Endodontist

The institutional research board of the Academic Centre for Dentistry Amsterdam approved the research protocol on 16 November 2012.
Former module of clinical training started with a preclinical training where students performed root canal treatments in extracted teeth. This training was basically on a tooth level, and the actual situation with a patient was not well simulated. This module proceeded with students performing root canal treatments on patients under supervision of the general dental practitioners. As a requirement for graduation, students had to perform several root canal treatments, including at least one in a molar, and had to pass a summative assessment. This former module of assessment comprised performing a root canal treatment in a premolar or a molar on a patient. During this summative assessment, students needed to demonstrate that they were able to perform root canal treatment of good quality without assistance of a supervisor.
Currently, in the revised clinical training module following the preclinical training, students proceed with a better simulated clinical training. This training comprises performing root canal treatments on extracted human teeth under conditions that closely mimic the actual situation with a patient: the teeth are mounted on an artificial jaw in a manikin head fixed to a dental chair in the clinic, and students have to act, and perform the treatment, as if it is a real patient. During this simulated component of the module, the students are supervised by endodontists. The revised module of assessment comprises a root canal treatment in a molar under the same strictly simulated conditions where the students demonstrate that they are able to perform root canal treatment of good quality without assistance of a supervisor. Passing this summative assessment is a requirement for students to be allowed to proceed to the last component of the revised clinical training module. In this component, unlike the former clinical training module, there are no minimum requirements regarding the number of root canal treatments performed on a patient before graduation. The students may graduate when they are considered well prepared for the task of a general dental practitioner. The preparedness for this task is assessed with the use of a formative assessment. The supervision component of the clinical training module has been revised as well. Currently, the students are supervised by general dental practitioners or by endodontists.
The number of tutorials in the revised theoretical training module has been increased. One extensive tutorial in the former module is replaced with trimester-long weekly tutorials guided by an endodontist. During those tutorials, various clinical cases, including the diagnoses, aetiology, prognoses, treatments and on-topic current endodontic literature, are discussed.
As a result of the implementation of the curricular changes, an intermediate cohort comprising students following the whole or a part of the former undergraduate endodontic programme and students following the whole or a part of the revised undergraduate endodontic programme had been formed. The students of this intermediate cohort, who differed in the combinations of modules and components they attended, were asked to volunteer in the present study in their final months prior to graduation. They were informed that the purpose of the present study was to evaluate the influence of teaching methods on their experience in endodontics, and that since their answers would be completely blinded, the researchers would be unable to link the data obtained to a specific student. Only after giving permission to use their data were students able to participate. Participation comprised filling out an online questionnaire that was composed for the present study.
Self-efficacy was assessed using the Dutch Adaptation of the General Self-Efficacy Scale (Bart Teeuw, Ralf Schwarzer & Matthias Jerusalem, Berlin, Germany, 1994), whose questions were adapted to endodontics. This adapted scale was named the ‘Endodontic General Self-Efficacy Scale’.
Self-perceived competence was assessed using a self-composed questionnaire, the English translation of which is shown in Table 1. To be consistent, for this ‘Endodontic Self-Perceived Competence Scale’, like the Endodontic General Self-Efficacy Scale, a four-point Likert-type format was used. Self-perceived competence was defined as the sum of the answers to questions 1 to 10.
Questionnaires are most effective if the separate questions of different questionnaires are mixed to form one combined questionnaire. The two questionnaires (i.e. the Endodontic General Self-Efficacy Scale and the Endodontic Self-Perceived Competence Scale) were, therefore, merged, and the separate questions of the scales randomly mixed to form one combined questionnaire. The online questionnaire contained this combined questionnaire and additional questions about the type of undergraduate endodontic programme the students followed. These questions concerned whether they attended the revised or former theoretical training modules, modules of assessment and clinical training modules as well as how many root canal treatments they performed on patients under supervision of the general dental practitioners and how many under supervision of the endodontists. It was assumed that the students answered the questions honestly.
All participants can be considered appropriately skilled in performing root canal treatment since they all succeeded in the summative assessment. Still, there might be differences in their performance. Therefore, two observers assessed the quality of the first root canal treatment the students performed on a patient, following succeeding in the summative assessment. This assessment was performed on a radiograph with the use of predetermined criteria. The quality of the treatment was evaluated per root canal, and it was scored as ‘good’ when it met the following criteria: root filling follows the natural root canal and is completely within the confines of the root (no extrusion); root filling ending not shorter than 0-2 mm from the apex; root filling appears well condensed on the periapical radiograph and no ledges, perforations, transportations or separated instruments are detectable on the periapical radiograph or reported in the chart. The quality of the root canal treatment under investigation was scored as ‘good’ when all the root canals of the corresponding tooth were scored as ‘good’. In case of disagreement between the observers, a discussion took place until a consensus was reached. To determine the intra-observer reliability, the assessment was repeated on onefourth of the sample a few months after the initial evaluation.