Skills development in the education of Dental students: the contribution of occupational therapy and psychology
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Skills development in the education of Dental students
Skills development in the education of Dental
students: the contribution of occupational therapy
and psychology
Isabel Cristina Luck Coelho de Holanda*; Luara da Costa França**; Sandra Helena de Carvalho
Albuquerque***; Veruska Gondim Fernandes****; Sharmênia de Araújo Soares Nuto*****
* Occupational Therapist, Professor of the School of Dentistry,
University of Fortaleza
** Psychologist, Professor of the School of Dentistry, University
of Fortaleza
*** Dental surgeon, Professor of the School of Dentistry,
University of Fortaleza
**** Psychologist, Professor of the School of Dentistry, University
of Fortaleza
***** Dental surgeon, Professor of the School of Dentistry,
University of Fortaleza, Researcher of the Oswaldo Cruz
Foundation
Received April 22, 2018. Approved January 13, 2019.
ABSTRACT
This paper reports the experience of a School of Dentistry in the development of psychomotor,
cognitive, and social skills of students, based on the interprofessional collaborative practice between
the areas of dentistry, psychology and occupational therapy. It describes the diagnosis and follow-up
of the development of these skills in compulsory curricular activities (curricular units) and non-
compulsory ones (Project for Follow-up of Dentistry Technical Competencies, known as PACTO). It
was verified that, in addition to the pioneering curricular insertion of psychology and occupational
therapy in the development of skills for dental praxis, this experience renders the psychomotor,
cognitive, and social aspects of the teaching-learning process in Dentistry noticeable for teachers,
students, and the academic community.
Descriptors: Teaching. Higher education. Students, Dental.
Revista da ABENO • 19(x):40-48, 2019 – DOI: 10.30979/rev.abeno.v19i1.661
40Skills development in the education of Dental students
1 INTRODUCTION subjectivity. The notion of subjectivity
The dental practice presupposes several corresponds to the unique mode of existence of
competencies, which involve multiple each being, affecting the student’s practice6,7.
knowledge, handling, and behaviours that help When performing an action with dexterity,
the professional to perform well a given solving a situation, even if somehow complex,
function. Competencies are obtained through or achieving a certain goal, the individual makes
academic education, training and professional use of these skills1, which represent important
experience. Employing these competencies in tools, in the dental practice, that should be
practical life, that is, the "know-how", perfected in the training of those who aspire to
corresponds to what we call skill 1. professional competency.
When observing the praxis of a dental Teaching based on the development of
surgeon, the presence of psychomotor, skills articulated to the humanization movement
cognitive, and social skills appears as a priority. in health has made it essential the inclusion of
Such skills are especially developed during new topics into the academic training of
childhood - considering the significant changes prospective dental surgeons, as well as the
from birth to adolescence - but undergo improvement of innovative strategies in
transformations along the life of the subject, building competencies of professionals in
since skills improvement occurs constantly training8. Therefore, the importance of reporting
throughout their history, influenced by each the experience being developed by the
one’s particular experiences². University of Fortaleza (UNIFOR) School of
The psychomotor skill presents a Dentistry.
reciprocal and systemic relationship between This program initiated its activities in
the psychism and the motricity, since we 1995, with a traditional curricular proposal. It
understand that, from simple to more complex was only in 2005 that the integrated curriculum
activities, a great number of coordinated and materialized, in which the old subjects based on
high-precision movements is encompassed, as clinical specialties were replaced by curricular
well as the sensations (vibrations) that induce units integrated according to the patients'
behavioral responses2. The cognitive skill complexity profile8. However, the curricular
results from mechanisms of the brain that are integration did not overcome the unsatisfactory
learned at different levels, which are related to performance of the students' fine motor skills
the processes of learning, understanding and during their professional training. Such
memorization of information3. Social skills are difficulties, reported by the teachers, especially
essential and necessary elements for a in the context of practical activities, were visible
successful interpersonal relationship. Their and often misinterpreted, qualifying the student
categories4 are civility, verbal and non-verbal as awkward, immature or disinterested.
