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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 265-273

Value of self-assessment as a learning tool in dental education and practice: A descriptive study


1 Department of Prosthodontics, Dental Education Unit, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
2 Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India

Date of Submission14-Mar-2021
Date of Acceptance03-May-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Sunila Bukanakere Sangappa
Room No. 10, Department of Prosthodontics and Crown and Bridge, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore - 570 015, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_37_21

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  Abstract 


BACKGROUND: Self-assessment (SA) skills are integral to lifelong learning process as they are a mode to share educational responsibility. Therefore, the purpose of this study was to explore the dental undergraduate student's perception, practice of SA, and its impact over their academic and clinical performance.
MATERIALS AND METHODS: This cross-sectional study was carried out among 444 dental students regarding practice of SA in their academic and clinical practice across all the years for a period of 3 months. Data were collected by a pilot-tested self-administered structured questionnaire adopting convenient sampling and analyzed using SPSS Version 22 Software.
RESULTS: Mean score for the value of SA skill as a learning tool was lower (60.21 ± 4.83) among 3rd-year dental students and highest (65.26 ± 4.69) among interns with an overall mean score of 62.59 ± 5.27, and the results of one-way ANOVA revealed that the year-wise mean score difference was statistically significant. The post hoc test revealed that the mean score for value of SA skills was significantly different between 1st-year and 3rd-year students. Although undergraduate students valued the need of SA skills for lifelong learning process, there is paucity toward their ability to accurately perform SA.
CONCLUSION: In the context of how SA is perceived by dental undergraduates, our study suggests that the acceptability of SA is seldom explored. The focused responses of the participants of this study underline the importance and need of training and practicing SA skills in dental undergraduate curriculum.

Keywords: Competency-based education, dental education, self-assessment skill, undergraduate students


How to cite this article:
Sangappa SB, Madhavi R. Value of self-assessment as a learning tool in dental education and practice: A descriptive study. Indian J Health Sci Biomed Res 2021;14:265-73

How to cite this URL:
Sangappa SB, Madhavi R. Value of self-assessment as a learning tool in dental education and practice: A descriptive study. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Jun 17];14:265-73. Available from: https://www.ijournalhs.org/text.asp?2021/14/2/265/317407




  Introduction Top


Competency-based dental education reduces the passive dependence on teachers and encourages student teamwork and critical self-assessment (SA). Competency is a point on a continuum where students are challenged to self-assess and then consider strategies for how they can further strengthen their knowledge and skills.[1] Among the recent changes to accreditation standards for predoctoral dental education is an elevation of the role of assessment. In the newly revised accreditation standards that will go into effect July 1, 2016, Standard 2–10 (SA) is explicit that graduates must demonstrate the ability to self-assess and plan for lifelong learning. In an environment that emphasizes critical thinking and humanistic values, it is essential for students to develop the capacity to self-assess.[2]

SA is a complex, potentially learned skill, requiring individuals to have insights into their own limitations and competencies.[3] Asadoorian and Batty defined SA as an active process of developing an awareness of a personal learning exigency: a pressing need within one's professional activities to guide the initiation of appropriate learning activities.[4]

SA is often advocated as a way to share educational responsibility and to develop patterns of reflective learning in students.[5],[6] The advantages of SA are said to be especially valuable in formative learning by helping students direct efforts toward information and/or skills that they have not yet developed.[7]

The ability to assess one's own work critically is often claimed as a goal of higher education even when SA exercises are not the part of curriculum.[8] SA is a process of formative assessment during which students reflect on and evaluate the quality of their work and their learning, judge the degree to which they reflect explicitly stated goals or criteria, identify strengths and weaknesses in their work, and revise accordingly.[9]

Studies have concluded that SA among medical graduates can increase the interest and motivation level of students for the subjects, leading to enhanced learning and better academic performance, helping them in development of critical skills for analysis of their own work.[10] In dental education, SA is widely accepted as a best practice and is performed after preclinical projects or clinical procedures, for both formative and summative activities, in the form of daily laboratory exercises, laboratory practical examinations, clinical treatment, and clinical competencies.[11]

A Commission on Dental Accreditation standard reinforces this pedagogical protocol, by stating that “graduates must demonstrate the ability to self-assess, including the development of professional competencies and the demonstration of professional values and capacities associated with self-directed, lifelong learning.”[12] Several studies have reported on the use of SA in predoctoral dental curricula, such as in dental anatomy,[13] operative dentistry,[14],[15] removable prosthodontics,[16],[17],[18] communication skills,[19] and clinical instruction.[20]

