Page 70 - Demo

Chapter 468requirements ‘to ensure clinical competence’ are a traditional mystery (Chambers 2012). Currently, a competency based approach is recommended (Cowpe et al.2010) and requirements for graduation are given in a list of competencies instead of fixed numbers of treatments; no recommendations are made on the appropriate number of root canal treatments (European Society of Endodontology 2013). For ethical reasons and patient safety, the students must already be competent when they start performing root canal treatment on patients. At this point, the students are supposed to have reached a maintenance stage of learning, and the number of additional root canal treatments to be performed on patients in order to further improve performance is not achievable during undergraduate education (Chambers 2012). The value of performing root canal treatments on patients during undergraduate education might actually be to transition from competent to self-efficacious, rather than increasing the level of competence. Self-efficacy increases due to positive experiences, but it decreases due to negative ones, particularly if they occur early in the course of events when no or only little positive experience has gained (Bandura 1977). Both retreatments and root canal treatments in molars were negatively associated with self-efficacy. Such treatments can be regarded as ‘difficult’ (Tanalp et al. 2013, Murray & Chandler 2014, Davey et al. 2015) and may evoke a negative experience to the student (Tanalp et al. 2013). It is debatable whether undergraduate students should be introduced to difficult cases at all (Tanalp et al. 2013). One might conclude that, to increase self-efficacy, students should perform as many root canal treatments as possible, but not too difficult ones. Interestingly, most participants of the present study did request more difficult root canal treatments on patients. It is important for students to be aware of the boundaries of their capabilities (Cowpe et al. 2010, European Society of Endodontology 2013) and having experience with more difficult cases might make them more aware of the reality of handling such cases (Murray & Chandler 2014). Although students might want to push those boundaries to acquire advanced competences in Endodontics (Tanalp et al. 2013, Murray & Chandler 2014, Baaij & Özok 2018a), patient safety should always be the prime concern. One of the participants of the standard programme at ACTA commented: 'I learned a lot from the supervising endodontist in the emergency clinic. If I cannot handle a case myself, I will refer the patient to an endodontist’. The Dutch Endodontic Treatment Index and Endodontic Treatment Classification are used by students and general practitioners in the Netherlands to assess difficulty; cases that are regarded too difficult are referred to an endodontist (Ree et al. 2003). Annemarie Baaij.indd 68 28-06-2023 12:26