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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 144-148

Evaluation of the Perceived Confidence of Undergraduate Dental Students in Performing Endodontic Treatment


1 Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
2 Dental Students’ Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Dental Public Health, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Date of Submission23-Mar-2021
Date of Decision30-Mar-2021
Date of Acceptance06-Apr-2021
Date of Web Publication2-Nov-2021

Correspondence Address:
DDS, MS Masoud Saatchi
Department of Endodontics, Dental Research Center, Dental Research Institute, Isfahan University of Medical Sciences, Hezar-Jarib Ave., Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_32_21

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  Abstract 


Introduction: Dental students’ confidence is a crucial factor affecting the success of endodontic teaching. The aim of this study was to determine the dental students’ confidence level in performing endodontic treatment. Materials and Methods: A total of 150 dental students of Isfahan University of Medical Sciences participated in this descriptive study by census sampling. A self-administered questionnaire, including demographic data, endodontic experience, confidence in performing different stages of endodontic treatment, and suggestions for improving the quality of endodontic training, was distributed among the fourth to sixth year students. Data were analyzed with SPSS version 20.0 (IBM Corp., Armonk, New York, USA), using t test, ANOVA, and linear regression analysis (α = 0.05). Results: The response rate was approximately 88%, and the highest and lowest confidence scores (standard deviation) were reported for establishing proper communication with patients with 4.0 (34.67) and finding all root canals with 3.0 (23.88). The confidence score of male students was significantly higher than female students (P < 0.05). There was no significant association between the total score of confidence and difficulty level of the first endodontic treatment and educational level (P > 0.05). The multiple linear regression showed a significant correlation between the difficulty level of the first endodontic treatment and confidence (β = −2.1, P = 0.02, 95% CI: −3.9–−0.2). Conclusion: Given the low confidence level of students in some skills, the following are suggested to be taught practically and theoretically. Female students should be provided with a technique to improve confidence. Moreover, the first tooth for endodontic treatment should be selected more thoughtfully.

Keywords: Confidence, dental students, education, endodontic treatment


How to cite this article:
Iranmanesh P, Tabatabaei SA, Saatchi M, Tahani B, Binandeh ES, Khademi A. Evaluation of the Perceived Confidence of Undergraduate Dental Students in Performing Endodontic Treatment. Dent Hypotheses 2021;12:144-8

How to cite this URL:
Iranmanesh P, Tabatabaei SA, Saatchi M, Tahani B, Binandeh ES, Khademi A. Evaluation of the Perceived Confidence of Undergraduate Dental Students in Performing Endodontic Treatment. Dent Hypotheses [serial online] 2021 [cited 2021 Dec 7];12:144-8. Available from: http://www.dentalhypotheses.com/text.asp?2021/12/3/144/329760




  Introduction Top


Endodontic treatments can cause stress among dentists, undergraduate students, and postgraduate students due to the nature of the procedure, that is, due to the lack of direct vision and the complexity of root canal system.[1] In students’ viewpoint, endodontic treatment and endodontics course are considered complicated, difficult, and stressful, making them feel unprepared and unconfident for independent endodontic treatment, especially in posterior teeth.[2]

It has been argued that dental students have lower confidence than dentists and endodontists, which affects their performance in different stages of education and practice of endodontics.[3],[4],[5],[6] Furthermore, studies have shown that students’ increased confidence enhances their clinical skills.[7] When students are trained correctly in a standard manner, they exhibit adequate confidence during dental procedures.[8]

Assessment of students’ strengths and weaknesses, as well as their confidence and stress in different stages of the practice, can help determine the educational priorities and cope with deficiencies.[9] Different studies around the world have evaluated the dental students’ confidence in performing various stages of endodontic treatment.[3],[4],[5] Since few studies have assessed the dental students’ confidence level in performing endodontic treatments in Iran, the present study was conducted to investigate their confidence in performing various stages of endodontic treatment at the Dental School of Isfahan University of Medical Sciences.


  Materials and Methods Top


A total of 150 fourth-, fifth-, and sixth-year undergraduate dental students at the Dental School of Isfahan University of Medical Sciences were included in this cross-sectional study through census sampling. This study was approved by the Ethics Committee of the Deputy of Research at Isfahan University of Medical Sciences (IR.MUI.REC.1397.3.115). Participation in this study was voluntary, and the participants were anonymous and were assured about the confidentiality of their responses.

Data were gathered using a self-administered questionnaire that consisted of four sections: (1) demographic data (gender, age, and semester), (2) students’ experience (number of endodontic treatments and difficulty level of the first endodontic treatment categorized as easy, moderate, and difficult), (3) students’ perceived confidence in carrying out various stages of endodontic treatment (12 items on different stages of endodontic treatment based on five-point Likert scale, ranging from very high to very low) [Table 1], and (4) students’ suggestions for improving the quality of endodontic training (items on the training hours, the number of endodontic treatments in each semester, teaching how to use different types nickel–titanium rotary files, teaching new root canal obturation techniques, and students’ preference for the treatment of easier teeth rather than difficult ones at university).
Table 1 Percentage of students based on confidence in performing different stages of endodontic treatment in each academic year

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The questionnaire items were developed based on a similar questionnaire designed by Alrahabi.[3] The content validity of the questionnaire was analyzed and confirmed by two endodontists involved in teaching undergraduate students. A pilot study was conducted to verify the reliability of the questionnaire. First, 20 questionnaires were submitted to a group of students. Then, the same questionnaire was submitted to the same students 2 weeks later. A brief explanation was provided for the participants about the study objectives and voluntary participation. The intra-class coefficient showed an excellent reliability (ICC = 0.77). The questionnaires were distributed among all the students in the last rotation of each semester.

