Routine oral examination: clinical vignettes, a promising tool for continuing professional development?

OBJECTIVES: To develop content for an educational system for dental professionals to be used for patient-tailored evidence-based decisions regarding routine oral examinations (ROEs) and to test the model as a tool in dental education.

METHODS: Initially, an electronic database was developed comprising conclusive data of a structured literature search and 27 ROE clinical cases which were selected on predefined criteria. A RAND-modified Delphi procedure was successfully conducted with 31 multidisciplinary dental experts. Twenty-one selected risk factors for oral disease were assessed for feasibility and subsequently modelled into 19 risk based clinical vignettes, each representing a specific group of ROE-patients. Each vignette comprised all relevant clinical and non-clinical data. Expert judgements were collected including ROE-content, risk level, bitewing frequency and recall interval. Feedback regarding evidence was provided for each of the topics. A pilot with 35 experienced General Dental Practitioners (GDPs) was conducted to assess the reliability of the model for continuing professional development (CPD). Decisions made on content screening items, bitewing frequencies and recall interval were compared with expert opinions.

RESULTS: A comprehensive set of clinical vignettes was developed. Expert consensus was reached with regard to risk factors to be applied, content of ROE-items, bitewing frequency and recall interval. Differences between GDPs and experts were found especially concerning recall length in low-risk patient groups.

CONCLUSIONS: Clinical vignettes provide a promising educational instrument for CPD to improve clinical performance. Further research is needed to test the reliability of these set of 19 vignettes.