European Journal of Dental Education ISSN 1396-5883

Communications skills in dental education: a systematic

research review
J. A. Carey1, A. Madill2 and M. Manogue1
1
Leeds Dental Institute, University of Leeds,
2
Institute of Psychological Sciences, University of Leeds, UK

Keywords Abstract
communication; skills; dental; dentistry;
education; interpersonal. Communication is an essential element of the relationship between patient and dentist.
Dental schools are required to ensure that undergraduates are adequately trained in
Correspondence communication skills yet little evidence exists to suggest what constitutes appropriate
J. A. Carey training and how competency can be assessed. This review aimed to explore the scope
Leeds Dental Institute and quality of evidence relating to communication skills training for dental students.
Clarendon Way Eleven papers fitted the inclusion criteria. The review found extensive use amongst
Leeds, LS2 9LU studies of didactic learning and clinical role-play using simulated patients. Reported
UK assessment methods focus mainly on observer evaluation of student interactions at
Tel: +44 (0)113 3437643 consultation. Patient involvement in training appears to be minimal. This review
Fax: +44 (0)113 3436165 recommends that several areas of methodology be addressed in future studies, the
e-mail: j.a.carey@leeds.ac.uk scope of research extended to include intra-operative communication, and that the role
of real patients in the development of communication skills be active rather than
Accepted: 6 April 2009
passive.
doi:10.1111/j.1600-0579.2009.00586.x

published evidence relating to methods of developing and

Introduction
Communication between patients and healthcare professionals
is a key process within the patient–clinician relationship from
the initial consultation onwards and therefore an area perceived
to be deserving of attention during undergraduate training for
dentists (1). The pool of research and guidance available in
respect of communication skills training in the broader
healthcare professions is vast yet there appears to be little
evidence relating directly to dental education. Undergraduate
dentistry programmes within the UK are regulated by The
General Dental Council which outlines the knowledge and
competencies required by dental graduates in the document,
‘The First Five Years’ (2). Key sections of this document guide
and direct training institutions in the provision of training in
communication skills, suggesting that training is an essential
aspect of undergraduate dental education.
The purpose of this review was to identify and evaluate the
recent literature relating to methods of learning, teaching, and
assessment in communication skills, specifically focussing on
the dental student population. The outcome of the review may
thus inform those responsible for development and provision
of communication skills training to dental undergraduates.
The review aimed to offer an answer to the following
question: What is the scope and quality of the recent journal
assessing competencies in communication skills amongst dental
undergraduates?
Methods
An initial informal search was performed for articles, relating
to communication skills learning and assessment, to gain an
overview of the scope of research in this area. A substantial
body of research was found to exist in a variety of aspects
of communication within a spectrum of healthcare
professions. Whilst studies involving undergraduate training
in other clinical disciplines may offer valuable findings,
clinical teaching in Dentistry was notably different to the
other healthcare professions (1). The specificity of the
question thus demanded that the review be limited to those
studies focussed on undergraduate dentistry. Hence the
inclusion and exclusion criteria, listed below, were developed
to reflect this.
Inclusion criteria
Research articles, published in peer-reviewed journals, primarily
evaluating communication skills learning/assessment methods.
Articles relating to undergraduate dental education.

