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Aspects of the Teaching Environment,
Student Learning, Perceived Confidence and
Feedback Practices in Dental Education
By
Albert N M Leung
BDS (Dundee), LLM (Cardiff), MA (London), FGDSRCS (Ireland),
FFGDP (UK), MGDSRCS (Ireland), MFGDP (UK), FHEA, FICD, LRSM
A portfolio of research submitted in partial fulfilment
of the award of the degree of Doctor of Philosophy by Publication
of the University of Portsmouth
University of Portsmouth Dental Academy
Faculty of Science and Health
University of Portsmouth
2020
ii
Abstract
This thesis explores, reflects, analyses and connects my portfolio of ten selected papers in
pedagogic research abbreviated below which I have published between 2009 and 2020,
details of which are on page five below.
A co-operative approach to team learning in a relaxed, dedicated primary dental care setting
is an excellent learning environment in clinical dentistry [#10(2009)]. When this learning
environment is staffed by experienced clinical teachers, the students’ learning experience is
much enriched [#9(2012)]. This environment facilitates and cultivates meaningful reflective
learning, promoting a reflective, tailored and personalised approach [#8(2013)].
Highly motivated teachers enhance the learning experience of their students and improve
their confidence in their clinical ability to treat their patients, resulting in well informed
treatment options for patients, and greater job opportunities for the dentists [#7(2017)].
In addition, a reflective environment such as the use of bespoke video vignettes enhances
reflective learning, creates the opportunity to capture and meaningfully utilise reflection-in-
action and reflection-on-action to improve learning [#6(2017)]. This enhancement in
confidence improves communication and clinical skills for the benefit of both the patients
and the healthcare professional [#7(2017)].
Confidence impacts positively on the standard of clinical dental practice. Teachers should
utilise contemporary pedagogy to help develop teaching aids [#6(2015)] to facilitate the
iii
development of students’ confidence which has a positive impact on clinical practice
[#7(2017) #5(2019)].
Appropriate, proportionate and timely feedback [#4(2018), #1(2020)] will further enhance
the effectiveness of teaching and facilitate learning. Novel feedback methods may help to
engender meaningful and sustainable feedback from students to teachers about their
teaching and how this can be improved [#4(2018)]. The continuing multifactorial
pedagogic issues arising from the delivery of the core undergraduate dental curriculum
[#2(2019)] and in the key continuing professional development arena [#3(2019)] illustrate
the need for quality feedback. On top of this, the timing, extent and quality of feedback
delivered by teachers to students are fundamentally and inextricably linked to enhancing
student satisfaction and learning which helps to raise the standards of clinical practice
[#1(2020)].
iv
Acknowledgments
I am indebted to Professor Chris Louca and Professor Graham Mills, my supervisors at the
University of Portsmouth, for their invaluable guidance, support and advice throughout the
preparation of this thesis.
I am grateful to the contributions of my fellow colleagues across the globe in clinical dentistry
and dental education whom I have the fortune to be collaborating with in the last 22 years. I
am very grateful to my co-authors and dental educator colleagues who have been involved
with the various studies included in this thesis.
I would like to pay tribute to Dr Brian Davies, my former Head of Department when I was a
Junior Lecturer at the millennium, whose infectious enthusiasm and encouragement sparked
my interests in pedagogic research. This spark has been growing steadily for the last 20 years
and pedagogic research has become an important integral part of my academic practice.
v
Dedication
This work is dedicated to Jane and Helen.
vi
Declaration
I declare that whilst studying for the degree of Doctor of Philosophy by Publication by the
University of Portsmouth I have not been registered for any other award at another
University.
The work undertaken for this degree has not been submitted elsewhere for any other award.
The work contained within this submission is my work and, to the best of my knowledge and
belief, contains no material previously published or written by another person, except where
due acknowledgement has been made in the text.
Albert Ngah Ming Leung
November 2020
vii
List of Abbreviations
ADEE Association of Dental Education in Europe
AGP Aerosol Generating Procedures
CGDent College of General Dentistry
COVID-19 Coronavirus Disease 2019
CPD Continuing Professional Development
ECPD Enhanced Continuing Professional Development
FGDP Faculty of General Dental Practice
GDC General Dental Council (UK)
GDP General Dental Practice
GDPs General Dental Practitioners
HMC Hamid Medical Corporation, Qatar
IADR International Association of Dental Research
KCLDI King’s College London Dental Institute. (Also known as King’s
College London Faculty of Dentistry, Oral & Craniofacial Sciences)
KIMS Kuwait Institute of Medical Specialization
MID Minimally Invasive Dentistry
MUB Medical University Bahrain
NAPC National Association for Primary Care
NSTA National Science Teachers’ Association
RCSI Royal College of Surgeons in Ireland
SIG Special Interest Group
UCL University College London
UK United Kingdom
1
Contents
ABSTRACT ............................................................................................................... II
ACKNOWLEDGMENTS ............................................................................................ IV
DEDICATION ........................................................................................................... V
DECLARATION ........................................................................................................ VI
LIST OF ABBREVIATIONS ....................................................................................... VII
PREFACE ................................................................................................................. 2
LIST OF PUBLISHED PAPERS SUBMITTED FOR THIS PHD DEGREE:............................. 5
CHAPTER 1: ENHANCING THE CLINICAL TEACHING AND LEARNING ENVIRONMENT IN DENTISTRY ......................................................................................................... 8
CHAPTER 2: ENHANCING CONFIDENCE TO CLINICAL PRACTICE .............................. 25
CHAPTER 3: ENHANCING TEACHING AND FEEDBACK PRACTICES ........................... 33
CHAPTER 4: OVERALL APPRAISAL AND CONCLUSION ............................................ 44
REFERENCES ......................................................................................................... 51
SCIENTIFIC PUBLICATIONS .................................................................................... 66
1. LIST OF PUBLISHED PAPERS SUBMITTED AND USED IN THE COMMENTARY FOR THIS PHD DEGREE: ................................................................................................ 66
APPENDIX 1 .......................................................................................................... 66
APPENDIX 2 .......................................................................................................... 83
APPENDIX 3 .......................................................................................................... 90
APPENDIX 4 .......................................................................................................... 96
APPENDIX 5 ........................................................................................................ 106
APPENDIX 6 ........................................................................................................ 116
APPENDIX 7 ........................................................................................................ 121
APPENDIX 8 ........................................................................................................ 131
APPENDIX 9 ........................................................................................................ 137
APPENDIX 10 ...................................................................................................... 144
APPENDIX 11: FORM UPR16 RESEARCH ETHICS REVIEW CHECKLIST ..................... 151
2. OTHER PUBLICATIONS INCLUDING PUBLISHED ABSTRACTS ............................. 152
3. NATIONAL AND INTERNATIONAL PRESENTATIONS AND INVITED TEACHING SESSIONS (2011 – NOW) ..................................................................................... 159
2
Preface
This thesis is based on my journey of research in dental education the seeds of which were
sown almost by complete accident in 1998, some twenty two years ago. A part-time teaching
position at King’s College London Dental Institute on the outreach programme in Primary
Care Dentistry including the legal aspects of dentistry became available unexpectedly. As a
general dental practitioner running my practice holding the then highest qualification in
Primary Care Dentistry from the Royal College of Surgeons as well as a Master of Laws, my
skills set was a good fit to this post. I was headhunted and invited for an interview with the
then Head of Department. The interview went extremely smoothly so much so that I learnt
from the Head of Department that his brother was a well-known concert pianist, something
which I had aspired to become before I embarked on studying dentistry in 1981, when I was
awarded a Licentiate of the Royal Schools of Music in piano performance two years
previously. When I was offered the job as a Clinical Lecturer on the spot, I accepted the offer
with no hesitation. After all, King’s College London Dental Institute was the largest
undergraduate dental school in Europe, and I was very pleased to be able to work in such a
prestigious Dental Institute.
Little did I know then, within two years of me working there, I would embark on my first
formal teaching qualification, at the Unit of Medical Education at King’s College London
Medical School, which I managed to complete very swiftly and smoothly in 2001. Almost at
the same time, I commenced my first dental education research project guided by an
extremely inspiring and knowledgeable mentor, the new Head of Department, to whom I was
very grateful for. It then took a long time and a lot of effort including collecting seven years’
data for my first paper on dental education to be published in 2009, but I have not looked
back ever since.
3
My pedagogic research profile formed a key element of my submission when I won the
prestigious Association of Dental Education in Europe (ADEE) Mature Career Dental Educator
award in 2017.
On the back of this award, I was granted a Chair in Dental Education at UCL Eastman Dental
Institute in 2017, which has, in turn, facilitated my pedagogic research and allowed me the
opportunity to co-chair a high profile Europe-wide Special Interest Group (SIG) within ADEE
researching feedback practices since 2018. I was elected Dean of the Faculty of Dentistry of
the Royal College of Surgeons in Ireland in 2020 and I fully intend to use all the opportunities
I have, to continue to enhance my output and quality in pedagogic research.
I am actively involved in devising, formulating, approving, conducting, writing up and
publishing many aspects of pedagogic research and policies in dental education which is
central to my professional life.
This thesis provides a narrative that combines ten selected peer reviewed and published
pedagogic research which I have played a significant role between 2009 and 2020. The
different chapters in this thesis illustrate a trend, direction and an intimate interplay amongst
the many generalizable and yet contextualised pedagogic factors which directly impact on the
quality of the delivery of contemporary dental education through my research.
Personally, different aspects of this work have resulted in invitations to speak, teach, deliver
seminars or workshops at different National and International arenas (e.g., General Dental
Council Overseas Registration Examinations Management Board, International Association of
Dental Research, Association of Dental Education in Europe, the Royal College of Surgeons
in Ireland, Hamid Medical Corporation Qatar, Medical University Bahrain, Khartoum
University Sudan, Peking University Shen Zhen and University College London).
4
The experience and knowledge gained from aspects of this work have also been extremely
useful in my present academic roles leading and managing an extensive change portfolio in
shaping national and international dental education as a result of COVID-19.
I believe that this body of published work entitled “Aspects of the Teaching Environment,
Student Learning, Perceived Confidence and Feedback Practices in Dental Education”
contributes to knowledge in this field and helps to raise the profile and importance of quality
dental education both in the UK and abroad.
In the appendices, all the ten papers are included in their full text format, alongside my
contributions to each of them, and their citation metrics. As it includes recent publications,
some do not have citations at present.
5
List of Published Papers Submitted for This PhD Degree:
Appendix
Title
Article Type
1
Leung, A., Fine, P., Blizard, R., Tonni, I. & Louca, C. (2020).
A quantitative study of feedback delivered by dental
teachers to dental students
Accepted for publication by the European Journal of Dental
Education, 19th October 2020
Research
Paper
2
O’Carroll, E., Leung, A., Fine, P., Boniface, D., & Louca, C.
(2019).
The teaching of occlusion in undergraduate dental schools
in the UK and Ireland
British Dental Journal, Volume 227 (6), pp 512-517
Research
Paper
3
Mirsiaghi, F., Leung, A., Fine, P., Blizard, B., & Louca, C.
(2018).
An investigation of general dental practitioners'
understanding and perceptions of minimally invasive
dentistry.
British Dental Journal, Volume 225 (5), pp 420-424
Research
Paper
6
4
Fine, P., Leung, A., Francis, J., & Louca, C. (2018).
The Use of Picture Cards to Elicit Postgraduate Dental
Student Feedback.
Dentistry Journal, Volume 6 (7), doi:10.3390/dj6020007
Research
Paper
5
Fine, P., Leung, A., Bentall, C., & Louca, C. (2019).
The Impact of Confidence on Clinical Dental Practice.
European Journal of Dental Education, Volume 23 (2), pp 159-
167
Research
Paper
6
Davies, B., Leung, A., Dunne, S., Dillon, J., & Blum, I. (2017).
Bespoke video vignettes - an approach to enhancing
reflective learning developed by dental undergraduates and
their clinical teachers.
European Journal of Dental Education, Volume 21 (1), pp 33-
36.