communication, assertiveness, empathic Faced with this scenario, the Dean’s
5
behavior, and behavioral flexibility . Office of the School of Dentistry started a
The sum of the psychomotor, cognitive, process of follow-up of the students, through the
and social skills domains results in the integral Project for Follow-up of Dentistry Technical
development of the subject, which is influenced Skills (known as PACTO, the Portuguese
by emotional, affective, cognitive, sensorial, acronym for “Projeto de Acompanhamento de
and behavioural aspects, constituting its Competências Técnicas de Odontologia”),
Revista da ABENO • 19(x):40-48, 2019 – DOI: 10.30979/rev.abeno.v19i1.661
41Skills development in the education of Dental students
initially with a non-compulsory curricular the compulsory curricular activities (curricular
character, in partnership with professors with units) and non-compulsory ones (PACTO),
degrees in occupational therapy and developed during the academic training with
psychology. students of several semesters.
The PACTO was launched in August
2015, starting by monitoring the pedagogical Compulsory curricular activities: diagnosis
development of dental students. As an initial and follow-up
action to structure the Project, the team that The curricular units of Introduction to
composes the PACT performed the following Dentistry, Preclinical I and Clinical
actions: (a) observation of the students' Propedeutics I carry out diagnostic activities
functional performance during training in (chart 1) and skills development (chart 2). In
laboratories and clinics; (b) listening to the the diagnosis, the students execute practices for
teachers about the difficulties in performing self-perception and the teachers observe their
procedures involving fine motor skills; (c) ability to develop the various dental skills. In
analysis of difficulties, also involving aspects of this process, the follow-up takes place through
psychomotor and relational skills. the training of the "know-how" articulated to
The PACTO non-compulsory curricular the dental praxis.
experience with students and teachers has Introduction to Dentistry takes place in
modified the way the development of skills is the first semester and, among its proposed
understood, being gradually included in the learning objectives, the student should
curricular matrix of the dental program into "develop awareness of the basic skills needed
several curricular units, since the training of an for professional performance as a dentist." For
aspiring dental surgeon is composed, for the skills development, practices of some non-
most part, by the development of techniques invasive procedures are performed in
with a set of procedures to be followed in a simulators and in their peers. Students also
sequence of actions and behaviors. participate in a psychomotor circuit. These
When researching other experiences, at activities constitute the first contact with the
the national level, related to the monitoring of dental instruments and the experience of
psychomotor, cognitive, and social skills of the postural awareness. During the activities, the
dental student, we verified the originality of the students fill in some checklists to report the
insertion of occupational therapy and degree of difficulties, while the teachers
psychology professors. observe and also describe their perceptions.
Thus, the objective of this article is to For development of skills, the Introduction to
report the experience of the UNIFOR School of Dentistry also has as one of its learning the
Dentistry in developing the student’s skills from Introduction to Dentistry objectives "to enable the
the interprofessional action between the areas of Introduction to Dentistry has as one of its learning
dentistry, psychology and occupational therapy, objectives to “qualify for the development of social
as subsidies for the teaching-learning process. skills, considering the communicational and
relational aspects". In this context, simulations such
2 EXPERIENCE REPORT as the anamnesis are carried out, when the students
This experience report involves the are asked to perform the initial interview with a
description of the interprofessional action in simulated patient.
Revista da ABENO • 19(x):40-48, 2019 – DOI: 10.30979/rev.abeno.v19i1.661
42Skills development in the education of Dental students
Chart 1. Summary of curricular units that perform diagnostic activities for development of
psychomotor, cognitive and social skills.
Areas of
Curricular
Semester Activities activity of the
unit
teachers
1st. Introduction to The profile of the dental surgeon to act in the Brazilian Dentistry
Dentistry reality Psychology
Why develop skills? Occupational
Circuit of development of psychomotor and cognitive therapy
abilities
Communication and interpersonal relationship laboratory
Simulated practices in laboratories and multidisciplinary
clinics
3rd. Preclinical I Monitoring of initial laboratory and clinical activities, Dentistry
stimulating and developing the basic skills for dental Occupational
praxis therapy
4th. Propedeutics I Monitoring of initial laboratory and clinical activities, Dentistry
stimulating and developing the basic skills for dental Occupational
praxis. therapy
All On demand Laboratory and clinical activities Dentistry
Chart 2. Summary of curricular units that develop psychomotor, cognitive, and social skills with the
involvement of teachers with degrees in the areas of occupational therapy and psychology.