Eur J Dent Educ 14 (2010) 69–78 ª 2010 The Authors. Journal compilation ª 2010 Blackwell Munksgaard 69
Communications skills in dental education
Articles available in the English Language.
Exclusion criteria
Studies not specifically relating to communication skills learn-
ing and/or assessment.
Studies not specific to dental students; i.e. generic pro-
grammes.
Studies where the sample group was mixed with other
healthcare trainees.
Studies relating to postgraduate dental education.
Articles published more than 10 years ago (to make the
review manageable).
A search for relevant literature was performed during
October 2007 using the OVID platform to jointly explore
several related databases detailed in Appendix 1. The search
process is fully outlined in Appendix 1. A search for the
term ‘communication$ skill$’ was performed using the ‘$’
symbol for truncation to ensure relevant literature was not
excluded through variation in keywords. This search yielded
a broad set of literature. A further combined set was created,
this comprising results of two searches for articles associated
with either of the keywords ‘dentist$’ or ‘dental’. These two
sets were combined using the ‘and’ function and then further
refined to only those articles including the keyword ‘stu-
dent$’. This narrowed the sample to 45 articles following
removal of duplicates.
Abstracts from these publications were then examined to
ascertain whether each approached the criteria for inclusion
in the review. This process resulted in a set of 28 journal
articles which were then examined in detail. Studies in which
communications skills were clearly a secondary issue to the
main research question were excluded. Two studies (3, 4)
examined communication skills within subjects including but
not limited to dental undergraduates and were considered
too generic for inclusion; they did not sufficiently differenti-
ate dental students from the combined sample population.
One article originating from Japan and apparently meeting
inclusion criteria (5) was excluded because an English trans-
lation was not available other than for the abstract. Ten arti-
cles were found to meet inclusion criteria. A citation search
was performed for each of these articles during December
2007 and this yielded one further paper (6) for inclusion.
Hence, a total of 11 research articles were included. These
articles are listed in Table 1.
Analysis
A content analysis of the studies was performed. Themes of
each study were recorded along with the nature and number
of participants, instruments used and selected findings (i.e.
key findings relevant to the review question). The resulting
data is presented in Table 1. In order to consistently assess
and record quality, a scoring system was developed and each
paper assessed according to the scoring criteria (shown in
Appendix 2). The average score for the included papers
was calculated for each criterion in order to rate the overall
quality of research in this area; the results of this analysis are
shown in Table 2.
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Carey et al.
Results
A total of 11 studies were examined in relation to the scoring
criteria. Table 2 shows that, in general, research in this area has
tended to clearly identify a research question and selected
appropriate participants. The main weaknesses are confounding
variables and reference to the broader literature. The main
findings of the review are summarised below.
Introduction: clarity of question(s)
The majority of studies clearly stated their research question(s)
and the questions were considered appropriate and relevant to
communication skills learning and assessment. However, only
four studies (6–9) explicitly and fully stated a research
question. Four studies (10–13) did not state a research question
although the question was implied within the introduction or
outline of methodology. The remaining three studies were
deemed to have been partially explicit in their statement of a
question (14–16).
Sample: participants
All of the studies appeared to have used an appropriate
subject group (dental undergraduates). However, only three
studies (8, 9, 11) explicitly accounted for all participants, e.g.
including teaching staff and number of simulated patients
used. Simulated patients (these being actors trained to imi-
tate patients) or the equivalent were used in seven studies
(9–11, 14–16) although description of the background of
patient simulators was not consistently stated between
articles. Five studies involved real patients (7, 8, 11–13).
