ttp://www.bsava.com
PAPER
Final year veterinary students’ attitudes towards small animal dentistry: a questionnaire-based survey R. Perry Grove Lodge Veterinary Hospital, Worthing, West Sussex BN14 9DL
OBJECTIVES: To investigate the attitudes of final year veterinary students towards small animal dentistry and to examine the teaching received in this subject, both at university and during extra-mural studies. METHODS: A cross-sectional study of all UK final year veterinary students in 2012 was designed and used by a self-administered Internet-based questionnaire. RESULTS: Six of seven universities participated with 188 student responses. All students felt that it was important or very important for a small animal practitioner to have a broad understanding of dentistry, and that orodental problems were common or very common in small animals. Almost all (99·5%) students perceived small animal dentistry as an important or very important subject. Less than 40% of students felt that the teaching had prepared them for entering practice. Over 50% reported that they neither felt confident in discussing orodental problems with clients nor in performing a detailed examination of the oral cavity. CLINICAL SIGNIFICANCE: Dental problems are perceived by students as frequently encountered in small animal practice. The veterinary surgeon should be adequately trained to detect, diagnose and treat dental disease in small animals and many students feel that their current teaching is inadequate. Journal of Small Animal Practice (2014) 55, 457–464 DOI: 10.1111/jsap.12258 Accepted: 12 June 2014; Published online: 7 August 2014
INTRODUCTION Dental disorders in dogs and cats are frequently encountered in small animal practice (Bell 1965, Golden et al. 1982, Lund et al. 1998, 1999, Kyllar & Witter 2005, Freeman et al. 2006). Periodontal disease is arguably the most common disease of dogs and cats (Lund et al. 1999, Niemiec 2008a, Lommer & Verstraete 2001, Kortegaard et al. 2008, Girard et al. 2009) with prevalence and severity increasing with age (Harvey et al. 1994). Tooth resorption (formerly known as feline odontoclastic resorptive lesions; AVDC 2014) is also common in cats with a prevalence of up to 67% (Lommer & Verstraete 2000, 2001, Ingham et al. 2001). Fractured teeth are also commonly encountered (Golden et al. 1982, Niemiec 2008b). These problems may be under-treated and are often overlooked sources of pain (Hellyer et al. 2007, Niemiec 2008b). Furthermore, periodontal disease may lead to severe local and systemic complications, including oronasal fistulae, pathological jaw fracture, osteomyelitis Journal of Small Animal Practice
•
Vol 55
•
September 2014
•
(Niemiec 2008a), chronic nasal disease (Tasker et al. 1999, Demko & Cohn 2007), chronic kidney disease (Glickman et al. 2011) and histological changes in kidney, liver and myocardium (DeBowes et al. 1996, Pavlica et al. 2008). It is therefore vital that veterinary surgeons are adequately trained in the diagnosis and treatment of these conditions. Dental procedures are commonly performed in practice, and new graduate veterinarians are expected to perform dental prophylaxis and tooth extractions on a frequent basis with little or no supervision (Clark et al. 2002, Greenfield et al. 2004). Despite the high prevalence of orodental diseases encountered in practice and the frequency with which treatments are performed, anecdotal evidence, expert opinion (Gorrel 2013) and research (Fitzpatrick & Mellor 2003) suggest veterinary surgeons receive inadequate education in small animal dentistry in their undergraduate years. Dentistry has been performed on animals since earliest recorded history (Harvey 1994), but has only relatively recently been recognised as a specialty in its own right. Unlike the situation in the USA, no university in
© 2014 British Small Animal Veterinary Association
457
R. Perry
the UK offering a veterinary degree has a dedicated small animal dentistry and oral surgery department. Teaching is therefore provided by external consultants, interest groups or non-dentistry specialist staff members. Students also undertake extra-mural studies (EMS), whereby time is spent in veterinary practices learning veterinary skills and attributes. These placements have been shown to be valuable for students in preparing them for practice, by emphasising the connection between theory and practice (Baguley 2006). It has been shown that much of what is learnt about dentistry is acquired during EMS (Fitzpatrick & Mellor 2003). The purpose of this research was to assess the attitudes of UK final year veterinary students towards small animal dentistry. It was designed to assess the provision of small animal dental education at university and assess whether students are graduating with sufficient knowledge and confidence to enter practice. A further aim was to assess experiences of dentistry during EMS. The results from this study may be used both by external providers and the universities to enhance the provision of small animal dental education.
