1. Introduction
HVRS, anxiety
Simulation training for invasive dental procedures is a core component of the pre-clinical dental curriculum. Besides conventional mannequin-based simulators, dental schools are now incorporating haptic virtual reality simulation (HVRS) devices to facilitate the transition of students from the simulated dental learning environment to the clinical settings. This study aimed to assess student performance and perceptions of HVRS training as a pedagogical tool in pre-clinical paediatric dentistry. After practicing the primary molar pulpotomy procedure on plastic teeth, participants were randomized into test and control groups. Test group students performed the same procedure on a HVRS device, namely the SIMtoCARE DenteUndergraduate dental education requires students to demonstrate pre-clinical competence in a variety of irreversible operative procedures prior to their clinical placement. Dental education programs are time- and place-bound which adds pressure on educators to assist students to achieve the requisite fine motor skills before they perform invasive clinical procedures on patients. Traditionally, dental schools have relied on pre-clinical simulation training using plastic teeth mounted on mannequins to optimise students’ practical skills and hand-eye-foot co-ordination. However, practicing dental procedures on virgin plastic teeth does not accurately simulate patient cases encountered in clinical practice and poses some limitations on the translational value of pre-clinical training. Moreover, plastic teeth do not replicate enamel and dentine hardness and it is difficult for students to receive realistic tactile feedback. The risk of injury associated with the use of sharp instruments during these sessions mandates close supervision which further restricts and reduces the number of pre-clinical simulated sessions that can be offered to students. With dental students required to show competency in increasingly complex procedures, conventional standalone mannequin simulators do not offer an ideal solution and technological advances are required to address their limitations [Dental schools around the world are now increasingly incorporating virtual reality simulators into pre-clinical training to facilitate the transition of students from the simulated dental learning environment into clinical settings. The experience of using virtual reality simulators has been reported to be more pleasurable and enjoyable by early year dental students [Several questions remain concerning the role and place HVRS should be given in pre-clinical dental education courses. Studies indicate that HVRS introduced in the early stages of undergraduate dental education has greater potential of predicting subsequent clinical performance scores compared to mannequin-based typodont models and also facilitates psychomotor skill acquisition [Pre-clinical training on operative skillsets in simulated dental learning environments is a fundamental educational strategy to ensure dental students demonstrate appropriate clinical procedural skills before they undertake invasive procedures in real patients. Training in simulated settings offers a safe environment to develop and consolidate core skills without the risk of harming patients. Management of paediatric dental patients poses additional challenges due to the anxiety within dental care settings often observed in young patients. Dental students often need additional time to calm children and establish a rapport with them using appropriate behaviour management techniques [There is clearly a need for more studies to evaluate the effectiveness and student perceptions of training with the HVRS compared to the conventional mannequin simulator for pre-clinical operative procedures in paediatric dentistry. Therefore, the aim of the study was to assess whether augmenting the conventional simulation environment (CSE) with HVRS is likely to affect student performance and experiences for performing the primary molar pulpotomy procedure. The research objectives of the study include: (i) to evaluate if augmenting the CSE pre-clinical training with HVRS for a primary molar pulpotomy can improve student performance scores and reduce procedural time in comparison to pre-clinical training only in the CSE; and (ii) gauging student perceptions of HVRS training for the pre-clinical primary molar pulpotomy procedure.The conceptual framework of the study was built on the theory of deliberate practice which emphasizes embedding a self-reflective feedback loop in the development of skills rather than simply performing a task repetitively to achieve mastery [