The collected data were fed into IBM SPSS Statistics, version 20.0 (IBM Corp., Armonk, New York, USA). The frequency of students’ responses to each question, the means and standard deviations (SD) of each item (between 1 and 5), and the total number of students’ responses to the 12 items (between 12 and 60) were extracted to measure the confidence level. ANOVA and t test were used to compare the results. Consequently, Spearman correlation test was used to determine the correlation between total confidence level and academic year, age, number of endodontic treatments, and the difficulty level of the first endodontic treatment. Multiple linear regression using the enter method was applied to determine the effect of factors influencing the students’ perceived confidence. P < 0.05 was considered significant.


  Results Top


Of 150 undergraduate students, 133 completed the questionnaires (response rate: 88.7%). Of the 133 students, 62 (46.6%) were female and 52 (39.1%) were male. Furthermore, 37 (27.8%) of them were the fourth-year, 46 (34.6%) were the fifth-year, and 50 (37.6%) were the sixth-year dental students. The questionnaire’s analysis revealed that 22.7% of the participants reported the first endodontic treatment as easy, 53% as moderate, and 24.2% as difficult. Most of the fourth-year students had performed six endodontic treatments, while the fifth-year students had carried out 11 treatments, and the sixth-year ones had carried out 20 endodontic treatments.

[Table 1] summarizes the results of the frequency distribution of the students’ perceived confidence in carrying out different stages of endodontic treatment in each academic year. The findings showed that most of the students reported moderate and high levels of confidence in items such as local anesthetic administration, rubber dam placement, access cavity preparation, determining a correct working length, finding all root canals, root canal instrumentation, root canal obturation, and management of endodontic treatment complications. Moreover, they reported high and very high confidence levels for items such as diagnosis of endodontic treatment need, temporary restoration placement, and establishing proper communication with patients.

[Table 1] presents the mean (SD) of each confidence item. The highest mean (SD) scores of confidence were related to establishing proper communication with patients with 4.34 (0.67), temporary restoration placement with 4.24 (0.69), and diagnosis of endodontic treatment need with 4.02 (0.63). The lowest mean scores of confidence were reported for finding all root canals and the management of endodontic treatment complications with 3.23 (0.88) and 3.26 (0.94), respectively.

The mean (SD) of students’ total confidence score was 42.6 (8.4). There was no significant association between the overall confidence score and difficulty level of the first endodontic treatment (P = 0.057, F = 2.9, ANOVA) or semester (P > 0.005, ANOVA). However, there was a significant relationship between the students’ total confidence score and gender (P = 0.04, t test). The male students exhibited a higher score than the female students, with 44.1 (6.8) and 41.5 (6.3), respectively.

Among all the variables analyzed, comprising the age, gender, the number of endodontic treatments, the difficulty level of the first endodontic treatment, and semester, using multiple linear regression analysis, there was only a significant correlation between the difficulty level of the first endodontic treatment and confidence mean (β = −21, P = 0.02, 95% CI: −3.9–−0.2). On the other hand, the students who reported a higher difficulty level for their first endodontic treatment had lower confidence. The variables of this model showed a correlation coefficient of 0.36 and explained 13% of the variance of the dependent variable [Table 2].
Table 2 The results of multiple linear regression analysis regarding the age, gender, academic year, difficulty level of the first endodontic treatment, and number of endodontic treatments, in terms of the students’ confidence level

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Moreover, 97.7%, 91.7%, 74.2%, 67.6%, and 29.2% of students recommended teaching how to use different types nickel–titanium rotary files, teaching new root canal filling methods, increasing the training hours of endodontics course, increasing the number of endodontic treatments in each semester, and endodontic treatment of easier teeth, respectively.


