aspects of the teaching environment, student learning

Aspects of the Teaching Environment,

Student Learning, Perceived Confidence and

Feedback Practices in Dental Education

By

Albert N M Leung

BDS (Dundee), LLM (Cardiff), MA (London), FGDSRCS (Ireland),

FFGDP (UK), MGDSRCS (Ireland), MFGDP (UK), FHEA, FICD, LRSM

A portfolio of research submitted in partial fulfilment

of the award of the degree of Doctor of Philosophy by Publication

of the University of Portsmouth

University of Portsmouth Dental Academy

Faculty of Science and Health

University of Portsmouth

2020

ii

Abstract

This thesis explores, reflects, analyses and connects my portfolio of ten selected papers in

pedagogic research abbreviated below which I have published between 2009 and 2020,

details of which are on page five below.

A co-operative approach to team learning in a relaxed, dedicated primary dental care setting

is an excellent learning environment in clinical dentistry [#10(2009)]. When this learning

environment is staffed by experienced clinical teachers, the students’ learning experience is

much enriched [#9(2012)]. This environment facilitates and cultivates meaningful reflective

learning, promoting a reflective, tailored and personalised approach [#8(2013)].

Highly motivated teachers enhance the learning experience of their students and improve

their confidence in their clinical ability to treat their patients, resulting in well informed

treatment options for patients, and greater job opportunities for the dentists [#7(2017)].

In addition, a reflective environment such as the use of bespoke video vignettes enhances

reflective learning, creates the opportunity to capture and meaningfully utilise reflection-in-

action and reflection-on-action to improve learning [#6(2017)]. This enhancement in

confidence improves communication and clinical skills for the benefit of both the patients

and the healthcare professional [#7(2017)].

Confidence impacts positively on the standard of clinical dental practice. Teachers should

utilise contemporary pedagogy to help develop teaching aids [#6(2015)] to facilitate the

iii

development of students’ confidence which has a positive impact on clinical practice

[#7(2017) #5(2019)].

Appropriate, proportionate and timely feedback [#4(2018), #1(2020)] will further enhance

the effectiveness of teaching and facilitate learning. Novel feedback methods may help to

engender meaningful and sustainable feedback from students to teachers about their

teaching and how this can be improved [#4(2018)]. The continuing multifactorial

pedagogic issues arising from the delivery of the core undergraduate dental curriculum

[#2(2019)] and in the key continuing professional development arena [#3(2019)] illustrate

the need for quality feedback. On top of this, the timing, extent and quality of feedback

delivered by teachers to students are fundamentally and inextricably linked to enhancing

student satisfaction and learning which helps to raise the standards of clinical practice

[#1(2020)].

iv

Acknowledgments

I am indebted to Professor Chris Louca and Professor Graham Mills, my supervisors at the

University of Portsmouth, for their invaluable guidance, support and advice throughout the

preparation of this thesis.

I am grateful to the contributions of my fellow colleagues across the globe in clinical dentistry

and dental education whom I have the fortune to be collaborating with in the last 22 years. I

am very grateful to my co-authors and dental educator colleagues who have been involved

with the various studies included in this thesis.

I would like to pay tribute to Dr Brian Davies, my former Head of Department when I was a

Junior Lecturer at the millennium, whose infectious enthusiasm and encouragement sparked

my interests in pedagogic research. This spark has been growing steadily for the last 20 years

and pedagogic research has become an important integral part of my academic practice.

v

Dedication

This work is dedicated to Jane and Helen.

vi

Declaration

I declare that whilst studying for the degree of Doctor of Philosophy by Publication by the

University of Portsmouth I have not been registered for any other award at another

University.

The work undertaken for this degree has not been submitted elsewhere for any other award.

The work contained within this submission is my work and, to the best of my knowledge and

belief, contains no material previously published or written by another person, except where

due acknowledgement has been made in the text.

Albert Ngah Ming Leung

November 2020

vii

List of Abbreviations

ADEE Association of Dental Education in Europe

AGP Aerosol Generating Procedures

CGDent College of General Dentistry

COVID-19 Coronavirus Disease 2019

CPD Continuing Professional Development

ECPD Enhanced Continuing Professional Development

FGDP Faculty of General Dental Practice

GDC General Dental Council (UK)

GDP General Dental Practice

GDPs General Dental Practitioners

HMC Hamid Medical Corporation, Qatar

IADR International Association of Dental Research

KCLDI King’s College London Dental Institute. (Also known as King’s

College London Faculty of Dentistry, Oral & Craniofacial Sciences)

KIMS Kuwait Institute of Medical Specialization

MID Minimally Invasive Dentistry

MUB Medical University Bahrain

NAPC National Association for Primary Care

NSTA National Science Teachers’ Association

RCSI Royal College of Surgeons in Ireland

SIG Special Interest Group

UCL University College London

UK United Kingdom

1

Contents

ABSTRACT ............................................................................................................... II

ACKNOWLEDGMENTS ............................................................................................ IV

DEDICATION ........................................................................................................... V

DECLARATION ........................................................................................................ VI

LIST OF ABBREVIATIONS ....................................................................................... VII

PREFACE ................................................................................................................. 2

LIST OF PUBLISHED PAPERS SUBMITTED FOR THIS PHD DEGREE:............................. 5

CHAPTER 1: ENHANCING THE CLINICAL TEACHING AND LEARNING ENVIRONMENT IN DENTISTRY ......................................................................................................... 8

CHAPTER 2: ENHANCING CONFIDENCE TO CLINICAL PRACTICE .............................. 25

CHAPTER 3: ENHANCING TEACHING AND FEEDBACK PRACTICES ........................... 33

CHAPTER 4: OVERALL APPRAISAL AND CONCLUSION ............................................ 44

REFERENCES ......................................................................................................... 51

SCIENTIFIC PUBLICATIONS .................................................................................... 66

1. LIST OF PUBLISHED PAPERS SUBMITTED AND USED IN THE COMMENTARY FOR THIS PHD DEGREE: ................................................................................................ 66

APPENDIX 1 .......................................................................................................... 66

APPENDIX 2 .......................................................................................................... 83

APPENDIX 3 .......................................................................................................... 90

APPENDIX 4 .......................................................................................................... 96

APPENDIX 5 ........................................................................................................ 106

APPENDIX 6 ........................................................................................................ 116

APPENDIX 7 ........................................................................................................ 121

APPENDIX 8 ........................................................................................................ 131

APPENDIX 9 ........................................................................................................ 137

APPENDIX 10 ...................................................................................................... 144

APPENDIX 11: FORM UPR16 RESEARCH ETHICS REVIEW CHECKLIST ..................... 151

2. OTHER PUBLICATIONS INCLUDING PUBLISHED ABSTRACTS ............................. 152

3. NATIONAL AND INTERNATIONAL PRESENTATIONS AND INVITED TEACHING SESSIONS (2011 – NOW) ..................................................................................... 159

2

Preface

This thesis is based on my journey of research in dental education the seeds of which were

sown almost by complete accident in 1998, some twenty two years ago. A part-time teaching

position at King’s College London Dental Institute on the outreach programme in Primary

Care Dentistry including the legal aspects of dentistry became available unexpectedly. As a

general dental practitioner running my practice holding the then highest qualification in

Primary Care Dentistry from the Royal College of Surgeons as well as a Master of Laws, my

skills set was a good fit to this post. I was headhunted and invited for an interview with the

then Head of Department. The interview went extremely smoothly so much so that I learnt

from the Head of Department that his brother was a well-known concert pianist, something

which I had aspired to become before I embarked on studying dentistry in 1981, when I was

awarded a Licentiate of the Royal Schools of Music in piano performance two years

previously. When I was offered the job as a Clinical Lecturer on the spot, I accepted the offer

with no hesitation. After all, King’s College London Dental Institute was the largest

undergraduate dental school in Europe, and I was very pleased to be able to work in such a

prestigious Dental Institute.

Little did I know then, within two years of me working there, I would embark on my first

formal teaching qualification, at the Unit of Medical Education at King’s College London

Medical School, which I managed to complete very swiftly and smoothly in 2001. Almost at

the same time, I commenced my first dental education research project guided by an

extremely inspiring and knowledgeable mentor, the new Head of Department, to whom I was

very grateful for. It then took a long time and a lot of effort including collecting seven years’

data for my first paper on dental education to be published in 2009, but I have not looked

back ever since.

3

My pedagogic research profile formed a key element of my submission when I won the

prestigious Association of Dental Education in Europe (ADEE) Mature Career Dental Educator

award in 2017.

On the back of this award, I was granted a Chair in Dental Education at UCL Eastman Dental

Institute in 2017, which has, in turn, facilitated my pedagogic research and allowed me the

opportunity to co-chair a high profile Europe-wide Special Interest Group (SIG) within ADEE

researching feedback practices since 2018. I was elected Dean of the Faculty of Dentistry of

the Royal College of Surgeons in Ireland in 2020 and I fully intend to use all the opportunities

I have, to continue to enhance my output and quality in pedagogic research.

I am actively involved in devising, formulating, approving, conducting, writing up and

publishing many aspects of pedagogic research and policies in dental education which is

central to my professional life.

This thesis provides a narrative that combines ten selected peer reviewed and published

pedagogic research which I have played a significant role between 2009 and 2020. The

different chapters in this thesis illustrate a trend, direction and an intimate interplay amongst

the many generalizable and yet contextualised pedagogic factors which directly impact on the

quality of the delivery of contemporary dental education through my research.

Personally, different aspects of this work have resulted in invitations to speak, teach, deliver

seminars or workshops at different National and International arenas (e.g., General Dental

Council Overseas Registration Examinations Management Board, International Association of

Dental Research, Association of Dental Education in Europe, the Royal College of Surgeons

in Ireland, Hamid Medical Corporation Qatar, Medical University Bahrain, Khartoum

University Sudan, Peking University Shen Zhen and University College London).

4

The experience and knowledge gained from aspects of this work have also been extremely

useful in my present academic roles leading and managing an extensive change portfolio in

shaping national and international dental education as a result of COVID-19.

I believe that this body of published work entitled “Aspects of the Teaching Environment,

Student Learning, Perceived Confidence and Feedback Practices in Dental Education”

contributes to knowledge in this field and helps to raise the profile and importance of quality

dental education both in the UK and abroad.

In the appendices, all the ten papers are included in their full text format, alongside my

contributions to each of them, and their citation metrics. As it includes recent publications,

some do not have citations at present.

5

List of Published Papers Submitted for This PhD Degree:

Appendix

Title

Article Type

1

Leung, A., Fine, P., Blizard, R., Tonni, I. & Louca, C. (2020).

A quantitative study of feedback delivered by dental

teachers to dental students

Accepted for publication by the European Journal of Dental

Education, 19th October 2020

Research

Paper

2

O’Carroll, E., Leung, A., Fine, P., Boniface, D., & Louca, C.

(2019).

The teaching of occlusion in undergraduate dental schools

in the UK and Ireland

British Dental Journal, Volume 227 (6), pp 512-517

Research

Paper

3

Mirsiaghi, F., Leung, A., Fine, P., Blizard, B., & Louca, C.

(2018).

An investigation of general dental practitioners'

understanding and perceptions of minimally invasive

dentistry.


Research

Paper

https://iris.ucl.ac.uk/iris/publication/1549274/1



6

4

Fine, P., Leung, A., Francis, J., & Louca, C. (2018).

The Use of Picture Cards to Elicit Postgraduate Dental

Student Feedback.

Dentistry Journal, Volume 6 (7), doi:10.3390/dj6020007

Research

Paper

5

Fine, P., Leung, A., Bentall, C., & Louca, C. (2019).

The Impact of Confidence on Clinical Dental Practice.

European Journal of Dental Education, Volume 23 (2), pp 159-

167

Research

Paper

6

Davies, B., Leung, A., Dunne, S., Dillon, J., & Blum, I. (2017).

Bespoke video vignettes - an approach to enhancing

reflective learning developed by dental undergraduates and

their clinical teachers.


36.

Research

Paper

7

Fine, P., Louca, C., & Leung, A. (2017).

The Impact of a Postgraduate Learning Experience on the

Confidence of General Dental Practitioners.

Dentistry Journal, Volume 5 (2), pp 16, doi:10.3390/dj5020016

Research

Paper









7

8

Davies, B., Leung, A., & Dunne, S. (2013).

Why do general dental practitioners become involved in

clinical teaching? A pilot study exploring the views of part-

time practitioner teachers, King's College London.


Research

Paper

9


So how do you see our teaching? Some observations

received from past and present students at the Maurice

Wohl Dental Centre.


143

Research

Paper

10


Perceptions of a simulated general dental practice facility -

reported experiences from past students at the Maurice

Wohl General Dental Practice Centre 2001-2008.


Research

Paper

Notes:

For practical reasons, to highlight the roles these 10 selected papers play within the thesis,

whenever they are quoted in the text, they are referenced and referred to by the

corresponding figures “#1” to “#10”, followed by the year of publication in brackets. Any

other references quoted in the text are as per the usual convention.










8

Chapter 1: Enhancing the Clinical Teaching and Learning

Environment in Dentistry [#10(2009), #9(2012), #8(2013), #7(2017), #6(2015)]

The research question for this chapter was to investigate aspects of a good clinical teaching

environment, and the human and pedagogic factors which would enhance this environment.

[#10(2009)] was an in depth 7 years’ longitudinal co-operative investigation into how

undergraduate dental students perceived the value of a simulated outreach general dental

practice centre at King’s College London Dental Institute (KCLDI), the first one in the UK,

where comprehensive patient care was being taught and delivered. This was a large scale

pioneer study which established that a team based approach to co-operative learning led by

well-trained and experienced practitioners was pivotal to the success of the teaching model as

part of dental students’ transition from novice to expert. This is echoed in #9(2012),

#8(2013), and #5(2019).

Ironically, recent dental school graduates are often criticized as not as good as they used to be

(Cabot & Radford 1999). Being trained to the level as “advanced beginners” (GDC, 2015a)

when they qualify, graduates may not always be ready to embark on independent primary

care dental practice, or even to undertake an extra year’s post-qualification Foundation

Training to be able to practice unsupervised within the National Health Service in a primary

care environment (Ali et al, 2014), an environment where over 90% of clinical dentistry is

delivered to the patients in the UK (NAPC, 2018).

