Haptic Simulation Technology: Rethinking Assessment of Dental Clinical Skills

Abstract

Conventional methods of assessment for dental clinical skills are subjective, based on the tutors’ opinion and there is no clear and accurate method of assessing the process of task-based learning. Students’ clinical skills performance for a cavity preparation task, in a mechanistic view, comprises of manual dexterity, visual perception, hand-eye-finger coordination, correct angle of holding the drill hand-piece, correct movement of the drill, maximum extraction of carious lesion, minimum exposure of healthy tissues (enamel and dentine) and no pulp exposure. A relationship between these abilities and conventional clinical performance can show how technology enhances the assessment methods of the students’ performance by measuring these factors more accurately and rigorously. Psychomotor parameters such as 3D/Depth perception, spatial awareness, spatial reasoning, fine and gross motor skills and hand-eye-finger coordination have been identified as important part of the students’ aptitude and ability to perform in clinical environment.
To evaluate the impact of a Virtual Reality Simulator system (the hapTEL : haptics Technology Enhanced Learning) on students’ learning, four cohort studies were considered to be part this investigation. These students were undergraduate dental students at King’s College London. This investigation included collecting the results of conventional assessment methods (clinical skills examinations: Clinical Skills in the second year and OSCE in the third, fourth and fifth years of the dental programme) and correlating these results with pre and post-psychometric tests’ scores.
The statistical analysis showed statistically significant correlation between the students’ psychomotor development using the conventional and VRS laboratories at different stages of their learning. Students who used the hapTEL system showed quicker and slightly better improvement in their spatial reasoning compared with the group who used the conventional system. Those who were among the best performers in their OSCE examinations used the hapTEL systems in their first year. The simulation-based laboratory such as the hapTEL not only provided a safe environment for learners with unlimited access for practice, but also the immediate feedback received from the system, the movement of the 3D vision of the worked-out tooth in space and accurate log-files saved on computer during the performance, improved their learning.
The findings of this study confirms the theory of skill acquisition (Ackerman, 1988; Anderson, 1982; Fitts & Posner, 1967) can provide a framework to establish new methods of assessment with the accurate measurement of psychomotor skills which could lead to identifying when exactly students’ psychomotor skills developed from cognitive stage to associative stage and from associative stage to autonomous stage. This could result with the enhancement of their clinical skills’ assessment methods.

Full text

12th Innovation in Education Colloquium (Brescia University)
8th – 11th May 2014
Clinical skills acquision, rethinking assessment using hapc virtual simulator
Dr Arash Shahriari-Rad
Professor Margaret Cox
Professor Mark Woolford
The Dental Institute. King’s College London
Background: According to Ackerman , during the skill learning process, learners go through
three phases of psychomotor development: Cognitive phase, Associative phase and
Autonomous phase. By measuring different psychomotor skills, these phases of skill
acquisition distinguish between a novice and an expert practitioner and could shape the
formative and summative assessment in identifying the stage of the trainees during their
learning process in the dental clinical environment.
Methods: As part of a cohort study, an investigation at King’s College London Dental
Institute was conducted with 144 first year dental undergraduate students who participated in
pre- and post-psychometric tests in 2009 and whose learning of clinical skills was measured
over three years. In the students’ first year of study, one third of this cohort used a Virtual
Reality Simulator (VRS) in the hapTEL1 laboratory and two thirds of the cohort used the
traditional Phantom-head laboratory. Their clinical skills were also measured by the
traditional practical test held towards the end of their second year. These measurements
included two cohorts before this group (entry cohorts of 2007/08 and 2008/09) who did not
use the hapTEL system and one cohort after (entry cohort of 2010/11).
Results: The correlation between pre and post-psychometric scores as well as the comparison
between students’ performance of the hapTEL group and of the control group (who used the
traditional Phantom-head) and their traditional test results show that the phases of skills’
development follow those identified by Ackerman.
Conclusions: These results confirmed the previous findings of Ackerman (e.g. the individual
determinants during skill acquisition) as well as supporting the theories of skill acquisition .
1 The overall aim of the hapTEL project was to develop haptic (relating to sense of touch) and synthetic online
devices which could be used by a range of dental students and professional to enhance and improve the quality of
their learning. Also, a more specific aim of the hapTEL project was to measure the impact of the Technology
Enhanced Learning (TEL) devices on teaching and learning. The name “hapTEL” stands for haptic Technology
Enhanced Learning.

These theories could therefore inform the development of formative and summative dental
clinical skills’ assessment to measure and monitor the student’s psychomotor training with
more regular and instant feedback in an objective way using computers along with the
traditional Phantom-head mannequin.
Ackerman, P. L. (1988) Determinants of Individual Differences During Skill Acquisition:
Cognitive Abilities and Information Processing. Journal of Experimental Psychology.
117 (3). 288-318.
Fitts, P. M. & Posner, M. I. (1967) Human Performance (Basic Conepts in Psychology)
Oxford Brooks and Cole.