Video calibration for faculty and students to advance graduation competency: a brief report

Introduction

The competency-based education model has gained prominence in health science education as a framework for assessing students’ development in knowledge, professionalism, and clinical skills application in patient care settings (1-4). In a competency-based education model, curriculum is developed around complex behaviors essential for a dentist to perform independent, unsupervised general practice, also known as competencies (5). Learning experiences are then intentionally designed to address one or more competencies. Assessments or evaluations are then designed to show evidence of the student’s ability to perform one or more competencies independently (6). To align with institutional competency statements, assessments in the dental school clinic must be designed to evaluate the student’s ability to understand the needs of a clinical procedure or behavior, critically assess their work, and determine the next course of action (7,8). Because competency is developed over time and not just determined from a single experience, institutions must carefully develop these competency-based assessments and ensure they are aligned with their learning objectives throughout the course of the student’s dental school journey. Additionally, these assessments must also reflect the milestones mandated by the Commission on Dental Accreditation (CODA) standards (9).

The coronavirus disease 2019 (COVID-19) pandemic forced dental institutions to quickly revamp how teaching material was delivered to students, requiring flexibility and additional resources to achieve student-centered learning, even from a distance (10-14). Students during the pandemic perceived online learning as a valuable tool, making it easier for them to participate in their education, and giving them more confidence and independence in their learning (15,16). Online videos became a frequently utilized modality to deliver content to students. These videos can also have multiple functions, including faculty calibration prior to teaching laboratory or clinical procedures to ensure consistency in evaluating student performance (17). Throughout this period of trying different educational modalities to maintain safe social distancing protocols, the pandemic changed the trajectory of traditional dental education, pointing to a direction where hybrid learning formats that combine in-person learning experiences with online modes of learning have become expected (18), with video resources scaffolding student learning outside of the classroom (11,13,19).

To the authors’ knowledge, limited studies have been conducted that evaluate the effectiveness of videos improving clinical assessment outcomes in local anesthesia dental education. A study by Chen et al. investigated the effectiveness of video demonstrations of an inferior alveolar nerve block and lingual nerve block on improving students’ local anesthesia skills prior to a hands-on training session. Their findings revealed that students who viewed the video demonstrations had statistically higher performance grades compared to their other peers. Students also expressed that having the criteria presented to them in advance and clearly through these videos improved their confidence and perceived performance during the hands-on local anesthesia session (20). Other studies have yielded similar findings in other disciplines in dental education (16,21,22).

A study by Wong et al. assessed the effectiveness of instructional videos in improving a student’s psychomotor skills in delivering local anesthesia in a preclinical course. A statistically significant correlation was found between the number of video views on block injections and the student’s grade received during their summative assessment. Students found these videos useful to review on their own time, and 90% reported they viewed the videos specifically to acquire skills that needed to be done with accuracy in local anesthesia. Additionally, 80% of students stated the videos were excellent supplemental resources to the in-person presentations. While this study utilized the videos to prepare students for an objective structured clinical examination (OSCE) on manikins and not in a traditional student-to-student preclinical practice, the authors underscored the need to evaluate a student’s retention of knowledge and skills in delivering local anesthesia in an authentic clinic patient environment (23).

The objective of this study is to discuss the implementation of a video to calibrate students and dental faculty on a local anesthesia competency during patient care and evaluate the video’s effectiveness in supporting the student’s performance on the competency assessment.

Methods

Design of the local anesthesia competency

Impetus of local anesthesia competency was created at the end of 2021 and then implemented for the 2023 and 2024 graduating classes. The director of local anesthesia curriculum developed both the competency assessment and accompanying calibration video. In the local anesthesia course, students were shown various techniques and concepts through in-class presentations and clinical rotations that highlighted how to achieve safe, successful anesthesia on patients. Students were also given verbal instruction on the expectations for their local anesthesia competency assessment. The calibration video was presented in the local anesthesia course and presented again at the start of their graduating year during their clinic orientation session. Students could review the video through the online course learning management system to review at any time with a stable internet connection.

In order for a case to be eligible for the local anesthesia competency, the planned patient procedure must require the use of a regional mandibular block and be indicated for a restorative, periodontal, or endodontic procedure. A mandibular block could include the inferior alveolar nerve block, lingual nerve block, and long buccal combination, or the Gow-Gates nerve block. The grading criteria remained consistent for each competency assessment, regardless of which mandibular block procedure was performed. Procedures completed for the local anesthesia competency were performed with calibrated direct faculty supervision in the main clinic, emergency clinic, or endodontic clinic, and could occur during any clinical session throughout the quarter, so long as the competency was attempted before the designated deadlines.