MATERIALS AND METHODS A cross-sectional study was designed, targeting all UK final year veterinary students entering the last term of study in 2012. All UK universities offering veterinary degrees were approached and invited to participate. Survey design and implementation A self-administered Internet-based questionnaire was constructed. This consisted of 29 questions (Supporting Information, Appendix S1), which were accessed via a secure link, sent in an e-mail by administrative staff. Two weeks later, a further e-mail was sent to all students, thanking those who had already participated and encouraging others to participate. A final request was sent after a further 2 weeks. All responses were voluntary, anonymous and confidential. Most questions were 5-point Likert response formats (Likert 1932, Oppenheim 1999, Carifio & Perla 2007). The first section reviewed the students’ place of study, their gender and proposed area of work after graduation. The second section reviewed the students’ current attitudes towards small animal dentistry, and the third assessed the students’ experiences of small animal dentistry during EMS. The fourth section explored the students’ experiences of teaching within the university. At The Royal (Dick) School of Veterinary Studies, Edinburgh, the research method was reviewed and accepted by an ethical review group. Qualitative analysis To understand the students’ responses more clearly, respondents were given opportunities to leave comments regarding their answers to certain questions. In addition, the last question was an open-ended question regarding the students’ experience of teaching in small animal dentistry. Responses were analysed for recurrent themes. 458
Statistical analyses To investigate any differences in responses between different universities, percentages are presented and chi-square tests were used to test for any statistically significant differences. All analyses were performed using commercially available software (IBM SPSS Statistics).
RESULTS Of the seven universities offering veterinary degrees in the UK, the following elected to participate: The University of Glasgow School of Veterinary Medicine (Glasgow), The Royal (Dick) School of Veterinary Studies (Edinburgh), The University of Liverpool School of Veterinary Science (Liverpool), The University of Cambridge Department of Veterinary Medicine (Cambridge), The University of Bristol School of Veterinary Sciences (Bristol) and the Royal Veterinary College, University of London (RVC). In total, 188 responses were received. The distribution of responses by university is shown in Table 1. The majority of students intended to go into mixed (n=76, 40·4%) or small animal practice (n=77, 41·0%; Fig 1), with only a small percentage (n=5, 3%) intending to pursue advanced studies. Overall, 87% (n=163) of students thought it was unlikely or highly unlikely that they would pursue specialist training in small animal dentistry and oral surgery. Student attitudes towards small animal dentistry are summarised in Tables 2 to 6. In total, 99·5% (n=187) of students
Table 1. Response rate by university Student responses by university
Number (%)
Number of students in year
Response rate (%)
Bristol Cambridge Edinburgh Glasgow Liverpool RVC Total
31 (16·5) 8 (4·3) 43 (22·9) 16 (8·5) 36 (19·1) 54 (28·7) 188 (100)
102 59 140 110 118 220 749
30·4 13·6 30·7 14·5 30·5 24·5 25·1
RVC Royal Veterinary College
FIG 1. Distribution of student expectation of employment after graduation
Journal of Small Animal Practice
•
Vol 55
•
September 2014
•
© 2014 British Small Animal Veterinary Association
Students’ attitudes towards small animal dentistry
Table 2. Student attitude towards the importance of small animal dentistry
Table 5. Perceived prevalence of oral/dental problems in small animals
Total Very unimportant Unimportant Neutral Important Very important Total
n % n % n % n % n %
0 0 0 0 1 0·5% 87 46·3% 100 53·2%
n
188
Total Very uncommon Uncommon Neutral Common Very common Total
Table 3. Student enjoyment of small animal dentistry as a subject
n % n % n % n % n %
0 0 0 0 0 0 31 16·5% 157 83·5%
n
188
Table 6. Perceived possibility that small animal oral/ dental problems may negatively affect welfare
Total I hate it
n % n % n % n % n % n
I don’t like it Neutral I enjoy it I really enjoy it Total
Total
5 2·7% 22 11·7% 69 36·7% 78 41·5% 14 7·4% 188
Very unlikely Unlikely Neutral Likely Very likely Total
Total n % n % n % n % n % n
Unimportant Neutral Important Very important Total
0 0 0 0 5 2·7% 70 37·2% 113 60·1% 188
thought that small animal dentistry is an important or very important subject, with 49% (n=92) reporting they enjoyed or really enjoyed it. All students thought that it is either important or very important for a small animal veterinary surgeon to have a broad understanding of dentistry. Likewise, all students thought orodental problems are common or very common in small animals and 97% (n=183) of students thought that these are likely or very likely to negatively affect welfare. The majority of students (n=180, 95·7%) believed that the teaching should prepare them for entering practice. However, less than 40% of students (n=75) felt suitably prepared (Table 7). These were statistically significant differences (p