However, it can also be argued, that current dental school graduates are actually at least as

good as their predecessors were before, if not better, the difference being that they have been

9

trained on contemporary concepts and techniques (Lynch et al, 2006). As clinical concepts

and treatment processes evolve and diagnosis advances, students have been adapting to these

constantly evolving concepts and techniques which are vastly different from the traditional

approaches to clinical dentistry (Lynch et al, 2010). On top of this, students also come under

a different teaching and learning environment [#10(2009)], hence compounding this potential

misconception.

Irrespective of what students learn or are expected to learn in contemporary clinical dentistry,

there is clear evidence that they require and do benefit from a calm, relaxed and co-operative

learning environment [#10(2009)], and quality teaching delivered by the teachers [#9(2012)].

I surveyed final year dental students’ perceptions over 7 years of their learning experience at

the UK’s first ever dedicated simulated primary dental care [general dental practice (GDP)]

outreach teaching environment situated at the Maurice Wohl GDP Centre at King’s College

London Dental Institute (KCLDI) using anonymous questionnaires [#10(2009)]. I found that

a co-operative team learning approach (Davies, 2000) in a dedicated primary dental care

setting was perceived extremely positively by the students [#10(2009)].

This model was run as an independent, but well supported clinical outreach teaching unit

(The Maurice Wohl GDP Centre) in a separate building approximately one hundred meters

from but as part of KCLDI, staffed both by experienced general dentists, academics and

specialists. It practiced four-handed dentistry in self-contained surgeries with the support of

appropriately trained dental nurses, treating a case mix of adult patients requiring a range of

comprehensive dental care. The Centre espoused a total patient care approach with the

student clinician planning, integrating and treating all different disciplines of work required

10

by the patient under a close support and reflective learning environment [#10(2009),

#9(2012)].

99% of respondents (n=135) indicating that they enjoyed their clinical treatment and learning,

and 96% of respondents expressing satisfaction with the teaching regime. Overall, students

reported their keenness for training in this outreach learning paradigm in preference to the

traditional dental school open clinic environments, with increasing confidence in their

abilities in clinical practice, the holistic management of patients, and in developing reflective

practices. [#10(2009)]

Rich qualitative data generated from the questionnaire responses identified six key themes

with this teaching model which enhanced the clinical learning environment in a primary

dental care setting. The six themes were

a) availability of close support four-handed dentistry to help the smoothness of clinical

procedures,

b) teachers’ provision of insight into practice management increased students’ preparedness

for independent practice and post-qualification training,

c) facilitation of effective teamwork in a friendly environment [#9(2012) and to be further

addressed in Chapter 2], was conducive to learning and confidence building [#7(2017),

#5(2019), and to be further explored in Chapters 2 & 3],

d) practicing in an environment closely simulating real life primary care clinical practice

which students would face once they qualified as a dentist,

e) providing a setting specifically designed to hone into developing practice communication

skills, and

f) providing a relaxed, close support, bespoke co-operative learning environment to facilitate

the swift acquisition of clinical skills and acumen [#10(2009)].

11

Many of these six desirable features were espoused or present in outreach setups at other

dental schools, such as in Manchester with a community outreach setting within the city

(Eklind, 2005), in Kay as foundation Dean setting up the outreach primary care clinics for the

then new Peninsular Dental School (Kay, 2007), in Leeds concerning block placement in a

restorative based primary care specific environment (Craddock, 2008) and in Cardiff, with

students spending a rotation of 12 months in a community based environment out with the

dental school (Lynch et al, 2010).

The characteristic “nurturing”, “hands-on” and “skills uplift” elements identified at the

KCLDI outreach [#10(2009)] compared very similarly with the Norwegian findings (Eriksen

et al, 2011) in Tromso, which had a similar operational background where dental care was

mostly delivered in a primary care setting. Although it serves a vastly dispersed population in

remote locations far away from the University in Tromso, the set-up of outreach centres both

for training dental students and health service delivery to achieve “a school without a wall”

(Eriksen et al, 2011), operates remarkably similar to the KCLDI outreach some 1,400 miles

away [#10(2009)].

This was therefore clear that my findings in [#10(2009)] could be generalizable and

applicable across the many different outreach settings across national boundaries.

Significantly, the same principles demonstrated in [#10(2009)] have continued to be applied

at KCLDI since the publication of this paper. In addition to the longstanding Maurice Wohl

General Dental Practice Centre outreach, the Institute developed a further extremely

successful dental outreach teaching facility in 2011 in a landmark collaboration with the

Portsmouth Dental Academy at Portsmouth University (Radford et al, 2014). The two

12

facilities together serve all KCLDI’s 160 final year undergraduate dental students every year,

with very notable successes to date ([#6(2015)], Wanyonyi, 2015, Radford & Hellyer, 2017).

#10(2009) therefore astride the forefront as an integral element of the literature offering

consistent and triangulated reassurances that flexible outreaching teaching away from the

main dental institutes deliver well perceived comprehensive clinical learning experiences in a

close support environment close to where patients live. There is no doubt that this paradigm

delivers the requisite learning outcomes in line with the expectations of the General Dental

Council (GDC) in the United Kingdom (GDC, 2015b) for a newly qualified dentist. This is

also in line with the key concept of “teaching excellence” of the Association of Dental

Education in Europe’s (ADEE) suggested graduating European dentists’ curriculum

framework (Field et al, 2017) adopted throughout the European Union and beyond (ADEE

2019).

By “allowing the learner to be a stakeholder in the learning process” [#10(2009)], “ to take

ownership and responsibility for their decision making” [#10(2009)] developed in a “co-

operative learning environment” [#10(2009)], the essential ingredients required to enhance

the clinical learning environment in dentistry to cultivate a congenial paradigm where rapid

learning through a modified apprentice approach (Benner, 1982) is espoused.

The outreach teaching model is therefore an excellent medium to cultivate a quality clinical

learning environment, echoing the wider arena and context across Europe and beyond as per

the Association of Dental Education in Europe (ADEE) (Field et al, 2017).

A cornerstone of the design of this extended learning environment was to have self-contained

surgeries (Architecture and Design Scotland, 2014) where students learn in a calm, quiet,

13

standalone, secluded, self-contained holistic environment closely supported by dedicated

teachers and dental care professionals.

For efficient use of space, circulation, ambience, cost effectiveness to be able to fit as many

dental chairs into a fixed open space, many contemporary student clinics have been designed

to be open-plan clinics (Architecture and Design Scotland, 2014)

Concerning the traditional pedagogically well perceived self-contained surgery design

espoused in #10(2009), the COVID-19 pandemic with an alarming community infection rate

associated with the healthcare setting (Anderson et al, 2020), brought home a clear message.

The message is, that the self-contained surgery set up strongly advocated in #10(2009),

#9(2012) and #8(2013) would be the ideal setting to carry out individual and personalised

clinical teaching of dentistry because it achieves natural social distancing to minimise the risk

of spreading the virus where dental students can be taught whilst crucial oral care is

simultaneously delivered to the patients (CGDent/FGDP, 2020).

The findings of the environment which enhanced clinical learning as in #10(2009) cogently

led me to investigate two missing links to this equation, namely the quality of teaching

required to bring about satisfactory learning in this enhanced learning environment

[#9(2012)], and an understanding of the reasons why these clinical teachers chose to teach

[#8(2013)] in this environment.

#9(2012) explored student perceptions of undergraduate clinical teaching delivered at the

outreach general dental practice centre at KCLDI with mixed data collected using on-line and

paper-based questionnaires, and semi-structured focus groups. The triangulated findings

indicated that students were overwhelmingly positive about this primary care based approach,

14

the close support teaching method, the closeness it was with the real world in general dental

practice. and the positive professional relationship between the teachers and the students.

Students overwhelmingly indicted that this facilitated learning and deep understanding of the

nuance of comprehensive patient care with a supportive and nurturing teaching style,

resonating with #10(2009), #8(2013) and #5(2019).

It was very clear that a calm, “friendly, non-threatening teaching environment is perceived by

students to be a good learning environment”; and that students also appreciated “the time and

space given to them to take ownership of their learning” [#9(2012)].

This concept was similarly expressed and reinforced by Garcia et al (2013), that with the

advent of “personalised medicine/medical treatment” it was vital that clinicians were

“assigned a fully equipped (self-contained) suite together with individual nursing support”,

and be trained “in a student centred, fully supported and dynamic environment to extract

maximum benefit for the learner”. This is a sound endorsement of my thematic findings in

#9(2012), that students treasure a fully supported learning environment where they are

“valued and respected as individuals….. with a sense of belonging”.

The above also reaffirmed the findings in #10(2009), that self-contained, fully equipped

clinical suites with individual nursing and reception support “would be an excellent

environment where students perceived as extremely desirable in terms of acquiring the skills

and acumen for clinical dentistry”.

Not only would this paradigm suit students’ natural learning styles and thereby cultivating

satisfaction for “real and rapid learning” (Wang and Liu, 2019), the environment which this

satisfactory teaching style is based upon would also be regarded very satisfactorily in the

15

current climate of the COVID-19 pandemic (Bedford et al, 2020), where “it is a chance to

step back and think about learning in a fundamentally different way”, and the circumstances

“in which real learning is visible” (NSTA, 2020).

It was ironic that the self-contained surgeries set up so much in favour by the students in

#10(2009) to be the ideal clinical learning environment as supposed to the widely used open-

clinic design, would also be the clinical set-up of choice (COVID-19 SOP, 2020) for Aerosol

Generating Procedures (AGPs) (SDCEP, 2020), delivering dental care to patients considering

the infection control risks during the COVID-19 pandemic (Ren et al, 2020).

Much of the clinical learning environment would be greatly complimented in the pedagogic

paradigm espoused in #10(2009) (dentistry in a close-support primary care focused clinical

environment), #9 (pedagogy based on good learning and teaching principles) and #8

(attracting well motivated teachers to teach and facilitate students to manage the challenges

encountered).

The finding above resonates with aspects of educational innovations including the

appropriate design and use of accommodation set up for teaching as per Lim et al (2014),

who showed that a well set up and comfortable environment promotes student learning.

These also reflect the pedagogical beliefs, as per Tondeur et al (2017), who investigated that

educational technologies, premises and teachers’ dedications are vital to the success of this

environment. Furthermore, in “developing reflection and critical thinking of students”, a key

qualitative theme identified in #9(2012), this main objective is further complimented with the

findings of #8(2013), with an overall response rate of a very respectable 78% and in line with

other similar non-incentivised surveys (Asch et al, 1997). #8(2013) also shows that a key job

16

satisfaction indicator for a good teacher is in their abilities is in “developing a reflective

practitioner”.

Combining the above in respect of #10(2009), #9(2012), and #8(2013), it is therefore logical

to conclude that in the COVID-19 environment and consequences the world is in at the time

this thesis is prepared and written, these three papers do reinforce compliance with

contemporary good practice in terms of minimising the spread of aerosols, reinforcing

infection prevention and control, and minimising cross-contamination, agreed by

CGDent/FGDP( 2020). Such a set up in teaching and learning would also support the notion,

that for the students to fully utilise the learning opportunities in the clinics, that it would be

important for their clinical teachers to know them well [#9(2012)], coupled with the

dedication and professionalism of these teachers as shown in #8(2013).

Apart from a high quality bespoke environment [#10(2009)] with high quality teaching

[#9(2012)], another vital ingredient to support and maintain this congenial exemplar in

dentistry is the continual availability and retention of quality teaching staff, which was

exactly the reason why I carried out the next piece of my pedagogic research in #8(2013).

#8(2013) highlighted the vital roles played by part-time faculty members in delivering

clinical teaching. I carried out a mixed method survey of all 40 part-time clinical teachers at

King’s College London Dental Institute investigating the reasons why they were involved in

teaching and to identify the challenges they faced. Although a majority of them would see

clinical teaching as a long-term career, a significant minority were dissatisfied mainly due to

the perceived lack of career development and a minority due to remuneration. #8(2013)

illustrated that formal training in teaching skills was vital to facilitate these part time teachers

to deliver the required standard of teaching and for their job satisfaction.

17

The findings from this study also complemented those from #10(2009), #9(2012), #7(2017)

and #1(2020), which showed that competency and satisfaction of teachers would be a vital

and indispensable ingredient for delivering good pedagogy, echoing Fish and Twinn (1997).

My finding in #8(2013) was that UK dental schools’ teaching would collapse without the

contributions of the part-time dental practitioner teachers, who made up a large proportion of

the clinical teaching staff at the dental school. This echoed similar findings made by

Craddock (2009) and Lynch et al (2010). With 23% of these teaching staff leaving within a

year of starting and only 31% of them staying for 5 years of more [#8(2013)], measures to

retain the service of valuable staff were therefore very important.

It was quite surprising to find that in the context of King’s College London Dental Institute,

remuneration did not feature highly at all but instead teachers vastly valued “a proper title

and a viable career pathway” as the main reward. This was a major factor for retaining their

service and loyalty, challenging the traditional ad hoc approach to the sustainability of

clinical teachers that for so long had underpinned the stability of the system.

Gamble Blakey et al (2019) took a similar approach investigating a multi-national cohort of

subjects and reinforced much of my findings in #8(2013), that salary might not be as high an

issue regarding the retention of clinical teachers, that their interests and keenness in teaching

were major factors in positively influencing job satisfaction and in determining how long

they would stay in their posts. Formicola (2017) showed similar findings of a survey of dental

care professionals. However, other studies such as Pacanins (2017) suggested that

remuneration was indeed an important factor for retaining staff, in contrast to my findings in

#8(2013).

18

For the successful delivery of dental education, it is important to have a satisfactory setting

[#10(2009)], an optimal quality of teaching [#9(2012)], with motivated, keen, and

knowledgeable teachers, cultivating the paradigm for natural learning [#8(2013)]. This is

because these are important factors to cultivate knowledgeable, reflective, empathetic and

well supported practitioners as shown by de Cossart and Fish (2005).

