Dental Internship Training Program Evaluation In Three Dental Colleges in The Kingdom Of Saudia Arabia

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Dental Internship Training Program Evaluation In
Three Dental Colleges in The Kingdom Of Saudia
Arabia

• Dr. Fahad Saleh Al Sweleh
• Prof. Margaret Elzubeir
• Dr. Michael Seefeldt
• Dr. Amir Omair

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After searching on various web sites like Pub
Med, Google scholar, yahoo, Elsevier,
Canadian Medical Association, SAGE
online Education resources information center (
ERIC) British Medical Journal (BMJ), Academic
Medicine journal, Journal of Dentistry, American
Journal of Evaluation web site Evaluation
Review, Evaluation and program planning
journal, European journal of dental education
Journal of Dental Education
3
No studies specifically evaluating dental
internship training programs or measuring the
satisfaction levels of interns in dental
education were found. Therefore there seems to
be a distinct lack of information regarding
perspectives of dental interns and program
satisfaction.
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• The aim of this evaluation study is to
• examine the structure, activities, and outcomes
  in three dental internship training programs, in
  order to
• Provide information to program leaders to be
  used in improving the program.
• Establish a basis for future program planning
  and enhancement.

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Method The study employed a mixed method design
using multiple case approach combining both
qualitative and quantitative research
methods. The triangulation design was used to
collect simultaneously both qualitative and
quantitative data.
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Setting This evaluation was conducted in three
Saudi Dental Colleges 1- King Saud University
KSU in Riyadh, the oldest dental college in the
Kingdom (1395 AH/1975 ) it graduates
approximately 100 students per year. 2- King
Abdulaziz University KAU in Jeddah. (1405
AH/ 1985 ) and graduates approximately 90
students per year. 3- University of Dammam UOD
in Dammam. (1415 AH/ 1995 ) and graduates
approximately 20 students per year.
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• Inclusion criteria of the study subjects
• Program Directors, staff, and dental faculty
  committee members.
• All dental interns who enrolled in the dental
  internship training programs of the (KSU, KAU
  and UOD) in 2009-2010 and have finished at least
  ten months in the program.

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The sample in this study was all members of the
study population who met the inclusion criteria
at KSU, KAU and UOD All interns for
questionnaire All relevant administrators,
faculty, staff, and program committee members for
interview and document review. Selection of
interns for interviewing was simple random
sampling by putting all names of interns in a
small container and picking randomly the name of
intern. (Total number of focus group interview
from all Colleges was N50 N 20 from KSU (10
male and 10 female) N 20 from KAU 10 male and
10 female) N10 male only from UOD
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• Qualitative methods
• Semi-structured focus group interviews with
  interns were conducted in respective Colleges.
• Semi-structured individual interviews with
  decision makers were conducted in respective
  Colleges .

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• Qualitative methods (cont.)
• Documentation study
• (Program data, i.e. plans, policies, program
  manuals, etc.)
• Documents were collected from the decision makers
  of the Colleges
• Questionnaire open ended items.

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Quantitative methods Intern Surveys. Using
questions that utilized a 5-point Likert scale.
Measuring satisfaction level. E-mail address
of all interns were collected from decision
makers of the Colleges. The Questionnaire was
sent by e mail to all interns. 4 times follow
up reminders. E mail was sent to those who did
not respond to the questionnaire, with a one
month period of time between reminders.
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Subgroups were studied based on
1- Gender.

