Measuring final-year dental students’ ability to remove teeth independently using independence ratios

Background. Universities are obliged to ensure that dental graduates possess the necessary skills to render safe and effective treatment. Empirical evidence regarding the development of safe and effective independent practice at undergraduate level is unfortunately lacking.Objectives. To measure final-year students’ abilities to correctly perform exodontia (tooth removal/extraction) skills independently, based on the applied postgraduate progressive independence theory. Methods. Fourteen clinical teachers systematically assessed 13 263 tooth extractions completed by final-year dental students (2014 - 2016). An independence ratio (extractions performed without assistance/total number of extractions) was used as the key performance indicator to provide feedback on the ability to complete procedures independently over time. A customised index was used for controlling the level of difficulty.Results. Final-year students (n=146) achieved independence ratios ranging between 90% and 94% (standard deviation 3.3%) by the end of their clinical training. Logical gradients of increased independence were illustrated with time, as well as variable performance among students. The level of difficulty index scores remained similar within cohorts per year of study. Acceptable assessment differences existed between clinical teachers, which could largely be explained by complex operational circumstances. Conclusions. As far as we are aware, this is the first study that quantified progressive independence in exodontia for undergraduate students. The measure was sensitive enough to show logical independence gradients and variance among students. Final-year students demonstrated that they could remove >8/10 teeth independently by the time of their graduation. The measure shows promise as a proxy of competence for skills that are often practised. It is recommended that factors that influence these measurements be examined in more detail.