SA has the potential for anchoring reflective learning if it is developed in the preclinical environment and then reinforced in the clinical environment. However, there is limited evidence that it is being systematically applied in both educational environments.[11] Although self-evaluation skills are integral to the lifelong learning process,[21] SA has not been a significant part of curricula in healthcare education.[22] An additional motivation for SA is that oral healthcare providers will need to implement changes to generate better performance during their professional career, and therefore, the development of these skills is important during training.[16],[17] In 1975, Knowles, sometimes known as the “father of adult education,” described the need for adults to learn how to learn, rather than only learn what is known.[23] Knowles described this as the process of self-directed learning, and its importance has since been endorsed by numerous authors.[24] The validity of this process depends on accurate SA, the critical first step in self-directed learning. Three primary factors provide the rationale for conducting SA in healthcare practice and are summarized as providing (i) direction to one's professional learning, (ii) efficiency in one's professional learning, and (iii) motivation to enhance one's professional learning and implement changes needed to augment or improve performance.[4] Therefore, the aim of this study was to explore the dental undergraduate students' understanding and practice of SA as a primary objective and its impact over their academic and clinical performance as a secondary objective using a questionnaire survey.


  Materials and Methods Top


This cross-sectional study was carried out with the objective of exploring the views of undergraduate dental students about the practice of SA practice in their academic study at following institutional ethical committee approval and the individual consent.

Closed-ended questionnaire was developed using a Likert scale. The first part of the study consisted of designing, developing, and pilot testing the questionnaire based on construct validity, content validity, and pretesting among ten undergraduate students from each academic year and ten intern students. The second part of the study tested the questionnaire among dental students of the institute across all the academic years of education.

Instrument

A self-administered questionnaire was designed based on relevance by the trained investigators after a consensus to identify the problems or challenges and facilitating factors or opportunities by the participants for construct validity. A questionnaire was designed with 20 items using a Likert scale with responses ranging from strong disagreement to strong agreement. The objectives were to explore the dental undergraduate students' understanding and practice of SA and its impact over their academic and clinical performance.

For all the questions, except for the two questions on perception of the nonusefulness of the SA skill in dental training, strongly agree was given a score of 5, agree a score of 4, neither agree/disagree a score of 3, disagree a score of 2 and strongly disagree a score of 1. However, scoring for the two questions was the opposite: strongly agree received a score of 1, and strongly disagree a score of 5, respectively. The content validity was established by five subject experts and was scored to obtain the content validity ratio (CVR), and the questionnaire was modified accordingly. Questions with CVR of <0.60, was deemed as inadequate and was deleted or changed by pretesting among 50 subjects with equal representation amongst all years. Internal consistency of the questionnaire was analyzed using intraclass correlation coefficient (Cronbach's alpha) [Table 1]. The students participated in the pilot study were excluded from the main study. The fifty participants in the pilot study were given the questionnaire again after 10 days to assess repeatability of the response using Cohen's kappa statistics. The final 14-item prevalidated survey questionnaire [Appendix 1] after the changes was used for the main study.
Table 1: Internal consistency of the questionnaire using intraclass correlation coefficient (Cronbach's alpha)

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Study population

The questionnaire was distributed to 450 participants. After checking for accuracy, during the process of cleaning, 444 questionnaires fully completed by the subjects were a part of the final sample across five academic years. This included 82 students from 1st year, 103 students from 2nd year, 73 students from 3rd year, 83 students from final year, and 103 interns, i.e. achieving response rate of 98.6%.

Data analysis

Data gathered were statistically analyzed using IBM SPSS version 20 software. Internal consistency of the questionnaire was analyzed using intraclass correlation coefficient (Cronbach's alpha). Responses leading to scores of 1, 2, and 3 were categorized under problems and challenges, and responses with scores of 4 and 5 were counted under facilitating factors or opportunities.

Ethical clearance

Study was conducted following institutional ethical committee approval at JSS Dental College & Hospital Mysuru. Ref no. JSS/DCH//Ethical/RP-14/207-18 dated 26-03-2018.


  Results Top


The study includes five different groups of students, i.e. 1st year (Group I), 2nd year (Group II), 3rd year (Group III), final year (Group IV), and interns (Group V).