Areas of
Semester Curricular unit Activities activity of the
teachers
1st. Introduction to Simulations Dentistry
Dentistry Monitoring of practical activities of skills development Psychology
Occupational
therapy
3rd. Preclinical I Monitoring of initial laboratory and clinical activities Dentistry
Occupational
therapy
3rd. Community Oral Simulations Dentistry
Health I Toothbrushing laboratory Psychology
Occupational
therapy
4th. Propedeutics I Monitoring of initial laboratory and clinical activities Dentistry
Occupational
therapy
4th. Dental Clinic I Simulations, monitoring of clinical activities, feedbacks Dentistry
Psychology
5th. Psychology of Development of communication skills, self-knowledge, Psychology
Relationship I self-control in the clinical practice
6th. Child Clinic I Simulations and feedbacks Dentistry
Psychology
7th. Psychology of Development of communication skills with child, Psychology
Relationship II adolescent and adult patients, and psychiatric patients
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43Skills development in the education of Dental students
For that, scripts are designed with the In the curricular units of Introduction to
psychological profile of simulated patients who Dentistry, Preclinical I and Clinical Propedeutics
defy the interview application, such as a I, occupational therapy is formally inserted with
transsexual patient who had a tooth fractured due the aim of developing and reinforcing the
to physical aggression perpetrated by the psychomotor skills (body awareness, spatial
companion, who is present. In face of the vision, tactile perception, manual dominance,
simulations, the students must deal with their movement precision); the cognitive skills
prejudgements, develop their emotional control (logical reasoning, executive functions -
before reactions of aggression, guilt and crying. planning, attention and memory); and the social
Following the simulation, they are given a skills (communication, behavior, decision
feedback, in which the possibilities of conduction making). In this way, the occupational therapy
and the required professional posture are professional facilitates the change or the
discussed, based on ethical-doctrinal principles improvement of factors that involve body
of the 1988 Federal Constitution9 and the Code functions and structures, and performance skills
of Ethics in Dentistry10. (motor, procedural and social interaction)1.
In the curricular units Preclinical I and The preclinical and clinical curricular units
Clinical Propedeutics I, which make up the that also develop skills with interprofessional
curricular matrix in the third and fourth follow-up are Community Oral Health I, Dental
semesters, respectively, the student's diagnosis is Clinic I, Psychology of Relationship I, Child
also elaborated in relation to the ability to Clinic I, Psychology of Relationship II (chart 2).
perform their tasks in the laboratory and in the During the curricular unit Community Oral
multidisciplinary clinic. These curricular units Health I, the 4th-semester students of the School
prepare the student for the development of skills of Dentistry should develop educational
that are essential to the initial learning of the activities in oral health with schoolchildren.
dental praxis. Among the proposed learning objectives, the
In Preclinical I, the student is faced with student should "communicate with clarity and
the first specific dental laboratory, when topics objectivity, and with cultural respect and
such as the principles of ergonomics applied to empathy in health education practices". To do so,
dentistry are approached; microbiology of dental an activity with simulated patients is proposed,
cavities and periodontal disease; prevention and representing the schoolchildren, such as a child
treatment of dental cavities and gum disease. with depressive symptoms, who is bullied by
Only in the following semester, in the curricular their colleagues for being treated for leukaemia;
unit of Clinical Propedeutics I, the practice is resisting the educational activities proposed by
actually developed in patients, by taking intra- the students.
and extra-oral radiographs, as well as their In this same curricular unit, the
interpretation for the construction of the clinical occupational therapist professor identified in the
diagnosis. Faced with the reality experienced by students limitations in supervised toothbrushing,
the students and through their observations and due to their inability to brush their own teeth. To
reports, the occupational therapist professor overcome this difficulty, the toothbrushing
identifies difficulties in performing the required laboratory was developed with the students, prior
activities, stimulating the development of initial to their practice at the schools, based on the
skills to learn the technique. contributions of occupational therapy.