Only one study (11) made use of both simulated and real
patients. None of the studies used or sufficiently described
their cohort of participants to allow further comparisons to
be drawn other than between the dental student subject
groups.
Methods: confounders/noise
The presence of confounding variables – for example variables
which may have impacted upon the validity of the conclu-
sions drawn – seemed to be a general problem amongst the
studies and this may have impacted upon the validity and/or
interpretation of the findings. Confounding variables were
considered to include factors such as modification of training
material and/or methods of assessment during the study. Four
studies (7, 11, 13, 14) were believed to have potentially signif-
icant confounders such as course modification during the
study which were not reflected upon in the report (11). How-
ever, the majority of studies were self critical, acknowledging
the main confounders and three studies (6, 8, 12) were found
to have minimal confounders with clear acknowledgment of
noise in their self-critique. None of the studies which used
real patients sought feedback from those patients, which is
somewhat surprising given the possibility that the best people
to inform students as to the acceptability of their
communication style and hence validate assessment might be
real patients themselves.
 TABLE 1. Summary of studies of dental undergraduate communications skills
Author(s)
(years, country) Themes
Broder & Janal Simulated patients
(2006, USA) Role play
Dental interview
Student evaluation
Learning & assessment
Cannick et al. Simulated patients
(2007, USA) Dental interview
Objective Structured
Clinical Examination (OSCE)
Smoking cessation
Learning & assessment
Eur J Dent Educ 14 (2010) 69–78 ª 2010 The Authors. Journal compilation ª 2010 Blackwell Munksgaard
Croft et al. Simulated patients
(2005, UK) Role play
Dental interview
Learning
Student evaluation
Gorter & Eijkman
(1997, The Real patients
Netherlands) Simulated patients
Role play
Dental interview
Learning methods
Student evaluation
71
Participants
3rd & 4th year dental students
Patient instructors (simulated
patients)
1st & 2nd year dental
students
‘Standardised patient’
‘Faculty members’
‘Reviewers’
1st, 2nd & 3rd year dental
students
Professional role players
(simulated patients)
1st, 3rd & 4th year
dental students
Psychologists experienced
in dental
education
Carey et al.
Size Instrument(s)/tool(s) Selected findings & comments
143 Learning: Students ACIR rating improved to satisfactory from
Didactic focussed an unsatisfactory
behavioural baseline but declined between learning episodes
sciences course separated by a 9 month period.
15-min role-play scenarios
Students were rated by the simulated patient
(s/p) after consultations
4? Assessment:
Students were given feedback by the s/p and
Arizona Clinical Interview
academic staff
Rating
Not clear how much the didactic course
Student evaluation
contributed vs. scenarios
questionnaire
Material changed between sessions towards
socio-cultural issues.
Students were from a wide variety of different cultures.
104 Learning: Brief training made no difference to communication skills
2-h training session with rating by s/p or to tobacco cessation counselling rating
simulated patients
Randomised controlled trial.
Assessment tools may not be assessing the correct areas.
1? Assessment:
All students had already received some training in com
? Interpersonal communication
skills via behavioural sciences teaching and tobacco
2 checklist and
cessation beforehand.
tobacco cessation counselling
Students performed an intra- and extra-oral exam.
checklist
Six checklist items were used which appeared very subjective
Videotape reviewing
180 Learning: All students felt the sessions were valuable.
Role-play scenario with 3rd year students felt the sessions were
debriefing & less valuable/enjoyable – had
role-player feedback done them in previous years
Peer observation Females rated the sessions higher than males
although m:f = 60:105
? Assessment: Students reported a lack of reality when viewed by peers
Student evaluation although generally felt the sessions were realistic/credible
questionnaire
Authors acknowledge dropouts
may have been due to learning style
>100* Learning: Student evaluation showed they highly rated the course,
Didactic practical sessions simulated patient contact, and professional relevance
4/5 Student role-play
Video reviewing real
student/patient consultations
Communications skills in dental education
72
TABLE 1. Continued.

