In this study three different classes were targeted; the dental students who are graduating in 2020, dentists graduated in 2019 and they are doing their prelicensure training, and dentists who graduated before 2019. All of the groups had similar dental school curriculum except that the classes graduated before 2019 had 10% more clinical training hours than the 2019 and 2020 classes.
The design of the survey was extracted from the required competencies for graduation of students from the school of dentistry from University of Jordan.
The range of the TPS for all the participants is 69-120 with a mean of 97.2 is considered satisfactory. Differences in TPS were noticed between the classes. The highest TPS was found for the dentists who graduated before 2019. One of the reasons could be that neither their pre-graduation clinical training nor their prelicensure training was affected by COVID-19.
Graduates before 2019 had higher level of confidence in multiple competencies compared to the other two classes. That could be related to the fact that those dentists have been practicing dentistry for multiple years. Their responses might have been influenced by their clinical experience in clinical practice. The concept of students considered themselves competent based on their previous experience of the task was mentioned previously in the literature.20 Additionally, the classes graduated before 2019 had 10% more clinical sessions in their training compared to the graduates of 2019 and 2020 which could have slightly increase their level of confidence and preparedness. In the study conducted by Manakil, the authors found that 71.4% of students suggested that an increase of the number of clinical sessions would enhance their educational experience and yield more confidence.21
The results of this study showed that 12.2% of 2020 class, and around 6% of the other two classes perceived themselves as extremely not confident performing surgical extraction. This in one of the procedures which is considered complex and the new graduates usually do not have adequate confidence to perform.5,6 Those findings agree with D.J.Scho ̈nwetter (2010) findings where he reported that recent graduates were least confidence in implantology, orofacial pain, trauma and surgical management and C.K.Y.Yiu findings where he concluded that there is apparent deficiencies of training in oral and maxillofacial surgery in the institution where the study was conducted.5,22 Although the 2020 class lost 8 weeks of their clinical training due to COVID-19 pandemic and could not continue their surgical extraction competency, 32.9% of them felt confident and extremely confident performing such procedure, which could indicate students over estimating their abilities.
When reviewing the results on oral cancer screening, the majority of our graduates reported being not confident and extremely not confident performing this task. Fortunately, by the time this manuscript was being prepared, the diagnostic science department introduced a special module in their curriculum to enhance the upcoming students’ skills in oral cancer screening. Participants’ low confident level in oral cancer screening was also reported in a national study done in the UK.23
Concerning removable prosthodontic tasks our students demonstrated lower level of confidence compared to restorative procedure tasks that could be due to the lower number of clinical sessions of removable prosthodontic clinics compared to operative and fixed prosthodontic clinics. The high students’ confidence in making secondary impression for a complete denture patient is most probably because it is the required task for the final exam of the removable prosthodontic clinic. Students tend to focus on this competency in particular to ensure doing it correctly in the final exam.
More than 90% of the participants of this survey reported being confident and extremely confident in the following modules: examination and treatment planning, restorative dentistry (profound local anesthesia, rubber dam isolation, direct restorations, and root canal treatment for a single root tooth), prevention and pediatric dentistry, periodontics and communication skills. Those results suggest that dental graduates of University of Jordan are prepared to perform the basic general dentistry procedures.
Around 60% of the participants reported that COVID-19 had some to severe impact on the level of confidence in performing general dentistry procedures. The lockdown that happened due to COVID-19 lead to almost two months loss of performing general dentistry. The impact affected all the classes of the participants with the highest impact on the dentists who graduated in 2019 and doing their prelicensure training (73.4%) and the lowest on the students who are graduating in 2020 (51.9%). The lower level of impact on 2020 class might be related to the possibility that students might be unaware of their proper level of clinical expertise. Additionally, psychological impact of this pandemic on students’ wellbeing and the stress of graduation during COVID-19 might also create a psychological defensive response from the participants who are graduating in 2020 affecting the accuracy of their answers about their confidence level. On the other hand, graduates with experience can better identify their strengths and weaknesses and could give more accurate answers regarding what they know and what they do not know. According to medical education literature the process of oneself assessment is complicated, and by its very nature can never be objective or free from the beliefs and values individuals hold about themselves.20 Therefore self-evaluation instruments are best used to help individuals analyze their work practices and to promote reaction on performance. They should not be used to judge the accuracy of the individual's evaluation.20 A good example on that is a study reported that graduates perceived their competency to be excellent in the four areas (treatment planning; community-based skills; management, administrative skills, and personal management; and professional development skills), on the other side, employers of those graduates felt that these are the areas that are of concern and needed attention.24
The highest level of impact reported by the 2019 class. Those participants might felt that the interruption which happened in their training did not allow them to work on their weaknesses as they planned.
More than half of the participants who graduated before 2019 reported that COVID-19 had some to severe impact in their confidence performing general dentistry procedures. This group actually neither their undergraduates training nor their pre-licensure training was affected by the lockdown. The learning opportunity they missed is basically the continuing education practical courses which was cancelled due to the lockdown. The impact on the confidence can be due to the possibility that those dentists are exposed to a high psychological tension from the fear of getting infected with COVID-19 and transmitting the disease to their family members and between their patients and the stress that comes from the financial aspect of their career.
Interestingly, GPA of the graduates had no effect on the level of confidence of the participants. That could be explained by the fact that the GPA is cumulative from both of the didactic and clinical courses. As found in the dental literature the correlation between the student’s performance in the didactic and clinical courses is weak.25 Furthermore, confidence can be directly associated with social skills and intelligence which is usually not precisely covered in the grading criteria.
There are multiple limitations of this study. One of the main limitations is the survey design. The survey was self-designed and not a standard one which limit the ability to compare this research findings with other similar researches. The Dental Undergraduates Preparedness Assessment Scale was not used since the authors wanted to check and validate the effectiveness of the specific competencies the dental school in University of Jordan teaches its graduates. Another limitation is the possibility that graduates before 2019 answers could be highly affected by the clinical experience they gained through their practice and not based on the skills they graduated with from the dental school. One more limitation is the low response rate from the students who are graduating in 2020 and the ones who graduated in 2019. The survey was conducted during the final exams of the graduating students which could justify the low response rate from them.