Concerning the practice of dentistry in the UK as per the provisions of the Dentists Act 1984

and the Orders made under it, since 2018, Enhanced Continuing Professional Development

(ECPD) for the dental profession (GDC, 2018) has been a requirement compared to the

General Continuing Professional Development required before then (GDC, 2013). The ECPD

requirements encourage dental professionals to enhance their knowledge and understanding

linked to “development outcomes” and “reflection in learning” as per the requirement of

enhanced CPD (GDC, 2018) in a confident, competent contemporary manner throughout

their professional careers in dentistry.

It was with this consideration in mind, that my pedagogic research journey took me next to a

twin track approach to address the above. Firstly #6(2017), which investigated bespoke video

vignettes as an approach to enhancing reflective learning, development by students in

collaboration with their teachers. Secondly #7(2017), which investigated the impact of a

bespoke postgraduate learning experience on how it enhanced the perceived confidence of

general dental practitioners (GDPs) in their abilities to learn and to offer better patient care.

[#7(2017)] also explored the relationship between participation in a learning experience and

the ensuing change in perceived confidence, and demonstrated a close link between them in

the context of a bespoke Masters in Restorative Dental Practice at UCL Eastman Dental

19

Institute. The findings in #7(2017) also echoed #8(2013), #9(2012), in that perceived

confidence was an important ingredient to facilitate clinical knowledge and performance,

particularly for those undertaking postgraduate dental programmes.

#6(2017) studied the selective use of video to support the reflective processes to enhance

learning in undergraduate dentistry. Carefully compiled bespoke video vignettes were used to

demonstrate how particular clinical procedures were undertaken and the challenges faced. A

video also captured the processes of reflection-in-action and reflection-on-action (Munby,

1989) by the students whilst aspiring to achieve as close to the “gold standard” as possible.

Sharing and discussing these vignettes in tutorials with further reflection whilst facilitated by

clinical teachers was perceived extremely well by the students who reported huge real life

benefits boosting confidence [#7(2017)] and competence [#10(2009), #9(2012)], with

extremely positive feedback, reinforcing the findings in [#1(2020)], which will be discussed

in Chapter 3 of this thesis.

The following two papers which involved both undergraduate and postgraduate students

[#7(2017) and #6(2017)] were conducted over the time when I moved jobs from King’s

College London Dental Institute to University College London Eastman Dental Institute. At

the former, undergraduate students were utilized, and at the latter, postgraduate dental

students were used in the studies. These studies investigated the role of pedagogies using

bespoke video vignettes which enhanced reflective learning in an undergraduate clinical

environment [#6(2017)]. It also investigated aspects of perceived confidence in clinical and

communications skills in respect of a flexible, but structural postgraduate learning experience

in a Master’s programme [#7(2017)]. This was in recognition that irrespective of whether the

20

learning environment was for undergraduate students or postgraduate dentists, the potential

for different interventions to improve the learning environment was the same.

It was clear in #6(2017), that “the development of an enriched contextualized materials bank

(in terms of generating bespoke video vignettes) allows for the analysis of best practice which

can then be discussed, meaningfully reflected upon and refined”. In other words, #6(2017)

reinforces the overall findings in #9(2012), #8(2013) and #7(2017), that a natural, relaxed,

unthreatened and well analyzed quality teaching environment in clinical dentistry would

cultivate genuine rapid and reflective learning, agreeing with de Cossart and Fish (2005), on

nurturing the reflective aspects of learning.

A clear and important qualitative theme emerged from the 122 statements generated from the

20 respondents engaged in #6(2017) who produced these well rounded video vignettes to

help with their learning, that “the bespoke learning episodes and environment cultivated

through these vignettes reinforce learning in a natural, meaningful and reflective way”

[#6(2017)]. These were clearly in agreement with Schon (1987) who showed, that

“practitioners are (reduced to) instrumental problem solvers who select technical means best

suited to a particular purpose”, since “most professional problems are not routine at all;

instead they are messy, indeterminate situations.”

The above also clearly implied, that a purely technical approach in learning (as with much of

clinical competencies in dentistry) could destroy the very heart and soul of genuine modes of

reflection-in-action and reflection-on-action types of learning. It is these two aspects that

Schon (1983) championed as a summit of unadulterated quality learning, by being the heart

and soul of it. These notions were similarly raised by Fish and Twinn (1997), about the ethos

and culture needed in a clinical environment to meaningfully exercise reflective learning, and

21

the value of “recording observations” to preserve “the rich texture of human interaction and

the quality of the work”.

The findings in #7(2017) support that the postgraduate learning environment studied was

“advantageous for building confidence, citing ….the opportunities to learn new skills and

incorporate them into clinical practice”. Moreover, it is “the development of self-efficacy in

the participants (which) provided the motivational support for individuals”; rounding the

circle between confidence and self-efficacy as per Bandura (1993).

The importance of these human and technical interactions which would have an indelible and

direct impact on “enhancing reflective learning” [#6(2017)] and confidence [#7(2017)],

according to Kinsella (2010), are often overlooked by the teachers, thereby creating “theory

practice gaps” as a result of teachers not utilizing all the teaching aids available (such as

videos, recording, photographs, and perhaps picture cards [#4(2018)]).

The use of these teaching aids could have further facilitated Schon’s (1983) theories of

reflection-in-action to effect professional development, similar to my findings in #6(2015)

and #7(2017). Mickleborough (2015) suggested that healthcare professionals should consider

“asking different questions (and using different mediums)” and utilize intuition along with

technical knowledge. This implies that the purpose of teaching would be “to foster intuition

in our professional education” (Mickleborough 2015) to allow practitioners to develop more

skills by being more confident [#7(2017)] and competent, linking feedback practices into the

equation.

Another key thematic finding in # 7(2017) was a clear increase in confidence and self-

efficacy following the education intervention, which impacted positively on the learning

22

experience, with increased motivation, and an uplift of the repertoire of clinical dentistry in

practice. My findings resonated that of Blum (2010), who found in the context of a high

fidelity nursing paradigm, that students’ perceived that confidence was noted to be hand-in-

hand with their competence to deliver (Clanton et al, 2014), particularly if the learning

occurred in a complex clinical setting, agreeing with Hall & Kiesners (2005).

Linking back into using bespoke video vignettes as an approach to enhance reflective

learning, another key thematic finding in #6(2015) was that video clips enhanced the quality

of reflection-in-action and reflection-on-action. This develops confidence as shown in

#7(2017), particularly via “small group clinical seminars …. to further inform practice… and

enhance better clinical decision-making” [#6(2015)].

My findings above were similar to that of Kinsella (2010), which agreed with and

additionally reflected on the work of Schon (1983), where he found that “the artistry of

professional practice involves tailoring theoretical and research-based knowledge to fit the

circumstances”. In other words, the use of video vignettes in my study “facilitated capturing

elements of reflection-in-action, and reflection-on-action typically found during every day

clinical practice” [#6(2015)], boosting self-confidence as shown also in #7(2017). These

findings agree with Thompson and Pascal (2012) who referred to “active... and participative

learning” referred to with the concept of delivering total patient care in #10(2009), thereby

echoing the latest learning outcomes for dental professionals (GDC, 2015a).

Relating aspects of reflective practices and perceived confidence [#7(2017)] was the next

direction of travel for my research, moving from an undergraduate to a postgraduate dentistry

environment. In a postgraduate learning environment, learners are already fully qualified

dentists. As their experience in dentistry increases, many of them would choose to undertake

23

formal postgraduate education (Bullock et al, 2020). [#7(2017)] investigated the perceived

confidence of practitioners who have undertaken structured postgraduate learning in

restorative dentistry, which itself would serve as a link to the next phase of my work

investigating the impact of confidence on clinical dental practice [#5(2019)].

In the context of #7(2017) and #5(2019), the broad meaning of confidence as an ordinary

English word was adopted. Confidence was defined as “a feeling of self-assurance arising

from an appreciation of one’s abilities or qualities” [Oxford English Dictionary, 2020]. In the

context of education and clinical dentistry as in my research, Bandura (1986)’s description of

confidence was taken into account, that confidence in clinical practice could be looked upon

as “self-efficacy”, described as “People’s judgement of their capabilities to organise and

execute courses of action required to attain designated types of performance”.

In other words, confidence relates to the perceptions of the judgement call to affect the

required professional to the standards required (GDC, 2015a) to discharge the required duty

of care [As per the legal cases of Bolam (1957) and Montgomery (2017)]. This would be the

key strategy which links #7(2017), the impact of a learning experience on confidence, with

#5(2019), the impact of confidence on clinical dental practice. The pedagogic implication of

these factors will be explored in the next chapter of this thesis.

Conclusion

A co-operative approach to team learning in a relaxed, dedicated primary dental care setting

would be an excellent learning environment for clinical dentistry[#10(2009)]. A clinical

environment which simulates a real comprehensive close support primary care dentistry

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paradigm has been confirmed to be well received and highly desirable by students

[#10(2009)]. When this learning environment is staffed by experienced clinical teachers

[#10(2009)], the students’ learning experience would be much enhanced [#9(2012)]. This

underlies the fact that the right environment and quality teaching would be the two

indispensable factors which facilitate meaningful learning in clinical dentistry [#9(2012)].

The combination of a learning environment and quality clinical teaching would facilitate and

cultivate reflective learning [#8(2013)], thereby promoting a tailored, deep and personalised

approach [#8(2013)]. This “teacher intensive” method is perceived by students as being

valuable and trusted [#8(2013)] and can be a real positive motivating factor as to why dentists

might wish to become involved in clinical teaching [#8(2013)].

Highly motivated teachers in such environments would enhance the learning experience of

their students irrespective of whether they are in an undergraduate or postgraduate

environment [#7(2017)], where the impact to students is profound and positive [#7(2017)].

Students who have experienced this paradigm reported increased perceived confidence in

their clinical ability to treat their patients, resulting in well informed treatment options for the

patients, and greater job satisfaction and opportunities for the dentists [#7(2017)].

Coupled with a high quality reflective environment such as the use of bespoke video

vignettes as an approach to enhance reflective learning [#6(2017)], the opportunity to capture

and meaningfully utilise reflection-in-action and reflection-on-action would promote

meaningful learning [#6(2017) in a resounding manner. This will in turn boost the confidence

of the practitioner and impact very positively on their learning experience [#7(2017)]. The

increase in confidence manifests itself in better communication and clinical skills, for the

benefit of both the patients and the healthcare professional [#7(2017)].

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Chapter 2: Enhancing Confidence to Clinical Practice [#7(2017), #5(2019)]

The research question for this chapter was to investigate the enhancement of confidence in

the clinical practice of dentistry, and how it might positively impact on the clinical teaching

and learning environment.

Confidence has been defined as “freedom from doubt, belief in yourself and your

abilities”(Oxford 2020). It is “content specific” (Pajares, 1994) and a “good predictor for

academic achievements” (Stankov et al, 2014). Confidence as a belief “is also important as a

concept because it closely and proportionately relates to actual competence” (Stankov et al,

2014).

In the context of my research presented in this thesis, dentists attending postgraduate

programmes within an optimal clinical environment [#9(2012), #10(2009)], with good

teachers [#8(2013), #9(2012)], and approaches which facilitate reflective learning [#6(2015)],

are likely to find confidence being nurtured in their clinical practice through this process

[#5(2019)].

The enhancement of perceived increases in confidence is important for clinical practice, as

clinical professionals carry out their professional tasks more effectively and comfortably

when they perceive themselves to be confident [#7(2017)]. My findings echo Stankov et al

(2014), who convincingly argued that “confidence is the best non-cognitive predictor of

academic achievements” by providing an “end goal” to motivate learners. In other words,

Stankov et al (2004) indicated by the same token, that the more confident one feels about

achieving the end goal, the more competent one is likely to be.

26

In the context of my work [#5(2019), #7(2017)], perceived confidence expressed at the

material time by the participants was not tagged to the actual progression and achievements

within the course to directly assess competence against the programme’s intended learning

outcomes. Despite this, the findings of Stankov et al (2014) demonstrated above resonate

with me about the link between confidence and competence.

In respect of the clinical practice of dentistry at a postgraduate level as in [#5(2019),

#7(2019)], all learners are already fully qualified dentists practising in their own rights. As to

their postgraduate learning experiences, the unfettered qualitative investigations on the many

aspects of perceived confidence in this context at #5(2019) and #7(2017) were important.

This was because participants knew they could freely express their genuine opinions on their

confidence, without having to worry about their perceptions being checked afterwards against

their actual achievement (competence). This was crucial as they could otherwise have held

them back from freely expressing their perceived confidence, the crux of the findings in

#5(2019) and #7(2017), limiting the validities of these two pieces of work.

As per Stankov et al (2014), it would be reasonable to presume a direct and proportionate link

between perceived confidence and the level of competence achieved in [#5(2019)], following

one or more stages of the Restorative Dental Practice Master’s programme undertaken by the

participants. This also echoed Elzubeir and Rizk (2001), that confidence was a reliable

predictor of success or competence.

Lee (2009) found that the learning styles might be different in different individuals to achieve

the same competency, but the fundamental principle as per Leung and Bond (2009), was that

understanding the beliefs and confidence were key markers for success (competence). These

27

aspects resonated with my findings in [#5(2019)] and reassured the intimate correlations

between expressed confidence and actual competence following the conclusion of the

educational intervention.

Despite the concerns that some may have with insider research (Saidin & Yacoob, 2017), the

use of insider researcher in #5(2019) and #7(2017) greatly facilitated the acquisition of subtle

key data for the research. This was because in the context, insider researchers had a deep

understanding and knowledge of the subject and these skills were essential as per Dwyer et al

(2009) to be able to conduct meaningful research in this framework and environment. Their

understanding and ability to fully utilised the research tools were instrumental in the context

as their ability to detect and observe the nuances in this specialised paradigm of a small,

highly selective programme within the field of Restorative Dental Practice.

Both #5(2019) and #7(2017) demonstrated increased perceived confidence through learning

which has the potential of changing insights of clinical practice for the better. By examining

how changes in confidence influence the clinical practice of the participants during and

following an extended period of postgraduate training, the increase in confidence to the

practitioners has been firmly established [#5(2019)].

It also showed that a lack of confidence was a primary driver for practitioners to attend

postgraduate training courses, because “they perceive a need to enhance confidence in their

clinical skills and knowledge, their ability to treat more complete cases and desire to develop

higher self-efficacy” [#5(2019)].

