Impact of Learning Experience on General Dental Practitioners' Confidence

1. The Impact on General Dental Practitioners of an Increase in Confidence Following a Learning Experience. SRHE 6th May 2016 Mr Peter D Fine Honorary Research Fellow Senior Clinical Teaching Fellow UCL Eastman Dental Institute

2. UCL Eastman Dental Institute, London, England

3. Introduction • The Restorative Dental Practice Programme • The study • Results • Future work

4. The Programme • Part time Masters in Restorative Dental Practice • Approximately 70 postgraduate students each year • Three elements: Certificate; Diploma and Masters • Flexible programme

5. Teaching Pedagogy

6. Teaching Pedagogy • Constructivism-’Community of Practice’ (Lave & Wenger, 2008) • Humanism-’Experiential Learning Theory (Kolb’s Learning Cycle,1984) • Design-Based Theory-’Relationship between Theory & Practice’ (Brown et al 1992) • Descriptive Theory-’Non-prescriptive learning’ (Bloom et al, 1956) • Social Development Theory- ‘Peer Support for Learning’ (Vygotsky, 1978) • Self-regulated Learning-’Motivation to Learn’ (Zimmerman, 2010)

7. Aims of the Study • How do changes in confidence influence the learning experience of GDPs? • To what extent do specific pedagogical learning interventions have an impact on GDPs perceived confidence following a Master’s programme? • In what ways do GDPs perceive changes in their confidence having an impact on clinical practice?

8. Methods of Data Collection & Analysis • Questionnaires: Quantitative/Qualitative • Focus Group discussions • Interviews • Field notes A satisfactory learning experience was received

9. MethodologyQuestionnaires • Pilot studies • Pre-course questionnaire • Post-Certificate Year questionnaire • Post-DiplomaYears questionnaire • Post-Masters’ Years questionnaire

10. MethodologyFocus Group Discussions Focus groups are a form of group interview, though not in the sense of backwards and forwards between interviewer and group. Rather, the reliance is on the interaction within the group who discuss a topic supplied by the researcher. (Morgan, 1998: 9). This yields a collective rather than individual view. • Schedule for focus groups (Morgan 1988) • Focus group size (Stewart et al. 1990) • Recording focus groups • Analysis of qualitative data

11. MethodologyFocus Group Discussions • 12 Focus group discussions • Differences between the groups • Differences within each group • Differences between 1st and 2nd meeting • Confidence levels

12. MethodologyPersonal Interviews Personal interviews following completion of the Masters programme

13. Quantitative ResultsPre-Programme aims and objectives of GDPs

14. ResultsDemographic Results, Certificate Course

15. ResultsDemographic Results, Diploma

16. ResultsDemographic Results, Master’s

17. Confidence levels on a scale of 1-10 comparing age groups prior to the start of the programme with communication skills and the ability to do dentistry. Communication skills Ability to do dentistry

18. Confidence levels on a scale of 1-10 comparing number of years qualified prior to the start of the programme with communication skills & ability to do dentistry Communication Ability to do dentistry

19. Confidence levels on a scale of 1-10 comparing gender, prior to the start of the programme with communication skills and the ability to do dentistry. Ability to do dentistry Communication skills

20. Results of the change in confidence levels, in communication skills after year 1.

21. Confidence levels in communication skills & ability to do dentistry, following completion of the Masters’ programme Communication Ability to Do Dentistry

22. Analysis of Qualitative Data Qualitative data collected during the study are the opinions, views and observations of the participants. • Patterns, Themes, Coding (Braun & Clarke, 2006) • Phenomenological (Smith, 2007) • Grounded theory (Glaser & Strauss, 1977)

23. Thematic Analysis of CRDP Course Data

24. Thematic Analysis of DRDP Course Data

25. Thematic Analysis of Masters’Course Data

26. Examples of Qualitative DataReasons for attending the programme Student 4: I hadn't done any formal training in a number of years. There are new techniques that I needed to know about, the younger dentists seemed to know a lot of things I didn't, so I had to update my knowledge Student 10: I very much perceived a need to do this programme I wanted to become a better clinician and I thought I am a trainer as well and I teach I would be better equipped and have more ammunition. I don’t go on courses so that I can tick boxes on the GDC thing but I wanted to do a proper course and the thing that attracted me in a way to this was it was modular.

27. Examples of Qualitative DataConfidence Student 8: I feel more confident in communicating with patients as I have the most up to date evidence based information and I believe I am doing my job to the best of my ability. That makes me confident. Student14: I am much more confident now than I was after even the first year certificate course. Learning in small groups has made me more confident, there is more time to get questions answered. You get better interaction between the students. The tutor is a more close relation Student 7: I have been more confident in my work so I can explain to patients exactly what I can achieve and what I can’t. So predictability, confidence and skills have definitely improved Student 16: Working in small, peer groups, did have an impact on my confidence. I knew if there was a problem I could ask somebody for advice, yes it did. There were good days and bad days. I think this is a personal thing. Student 19: Now I feel more confident but in the first year I felt intimidated. I didn't want to say anything when I was first in the group and I was quiet. What made my confidence improve was the motivation from the tutors. They would push you and if you needed it give you personal feedback.

28. Examples of Qualitative DataLearning Experience ‘I have come from a background of problem based learning (undergraduate degree course) and have found the lecture based plus practical teaching to be great’ Student 4: Working in small groups was generally a positive experience. Even in the informal discussions at lunch time you learnt something talking to other colleagues or tutors. Yes it was quite encouraging Student 17: Yes I reflected on what I was doing, what I could have done differently and yes definitely the start point which was occlusion was emphasised during the course was also really helpful. ‘The pre-course reading was relevant but quite a lot to do. Would it be possible to get more on-line?’ Student 11: I think the practical/hands-on sessions are the most confidence boosting. The clinical sessions you actually get to see what is going on. The programme made me more professional I would say. I can explain the options to the patients very well, I am more confident in saying what is available for the patient

29. Examples of Qualitative DataMotivation

30. Examples of Qualitative DataRelevance to Clinical Practice Student 3: I don't get my self into problems as I can look at a case, I look at the occlusion, I look at the…I can spot habits at a mile off from my patients…. I had a patient from my principle where he had done a large composite build-up and the patient had come back 5-6 times and he can't get the patient happy and I look and at it and I know why it is wrong. I think the patients and my nurse respect me more. My principle will ask me when he has a problem. Student 13: I think the programme has influenced my sense of professionalism. You need to be offering the patients more options. I think part of the question is having the confidence to do that, also giving the patient an honest opinion; for example if a tooth is completely unrestorable then being honest with the patient about that. Student 19: It has just been a positive impact on my practice, to my patients and myself. I am able to inform them in a constructive way, in a systematic way, in an organised way because I have more knowledge then I can explain to them what the alternatives are, the options etc.

31. Discussion • Confidence was one of the main reasons for wanting to embark on the programme, the participants perceived a need to be more confident • The increase in knowledge was a major factor in increases in confidence • The limitations of a linear measure of confidence were addressed by qualitative data • Self-doubts were addressed by the teaching pedagogy, motivation of the individual & personal support • Small group, peer learning, was considered to be good for confidence

32. Future Plans for this study. • Continue to collect data for a few more years • To investigate why there was such a large number of GDPs not completing the programme • To investigate the use of confidence measures as an indication of academic success • To compare this very traditional teaching pedagogy with a more blended learning approach to a masters programme • To follow up the two cohorts over a prolonged period of time

33. Thank you for your attention.Any questions?