OBJECTIVE:Dealodontics, an original learning card game, supports skills in predoctoral orthodontics. The purpose of this study was to assess the pre-posttest learning effect from gameplay compared to a control group and to characterize the effect size. METHODS:This study was exempted by the New York University (NYU) Institutional Review Board (FY2021-5698). In Academic Year (AY) 2022-2023, second-year dental (D2) students enrolled in a Predoctoral Orthodontics Lab Session at NYU College of Dentistry were assigned into two groups: Control (N = 70) received a PowerPoint lesson, and Game (N = 139) played Dealodontics. Groups received identical pre- and post-tests with 14 questions. In AY 2023-2024, D2 students were assigned to only one group: Game (N = 139) received 28 identical pre- and post-test questions. The analysis included t-tests, and effect size based on pre-posttest differences. RESULTS:In AY 2022-2023, Control and Game groups demonstrated pre-posttest learning gains: Control (0.39, standard deviation [SD] = 2.00, p = 0.10) and Game (1.0, SD = 1.95, p ≤ 0.0001). The difference in pre-posttest effects between groups was 0.65 (p = 0.03), favoring the Game.  In AY 2023-2024, Game pre-posttest results were positive (2.77, SD = 4.36, p ≤ 0.0001), with a medium to large effect size (d = 0.64). CONCLUSIONS:In contrast to the Control group, students who played Dealodontics consistently demonstrated significant pre-posttest learning gains with a medium-large effect size. This study supports the use of the learning card game Dealodontics in the curriculum.

This perspective paper addresses the current landscape of predoctoral orthodontic education in the United States. A history of American Dental Education Association (ADEA) senior dental student exit surveys consistently reveals that graduates lack confidence in space management and malocclusion. The authors, with over 50 years of combined experience in dental education, present variations in predoctoral orthodontics programs, common challenges, and underscore the need for aligning curricula with the distinct characteristics of the current Gen Z student cohort. Variations include instructional clock hours, timing and sequence, and instructor qualification. An examination of the topics covered in predoctoral orthodontics demonstrates stability from the 1993 ADEA guidelines to a 2021 consensus panel's recommendations. Specific examples stemming from the direct experiences of the authors demonstrate the variety of approaches used in predoctoral orthodontic education. Challenges in predoctoral education stem from not distinguishing curricular goals from Advanced Education in Orthodontics, or clearly defining parameters for competence. Training dental students to treat malocclusion is not practical or possible within the present dental curriculum. The authors stress the importance of shifting educational goals towards competency training in recognizing, diagnosing, and managing malocclusion, to increase relevance to general dental clinical practice. The paper highlights innovative teaching strategies to engage students in competency-based learning: Problem Based Learning, Gamification, Case-based learning, Cold calling, Test enhanced Learning, Spiral Curriculum. The paper also presents educational technological applications used in traditional classrooms or remote environments for teaching and assessment, well suited for Gen Z's preference for technologically driven interactive learning methods. Despite its challenges, predoctoral orthodontics education in the United States is filled with opportunities for growth, which will only lead to elevating the standard of dental care for all patients.

Learning games that are based on current scientific concepts are underutilized in dental education. This paper explores the relevant science of learning and discusses several principles that are conducive to learning and teaching in an educational setting, namely retrieval practice, feedback, motivation, and engagement. A discussion of learning games in health professional education ensues, followed by a description of relevant best practices in game design for learning. This paper concludes by presenting Dealodontics©, a card game developed at New York University College of Dentistry with the goal of helping second-year dental students review, practice, and apply basic skills relevant to their orthodontics competency requirements.

OBJECTIVE:To describe changes in a competency-based orthodontics course in response to the COVID-19 pandemic, and compare outcomes before and after these adaptations.METHODS:Exempted by NYU IRB (#FY2021-4795, #FY2021-5748). At NYU College of Dentistry, assessments and surveys for D3 course groups were compared: 2018 (N = 89, in-person) and 2022 (N = 109, hybrid; remote synchronous with cold-calling). Assessments were identical and proctored. Pass rates, mean scores, and score distributions were compared using t-tests and Z-scores. Internal consistency of surveys was evaluated with Cronbach's alpha. Six paired Likert items were categorized into Positive, Neutral, and Negative and compared using Fisher's exact test and phi coefficients. Four items were added to the 2022 survey to assess students' responses to "cold-calling" and were evaluated using descriptive statistical methods.RESULTS:No significant differences in pass rates or mean assessment scores were found between 2018 (79.8%, 1.45 ± 1.11) and 2022 (80.7%, 1.50 ± 0.97) groups. Surveys demonstrated high internal consistency (Cronbach's alpha: 0.95 and 0.81). Response rates were 79% and 80% for both groups with a median score of 4 (Agree) or higher, indicating positive confidence and motivation. Fisher's exact test and phi coefficients did not find significant differences across surveys (p ≤ 0.05). The four additional Likert items in the 2022 group survey suggested that cold-calling increased preparedness and anxiety. The median score for cold-call items = 4 (Agree).CONCLUSIONS:The null hypothesis was upheld. Assessment and survey outcomes for 2018 and 2022 were similar. Students displayed increased confidence and motivation. "Cold-calling" was associated with increased preparedness, engagement, and anxiety.

