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Statistical analysis
The instruments emploHyed in the study were designed to ensure that a quantitative data analysis procedure would be supplemented by a qualitative data analysis procedure. This approach is described in the literature as a multi-method design approach (122). Employing the two methods in parallel ensures more comprehensive data and as a result, greater confidence in the results of the study (122).
The combined rubric (Table 26 – Chapter 5, section 5.2.2; Appendix A) was employed during steps 2 and 5 (Figure 9 – Chapter 6, section 6.2) of the implementation cycle of Phase III of the study to assess students’ base line communication skills and newly developed communication skills, respectively. The data obtained was statistically analysed to investigate and confirm the construct validity and internal consistency of the combined rubric by means of a series of factor- and item analyses according to Eigen values and Cronbach’s alpha coefficient, respectively. The series of factor- and item analyses determined which items contribute to which dimension of the rubric as well as each item’s degree of contribution (loading) to a particular dimension. Each set of items’ contribution to a particular dimension is a function of the inter-item correlation within a particular set of items. Changes in students’ interviewing skills were determined and measured by means of the Wilcoxon Rank Sum Test and the Signed Rank Test for training cycle 1 and 2 respectively. To determine the differences in students’ performance between training cycles 1 and 2, it is necessary to mention the following: Paired data, for example Rubric for training cycle 1 versus Rubric for training cycle 2 (Table 36 – Chapter 8, section 8.2.1.4) was compared by applying the non-parametric Signed Rank Test (Wilcoxon Signed Rank Test). In effect this is comparing the mean of a pre-value (training cycle 1) to the mean of a post-value (training cycle 2) in the case of training cycles. Scores on the original individual Likert score and composite Likert scores based on the individual scores, did contain many ties and were transformed as follows: to each of these scores a small random value was added in such a manner so as to preserve the ordering on the original Likert and composite Likert scales and to break the above-mentioned ties. These transformed scores were then used in the non-parametric statistical analysis (Wilcoxon Rank Sum Test) to compare independent groups for example gender (male versus female). This would in effect be comparing means (or medians) between groups. This was done to exclude the confounding effect of gender in the learning process since only one SP of one gender was used in the study. A five per cent level of significance was chosen for all statistical tests.
Qualitative data: Summary of main findings
? As a result of the factor- and item analyses employed in the study, the initial, combined rubric of relational communication skills consisting of seven dimensions (A – G) and 43 items (1 – 43), was converted into a final, adjusted rubric consisting of six dimensions (A – F) and 42 items (1 – 42).
? Male students scored higher than female students during training cycle 1 in all six dimensions of the rubric.
? For training cycle 2, female students obtained higher mean scores than male students for all the dimensions of the rubric except for Dimension: “Understanding the patient’s perspective” in which male and female students obtained equal mean scores of 2.68.
? No significant differences existed between male and female students with regard to the different dimensions of the Rubric in either the first or second cycle – except that during cycle 2, female students performed significantly better than male students in terms of Dimension: “Opening the interview.”
? Both male and female students (including the class as a whole) scored significantly higher during training cycle 2 than training cycle 1 (p < 0.0001) for all dimensions except Dimension: “Opening the interview.”
? No significant differences existed between male and female students in terms of each gender’s development in communication skills between training cycle 1 and
2. Communication skills training did not benefit a specific gender significantly more than for the other gender (p = 0.2566).
? In terms of the “patient’s” feedback, there were no significant differences between male and female students in either training cycle one or two. This finding corresponds with the SP’s feedback in terms of the Rubric.
? “Patient’s” feedback was significantly higher for training cycle 2 than for training cycle 1 with regard to male – and female students (p < 0.05 and p < 0.0001, respectively).
? Male students were significantly more “comfortable interviewing patients” compared to female students during training cycle 1 (p = 0.0051). However, no ? As a result of the factor- and item analyses employed in the study, the initial, combined rubric of relational communication skills consisting of seven dimensions (A – G) and 43 items (1 – 43), was converted into a final, adjusted rubric consisting of six dimensions (A – F) and 42 items (1 – 42).
? Male students scored higher than female students during training cycle 1 in all six dimensions of the rubric.
? For training cycle 2, female students obtained higher mean scores than male students for all the dimensions of the rubric except for Dimension: “Understanding the patient’s perspective” in which male and female students obtained equal mean scores of 2.68.
? No significant differences existed between male and female students with regard to the different dimensions of the Rubric in either the first or second cycle – except that during cycle 2, female students performed significantly better than male students in terms of Dimension: “Opening the interview.”
? Both male and female students (including the class as a whole) scored significantly higher during training cycle 2 than training cycle 1 (p < 0.0001) for all dimensions except Dimension: “Opening the interview.”
? No significant differences existed between male and female students in terms of each gender’s development in communication skills between training cycle 1 and
2. Communication skills training did not benefit a specific gender significantly more than for the other gender (p = 0.2566).
? In terms of the “patient’s” feedback, there were no significant differences between male and female students in either training cycle one or two. This finding corresponds with the SP’s feedback in terms of the Rubric.
? “Patient’s” feedback was significantly higher for training cycle 2 than for training cycle 1 with regard to male – and female students (p < 0.05 and p < 0.0001, respectively).