Research
Paper
7
Fine, P., Louca, C., & Leung, A. (2017).
The Impact of a Postgraduate Learning Experience on the
Confidence of General Dental Practitioners.
Dentistry Journal, Volume 5 (2), pp 16, doi:10.3390/dj5020016
Research
Paper
7
8
Davies, B., Leung, A., & Dunne, S. (2013).
Why do general dental practitioners become involved in
clinical teaching? A pilot study exploring the views of part-
time practitioner teachers, King's College London.
British Dental Journal, Volume 214 (9), pp 461-465
Research
Paper
9
Davies, B., Leung, A., & Dunne, S. (2012).
So how do you see our teaching? Some observations
received from past and present students at the Maurice
Wohl Dental Centre.
European Journal of Dental Education, Volume 16 (3), pp 138-
143
Research
Paper
10
Davies, B., Leung, A., & Dunne, S. (2009).
Perceptions of a simulated general dental practice facility -
reported experiences from past students at the Maurice
Wohl General Dental Practice Centre 2001-2008.
British Dental Journal, Volume 207 (8), pp 371-376
Research
Paper
Notes:
For practical reasons, to highlight the roles these 10 selected papers play within the thesis,
whenever they are quoted in the text, they are referenced and referred to by the
corresponding figures “#1” to “#10”, followed by the year of publication in brackets. Any
other references quoted in the text are as per the usual convention.
8
Chapter 1: Enhancing the Clinical Teaching and Learning
Environment in Dentistry [#10(2009), #9(2012), #8(2013), #7(2017), #6(2015)]
The research question for this chapter was to investigate aspects of a good clinical teaching
environment, and the human and pedagogic factors which would enhance this environment.
[#10(2009)] was an in depth 7 years’ longitudinal co-operative investigation into how
undergraduate dental students perceived the value of a simulated outreach general dental
practice centre at King’s College London Dental Institute (KCLDI), the first one in the UK,
where comprehensive patient care was being taught and delivered. This was a large scale
pioneer study which established that a team based approach to co-operative learning led by
well-trained and experienced practitioners was pivotal to the success of the teaching model as
part of dental students’ transition from novice to expert. This is echoed in #9(2012),
#8(2013), and #5(2019).
Ironically, recent dental school graduates are often criticized as not as good as they used to be
(Cabot & Radford 1999). Being trained to the level as “advanced beginners” (GDC, 2015a)
when they qualify, graduates may not always be ready to embark on independent primary
care dental practice, or even to undertake an extra year’s post-qualification Foundation
Training to be able to practice unsupervised within the National Health Service in a primary
care environment (Ali et al, 2014), an environment where over 90% of clinical dentistry is
delivered to the patients in the UK (NAPC, 2018).
However, it can also be argued, that current dental school graduates are actually at least as
good as their predecessors were before, if not better, the difference being that they have been
9
trained on contemporary concepts and techniques (Lynch et al, 2006). As clinical concepts
and treatment processes evolve and diagnosis advances, students have been adapting to these
constantly evolving concepts and techniques which are vastly different from the traditional
approaches to clinical dentistry (Lynch et al, 2010). On top of this, students also come under
a different teaching and learning environment [#10(2009)], hence compounding this potential
misconception.
Irrespective of what students learn or are expected to learn in contemporary clinical dentistry,
there is clear evidence that they require and do benefit from a calm, relaxed and co-operative
learning environment [#10(2009)], and quality teaching delivered by the teachers [#9(2012)].
I surveyed final year dental students’ perceptions over 7 years of their learning experience at
the UK’s first ever dedicated simulated primary dental care [general dental practice (GDP)]
outreach teaching environment situated at the Maurice Wohl GDP Centre at King’s College
London Dental Institute (KCLDI) using anonymous questionnaires [#10(2009)]. I found that
a co-operative team learning approach (Davies, 2000) in a dedicated primary dental care
setting was perceived extremely positively by the students [#10(2009)].
This model was run as an independent, but well supported clinical outreach teaching unit
(The Maurice Wohl GDP Centre) in a separate building approximately one hundred meters
from but as part of KCLDI, staffed both by experienced general dentists, academics and
specialists. It practiced four-handed dentistry in self-contained surgeries with the support of
appropriately trained dental nurses, treating a case mix of adult patients requiring a range of
comprehensive dental care. The Centre espoused a total patient care approach with the
student clinician planning, integrating and treating all different disciplines of work required
10
by the patient under a close support and reflective learning environment [#10(2009),
#9(2012)].
99% of respondents (n=135) indicating that they enjoyed their clinical treatment and learning,
and 96% of respondents expressing satisfaction with the teaching regime. Overall, students
reported their keenness for training in this outreach learning paradigm in preference to the
traditional dental school open clinic environments, with increasing confidence in their
abilities in clinical practice, the holistic management of patients, and in developing reflective
practices. [#10(2009)]
Rich qualitative data generated from the questionnaire responses identified six key themes
with this teaching model which enhanced the clinical learning environment in a primary
dental care setting. The six themes were
a) availability of close support four-handed dentistry to help the smoothness of clinical
procedures,
b) teachers’ provision of insight into practice management increased students’ preparedness
for independent practice and post-qualification training,
c) facilitation of effective teamwork in a friendly environment [#9(2012) and to be further
addressed in Chapter 2], was conducive to learning and confidence building [#7(2017),
#5(2019), and to be further explored in Chapters 2 & 3],
d) practicing in an environment closely simulating real life primary care clinical practice
which students would face once they qualified as a dentist,
e) providing a setting specifically designed to hone into developing practice communication
skills, and
f) providing a relaxed, close support, bespoke co-operative learning environment to facilitate
the swift acquisition of clinical skills and acumen [#10(2009)].
11
Many of these six desirable features were espoused or present in outreach setups at other
dental schools, such as in Manchester with a community outreach setting within the city
(Eklind, 2005), in Kay as foundation Dean setting up the outreach primary care clinics for the
then new Peninsular Dental School (Kay, 2007), in Leeds concerning block placement in a
restorative based primary care specific environment (Craddock, 2008) and in Cardiff, with
students spending a rotation of 12 months in a community based environment out with the
dental school (Lynch et al, 2010).
The characteristic “nurturing”, “hands-on” and “skills uplift” elements identified at the
KCLDI outreach [#10(2009)] compared very similarly with the Norwegian findings (Eriksen
et al, 2011) in Tromso, which had a similar operational background where dental care was
mostly delivered in a primary care setting. Although it serves a vastly dispersed population in
remote locations far away from the University in Tromso, the set-up of outreach centres both
for training dental students and health service delivery to achieve “a school without a wall”
(Eriksen et al, 2011), operates remarkably similar to the KCLDI outreach some 1,400 miles
away [#10(2009)].
This was therefore clear that my findings in [#10(2009)] could be generalizable and
applicable across the many different outreach settings across national boundaries.
Significantly, the same principles demonstrated in [#10(2009)] have continued to be applied
at KCLDI since the publication of this paper. In addition to the longstanding Maurice Wohl
General Dental Practice Centre outreach, the Institute developed a further extremely
successful dental outreach teaching facility in 2011 in a landmark collaboration with the
Portsmouth Dental Academy at Portsmouth University (Radford et al, 2014). The two
12
facilities together serve all KCLDI’s 160 final year undergraduate dental students every year,
with very notable successes to date ([#6(2015)], Wanyonyi, 2015, Radford & Hellyer, 2017).
#10(2009) therefore astride the forefront as an integral element of the literature offering
consistent and triangulated reassurances that flexible outreaching teaching away from the
main dental institutes deliver well perceived comprehensive clinical learning experiences in a
close support environment close to where patients live. There is no doubt that this paradigm
delivers the requisite learning outcomes in line with the expectations of the General Dental
Council (GDC) in the United Kingdom (GDC, 2015b) for a newly qualified dentist. This is
also in line with the key concept of “teaching excellence” of the Association of Dental
Education in Europe’s (ADEE) suggested graduating European dentists’ curriculum
framework (Field et al, 2017) adopted throughout the European Union and beyond (ADEE
2019).
By “allowing the learner to be a stakeholder in the learning process” [#10(2009)], “ to take
ownership and responsibility for their decision making” [#10(2009)] developed in a “co-
operative learning environment” [#10(2009)], the essential ingredients required to enhance
the clinical learning environment in dentistry to cultivate a congenial paradigm where rapid
learning through a modified apprentice approach (Benner, 1982) is espoused.
The outreach teaching model is therefore an excellent medium to cultivate a quality clinical
learning environment, echoing the wider arena and context across Europe and beyond as per
the Association of Dental Education in Europe (ADEE) (Field et al, 2017).
A cornerstone of the design of this extended learning environment was to have self-contained
surgeries (Architecture and Design Scotland, 2014) where students learn in a calm, quiet,
13
standalone, secluded, self-contained holistic environment closely supported by dedicated
teachers and dental care professionals.
For efficient use of space, circulation, ambience, cost effectiveness to be able to fit as many
dental chairs into a fixed open space, many contemporary student clinics have been designed
to be open-plan clinics (Architecture and Design Scotland, 2014)
Concerning the traditional pedagogically well perceived self-contained surgery design
espoused in #10(2009), the COVID-19 pandemic with an alarming community infection rate
associated with the healthcare setting (Anderson et al, 2020), brought home a clear message.
The message is, that the self-contained surgery set up strongly advocated in #10(2009),
#9(2012) and #8(2013) would be the ideal setting to carry out individual and personalised
clinical teaching of dentistry because it achieves natural social distancing to minimise the risk
of spreading the virus where dental students can be taught whilst crucial oral care is
simultaneously delivered to the patients (CGDent/FGDP, 2020).
The findings of the environment which enhanced clinical learning as in #10(2009) cogently
led me to investigate two missing links to this equation, namely the quality of teaching
required to bring about satisfactory learning in this enhanced learning environment
[#9(2012)], and an understanding of the reasons why these clinical teachers chose to teach
[#8(2013)] in this environment.
#9(2012) explored student perceptions of undergraduate clinical teaching delivered at the
outreach general dental practice centre at KCLDI with mixed data collected using on-line and
paper-based questionnaires, and semi-structured focus groups. The triangulated findings
indicated that students were overwhelmingly positive about this primary care based approach,
14
the close support teaching method, the closeness it was with the real world in general dental
practice. and the positive professional relationship between the teachers and the students.
Students overwhelmingly indicted that this facilitated learning and deep understanding of the
nuance of comprehensive patient care with a supportive and nurturing teaching style,
resonating with #10(2009), #8(2013) and #5(2019).
It was very clear that a calm, “friendly, non-threatening teaching environment is perceived by
students to be a good learning environment”; and that students also appreciated “the time and
space given to them to take ownership of their learning” [#9(2012)].
This concept was similarly expressed and reinforced by Garcia et al (2013), that with the
advent of “personalised medicine/medical treatment” it was vital that clinicians were
“assigned a fully equipped (self-contained) suite together with individual nursing support”,
and be trained “in a student centred, fully supported and dynamic environment to extract
maximum benefit for the learner”. This is a sound endorsement of my thematic findings in
#9(2012), that students treasure a fully supported learning environment where they are
“valued and respected as individuals….. with a sense of belonging”.
The above also reaffirmed the findings in #10(2009), that self-contained, fully equipped
clinical suites with individual nursing and reception support “would be an excellent
environment where students perceived as extremely desirable in terms of acquiring the skills
and acumen for clinical dentistry”.
Not only would this paradigm suit students’ natural learning styles and thereby cultivating
satisfaction for “real and rapid learning” (Wang and Liu, 2019), the environment which this
satisfactory teaching style is based upon would also be regarded very satisfactorily in the
15
current climate of the COVID-19 pandemic (Bedford et al, 2020), where “it is a chance to
step back and think about learning in a fundamentally different way”, and the circumstances
“in which real learning is visible” (NSTA, 2020).