Author(s)
(years, country) Themes Participants Size Instrument(s)/tool(s) Selected findings & comments

Simulated patients ? Assessment Students videotape their own encounters with a patient on
University Communication 1? Course evaluation questionnaire the clinic – planned in advance. Courses were
Skills teachers modified during the study
* individual student numbers are difficult to ascertain;
results are based on evaluation by years 1, 2, & 3
over a 6 year period and therefore some students
will have contributed more than once
Simulated 3rd year dental 67 Learning: Students rated their experiences highly
Hannah et al. patients students Class tuition & role plays Communication skills were rated as more
Communications skills in dental education

(2004, Role play Psychologists 2 Interview a member of the public important after the course
New Zealand) Dental interview Dental specialist 1 Case based scenarios
Learning & Simulated patients ? Review of interview in role play Authors acknowledge students not enjoying the course rated
assessment Members of public ? the value less highly
Student evaluation Dental clinician 1 Assessment: Learning style not appropriate for all students
Patient response form by s/p Acknowledges nature of feedback can affect enjoyment
Student marking by tutor Acknowledges students may have been
Student evaluation questionnaire better without peer observation

Real patients ‘Dental students’ 18 Learning: Interpersonal skills improved significantly after training
Hiler (2001, USA) Dental interview ‘Observers’ 3 35-h training course – Most effective for reducing anxiety, also for being sensitive
Non-verbal focussed on concepts of to cultural and ethnic issues
communication interpersonal communication
Real patients 18? Students were blind to when the rating would be
Learning & and identifying verbal and non-verbal
Tutor(s) (psychologist?) ? Training course is not described explicitly;
assessment manifestations of anxiety
appears to be didactic
Did not ask patients for their opinions
Assessment:
Use of global rating may have been useful
Global rating
to validate the rating scale
Rating scale
Real patients 3rd year dental 78 Learning: Students were more attentive to patient’s non-verbal behaviour,
Hottel & Hardigan Role play students Didactic focussed behavioural sciences anxiety and comfort as rated by observers
(2005, USA) Dental interview Psychology 10 course and role-play Maintaining eye contact was least improved
Learning & graduates
assessment Real patients ? Assessment: Students were unaware of when they would be observed
Clinical 1 Behavioural observation form Psychology graduates were specifically trained in an attempt
psychologist to standardise ratings
No feedback was sought from patients
Unclear if same patients used before and after training
Early patient Year 1st & 2nd dental 108 Learning: Students reported an increase in their
Ratzmann et al. contact students Early patient contact motivation and confidence and
(2007, Germany) Real patients ‘Problem oriented learning’ that the experience eased progression to clinical work
Dental interview
Learning
Student evaluation

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Carey et al.
 TABLE 1. Continued.

Author(s)
(years, country) Themes Participants size Instrument(s)/tool(s) Selected findings & comments
Carey et al.

Real patients Assessment: Communication skills learning seems to be somewhat secondary

108? Course evaluation questionnaire No feedback was sought from patients
The study evaluated the course rather than communications skills
Students gave oral hygiene instruction to patients and
explored their medical/social history

Theaker et al. Real patients 3rd year dental 43 Review of assessment tools Developed and validated an assessment tool (DCCC)
(2000, UK) Dental interview students Assessment: Tool has high inter-observer reliability in all
assessment Research assistant 1 Pilot and design of Dental areas covered except eye contact
Consultants ? Consultation Instrument was found to be acceptable and
Communications easy to use by observers
Checklist (DCCC)
Lecturers ? Tool developed by observation of real
Real patients ? patient/clinician interactions
Observers 2 Pilot used to test tool
Staff members 10 Used independent observers for rating of
communications skills
Patients did not give feedback

Van der Molen et al.
(2004,
The Netherlands)
Simulated 4th year dental 34 Learning: No significant difference on knowledge test
patients students ‘Micro skills training’ (5 · 3 h) Course effective for improving
Role play Theoretical instruction introduction skills, communication skills and
Dental interview Modelling real practice assessment of anxiety
Learning & Role play Students acquired more skills in detection
assessment Assessment: of and dealing with anxiety
MCQ MCQ on knowledge Small control group
Behavioural role play test

Eur J Dent Educ 14 (2010) 69–78 ª 2010 The Authors. Journal compilation ª 2010 Blackwell Munksgaard
Actor (simulated 1 Small control group
Video-tape assessment using
patient) Used a validated assessment tool (Theaker)
Manchester tool (DCCC)
Independent 3
Learner log
observers

Wagner et al. Simulated patients Dental students 79 Learning: Students skills improved with each rotation
(2007, USA) Role play Workshops on com skills Most improvement was noted during
Dental interview Three half day sessions with students’ first rotation
Learning & simulated patient Variable performance across rotations – the
assessment consultations best being on the final rotation
Patient instructors ? Feedback from The study used ‘several’ s/p’s, 2 or 3 sessions,
(simulated patients) patient instructor ‘PI’ spread out over 2 years
Clinical dentists ? Group debriefing Increasing levels of complexity of
Behavioural ? scenarios per rotation
scientists Assessment: Ebel standard setting was used for the interview checklist
Interview checklists Each student saw 11 patient instructors
(content & patterns of content)

*Individual student numbers are difficult to ascertain; results are based on evaluation by years 1, 2 & 3 over a 6-year period and therefore some students will have contributed more than once; ? substitutes the
Communications skills in dental education

73
number or variable when it is unknown or incompletely specified by the reviewed article..
Communications skills in dental education Carey et al.

