Children's Perspectives of Dental Experiences in Student Clinical Evaluations
There has been an increasing emphasis in dentistry to incorporate children's perspectives of care to improve patient services, develop prevention and promotion strategies, and inform dental education. This move is in line with patient-and family-centered care, which has become the driving focus of health care systems, replacing the paternalistic view of health provision that preceded it. Patient-and family-centered care emphasizes that the patient's health care decisions should involve them and
... recognize the role family members play in extended caregiving. Regarding children specifically, the inclusion of their perspectives in their own oral health is crucial in the upholding of children's rights, for fostering the sense of ownership within children of their own health, and for understanding various facets of dentistry throughout a patients' lifetime. Increasing the frequency of opportunities for patient feedback in health education curricula may help normalize patient-and family-centered principles throughout students' careers and serve to prepare them for being receptive to and welcoming of patient feedback. Patient feedback is gaining recognition as an important measure of patient-centered care, satisfaction, and efficacy of health programs in research, policy, and education. Despite the importance of the patient and their family's perspectives in the provision of quality dental care, there is a paucity of pediatric patient and family feedback in the education and assessment of dental students. In dental education clinical curricula, the perspective of the patient, particularly pediatric patients, is often the missing lens in student evaluations of clinical performance. It is possible to involve their perspectives ethically and effectively, but currently, there is little guidance for program directors regarding the best-practices for gathering and integrating patient feedback into the curricula, the ethical considerations of research with children, and the time and effort required to implement and analyze holistic methods of gathering children's perspectives. iii Projective methods, such as drawing, combined with traditional ones, such as verbal interviewing, are rising approaches used for exploring the perceptions of children. A handful of studies have used this combination of approaches to inquire into children's perspectives of dental treatment, but none explored the child's perspective of treatment in dental education. This thesis, therefore, proposes a framework for gathering children's perception of their dental experiences at a teaching dental clinic, and then explores how the children's feedback is related to the evaluation of student performance. The two research questions for this study are: 1) What insights into children's perspectives of dentistry can be gathered from drawings? 2) How do children's perspectives inform current dental student evaluation? Fourty-two child patients of the teaching clinic between the ages of 5 and 8 years were included in all stages of the study. For the first research question, the child participants were asked to draw all about themselves at the dentist and then to verbally explain their artwork. The drawings were analyzed using the Child Drawing: Hospital instrument to determine the child's anxiety score, while the verbal interviews were analyzed using deductive and inductive forms of thematic analysis to establish the factors which contributed to the child having a positive or a negative experience. The relationships between the children's level of anxiety and their experience and the student clinical assessment data were then analyzed using correlation analyses and binary logistic regressions. Most children in the study exhibited average levels of anxiety and had an overall positive perception of the dentist. The correlation and regression analyses determined that when children presented higher levels of anxiety, the students received statistically significant higher scores in evidenceinformed practice and their tolerance for error during procedures. No other grading criteria was related to the children's anxiety or whether their experience was positive or negative. Most notably, the students' grades on professionalism and communication did not show any iv relationship to the children's data. Although this study provided a framework for exploring children's perspectives of their experiences in teaching clinical settings, more research is needed to refine the method for student evaluation.