It was ironic that the self-contained surgeries set up so much in favour by the students in
#10(2009) to be the ideal clinical learning environment as supposed to the widely used open-
clinic design, would also be the clinical set-up of choice (COVID-19 SOP, 2020) for Aerosol
Generating Procedures (AGPs) (SDCEP, 2020), delivering dental care to patients considering
the infection control risks during the COVID-19 pandemic (Ren et al, 2020).
Much of the clinical learning environment would be greatly complimented in the pedagogic
paradigm espoused in #10(2009) (dentistry in a close-support primary care focused clinical
environment), #9 (pedagogy based on good learning and teaching principles) and #8
(attracting well motivated teachers to teach and facilitate students to manage the challenges
encountered).
The finding above resonates with aspects of educational innovations including the
appropriate design and use of accommodation set up for teaching as per Lim et al (2014),
who showed that a well set up and comfortable environment promotes student learning.
These also reflect the pedagogical beliefs, as per Tondeur et al (2017), who investigated that
educational technologies, premises and teachers’ dedications are vital to the success of this
environment. Furthermore, in “developing reflection and critical thinking of students”, a key
qualitative theme identified in #9(2012), this main objective is further complimented with the
findings of #8(2013), with an overall response rate of a very respectable 78% and in line with
other similar non-incentivised surveys (Asch et al, 1997). #8(2013) also shows that a key job
16
satisfaction indicator for a good teacher is in their abilities is in “developing a reflective
practitioner”.
Combining the above in respect of #10(2009), #9(2012), and #8(2013), it is therefore logical
to conclude that in the COVID-19 environment and consequences the world is in at the time
this thesis is prepared and written, these three papers do reinforce compliance with
contemporary good practice in terms of minimising the spread of aerosols, reinforcing
infection prevention and control, and minimising cross-contamination, agreed by
CGDent/FGDP( 2020). Such a set up in teaching and learning would also support the notion,
that for the students to fully utilise the learning opportunities in the clinics, that it would be
important for their clinical teachers to know them well [#9(2012)], coupled with the
dedication and professionalism of these teachers as shown in #8(2013).
Apart from a high quality bespoke environment [#10(2009)] with high quality teaching
[#9(2012)], another vital ingredient to support and maintain this congenial exemplar in
dentistry is the continual availability and retention of quality teaching staff, which was
exactly the reason why I carried out the next piece of my pedagogic research in #8(2013).
#8(2013) highlighted the vital roles played by part-time faculty members in delivering
clinical teaching. I carried out a mixed method survey of all 40 part-time clinical teachers at
King’s College London Dental Institute investigating the reasons why they were involved in
teaching and to identify the challenges they faced. Although a majority of them would see
clinical teaching as a long-term career, a significant minority were dissatisfied mainly due to
the perceived lack of career development and a minority due to remuneration. #8(2013)
illustrated that formal training in teaching skills was vital to facilitate these part time teachers
to deliver the required standard of teaching and for their job satisfaction.
17
The findings from this study also complemented those from #10(2009), #9(2012), #7(2017)
and #1(2020), which showed that competency and satisfaction of teachers would be a vital
and indispensable ingredient for delivering good pedagogy, echoing Fish and Twinn (1997).
My finding in #8(2013) was that UK dental schools’ teaching would collapse without the
contributions of the part-time dental practitioner teachers, who made up a large proportion of
the clinical teaching staff at the dental school. This echoed similar findings made by
Craddock (2009) and Lynch et al (2010). With 23% of these teaching staff leaving within a
year of starting and only 31% of them staying for 5 years of more [#8(2013)], measures to
retain the service of valuable staff were therefore very important.
It was quite surprising to find that in the context of King’s College London Dental Institute,
remuneration did not feature highly at all but instead teachers vastly valued “a proper title
and a viable career pathway” as the main reward. This was a major factor for retaining their
service and loyalty, challenging the traditional ad hoc approach to the sustainability of
clinical teachers that for so long had underpinned the stability of the system.
Gamble Blakey et al (2019) took a similar approach investigating a multi-national cohort of
subjects and reinforced much of my findings in #8(2013), that salary might not be as high an
issue regarding the retention of clinical teachers, that their interests and keenness in teaching
were major factors in positively influencing job satisfaction and in determining how long
they would stay in their posts. Formicola (2017) showed similar findings of a survey of dental
care professionals. However, other studies such as Pacanins (2017) suggested that
remuneration was indeed an important factor for retaining staff, in contrast to my findings in
#8(2013).
18
For the successful delivery of dental education, it is important to have a satisfactory setting
[#10(2009)], an optimal quality of teaching [#9(2012)], with motivated, keen, and
knowledgeable teachers, cultivating the paradigm for natural learning [#8(2013)]. This is
because these are important factors to cultivate knowledgeable, reflective, empathetic and
well supported practitioners as shown by de Cossart and Fish (2005).
Concerning the practice of dentistry in the UK as per the provisions of the Dentists Act 1984
and the Orders made under it, since 2018, Enhanced Continuing Professional Development
(ECPD) for the dental profession (GDC, 2018) has been a requirement compared to the
General Continuing Professional Development required before then (GDC, 2013). The ECPD
requirements encourage dental professionals to enhance their knowledge and understanding
linked to “development outcomes” and “reflection in learning” as per the requirement of
enhanced CPD (GDC, 2018) in a confident, competent contemporary manner throughout
their professional careers in dentistry.
It was with this consideration in mind, that my pedagogic research journey took me next to a
twin track approach to address the above. Firstly #6(2017), which investigated bespoke video
vignettes as an approach to enhancing reflective learning, development by students in
collaboration with their teachers. Secondly #7(2017), which investigated the impact of a
bespoke postgraduate learning experience on how it enhanced the perceived confidence of
general dental practitioners (GDPs) in their abilities to learn and to offer better patient care.
[#7(2017)] also explored the relationship between participation in a learning experience and
the ensuing change in perceived confidence, and demonstrated a close link between them in
the context of a bespoke Masters in Restorative Dental Practice at UCL Eastman Dental
19
Institute. The findings in #7(2017) also echoed #8(2013), #9(2012), in that perceived
confidence was an important ingredient to facilitate clinical knowledge and performance,
particularly for those undertaking postgraduate dental programmes.
#6(2017) studied the selective use of video to support the reflective processes to enhance
learning in undergraduate dentistry. Carefully compiled bespoke video vignettes were used to
demonstrate how particular clinical procedures were undertaken and the challenges faced. A
video also captured the processes of reflection-in-action and reflection-on-action (Munby,
1989) by the students whilst aspiring to achieve as close to the “gold standard” as possible.
Sharing and discussing these vignettes in tutorials with further reflection whilst facilitated by
clinical teachers was perceived extremely well by the students who reported huge real life
benefits boosting confidence [#7(2017)] and competence [#10(2009), #9(2012)], with
extremely positive feedback, reinforcing the findings in [#1(2020)], which will be discussed
in Chapter 3 of this thesis.
The following two papers which involved both undergraduate and postgraduate students
[#7(2017) and #6(2017)] were conducted over the time when I moved jobs from King’s
College London Dental Institute to University College London Eastman Dental Institute. At
the former, undergraduate students were utilized, and at the latter, postgraduate dental
students were used in the studies. These studies investigated the role of pedagogies using
bespoke video vignettes which enhanced reflective learning in an undergraduate clinical
environment [#6(2017)]. It also investigated aspects of perceived confidence in clinical and
communications skills in respect of a flexible, but structural postgraduate learning experience
in a Master’s programme [#7(2017)]. This was in recognition that irrespective of whether the
20
learning environment was for undergraduate students or postgraduate dentists, the potential
for different interventions to improve the learning environment was the same.
It was clear in #6(2017), that “the development of an enriched contextualized materials bank
(in terms of generating bespoke video vignettes) allows for the analysis of best practice which
can then be discussed, meaningfully reflected upon and refined”. In other words, #6(2017)
reinforces the overall findings in #9(2012), #8(2013) and #7(2017), that a natural, relaxed,
unthreatened and well analyzed quality teaching environment in clinical dentistry would
cultivate genuine rapid and reflective learning, agreeing with de Cossart and Fish (2005), on
nurturing the reflective aspects of learning.
A clear and important qualitative theme emerged from the 122 statements generated from the
20 respondents engaged in #6(2017) who produced these well rounded video vignettes to
help with their learning, that “the bespoke learning episodes and environment cultivated
through these vignettes reinforce learning in a natural, meaningful and reflective way”
[#6(2017)]. These were clearly in agreement with Schon (1987) who showed, that
“practitioners are (reduced to) instrumental problem solvers who select technical means best
suited to a particular purpose”, since “most professional problems are not routine at all;
instead they are messy, indeterminate situations.”
The above also clearly implied, that a purely technical approach in learning (as with much of
clinical competencies in dentistry) could destroy the very heart and soul of genuine modes of
reflection-in-action and reflection-on-action types of learning. It is these two aspects that
Schon (1983) championed as a summit of unadulterated quality learning, by being the heart
and soul of it. These notions were similarly raised by Fish and Twinn (1997), about the ethos
and culture needed in a clinical environment to meaningfully exercise reflective learning, and
21
the value of “recording observations” to preserve “the rich texture of human interaction and
the quality of the work”.
The findings in #7(2017) support that the postgraduate learning environment studied was
“advantageous for building confidence, citing ….the opportunities to learn new skills and
incorporate them into clinical practice”. Moreover, it is “the development of self-efficacy in
the participants (which) provided the motivational support for individuals”; rounding the
circle between confidence and self-efficacy as per Bandura (1993).
The importance of these human and technical interactions which would have an indelible and
direct impact on “enhancing reflective learning” [#6(2017)] and confidence [#7(2017)],
according to Kinsella (2010), are often overlooked by the teachers, thereby creating “theory
practice gaps” as a result of teachers not utilizing all the teaching aids available (such as
videos, recording, photographs, and perhaps picture cards [#4(2018)]).
The use of these teaching aids could have further facilitated Schon’s (1983) theories of
reflection-in-action to effect professional development, similar to my findings in #6(2015)
and #7(2017). Mickleborough (2015) suggested that healthcare professionals should consider
“asking different questions (and using different mediums)” and utilize intuition along with
technical knowledge. This implies that the purpose of teaching would be “to foster intuition
in our professional education” (Mickleborough 2015) to allow practitioners to develop more
skills by being more confident [#7(2017)] and competent, linking feedback practices into the
equation.
Another key thematic finding in # 7(2017) was a clear increase in confidence and self-
efficacy following the education intervention, which impacted positively on the learning
22
experience, with increased motivation, and an uplift of the repertoire of clinical dentistry in
practice. My findings resonated that of Blum (2010), who found in the context of a high
fidelity nursing paradigm, that students’ perceived that confidence was noted to be hand-in-
hand with their competence to deliver (Clanton et al, 2014), particularly if the learning
occurred in a complex clinical setting, agreeing with Hall & Kiesners (2005).
Linking back into using bespoke video vignettes as an approach to enhance reflective
learning, another key thematic finding in #6(2015) was that video clips enhanced the quality
of reflection-in-action and reflection-on-action. This develops confidence as shown in
#7(2017), particularly via “small group clinical seminars …. to further inform practice… and
enhance better clinical decision-making” [#6(2015)].
My findings above were similar to that of Kinsella (2010), which agreed with and
additionally reflected on the work of Schon (1983), where he found that “the artistry of
professional practice involves tailoring theoretical and research-based knowledge to fit the
circumstances”. In other words, the use of video vignettes in my study “facilitated capturing
elements of reflection-in-action, and reflection-on-action typically found during every day
clinical practice” [#6(2015)], boosting self-confidence as shown also in #7(2017). These
findings agree with Thompson and Pascal (2012) who referred to “active... and participative
learning” referred to with the concept of delivering total patient care in #10(2009), thereby
echoing the latest learning outcomes for dental professionals (GDC, 2015a).