TABLE 2. Study rating

Introduction Sample Methods Results Discussion Conclusions TOTAL

Indication
Reference of
Clarity of Confounders/ Outcome Value/ to Acknowledges future
Author(s) (year, country) question(s) Participants noise measures analysis literature limitations directions Validity Value /50

Broder & Janal (2006, USA) 31 3 3 4 4 2 3 3 4 4 33

Cannick et al. (2007, USA) 4 4 1 2 2 2 2 2 1 1 21
Croft et al. (2005, UK) 4 4 3 3 3 2 4 3 3 3 32
Gorter & Eijkman (1997, 3 5 2 1 2 3 3 2 4 3 28
Netherlands)
Hannah et al. (2004, 4 4 3 3 3 4 4 4 2 3 34
New Zealand)
Hiler, C. (2001, USA) 3 4 4 4 4 3 4 4 4 4 38
Hottel & Hardigan (2005, USA) 5 4 2 4 4 2 2 1 3 3 30
Ratzmann et al. (2007, 3 4 2 2 3 3 2 2 3 3 27
Germany)
Theaker et al. (2000, UK) 5 5 4 5 5 4 4 5 5 4 46
Van der Molen et al. (2004, 5 5 3 5 3 4 4 4 2 2 37
Netherlands)
Wagner et al. (2007, USA) 5 4 4 4 5 3 3 4 4 4 40
Mean 3.9 4.0 2.8 3.3 3.4 2.8 3.3 3.0 3.1 3.1 32.8
1
Score out of a maximum of 5.

learning and duration of learning episodes but none described

Methods: outcome measures
All of the studies explored communication at dental interview
(consultation). Only two studies involved provision of
treatment in the form of patient instruction; one (13) used oral
hygiene instruction for real patients but did not evaluate its
effect, the other (14) assessed delivery of smoking cessation
counselling but mainly by content of the advice delivered.
None of the studies specifically explored communication during
operative treatment. Control groups were used in only two
studies (9, 14). The remaining studies did not include the use
of a control group in their study design. Lack of a control
could have an impact on the accuracy of interpretation of the
study results in that it might be difficult to ascertain the
influence of interventions on the outcome measures. Cannick et
al. circumnavigated this ethical dilemma by providing the
equivalent training to the control group, as received by the
intervention group, after the study. Indeed, in this study whilst
the results from the intervention group demonstrated an
improvement in smoking-cessation counselling and
communication skills after brief training, an identical effect was
observed in the (untrained) control group. However, it must
be acknowledged that the use of a control group in educational
studies may present practical and ethical difficulties, e.g. when
resources are limited or learning material is required to be
taught in a specific order as one report (9) discussed.
Training programmes ranged between studies from a 2-h
session to 35-h courses. One study (8) focussed solely on devel-
opment of an assessment tool. The remaining studies used a
mixture of didactic behavioural sciences teaching and role play
scenarios with feedback given to the learner after the
interaction. Studies varied in the time spent on each method of
or quantified learning methods sufficiently to allow further
comparability of outcomes between studies. Only two studies
used an identical assessment tool; one study (9) used the
assessment tool developed in another (8).
The sole outcome measure in three studies was a student
evaluation questionnaire and therefore students’ acceptance and
perceived value of their communication skills training was the
only measure of viability of the learning methods used (11, 13,
15). Six studies (6, 7, 10, 12, 14, 16) used interview rating tools
which had been validated but were not dentally specific. One
study (8) actually developed and evaluated a tool specific to
communication at dental consultation – a ‘Dental Consultation
Communications Checklist’. This was further verified in
another study (9) which additionally used a Multiple Choice
Questionnaire (MCQ) to assess student knowledge. Only one
investigator used standard setting to rate the level of impor-
tance of each aspect of the assessment tool (6); this involved
patient–instructor ‘preceptors’ (faculty members) using an
Ebel-style rating (18) to determine the relative importance of
each aspect of communication assessed by the assessment tool.
A global rating, made by the assessor, was used for additional
validation of the assessment tool by two investigators (7, 12)
although this is not discussed in detail in either report.
Video-taping of students’ interactions with simulated
patients was used in several studies. One used video reviewing
of student–patient interactions to facilitate student learning
(16). Another (9) used video footage of a variety of experienced
dentists for review by students to assist their learning. Video
reviewing was used in one study to standardise assessment of
students (10); patient instructors reviewed videos of student
interactions and their assessments were compared prior with

