Most students need a textbook that will provide all the basic facts within a discipline and that also facilitates understanding of the subject. This textbook achieves these objectives and also provides test questions for the student to explore their level of knowledge. It is also important for students to achieve a ‘feel for the subject’ and learn communication skills.
The book is designed to provide basic information necessary to pass an undergraduate examination in restorative, paediatric and orthodontic dentistry. It also expands on the core curriculum to allow the motivated student an opportunity to pursue the subject in greater detail. The information is presented in such a way as to aid recall for examination purposes but also to facilitate understanding of the subject. Key facts are highlighted, and principles of diagnosis and management emphasised. It is hoped that the book will also be a satisfactory basis for postgraduate practice and studies.
Do not think though that this book offers a ‘syllabus’. It is impossible to draw boundaries around the scientific basis and clinical practice of dentistry. Learning is, therefore, a continuous process carried out throughout your career. This book includes all that you must know, most of what you should know and some of what you might already know.
We assume that you are working towards one or more examinations, probably in order to qualify. Our purpose is to show you how to overcome this barrier. As we feel strongly that learning is not simply for the purpose of passing examinations, the book aims to help you to pass but also to develop useful knowledge and understanding.
This introductory chapter aims to help you:
• to understand how the emphasis on self-assessment can make learning easier and more enjoyable
• to use this book to increase your understanding as well as knowledge
Each chapter begins with a brief overview of the content and a number of learning objectives are listed at the start of each subsection. The main part of the text in each chapter describes important topics in major subject areas. We have tried to provide the essential information in a logical order with explanations and links. In order to help you, we have used lists to set out frameworks and to make it easier for you to put facts in a rational sequence. Tables are used to link quite complex and more detailed information. Techniques used in various procedures are listed in boxes.
You have to be sure that you are reaching the required standards, so the final section of each chapter is there to help you to check your knowledge and understanding. The self-assessment is in the form of multiple choice questions, extended matching items questions, case histories, short notes, data interpretation, possible viva questions and picture questions. Questions are designed to integrate knowledge across different chapters and to focus on the decisions you will have to take in a given clinical situation. Detailed answers are given with reference to relevant sections of the text; the answers also contain information and explanations that you will not find elsewhere, so you have to do the assessments to get the most out of this book.
If you are using this book as part of your examination preparations, we suggest that your first task should be to map out on a sheet of paper three lists dividing the major subjects (corresponding to the chapter headings) into your strong, reasonable and weak areas. This will give you a rough outline of your revision schedule, which you must then fit in with the time available. Clearly, if your examinations are looming, you will have to be ruthless in the time allocated to your strong areas. The major subjects should be further classified into individual topics. Encouragement to store information and to test your ongoing improvement is by the use of the self-assessment sections – you must not just read passively. It is important to keep checking your current level of knowledge, both strengths and weaknesses. This should be assessed objectively – self-rating in the absence of testing can be misleading. You may consider yourself strong in a particular area whereas it is more a reflection on how much you enjoy and are stimulated by the subject. Conversely, you may be weaker in a subject than you would expect simply because the topic does not appeal to you.
It is a good idea to discuss topics and problems with colleagues/friends; the areas that you understand least well will soon become apparent when you try to explain them to someone else.
You may have wondered why an approach to learning that was so successful in secondary school does not always work at university. One of the key differences between your studies at school and your current learning task is that you are now given more responsibility for setting your own learning objectives. While your aims are undoubtedly to pass examinations, you should also aim to develop learning skills that will serve you throughout your career. That means taking full responsibility for self-directed learning. The earlier you start, the more likely you are to develop the learning skills you will need to keep up with changes in clinical practice.
We know that students learn in all sorts of different ways, and differ in their learning patterns at different stages in a given course. You may intend to do as little work as you can get away with, or you may do the least that will guarantee to get you through the examinations; however, the students who gain most are usually those who take a deep and sustained interest in the subject. It will be worth the effort to start out this way, even if good intentions flag a little towards the end.