2- Institution. The questionnaire had four
domains after an initial demographic section

1- Scientific activities (5 items).
2-
Research (10 items).
3- Supervision (10
items).
4- Clinical training (24 items).
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Data Management and Analysis Qualitative
Content analysis by using a thematic approach
(starting by coding and formulating a theme) was
conducted for all qualitative data from
interviews, open-ended questionnaire items, and
documentation study.
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Quantitative Percentage of satisfaction of all
interns was calculated The total score for
each domain was then converted into a percentage
Significant testing between subgroup means was
conducted using the SPSS (18) program.
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Student t-test was used to compare the mean
percentage score of each domain between males and
females. ANOVA was used to compare the means
between the three universities. Chi square test
was used to determine any differences between
institutions in items of each domain. A p-value
of lt 0.05 was considered as being statistically
significant for all the statistical tests.
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Results and Discussion
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Results Focus group analysis and
reporting Focus group interviews were conducted
in the Colleges of Dentistry with all sampled
interns. A total number 47 interns participated
in the focus group interview 28 males 19
females 10 males 9 females from KSU, 10 males
10 females from KAU 8 males only from UOD.
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Findings from Individual interviews with decision
makers Individual interviews were conducted in
the College of Dentistry with all identified
decision makers. A total number 13 decision
makers participated in individual interviews. 7
decision makers from KSU Dean, Vice Dean for
administration affairs, Vice Dean for Female
Student Affairs, Director of Clinic in male
building, Assistant Director of Clinic in male
building, Director of Clinic in female building
and Intern's Supervisor. 3 decision makers from
KAU Dean, Program Coordinator and Clinical
Supervisor. 3 decision makers from UOD Dean,
Vice Dean for Clinical Affairs and Program
Coordinator.
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Results of quantitative method The overall
response rate of interns 52 (106/205). The
overall response rate for each Dental College
was 76 (62/93) from KSU, 38 (37/97) from
KAU, 47 ( 7/15) from UOD. Cronbach alpha was
0.6 - 0.8 for questionnaire domains
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The percentage satisfaction of all interns for
each domain
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ANOVA p-value was significant between all
universities p 0.023
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One way ANOVA was used to compare the mean
percentage score for each domain in each
university. The p-value was significant (lt 0.05)
in two domains (supervision and clinical
training).
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Highest satisfaction items for each domain
Item Domain
47 Weekly presentation topics. Scientific activities
57 Cooperation of faculty in conducting research with you. Research
57 Relationship between the supervisors of other training centers and interns. Supervision
88 Cooperation of dental assistants in clinics of other training centers. Clinical training
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Lowest satisfaction items for each domain
Item Domain
12 Periodical hands-on workshops. Scientific activities
16 Availability of research laboratories that are well equipped to conduct research. Research
11 Availability of supervisors in clinics of the college in the summer. Supervision
3 The training on Dental implant cases. Clinical training
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Discussion Findings of this study are
discussed under the following standards of NCAAA.
Mission Goals and Objectives A Program
mission did not exist for all universities, Even
though written objectives were written and
evaluated by the Committee, the objectives were
vague, not specific or measurable some included
multiple objectives in one objective "to gain
more experience" (KSU) "To advance the knowledge
skills" (KAU) " instill a sense of how "
"foster an educational environment " (UOD) Kern
D E, et al., Curriculum development for medical
education a six-step approach 1998, Baltimore,
Maryland The Johns Hopkins University Press.
28-29.
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Mission Goals and Objectives (Cont) On the
other hand intern in all universities could not
specify the objectives and did not obtain them
from the manual. "We did not read the
objectives" (KSU). To prepare interns to be a
doctor working without close supervision (KAU)
there were no objectives UOD
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Mission Goals and Objectives (Cont) Orientations
before starting the program was insufficient
and was overloaded with information. There was
also inconsistencies was found between
information provided on the web-sites and manuals
of some universities. This problem led some
participants to work without clear a vision,
target, objectives and purpose of the internship
program. There was also a conflict of opinion
regarding receipt of the program manual which
indicates there was a gap between interns and
decision makers.
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Learning and Teaching There was variability in
clinical training between universities, For
example, in KSU interns worked 4 to 8 months in