Relating aspects of reflective practices and perceived confidence [#7(2017)] was the next
direction of travel for my research, moving from an undergraduate to a postgraduate dentistry
environment. In a postgraduate learning environment, learners are already fully qualified
dentists. As their experience in dentistry increases, many of them would choose to undertake
23
formal postgraduate education (Bullock et al, 2020). [#7(2017)] investigated the perceived
confidence of practitioners who have undertaken structured postgraduate learning in
restorative dentistry, which itself would serve as a link to the next phase of my work
investigating the impact of confidence on clinical dental practice [#5(2019)].
In the context of #7(2017) and #5(2019), the broad meaning of confidence as an ordinary
English word was adopted. Confidence was defined as “a feeling of self-assurance arising
from an appreciation of one’s abilities or qualities” [Oxford English Dictionary, 2020]. In the
context of education and clinical dentistry as in my research, Bandura (1986)’s description of
confidence was taken into account, that confidence in clinical practice could be looked upon
as “self-efficacy”, described as “People’s judgement of their capabilities to organise and
execute courses of action required to attain designated types of performance”.
In other words, confidence relates to the perceptions of the judgement call to affect the
required professional to the standards required (GDC, 2015a) to discharge the required duty
of care [As per the legal cases of Bolam (1957) and Montgomery (2017)]. This would be the
key strategy which links #7(2017), the impact of a learning experience on confidence, with
#5(2019), the impact of confidence on clinical dental practice. The pedagogic implication of
these factors will be explored in the next chapter of this thesis.
Conclusion
A co-operative approach to team learning in a relaxed, dedicated primary dental care setting
would be an excellent learning environment for clinical dentistry[#10(2009)]. A clinical
environment which simulates a real comprehensive close support primary care dentistry
24
paradigm has been confirmed to be well received and highly desirable by students
[#10(2009)]. When this learning environment is staffed by experienced clinical teachers
[#10(2009)], the students’ learning experience would be much enhanced [#9(2012)]. This
underlies the fact that the right environment and quality teaching would be the two
indispensable factors which facilitate meaningful learning in clinical dentistry [#9(2012)].
The combination of a learning environment and quality clinical teaching would facilitate and
cultivate reflective learning [#8(2013)], thereby promoting a tailored, deep and personalised
approach [#8(2013)]. This “teacher intensive” method is perceived by students as being
valuable and trusted [#8(2013)] and can be a real positive motivating factor as to why dentists
might wish to become involved in clinical teaching [#8(2013)].
Highly motivated teachers in such environments would enhance the learning experience of
their students irrespective of whether they are in an undergraduate or postgraduate
environment [#7(2017)], where the impact to students is profound and positive [#7(2017)].
Students who have experienced this paradigm reported increased perceived confidence in
their clinical ability to treat their patients, resulting in well informed treatment options for the
patients, and greater job satisfaction and opportunities for the dentists [#7(2017)].
Coupled with a high quality reflective environment such as the use of bespoke video
vignettes as an approach to enhance reflective learning [#6(2017)], the opportunity to capture
and meaningfully utilise reflection-in-action and reflection-on-action would promote
meaningful learning [#6(2017) in a resounding manner. This will in turn boost the confidence
of the practitioner and impact very positively on their learning experience [#7(2017)]. The
increase in confidence manifests itself in better communication and clinical skills, for the
benefit of both the patients and the healthcare professional [#7(2017)].
25
Chapter 2: Enhancing Confidence to Clinical Practice [#7(2017), #5(2019)]
The research question for this chapter was to investigate the enhancement of confidence in
the clinical practice of dentistry, and how it might positively impact on the clinical teaching
and learning environment.
Confidence has been defined as “freedom from doubt, belief in yourself and your
abilities”(Oxford 2020). It is “content specific” (Pajares, 1994) and a “good predictor for
academic achievements” (Stankov et al, 2014). Confidence as a belief “is also important as a
concept because it closely and proportionately relates to actual competence” (Stankov et al,
2014).
In the context of my research presented in this thesis, dentists attending postgraduate
programmes within an optimal clinical environment [#9(2012), #10(2009)], with good
teachers [#8(2013), #9(2012)], and approaches which facilitate reflective learning [#6(2015)],
are likely to find confidence being nurtured in their clinical practice through this process
[#5(2019)].
The enhancement of perceived increases in confidence is important for clinical practice, as
clinical professionals carry out their professional tasks more effectively and comfortably
when they perceive themselves to be confident [#7(2017)]. My findings echo Stankov et al
(2014), who convincingly argued that “confidence is the best non-cognitive predictor of
academic achievements” by providing an “end goal” to motivate learners. In other words,
Stankov et al (2004) indicated by the same token, that the more confident one feels about
achieving the end goal, the more competent one is likely to be.
26
In the context of my work [#5(2019), #7(2017)], perceived confidence expressed at the
material time by the participants was not tagged to the actual progression and achievements
within the course to directly assess competence against the programme’s intended learning
outcomes. Despite this, the findings of Stankov et al (2014) demonstrated above resonate
with me about the link between confidence and competence.
In respect of the clinical practice of dentistry at a postgraduate level as in [#5(2019),
#7(2019)], all learners are already fully qualified dentists practising in their own rights. As to
their postgraduate learning experiences, the unfettered qualitative investigations on the many
aspects of perceived confidence in this context at #5(2019) and #7(2017) were important.
This was because participants knew they could freely express their genuine opinions on their
confidence, without having to worry about their perceptions being checked afterwards against
their actual achievement (competence). This was crucial as they could otherwise have held
them back from freely expressing their perceived confidence, the crux of the findings in
#5(2019) and #7(2017), limiting the validities of these two pieces of work.
As per Stankov et al (2014), it would be reasonable to presume a direct and proportionate link
between perceived confidence and the level of competence achieved in [#5(2019)], following
one or more stages of the Restorative Dental Practice Master’s programme undertaken by the
participants. This also echoed Elzubeir and Rizk (2001), that confidence was a reliable
predictor of success or competence.
Lee (2009) found that the learning styles might be different in different individuals to achieve
the same competency, but the fundamental principle as per Leung and Bond (2009), was that
understanding the beliefs and confidence were key markers for success (competence). These
27
aspects resonated with my findings in [#5(2019)] and reassured the intimate correlations
between expressed confidence and actual competence following the conclusion of the
educational intervention.
Despite the concerns that some may have with insider research (Saidin & Yacoob, 2017), the
use of insider researcher in #5(2019) and #7(2017) greatly facilitated the acquisition of subtle
key data for the research. This was because in the context, insider researchers had a deep
understanding and knowledge of the subject and these skills were essential as per Dwyer et al
(2009) to be able to conduct meaningful research in this framework and environment. Their
understanding and ability to fully utilised the research tools were instrumental in the context
as their ability to detect and observe the nuances in this specialised paradigm of a small,
highly selective programme within the field of Restorative Dental Practice.
Both #5(2019) and #7(2017) demonstrated increased perceived confidence through learning
which has the potential of changing insights of clinical practice for the better. By examining
how changes in confidence influence the clinical practice of the participants during and
following an extended period of postgraduate training, the increase in confidence to the
practitioners has been firmly established [#5(2019)].
It also showed that a lack of confidence was a primary driver for practitioners to attend
postgraduate training courses, because “they perceive a need to enhance confidence in their
clinical skills and knowledge, their ability to treat more complete cases and desire to develop
higher self-efficacy” [#5(2019)].
[#7(2017)] demonstrated that there is a general trend “towards individuals becoming more
confident after a prolonged period of study”. This is hardly surprising of an education
28
intervention and the positive knowledge and effect which it brings to the practitioner having
undertaken such studies “in an interactive social environment” [#5(2019)].
These findings agree with the Social Cognitive Theory, where “ human behaviour is
extensively motivated and regulated by the on-going application of self-influence” (Bandura,
1986). With “technological changes that are transforming the nature and scope of human
influence; [and] analyzes the determinants and processes governing personal and social
change” (Bandura, 1986).
This complex picture illustrates why perceived confidence [#5(2019)] is so important in
effecting rapid cognitive learning in “positively influencing personal standards and effective
self-reaction” (Bandura 1993). This concept of confidence and self-efficacy through learning
experience as in “With confidence, I can justify my treatment plan which is evidence based”
[#7(2017)] resonates with the literature discussed here. In relation to confidence and self-
efficacy, “peer learning has a positive impact on me (confidence) because I am always
inspired to do my best…. and I know I have improved my skills (competence)” [#5(2019)].
With thematically analysed qualitative data on confidence as per Sander and Sanders (2002)
who measured confidence in academic study, the enhancement in confidence with time and
the right environment in clinical practice “encourages direct skill acquisition through a
positive impact on motivation” [#7(2017)]. This has a genuinely positive impact on the
breadth and depth of clinical practise offered through “increased confidence to take on bigger
cases that I used to have to refer” [#7(2017)]. It demonstrates the clear value appropriate
education intervention has in helping to improve standards (competence).
29
Both #5(2019) and #7(2017) investigated students from the Masters’ in Restorative Dentistry
Programme at UCL Eastman Dental Institute where I am the Programme Director. To
minimise potential bias due to the inherent power relation that existed, where the “division of
roles between researcher and participant is dichotomous, constant, uniform and pre-
determined” (Karnieli-Miller et al, 2009), I was not directly involved in any aspects of
collecting qualitative data from the students.
Consideration was made of the potential drawbacks using insider-researchers as per Trowler
(2011) to researching one’s Institution as an insider. However, due to the very specialised and
specific nature of the programme, it was decided on balance insider researcher would still be
needed for #5(2019) and #7(2017).
Careful steps were undertaken, including minimising the potential for implicit coercion of
participants, confidentiality, “identifying potential biases and to ensure transparency, thereby
neutralising the role duality (of insider researcher)” as per Brannick and Coughlan (2007) and
agreed by Dwyer and Buckle (2009).
Fleming (2018) addressed similar issues faced by #5(2019) and #7(2017), by “recognizing
the challenges using an insider approach and attempt to resolve or minimize the impact of
these”. It was on this basis, that the data generated and collated from #5(2019) and #7(2017)
were truthfully reported and analysed, forming the basis of the discussion and conclusion
generated therein for these two pieces of published work.
In a sense, #5(2019) which was published almost two years after #7(2017), could be viewed
as its extension, covering twice the length of the timeframe, investigating the impact of
30
confidence on clinical dental practice to a greater depth. However, the key findings in
#5(2019) consolidated and advanced those derived from #7(2017).
In respect of the key themes of confidence in clinical dental practice, it was clear that
undertaking postgraduate restorative dentistry training by going through one or more stages
of the Restorative Dental Practice Master’s programme, participants identified increases in
confidence (and self-efficacy, as espoused by Bandura [1993]). They also reported an
increase in their abilities to undertake dental procedures, confidence in communication skills,
and their abilities to undertake more complex restorative clinical procedures when these
patients would otherwise have had to be referred on, in agreement with Eaton et al (2011).
“Learning is a social process. Relationships matters” (Sturgis, 2019), whilst nurturing a
culture of learning and inclusivity [#5(2019)]. Using this as a means to cultivate competency
for students, “Teachers need to be able to assess the levels of confidence and make
improvements when it is low…….. address the issue of misplaced over-confidence”
[#7(2017)]. This inherent intimacy in the relationships between perceived confidence, self-
efficacy and professional performance (competency) as per the nuances of the themes/sub-
themes identified in [#7(2017)] and reflected in [#5(2019)] were very interesting and perhaps
unexpected findings.
This was interesting because reading though [#7(2017)] and [#5(2019)] separately as
individuals papers, even though I had been closely involved with both papers, the relationship
described above simply did not ring true. However, when the two were studied together,
particularly when the thematic findings were digested and analysed in conjunction with each
other, this innate but sublime relationship amongst confidence, self-efficacy and competency
resonated with me.
