Participants in the study were all 91 fourth-year dental students in two subsequent classes who took part in a five-week Geriatrics and Special Needs Clinic rotation in the spring of 2015 and 2016. The students were introduced to the ROHD concept and asked to use the guide in a presentation during their rotation. The students were graded on an A, G, or M scale (Applied concept, Grasped and applied concept, or Missed application of concept). Students were also asked to assess their learning experience, and their answers were thematically grouped and analyzed. For eight of the ten steps, at least 93% of the students were graded A or G. The exceptions were the steps about developing a communications plan, which was missed by 23.1%, and self-assessment, which was missed by 30.8%. Interexaminer agreement on students' applying (A + G grades) versus missing the step was moderate or high on six of ten items. Nearly all the students (98.7%) considered assessing the risk of ROHD an important or very important skill. In this study, a learning strategy to teach dental students how to assess the risk of ROHD among elderly patients was developed and successfully implemented.

Research on dental students' perceptions of clinical learning environments is needed to identify strengths, weaknesses, and need for interventions to sustain high-quality dental education, but a primary challenge has been the absence of an instrument designed to assess these perceptions. The Dental Clinical Learning Environment Instrument (DECLEI) is a new instrument developed specifically for dental clinical learning environments according to psychometric standards and validated in Europe. The aim of this study was to perform a preliminary validation of DECLEI in a U.S. dental school, thus providing data for subsequent validation in a larger, multi-institution sample. After five experienced faculty members assessed DECLEI's item relevance and content validity, the instrument was distributed in 2016 to 144 third- and fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. All 144 questionnaires were completed (100% response rate). The results were tabulated and submitted to principal component analysis with an orthogonal rotation to assess internal structure of the measure. Internal consistency reliability was assessed using Cronbach's alpha coefficient and corrected item-total correlations. The results showed that, of the initial 24 items, principal component analysis allowed 18 items grouped in five domains: student-faculty interaction, equipment and patient issues, didactic-clinical components interaction, negative perceptions, and self-assessment. The Cronbach's alpha coefficients for these five domains ranged from 0.52 to 0.80. These results suggest that DECLEI has the potential for use as a reliable instrument to assess students' perceptions of clinical learning environments at U.S. dental schools, thus supporting the need for a definitive validation analysis in a larger sample.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.