4. Discussion
incongruity, HVRS
CAVITY
Procedure-based dental specialties like paediatric dentistry require students to demonstrate high levels of psychomotor skills before they start treating patients in clinics. Consequently, acquisition of psychomotor skills is fundamental to developing competency in operative procedures during pre-clinical training for undergraduate dental students. While mannequin-based simulation training using typodont teeth has conventionally been the standard pedagogical tool used in the pre-clinical teaching curriculum, dental schools have also been investing in virtual reality simulators to further enhance fine motor skills of their students. However, the impact of these digital methods of pre-clinical training on students’ learning experiences in paediatric dentistry needs further investigation. Previous studies from around the world have reported low confidence among undergraduate dental students in performing pulp treatment in children and reiterated the need to improve pre-clinical training [A plausible reason why no performance score differences were found in this study could be attributed to the fact that study participants had previously experienced both the simulation environments for other pre-clinical tasks in the earlier years of their training. Additionally, the plastic teeth used in this study were customized for the pulpotomy procedure with wax inserts in the pulp chamber, allowing students to ‘feel’ the pulp in both the simulation environments. In this study, study group students were exposed to approximately 60 min of haptic pulpotomy exercises prior to the combined performance evaluation with the control group students on plastic teeth. Whether a longer time for practice on the HVRS device could have significantly improved student performance scores needs further investigation. Qualitative data on student perceptions about pre-clinical HVRS training for the primary molar pulpotomy procedure was also collected in this study. The vast majority of the study participants did not consider HVRS training to be an adequate replacement for conventional simulation training and instead preferred the HVRS be used as an adjunct along with conventional mannequin simulators. This is in agreement with the findings reported by Zafar et al. in a similar pre-clinical paediatric dentistry training study of Australian dental students [The willingness of a large proportion of the students to engage in more HVRS sessions for pre-clinical paediatric dental procedures is of interest. This apparent incongruity could be explained by the fact that the HVRS allows students’ multiple practice attempts with less time pressures as indicated in the student responses to the open-ended questions of the survey. Furthermore, HVRS training allows the students to receive multi-source feedback, that includes not just instructor- and computer-generated feedback, but also the opportunity and time for self-reflective feedback.Recreating a clinical experience in a simulated environment is challenging and complex, but it remains the core component of the pre-clinical dental curriculum. This makes it important to explore the benefits of different simulation training environments from the students’ perspective and their relevance to actual clinical practice of different dental procedures. To the best of our knowledge, this is the first study to assess both students’ performance scores and perceptions for a pre-clinical pediatric dental procedure in two simulation environments. The randomisation of students and blinding of assessors in this study improve and reduce selection and detection/performance bias, respectively. Despite recruiting 100% of students attending the paediatric dental pre-clinical training, the low number of participants in this pilot study coupled with the use of a single operative procedure might have affected the results of this study. Another limitation of the study was that the unidimensional Likert scales used to assess student perceptions may not have fully captured the entire gamut of student perceptions. This was partly overcome by including four open-ended questions in the questionnaire to obtain a wider range of student opinions. While the study results should not be over generalized, the study does provide preliminary data for dental faculty considering the use of HVRS as a pedagogical tool for pre-clinical paediatric dentistry training. A multi-center assessment of the effect of HVRS as an adjunct to CSE on a larger cohort of students with different operative procedures such as conventional stainless steel crown preparation and restorative techniques such Class II cavity preparation on primary molars could help further investigate the true benefits of augmenting the conventional simulation with HVRS.