PAPER
Final year veterinary students’ attitudes towards small animal dentistry: a questionnaire-based survey R. Perry Grove Lodge Veterinary Hospital, Worthing, West Sussex BN14 9DL
OBJECTIVES: To investigate the attitudes of final year veterinary students towards small animal dentistry and to examine the teaching received in this subject, both at university and during extra-mural studies. METHODS: A cross-sectional study of all UK final year veterinary students in 2012 was designed and used by a self-administered Internet-based questionnaire. RESULTS: Six of seven universities participated with 188 student responses. All students felt that it was important or very important for a small animal practitioner to have a broad understanding of dentistry, and that orodental problems were common or very common in small animals. Almost all (99·5%) students perceived small animal dentistry as an important or very important subject. Less than 40% of students felt that the teaching had prepared them for entering practice. Over 50% reported that they neither felt confident in discussing orodental problems with clients nor in performing a detailed examination of the oral cavity. CLINICAL SIGNIFICANCE: Dental problems are perceived by students as frequently encountered in small animal practice. The veterinary surgeon should be adequately trained to detect, diagnose and treat dental disease in small animals and many students feel that their current teaching is inadequate. Journal of Small Animal Practice (2014) 55, 457–464 DOI: 10.1111/jsap.12258 Accepted: 12 June 2014; Published online: 7 August 2014
INTRODUCTION Dental disorders in dogs and cats are frequently encountered in small animal practice (Bell 1965, Golden et al. 1982, Lund et al. 1998, 1999, Kyllar & Witter 2005, Freeman et al. 2006). Periodontal disease is arguably the most common disease of dogs and cats (Lund et al. 1999, Niemiec 2008a, Lommer & Verstraete 2001, Kortegaard et al. 2008, Girard et al. 2009) with prevalence and severity increasing with age (Harvey et al. 1994). Tooth resorption (formerly known as feline odontoclastic resorptive lesions; AVDC 2014) is also common in cats with a prevalence of up to 67% (Lommer & Verstraete 2000, 2001, Ingham et al. 2001). Fractured teeth are also commonly encountered (Golden et al. 1982, Niemiec 2008b). These problems may be under-treated and are often overlooked sources of pain (Hellyer et al. 2007, Niemiec 2008b). Furthermore, periodontal disease may lead to severe local and systemic complications, including oronasal fistulae, pathological jaw fracture, osteomyelitis Journal of Small Animal Practice
•
Vol 55
•
September 2014
•
(Niemiec 2008a), chronic nasal disease (Tasker et al. 1999, Demko & Cohn 2007), chronic kidney disease (Glickman et al. 2011) and histological changes in kidney, liver and myocardium (DeBowes et al. 1996, Pavlica et al. 2008). It is therefore vital that veterinary surgeons are adequately trained in the diagnosis and treatment of these conditions. Dental procedures are commonly performed in practice, and new graduate veterinarians are expected to perform dental prophylaxis and tooth extractions on a frequent basis with little or no supervision (Clark et al. 2002, Greenfield et al. 2004). Despite the high prevalence of orodental diseases encountered in practice and the frequency with which treatments are performed, anecdotal evidence, expert opinion (Gorrel 2013) and research (Fitzpatrick & Mellor 2003) suggest veterinary surgeons receive inadequate education in small animal dentistry in their undergraduate years. Dentistry has been performed on animals since earliest recorded history (Harvey 1994), but has only relatively recently been recognised as a specialty in its own right. Unlike the situation in the USA, no university in
© 2014 British Small Animal Veterinary Association
457
R. Perry
the UK offering a veterinary degree has a dedicated small animal dentistry and oral surgery department. Teaching is therefore provided by external consultants, interest groups or non-dentistry specialist staff members. Students also undertake extra-mural studies (EMS), whereby time is spent in veterinary practices learning veterinary skills and attributes. These placements have been shown to be valuable for students in preparing them for practice, by emphasising the connection between theory and practice (Baguley 2006). It has been shown that much of what is learnt about dentistry is acquired during EMS (Fitzpatrick & Mellor 2003). The purpose of this research was to assess the attitudes of UK final year veterinary students towards small animal dentistry. It was designed to assess the provision of small animal dental education at university and assess whether students are graduating with sufficient knowledge and confidence to enter practice. A further aim was to assess experiences of dentistry during EMS. The results from this study may be used both by external providers and the universities to enhance the provision of small animal dental education.