Table 1 outlines the criteria utilized for the local anesthesia competency. The local anesthesia competency assesses students on ten different criteria, including assembly of armamentarium, accurate placement of topical anesthesia, acceptable delivery of anesthesia, management of patient’s pain throughout anesthesia delivery and 1 hour into the appointment, and overall patient comfort during the entire appointment. The assessment criteria were adapted from both the American Dental Education Association (ADEA) and institutional competencies (24,25).

All students of the class of 2023 and 2024 were expected to complete and pass the local anesthesia competency assessment during their senior year. Students needed a score of 70% or higher to pass the competency assessment and complete two local anesthesia competencies before the graduation deadline: one before the end of the Autumn quarter, and a final one by the end of Spring quarter of their graduating year. Since the institution runs on a quarter system, timing allowed students the opportunity to attempt/complete the first competency within Summer or Autumn, then complete the final competency within the last two quarters (Winter and Spring) before graduation. Students were advised to complete both competencies within each time frame. If a student did not get 70% or higher, the student was notified to complete and successfully pass another competency within the given deadline.

The electronic medical record system used was Axium^®, and the form to evaluate student performance would appear when procedures are ready to be approved in the system. A sample completed evaluation form can be seen in Figure 1. A single calibrated faculty member was required to evaluate the student’s performance for the competency. The calibration process of a faculty member consisted of a live, in-person presentation of the local anesthesia competency components during the quarterly faculty calibration session in the Summer quarter of 2022. Any part-time or full-time clinical faculty with a valid dental license was eligible to be calibrated for this assessment. Faculty attendance was tracked via a sign-up sheet available at the start of the live presentation. For those unable to attend in-person, the presentation was recorded, and a timeframe of 1 month was placed for faculty to view the recording and take the 10-question post-module assessment. A faculty member was considered calibrated after completing the online learning module during the institution’s quarterly faculty calibration, or after viewing the presentation online and achieving a score of 100% on the post-module assessment. Faculty members who successfully completed the calibration requirements were also granted 1 hour of continuing education credit through the institution. Faculty also had access to review the video online and take the assessment at their leisure, allowing them to complete their calibration conveniently and at any time before the deadline. After the calibration session, the video remained accessible for all calibrated faculty to use as reference for review prior to grading. Figure 2 displays how many times the video was referenced and viewed since its creation.

Figure 1 Sample form from Axium^® used to evaluate the student performance in the local anesthesia competency assessment.

Figure 2 Monthly viewership of video since its during faculty calibration.

Design and content of local anesthesia competency video

The video was designed so that the content could be utilized for both faculty and student viewers, with the intention of increasing clarity and consistency between the two groups. The total run time of the video was 3 minutes and 57 seconds. The videos consisted of slides and images with voice narration to detail the behaviors and actions the student must perform in order for their competency to be scored appropriately. The video also clearly and succinctly described what behaviors would be scored excellent (score: 5), clinically unacceptable (score: 3), or a critical error (score: 1). In addition, an explanation of how a student earns a failing score for the competency was further detailed. The deadline requirement for the two local anesthesia competencies, as described earlier, was also explained to the viewer. Figure 3 highlights which aspects of the video were most watched. Red indicates high levels of individuals viewing content from the video.

Figure 3 Hot spots (indicated in red) of video showcasing timing of most watched scenes.

Support through email reminders

Throughout the year, reminders were sent to the students’ institutional email addresses to complete the competency within the given deadline for graduation. Within the email, the video that was presented to faculty during calibration as a resource was linked for students to review.

The director of the local anesthesia curriculum generated spreadsheets from Axium^®, tracking which students successfully completed local anesthesia competency. From a frequent review of this spreadsheet, the director would then send timely reminders to the entire class. Individual students were emailed about the deadline or if the student needed to complete an additional competency because of unsuccessful previous cumulative score.

Results

The institution identified 100% completion of the local anesthesia competency for the 2023 and 2024 graduating classes (163 and 175, respectively) before the graduation deadline. There were 55 members of the main clinic faculty that were calibrated to score students. Viewership of the calibration was highest when the video was first released and just before the end of the Autumn and Spring quarters, which was the deadline for the two competencies. This suggests that students and faculty may have accessed the video for “just-in-time” preparation for a local anesthesia competency assessment. The highest viewed portion of the video discussed was between the 2:00 and 3:10 timestamps. This portion of the video reviewed specifically how the local anesthesia competency assessment was scored (see Figure 3).