[#7(2017)] demonstrated that there is a general trend “towards individuals becoming more

confident after a prolonged period of study”. This is hardly surprising of an education

28

intervention and the positive knowledge and effect which it brings to the practitioner having

undertaken such studies “in an interactive social environment” [#5(2019)].

These findings agree with the Social Cognitive Theory, where “ human behaviour is

extensively motivated and regulated by the on-going application of self-influence” (Bandura,

1986). With “technological changes that are transforming the nature and scope of human

influence; [and] analyzes the determinants and processes governing personal and social

change” (Bandura, 1986).

This complex picture illustrates why perceived confidence [#5(2019)] is so important in

effecting rapid cognitive learning in “positively influencing personal standards and effective

self-reaction” (Bandura 1993). This concept of confidence and self-efficacy through learning

experience as in “With confidence, I can justify my treatment plan which is evidence based”

[#7(2017)] resonates with the literature discussed here. In relation to confidence and self-

efficacy, “peer learning has a positive impact on me (confidence) because I am always

inspired to do my best…. and I know I have improved my skills (competence)” [#5(2019)].

With thematically analysed qualitative data on confidence as per Sander and Sanders (2002)

who measured confidence in academic study, the enhancement in confidence with time and

the right environment in clinical practice “encourages direct skill acquisition through a

positive impact on motivation” [#7(2017)]. This has a genuinely positive impact on the

breadth and depth of clinical practise offered through “increased confidence to take on bigger

cases that I used to have to refer” [#7(2017)]. It demonstrates the clear value appropriate

education intervention has in helping to improve standards (competence).

29

Both #5(2019) and #7(2017) investigated students from the Masters’ in Restorative Dentistry

Programme at UCL Eastman Dental Institute where I am the Programme Director. To

minimise potential bias due to the inherent power relation that existed, where the “division of

roles between researcher and participant is dichotomous, constant, uniform and pre-

determined” (Karnieli-Miller et al, 2009), I was not directly involved in any aspects of

collecting qualitative data from the students.

Consideration was made of the potential drawbacks using insider-researchers as per Trowler

(2011) to researching one’s Institution as an insider. However, due to the very specialised and

specific nature of the programme, it was decided on balance insider researcher would still be

needed for #5(2019) and #7(2017).

Careful steps were undertaken, including minimising the potential for implicit coercion of

participants, confidentiality, “identifying potential biases and to ensure transparency, thereby

neutralising the role duality (of insider researcher)” as per Brannick and Coughlan (2007) and

agreed by Dwyer and Buckle (2009).

Fleming (2018) addressed similar issues faced by #5(2019) and #7(2017), by “recognizing

the challenges using an insider approach and attempt to resolve or minimize the impact of

these”. It was on this basis, that the data generated and collated from #5(2019) and #7(2017)

were truthfully reported and analysed, forming the basis of the discussion and conclusion

generated therein for these two pieces of published work.

In a sense, #5(2019) which was published almost two years after #7(2017), could be viewed

as its extension, covering twice the length of the timeframe, investigating the impact of

30

confidence on clinical dental practice to a greater depth. However, the key findings in

#5(2019) consolidated and advanced those derived from #7(2017).

In respect of the key themes of confidence in clinical dental practice, it was clear that

undertaking postgraduate restorative dentistry training by going through one or more stages

of the Restorative Dental Practice Master’s programme, participants identified increases in

confidence (and self-efficacy, as espoused by Bandura [1993]). They also reported an

increase in their abilities to undertake dental procedures, confidence in communication skills,

and their abilities to undertake more complex restorative clinical procedures when these

patients would otherwise have had to be referred on, in agreement with Eaton et al (2011).

“Learning is a social process. Relationships matters” (Sturgis, 2019), whilst nurturing a

culture of learning and inclusivity [#5(2019)]. Using this as a means to cultivate competency

for students, “Teachers need to be able to assess the levels of confidence and make

improvements when it is low…….. address the issue of misplaced over-confidence”

[#7(2017)]. This inherent intimacy in the relationships between perceived confidence, self-

efficacy and professional performance (competency) as per the nuances of the themes/sub-

themes identified in [#7(2017)] and reflected in [#5(2019)] were very interesting and perhaps

unexpected findings.

This was interesting because reading though [#7(2017)] and [#5(2019)] separately as

individuals papers, even though I had been closely involved with both papers, the relationship

described above simply did not ring true. However, when the two were studied together,

particularly when the thematic findings were digested and analysed in conjunction with each

other, this innate but sublime relationship amongst confidence, self-efficacy and competency

resonated with me.

31

Synthesising them, I noticed an unintended and unreported finding when triangulating the

qualitative themes of [#5(2019)] and [#7(2017)]. It was quite clear to me, that there was only

a thin line between one’s perceived confidence (and self-efficacy as per Bandura (1986)), and

the competency achieved, following a well-structured and well supported postgraduate

learning experience resonating with #10(2009), #9(2012) #8(2013), already discussed in

Chapter 1 of this thesis. In this particular paradigm for [#5(2019) and #7(2017)], it was the

Restorative Dental Practice Master’s at UCL Eastman Dental Institute although this could

arguably be generalizable to include other comparable programmes as well.

There is no doubt that participation in a postgraduate learning experience enhances

confidence which helps to nurture competence in clinical practice [#7(2017)]. An increase in

confidence impacts positively on clinical practice [#5(2019)]. However, it is also important to

put these two factors into perspective and to bring in the wider area of professionalism

(Evans, 2008) and compliance (GDC, 2014) into the equation.

In the wider area of clinical dental education, irrespective of whether one is an insider-

researcher, teacher, mentor, peer tutor, tutee, or indeed in any other role, it is imperative that

genuine concerns about any healthcare workers’ professional performances are raised and

reported where necessary, irrespective of any individual’s level of perceived confidence. The

ethical guidelines issued by the General Dental Council (GDC, 2014) for dental healthcare

professionals in the UK, has the primary aim of protecting the health and well-being of

patients. Their ethical guidance must be observed by dental healthcare professionals who are

all registered with the GDC, putting perceived confidence in the clinical practice of dentistry

in perspective.

32

Conclusion

Confidence has a strong positive impact on the standard of clinical dental practice. In turn,

enrolment in the Restorative Dental Practice Master’s programme enhanced the confidence of

the course participants in their clinical practice, where they reported to be carrying out their

restorative professional tasks more comfortably and effectively whilst they perceive

themselves to be confident.

The sense and generality of self-efficacy also have an impact on the confidence of individuals

who have completed a postgraduate learning experience. To enhance the learning experience,

my research thus far as reported in this thesis has linked the desirable close support primary

care based learning environment [#10(2009)] with the need to have quality teachers

[#9(2012)] who are well motivated [#8(2013)]. Teachers should be utilising contemporary

pedagogy and develop teaching aids [#6(2015)] to promote the students’ confidence which

has a positive impact on clinical practice [#7(2017) #5(2019)], allowing students to reap

maximum benefits following their engagement with relevant postgraduate studies.

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Chapter 3: Enhancing Teaching and Feedback Practices [#4(2018), #3(2018), #2(2019), #1(2020)]

The general research question for this chapter was to investigate how feedback practices

would enhance teaching and learning in clinical practice.

Confidence has a positive impact on learning [#7(2017)] and is an important factor in

facilitating clinical dental practice [#5(2019)]. Confidence is part of an important jig-saw in

enhancing learning on top of other factors which the portfolio of my pedagogic research has

already explored and presented in this thesis. These factors include the learning environment

[#10(2009)], teaching practices [#9(2012)], the quality of teachers [#8(2013)], and the use of

teaching aids to enhance reflective learning [#6(2017)].

On top of the issue of confidence, it is a natural logical extension of my pedagogic research to

explore aspects of feedback practices [#4(2018), #1(2020)]. It is additionally demonstrated by

the work of Hattie and Temperley (2007), that feedback as a vital and integral feature to

facilitate meaningful learning.

#4(2018) investigated perceptions of the feedback given by students at UCL Eastman Dental

Institute about the teaching they experienced by using a picture card based model of students

giving feedback. This involved the student choosing from a selection of picture cards and

picking the card which most closely represented their individual learning experience. The

chosen card would reflect the feedback they were about to give by facilitating them to talk.

On the other hand, [#1(2020)] investigated the feedback practices of a broad cohort of dental

teachers within the constituent schools of the Association of Dental Education in Europe

(ADEE). This work is ongoing, and I am currently investigating the perceptions these

34

students have on the feedback they receive from their teachers. This is beyond the remit of

this thesis.

Using picture cards to elicit feedback from students about their programme is an innovative

concept of delivering feedback [#4(2018)]. This novel method of prompting feedback has its

value and support because “there is a perceived need to alternative approaches to producing

feedback (to reinforce practice)” (Hounsell, 2003). This was further espoused by Davidson et

al (2009), that one should “prioritise the use of visual sources, particularly visual texts and

visual data” to help with generating thoughts and feedback. Picture cards are therefore a

useful evolving method of facilitating feedback.

It is clear that “students may be caught in the tension between the established and emerging

standards of (delivering) … feedback” because “innovations inherently take more time to

become established” (Davidson et al, 2009). However, the concept of using novel methods to

stimulate student feedback should be encouraged (Brookhart, 2008).

The use of visual texts “gives voice to the hidden experiences of the learner’s consciousness”

(Dottin, 2007). I found the same in [#4(2018)], that there is a psychological element in

generating this type of feedback. In the context of #4(2018), specific visual items were used

to facilitate students to generate feedback about the programme they had enrolled on. The

introduction and use of a range of real, figurative and abstract images as picture cards to elicit

feedback were met with an overall mixed but positive response by the participating student in

[#4(2018)], echoing Davidson et al, (2009).

In #4(2018), picture cards were found to be a useful tool to generate feedback in the context.

77% (n=20) of respondents enjoyed giving feedback using this novel approach giving

35

feedback based on selecting a picture which most suited their thinking and perceptions

concerning the course which reinforced the feedback process.

83% (n=22) of respondents reported that this form of feedback positively stimulated their

thoughts, with comments such as “good means of reflection and applying feedback”.

However, the unconventional nature of the approach may have contributed to a minority of

participants not warming to this novel concept, such as “I don’t think it helped discussion”

and “It wasn’t going to alter my ability to give feedback”, agreeing with Davidson et al,

(2009).

My work at #4(2018) identified that “there is more than one idea of feedback struggling for

wider acceptance which needs to be heard ”. This was in full agreement with Boud and

Molloy (2012), that the models of feedback for learning should be rethought and the design

challenged to address its inadequacies.

Interestingly, reinforcing the findings of #7(2017) about the merits on using insider research,

a majority of respondents in #4(2018) also identified that they would most prefer to give

feedback to someone they know within the programme (insider researcher). This would be

because “I feel they understand more, and my feedback will be taken on board more”

[#4(2018)], and this debate continues.

I found that “the results of image elucidation can be a profound aid to data collection (of

feedback)…. promoting this important and yet often ignored process ” [#4(2018)], a fresh

means of stimulating feedback responses, kick-starting the process of “reducing discrepancies

between current understanding, performance and a desired goal” [#4(2018)]. This unleashes

36

“one of the most powerful influences on learning and achievement” to enhance learning and

practice [#4(2018)].

Whilst #4(2018) investigated how picture cards were used as tools to facilitate feedback

practices to enhance student learning, #3(2018) and #2(2019) identified some perceived

pedagogic gaps in clinical dentistry, reflecting the fact that there was room for improvement.

#3(2018) explored general dental practitioners’ understanding, knowledge and perceptions of

MID, a very fundamental concept in contemporary clinical restorative dentistry, which would

preserve the maximum amount of viable tooth substances when teeth are being restored. This

would be in direct contrast with a traditional more invasive approach which could be viewed

as destructive (Mount & Ngo, 2000).

#2(2019) investigated the teaching of the subject of Occlusion in undergraduate dentistry in

the Dental Schools in the UK and Ireland. Occlusion is very simply defined as “the bringing

of the opposing surfaces of the teeth of the two jaws into contact, and the study of the

relationship between the surfaces when in contact” (Oxford). In the context of this thesis,

along the educational research journey that I have undertaken, the deficiencies in teaching

and learning in this important area of clinical practice were identified and explored.

Within the crux of MID, in terms of the contemporary principles for the removal of caries,

the following principles must be adopted, that “after preventive non-operative control of

caries, selective caries removal in the minimally invasive operative management of non-

cleansable, cavitated carious lesions should now be the norm” (Banerjee et al, 2017). As far

as dental caries is concerned, it is “a bio-film based and lifestyle-mediated disorder”, and that

“for deep lesions in teeth with vital pulps, maintaining pulp vitality is the priority”

37

(Schwendicke et al 2018). It would not be unreasonable to expect that 100% of respondents

should know, understand and practice these fundamental principles in clinical dentistry.

On the contrary, based upon #3(2018), (n= 149), that only 58% of respondents reported

having “some” knowledge of this aspect of MID, and just 11% reported of “knowing a great

deal” about MID. The general lack of understanding of this pertinent area of the practice of

dentistry was disappointing. It demonstrates that there is a lot of room for improvement in a

multitude of areas to effect better teaching and learning. This starts from having a good

learning environment [#10(2009)], executing good teaching practices for the education

providers [#9(2012)] and having quality teachers [#8(2013)], in a reflective learning

environment [#6(2017)]. On top of these, it is also imperative to maintain confidence to

nurture competence [#5(2019), #4(2018)], and to have an effective feedback system

[#1(2020] to complement this pedagogic loop as illustrated below.

In the questions testing basic competency of MID, #3(2018) found that those respondents

with a self-reported knowledge in the subject scored better than those who did not. This

implies that self-confidence may be a factor to play in this, that “increasing confidence

through learning has the potential to change (dentists’) perceptions of clinical practice”

[#5(2019)], and that with education and continuing professional development, there is “an

increased confidence in ….ability to undertake dental procedures”.

The important pedagogic message here is that an increase in skills [#9(2012)], confidence

[#4(2018] and a learning experience [#5(2019)], will lead to a natural inclination to

communicate better with colleagues and patients alike [#5(2019]. This paradigm shift, as per

Morgan & Cleave-Hogg (2002), cultivates an environment to develop great skills and

competence. To push this one step further, as per the portfolio presented herewith for this

38

thesis, that good feedback practice would embrace and cement this further [#1(2020),

#4(2018)].