? Male students were significantly more “comfortable interviewing patients” compared to female students during training cycle 1 (p = 0.0051). However, no significant differences existed between male and female students with regard to the other aspects of their “experience as dentist” during training cycle 1.
? Male students rated their communication significantly more relaxed than that of female students during training cycle 1 (p = 0.0073).
? No significant differences exist between male and female students’ rating of “aspects of communication that needs further development” except that during training cycle 1, female students rated “My posture and position as ideal nonverbal behaviour” as an aspect that needed further development.
? Male students felt significantly more “comfortable” than female students during training cycle 1 (p = 0.0296).
? Male students experienced the sessions significantly more enjoyable than did female students during training cycle 1.
? Both male and female students rated their “experience as dentist” significantly higher during the second training cycle than during the first training cycle (p = 0.0219 and p = 0.0010 respectively).
? Female students also rated their “communication as dentist” significantly higher during the second training cycle as compared with the first training cycle (p < 0.0001).
? Students rated themselves higher as compared with the SP’s rating of their communication skills.
? Both male and female students rated the importance of the respective topics addressed during the lecture, as rather important – average scores for male and female students were 4.27 and 4.25, respectively.
CHAPTER 1 – BACKGROUND
1.1 Introduction
1.2 Aim of the Study
1.3 Objectives of the Study
1.4 Phases of the Study
1.5 Methodology
1.6 Structure of the Thesis
1.7 Reference Style
1.8 Conclusion
PHASE I: MACRO-ANALYSIS OF THE SOUTH AFRICAN DENTAL MARKET
CHAPTER 2 – INTERACTING FORCES INFLUENCING DENTISTRY IN SA
2.1 Introduction
2.2 The Dental Profession
2.3 The Dental Market
2.4 Dental Education in SA
2.5 Implications of the Interacting Forces
2.6 Conclusion
CHAPTER 3 – PROBLEM STATEMENT & HYPOTHESIS
3.1 Problem Statement
3.2 Hypothesis
3.3 Proposed Intervention
3.4 Envisaged Future Outcome of Proposed Intervention
3.5 Conclusion
CHAPTER 4 – SUMMARY OF THE REVIEW OF THE LITERATURE
4.1 Index
4.2 Consumerism and the Attitude of Patients
4.3 Customer Relationship Management (CRM)
4.4 Dimensions of Buyer-Seller Relationships
4.5 What is Trust?
4.6 Dimensions of Trust
4.7 Trust in the Patient-Physician Relationship
4.8 The Patient-Physician Relationship
4.9 The Therapeutic Relationship
4.10 Characteristics of Relationship-Centered Care
4.11 The Link between Communication Skills and Health Outcomes
4.12 Communication Elements as Indicators of Relationship-Centered Care
4.13 Deficiencies in Communication
4.14 Evidence that Communication Skills can Overcome Deficiencies in Doctor-Patient Communication
4.15 Interpersonal Communication Skills Teaching in United States and Canadian Dental Schools
4.16 Interpersonal Communication Skills Teaching in European Dental Schools
4.17 Teaching Communication Skills
4.18 Assessing Communication- and Interpersonal Skills
4.19 Using Standardised Patients to Teach and Evaluate Interviewing Skills
4.20 Use of Video Feedback to Enhance Communication Skills Training
4.21 Potential Major Influences on Communication
4.22 A Communication Skills Model
4.23 Conclusion
PHASE II: DENTAL EDUCATIONAL RESEARCH INTERVENTION
CHAPTER 5 – PROPOSED INTERVENTION
5.1 Introduction
5.2 Curriculum development
5.3 Conclusion
PHASE III: IMPLEMENTATION AND EVALUATION OF THE DENTAL EDUCATIONAL RESEARCH INTERVENTION THROUGH ACTION LEARNING AND -RESEARCH
CHAPTER 6 – PLANNING
6.1 Introduction
6.2 Design
6.3 Pilot Study
6.4 Conclusion
CHAPTER 7 – IMPLEMENTATION
7.1 Introduction
7.2 Subjects
7.3 Instruments
7.4 Procedures
7.5 Statistical Analysis
7.6 Conclusion
CHAPTER 8 – OBSERVATION
8.1 Introduction
8.2 Quantitative Data Analysis
8.3 Qualitative Data Analysis
8.4 Summary and Conclusion
CHAPTER 9 – REFLECTION
9.1 Introduction
9.2 Rubric: Investigation of the Construct Validity of the Combined Rubric
9.3 Rubric
9.4 “Patient’s” Feedback
9.5 “Patient’s” Feedback compared with Rubric
9.6 “Patient’s” Feedback compared with “Dentist’s” Feedback
9.7 “Dentist’s” Feedback
9.8 “Dentist’s” Feedback Compared with Rubric
9.9 “Dentist’s” Feedback in Terms of Topics Addressed
9.10 Appropriateness of Teaching Methods
9.11 Most Important Outcomes of the Study
9.12 Conclusion
IMPLICATIONS OF THE DENTAL EDUCATIONAL RESEARCH INTERVENTION
CHAPTER 10 – RE-PLANNING
10.1 Introduction
10.2 Reflection
10.3 Recommendations
10.4 Conclusion