You will also get more out of your course by participating actively. Handouts, if given, may help, but they are rarely a satisfactory substitute for your own lecture notes. Remember that timetabled teaching sessions are not the only opportunities for effective learning. It is safer to regard lectures, practicals and tutorials as a guide to the core material that you are expected to master. Greater depth and breadth to this core knowledge must be achieved by reference to more detailed texts. Well-organised departments will provide a set of learning objectives and a reading list early in the course. Many lecturers will give more detailed learning objectives, either in their handouts or verbally at the start of a lecture. If not, paragraph headings can be used as a rough guide to the teacher’s expectations. An active approach to learning does not necessarily mean being highly individualistic or overcompetitive. Many students gain a broader and deeper understanding of the subject by working in small informal groups. This may be particularly helpful when it comes to revision.
The final run up to examinations should require little more than a tying up of loose ends and a filling of learning gaps. An effective way of doing this is to work through a steady stream of self-assessment questions and to keep a daily note of points that need clearing up. In other words, concentrate on what you do not know and strengthen the links with what you already know. By this time, the value of pigeonholing factual information within a framework should be self-evident.
The discipline of learning is closely linked to preparation for examinations. Many of us opt for a process of superficial learning that is directed towards retention of facts and recall under examination conditions because full understanding is often not required. It is much better if you try to acquire a deeper knowledge and understanding, combining the necessity of passing examinations with longer-term needs, particularly with the prospect of continuing professional development after qualification.
First you need to know how you will be examined. Does the examination involve clinical assessment such as history taking and clinical examination? If you are sitting a written examination, what are the length and types of question? How many must you answer and how much choice will you have?
Now you have to choose what sources you are going to use for your learning and revision. Textbooks come in different forms. At one extreme, there is the large reference book. This type of book should be avoided at this stage of revision and only used (if at all) for reference, when answers to questions cannot be found in smaller books. At the other end of the spectrum is the condensed ‘lecture note’ format, which often relies heavily on lists. Facts of this nature on their own are difficult to remember if they are not supported by understanding. In the middle of the range are the medium-sized textbooks. These are often valuable irrespective of whether you are approaching final university examinations or the first part of professional examinations. Our advice is to choose one of the several medium-sized books on offer on the basis of which you find the most readable. The best approach is to combine your lecture notes, textbooks (appropriate to the level of study) and past examination papers as a framework for your preparation.
Armed with information about the format of the examinations, a rough syllabus, your own lecture notes and some books that you feel comfortable in using, your next step is to map out the time available for preparation. You must be realistic, allow time for breaks and work steadily, not cramming. If you do attempt to cram, you have to realise that only a certain amount of information can be retained in your short-term memory. Cramming simply retains facts. If the examination requires understanding, you will undoubtedly have problems.
It is often a good idea to begin by outlining the topics to be covered and then attempting to summarise your knowledge about each in note form. In this way, your existing knowledge will be activated and any gaps will become apparent. Self-assessment also helps to determine the time to be allocated to each subject for examination preparation. If you are consistently scoring excellent marks in a particular subject, it is not very effective to spend a lot of time trying to achieve the ‘perfect’ mark.
In an essay, it is many times easier to obtain the first 50% of the marks than the last. You should also try to decide on the amount of time to assign to each subject based on the likelihood of it appearing in the examination.
Most multiple choice questions test recall of information. The aim is to gain the maximum marks from what you can remember. The common form consists of a stem with several different phrases that complete the statement. Each statement is to be considered in isolation from the rest and you have to decide whether it is ‘True’ or ‘False’. There is no need for ‘Trues’ and ‘Falses’ to balance out for statements based on the same stem; they may all be ‘True’ or all ‘False’. The stem must be read with great care and, if it is long with several lines of text or data, you should try and summarise it by extracting the essential elements. Make sure you look out for the ‘little’ words in the stem such as only, rarely, usually, never and always. Negatives such as not, unusual and unsuccessful often cause marks to be lost. May occur has entirely different connotations to characteristic. The latter generally indicates a feature that is normally observed, the absence of which would represent an exception to a general rule, e.g. regular elections are a characteristic of a democratic society. Regular (if dubious) elections may occur in a dictatorship but they are not characteristic.
Remember to check the marking method before starting. Some still employ a negative system in which marks are lost for incorrect answers. The temptation is to adopt a cautious approach answering a relatively small number of questions. This can lead to problems, however, as we all make simple mistakes or even disagree vehemently with the answer favoured by the examiner! Caution may lead you to answer too few questions to pass after the marks have been deducted for incorrect answers.