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44Skills development in the education of Dental students
In Dental Clinic I, among the learning child, among other situations.
objectives are "anamnesis and physical In Psychology of Relationship II, the
examination for construction of the diagnosis". seventh semester continues to prioritize the
With that aim, the teachers with a psychology development of social skills (communication and
background are present during the clinical relationship). In this curricular unit, the focus is
procedures, monitoring the development of set on the relationship with the child, adolescent,
social skills and performing simulations, in order adult, elderly patient, and with psychiatric
to prepare the students for clinical care during the disorder. The students also receive training on
semester. The psychologists observe the student breaking bad news to cancer patients, integrating
performance during care procedures and provide horizontally with the curricular unit Clinical
feedback. Propedeutics III, in which the oral lesions are
Psychology of Relationship I, in the fifth studied. Throughout the semester, role-playing is
semester, corresponds to a practical and used as a didactic resource11, in addition to other
experiential curricular unit, in which the students psychology techniques of positive behavioural
find space to discuss the relation and the support, specifically with regard to the training of
communication with the patients, based on their social skills.
experiences in the routine of the clinic. The compulsory curricular activities are
Throughout the meetings, activities are proposed referenced by the theoretical framework of
with the objectives of developing communication occupational therapy and psychology, since the
skills, self-knowledge and self-control in the identification of behaviors and their changes are
clinical practice. Feedback and guidance on not easy tasks for the dental surgeon, whose
attitudinal, behavioral, and ethical issues are also education rarely includes observational or
provided. managerial training in behavioural sciences12.
Child Clinic I, inserted in the sixth Veerkamp et al.13 establish the specialized
semester, corresponds to the first clinic in which training to identify behaviours as a necessary
the students will provide care for children, and condition, in order to evaluate patients' reactions
one of its learning objectives is "to interact with and to perform interventions to minimize anxiety
the child and their caregivers through appropriate and improve collaborative performance. To
communication, ethical and welcoming posture, reinforce this trend in health training, it is
with the use of behaviour management strategies important to establish a bond between the dental
and approaches that favour dental care." In one surgeon and the patient for development of an
of the practices, cases are distributed among adequate treatment plan14.
groups of students and they develop simulations It is believed that it is necessary to develop
of care procedures supported by the paediatric in the student an adequate relationship with the
dentistry theoretical reference. The teacher and patient, through the improvement of
psychologist participate and evaluates the interpersonal communication techniques, being
presentations in the conduct of the cases. This able to analyse the moral and legal aspects for the
practice precedes their first appointment to attend dignified, respectful, responsible, licit and fair
to patients and deals with topics such as the professional practice, based on the principles of
patient with psychomotor agitation, hearing citizenship. The ability of the individual to
impairment, history of sexual abuse, articulate feelings, thoughts, and behaviours in
noncooperative parents/companions, bereaved order to achieve personal, cultural and situational
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45Skills development in the education of Dental students
goals is a competency acquired through social movement or the execution of the task, the
skills training4. objective is also to reduce the physical and
mental energy expenditure, as well as the time
Non-compulsory curricular activities: spent to perform an action1. Postural control,
PACTO through body awareness, also plays a role during
In addition to these curricular units, the procedures, as it is intrinsically related to sensory
PACTO receives students who were referred by and cognitive aspects2.
teachers assigned to other semesters, when they All this process is personalized, developed
identify in the student some difficulties to face-to-face, and associated with the guidelines
perform activities that require one or more basic for carrying out activities at home. It should also
skills (psychomotor, cognitive and social). be pointed out that feedback is given to the
Throughout the curricular units, the student is students participating in the Project and to the
given feedback and those who need more teachers working in these curricular units.
effective follow-up are invited to participate in What the performance achievement of the
the PACTO. Because the Project is widely student will be like during the execution of a
publicized by its participants, professors, and given task will depend on the individual basic
secretariat of the School of Dentistry, it has also skills and training of their abilities15. Therefore,
received students who wish to improve their when referring to the process of learning a skill,
basic skills. it is assumed, in the student, the existence of a
From the student's referral to the PACTO, series of components involved, such as
an assessment instrument is applied, qualified motivation, interest, perception, and awareness
individualized listening is performed, addressing of their needs.