OBJECTIVES:Dealodontics is a card game developed at New York University College of Dentistry for dental students to reinforce and apply basic orthodontic concepts. Dealodontics incorporates clinical photographs and questions to assess students' skills in diagnosis and patient management. The game was designed to be an enjoyable, interactive, and collaborative learning experience, supplementing competency-based instruction. The purpose of this project was to present this novel educational method and to evaluate dental students' engagement and game-playing experience.METHODS:The survey was modeled after the "Game Experience Questionnaire" and followed the same methodology collapsing 16 survey questions into eight categories. The 5-point Likert scale was collapsed into a 3-point graduated scale (negative, neutral, and positive). Results were tabulated and scored using methods developed by IJsselsteijn et.al. Comparisons were made between two years: 2019 (N = 385) and 2021 (N = 245). Additionally, students were asked an open-ended question, to list three words to describe the game-playing experience.RESULTS:Response rates declined from 72% in 2019 to 50.2% in 2021. Response trends were similar: Positive gameplay experiences (competence, positive affect, immersion, challenge, and learning) and lack of negative experiences (tension/annoyance, negative affect). In the category of flow, 2021 responses were more positive (42.68%) when compared to the responses in 2019 (38.3%). Open-ended responses were similar with "fun" being the most commonly occurring word.CONCLUSIONS:Dealodontics is an effective and engaging tool for learning which can be used to supplement traditional methods.

Despite obvious challenges, the COVID pandemic has given educators time to pause and consider how to construct remote instruction that is effective — and possibly better than — the use of traditional methods. The purpose of this report is to contrast pre-COVID and COVID-era methods, describe new methods developed, and present early outcomes data. Key points include: 1) Increasing active formative "clinical" experiences 2) Methods to enhance in-class engagement 3) A new case-based competency assessment that evaluates the student's ability to make evidence-based decisions in diagnosis and patient management. Although this report is based on a D3 course, "Clinical Applications in Orthodontics Seminars," these methods can be used in any clinical area that emphasizes critical thinking skills.

Feedback can exert a powerful influence on learning and achievement although its effect varies. The aim of this study was to investigate the effects of three types of feedback on dental students' attitudes and confidence in a competency-based course in predoctoral orthodontics at New York University College of Dentistry. In 2013-14, all 253 third-year students in a course using test-enhanced instructional methods received written feedback on formative assessments. The type of feedback varied across three groups: pass/fail grades (PF) N=77, emoticons (EM) N=90, or written comments (WC) N=86. At the end of the course, students completed surveys that included four statements addressing their attitudes toward course instruction and confidence in their abilities. The survey response rate ranged from 75% to 100% among groups. The lowest response rate (75%) was in the PF group. In attitudes toward course instruction and confidence in their abilities, the WC group trended to more positive responses than the other groups, while the PF group trended to negative responses. On two of the four statements, the trend for the WC group was significant (95% CI). In both statements concerning attitudes toward instruction, the PF group trended to negative responses that were significant (95% CI). These results support the effectiveness of descriptive written comments over pass/fail grades or emoticons in improving dental students' confidence in their abilities and their attitudes toward instruction.

Dental educators intend to promote integration of knowledge, skills, and values toward professional competence. Studies report that retrieval, in the form of testing, results in better learning with retention than traditional studying. The aim of this study was to evaluate test-enhanced experiences on demonstrations of competence in diagnosis and management of malocclusion and skeletal problems. The study participants were all third-year dental students (2011 N=88, 2012 N=74, 2013 N=91, 2014 N=85) at New York University College of Dentistry. The 2013 and 2014 groups received the test-enhanced method emphasizing formative assessments with written and dialogic delayed feedback, while the 2011 and 2012 groups received the traditional approach emphasizing lectures and classroom exercises. The students received six two-hour sessions, spaced one week apart. At the final session, a summative assessment consisting of the same four cases was administered. Students constructed a problem list, treatment objectives, and a treatment plan for each case, scored according to the same criteria. Grades were based on the number of cases without critical errors: A=0 critical errors on four cases, A-=0 critical errors on three cases, B+=0 critical errors on two cases, B=0 critical errors on one case, F=critical errors on four cases. Performance grades were categorized as high quality (B+, A-, A) and low quality (F, B). The results showed that the test-enhanced groups demonstrated statistically significant benefits at 95% confidence intervals compared to the traditional groups when comparing low- and high-quality grades. These performance trends support the continued use of the test-enhanced approach.