In [#3(2018)] when testing application of three fundamental pieces of essential knowledge in

MID, only 28% of respondents scored all three correct, with 15% score none correctly, and

26% scoring only one correct. This illustrates the concerns that, if practitioners are in the

potential realm that somehow they are not managing to be sufficiently robust to keep

themselves up-to-date with the latest development in dentistry, that they can fall behind

contemporary practices inadvertently. Reflecting on this, therefore, it is important to have an

appropriate feedback loop [#1(2020)] to help to ameliorate the possible lack of awareness,

but in a user friendly 360 degree manner (Mohapatra, 2005), which will help to minimise

these risks. The role of feedback in maintaining standards and plugging this gap cannot

therefore be under-estimated.

To hit this right at the crux of this learning mismatch as per the findings in #3(2018), that,

“The poor knowledge of MID indicated by this study might be due to gaps in knowledge and

understanding or gaps in knowledge in training”, although the majority of participants in this

study “were younger and more recently qualified”, reflecting something more important than

just the facilities and teaching methods. In other words, appropriate reflective practices

[#5(2019)] and feedback [#4(2018), #1(2020)] feature highly in reinforcing a satisfactory

overall approach required for proper pedagogic development and support of practitioners. At

the end of it all, this approach benefits patients and facilitates practitioners to adequately

discharge their legal duties of care (Bolam, 1957).

In #2(2019), a mixed method approach was used to investigate the teaching of occlusion in

undergraduate dental schools in the UK and Ireland. Although every dental school in the UK

39

and Ireland taught occlusion in their curriculum, 28% of them reported “insufficient time for

the teaching (of occlusion) in the curriculum”, with marked variations in teaching methods,

resources, assessment techniques and barriers to teaching this important subject in clinical

dentistry. What had been highlighted was “a lack of co-ordination regarding occlusion

teaching”, and the lack of strategy, understanding and feedback mechanisms on such teaching

and learning. It was no surprise therefore, that there was “a degree of confusion in identifying

where it (occlusion) is taught in the curriculum” [#2(2019)].

The required learning outcomes for the teaching of occlusion to dental students in the UK and

Ireland were clear as per Preparing for Practice (GDC, 2015a) and the Profiles and

Competencies for the European Dentists published by the Association of Dental Education in

Europe (ADEE) (Field et al, 2017). However, it was also obvious that the different teachers,

departments and students were not communicating with each other about this important

subject, reflecting the observations that “it (occlusion) is probably taught in silos”, with “a

lack of awareness of what everyone else is doing” [#2(2019)].

The teaching time dedicated to this important subject has been being reported in #2(2019) to

be “between 10 to 310 hours” amongst the different schools, taught either separately or

sandwiched between different subjects, lacking in any awareness of meaningful feedback

from students. It was no surprise therefore, that this incoherent and disjointed approach

illustrated by “a lack of co-ordination”, “a lack of dedicated teaching” and “a lack of

communication” has resulted in “a lack of understanding of (and dissatisfaction with) this

important subject when students graduate” [#2(2019)].

In terms of student learning, it was clear that “when they start applying the theoretical

knowledge intelligently that they start to grasp topic relevance” [#2(2019)], echoing the

40

importance of a co-ordinated [#9(2012)] and close support [#10(2009)] teaching method. It

also indicated that a reflective approach [#6(2017)] which captures elements of reflection-in-

action and reflection-on-action (Schon, 1983, 1987) would naturally “require us to talk

together” [#2(2019)] to exchange, reflect, understand, adapt and be co-ordinated [#10(2009)].

This approach could be facilitated by high quality feedback as advocated by my work in

#1(2020), resulting in a win-win situation for both the teachers and the students in this

important clinical subject. The respondents as in #2(2019) “identified the importance and

reliance on student feedback in evaluating teaching” because “students are customers now,

and their feedback is taken very seriously”. This reflects a pleasant progression in pedagogic

approaches during the eleven years of my selected pedagogic research output as represented

in this thesis.

From an exploratory approach on the basic components, facilities and ingredients in the

earlier research outputs [#10(2009), #9(2012), #8(2013)], my pedagogic research has

investigated more deeply, more specifically and in a more sophisticated manner [#5(2019),

#4(2018)], #1(2020]. This progression reflects the increased complexity and a contextualised

focused approach over time, allowing deeper learning through reflection (Schon, 1987),

greater confidence [#5(2019)], utilising the feedback loop [#1(2020)] as a mechanism to

achieve the above.

Although feedback was not explicitly mentioned in #2(2019) and #3(2018), with the benefit

of hindsight, combined with observations made in #1(2020), it was clear on reflection, that it

would have been desirable also to consider feedback as part of the issue when considering

other aspects of teaching and learning in these two papers.

41

The educational deficiencies noted in the learning processes in #2(2019) and #3(2018), would

have been more effectively addressed by ascertaining more student feedback which was sadly

lacking in these two aspects of teaching. Aspects of these limitations were investigated in

[#1(2020)] I had the opportunity and platform to look with my colleagues at feedback

practices and perceptions given by a teacher to students amongst the ADEE educators

membership.

#1(2020) was based upon the opinions and perceptions of feedback from teachers to dental

students. This was based upon three elements; as information, as a reaction and as a cycle,

involving information as a tool for goal setting and improvements in performance. (van de

Ridder et al, 2008).

The use of feedback “in reducing discrepancies between current understandings or

performance and the desired goal” (Hattie & Temperley, 2007) was a key finding in

[#1(2020)].

There was clear evidence that “a vast majority of respondents (teachers) providing feedback

to their students following formative assessment, summative assessment, informally…. (and)

feedforward particularly when supervising Master’s students” [#1(2020)].

These findings in [#1(2020)] were reassuring in that there was “a strong ethos of delivering

feedback to dental students”, and a very desirable entrenched practice philosophy resonating

with Hardavella et al (2017), which is “embedded in education, training and daily

professional activities”. I found in [#1(2020)], that constructive criticism and self-reflection

were the two most popular styles of feedback. These styles of feedback were overwhelmingly

preferred and delivered by teachers and reported as being “the best and what students want”.

42

My findings here echoed the cornerstone “feedback sandwich technique” which enhances the

intensity, effectiveness and acceptance of feedback from teachers (Hardavella et al, 2017).

This also reverberated with my earlier findings in confidence in clinical practice [#5(2019)],

linking this with feedback practices [#1(2020)], that “Appropriate feedback contributes

significantly in developing learners’ competence and confidence at all stages of their

professional careers” (Hardavella et al, 2017).

[#1(2020)] found unequivocally, that appropriate feedback given by teachers helps students

think and reflect upon the gaps between what they had attained and what they wanted to

achieve. In other words, effective feedback could be the catalyst [#1(2020)], where reflective

learning is nurtured [#6(2015)], where confidence and competence are developed [#5(2019)],

where the innate pedagogic deficiencies identified at [#3(2018) and #2(2019)] are being

ameliorated.

When it came to students delivering feedback to teachers about their teaching as part of the

360 degree approach (Krammer et al, 2019) to disseminate feedback, it was encouraging to

see clearly that “83% of the teacher respondents reported that their teaching changed for the

better as a result of feedback from students” [1#(2020)]. This echoes Hattie and Temperley

(2007) that “feedback is one of the most powerful influences on learning and achievement

both for the teachers and the students”. Perhaps through the combination of reflections

[#6(2017)], increased confidence [#5(2019)], that the feedback process is enhanced and

reinforced, bring pedagogy into a new level.

Conclusion

Confidence impacts positively on learning [#7(2017)] and nurtures competency in clinical

dental practice [#5(2019)]. In addition, appropriate, proportionate and timely feedback

43

practices [#4(2018), #1(2020)] enhance the effectiveness of teaching and facilitate learning.

As far as feedback is concerned, whilst novel feedback methods may help to gather thoughts

and generate meaningful and sustainable feedback from students to teachers about their

teaching and how this can be improved [#4(2018)]. However, the timing, extent and quality

of feedback delivered by teachers to students are fundamentally and inextricably linked to

enhancing student satisfaction, learning and standards of clinical practice [#1(2020)].

Whilst examining the specific arenas in clinical practice [#3(2018)] and teaching [#2(2019)],

my research has shown that there is plenty of room for improvements in these areas thereby

reinforcing the crucial roles for feedback [#4(2018), #1(2020)]. It also invigorates and

enhances learning and teaching, often acting as a catalyst to nurture reflective learning

[#6(2015)], and also when confidence and competence in clinical practice are developed

[#5(2019)].

44

Chapter 4: Overall appraisal and conclusion

This Chapter appraises the overall research undertaken in this thesis and how the research has

advanced dental education both in the United Kingdom and abroad. It also briefly looks at

some potential directions of future related research in dental education based on the above

work.

Overall appraisal

The portfolio of my research presented in this thesis explored, developed, contextualised,

analysed and discussed three important paradigms in dental education. First, how the clinical

teaching and learning environment in dentistry could be enhanced [#10(2009), #9(2012),

#8(2013), #7(2017), #6(2015)]; Second, the role of confidence in learning in clinical practice

[#7(2017), #5(2019)]; and Third, how feedback practices could help to enrich teaching and

learning [#4(2018), #3( 2018), #2(2019), #1(2020)].

On the surface, these individual papers represent separate areas in dental education which I

investigated chronologically from 2009[#10] to 2020[#1]. However, exploring deeper beyond

the surface and when considered together, these papers represented my unique, enjoyable,

exciting and sometimes tough and often unexpected pedagogic research journey in dental

education over the last eleven years.

The nuances by design, on top of some unexpected twists and turns, in combination all of

which contributed to the unique richness, freshness and relevance to aspects of contemporary

dental education had been demonstrated. The analysis of the findings of my work as

presented in Chapters 1 to 3 and the associated discussions regarding the literature available

both during the studies and after conveyed this sentiment.

45

My work [#10(2009)] demonstrated that a teaching environment with a comprehensive,

friendly, well equipped, well supported self-contained primary care surgery set up would be

excellent for simulating a real world clinical environment with students as trainee dentists

learning total patient care delivery. I then investigated the important human factor required to

make this set up function effectively [#9(2012)]. I found that a friendly, reflective, efficient,

close support, self-contained, simulated environment which was perceived by students to be

an effective setting for learning [#9(2012)]. Ironically my findings that self-contained

surgeries are congenial to teaching and learning in clinical dentistry has proven to be

extremely desirable and compatible in the COVID-19 environment which the human race is

experiencing at the time this thesis is written up.

There was no doubt that these clinics needed to be staffed with appropriate teachers. I

therefore turned my attention to investigate why experienced colleagues would become

involved in clinical teaching [#8(2013)], showing that these clinical teachers have a strong

influence on the success or otherwise of the modern dental curriculum. I showed that they did

not necessarily seek remuneration as their main reward whilst job satisfaction and a career

pathway were deemed more important [#8(2013)].

Next stop, my research moved to a different approach investigating how reflective learning

could be facilitated and enhanced by the use of bespoke video vignettes [#6(2017)] in a

simulated undergraduate environment. Whilst also noticing that some undergraduate students

lacked confidence, the opportunity to investigate this arose when my career progressed from

an undergraduate to a postgraduate dental teaching environment, where fully qualified

dentists treated patients in practice. I had the opportunity to investigate the impact

postgraduate studies had on the perceived confidence of postgraduate students who were

46

qualified dentists [#7(2017)]. I found that perceived confidence enhanced the sense of self-

efficacy, motivation and positivity towards practice in the real world.

Sensing that there was more mileage in the issue of confidence, I then examined the impact

confidence had on clinical dental practice [#5(2018)], showing that perceived confidence

reflected competence which had a very positive impact on clinical dental practice, reinforcing

the findings of [#7(2017)].

Having investigated the learning environment, the required human factors, reflective

practices, the role of confidence and to maintain the overall learning environment, the natural

next stage of my research was to examine feedback practices. Feedback is what binds these

other factors together and is fundamental to effective learning.

[#4(2018), #1(2020)] established that appropriate, proportionate and timely feedback

practices enhanced the effectiveness of teaching and facilitated learning. The picture card

paradigm in [#4(2018)] demonstrated the perceived value alternative approaches such as

image elicitation had to facilitate the generation of feedback.

Being able to deliver effective feedback would be very desirable as #3(2018) and #2(2019)

identified that there was room for improvements in respect of the teaching both in

undergraduate [#2(2019)] and in postgraduate dentistry [#3(2018)]. To complete the loop,

[#1(2020)] investigated the extent, type, timing, frequency, and perceived effectiveness of

feedback given by dental teachers to their students. It was clear that effective feedback from

teachers to students would be constructive, professional, truthful, timely and consistent.

Feedback could also be a pathway to setting achievable targets by teachers for students

[#9(2012)] and for them to develop reflective practices [#6(2017)] in a relaxed and well set

47

up [#10(2009)] co-operative learning paradigm [#8(2013)]. This allows confidence in clinical

practice to develop [#5(2019)] as part of the programme of studies [#6 (2017)] being

undertaken.

This completes the appraisal of the portfolio and the exciting and hitherto unexpected journey

of pedagogic research I have experienced between 2009 and 2020 as presented in this thesis.

It links the findings and the nuances of the ten papers presented together in this thesis in a

thematic manner to demonstrate the role I have contributed to the advancement of dental

education.

Challenges and opportunities for the overall research:

There was a lot of searching in the dark in the early 2000s when I took my first steps in

pedagogic research. My first publication alone took seven years with data collected from six

different cohorts of students to establish consistently reproducible data.

As a part-time researcher having to multi-task a long list of other essential jobs, generating

and maintaining momentum for educational research was a challenge. Self-motivation and

self-discipline never to give up have been a useful motto from my perspective. Unlike other

areas of scientific research which can be more easily planned over some time, educational

research is often opportunistic and dependent on the educational and training that is being

delivered at the time. Despite these challenges, I feel that I have been able to develop a clear

vision of several inter-related areas of pedagogic research to contribute meaningfully to the

advancement of dental education.