MATERIALS AND METHODS A cross-sectional study was designed, targeting all UK final year veterinary students entering the last term of study in 2012. All UK universities offering veterinary degrees were approached and invited to participate. Survey design and implementation A self-administered Internet-based questionnaire was constructed. This consisted of 29 questions (Supporting Information, Appendix S1), which were accessed via a secure link, sent in an e-mail by administrative staff. Two weeks later, a further e-mail was sent to all students, thanking those who had already participated and encouraging others to participate. A final request was sent after a further 2 weeks. All responses were voluntary, anonymous and confidential. Most questions were 5-point Likert response formats (Likert 1932, Oppenheim 1999, Carifio & Perla 2007). The first section reviewed the students’ place of study, their gender and proposed area of work after graduation. The second section reviewed the students’ current attitudes towards small animal dentistry, and the third assessed the students’ experiences of small animal dentistry during EMS. The fourth section explored the students’ experiences of teaching within the university. At The Royal (Dick) School of Veterinary Studies, Edinburgh, the research method was reviewed and accepted by an ethical review group. Qualitative analysis To understand the students’ responses more clearly, respondents were given opportunities to leave comments regarding their answers to certain questions. In addition, the last question was an open-ended question regarding the students’ experience of teaching in small animal dentistry. Responses were analysed for recurrent themes. 458
Statistical analyses To investigate any differences in responses between different universities, percentages are presented and chi-square tests were used to test for any statistically significant differences. All analyses were performed using commercially available software (IBM SPSS Statistics).
RESULTS Of the seven universities offering veterinary degrees in the UK, the following elected to participate: The University of Glasgow School of Veterinary Medicine (Glasgow), The Royal (Dick) School of Veterinary Studies (Edinburgh), The University of Liverpool School of Veterinary Science (Liverpool), The University of Cambridge Department of Veterinary Medicine (Cambridge), The University of Bristol School of Veterinary Sciences (Bristol) and the Royal Veterinary College, University of London (RVC). In total, 188 responses were received. The distribution of responses by university is shown in Table 1. The majority of students intended to go into mixed (n=76, 40·4%) or small animal practice (n=77, 41·0%; Fig 1), with only a small percentage (n=5, 3%) intending to pursue advanced studies. Overall, 87% (n=163) of students thought it was unlikely or highly unlikely that they would pursue specialist training in small animal dentistry and oral surgery. Student attitudes towards small animal dentistry are summarised in Tables 2 to 6. In total, 99·5% (n=187) of students
Table 1. Response rate by university Student responses by university
Number (%)
Number of students in year
Response rate (%)
Bristol Cambridge Edinburgh Glasgow Liverpool RVC Total
31 (16·5) 8 (4·3) 43 (22·9) 16 (8·5) 36 (19·1) 54 (28·7) 188 (100)
102 59 140 110 118 220 749
30·4 13·6 30·7 14·5 30·5 24·5 25·1
RVC Royal Veterinary College
FIG 1. Distribution of student expectation of employment after graduation
Journal of Small Animal Practice
•
Vol 55
•
September 2014
•
© 2014 British Small Animal Veterinary Association
Students’ attitudes towards small animal dentistry
Table 2. Student attitude towards the importance of small animal dentistry
Table 5. Perceived prevalence of oral/dental problems in small animals
Total Very unimportant Unimportant Neutral Important Very important Total
n % n % n % n % n %
0 0 0 0 1 0·5% 87 46·3% 100 53·2%
n
188
Total Very uncommon Uncommon Neutral Common Very common Total
Table 3. Student enjoyment of small animal dentistry as a subject
n % n % n % n % n %
0 0 0 0 0 0 31 16·5% 157 83·5%
n
188
Table 6. Perceived possibility that small animal oral/ dental problems may negatively affect welfare
Total I hate it
n % n % n % n % n % n
I don’t like it Neutral I enjoy it I really enjoy it Total
Total
5 2·7% 22 11·7% 69 36·7% 78 41·5% 14 7·4% 188
Very unlikely Unlikely Neutral Likely Very likely Total
Total n % n % n % n % n % n
Unimportant Neutral Important Very important Total
0 0 0 0 5 2·7% 70 37·2% 113 60·1% 188
thought that small animal dentistry is an important or very important subject, with 49% (n=92) reporting they enjoyed or really enjoyed it. All students thought that it is either important or very important for a small animal veterinary surgeon to have a broad understanding of dentistry. Likewise, all students thought orodental problems are common or very common in small animals and 97% (n=183) of students thought that these are likely or very likely to negatively affect welfare. The majority of students (n=180, 95·7%) believed that the teaching should prepare them for entering practice. However, less than 40% of students (n=75) felt suitably prepared (Table 7). These were statistically significant differences (p