Our College recently convened a series of retreats bringing together faculty, administrators and employees to identify common concerns. Stakeholders working independently in small groups separately and collectively agreed that our major organizational concern was communication. This theme played out in various ways. From not knowing what was going on beyond an individual's immediate work area to broader interpersonal challenges. Some felt a lack of caring or appreciation. Often the word, "respect," was used. Perceived deficiencies extended to students, faculty, administrators, staff, and most troubling, to patients. Communication skills are recognized as essential to professional competence by the Commission on Dental Accreditation, the American Dental Education Association, and the Inter-professional Educational Collaborative. It is a theme that crosses disciplines and is foundational to patient-centered care. As scientifically driven evidence-based healthcare and technologies progress, the emotional, psychological, social and cultural needs of patients may be neglected. Communication skills centered on empathy and showing you care, yield benefits to both the doctor and patient in terms of satisfaction, compliance, and treatment outcomes.

INTRODUCTION:Esthetic considerations play an increasingly important role in patient care, and clinicians need a methodology that includes imaging techniques to capture the dynamic nature of the smile. Photographs of the posed smile are routinely used to guide diagnosis and treatment, but there is no standardized and validated method for recording the dynamic smile. The purposes of this study were to (1) determine whether a posed smile is reproducible, (2) compare visual and verbal cues in eliciting a smile, and (3) compare the diagnostic value of videography and photography in evaluating a patient's smile.METHODS:The smiles of 22 subjects were simultaneously photographed and videotaped on 2 separate occasions. For objective comparisons, measurements of the smile were obtained from 8 × 10 color still photographs and selected digitized video images. A panel consisting of a layperson, an oral surgeon, an orthodontist, and a prosthodontist subjectively assessed the reproducibility of the smile, posed vs spontaneous smiles, and the diagnostic value of video vs still images.RESULTS:Objective measurements showed that the posed smile can be reliably reproduced, whether captured by videography or still photography. However, subjectively, the panel members detected differences between the posed smiles taken on different days 80% of the time. The clinician panel members expressed a strong preference for videography over photography and for the spontaneous over the posed smiles.CONCLUSIONS:This study emphasizes the need to continue to investigate and standardize the methods of eliciting and recording a smile of diagnostic quality.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises reflecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite specific examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

Even if a clinician possesses basic knowledge in esthetic dentistry and clinical skills, many cases presenting in modern dental practices simply cannot be restored to both the clinician's and the patient's expectations without incorporating the perspectives and assistance of several dental disciplines. Besides listening carefully to chief complaints, clinicians must also be able to evaluate the patient's physical, biologic, and esthetic needs. This article demonstrates the use of a smile evaluation form designed at New York University that assists in developing esthetic treatment plans that might incorporate any and all dental specialties in a simple and organized fashion.

A process for the development of assessments and supporting instructional components in competency-based dental education is described. This process is illustrated using the example of an educational module in the management of malocclusion and skeletal problems at New York University College of Dentistry. The process begins with identifying the final outcome of the skill to be assessed and constructing an assessment that represents a relevant clinical situation. Such an assessment requires students to employ key enabling or foundational knowledge, specified subskills, and evaluative criteria. Once the components essential to mastering the assessment are identified, an instructional module that facilitates attainment of competence can be developed. This module is complemented by a companion piece that is content-specific and directs teachers and students to reach instructional targets. Assessments, supported by the components described in this process, increase the cognizance of the dental educator and provide mechanisms to evaluate student achievement and instructional effectiveness.

A course developed at the New York University College of Dentistry provides third-year predoctoral students with instruction and formative experiences leading toward competence in the management of malocclusion and skeletal problems. Based on clearly defined evaluation criteria that can be objectively assessed, faculty and students share a common standardized language to evaluate malocclusion and skeletal problems. The course incorporates clinical simulation cases reflecting a variety of malocclusions and dentofacial conditions at different developmental stages. Formative experiences including interviewing techniques and cephalometric, facial, and study cast analyses build skills that are applied to diagnosis and treatment planning. Objectified competency evaluation criteria facilitate student instruction, faculty standardization, and assessment. Elements of this course may be used to create a more uniform competency-based approach to predoctoral orthodontic curricula across dental schools, while also providing a model for the development of courses in other areas of education, especially with regard to credentialing health providers.