Discussion

The mission for CODA states that the entity “serves the public and dental professions by developing and implementing accreditation standards that promote and monitor the continuous quality and improvement of dental education programs” (26). This commission is offered in the United States, Canada, and limited international dental programs. Accreditation gives schools guidance for function, but each school determines whether to apply competency-based or outcome-based assessments for graduation within their curriculum (4).

The local anesthesia competency discussed in this article assesses students on their knowledge, technique, patient outcomes, and pain management. Specifically, the competency evaluates the student’s ability to safely prepare the anesthesia armamentarium, observes aspiration prior to anesthesia delivery when at depth, and monitors the retraction method used during delivery. Patient comfort and satisfaction are other criteria observed by the faculty grader and are important for the student to recognize. In a study by Ebn Ahmady et al., the five dimensions included in dental school patient satisfaction surveys include quality of care, interpersonal interactions, access to care, environment, and cost. With patient-centered care as a cornerstone of many dental school clinic operations, the perceived quality, reliability, and expectations of the patient can be considered key indicators on a dental student’s overall clinical outcome (27). With this in mind, the competency rubric included patient comfort to allow the student to note that patient satisfaction and management of pain throughout appointment are critical to their education and that their own technique and knowledge are not the only things that dictate clinical success (28).

Student success meant that they must achieve a 70% cumulative score to pass the competency. Seventy percent was determined to be a measurable score as per literature, inferior alveolar nerve block injections have a high failure rate, and alternative blocks are also known to not provide 100% success (29).

When designing the calibration video, careful thought was put into ensuring its content and delivery were pertinent to both faculty and students. The value of asynchronous online dental school faculty calibration through videos can yield increased faculty confidence and preparedness when evaluating students, as well as faculty satisfaction due to the self-paced nature of online calibration, allowing faculty more flexibility in its completion (30,31). A study by Biorn et al. showed that there was no statistically significant difference in faculty knowledge retention between in-person and online calibration, suggesting that the latter can be just as effective as traditional calibration formats (32).

Student access to the same video gave clarity of what was expected of them during the local anesthesia competency. Specifically, the video reviewed what observable behaviors from the student’s performance during the procedure would lead to a successful completion of the competency, and what behaviors would be considered a critical error. Behavioral videos like these have been shown to be beneficial to dental students, shaping their clinical behaviors in a low-stakes format and guiding them towards becoming safe, novice practitioners. A study by Alvear Fa et al. found a 15% reduction in student intraoral needlestick injuries during anesthesia delivery after implementation of a video that helped students identify unsafe practices and inappropriate retraction behaviors (33). When these videos are then offered as a resource to students, they can serve as adjunctive study material that can be watched to review concepts and prepare for assessments (23,34).

Another factor considered was the timing of when competency could be completed. Studies have shown that the “testing effect” has a profound positive effect on student retention of knowledge, including clinical skill assessments (35-37). A study by Sennhenn-Kirchner et al. revealed that repeated testing of a clinical skill can have a considerable effect compared to repeated practice alone (38). With this in mind, having two assessments spaced throughout the student’s graduating year of dental school would potentially foster benefits from both the testing effect and repeated testing features of the competency.

Limitations of this study are observed as not all dental schools have similar competencies for graduation; therefore, this study shares information from a single institution. Additionally, having a single faculty member assess a competency may have invited subjectivity when grading the student, potentially skewing the data towards a higher pass rate. Additional data analysis would be ideal to review the data comprehensively. Further studies need to be carried out over time to assess the reliability of the video calibration and competency design in subsequent class years. Having similar studies in other dental institutions in the future would also allow for more data and analysis, too.

Conclusions

Through the findings of this study, it can be concluded that calibration videos that provide expectations for a graduation competency can be effective in preparing students to successfully pass the assessment. Student access to calibration videos allows for student-led, in-the-moment learning initiatives and “just in time” review before assessments that can be invaluable to their preparation. Similar videos could be created to support student completion of other clinical competency assessments prior to graduation.

Acknowledgments

The authors would like to acknowledge the clinical faculty members at the University of the Pacific, Arthur A. Dugoni School of Dentistry.

Footnote

Peer Review File: Available at https://joma.amegroups.com/article/view/10.21037/joma-25-11/prf

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://joma.amegroups.com/article/view/10.21037/joma-25-11/coif). B.A.F. serves as an unpaid editorial board member of Journal of Oral and Maxillofacial Anesthesia from October 2023 to September 2025. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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