31
Synthesising them, I noticed an unintended and unreported finding when triangulating the
qualitative themes of [#5(2019)] and [#7(2017)]. It was quite clear to me, that there was only
a thin line between one’s perceived confidence (and self-efficacy as per Bandura (1986)), and
the competency achieved, following a well-structured and well supported postgraduate
learning experience resonating with #10(2009), #9(2012) #8(2013), already discussed in
Chapter 1 of this thesis. In this particular paradigm for [#5(2019) and #7(2017)], it was the
Restorative Dental Practice Master’s at UCL Eastman Dental Institute although this could
arguably be generalizable to include other comparable programmes as well.
There is no doubt that participation in a postgraduate learning experience enhances
confidence which helps to nurture competence in clinical practice [#7(2017)]. An increase in
confidence impacts positively on clinical practice [#5(2019)]. However, it is also important to
put these two factors into perspective and to bring in the wider area of professionalism
(Evans, 2008) and compliance (GDC, 2014) into the equation.
In the wider area of clinical dental education, irrespective of whether one is an insider-
researcher, teacher, mentor, peer tutor, tutee, or indeed in any other role, it is imperative that
genuine concerns about any healthcare workers’ professional performances are raised and
reported where necessary, irrespective of any individual’s level of perceived confidence. The
ethical guidelines issued by the General Dental Council (GDC, 2014) for dental healthcare
professionals in the UK, has the primary aim of protecting the health and well-being of
patients. Their ethical guidance must be observed by dental healthcare professionals who are
all registered with the GDC, putting perceived confidence in the clinical practice of dentistry
in perspective.
32
Conclusion
Confidence has a strong positive impact on the standard of clinical dental practice. In turn,
enrolment in the Restorative Dental Practice Master’s programme enhanced the confidence of
the course participants in their clinical practice, where they reported to be carrying out their
restorative professional tasks more comfortably and effectively whilst they perceive
themselves to be confident.
The sense and generality of self-efficacy also have an impact on the confidence of individuals
who have completed a postgraduate learning experience. To enhance the learning experience,
my research thus far as reported in this thesis has linked the desirable close support primary
care based learning environment [#10(2009)] with the need to have quality teachers
[#9(2012)] who are well motivated [#8(2013)]. Teachers should be utilising contemporary
pedagogy and develop teaching aids [#6(2015)] to promote the students’ confidence which
has a positive impact on clinical practice [#7(2017) #5(2019)], allowing students to reap
maximum benefits following their engagement with relevant postgraduate studies.
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Chapter 3: Enhancing Teaching and Feedback Practices [#4(2018), #3(2018), #2(2019), #1(2020)]
The general research question for this chapter was to investigate how feedback practices
would enhance teaching and learning in clinical practice.
Confidence has a positive impact on learning [#7(2017)] and is an important factor in
facilitating clinical dental practice [#5(2019)]. Confidence is part of an important jig-saw in
enhancing learning on top of other factors which the portfolio of my pedagogic research has
already explored and presented in this thesis. These factors include the learning environment
[#10(2009)], teaching practices [#9(2012)], the quality of teachers [#8(2013)], and the use of
teaching aids to enhance reflective learning [#6(2017)].
On top of the issue of confidence, it is a natural logical extension of my pedagogic research to
explore aspects of feedback practices [#4(2018), #1(2020)]. It is additionally demonstrated by
the work of Hattie and Temperley (2007), that feedback as a vital and integral feature to
facilitate meaningful learning.
#4(2018) investigated perceptions of the feedback given by students at UCL Eastman Dental
Institute about the teaching they experienced by using a picture card based model of students
giving feedback. This involved the student choosing from a selection of picture cards and
picking the card which most closely represented their individual learning experience. The
chosen card would reflect the feedback they were about to give by facilitating them to talk.
On the other hand, [#1(2020)] investigated the feedback practices of a broad cohort of dental
teachers within the constituent schools of the Association of Dental Education in Europe
(ADEE). This work is ongoing, and I am currently investigating the perceptions these
34
students have on the feedback they receive from their teachers. This is beyond the remit of
this thesis.
Using picture cards to elicit feedback from students about their programme is an innovative
concept of delivering feedback [#4(2018)]. This novel method of prompting feedback has its
value and support because “there is a perceived need to alternative approaches to producing
feedback (to reinforce practice)” (Hounsell, 2003). This was further espoused by Davidson et
al (2009), that one should “prioritise the use of visual sources, particularly visual texts and
visual data” to help with generating thoughts and feedback. Picture cards are therefore a
useful evolving method of facilitating feedback.
It is clear that “students may be caught in the tension between the established and emerging
standards of (delivering) … feedback” because “innovations inherently take more time to
become established” (Davidson et al, 2009). However, the concept of using novel methods to
stimulate student feedback should be encouraged (Brookhart, 2008).
The use of visual texts “gives voice to the hidden experiences of the learner’s consciousness”
(Dottin, 2007). I found the same in [#4(2018)], that there is a psychological element in
generating this type of feedback. In the context of #4(2018), specific visual items were used
to facilitate students to generate feedback about the programme they had enrolled on. The
introduction and use of a range of real, figurative and abstract images as picture cards to elicit
feedback were met with an overall mixed but positive response by the participating student in
[#4(2018)], echoing Davidson et al, (2009).
In #4(2018), picture cards were found to be a useful tool to generate feedback in the context.
77% (n=20) of respondents enjoyed giving feedback using this novel approach giving
35
feedback based on selecting a picture which most suited their thinking and perceptions
concerning the course which reinforced the feedback process.
83% (n=22) of respondents reported that this form of feedback positively stimulated their
thoughts, with comments such as “good means of reflection and applying feedback”.
However, the unconventional nature of the approach may have contributed to a minority of
participants not warming to this novel concept, such as “I don’t think it helped discussion”
and “It wasn’t going to alter my ability to give feedback”, agreeing with Davidson et al,
(2009).
My work at #4(2018) identified that “there is more than one idea of feedback struggling for
wider acceptance which needs to be heard ”. This was in full agreement with Boud and
Molloy (2012), that the models of feedback for learning should be rethought and the design
challenged to address its inadequacies.
Interestingly, reinforcing the findings of #7(2017) about the merits on using insider research,
a majority of respondents in #4(2018) also identified that they would most prefer to give
feedback to someone they know within the programme (insider researcher). This would be
because “I feel they understand more, and my feedback will be taken on board more”
[#4(2018)], and this debate continues.
I found that “the results of image elucidation can be a profound aid to data collection (of
feedback)…. promoting this important and yet often ignored process ” [#4(2018)], a fresh
means of stimulating feedback responses, kick-starting the process of “reducing discrepancies
between current understanding, performance and a desired goal” [#4(2018)]. This unleashes
36
“one of the most powerful influences on learning and achievement” to enhance learning and
practice [#4(2018)].
Whilst #4(2018) investigated how picture cards were used as tools to facilitate feedback
practices to enhance student learning, #3(2018) and #2(2019) identified some perceived
pedagogic gaps in clinical dentistry, reflecting the fact that there was room for improvement.
#3(2018) explored general dental practitioners’ understanding, knowledge and perceptions of
MID, a very fundamental concept in contemporary clinical restorative dentistry, which would
preserve the maximum amount of viable tooth substances when teeth are being restored. This
would be in direct contrast with a traditional more invasive approach which could be viewed
as destructive (Mount & Ngo, 2000).
#2(2019) investigated the teaching of the subject of Occlusion in undergraduate dentistry in
the Dental Schools in the UK and Ireland. Occlusion is very simply defined as “the bringing
of the opposing surfaces of the teeth of the two jaws into contact, and the study of the
relationship between the surfaces when in contact” (Oxford). In the context of this thesis,
along the educational research journey that I have undertaken, the deficiencies in teaching
and learning in this important area of clinical practice were identified and explored.
Within the crux of MID, in terms of the contemporary principles for the removal of caries,
the following principles must be adopted, that “after preventive non-operative control of
caries, selective caries removal in the minimally invasive operative management of non-
cleansable, cavitated carious lesions should now be the norm” (Banerjee et al, 2017). As far
as dental caries is concerned, it is “a bio-film based and lifestyle-mediated disorder”, and that
“for deep lesions in teeth with vital pulps, maintaining pulp vitality is the priority”
37
(Schwendicke et al 2018). It would not be unreasonable to expect that 100% of respondents
should know, understand and practice these fundamental principles in clinical dentistry.
On the contrary, based upon #3(2018), (n= 149), that only 58% of respondents reported
having “some” knowledge of this aspect of MID, and just 11% reported of “knowing a great
deal” about MID. The general lack of understanding of this pertinent area of the practice of
dentistry was disappointing. It demonstrates that there is a lot of room for improvement in a
multitude of areas to effect better teaching and learning. This starts from having a good
learning environment [#10(2009)], executing good teaching practices for the education
providers [#9(2012)] and having quality teachers [#8(2013)], in a reflective learning
environment [#6(2017)]. On top of these, it is also imperative to maintain confidence to
nurture competence [#5(2019), #4(2018)], and to have an effective feedback system
[#1(2020] to complement this pedagogic loop as illustrated below.
In the questions testing basic competency of MID, #3(2018) found that those respondents
with a self-reported knowledge in the subject scored better than those who did not. This
implies that self-confidence may be a factor to play in this, that “increasing confidence
through learning has the potential to change (dentists’) perceptions of clinical practice”
[#5(2019)], and that with education and continuing professional development, there is “an
increased confidence in ….ability to undertake dental procedures”.
The important pedagogic message here is that an increase in skills [#9(2012)], confidence
[#4(2018] and a learning experience [#5(2019)], will lead to a natural inclination to
communicate better with colleagues and patients alike [#5(2019]. This paradigm shift, as per
Morgan & Cleave-Hogg (2002), cultivates an environment to develop great skills and
competence. To push this one step further, as per the portfolio presented herewith for this
38
thesis, that good feedback practice would embrace and cement this further [#1(2020),
#4(2018)].
In [#3(2018)] when testing application of three fundamental pieces of essential knowledge in
MID, only 28% of respondents scored all three correct, with 15% score none correctly, and
26% scoring only one correct. This illustrates the concerns that, if practitioners are in the
potential realm that somehow they are not managing to be sufficiently robust to keep
themselves up-to-date with the latest development in dentistry, that they can fall behind
contemporary practices inadvertently. Reflecting on this, therefore, it is important to have an
appropriate feedback loop [#1(2020)] to help to ameliorate the possible lack of awareness,
but in a user friendly 360 degree manner (Mohapatra, 2005), which will help to minimise
these risks. The role of feedback in maintaining standards and plugging this gap cannot
therefore be under-estimated.
To hit this right at the crux of this learning mismatch as per the findings in #3(2018), that,
“The poor knowledge of MID indicated by this study might be due to gaps in knowledge and
understanding or gaps in knowledge in training”, although the majority of participants in this
study “were younger and more recently qualified”, reflecting something more important than
just the facilities and teaching methods. In other words, appropriate reflective practices
[#5(2019)] and feedback [#4(2018), #1(2020)] feature highly in reinforcing a satisfactory
overall approach required for proper pedagogic development and support of practitioners. At
the end of it all, this approach benefits patients and facilitates practitioners to adequately
discharge their legal duties of care (Bolam, 1957).
In #2(2019), a mixed method approach was used to investigate the teaching of occlusion in
undergraduate dental schools in the UK and Ireland. Although every dental school in the UK
39
and Ireland taught occlusion in their curriculum, 28% of them reported “insufficient time for
the teaching (of occlusion) in the curriculum”, with marked variations in teaching methods,
resources, assessment techniques and barriers to teaching this important subject in clinical
dentistry. What had been highlighted was “a lack of co-ordination regarding occlusion
teaching”, and the lack of strategy, understanding and feedback mechanisms on such teaching
and learning. It was no surprise therefore, that there was “a degree of confusion in identifying
where it (occlusion) is taught in the curriculum” [#2(2019)].
The required learning outcomes for the teaching of occlusion to dental students in the UK and
Ireland were clear as per Preparing for Practice (GDC, 2015a) and the Profiles and
Competencies for the European Dentists published by the Association of Dental Education in
Europe (ADEE) (Field et al, 2017). However, it was also obvious that the different teachers,
departments and students were not communicating with each other about this important
subject, reflecting the observations that “it (occlusion) is probably taught in silos”, with “a
lack of awareness of what everyone else is doing” [#2(2019)].