Mean score for the value of SA skill as a learning tool was lower (60.21 ± 4.83) among 3rd-year dental students and highest (65.26 ± 4.69) among interns with an overall mean score of 62.59 ± 5.27, the results of one-way ANOVA as presented in [Table 2] revealed that the year-wise mean score difference was statistically significant, and the post hoc test results for the same are presented in [Table 3]. The post hoc test revealed that the mean score for value of SA skills was significantly different between 1st-year and 3rd-year students (mean difference = 3.173, P = 0.001), between 2nd year and interns (mean difference = −3.699, P = 0.000), between 3rd year and interns (mean difference = −5.057, P = 0.000), and between final-year students and interns (mean difference = −3.407, P = 0.000). The value of SA skill as a learning tool was significantly higher for interns and mean difference between 2nd, 3rd, and final year was statistically significant.
Table 2: Comparison of mean score of value of self-assessment skill among dental students

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Table 3: Post hoc tests for the comparison of mean scores

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[Table 4] describes the comparison of perception of the value of SA skill as a learning tool among dental students across all the 5 years of BDS course. From [Table 3], we observe that majority, i.e. 86.4%, of interns perceived SA skill as a practice assessment for lifelong learning process. More than 70% of 1st year and interns perceived that SA helps them for better performance in assessment tests. Around 80% of the interns strongly agreed that more efforts would be put for SA activities if they were graded for the SA skills. A statistically significant number of interns (75.7%) felt that SA motivates them to read more about the subject. Nearly 70% of the 1st year and interns strongly perceived that SA helps prepare for a clinical exercise. Nearly half of the 2nd-year, 3rd-year, and final-year students and around 70% of 1st-year students and interns strongly agreed that SA improves critical thinking skill. However, the year-wise difference was not significant, and there was no significant difference in the perception of SA to make them confident to present their work to faculty for evaluation.
Table 4: Year-wise perception on value of self-assessment skill as learning tool

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[Table 5] describes the comparison of the value of SA skill for future professional practice, and it is observed that more than 80% of 1st-year students and interns strongly agreed that practicing SA would make them to become an independent learner to understand the “things they could do” and were valuable in delivering quality dental care and always would judge work first against the set criteria and standards. Almost 85% of 1st-year students and 70% of interns agreed that practicing SA would make them more competent at identifying gaps in their learning and performance and SA would help them to evaluate their work for better quality.
Table 5: Year-wise perception on value of self-assessment skill as a tool for future professional practice

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From [Table 6], we observed that nearly 40% of 3rd-year students were not sure about their ability to accurately perform SA and only less than 10% of 2nd- and 3rd-year students disagreed that their SA was not useful in their dental training.
Table 6: Perception of the nonusefulness of the self-assessment skill in dental training

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  Discussion Top


SA is an indispensable skill that oral healthcare providers must possess and utilize it on daily basis. The acceptability of SA as an educational tool is assumed rather than explored in the literature.[3] The primary aim of this study was to explore the dental undergraduate students understanding of the practice of SA. The value of SA skill as a learning tool was significantly higher for interns as compared to other undergraduate students, and the mean difference between 2nd, 3rd, and final year was statistically significant. According to a previous study on student's SA skills,[12] this may be the result that these students have experienced several years of a system where they were regulated by instructors' feedback and performance checks. Despite the fact SA skill training is generally absent from most dental curricula,[12] dental students who are intelligent, goal-oriented adult learners should be accurate in assessing their clinical skills.[25] If SA is to remain the cornerstone of continuing professional development and in determining how regulatory appraisal requirements are to be met, we need to have a greater understanding of what forms of SA are useful in determining learning needs and what impact these have on future learning activities.[3]

SA is integral to lifelong learning in the healthcare professions.[3] 86.4% of interns perceived SA skill as a practice assessment for lifelong learning process. This is in consensus with studies that have emphasized that independent SA may be an important component of lifelong learning in dental education.[5],[25] Recent American Dental Association Accreditation standards demand that “graduates recognize the role of lifelong learning and SA in maintaining competency.”[5] The intent of this standard is to ensure that academic dental institutions provide students with the necessary tools for their development into lifelong learners and that they become active participants in their own learning.[12]

Reflective analysis of the data indicated that majority of student participants did not feel adequately prepared to accurately perform SA. This perception may be attributed to the lack exposure to SA in any prerequisite coursework. While it is unlikely that students had not experienced some form of SA in their prior education, it is more likely that they did not transfer what they had experienced previously to what they were being asked to do in their new role as a student clinician.[26] In other words, they might have been more capable of self-assessing their writing than their thought processes. This line of thinking parallels findings in the BEME review, which suggested that practical tasks lend themselves to SA more readily than cognitive tasks.[3]