  Discussion Top


Out of 150 dental students, 88.7% of the students responded to the questionnaires. In a similar study on 40 dental students in Saudi Arabia, the response rate was 93%.[3] In another study in Sudan, all 55 students responded to the questionnaires.[4] Low response rate in the present study could be due to the larger study population as well as cultural and social factors. Refusal of contribution and inaccessibility of the participants were reported as the main reasons for reducing response rates.[10] Considering the target sample, some students might have been absent at the time of questionnaire distributions or unwilling to take part due to the fear of disclosure of their names and ideas. Nevertheless, all the abovementioned response rates confirmed the standards proposed in this respect (at least 40%) and not subjected to nonresponse bias.[11]

In the present study, most of the fourth-, fifth-, and six-year students had carried out six, 11, and 20 endodontic treatments, respectively. It might seem logical that more clinical exposure could enhance confidence and competency; however, no recommendation was reported about the proper number of endodontic treatments for dental students to reach a threshold of competence by the last undergraduate curriculum guidelines for Endodontology. Instead, this guideline emphasized the consistency and quality of the performance of dental students. Hence, in addition to clinical exposure, other determinants for competency should be considered.[12]

In the present study, the maximum mean scores of confidence were found for establishing proper communication with patients, temporary restoration placement, and diagnosis of endodontic treatment need. This higher level of confidence can be attributed to the curriculum and higher level of clinical experience. Since the students were in direct contact with patients in other departments and learned those items earlier, they might have had greater confidence. The highest level of confidence in others studies were observed for local anesthetic administration, temporary restoration placement, and the diagnosis of endodontic treatment need.[3],[4] The outcomes obtained for students’ confidence seem to be related to differences in curricula.

In the current research, the minimum mean scores of confidence were recorded for finding all root canals and management of endodontic treatment complications, which might be due to the curriculum in which the moderate and high difficulty teeth were not requirement for dental students, hence resulted in lack of clinical experiences. Several studies have shown that students have the lowest level of confidence in the treatment of multi-rooted teeth, due to the complexity of the root canal system.[6],[9],[13],[14],[15] Awooda et al.[4] reported the lowest level of confidence for the working length determination using an electronic apex locator and root resorption management, which was due to inaccessibility of the device and fewer encounters of students to root resorption. In a study at the Yeditepe University, students reported low confidence in bleaching restored teeth, managing flare-ups, and placing rubber dams.[6] Differences in this regard might be due to different questionnaires used, differences in the quality of education, strict supervision, and educational curricula of various centers. For example, the students’ confidence might be compromised by an excessively laborious educational curriculum.[16] The number of requirements and order of clinical exposure are the other factors that might alter the clinical experience and consequently the confidence level.[3],[9]

In the present study, no significant association was found between the total score of confidence and academic year. In the study by Alrahabi,[3] the perceived confidence of the fourth-year students was higher than the fifth-year students in some areas, and the researcher argued that this might be due to fewer requirements, a fewer number of fourth-year students, and more strict supervisions over the performance of the fourth-year students. However, Murray and Chandler,[9] and Davey et al.[5] reported significantly lower confidence and competence in junior students than the seniors, which was attributed to the junior students’ lack of clinical experience.

In the present study, the total score of confidence was significantly higher among the male than the female students. However, this effect was not significant among the other variables in the regression model. Lundeberg et al.[17] and Lenney[18] argued that although females’ confidence levels have been reported to be lower than their male counterparts in most studies, this difference is influenced by various factors, such as skills, social attitudes, and regional culture. Mezerji et al.[19] reported that men had higher confidence than women in making decisions, but the difference was not significant. It should be noted that participants’ baseline confidence levels were not measured in the present study, so the lower confidence of female student may be related to the other sociocultural factors and future studies should investigate by considering various underlying factors. Yet, more attention should be paid to females’ learning.

No correlation was found between students’ confidence level and their age, academic year, and the number of endodontic treatments. Moreover, using the regression model, the only significant factor was the difficulty level of first endodontic treatments that partially explained the confidence level; however, this effect was not found in the univariate analysis. It seems that the first tooth for endodontic treatment should be selected with great care.[6] Frequency of treatment failures, teacher’s reaction, and tendency to earn a degree in endodontic may also effect on the students’ confidence[4] and further studies are recommended to take it into account.

In the present research, most students suggested an increase in the training hours of endodontics course, an increase in the number of endodontic treatments in each semester, and teaching how to use different types of NiTi rotary files. Researchers have reported that including new advancements, such as NiTi rotary files in the curriculum is quite safe and can promote the clinical experience, self-confidence, and education by increasing the number of endodontic treatments.[3],[20] It was argued that inexperienced operators could learn how to work with NiTi rotary files through a brief training.[21] Providing more information in training sessions, increasing the number of trainers, running more organized training sessions, improving the educational equipment, providing online instructions, and performing more endodontic treatments[5],[22] can enhance the students’ confidence through acquiring more experience.[22],[23]

A limitation of this research was the students’ noncooperation in completing the questionnaires. For this reason, the students were reassured that the data was confidential and would not affect their course scores. Further studies are suggested to explore the association between students’ confidence level and other variables, such as the type of treated tooth, frequency of treatment failures, professors’ behavior, and willingness to earn a degree in endodontics.


  Conclusion Top


Students’ self-evaluation of the acquired skills and confidence level is a helpful tool for a realistic assessment of the dentistry curriculum, which will eventually help identify and overcome the barriers.[3] Since the lowest score of confidence was reported for finding all root canals and the management of endodontic treatment complications, more attention is recommended to the theoretical and practical teaching of these issues. Furthermore, considering the lower confidence of female students, they need to be trained more. Last but not least, the first endodontic treatment should be selected with great care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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