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Original Article

Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis

Anbarasi K1orcid, Kasim Mohamed K1orcid, Phagalvarthy Vijayaraghavan2orcid, Deivanayagam Kandaswamy1orcid
Korean Journal of Medical Education 2016;28(4):333-342.
Published online: December 1, 2016

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Corresponding Author: Anbarasi K (http://orcid.org/0000-0002-7667-8112) Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai 600116, India Tel: +91.4445928600 Fax: +91.4445928643 email: anbarasi815@gmail.com
• Received: May 20, 2016   • Revised: July 30, 2016   • Accepted: September 22, 2016

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Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis
Korean J Med Educ. 2016;28(4):333-342.   Published online December 1, 2016
DOI: https://doi.org/10.3946/kjme.2016.39
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Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis
Korean J Med Educ. 2016;28(4):333-342.   Published online December 1, 2016
DOI: https://doi.org/10.3946/kjme.2016.39
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Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis
Image Image Image Image
Fig. 1. Program Plan for Complete Denture Training in Flipped Method
Fig. 2. Comparison of Number of Students Preparing Acceptable and Unacceptable Dentures among the Study (Flipped) and Control (Traditional) GroupsA total number of students who demonstrated competency by preparing acceptable dentures with no evidence of errors and dentures with minor errors that can be corrected (scored 3 and 2) and total number of students who demonstrated incompetence by preparing unacceptable dentures with major errors (scored 1) among study and control groups.
Fig. 3. Comparing the Effectiveness of Traditional and Flipped Training Method by Projecting the Percentage of Students Scored 1, 2, and 3Batches A, B, and C: Traditional training; Batches I, II, and III: Flipped training.
Fig. 4. Template for Flipped Training

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Flipped clinical training: a structured training method for undergraduates in complete denture prosthesis
Plan Action Expected outcome
Clinical learning center (phase I)
 Clinical posting Final year dental students were divided into small groups (6 or 7)
 Preliminary phase (1 wk) Revision of theoretical aspects of preclinical and clinical tasks Enable students to recognise and relate knowledge-in-use intellectual content
Resources: (1) text books, (2) handouts, (3) color atlas
 Competency assessment FA-1 (for knowledge appraisal) Objective structured practical exam (OSPE) Accountability for learning
Viva-voce
 Faculty feedback Oral feedback Assurance for knowledge (or) remedial measures
Feedback grid
 Audio-synchronised video demonstration of the procedure (20 min) Faculty-student interactive sessions Students learn at their own pace in a comfortable environment
 Audio-synchronised video display of possible errors that may occur during procedure and directions to overcome such errors (30 min) Observational learning Ability for unsupervised performance
Faculty-student interactive sessions
 Foundation phase Familiarising assessment methods: (1) checklist criterion, (2) rubrics scoring pattern Transparency in teaching-learning and assessment
 Competency assessment (FA-2) and faculty feedback Clickers Assurance for technical knowledge
Clinical training (phase II)
 Live demonstration of the procedure with minimal instruction Observational learning Learning in real environment
 Prefixed number of performance under the faculty clinician supervision Implementing the acquired knowledge and skill Minimizing the errors and maximizing the competency
Assessment
 Competency assessment Viva-voce Assurance for harmonized motor and cognitive skill (or) remedial measures
Student name:
 Name of evaluator:
Assessment period:
Assessment objective Checklist item Remarks (yes or no)
1. Complete intra oral examination Evaluation of supporting and limiting structures
2. Ability to assess the ridge type and select the impression technique (1) Normal, flabby, and sclerotic
(2) Mucostatic or mucoselective
3. Cast fabrication (1) Accuracy of anatomic details
(2) Sufficient thickness
(3) Free of voids and nodules
4. Fabrication of temporary record base (1) Adequate thickness till sulcus area
(2) Thickness of base should be uniformly 2 mm thickness in all areas except buccal slopes and crest where it should be 1 mm thick
5. Fabrication of occlusal rim (1) Acceptable height and width should be established
(2) In maxilla, center of occlusal rim should be slightly away from center of crest of residual ridge to compensate resorption pattern. In mandible center of occlusal rim should be almost on center of the ridge.
6. Jaw relation (1) Vertical jaw relation
 - Establishing proper vertical
 - Dimension without
 - Compromising esthetics
(2) Horizontal jaw relation
 - Recording centric relation
7. Articulation and teeth arrangement (1) Occlusal plane
(2) Midline
(3) Principles of teeth setting
8. Try-in and esthetics Only incisal one-third of upper anterior teeth should be visible and mandibular premolar cusp tips should be 2–3 mm below the corner of mouth during functional mouth opening
Recheck for (1) overjet–overbite, (2) smile line, (3) buccal corridor space, (4) plane of occlusion, (5) centric relation, (6) clarity of speech
9. Denture insertion (1) Verifying retention and stability
(2) Verifying the extensions in relation to limiting structure
(3) Rule out anterior and posterior open bite
(4) Checking for centric relation
10. Immediate post insertion review (after 24 hours) Checking for comfort, soreness and ulcer
Expected level component Acceptable denture Acceptable denture with minimal correction Unacceptable denture
Denture base extension Adequate extension of flanges till limiting structures Over extension of the flanges Under extension of flanges
Posterior peripheral seal and posterior palatal seal Proper peripheral seal with accurate posterior palatal seal Proper peripheral seal with inadequate posterior palatal seal Inadequate peripheral seal and poor posterior palatal seal
Jaw relation Correct centric relation and vertical dimension Minimal anterior and posterior open bite at centric relation Excessive anterior or/and posterior open bite
Altered centric relation
Aesthetics Aesthetics is satisfactory Aesthetics can be improved with modification on following errors: Unacceptable aesthetics due to:
(1) Excessive fullness due to thickened flanges (1) Inadequate room for tongue
(2) More than one-third of incisal visibility (2) Obliteration of philtrum, nasolabial fold and mentolabial sulcus
(3) Reduction in lip fullness
(4) Altered smile line
(5) Loss of buccal cortical space (dead space)
Table 1. Flipping Framework

FA: Formative assessment.

Table 2. Individual Observation Checklist for Competency-Based Assessment in Removable Complete Denture Treatment
Table 3. Rubrics Used for the Assessment of Complete Dentures

Competency scoring: a score of 1 for unacceptable dentures with major errors; a score of 2 for acceptable dentures with minor errors that do not compromise outcome; a score of 3 for acceptable dentures with no evidence of errors.

Table 1.

Table 2.

Table 3.

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