The extended matching items questions are becoming more popular for dental assessments and lend themselves well to clinical dental situations. You are usually presented with an overarching theme for the question set and then a list of 10–15 options from which you have to choose your answers. There is then a short lead-in statement followed by the stems; a set of questions, often clinical vignettes, for which you are asked to select, in your opinion, the one best response from the aforementioned list. For example, the list may be causes of dental pain (NUG, reversible pulpitis, irreversible pulpitis and so on), and the clinical vignettes describe signs and symptoms for which there is ONE BEST ANSWER to select from the list. Occasionally, you may be asked to select two answers from the list or more than one answer may be appropriate for the one question. As with any type of assessment, it is crucial that you read the instructions for the question before attempting to answer so that you know exactly what you are being asked to do. EMIs are notoriously time-consuming and difficult to write and are usually as challenging for the examiners to write as they are for the candidates to answer! One of the more common pitfalls when writing these questions is for the list of potential options to comprise heterogeneous, unrelated items, for example five causes of dental pain, three partial denture components, two drugs used for sedation and two periodontal diagnoses. If the vignette is based on dental sedation then you only have to choose from the two drugs rather than the other options that are simply irrelevant. These questions tend not to be negatively marked so you would then have a 50–50 chance of being right should you need to guess!
Essays are not negatively marked. Relevant facts will receive marks as will a logical development of the argument or theme. Conversely, good marks will not be obtained for an essay that is a set of unconnected statements. Length matters little if there is no cohesion. Relevant graphs and diagrams should also be included but must be properly labelled.
Most people are aware of the need to ‘plan’ their answer yet few do this. Make sure that what you put in your plan is relevant to the question asked, as irrelevant material is, at best, a waste of valuable time and, at worst, causes the examiner to doubt your understanding. It is especially important in an examination based on essays that time is managed and all questions are given equal weight, unless guided otherwise in the instructions. A brilliant answer in one essay will not compensate for not attempting another because of time. Nobody can get more than 100% (usually 70–80%, tops) on a single answer! It may even be useful to begin with the questions about which you feel you have least to say so that any time left over can be safely devoted to your areas of strength at the end.
Short notes are not negatively marked. The system is usually for a ‘marking template’ to be devised that gives a mark(s) for each important fact (also called criterion marking). Nothing is gained for style or superfluous information. The aim is to set out your knowledge in an ordered, concise manner. The major faults of students are, first, devoting too much time to a single question thereby neglecting the rest, and, second, not limiting their answer to the question asked. For example, in a question about the treatment of periodontal disease, all facts about periodontal disease should not be listed, only those relevant to its treatment.
Pattern recognition is the first step in a picture quiz. This should be coupled with a systematic approach looking for, and listing, abnormalities. For example, the general appearance of the facial skeleton as well as the local appearance of the individual bones and any soft tissue shadows can be examined in any radiograph. Make an attempt to describe what you see even if you are in doubt. Use any additional statements or data that accompany the radiographs as they will give a clue to the answer required.
A more sophisticated form of examination question is an evolving case history with information being presented sequentially; you are asked to give a response at each stage. They are constructed so that a wrong response in the first part of the question still means that you can obtain marks from the subsequent parts. Patient management problems are designed to test the recall and application of knowledge through an understanding of the principles involved. You should always give answers unless the instructions indicate the presence of negative marking.
The viva or oral examination can be a nerve-wracking experience. You are normally faced with two examiners (perhaps including an external examiner) who may react with irritation, boredom or indifference to what you say. You should try and strike a balance between saying too little and too much. It is important to try not to go off the topic. Aim to keep your answers short and to the point. It is worthwhile pausing for a few seconds to collect your thoughts before launching into an answer. Do not be afraid to say ‘I don’t know’; most examiners will want to change tack to see what you do know.
In some centres, oral examinations are only offered to candidates who have either distinguished themselves or who are in danger of failing. Interviews for the two types of candidate vary considerably. In the ‘distinction’ setting, the examiner may try to discover what the candidate does not know and may also be looking for evidence of knowledge of the current literature. A small number of topics will usually be considered in depth. In the pass/fail setting, the examiner will try to cover many topics, often quite superficially. She/he will try to establish whether the candidate did badly in the written examination because of ignorance in just a couple of areas, or whether ignorance is wide ranging.
Remember also that the examiners may have your written paper in front of them; if you have done particularly badly in one topic, they may well take this up in the oral examination. This is not an attempt to be unpleasant, but a chance for you to redeem yourself somewhat, so be prepared.