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Carey et al.
the study. Video was used to assess student interviews in one
study (14) and three studies (6, 9, 11) used video reviewing for
both learning and assessment purposes.
Results: value/analysis
In general, the studies used appropriate analysis of results
and retrieved data of reasonable value in terms of being
informative (Table 2). Five studies (10, 11, 13, 15, 16) used
student feedback to evaluate the learning methods and stu-
dents in each of these studies highly rated their learning
experiences. One study (13) found that early patient contact
and ‘problem oriented learning’ were well received and
resulted in a subjective increase in confidence and motivation
of students; however, no control was used and no objective
evidence from assessment offered to support this. One study
(16) found that students felt communications skills were
more important after a learning episode – however, this may
be the case after any learning material is emphasised. A fur-
ther study (15) found that students reported scenarios
involving simulated patients were less realistic when observed
by their peers. Students’ interpersonal skills declined some-
what in the 9-month period between learning episodes in
one study (10). However, their skills remained above base-
line, the two learning episodes were not identical and the
scenarios assessed were more complex.
Discussion: reference to literature,
acknowledgement of limitations,
indication of future directions
All the papers at least referred to literature directly relevant to
their study question(s) although only three studies (8, 15, 16)
were deemed to have presented a more extensive review of the
wider literature. The majority of reports acknowledged key lim-
itations in their methodology although three study reports
failed to recognise several important limitations which may
have had significant impact on their findings (7, 13, 14). Whilst
all reviewed studies offered some indication of future research
direction, a well-reasoned indication of future directions and
methodology for such research was most explicitly presented in
five articles (6, 8, 9, 12, 16).
Conclusions: validity and value
Selected findings and conclusions for each article are sum-
marised in Table 1. All studies using student evaluation
report a perception by students of communication skills
learning as important. Three studies offered conclusions
which were either questionable, or for which further study
would be required, given confounding variables or a need
for revision of aspects of the methodology (9, 14, 16) and in
one of those studies (14), the findings were felt to be of
questionable value. Four studies (6, 8, 10, 12) offered con-
clusions deemed to be of high value in terms of novel prac-
tice or a relatively broad range of implications for practice
and/or future research.
There is evidence to suggest that enhancement of
communication skills amongst undergraduates may decline
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Communications skills in dental education
between learning episodes; the caveat must be added that
this observation is limited to those factors assessed in dental
schools and the tools which they use. There is no evidence
relating to frequency or accumulation of learning episodes
and retention of communication skills learning beyond
30 months.
Discussion
Most studies have involved the use of simulated patients and
evidence has been presented that students have perceived this
to be beneficial. Learning methods tend to vary in type and
duration between studies but the methods used appeared to
be similar, involving a mixture of didactic episodes and clini-
cal scenarios. The simulated patients described in this group
of studies are almost exclusively actors and are invariably
acting out scenarios devised by dental educators. It is con-
ceivable that such actors may be somewhat socialised into
relating to the student and scenario in a more artificial man-
ner than might be observed with real patients – further
research is required to investigate whether this is the case.
As the patient represents one-half of the patient and clinician
interaction, future studies might explore the use of real
patients as active rather than passive participants within den-
tal student learning and assessment in this area. Indeed
learning and assessment methods might be developed to be
dynamic such that adaptation to individual student and
patient needs is possible.
Only two studies used an assessment tool specific to dental
consultation and one of these studies (8) actually developed
the tool and this study used item-specific weighted kappa
scores to demonstrate inter-observer agreement. However,
given that the tools used to assess communication are
designed to assess dental student skill in their interaction
with patients, it is remarkable that real patient input was
not sought in any of the studies reviewed. Similarly, there
does not appear to have been any direct dental patient
involvement in development or validation of any of the tools
used. In addition, assessment appears to be limited to dental
interviewing or consultation skills and no studies have
explored interpersonal communication intra- or post-opera-
tively. Given that patients’ anxieties relate mainly to issues
