Factors affecting level of perceived clinical competency attainment and changes in teaching-learning approach in postgraduate orthodontic training during Covid-19 pandemic: a mixed-method study [EMBARGOED]

Abstract

The COVID-19 pandemic has undoubtedly disrupted well-established standard clinical teaching and learning. This study aimed to ascertain the effects of COVID-19 specifically on the practice and training of four clinical postgraduate orthodontic programs in Malaysia and how it affects the perceived clinical competency attainment among the PG residents themselves and from the view of their lecturers. This study was a sequential, exploratory, mixed-method study. In the quantitative phase, a cross-sectional survey was conducted among 56 respondents (34 residents and 22 lecturers) from four universities (IIUM, UM, UKM and UiTM), using the newly developed CAT-LC Scale instrument. It was designed with sixty-five (65) items and was validated for Content validation (CV) and Face validation (FV) by six (6) orthodontic experts and 10 postgraduate residents respectively. The internal consistency of the scale was examined by reliability analysis via a pilot study. The scale has three main sections that were demographic data, factors (practice, training & alternative clinical teaching) and perceived competency (self and others). Data were analyzed using descriptive indicators (frequency, percentage, median and mean). Comparison between the two groups was done using Mann-Whitney. In the qualitative phase, in-depth interviews were conducted with 10 respondents (4 residents and 6 lecturers) till saturation achieved. Data were analyzed by thematic analysis using Atlas Ti. Two good validity indices (CVI was at least 0.83, FVI was at least 0.80) and Cronbach’s alpha coefficient value of more than 0.60, suggested that the research instrument has a good internal consistency, valid and reliable. Orthodontic practice was significantly impacted by the COVID-19 with the median score of 16.50 (13.00-19.00) for residents and 18.00 (15.00-20.00) for lecturers. Postgraduate orthodontic training was also affected by the pandemic with a median score 23.00 (19.75-24.25) for residents and 23.50 (21.75-28.25) for lecturers. The alternative clinical teaching method implemented during COVID-19 was deemed effective, with median scores of 27.00 (24.75-28.00) for residents and 26.00 (24.50-27.00) for lecturers. 67.7% of the residents expressed concern that the modifications made to the curriculum due to pandemic have impacted their clinical skills. However, only 41.2% concurred that there had been a decline in the quality of the academic program. This sentiment was reflected in the residents’ self-perceived competency attainment in clinical orthodontic skills, where residents displayed confidence in the areas of examination and diagnosis, and fairly confidence in treatment planning and case management. Qualitative analysis revealed five dominant themes which were adaptation, engagement, challenges, education management and experience. In conclusion, the level of self and others’ perceived competency attainment in clinical skills of the residents were affected by the COVID-19 pandemic. However, the pragmatic approach of all universities in providing effective alternative clinical teaching methods, coupled with the fast adaptation by both residents and lecturers, gave the experience a positive one; thus, notably attenuates the pandemic’s impact on the quality of the postgraduate orthodontic programs in Malaysia