Changing jobs from a predominantly undergraduate teaching environment at King’s College

London Dental Institute to an exclusively postgraduate teaching environment at University

48

College London Eastman Dental Institute in 2013-14 were definite challenges. However, this

also presented valuable opportunities to diversify my areas of research interests along with

similar over-riding pedagogic principles. I have been very fortunate to have been able to

work with some fantastic colleagues which allowed me to refocus and progress swiftly with

my dental education research.

This change in working environment turned out to be something very positive because it

enriched the quality and variety of my research output. It allowed me the opportunity to

conduct deeper meaningful research which was more conceptual, but more interesting and

more rewarding in the overall scheme of things. It also allowed me to take a quality reflective

approach built on what had already been achieved in the previous working environment.

Collaboration has proved to be critical in the completion of successful pedagogic research. As

Head of Department of Continuing Professional Development and Programme Director of the

Masters’ in Restorative Dental Practice, I have been fortunate to have successfully directed

and supervised (primary or secondary) approximately 70 Masters’ dissertations to-date. This

allowed me to direct and plan strategically, and yet be fully involved in all aspects of

education research in the department whilst determining the direction of travel for each piece

of research.

In respect of the portfolio of work presented in this thesis, the limitations of each paper have

already been discussed.

49

Concluding remarks:

Based on my findings of the learning environment, perceived confidence, feedback practices

and student learning in dental education as per my published papers included in this thesis,

within the context of teaching and learning in clinical dentistry, it is reasonable to conclude as

follows:

Given the following parameters

An optimal, ambient environment set up which is congenial to clinical dentistry

A friendly, relaxed and non-threatening teaching environment

The availability of suitably qualified, experienced and motivated teaching staff

An optimal, enriched and contextualised teaching materials and strategies in a

contemporary paradigm which promotes close support, with reflection-on-action and

reflection-in-action

It is possible to facilitate or nurture

Student confidence as part of the learning experience resulting in a very positive and

profound impact on their clinical practice central to their personal development,

performance and competence

Furthermore

This paradigm will be reinforced by the practice of appropriate feedback practices,

both from students to their teachers and from teachers to their students

Even though the above theory on feedback is great, in both undergraduate and

postgraduate dentistry environments, there is much room for improvement in practice

The standard, frequency, scope, quality, timeliness, effectiveness and appropriateness

of feedback delivered by dental educators in Europe and beyond to their students are

very positive and encouraging. This bodes well for the future of dental education

50

In short:

Based on the presented portfolio of my eleven years’ published pedagogic research presented

herewith, I have found that in the right teaching environment, with the appropriate number of

well qualified and highly motivated staff, students are likely to enjoy this congenial and

reflective learning paradigm. This will in turn enhance their perceived confidence and

facilitate the development of their competence. Furthermore, if the appropriate feedback

mechanisms and practices are also in place, both students and teachers are likely to be

contented and satisfied.

The Future

Despite the unprecedented challenges faced by dental educators and their students as a result

of the global COVID-19 pandemic, this has also presented several excellent developmental

opportunities. They include the accelerated use of technology to enhance learning such as the

meaningful use of simulations, synchronous and asynchronous delivery of teaching, on-line

assessments and remote learning.

Indeed, social distancing, wearing of personal protective equipment, self-isolation, working

from home operating on Zoom® or Teams®, track and trace and immunisation may all be

relatively long term features for most of us. The “new normal” approach to teaching and

learning will be very different from the past. As we step into the unknown, I treasure the

exciting opportunities and challenges which will accompany me to continue my pedagogic

research journey for the future.

51

References

References are listed in alphabetical order. Those in bold contribute to the body of published

work submitted in evidence for the award of PhD by publication and are also appropriately

numbered.

[#1(2020)] Leung, A., Fine, P., Blizard, R., Tonni, I. Louca, C. (2020). A quantitative study

of feedback delivered by dental teachers to dental students. Accepted for publication by

the European Journal of Dental Education, 19th October 2020.

[#2(2019)] O’Carroll, E., Leung, A., Fine, P., Boniface, D., Louca, C. (2019). The

teaching of occlusion in undergraduate dental schools in the UK and Ireland. British

Dental Journal. British Dental Journal, Volume 227 (6), pp 512-517

[#3(2018)] Mirsiaghi, F., Leung, A., Fine, P., Blizard, B., Louca, C. (2018). An

investigation of general dental practitioners' understanding and perceptions of

minimally invasive dentistry. British Dental Journal, Volume 225 (5), pp 420-424

[#4(2018)] Fine, P., Leung, A., Francis, J., Louca, C. (2018). The Use of Picture Cards to

Elicit Postgraduate Dental Student Feedback. Dentistry Journal, Volume 6 (7),

doi:10.3390/dj6020007

[#5(2019)] Fine, P., Leung, A., Bentall, C., Louca, C. (2019). The Impact of Confidence

on Clinical Dental Practice. European Journal of Dental Education, Volume 23, pp 159-

167








52

[#6(2017)] Davies, B., Leung, A., Dunne, S., Dillon, J., Blum, I. (2017). Bespoke video

vignettes - an approach to enhancing reflective learning developed by dental

undergraduates and their clinical teachers. European Journal of Dental Education,

Volume 21 (1), pp 33-36

[#7(2017)] Fine, P., Louca, C., Leung, A. (2017). The Impact of a Postgraduate Learning

Experience on the Confidence of General Dental Practitioners. Dentistry Journal,

Volume 5 (2), doi:10.3390/dj5020016

[#8(2013)] Davies, B., Leung, A., Dunne, S. (2013). Why do general dental practitioners

become involved in clinical teaching? A pilot study exploring the views of part-time

practitioner teachers, King's College London. British Dental Journal, Volume 214 (9),

pp 461-465

[#9(2012)] Davies, B., Leung, A., Dunne, S. (2012). So how do you see our teaching?

Some observations received from past and present students at the Maurice Wohl Dental

Centre. European Journal of Dental Education, Volume 16 (3), pp 138-143

[#10(2009)] Davies, B., Leung, A., Dunne, S. (2009). Perceptions of a simulated general

dental practice facility - reported experiences from past students at the Maurice Wohl

General Dental Practice Centre 2001-2008. British Dental Journal, Volume 207 (8), pp

371-376

Ali, K., Tredwin, C., Kay, E., Slade, A., Pooler, J. (2014) Preparedness of dental graduates

for foundation training: a qualitative study. British Dental Journal, Volume 217, pp145–149.















53

Anderson, R., Hollingsworth, T., Baggerley, R., Maddren, R., Vegvari, C. (2020). COVID-19

spread in the UK: the end of the beginning? The Lancet. Volume 396 (10251), pp 587-590

Architecture and Design Scotland (2014). Dental Surgery Design: A quick guide illustrating

the impact of circulation, layout and design on the user experience. Architecture and design

Scotland, the Scottish Government and Health Facilities Scotland.

Retrieved from: https://www.ads.org.uk/healthier-places/

Asch, D., Jedrziewski, M., Christakis, N (1997) . Response rates to mail surveys published in

medical journals. Journal of Clinical Epidemiology. Volume 50, pp 1129-1136

Association of Dental Education (ADEE) (2019). Annual activity report 2019. Retrieved from

https://adee.org/sites/default/files/Annual%20Activity%20Report%202019%20Signed_0.pdf

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory.

Prentice-Hall series in social learning theory. Prentice-Hall Inc

Bandura, A (1993). Perceived self-efficacy in cognitive development and functioning.

Educational Psychologist, Volume 28 (2), pp 117-148

Banerjee, A., Frencken, J., Schwendicke, F, Innes, N. (2017). Contemporary operative caries

management: consensus recommendations on minimally invasive caries removal. British

Dental Journal, Volume 223, pp 215–222

Bedford, J., Enria, D., Giesecke, G., Heymann. D., Ihekweazu, C., Kobinger, G., Clifford

Lane, H., Memish, Z., Oh, M., Sall, A., Schuchat, A., Ungchusak, K., Wieler, L. Towards

https://www.ads.org.uk/healthier-places/

https://adee.org/sites/default/files/Annual%20Activity%20Report%202019%20Signed_0.pdf

54

controlling of a pandemic. (2020). The Lancet. March 16th 2020. Retrieved from

https://doi.org/10.1016/

Benner, P. (1982). From novice to expert. The American Journal of Nursing, Volume 82 (3),

pp 402-407

Blum, C., Borglund, J., Parcells. D. (2010). High-fidelity nursing simulation: impact on

student self-confidence and clinical competence. International Journal of Nursing Education

Scholarship, Volume 7, Issue. 1, Article 18, pp 1-14

Bolam v Friern Hospital Management Committee [1957] 1 WLR 582

Boud, D., Molloy, E. (2013) Rethinking models of feedback for learning: the challenge of

design. Assessment & Evaluation in Higher Education, Volume 38 (6), pp 698-712

Brannick, T., Coghlan, D. (2007). In defence of being "native": The case for insider academic

research. Organizational Research Methods, 10(1), 59–74. doi:10.1177/1094428106289253

Brookhart, S. (2008) How to give effective feedback to your students. Association for

Supervision and Curriculum Development (ASCD). Alexandria, VA, USA.

ISBN 978-1-4166-0736-6

Bullock, A., Kavadella, A., Cowpe, J., Barnes, E., Quinn, B., Murphy, D. (2020). Tackling

the challenge of the impact of continuing education: An evidence synthesis charting a global,

cross-professional shift away from counting hours. European Journal of Dental Education,

Volume 24, pp 390–397

https://doi.org/10.1016/

55

Cabot, L., Radford, D. (1999). Are graduates as good as they used to be? British Dental

Journal, Vol 186, pp 318-319

Clanton. J., Gardner, A., Cheung, M. (2014). The relationship between confidence and

competence in the development of surgical skills. Journal of Surgical Education, Vol 71 (3),

pp 405-412

College of General Dentistry (CGDent) and the Faculty of General Dental Practice (FGDP)

(2020). Implications of COVID-19 for the safe management of general dental practice: A

practical guide. Version 2, 2nd October 2020. Published online by the FGDP. Retrieved from:

https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-

practical-guide

COVID-19 guidance and standard operating procedure (2020). The Delay phase. NHS

England and NHS Improvement, Version 1. Published on-line by the Department of Health

England, 15th April 2020. Retrieved from:

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0813-covid-

19-urgent-dental-care-sop-v4-15-apr.pdf

Craddock, H. (2008). Outreach teaching – the Leeds experience: reflections after one year.

British Dental Journal, Volume 204, pp 319–324

Davidson, J., Dottin, J., Penna, S., Robertson, S. (2009). Visual sources and the qualitative

research dissertation: Ethics, evidence and politics of academia-Moving innovation in higher

education from the centre to the margins. International Journal of Education & the Arts,

Volume 10 (27), pp 1-40

https://www.sciencedirect.com/science/journal/19317204

https://www.sciencedirect.com/science/journal/19317204/71/3

56

Davies, B. (2000). Moving towards co-operative learning at the Maurice Wohl GDP Centre.

M Med Ed dissertation, University of Dundee

De Cossart, L., Fish, D. (2005). Cultivating a thinking Surgeon: New perspectives on clinical

teaching, learning and assessment. TFM Publishing Ltd, Nr Shrewsbury, UK

Dottin, J. (2007). Transcending knowledge barriers: An integrated instructional approach to

transforming the learning experience of adult learners in higher education. PhD Dissertation,

University of Massachusetts Lowell, Lowell, MA, USA

Dwyer, C., Buckle, J. (2009). The space between: on being an insider-outsider in qualitative

research. International Journal of Qualitative Methods, Volume 8(1), pp 54-63

Eaton, K., Brooks, J., Patel, R., Batchelor, P., Merali, F., Narain, A. (2011). The impact of

continuing professional development in dentistry: a literature review. The Faculty of General

Dental Practice (UK). Retrieved from

https://www.fgdp.org.uk/sites/fgdp.org.uk/files/docs/in-practice/amps-

online/final%20impact%20of%20cpd%20on%20dentistry%20november%202011.pdf.

Elkind, A., Potter, C., Watts, C., Blinkhorn, F., Duxbury, J., Hull, P., Blinkhorn, A. (2005).

Patients treated by dental students in outreach: the first year of a pilot project. European

Journal of Dental Education, Volume 9, pp 49-52

57

Elzubeir, M., Rizk, D. (2001). Assessing confidence and competence of senior medical

students in an obstetrics and gynaecology clerkship using an OSCE. Education for Health

(Abingdon). Volume14(3), pp 373‐382

Eriksen, H., Bergdahl, M., Byrkjeflot, I., Crossner, C.‐G., Widström, E., Tillberg, A. (2011).

Evaluation of a dental outreach teaching programme. European Journal of Dental Education,

Volume 15, pp 3-7

Evans, L. (2008) Professionalism, professionality and the development of education

professionals. British Journal of Educational Studies, Volume 56 (1), pp. 20-38

Field, J., Cowpe, J., Walmsley, A. (2017). The graduating European dentist: A new

undergraduate curriculum framework. European Journal of Dental Education. Volume 21

(Suppl. 1), pp 2‐10

Fish, D., Twinn, S. (1997). Quality clinical supervision in healthcare professions: principle

approached to practice. Oxford: Butterworth Heinnenmann

Fleming, J. (2018). Recognizing and resolving the challenges of being an insider researcher

in work-integrated learning. International Journal of Work-Integrated Learning, Volume 19

(3), pp 311-320

Formicola, A. (2017). Current state of dental education: executive summary. Journal of Dental

Education, Volume 81 (8) pp 1008-1014

58

Gamble Blakey, A., Smith-Han, K., Anderson, L. (2019). “They cared about us students:”

learning from exemplar clinical teaching environments. BMC Medical Education, Volume

19, pp 119-128

Garcia, I., Kuska, R., Somerman, M. (2013) Expanding the foundation for personalized

medicine: implications and challenges for dentistry. Journal of Dental Research, Vol 92 (7),

pp S3-S10

General Dental Council (GDC). (2013). Continuing Professional Development for the Dental

Team (requirements from 2008 onwards). Retrieved from https://www.gdc-

uk.org/information-standards-guidance/standards-and-guidance

General Dental Council (GDC). (2014). Standards for the Dental Team. General Dental

Council publications. Retrieved from https://www.gdc-uk.org/information-standards-

guidance/standards-and-guidance

General Dental Council (GDC). (2015a). Preparing for Practice: dental teams learning

outcomes for registration. General Dental Council publications. Retrieved from

https://www.gdc-uk.org/information-standards-guidance/standards-and-guidance

General Dental Council (GDC). (2015b). Standards for Education. Standards and

requirements for providers. General Dental Council publications. Retrieved from








59

General Dental Council (GDC). (2018). Enhanced Continuing Professional Guidance

(ECPD). General Dental Council publications. Retrieved from https://www.gdc-

uk.org/information-standards-guidance/standards-and-guidance

Hall, L., Kiesners, D. (2005). A narrative approach to understanding the nursing work

environment in Canada. Social Science and Medicine, Volume 61, pp 2482-2491

Hardavella, G., Aamli-Gaagnat, A., Saad, N., Rousalova. I., Sreter. K. (2017). How to give

and receive feedback effectively. Breathe, Volume 13 (4), pp 327–333

Hattie, J., Temperley, H. (2007). The power of feedback. Review of Educational Research,

Volume 77(1), pp 81-112

Hounsell, D. (2003). Student Feedback, Learning and Development. In M Slowey & D

Watson (Ed); Higher Education and the life course. Society for Research in Higher Education

and Open University Press, Buckingham, UK, pp 67-78

Karnieli-Miller, O., Strier, R., Pessach, L. (2009). Power relations in qualitative research.

