Student‐to‐Student Dental Local Anesthetic Preclinical Training: Impact on Students’ Confidence and Anxiety in Clinical Practice

Abstract

Effective dental local anesthetic administration forms the basis of pain‐free dentistry; therefore, the application of theoretical knowledge and the ability to deliver injections safely and competently are vital aspects of student learning. Student‐ to‐student administration of the first local anesthetic injection has been a traditional method for preclinical training. The aim of this study was to evaluate oral health students’ perceived value of such practice and the impact on their level of anxiety and confidence in giving their first injections to patients. A sequential mixed‐methods cohort study design was used. After their local anesthesia training, all 42 second‐year students in the oral health program at the Sydney Dental School, University of Sydney, Australia, in 2016–17 were asked to complete five short questionnaires. All 42 students completed each questionnaire, after which seven of them participated in a voluntary focus group. The students reported that they valued the one‐on‐one feedback from the educators during student‐to‐student preclinical training. The students’ primary concern was the possible pain and discomfort that may arise when they perform the first infiltration or inferior alveolar nerve block injections on patients. Most students reported they felt “a little nervous” and experienced a similar level of confidence in administering the two types of injections. The oral health students valued the experiential learning of student‐to‐student preclinical dental local anaesthetic training. Students’ level of anxiety and confidence was affected by the age of patients and type of local anesthetic injections. The level of anxiety students experienced was negatively correlated with their confidence in giving first local anesthetic injections to patients. Further investigation is needed to determine if this level changes with more clinical experience.

A Tale of Two Teaching Methods: Students' Clinical Perspectives on Administering Dental Local Anesthetics

“…All students in the second year in the Bachelor of Oral Health program in 2016 (n=42; men=7, wom-en=35) 11 and in 2017 (n=31; men=5, women=26) participated in the study. The responses of the two cohorts (2016: training using student-to-student practice; 2017: training using manikin simulation models) are shown in Table 1.…”

“…11 We collected quantitative data using a five-point Likert-scale questionnaire; after the survey, we collected qualitative data from a subgroup of the same students using focus groups. Responses of the 2016 cohort were previously published.…”

“…Responses of the 2016 cohort were previously published. 11 We collected quantitative data using a five-point Likert-scale questionnaire; after the survey, we collected qualitative data from a subgroup of the same students using focus groups. The same questionnaire and focus group questions were used with both cohorts.…”

“…However, the process of learning and mastering these skills, especially with inferior alveolar nerve block (IANB) injections, can create stress and anxiety in students due to variations in anatomical landmarks and the required accuracy of the insertion point. [9][10][11] However, Holden noted that a degree of coercion exists due to the power imbalance between faculty and students, which constitutes undue influence on students' consent to participate in the practice. The use of students as practice subjects for administering LA, although invasive and with potential complications, such as parathesia, and ethical concerns, remains the most common preclinical practice in the U.S. and Europe.…”

“…[6][7][8] Previous studies reported that students viewed the feedback from their peers and educators during student-to-student practice as beneficial as it made them feel better prepared and more able to empathize with the patient during an LA injection. [9][10][11] However, Holden noted that a degree of coercion exists due to the power imbalance between faculty and students, which constitutes undue influence on students' consent to participate in the practice. 12 In addition, Rosenberg et al argued that it is unacceptable to give LA injections to one another that are not to address any procedural need and carry risks of serious complications.…”