The teaching time dedicated to this important subject has been being reported in #2(2019) to
be “between 10 to 310 hours” amongst the different schools, taught either separately or
sandwiched between different subjects, lacking in any awareness of meaningful feedback
from students. It was no surprise therefore, that this incoherent and disjointed approach
illustrated by “a lack of co-ordination”, “a lack of dedicated teaching” and “a lack of
communication” has resulted in “a lack of understanding of (and dissatisfaction with) this
important subject when students graduate” [#2(2019)].
In terms of student learning, it was clear that “when they start applying the theoretical
knowledge intelligently that they start to grasp topic relevance” [#2(2019)], echoing the
40
importance of a co-ordinated [#9(2012)] and close support [#10(2009)] teaching method. It
also indicated that a reflective approach [#6(2017)] which captures elements of reflection-in-
action and reflection-on-action (Schon, 1983, 1987) would naturally “require us to talk
together” [#2(2019)] to exchange, reflect, understand, adapt and be co-ordinated [#10(2009)].
This approach could be facilitated by high quality feedback as advocated by my work in
#1(2020), resulting in a win-win situation for both the teachers and the students in this
important clinical subject. The respondents as in #2(2019) “identified the importance and
reliance on student feedback in evaluating teaching” because “students are customers now,
and their feedback is taken very seriously”. This reflects a pleasant progression in pedagogic
approaches during the eleven years of my selected pedagogic research output as represented
in this thesis.
From an exploratory approach on the basic components, facilities and ingredients in the
earlier research outputs [#10(2009), #9(2012), #8(2013)], my pedagogic research has
investigated more deeply, more specifically and in a more sophisticated manner [#5(2019),
#4(2018)], #1(2020]. This progression reflects the increased complexity and a contextualised
focused approach over time, allowing deeper learning through reflection (Schon, 1987),
greater confidence [#5(2019)], utilising the feedback loop [#1(2020)] as a mechanism to
achieve the above.
Although feedback was not explicitly mentioned in #2(2019) and #3(2018), with the benefit
of hindsight, combined with observations made in #1(2020), it was clear on reflection, that it
would have been desirable also to consider feedback as part of the issue when considering
other aspects of teaching and learning in these two papers.
41
The educational deficiencies noted in the learning processes in #2(2019) and #3(2018), would
have been more effectively addressed by ascertaining more student feedback which was sadly
lacking in these two aspects of teaching. Aspects of these limitations were investigated in
[#1(2020)] I had the opportunity and platform to look with my colleagues at feedback
practices and perceptions given by a teacher to students amongst the ADEE educators
membership.
#1(2020) was based upon the opinions and perceptions of feedback from teachers to dental
students. This was based upon three elements; as information, as a reaction and as a cycle,
involving information as a tool for goal setting and improvements in performance. (van de
Ridder et al, 2008).
The use of feedback “in reducing discrepancies between current understandings or
performance and the desired goal” (Hattie & Temperley, 2007) was a key finding in
[#1(2020)].
There was clear evidence that “a vast majority of respondents (teachers) providing feedback
to their students following formative assessment, summative assessment, informally…. (and)
feedforward particularly when supervising Master’s students” [#1(2020)].
These findings in [#1(2020)] were reassuring in that there was “a strong ethos of delivering
feedback to dental students”, and a very desirable entrenched practice philosophy resonating
with Hardavella et al (2017), which is “embedded in education, training and daily
professional activities”. I found in [#1(2020)], that constructive criticism and self-reflection
were the two most popular styles of feedback. These styles of feedback were overwhelmingly
preferred and delivered by teachers and reported as being “the best and what students want”.
42
My findings here echoed the cornerstone “feedback sandwich technique” which enhances the
intensity, effectiveness and acceptance of feedback from teachers (Hardavella et al, 2017).
This also reverberated with my earlier findings in confidence in clinical practice [#5(2019)],
linking this with feedback practices [#1(2020)], that “Appropriate feedback contributes
significantly in developing learners’ competence and confidence at all stages of their
professional careers” (Hardavella et al, 2017).
[#1(2020)] found unequivocally, that appropriate feedback given by teachers helps students
think and reflect upon the gaps between what they had attained and what they wanted to
achieve. In other words, effective feedback could be the catalyst [#1(2020)], where reflective
learning is nurtured [#6(2015)], where confidence and competence are developed [#5(2019)],
where the innate pedagogic deficiencies identified at [#3(2018) and #2(2019)] are being
ameliorated.
When it came to students delivering feedback to teachers about their teaching as part of the
360 degree approach (Krammer et al, 2019) to disseminate feedback, it was encouraging to
see clearly that “83% of the teacher respondents reported that their teaching changed for the
better as a result of feedback from students” [1#(2020)]. This echoes Hattie and Temperley
(2007) that “feedback is one of the most powerful influences on learning and achievement
both for the teachers and the students”. Perhaps through the combination of reflections
[#6(2017)], increased confidence [#5(2019)], that the feedback process is enhanced and
reinforced, bring pedagogy into a new level.
Conclusion
Confidence impacts positively on learning [#7(2017)] and nurtures competency in clinical
dental practice [#5(2019)]. In addition, appropriate, proportionate and timely feedback
43
practices [#4(2018), #1(2020)] enhance the effectiveness of teaching and facilitate learning.
As far as feedback is concerned, whilst novel feedback methods may help to gather thoughts
and generate meaningful and sustainable feedback from students to teachers about their
teaching and how this can be improved [#4(2018)]. However, the timing, extent and quality
of feedback delivered by teachers to students are fundamentally and inextricably linked to
enhancing student satisfaction, learning and standards of clinical practice [#1(2020)].
Whilst examining the specific arenas in clinical practice [#3(2018)] and teaching [#2(2019)],
my research has shown that there is plenty of room for improvements in these areas thereby
reinforcing the crucial roles for feedback [#4(2018), #1(2020)]. It also invigorates and
enhances learning and teaching, often acting as a catalyst to nurture reflective learning
[#6(2015)], and also when confidence and competence in clinical practice are developed
[#5(2019)].
44
Chapter 4: Overall appraisal and conclusion
This Chapter appraises the overall research undertaken in this thesis and how the research has
advanced dental education both in the United Kingdom and abroad. It also briefly looks at
some potential directions of future related research in dental education based on the above
work.
Overall appraisal
The portfolio of my research presented in this thesis explored, developed, contextualised,
analysed and discussed three important paradigms in dental education. First, how the clinical
teaching and learning environment in dentistry could be enhanced [#10(2009), #9(2012),
#8(2013), #7(2017), #6(2015)]; Second, the role of confidence in learning in clinical practice
[#7(2017), #5(2019)]; and Third, how feedback practices could help to enrich teaching and
learning [#4(2018), #3( 2018), #2(2019), #1(2020)].
On the surface, these individual papers represent separate areas in dental education which I
investigated chronologically from 2009[#10] to 2020[#1]. However, exploring deeper beyond
the surface and when considered together, these papers represented my unique, enjoyable,
exciting and sometimes tough and often unexpected pedagogic research journey in dental
education over the last eleven years.
The nuances by design, on top of some unexpected twists and turns, in combination all of
which contributed to the unique richness, freshness and relevance to aspects of contemporary
dental education had been demonstrated. The analysis of the findings of my work as
presented in Chapters 1 to 3 and the associated discussions regarding the literature available
both during the studies and after conveyed this sentiment.
45
My work [#10(2009)] demonstrated that a teaching environment with a comprehensive,
friendly, well equipped, well supported self-contained primary care surgery set up would be
excellent for simulating a real world clinical environment with students as trainee dentists
learning total patient care delivery. I then investigated the important human factor required to
make this set up function effectively [#9(2012)]. I found that a friendly, reflective, efficient,
close support, self-contained, simulated environment which was perceived by students to be
an effective setting for learning [#9(2012)]. Ironically my findings that self-contained
surgeries are congenial to teaching and learning in clinical dentistry has proven to be
extremely desirable and compatible in the COVID-19 environment which the human race is
experiencing at the time this thesis is written up.
There was no doubt that these clinics needed to be staffed with appropriate teachers. I
therefore turned my attention to investigate why experienced colleagues would become
involved in clinical teaching [#8(2013)], showing that these clinical teachers have a strong
influence on the success or otherwise of the modern dental curriculum. I showed that they did
not necessarily seek remuneration as their main reward whilst job satisfaction and a career
pathway were deemed more important [#8(2013)].
Next stop, my research moved to a different approach investigating how reflective learning
could be facilitated and enhanced by the use of bespoke video vignettes [#6(2017)] in a
simulated undergraduate environment. Whilst also noticing that some undergraduate students
lacked confidence, the opportunity to investigate this arose when my career progressed from
an undergraduate to a postgraduate dental teaching environment, where fully qualified
dentists treated patients in practice. I had the opportunity to investigate the impact
postgraduate studies had on the perceived confidence of postgraduate students who were
46
qualified dentists [#7(2017)]. I found that perceived confidence enhanced the sense of self-
efficacy, motivation and positivity towards practice in the real world.
Sensing that there was more mileage in the issue of confidence, I then examined the impact
confidence had on clinical dental practice [#5(2018)], showing that perceived confidence
reflected competence which had a very positive impact on clinical dental practice, reinforcing
the findings of [#7(2017)].
Having investigated the learning environment, the required human factors, reflective
practices, the role of confidence and to maintain the overall learning environment, the natural
next stage of my research was to examine feedback practices. Feedback is what binds these
other factors together and is fundamental to effective learning.
[#4(2018), #1(2020)] established that appropriate, proportionate and timely feedback
practices enhanced the effectiveness of teaching and facilitated learning. The picture card
paradigm in [#4(2018)] demonstrated the perceived value alternative approaches such as
image elicitation had to facilitate the generation of feedback.
Being able to deliver effective feedback would be very desirable as #3(2018) and #2(2019)
identified that there was room for improvements in respect of the teaching both in
undergraduate [#2(2019)] and in postgraduate dentistry [#3(2018)]. To complete the loop,
[#1(2020)] investigated the extent, type, timing, frequency, and perceived effectiveness of
feedback given by dental teachers to their students. It was clear that effective feedback from
teachers to students would be constructive, professional, truthful, timely and consistent.
Feedback could also be a pathway to setting achievable targets by teachers for students
[#9(2012)] and for them to develop reflective practices [#6(2017)] in a relaxed and well set
47
up [#10(2009)] co-operative learning paradigm [#8(2013)]. This allows confidence in clinical
practice to develop [#5(2019)] as part of the programme of studies [#6 (2017)] being
undertaken.
This completes the appraisal of the portfolio and the exciting and hitherto unexpected journey
of pedagogic research I have experienced between 2009 and 2020 as presented in this thesis.
It links the findings and the nuances of the ten papers presented together in this thesis in a
thematic manner to demonstrate the role I have contributed to the advancement of dental
education.
Challenges and opportunities for the overall research:
There was a lot of searching in the dark in the early 2000s when I took my first steps in
pedagogic research. My first publication alone took seven years with data collected from six
different cohorts of students to establish consistently reproducible data.
As a part-time researcher having to multi-task a long list of other essential jobs, generating
and maintaining momentum for educational research was a challenge. Self-motivation and
self-discipline never to give up have been a useful motto from my perspective. Unlike other
areas of scientific research which can be more easily planned over some time, educational
research is often opportunistic and dependent on the educational and training that is being
delivered at the time. Despite these challenges, I feel that I have been able to develop a clear
vision of several inter-related areas of pedagogic research to contribute meaningfully to the
advancement of dental education.
Changing jobs from a predominantly undergraduate teaching environment at King’s College
London Dental Institute to an exclusively postgraduate teaching environment at University
48
College London Eastman Dental Institute in 2013-14 were definite challenges. However, this
also presented valuable opportunities to diversify my areas of research interests along with
similar over-riding pedagogic principles. I have been very fortunate to have been able to
work with some fantastic colleagues which allowed me to refocus and progress swiftly with
my dental education research.