clinics while in KAU and UOD this was 6 months.
There was conflict between intern interviews,
decision makers interviews and document reviews
regarding presence of a clinical supervisor in
the clinic for consultation.
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Learning and Teaching (Cont) Document reviews
and interviews with decision makers revealed that
some doctors were assigned to be clinical
supervisors in the clinic of the college, in
contrast, interns mentioned a low percentage of
presence of clinical supervisors in the clinic of
the college compared with a perceived high
percentage of clinical supervisor presence
outside of the college.
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Learning and Teaching (Cont) Teaching
strategies in all universities depended on
clinical training, lectures and a few
workshops. There was no evidence of
implementation of new educational strategies
(such as PBL , integrated learning, role models,
demonstration, audio or video review of learners,
role play, and self directed learning). Old
educational strategies and unclear guidelines for
training centers led some of the interns in focus
group interviews to perceive that they had not
enough experience, knowledge and clinical skills
at the end of program.
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Learning and Teaching (Cont) The assessment of
Interns in all universities depended on various
strategies as mentioned in the documents reviewed
and interviews with decision makers These
included clinical performance, research
evaluation, training center evaluation or
additionally clinical requirements at for
example, KAU and UOD, These assessment methods
were followed by provision of feedback to
interns ,
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Learning and Teaching (Cont) However, in
contrast some interns in focus group interviews
mentioned there was no assessment and some from
KSU referred to assessment depending on
attendance without feedback and other from KAU
indicated the presence of assessment but it was
in secret. "our assessment was secret, we did
not see it (KAU)
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Learning and Teaching (Cont) These conflicting
views indicate that assessment methods were
unclear for interns and decision makers tended
not provide effective feedback to all interns
periodically. Providing effective continuous
feedback will change and improve the behavior of
student over time. As Hattie and Timperley
(2007) indicated in their review of feedback in
higher education, feedback is a very important
influence on learning and achievement. The
quality and timing of feedback is especially
important. Richardson, B.K., Feedback. Acad
Emerg Med, 2004. 11(12) p. e1-5. Hattie, J. and
H. Timperley, The Power of Feedback. Review of
Educational Research March 2007 77(1) p. pp.
81-112.
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Limitations of the Study The qualitative
approach to data collection which is well known
to require subjective interpretation of the
researcher and therefore open to some bias.
The fact that interviews were not audio
recorded because of the sensitivity of the study
from perspectives of participants, which may have
led to some information being missed. The small
sample size of respondents in KAU and UOD may
also be considered a limitation. This may be
because the questionnaires were sent via email
and some may have gone to junk mail or spam
boxes.  
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• Main recommendations for program improvements
  include
• Review regulations and protocols of the dental
  internship program utilizing the input of a task
  force or committee consisting of multiple
  agencies such as Ministry of Higher Education,
  Ministry of Civil Services and Ministry of
  Finance as well as members from the Dental
  Colleges.
• Write program objectives using specific,
  measurable and not vague statements and words
  that can be interpreted in variable ways. These
  statements should have five basic elements (who,
  will do, how much(how well), of what and by when
• Kern D E, et al., Curriculum development for
  medical education a six-step approach 1998,
  Baltimore, Maryland The Johns Hopkins University
  Press. 28-29.

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• Main recommendations (Cont.)
• Administer the program by team work and
  collaboration with committee members.
• Assign a full time specialist clinical supervisor
  for clinical consultation.
• Provide effective constructive feedback to all
  interns periodically.

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• Main recommendations (Cont.)
• Write a program manual that describes the program
  in detail, including. enrolment system, interns
  rights, regulations, activities, assessment, etc.
• Evaluate training centers periodically.
• Re evaluate the program using surveys and
  interviews with interns and staff.

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Conclusion Reviewing the content of dental
internship programs revealed that All programs
in all universities were ill-structured,
according to accreditation standards. Indeed,
these standards were on whole not met. This is
not necessarily considered as failure but
indicates that accreditation standards must be
considered when developing programs. There was
considerable variability in the quality of
programs, although some universities exhibited
exemplary characteristics, while others did not.
Various concerns, issues, and needs were
identified from perspectives of key
stakeholders. Several recommendations are made
for improvement of programs.  
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Thank you