Determining competence in prosthodontics in undergraduate dental school programmes: an international study

Background and aims: In an era of increased attention on patient safety, as well as increased student mobility between many countries, it is of interest to investigate contemporary international trends in the teaching and assessment of prosthodontics. The aims of this PhD project were to investigate the teaching and assessment methods of the prosthodontics domains and to determine if it is possible to agree on competency standards in prosthodontics. Structure and methods: This thesis includes an introductory chapter (Chapter 1), a narrative review of relevant educational and prosthodontic literature (Chapter 2), four original quantitative (questionnaire-base) studies to assess the contemporary teaching and assessment methods of prosthodontics on international basis (Chapters 3-6), and a mixed-method Delphi approach among prosthodontic/restorative dentistry experts to obtain a consensus on the most suitable undergraduate teaching and assessment methods (Chapter 7). Chapter 8 includes a qualitative study using one-to-one interview to explore the perspectives and opinions of senior dental academics that did not reach consensus using the Delphi method. Chapter 9 contains a systematic review synthesising the response rates in dental literature of questionnaire-base studies. Finally, a brief conclusion of the thesis was presented (Chapter 10). Results: Narrative review: there was significant divergence among prosthodontic curricula in dental schools in terms of teaching methods, assessment criteria and how student competence is determined. Quantitative studies: Our findings from the quantitative studies reinforced the findings of the narrative review; there was a significant international divergence of undergraduate teaching and assessment trends among dental schools, including the preclinical and clinical course, of the prosthodontics divisions (complete denture, removable partial denture, fixed prosthodontics and dental implants). Divergence was evident in dental schools even within the same country. Mixed-method Delphi and qualitative studies: A total of 23 senior academic experts from 11 countries participated in the Delphi study. There was a high level (92.6%, 175 statements out of 189) of consensus agreement over three iterative rounds, whereas 14 statements (7.4%) did not achieve a consensus. A total of 12 senior dental academics from seven countries participated in semi-structured interviews, it was agreed that academic professors, consultants, or specialists were the most suitable staff members to supervise students during preclinical hands-on sessions in removable and fixed prosthodontics. In addition, participants mentioned the availability of suitable patients for treatment, dental schools’ curriculum and the level of students’ skills as factors influencing the starting point of clinical sessions in fixed prosthodontics. We also found differences among the participating schools in regard to course contents and extent of teaching on dental implants. The experts suggested tailoring the curriculum according to what is expected from the graduating dentists and allowing students to observe dental implant cases before treating simple cases. Systematic review of response rate: Overall, 133 studies with 149 response rates were included. The median response rate across the included studies was 77%, a significant negative correlation was observed between the response rate and the actual number of distributed questionnaires (sample size) (r = -0.4127; P