With reference to the second objective of present study regarding students' perception on SA and its impact over their academic and clinical performance, data analysis indicates that more than 70% of students perceived that SA aids for better performance in assessment tests, SA activities if they were graded motivates them to read more, helps to prepare for a clinical exercise, and improves critical thinking skill. To fulfill these various functions, it seems that SA must be effectively enacted in three forms: summatively, predictively, and concurrently.[26] Enacting SA summatively, a professional must reflect on completed performances both for the purposes of assessing the specific performance and for the purposes of assessing his/her abilities generally. When evaluating performance on a particular task, the professional can often assess the overall quality of the completed job as a question that may come in various forms. In the concurrent mode, SA acts as an ongoing monitoring process during the performance of a task.[27]

Ward et al.[28] implies that SA is the “ability to accurately assess one's strengths and weaknesses.” SA has been defined broadly as the involvement of learners in judging whether learner-identified standards have been met. Almost 85% of 1st-year students and 70% of interns agreed that practicing SA would make them more competent at identifying gaps in their learning and performance and SA would help them evaluate their work for better quality.

Although more than 70% of the interns strongly agreed that more efforts would be put for SA activities if they were graded for the SA skills motivating them to read more about the subject, there is no recommendation by the Dental Council of India for practicing SA as integral part of dental curriculum.

The acceptability of SA as an educational tool is assumed rather than explored in the literature. The lack of a robust evidence-base about attitudes toward self-assessed activities is somewhat contrary to their importance in practice for identifying leaning needs and maintaining competence in health professional behavior.[3] As to our knowledge and evidence from literature, this study is first of its kind in the country to focus on the attitude of the students toward value of SA as a learning tool in dental education and practice. Previous studies have emphasized the recognition of dental students as active participants in educational process and are central to changes in dental curricula and learning environment improvements.[29],[30] It is also highlighted that undergraduate dental students are required to acquire specific competences and knowledge in the 4–6 years' period of their training.[31] Interprofessional education (IPE) for collaborative patient-centered practice has been identified as a key mechanism to address healthcare needs and priorities. Faculty development can play a unique role in promoting IPE by addressing some of the barriers to teaching and learning that exist at both the individual and the organizational level and by providing individuals with the knowledge and skills needed to design and facilitate IPE. Faculty members play a critical role in the teaching and learning of IPE, and they must be prepared to meet this challenge. The need of the hour is to model teaching activities on personal experiences, together with recent educational evidence and the academic culture. Faculties need to be involved in research-oriented activities and make it more available by publishing it, more understandable by reducing educational jargon, and more relevant to the day-to-day teaching issues that dental faculty encounter in classrooms, laboratories, and clinics.

Limitations

The present study showed some limitations. Subjectivity of the responses can be a limitation. This study focused on measuring the students' perceived value toward SA while gender differences if any was not analyzed. Further qualitative analysis needs to be conducted to better understand students' attitude, abilities, and apparent inability to self-assess accurately in learning environments with a larger cohort and across different institutions. Faculty feedback regarding their opinion on the implementation of SA skills in undergraduate curriculum was not included in this study.

Recommendations

We recommend that SA needs to be used as a tool among other sources of feedback to students to provide a more complete appraisal of competence in healthcare practice. Video recordings/exercises during clinical skill performance provide the opportunity to students to reexamine the clinical skill performance to identify deficiencies in their performance with faculty feedback.


  Conclusion Top


In the context of how SA is perceived by dental undergraduates, our study suggests that the acceptability of SA is seldom explored. We can infer that attitudes toward SA may be influenced by the purpose of the SA activity itself that is whether SA is undertaken for formative or summative outcomes. The focused responses of the participants of this study underline the importance and need of training and practicing SA skills by the students in dental undergraduate curriculum shifting toward competency-based education.

Acknowledgement

The authors would like to thank Dr. Madhu B , Associate Professor and Dr.Rajeswari (Postgraduate student) Dept of Community Medicine, JSSMC, JSSAHER for their assistance in data analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Appendix 1 Top


1=Strongly Disagree; 2= Disagree; 3= Neither Agree/Disagree; 4= Agree; 5=Strongly Agree;





 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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