Qualitative Health Research, Volume 19, pp 279-289

Kay, E. (2007) Dental education – where it needs to be. Dentistry for the community. British

Dental Journal, Volume 202 (1), p1

Kinsella, E. (2010). The art of reflective practice in health and social care: reflections on the

legacy of Donald Schon. Reflect Practice, Volume 11(4), pp 565–575



60

Krammer, G., Pflanzl, B., Mayr, J. (2019) Using students’ feedback for teacher education:

measurement invariance across pre-service teacher-rated and student-rated aspects of quality

of teaching, Assessment & Evaluation in Higher Education, Volume 44 (4), pp 596-609

Lee, J. (2009). Universals and specifics of math self-concept, math self-efficacy, and math

anxiety across 41 Programme for International Student Assessment (PISA) 2003 participating

countries. Learning and Individual Differences, Volume 19, pp 355–365

Leung, K., Bond, M. (Eds.) (2009). Psychological aspects of social axioms: Understanding

global belief systems pp 1-9. New York, NY: Springer SBM

Lim, C., Tondeur, J., Nastiti, H., Pagram, J. (2014). Educational innovations and pedagogical

beliefs: The case of a professional development program for Indonesian teachers. Journal of

Applied Research in Education, Volume 18, pp 1–14

Lynch, C., Ash, P., Chadwick, B. (2010), Student perspectives and opinions on their

experience at an undergraduate outreach dental teaching centre at Cardiff: a 5‐year study.

European Journal of Dental Education, Volume 14: pp 12-16

Lynch, C., Frazier, K., McConnell, R. (2010). State-of-the-art techniques in operative

dentistry: contemporary teaching of posterior composites in UK and Irish dental schools.

British Dental Journal Volume 209, pp 129–136

Lynch, C., McConnell, R., Wilson, N. (2006). Challenges to teaching posterior composites in

the United Kingdom and Ireland. British Dental Journal, Volume 201, pp 747–750

61

Mickleborough, T. (2015). Intuition in medical practice: A reflection on Donald Schon’s

reflective practitioner. Medical Teacher, Volume 37, pp 889–891

Mohapatra, M. (2015). 360 Degree Feedback: A Review of Literature. International Journal

of Research and Scientific Innovation (IJRSI), Volume 2, (1), Retrieved at:

https://www.semanticscholar.org/paper/360-Degree-Feedback%3A-A-Review-of-Literature-

Mohapatra/50a6145755f0129bfc05476cdd95004774eeae5d

Montgomery v Lanarkshire Health Board [2015] SC 11 [2015] 1 AC 1430

Morgan. P., Cleave-Hogg. D. (2002). Comparison between medical students’ experience,

confidence and competence. Medical Education, Volume 36, pp534-539

Mount. G., Ngo. H. (2000). Minimal intervention: a new concept for operative dentistry.

Quintessence International, Volume 31(8), pp 527-533

Munby, H. (1989). Reflection-in-action and Reflection-on-action (after Schon). Paper

presented at the Annual Meeting of the American Educational Research Association (San

Francisco, CA, March 27-31, 1989). Retrieved from

https://files.eric.ed.gov/fulltext/ED309163.pdf

National Association for Primary Care (NAPC) (2018). Primary care home: exploring the

potential for dental care to add value. Retrieved from https://napc.co.uk/wp-

content/uploads/2018/01/Dental-care-and-PCH.pdf.

https://www.semanticscholar.org/paper/360-Degree-Feedback%3A-A-Review-of-Literature-Mohapatra/50a6145755f0129bfc05476cdd95004774eeae5d

https://www.semanticscholar.org/paper/360-Degree-Feedback%3A-A-Review-of-Literature-Mohapatra/50a6145755f0129bfc05476cdd95004774eeae5d

https://napc.co.uk/wp-content/uploads/2018/01/Dental-care-and-PCH.pdf

https://napc.co.uk/wp-content/uploads/2018/01/Dental-care-and-PCH.pdf

62

National Science Teachers Association (NSTA) Reports (2020). Teaching in the coronavirus

era. Volume 31 (9) pp 1. Retrieved from

https://static.nsta.org/pdfs/nstareports/nstareports202005.pdf

Oxford English Dictionary. (2020). Retrieved from https://www.lexico.com/definition/.

Pacanins, C., Thomson, K., Coplen, A., Bell, K. (2017). Compensation and Position

Characteristics of Dental Hygiene Programme Directors. Journal of Dental Hygiene, Volume

91(6), pp 59-68

Pajares, F., Johnson, M. (1994). Confidence and competence in writing: the role of self‐

efficacy, outcome expectancy and apprehension. Research in the Teaching of English,

Volume 28(3), pp 313‐331

Radford, D., Hellyer, P. (2017). Empowerment in a model of outreach undergraduate dental

education. British Dental Journal, Volume 222, pp 41–46

Radford, D., Hellyer, P., Jones, K., Meakin, N. (2014). Experienced general dental

practitioners as clinical teachers: a qualitative study of their experience over the first three

years as novice clinical teachers in an outreach setting. Journal of Interdisciplinary Medicine

and Dental Science, Volume 2 (6), 1000147. Retrieved from: https://doi.org/10.4172/2376-

032X.1000147

Ren, Y., Feng, C., Rasubala, L., Malmstrom, H., Eliav E. (2020). Risk for dental healthcare

professionals during the COVID-19 global pandemic: an evidence-based assessment. Journal

of Dentistry, Vol 101 (2020), 103434. Retrieved from: doi.org/10.1016/j,dent.2020.103434

https://www.lexico.com/definition/

https://researchportal.port.ac.uk/portal/en/persons/david-radford(724ad19b-db5b-4997-81bd-561bdf0d7e27).html

https://researchportal.port.ac.uk/portal/en/persons/paul-hellyer(182280e1-398e-4ddf-8b28-321887aef704).html

https://researchportal.port.ac.uk/portal/en/persons/kim-jones(2d2763ea-ea21-49c0-aa2e-7c03ab02ce1f).html

https://researchportal.port.ac.uk/portal/en/publications/experienced-general-dental-practitioners-as-clinical-teachers(febb407a-e34a-4968-8848-8f7c611b1a7f).html



https://doi.org/10.4172/2376-032X.1000147

https://doi.org/10.4172/2376-032X.1000147

63

Saidin, K., Yacoob, A. (2017). Insider researchers: challenges and opportunities. Proceeding

of the International seminar on generating knowledge through research, Volume 1, pp 849-

854. Retrieved from http://ojs.umsida.ac.id/index.php/icecrs

Sander, P., Sanders, L. (2002). Measuring Confidence in academic study: A Summary report.

Electronic Journal of Research in Educational Psychology and Psychopedagogy. Volume 1,

pp 1–17. Retrieved from

http://ecujweb.amberwell.net/old_ecujweb/reflective_practice/RP_docs/measuring%20confid

ence%20in%20academic%20study.pdf

Schon, D. (1983). The reflective practitioner: How professionals think in action. New York:

Basic Books

Schon, D. (1987). Educating the reflective practitioner. San Francisco CA: Jossey Bass

Schwendicke, F., Frencken, J., Innes, N. (2018). Current concepts in carious tissue removal.

Current Oral Health reports. Volume 5, pp 154-162

Scottish Dental Clinical Effectiveness Programme (SDCEP) (2020). Mitigation of aerosol

generating procedures in dentistry, a rapid review. Version 1.0, 25th September 2020.

National Health Service (NHS) Education Scotland.

Retrieved from: https://www.sdcep.org.uk/wp-content/uploads/2020/09/SDCEP-Mitigation-

of-AGPS-in-Dentistry-Rapid-Review.pdf

64

Stankov, L., Morony, S., Lee., Y. (2014). Confidence: the best non-cognitive predictor of

academic achievement? Educational Psychology, Volume 34:1, pp 9-28

Sturgis, C. (2019). Nurture a culture of learning and inclusivity in competency-based

education. Aurora Institute Education Domain Blog. Retrieved from

https://aurora-institute.org/blog/nurture-a-culture-of-learning-and-inclusivity-in-competency-

based-education/

Thompson, N., Pascal. J. (2012). Developing critically reflective practice. Reflective Practice,

Volume 13:2, pp 311-325

Tondeur, J., van Braak, J., Ertmer, P. (2017). Understanding the relationship between

teachers’ pedagogical beliefs and technology use in education: a systematic review of

qualitative evidence. Education Technology Research Development , Volume 65, pp 555–

575

Trowler, P. (2011). Researching your own institution: Higher education. British Educational

Research Association (BERA) on-line resource. Retrieved from:

http://www.bera.ac.uk/resources/researching-your-own-institution-higher-education.

Van de Ridder. J., Stocking, K., McGaghie. W., ten Cate, O. (2008). What is feedback in

clinical education? Medical Education, Volume 42, pp 189–197

Wang, R., Liu, C. (2019). The relation of dental students’ learning styles to their satisfaction

with traditional and inverted classroom models. BMC Medical Education, Volume 19, pp

315- 322

https://aurora-institute.org/blog/nurture-a-culture-of-learning-and-inclusivity-in-competency-based-education/

https://aurora-institute.org/blog/nurture-a-culture-of-learning-and-inclusivity-in-competency-based-education/

http://www.bera.ac.uk/resources/researching-your-own-institution-higher-education

65

Wanyonyi, K. (2015). The delivery of primary dental care in a training environment through

team working: implications for dental skill mix in England. Doctoral Thesis, Doctor of

Philosophy, King’s College London. Retrieved from: https://kclpure.kcl.ac.uk/portal/

https://kclpure.kcl.ac.uk/portal/

66

Scientific Publications

1. List of Published Papers Submitted and used in the

commentary for This PhD Degree:

Appendix 1

Leung, A., Fine, P., Blizard, R., Tonni, I., & Louca, C. (2020). A quantitative study of

feedback delivered by dental teachers to dental students.

Accepted for publication by the European Journal of Dental Education, 19th October 2020

Contributions by Albert Leung

Concept

Design

Literature review

Study and questionnaire design

Data collection

Interpretation of results

Manuscript writing & editing

Citation Metrics

Google Scholar: 0

83

Appendix 2

O’Carroll, E., Leung, A., Fine, P., Boniface, D., Louca, C. (2019). The teaching of

occlusion in undergraduate dental schools in the UK and Ireland. British Dental Journal,

Volume 227 (6), pp 512-517


Concept

Literature review




Citation Metrics

Google Scholar: 0

90

Appendix 3

Mirsiaghi, F., Leung, A., Fine, P., Blizard, B., Louca, C. (2018). An investigation of

general dental practitioners' understanding and perceptions of minimally invasive

dentistry. British Dental Journal, Volume 225 (5), pp 420-424


Concept

Design

Literature review




Citation Metrics

Google Scholar: 3




96

Appendix 4

Fine, P., Leung, A., Francis, J., Louca, C. (2018). The Use of Picture Cards to Elicit

Postgraduate Dental Student Feedback. Dentistry Journal, Volume 6 (7),

doi:10.3390/dj6020007


Concept

Literature review

Data collection



Citation Metrics

Google Scholar: 0



106

Appendix 5

Fine, P., Leung, A., Bentall, C., Louca, C. (2018). The Impact of Confidence on Clinical

Dental Practice. European Journal of Dental Education, Volume 23, pp 159-167


Concept

Literature review



Citation Metrics

Google Scholar: 0



116

Appendix 6

Davies, B., Leung, A., Dunne, S., Dillon, J., Blum, I. (2017). Bespoke video vignettes - an

approach to enhancing reflective learning developed by dental undergraduates and

their clinical teachers. European Journal of Dental Education, Volume 21 (1), pp 33-36.


Concept

Literature review


Data collection


Data analysis


Citation Metrics

Google Scholar: 3




121

Appendix 7

Fine, P., Louca, C., & Leung, A. (2017). The Impact of a Postgraduate Learning

Experience on the Confidence of General Dental Practitioners. Dentistry Journal, Volume

5 (16). doi:10.3390/dj5020016


Concept

Literature review



Citation Metrics

Google Scholar: 0



131

Appendix 8

Davies, B., Leung, A., Dunne, S. (2013). Why do general dental practitioners become

involved in clinical teaching? A pilot study exploring the views of part-time practitioner

teachers, King's College London. British Dental Journal, Volume 214 (9), pp 461-465.


