Standardized patient interactions improve dental student confidence following procedural errors

Irreversible errors happen in the field of dentistry every day and it can be extremely challenging for a young dentist to not only critically think and process the situation, but also to then manage the situation in a professional humanistic manner. Ideally, dental students would develop the humanistic skills to manage difficult patient interactions while in training. However, it is likely that many students will not experience the clinical scenario of a wrong site error for an irreversible procedure while in school. Unfortunately, wrong site extraction is one of the most common malpractice claims, with studies finding it makes up 15% of all claims.1 This means that a dentist will likely encounter this situation for the first time without the supportive environment of faculty providing immediate guidance. Simulation allows unskilled providers to practice skills in rare, difficult, or potentially harmful situations in supportive environments. Simulation with standardized patients (SPs) involves a trained actor in a case scenario where a student can develop interview skills, and exam skills, and improve their bedside manner.2, 3 With the support of the medical school clinical simulation center, a patient case scenario was developed in which the incorrect tooth was extracted and the students had to disclose that they committed a procedural error. The actors were trained to: get upset/raise their voices, ask for an explanation as to how the mistake happened, and request a solution to the problem. Then, over two afternoons, all 106 students in the 3rd year class participated in the simulation in blocks of seven students interacting with seven SPs concurrently for 15 min. The students were presented with a door note (Figure 1) and then proceeded into a 15-min encounter. A small group debrief (Figure 2) led by Oral Maxillofacial Surgery faculty occurred immediately after the interactions. Institutional Review Board exemption was obtained for this study (HSC-DB-23-0957). This innovative clinical simulation enhanced the students’ education. Data from the pre- and post-interaction surveys demonstrated that the students had improved confidence and comfort in regards to interacting with, apologizing to, and offering a resolution to an angry patient on whom an irreversible procedural error was made (Figure 3). The medical school simulation center was integral in developing the patient case, their team provided sample templates of patient encounters in other disciplines. Additionally, the center provided video recordings of each student and patient encounter which were reviewed by students post-session allowing them to self-assess and gain more perspective on managing patients. There were two afternoons for all 106 students to have their interaction. When constructing the timeline for each afternoon, dedicated time for SPs to give feedback to the students was not scheduled. Some students who finished early got to discuss the interaction with the SP and found it extremely beneficial to their learning. Future sessions will need to be scheduled such that there is dedicated time for SP feedback. Overall, this was a highly successful program with 96.8% of student respondents to the post-survey indicating the simulation should be repeated next year. Thank you to the University of Texas Health Science Center School of Dentistry Dean's Small Grant for funding this project. The authors thank Shadi Qaddoura, Marcy Hamburger, and Stephen Shewmake of the Surgical & Clinical Skills Center, Office of Educational Programs at UTHealth McGovern Medical School.