This change in working environment turned out to be something very positive because it
enriched the quality and variety of my research output. It allowed me the opportunity to
conduct deeper meaningful research which was more conceptual, but more interesting and
more rewarding in the overall scheme of things. It also allowed me to take a quality reflective
approach built on what had already been achieved in the previous working environment.
Collaboration has proved to be critical in the completion of successful pedagogic research. As
Head of Department of Continuing Professional Development and Programme Director of the
Masters’ in Restorative Dental Practice, I have been fortunate to have successfully directed
and supervised (primary or secondary) approximately 70 Masters’ dissertations to-date. This
allowed me to direct and plan strategically, and yet be fully involved in all aspects of
education research in the department whilst determining the direction of travel for each piece
of research.
In respect of the portfolio of work presented in this thesis, the limitations of each paper have
already been discussed.
49
Concluding remarks:
Based on my findings of the learning environment, perceived confidence, feedback practices
and student learning in dental education as per my published papers included in this thesis,
within the context of teaching and learning in clinical dentistry, it is reasonable to conclude as
follows:
Given the following parameters
An optimal, ambient environment set up which is congenial to clinical dentistry
A friendly, relaxed and non-threatening teaching environment
The availability of suitably qualified, experienced and motivated teaching staff
An optimal, enriched and contextualised teaching materials and strategies in a
contemporary paradigm which promotes close support, with reflection-on-action and
reflection-in-action
It is possible to facilitate or nurture
Student confidence as part of the learning experience resulting in a very positive and
profound impact on their clinical practice central to their personal development,
performance and competence
Furthermore
This paradigm will be reinforced by the practice of appropriate feedback practices,
both from students to their teachers and from teachers to their students
Even though the above theory on feedback is great, in both undergraduate and
postgraduate dentistry environments, there is much room for improvement in practice
The standard, frequency, scope, quality, timeliness, effectiveness and appropriateness
of feedback delivered by dental educators in Europe and beyond to their students are
very positive and encouraging. This bodes well for the future of dental education
50
In short:
Based on the presented portfolio of my eleven years’ published pedagogic research presented
herewith, I have found that in the right teaching environment, with the appropriate number of
well qualified and highly motivated staff, students are likely to enjoy this congenial and
reflective learning paradigm. This will in turn enhance their perceived confidence and
facilitate the development of their competence. Furthermore, if the appropriate feedback
mechanisms and practices are also in place, both students and teachers are likely to be
contented and satisfied.
The Future
Despite the unprecedented challenges faced by dental educators and their students as a result
of the global COVID-19 pandemic, this has also presented several excellent developmental
opportunities. They include the accelerated use of technology to enhance learning such as the
meaningful use of simulations, synchronous and asynchronous delivery of teaching, on-line
assessments and remote learning.
Indeed, social distancing, wearing of personal protective equipment, self-isolation, working
from home operating on Zoom® or Teams®, track and trace and immunisation may all be
relatively long term features for most of us. The “new normal” approach to teaching and
learning will be very different from the past. As we step into the unknown, I treasure the
exciting opportunities and challenges which will accompany me to continue my pedagogic
research journey for the future.
51
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66
Scientific Publications
1. List of Published Papers Submitted and used in the
commentary for This PhD Degree:
Appendix 1
Leung, A., Fine, P., Blizard, R., Tonni, I., & Louca, C. (2020). A quantitative study of
feedback delivered by dental teachers to dental students.
Accepted for publication by the European Journal of Dental Education, 19th October 2020
Contributions by Albert Leung
Concept
Design
Literature review
Study and questionnaire design
Data collection
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 0
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
Appendix 2
O’Carroll, E., Leung, A., Fine, P., Boniface, D., Louca, C. (2019). The teaching of
occlusion in undergraduate dental schools in the UK and Ireland. British Dental Journal,
Volume 227 (6), pp 512-517
Contributions by Albert Leung
Concept
Literature review
Study and questionnaire design
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 0
84
85
86
87
88
89
90
Appendix 3
Mirsiaghi, F., Leung, A., Fine, P., Blizard, B., Louca, C. (2018). An investigation of
general dental practitioners' understanding and perceptions of minimally invasive
dentistry. British Dental Journal, Volume 225 (5), pp 420-424
Contributions by Albert Leung
Concept
Design
Literature review
Study and questionnaire design
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 3
91
92
93
94
95
96
Appendix 4
Fine, P., Leung, A., Francis, J., Louca, C. (2018). The Use of Picture Cards to Elicit
Postgraduate Dental Student Feedback. Dentistry Journal, Volume 6 (7),
doi:10.3390/dj6020007
Contributions by Albert Leung
Concept
Literature review
Data collection
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 0
97
98
99
100
101
102
103
104
105
106
Appendix 5
Fine, P., Leung, A., Bentall, C., Louca, C. (2018). The Impact of Confidence on Clinical
Dental Practice. European Journal of Dental Education, Volume 23, pp 159-167
Contributions by Albert Leung
Concept
Literature review
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 0
107
108
109
110
111
112
113
114
115
116
Appendix 6
Davies, B., Leung, A., Dunne, S., Dillon, J., Blum, I. (2017). Bespoke video vignettes - an
approach to enhancing reflective learning developed by dental undergraduates and
their clinical teachers. European Journal of Dental Education, Volume 21 (1), pp 33-36.
Contributions by Albert Leung
Concept
Literature review
Study and questionnaire design
Data collection
Interpretation of results
Data analysis
Manuscript writing & editing
Citation Metrics
Google Scholar: 3
117
118
119
120
121
Appendix 7
Fine, P., Louca, C., & Leung, A. (2017). The Impact of a Postgraduate Learning
Experience on the Confidence of General Dental Practitioners. Dentistry Journal, Volume
5 (16). doi:10.3390/dj5020016
Contributions by Albert Leung
Concept
Literature review
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 0
122
123
124
125
126
127
128
129
130
131
Appendix 8
Davies, B., Leung, A., Dunne, S. (2013). Why do general dental practitioners become
involved in clinical teaching? A pilot study exploring the views of part-time practitioner
teachers, King's College London. British Dental Journal, Volume 214 (9), pp 461-465.
Contributions by Albert Leung
Concept
Design
Literature review
Study and questionnaire design
Data collection
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 11
132
133
134
135
136
137
Appendix 9
Davies, B., Leung, A., Dunne, S. (2012). So how do you see our teaching? Some
observations received from past and present students at the Maurice Wohl Dental
Centre. European Journal of Dental Education, Volume, 16 (3), pp 138-143
Contributions by Albert Leung
Concept
Design
Literature review
Study and questionnaire design
Data collection
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 18
138
139
140
141
142
143
144
Appendix 10
Davies, B., Leung, A., Dunne, S. (2009). Perceptions of a simulated general dental
practice facility - reported experiences from past students at the Maurice Wohl General
Dental Practice Centre 2001-2008. British Dental Journal, Volume 207 (8), pp 371-376
Contributions by Albert Leung
Concept
Design
Literature review
Study and questionnaire design
Data collection
Interpretation of results
Manuscript writing & editing
Citation Metrics
Google Scholar: 19
145
146
147
148
149
150
151
Appendix 11: Form UPR16 Research Ethics Review Checklist
152
2. Other Publications Including Published Abstracts
1. Sybaite, J., Sharma, P., Fine, P., Blizard, R., Leung, A. (2020). The influence of
varying gingival display of maxillary anterior teeth on the perceptions of smile
aesthetics. Journal of Dentistry. Accepted for publication on 15th October 2020.
https://doi.org/10.1016/j.jdent.2020.103504
2. Shah, P., Louca, C., Patel, R., Fine, P., Blizard, R., Leung, A. (2020). Investigating
working practices of dentists on shade taking: evidence based good practice
versus observed practice. Journal of Dentistry, Volume 97 (2020), 103341.
doi:10.1016/j.jdent.2020.103341
Contribution to journal › Article
3. Tonni, I., Fine, P., Louca, P., Leung, A. (2020). Students’ perceptions of tutor
feedback, a pilot study. (IADR 1396)
Contribution to journal › Meeting abstract and oral presentation
4. Fine, P., Louca, C., Leung, A. (2020). Feedback to dental student, its significance
and importance: a pilot study. (IADR 2431)
Contribution to journal › Meeting abstract and oral presentation
5. Wijey, T., Leung, A., Louca, C., Suvan, J. (2019). Patient perceptions of healthy
weight promotion in dental settings. Journal of Dentistry, Volume X1 (2019),
100002. doi:10.1016/j.jjodo.2019.100002
Contribution to journal › Article
6. Fine, P., Leung, A., Tonni, I., Louca C. (2019). Tutor feedback to enhance student
learning – a qualitative study. (IADR 0197)
Contribution to journal › Meeting abstract and oral presentation
7. Louca, C., Fine, P., Tonni, I., Leung, A. (2019). Tutor feedback to enhance student
learning – a quantitative study. (IADR 0198)
Contribution to journal › Meeting abstract and oral presentation
153
8. Kailalyapillai, G., Leung, A., Sharma, P., Croysdill, A., Fine, P. (2019). Direct or
indirect restorations: the choice is yours (IADR 1999)
Contribution to journal › Meeting abstract
9. Oxborrow, S., Leung, A., Fine, P., Suvan, J. (2019). 5As communication tool for
sugar consumption, oral health and obesity. (IADR 0220)
Contribution to journal › Meeting abstract
10. Casla-Veiga, L., Patel, R., Fine, P., Blizard, B., Leung A. (2019). Professional and
educational interest of UK dentists in social media. (IADR 3166)
Contribution to journal › Meeting abstract
11. Fine, P., Louca, C, and Leung, A. (2019). Sports dentistry principles and practice.
Chichester, West Sussex. Wiley Blackwell.