Concept

Design

Literature review


Data collection



Citation Metrics

Google Scholar: 11




137

Appendix 9

Davies, B., Leung, A., Dunne, S. (2012). So how do you see our teaching? Some

observations received from past and present students at the Maurice Wohl Dental

Centre. European Journal of Dental Education, Volume, 16 (3), pp 138-143


Concept

Design

Literature review


Data collection



Citation Metrics

Google Scholar: 18




144

Appendix 10

Davies, B., Leung, A., Dunne, S. (2009). Perceptions of a simulated general dental

practice facility - reported experiences from past students at the Maurice Wohl General

Dental Practice Centre 2001-2008. British Dental Journal, Volume 207 (8), pp 371-376


Concept

Design

Literature review


Data collection



Citation Metrics

Google Scholar: 19




151

Appendix 11: Form UPR16 Research Ethics Review Checklist

152

2. Other Publications Including Published Abstracts

1. Sybaite, J., Sharma, P., Fine, P., Blizard, R., Leung, A. (2020). The influence of

varying gingival display of maxillary anterior teeth on the perceptions of smile

aesthetics. Journal of Dentistry. Accepted for publication on 15th October 2020.

https://doi.org/10.1016/j.jdent.2020.103504

2. Shah, P., Louca, C., Patel, R., Fine, P., Blizard, R., Leung, A. (2020). Investigating

working practices of dentists on shade taking: evidence based good practice

versus observed practice. Journal of Dentistry, Volume 97 (2020), 103341.

doi:10.1016/j.jdent.2020.103341

Contribution to journal › Article

3. Tonni, I., Fine, P., Louca, P., Leung, A. (2020). Students’ perceptions of tutor

feedback, a pilot study. (IADR 1396)

Contribution to journal › Meeting abstract and oral presentation

4. Fine, P., Louca, C., Leung, A. (2020). Feedback to dental student, its significance

and importance: a pilot study. (IADR 2431)


5. Wijey, T., Leung, A., Louca, C., Suvan, J. (2019). Patient perceptions of healthy

weight promotion in dental settings. Journal of Dentistry, Volume X1 (2019),

100002. doi:10.1016/j.jjodo.2019.100002


6. Fine, P., Leung, A., Tonni, I., Louca C. (2019). Tutor feedback to enhance student

learning – a qualitative study. (IADR 0197)


7. Louca, C., Fine, P., Tonni, I., Leung, A. (2019). Tutor feedback to enhance student

learning – a quantitative study. (IADR 0198)


https://doi.org/10.1016/j.jdent.2020.103504




153

8. Kailalyapillai, G., Leung, A., Sharma, P., Croysdill, A., Fine, P. (2019). Direct or

indirect restorations: the choice is yours (IADR 1999)

Contribution to journal › Meeting abstract

9. Oxborrow, S., Leung, A., Fine, P., Suvan, J. (2019). 5As communication tool for

sugar consumption, oral health and obesity. (IADR 0220)


10. Casla-Veiga, L., Patel, R., Fine, P., Blizard, B., Leung A. (2019). Professional and

educational interest of UK dentists in social media. (IADR 3166)


11. Fine, P., Louca, C, and Leung, A. (2019). Sports dentistry principles and practice.

Chichester, West Sussex. Wiley Blackwell.

Contribution › Book

12. Fine, P., Sharma, G., Leung, A., Louca, C. (2018). Factors influencing dentistry as a

second career choice. (IADR E2033)


13. Leung, A., Shah, P., Patel, R., Louca, C., Fine P (2018). Observed practice during

shade taking. (IADR E1454)


14. Leung, A., Paul, S., Louca, C., Fine, P. (2017). Erosive tooth wear: knowledge and

awareness amongst Northern Ireland dentist (ADEE)


15. Fine, P., Gill, A., Leung, A., Louca, C. (2017). Feedback to postgraduate students:

how this facilitates the learning process. (ADEE)


16. Fine, P., Louca, C., Leung, A. (2017). Perceptions of recorded audio against

written feedback-a pilot study. (ADEE/ADEA)


154

17. Leung, A., Louca, C., Fine, P. (2017). Feedback given to postgraduate dental

students following a summative assessment. (IADR E3321)


18. Louca, C., Leung, A., Fine, P., Francis, J. (2017). The use of visual images to elicit

student feedback. (IADR E3319)


19. Karadobreva, P., Leung, A., Blizard, R., Louca, C., Suvan, J. (2017). Dental

professionals’ perceptions of sugar consumption and obesity: advice in the dental

practice. (IADR C2076)


20. Fine, P., Louca, C., Leung, A. (2017). General dental practitioners’ perceptions of

confidence following a Masters’ programme. (IADR E0196)


21. Matsakas, F., Patel, D., Leung, A., Louca, C. (2016). Evaluation of non-university

postgraduate implant training courses in the UK. (European Congress of

Osseointegration)


22. Hussein, A., Leung, A., Louca, C., Sharma, P., Blizard, R. (2016). The influence of

varying maxillary incisor shape on perceived smile aesthetics. Journal of Dentistry,

Volume 50 (2016), pp 12-20


23. Dehghanpour, M., Leung, A., Louca, C. (2016). Practitioners’ adherence to

instructions when using dental adhesives. Journal of Dental Research, Volume 95

(B), 0662

Contribution to journal › Meeting Abstract



155

24. Fine, P., Leung, A., Louca, C. (2016). A pilot study to investigate the use of

feedback in postgraduate dental education. Journal of Dental Research, Volume 95

(B), 0728


25. Louca, C., Makwana, J., Fine, P., Blizard, R., Leung, A. (2016). UK medical

practitioners’ knowledge of managing dental emergencies. Journal of Dental

Research, Volume 95 (B), 0908


26. Leung, A., Gupta, M., Patel, M., Patel, D., Louca, C., Blizard, R. (2016). Crown

finish lines by general dentists: should they be improved? Journal of Dental



27. Davies, B., Chau, K., Leung, A., Cox, M., Blum, I. (2016). Using video vignettes to

enhance dental students’ reflective learning experiences. Journal of Dental



28. Fine, P., Louca, C., Bentley, C., Leung, A. (2016). Qualitative data analysis

following a part-time master’s programme. (ADEE)


29. Leung, A., Dave, A., Louca, C., Fine, P. (2016). A survey of undergraduate

teaching of occlusion in the UK & Ireland. (ADEE)


30. Louca, C., Cunningham, S., Patel, D., Leung, A. (2016). Evaluation of flipped class

teaching in postgraduate dentistry. (ADEE)


31. Fine, P., Louca, C., Leung, A. (2016). Perceptions of recorded audio against

written feedback- a pilot study. (University College London CALT Annual

Conference)


156

32. Davies, B., Leung, A., Dunne, S., Dillon, J. (2015). Enriched reflective learning

using bespoke video clips developed by dental students and clinical teachers.

European Journal of Dental Education 19, e8-e35


33. Fine, P., Martinez, K., Leung, A., Louca, C. (2015). Dental Foundation Year 1

(DF1) graduate opinions of their undergraduate and DF1 training. European

Journal of Dental Education 19, e8-e35


34. Leung, A., Fine, P., Spyer, E., Martinez, K., Louca, C. (2015). A Two year study of

the perceptions of dental foundation year 1 graduates of their undergraduate and

dental foundation training. (ADEE)


35. Louca, C., Fine, P., Spyer, E., Martinez, K., Leung, A. (2015). Perceptions of male

and female dental foundation year 1 dentists of employment and continuing

professional development. (ADEE)


36. Louca, C., Donde, S., Leung, A., Blizard, R. (2015). Newly qualified dentists’

perceptions of amalgam restorations. Journal of Dental Research 94 (Spec Iss A)

954


37. Fine, P., Leung, A., Louca, C. (2015). Dental practitioners’ perceptions of a part

time Masters programme. Journal of Dental Research 94 (Spec Iss A) 956


38. Fine, P., Leung, A., Louca, C. (2015). Qualitative analysis of dental practitioners’

perceptions of a part time Master’s in Restorative Dentistry. Clinical Oral

Investigations, Volume 19, pp 1701–1754, 1731


157

39. Mottaleb, E., Tay, W., Louca, C., Leung, A., Blizard R (2015). Assessment of the

accuracy and repeatability of shade taking using visual and digital shade guides.

Clinical Oral Investigations, Volume 19, pp 1701–1754, 1749


40. Sutherland, J., Fine, P., Leung, A., Louca, C. (2015). An investigation of the dental

knowledge of doctors. European Journal of Dental Education, Volume 19, e8-e35


41. Louca, C., Leung, A., Patel, D., George, P. (2014). An evaluation of postgraduate

implant dentistry training in the UK. Journal of Dental Research, Volume 93

(Special Issue B) 998


42. Davies, B., Leung, A., Dunne, S., Dillon, J. (2013). Enriching learning in primary

care dentistry by sharing reflective experiences using video clips developed by

dental students and clinical teachers. 7th King’s Learning Institute Annual

Excellence in Teaching Conference Proceedings. ISBN 978-0-9576764-2-8, 5-14

Contribution to journal › Published refereed conference proceedings

43. Davies, B., Leung, A., Dunne, S. (2012). Career perceptions of part-time clinical

teachers: a damp squib or something more contentious? 6th King’s Learning

Institute Annual Excellence in Teaching Conference Proceedings. ISBN 978-0-

9576764-1-1, p44


44. Davies, B., Leung, A., Dunne, S. (2011). Relationship teaching - common sense or

just old ideas revisited- a preliminary study. 5th King’s Learning Institute Annual

Excellence in Teaching Conference Proceedings. ISBN 978-0-9558633-6-3, pp 50-58


45. Davies, B., Leung, A. (2011). Contemporary teaching of Endodontics: Some

pedagogic challenges and solutions. 5th Excellence in Teaching Conference of the

King’s Learning Institute, King’s College, University of London

Contribution to journal: Meeting abstract

158

46. Davies, B., Leung, A., Dunne, S. (2010). Relationship teaching- common sense or

just old ideas revisited- a preliminary study. 4th Excellence in Teaching Conference

of the King’s Learning Institute, King’s College, University of London

Contribution to journal: Meeting abstract

47. Leung, A. (2008). Investigating dental students’ perceptions of the experience of

four-handed dentistry in clinical learning. 2nd King’s Institute for Learning and

Teaching Conference proceedings. ISBN 978-0-9558633-1-8, pp 107-118


48. Leung, A., Davies, B., Dunne, S., Wilson, N. (2006). Extended clinical

environments in primary dental care: Aspects of close support dentistry as

perceived by undergraduate dental students at the Dental Institute of Guy’s

King’s and St Thomas’ Hospitals


49. Davies, B., Leung, A., Dunne, S. (2004). Perceptions of an undergraduate

primary dental care teaching facility as seen by recent graduates from the

Guy’s, King’s and St. Thomas’ Dental Institute.


159

3. National and International Presentations and Invited Teaching

Sessions (2011 – now)

Year &

Month

Invited by & location Details

Oct 2020 Royal College of Surgeons in Ireland

(RCSI) Faculty of Dentistry Annual

Scientific Meeting entitled

“Dentistry in the new decade”

Chair (as RCSI Dean)

July 2020 Royal College of Surgeons in Ireland

(RCSI) . International Webinar on

“Back to School in the time of

COVID-19, an international

perspective”

Chair (as RCSI Dean)

June 2020 Royal College of Surgeons (RCS) of

England: Deans’ webinar on “Health

and well-being”

Invited Speaker (as RCSI Dean)

May 2020 Royal College of Surgeons of

Edinburgh: Deans’ webinar on

“COVID-19 Aerosols and patient

safety- where are we now”


May 2020 Faculty of General Dental Practice,

RCS England: Deans’ webinar on

“Preparing the challenges ahead”


Apr 2020 Royal College of Physician and

Surgeons of Glasgow: Deans’

webinar on “Managing the

emergency dental patient during

COVID-19”


Apr 2020 Royal College of Surgeons (RCS) of

England: Deans’ webinar on

“COVID-19, Q & A with the Deans

of the Dental Faculties”


Feb 2020 Hamid Medical Corporation (HMC),

Qatar

Invited teaching sessions

including appraisal of research

projects (as RCSI Dean)

160

Nov 2019

Royal College of Surgeons in Ireland,

(RCSI), at Medical University

Bahrain (MUB)


Aug 2019 Association of Dental

Education in Europe (ADEE)

Berlin

Workshop and Poster/Oral

presentations

Jun 2019 International Association of

Dental Research (IADR) in

Vancouver

Oral and poster

presentations

Apr 2019

Hamid Medical Corporation

(HMC), Qatar


including appraisal of

research projects

Mar 2019 RCSI, Dublin Invited teaching sessions

Oct 2018 Royal College of Surgeons in

Ireland, (RCSI), at Medical

University Bahrain (MUB)


Sep 2018 RCSI, Dublin Invited teaching sessions

Aug 2018 ADEE (Oslo) Workshop and Poster/Oral

presentations

July 2018 IADR (London) Poster presentations and

session chair

May 2018 Hamid Medical Corporation

(HMC), Qatar


including mentoring of

research projects

Nov 2017 Royal College of Surgeons in





Aug 2017 ADEE (Vilnius Lithuania) Oral and poster

presentations

161

Apr 2017 Hamid Medical Corporation

(HMC), Qatar


including mentoring of

research projects

Mar 2017 IADR (San Francisco)

Poster presentations

Feb 2017 RCSI Dublin


Oct 2016 Royal College of Surgeons in




Sep 2016 RCSI Dublin Invited teaching sessions

Aug 2016 ADEE (Szeged, Hungary) Oral and poster

presentations

Jun 2016 IADR (Seoul, South Korea) Oral and poster

presentations. Session Chair

Mar 2016 Hamid Medical Corporation

(HMC), Qatar



Nov 2015 RCSI, Dublin Invited teaching sessions


May 2015 Kuwait Institute of Medical

Specialisation (KIMS),

Kuwait




May 2014 KIMS, Kuwait Invited teaching sessions


Nov 2013 RCSI, Dublin Invited teaching sessions


162

May 2013 KIMS, Kuwait Invited teaching sessions

Apr 2013 RCSI, Dublin Invited teaching sessions

Dec 2012 RCSI, Dublin Invited teaching sessions

Sep 2012 Faculty of Dentistry,

Khartoum University, Sudan


Jun 2012 King’s College London

Dental Hospital, London

Gateway to practice lectures

Feb 2012 KIMS, Kuwait Invited teaching sessions

Oct 2011 RCSI, Dublin Invited teaching sessions

Sep 2011 Faculty of Dentistry,

Khartoum University, Sudan


Jun 2011 King’s College London

Dental Hospital, London

Gateway to practice lectures

May 2011 KIMS, Kuwait


aspects of the teaching environment, student learning

Documents