the specific needs of the interested parties and, Learning the technique is associated with
after that, weekly individual or group meetings the understanding of handling the dental
are scheduled for occupational therapy instruments, the development of tactile
interventions, psychological listening and, when perception and proprioception awareness, as well
necessary, referrals of various orders (to as the use of pincer grasp and indirect vision,
psychological, neurological, psychiatric services, among other skills. Often, the teaching of the
physical educator, among others). technique is constructed assuming that the
The activities developed in the PACTO are manual skill is already developed, which further
not part of the mandatory curriculum accentuates the difficulty of the student15.
requirements and are held at alternative In the clinical practice, the teacher is able
moments. It provides awareness of the to identify the difficulty in some basic skill, but
difficulties presented and the possibilities of can not manage to make the diagnosis of the
cooperation and partnership between the student nature of the problem and to elaborate a skill
and the Project. development plan. Linked to this, unfortunately,
The occupational therapy follow-up is the academic routine does not allow the teachers,
carried out in the following steps: (a) along with the student, to create strategies aimed
identification of difficulties in specific skill(s) at solving difficulties or at the skills
and their origin; (b) development of the student’s development.
individual potential to perform the specific tasks Motor fitness is a set of motor skills of an
of the dental surgeon. Beyond the precision of the individual that is given by the accomplishment of
Revista da ABENO • 19(x):40-48, 2019 – DOI: 10.30979/rev.abeno.v19i1.661
46Skills development in the education of Dental students
an action, also motor, that has a specific purpose In addition to the pioneering experience of
to be achieved, and it can be subdivided into the curricular insertion of psychology and
gross or fine skills2. Gross motor skills use large occupational therapy in the development of
muscle groups and are characterized by activities skills, these experiences are believed to bring
such as running, jumping and leaping; fine skills benefits for the students, teachers, and the
are characterized by the movements of small assisted community as well.
muscles, that is, those that require motor As future indications for consolidation of
dexterity and use of minimal force, but denote the experience, these goals should be pursued: (a)
delicacy, precision, and firmness. Fine skills optimization of the continuous evaluation
involve the movements of hands and fingers, process of actions and results; (b) development
feet, face, tongue, and lips2. of the students’ and teachers’ awareness of the
Such conceptual elaborations are not part formative process in dental practice; (c)
of the routine of studies of dental teachers, so that increasing visibility of the psychomotor,
the detection of the student’s impediments occurs cognitive, and social aspects in the teaching-
in the field of perception, without a resolutive learning process in dentistry.
diagnosis coming from the theoretical analysis of
the motor skill. Therefore, the occupational RESUMO
therapy is a strategic field in the dentistry Desenvolvimento de habilidades na formação
program. de estudantes de Odontologia: a contribuição
The importance of the activities developed da Terapia Ocupacional e da Psicologia
in the PACTO is evidenced by the adhesion of Relata-se a experiência de um Curso de
Odontologia no desenvolvimento de habilidades
new students each semester. Since its
psicomotoras, cognitivas e sociais dos discentes
implementation, the number of participants has a partir da atuação interprofissional entre as áreas
seen a gradual increase. All the students and de Odontologia, Psicologia e Terapia
appointments are registered, making it possible Ocupacional. Descreve-se o diagnóstico e o
to control the dropout. Thus, during the initial acompanhamento do desenvolvimento dessas
semester, 2015.2, 21 (3%) of the students habilidades em atividades curriculares
obrigatórias (unidades curriculares) e não
enrolled at the School of Dentistry participated,
obrigatórias (Projeto de Acompanhamento de
totaling 63 appointments, whereas, in the Competências Técnicas de Odontologia –
semester 2018.2, there was a significant increase, PACTO). Verificou-se que, além do pioneirismo
with 128 (17%) of the enrolled students attending da inserção curricular da Psicologia e da Terapia
741 appointments. Ocupacional no desenvolvimento de habilidades
para a práxis odontológica, essa experiência
3 FINAL CONSIDERATIONS visibiliza aos docentes e discentes e à
comunidade acadêmica a importância dos
The teaching-learning process has an
aspectos psicomotores, cognitivos e sociais no
inseparable relationship with the psychomotor, processo de ensino-aprendizagem em
cognitive, and social aspects, which are Odontologia.
indispensable for the development of a safe Descritores: Ensino. Educação Superior.
professional practice. Learning is also backed up Estudantes de Odontologia.
by repeated, step-by-step practices that enable
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