Contribution › Book
12. Fine, P., Sharma, G., Leung, A., Louca, C. (2018). Factors influencing dentistry as a
second career choice. (IADR E2033)
Contribution to journal › Meeting abstract
13. Leung, A., Shah, P., Patel, R., Louca, C., Fine P (2018). Observed practice during
shade taking. (IADR E1454)
Contribution to journal › Meeting abstract
14. Leung, A., Paul, S., Louca, C., Fine, P. (2017). Erosive tooth wear: knowledge and
awareness amongst Northern Ireland dentist (ADEE)
Contribution to journal › Meeting abstract
15. Fine, P., Gill, A., Leung, A., Louca, C. (2017). Feedback to postgraduate students:
how this facilitates the learning process. (ADEE)
Contribution to journal › Meeting abstract
16. Fine, P., Louca, C., Leung, A. (2017). Perceptions of recorded audio against
written feedback-a pilot study. (ADEE/ADEA)
Contribution to journal › Meeting abstract
154
17. Leung, A., Louca, C., Fine, P. (2017). Feedback given to postgraduate dental
students following a summative assessment. (IADR E3321)
Contribution to journal › Meeting abstract
18. Louca, C., Leung, A., Fine, P., Francis, J. (2017). The use of visual images to elicit
student feedback. (IADR E3319)
Contribution to journal › Meeting abstract
19. Karadobreva, P., Leung, A., Blizard, R., Louca, C., Suvan, J. (2017). Dental
professionals’ perceptions of sugar consumption and obesity: advice in the dental
practice. (IADR C2076)
Contribution to journal › Meeting abstract
20. Fine, P., Louca, C., Leung, A. (2017). General dental practitioners’ perceptions of
confidence following a Masters’ programme. (IADR E0196)
Contribution to journal › Meeting abstract and oral presentation
21. Matsakas, F., Patel, D., Leung, A., Louca, C. (2016). Evaluation of non-university
postgraduate implant training courses in the UK. (European Congress of
Osseointegration)
Contribution to journal › Meeting abstract
22. Hussein, A., Leung, A., Louca, C., Sharma, P., Blizard, R. (2016). The influence of
varying maxillary incisor shape on perceived smile aesthetics. Journal of Dentistry,
Volume 50 (2016), pp 12-20
Contribution to journal › Article
23. Dehghanpour, M., Leung, A., Louca, C. (2016). Practitioners’ adherence to
instructions when using dental adhesives. Journal of Dental Research, Volume 95
(B), 0662
Contribution to journal › Meeting Abstract
155
24. Fine, P., Leung, A., Louca, C. (2016). A pilot study to investigate the use of
feedback in postgraduate dental education. Journal of Dental Research, Volume 95
(B), 0728
Contribution to journal › Meeting abstract
25. Louca, C., Makwana, J., Fine, P., Blizard, R., Leung, A. (2016). UK medical
practitioners’ knowledge of managing dental emergencies. Journal of Dental
Research, Volume 95 (B), 0908
Contribution to journal › Meeting abstract
26. Leung, A., Gupta, M., Patel, M., Patel, D., Louca, C., Blizard, R. (2016). Crown
finish lines by general dentists: should they be improved? Journal of Dental
Research, Volume 95 (B), 1951
Contribution to journal › Meeting abstract
27. Davies, B., Chau, K., Leung, A., Cox, M., Blum, I. (2016). Using video vignettes to
enhance dental students’ reflective learning experiences. Journal of Dental
Research, Volume 95 (B), 2474
Contribution to journal › Meeting abstract
28. Fine, P., Louca, C., Bentley, C., Leung, A. (2016). Qualitative data analysis
following a part-time master’s programme. (ADEE)
Contribution to journal › Meeting abstract
29. Leung, A., Dave, A., Louca, C., Fine, P. (2016). A survey of undergraduate
teaching of occlusion in the UK & Ireland. (ADEE)
Contribution to journal › Meeting abstract
30. Louca, C., Cunningham, S., Patel, D., Leung, A. (2016). Evaluation of flipped class
teaching in postgraduate dentistry. (ADEE)
Contribution to journal › Meeting abstract
31. Fine, P., Louca, C., Leung, A. (2016). Perceptions of recorded audio against
written feedback- a pilot study. (University College London CALT Annual
Conference)
Contribution to journal › Meeting abstract
156
32. Davies, B., Leung, A., Dunne, S., Dillon, J. (2015). Enriched reflective learning
using bespoke video clips developed by dental students and clinical teachers.
European Journal of Dental Education 19, e8-e35
Contribution to journal › Meeting abstract
33. Fine, P., Martinez, K., Leung, A., Louca, C. (2015). Dental Foundation Year 1
(DF1) graduate opinions of their undergraduate and DF1 training. European
Journal of Dental Education 19, e8-e35
Contribution to journal › Meeting abstract
34. Leung, A., Fine, P., Spyer, E., Martinez, K., Louca, C. (2015). A Two year study of
the perceptions of dental foundation year 1 graduates of their undergraduate and
dental foundation training. (ADEE)
Contribution to journal › Meeting abstract
35. Louca, C., Fine, P., Spyer, E., Martinez, K., Leung, A. (2015). Perceptions of male
and female dental foundation year 1 dentists of employment and continuing
professional development. (ADEE)
Contribution to journal › Meeting abstract
36. Louca, C., Donde, S., Leung, A., Blizard, R. (2015). Newly qualified dentists’
perceptions of amalgam restorations. Journal of Dental Research 94 (Spec Iss A)
954
Contribution to journal › Meeting abstract
37. Fine, P., Leung, A., Louca, C. (2015). Dental practitioners’ perceptions of a part
time Masters programme. Journal of Dental Research 94 (Spec Iss A) 956
Contribution to journal › Meeting abstract
38. Fine, P., Leung, A., Louca, C. (2015). Qualitative analysis of dental practitioners’
perceptions of a part time Master’s in Restorative Dentistry. Clinical Oral
Investigations, Volume 19, pp 1701–1754, 1731
Contribution to journal › Meeting abstract
157
39. Mottaleb, E., Tay, W., Louca, C., Leung, A., Blizard R (2015). Assessment of the
accuracy and repeatability of shade taking using visual and digital shade guides.
Clinical Oral Investigations, Volume 19, pp 1701–1754, 1749
Contribution to journal › Meeting abstract
40. Sutherland, J., Fine, P., Leung, A., Louca, C. (2015). An investigation of the dental
knowledge of doctors. European Journal of Dental Education, Volume 19, e8-e35
Contribution to journal › Meeting abstract
41. Louca, C., Leung, A., Patel, D., George, P. (2014). An evaluation of postgraduate
implant dentistry training in the UK. Journal of Dental Research, Volume 93
(Special Issue B) 998
Contribution to journal › Meeting abstract
42. Davies, B., Leung, A., Dunne, S., Dillon, J. (2013). Enriching learning in primary
care dentistry by sharing reflective experiences using video clips developed by
dental students and clinical teachers. 7th King’s Learning Institute Annual
Excellence in Teaching Conference Proceedings. ISBN 978-0-9576764-2-8, 5-14
Contribution to journal › Published refereed conference proceedings
43. Davies, B., Leung, A., Dunne, S. (2012). Career perceptions of part-time clinical
teachers: a damp squib or something more contentious? 6th King’s Learning
Institute Annual Excellence in Teaching Conference Proceedings. ISBN 978-0-
9576764-1-1, p44
Contribution to journal › Published refereed conference proceedings
44. Davies, B., Leung, A., Dunne, S. (2011). Relationship teaching - common sense or
just old ideas revisited- a preliminary study. 5th King’s Learning Institute Annual
Excellence in Teaching Conference Proceedings. ISBN 978-0-9558633-6-3, pp 50-58
Contribution to journal › Published refereed conference proceedings
45. Davies, B., Leung, A. (2011). Contemporary teaching of Endodontics: Some
pedagogic challenges and solutions. 5th Excellence in Teaching Conference of the
King’s Learning Institute, King’s College, University of London
Contribution to journal: Meeting abstract
158
46. Davies, B., Leung, A., Dunne, S. (2010). Relationship teaching- common sense or
just old ideas revisited- a preliminary study. 4th Excellence in Teaching Conference
of the King’s Learning Institute, King’s College, University of London
Contribution to journal: Meeting abstract
47. Leung, A. (2008). Investigating dental students’ perceptions of the experience of
four-handed dentistry in clinical learning. 2nd King’s Institute for Learning and
Teaching Conference proceedings. ISBN 978-0-9558633-1-8, pp 107-118
Contribution to journal › Published refereed conference proceedings
48. Leung, A., Davies, B., Dunne, S., Wilson, N. (2006). Extended clinical
environments in primary dental care: Aspects of close support dentistry as
perceived by undergraduate dental students at the Dental Institute of Guy’s
King’s and St Thomas’ Hospitals
Contribution to journal › Meeting abstract
49. Davies, B., Leung, A., Dunne, S. (2004). Perceptions of an undergraduate
primary dental care teaching facility as seen by recent graduates from the
Guy’s, King’s and St. Thomas’ Dental Institute.
Contribution to journal › Meeting abstract
159
3. National and International Presentations and Invited Teaching
Sessions (2011 – now)
Year &
Month
Invited by & location Details
Oct 2020 Royal College of Surgeons in Ireland
(RCSI) Faculty of Dentistry Annual
Scientific Meeting entitled
“Dentistry in the new decade”
Chair (as RCSI Dean)
July 2020 Royal College of Surgeons in Ireland
(RCSI) . International Webinar on
“Back to School in the time of
COVID-19, an international
perspective”
Chair (as RCSI Dean)
June 2020 Royal College of Surgeons (RCS) of
England: Deans’ webinar on “Health
and well-being”
Invited Speaker (as RCSI Dean)
May 2020 Royal College of Surgeons of
Edinburgh: Deans’ webinar on
“COVID-19 Aerosols and patient
safety- where are we now”
Invited Speaker (as RCSI Dean)
May 2020 Faculty of General Dental Practice,
RCS England: Deans’ webinar on
“Preparing the challenges ahead”
Invited Speaker (as RCSI Dean)
Apr 2020 Royal College of Physician and
Surgeons of Glasgow: Deans’
webinar on “Managing the
emergency dental patient during
COVID-19”
Invited Speaker (as RCSI Dean)
Apr 2020 Royal College of Surgeons (RCS) of
England: Deans’ webinar on
“COVID-19, Q & A with the Deans
of the Dental Faculties”
Invited Speaker (as RCSI Dean)
Feb 2020 Hamid Medical Corporation (HMC),
Qatar
Invited teaching sessions
including appraisal of research
projects (as RCSI Dean)
160
Nov 2019
Royal College of Surgeons in Ireland,
(RCSI), at Medical University
Bahrain (MUB)
Invited teaching sessions
Aug 2019 Association of Dental
Education in Europe (ADEE)
Berlin
Workshop and Poster/Oral
presentations
Jun 2019 International Association of
Dental Research (IADR) in
Vancouver
Oral and poster
presentations
Apr 2019
Hamid Medical Corporation
(HMC), Qatar
Invited teaching sessions
including appraisal of
research projects
Mar 2019 RCSI, Dublin Invited teaching sessions
Oct 2018 Royal College of Surgeons in
Ireland, (RCSI), at Medical
University Bahrain (MUB)
Invited teaching sessions
Sep 2018 RCSI, Dublin Invited teaching sessions
Aug 2018 ADEE (Oslo) Workshop and Poster/Oral
presentations
July 2018 IADR (London) Poster presentations and
session chair
May 2018 Hamid Medical Corporation
(HMC), Qatar
Invited teaching sessions
including mentoring of
research projects
Nov 2017 Royal College of Surgeons in
Ireland, (RCSI), at Medical
University Bahrain (MUB)
Invited teaching sessions
Sep 2017 RCSI, Dublin Invited teaching sessions
Aug 2017 ADEE (Vilnius Lithuania) Oral and poster
presentations
161
Apr 2017 Hamid Medical Corporation
(HMC), Qatar
Invited teaching sessions
including mentoring of
research projects
Mar 2017 IADR (San Francisco)
Poster presentations
Feb 2017 RCSI Dublin
Invited teaching sessions
Oct 2016 Royal College of Surgeons in
Ireland, (RCSI), at Medical
University Bahrain (MUB)
Invited teaching sessions
Sep 2016 RCSI Dublin Invited teaching sessions
Aug 2016 ADEE (Szeged, Hungary) Oral and poster
presentations
Jun 2016 IADR (Seoul, South Korea) Oral and poster
presentations. Session Chair
Mar 2016 Hamid Medical Corporation
(HMC), Qatar
Invited teaching sessions
Mar 2016 RCSI, Dublin Invited teaching sessions
Nov 2015 RCSI, Dublin Invited teaching sessions
Sep 2015 RCSI, Dublin Invited teaching sessions
May 2015 Kuwait Institute of Medical
Specialisation (KIMS),
Kuwait
Invited teaching sessions
Mar 2015 RCSI, Dublin Invited teaching sessions
Sep 2014 RCSI, Dublin Invited teaching sessions
May 2014 KIMS, Kuwait Invited teaching sessions
Mar 2014 RCSI, Dublin Invited teaching sessions
Nov 2013 RCSI, Dublin Invited teaching sessions
Sep 2013 RCSI, Dublin Invited teaching sessions
162
May 2013 KIMS, Kuwait Invited teaching sessions
Apr 2013 RCSI, Dublin Invited teaching sessions
Dec 2012 RCSI, Dublin Invited teaching sessions
Sep 2012 Faculty of Dentistry,
Khartoum University, Sudan
Invited teaching sessions
Jun 2012 King’s College London
Dental Hospital, London
Gateway to practice lectures
Feb 2012 KIMS, Kuwait Invited teaching sessions
Oct 2011 RCSI, Dublin Invited teaching sessions
Sep 2011 Faculty of Dentistry,
Khartoum University, Sudan
Invited teaching sessions
Jun 2011 King’s College London
Dental Hospital, London
Gateway to practice lectures
May 2011 KIMS, Kuwait
Invited teaching sessions