during treatment (12), it is proposed that communication
between patient and dental student is potentially more
complex during treatment and is at least as important as at
consultation.
Two studies (10, 12) considered clinicians’ communicative
sensitivity to patients’ cultural background and it is reason-
able to suggest that cultural variations may influence the
interaction between clinician and patient. In addition to
broader cultural variations, there are a host of other inter-
personal variations such as accent, sex, social background,
age and status. There is some evidence to suggest that social
status influenced dental students’ perceptions of patients’
communication skills and intelligence (17). Future research
might further examine such variables in the dental under-
graduate context. Similarly, few studies truly separated
interactions into verbal and non-verbal forms with their
assessment tool. Notably, one study (12) attempted to do so
75
Communications skills in dental education
but, as with cultural sensitivity, this study relied on observer
rating rather than patient feedback.
Evidence offered from those studies which used video
reviewing for learning and assessment supported its use; it has
distinct advantages and is well received by the majority of
students. Only the student and patient need to be present for
the consultation and this might minimise the feeling of
‘unreality’ of scenarios, reported by some students, when
simultaneously observed by peers (15). Similarly, the use of
video offers an audio–visual record of interactions which might
be valuable for further analysis.
Conclusions
The research-based evidence for learning and assessment of
communications skills in Dentistry appears to be of variable
quality, albeit reasonable overall, and indicates that most
dental students are receptive to communication skills learning
and to the use of simulated patient interactions as a
pedagogic tool. The use of video-reviewing in both learning
and assessment seems to be a valuable tool for both learner
and tutor. There may be value in further clarification of
verbal and non-verbal aspects of communication between
dental student and patient. There is little evidence regarding
the influence of each on the student–patient interaction in
the dental environment. Intra-operative communication also
requires further exploration; there is no evidence relating to
differences between the patient and student interaction at
consultation and during treatment. Further research is
required to validate existing methods of learning and explore
alternative and perhaps more longitudinal methods within
dental curricula. Future studies should be also explicit in
their research question(s) and clear in their description of
participants, their background and the role and influence
they have within the study. Controls should be used where
appropriate.
A variety of learning and assessment methods have been
evaluated but these are limited in scope to an agenda set by
clinicians and seem to take a ‘one size fits all’ approach. The
involvement of real patients in the structured learning and
assessment of communication skills appears to be peripheral.
Similarly, there is no evidence relating to the patient experience
and impact of dental undergraduate communication skills
learning and assessment; the patient experience is implied. As
patients may have varying communication styles, further
research is required to ascertain the impact of communication
skills learning methods upon patient experience. Indeed, patient
experience may be of great value in helping to drive
communications skills. Outcome measures and assessment tools
in this area may be guided by patient experience and this could
be a valuable starting point for future studies where patient
input into assessment may ultimately help to guide and shape
learning.
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Appendix 1: literature retrieval methods
This search was conducted during October 2007.
OVID platform search comprising the following databases:
CINAHL (nursing)
CDSR (Cochrane)
ACP Journal Club (acp)
DARE
CCTR
EMBASE (emef)
Ovid MEDLINE(R) (medf)
Ovid MEDLINE(R) In-Process & Other Non-indexed
Citations (prem)
PsycINFO (psyf)
Carey et al. Communications skills in dental education

Search terms (keyword search):

Score Outcome measures
Set Search terms/keywords Number of results
5 Tool(s) validated, specific to dental communication skills
1 Communication$ skill$ 14 306 4 Tool(s) validated, measures appropriate
2 Dentist$ 32 983 3 Tool(s) validated, measures partially appropriate
3 Dental 130 418 2 Tool(s) not validated, measures appropriate
4 2 or 3 138 577 1 Tool(s) not validated, measures inappropriate
5 1 and 4 110 0 Entirely inappropriate
6 Student$ 403 056
7 5 and 6 57
8 Remove duplicates from 7 45 Score Value/analysis
17 clearly excluded by reference to abstract 28
5 Several key findings, good clear and valid analysis
4 One or two key findings, appropriate, valid analysis
The keyword ‘student$’ was introduced as a filter after reviewing the 3 Clear finding, appropriate and valid analysis
110 abstracts of the 5th set. The inclusion/exclusion criteria were used to 2 Results questionable/analysis poor
filter the remaining set of 28 papers into a subset of 11 strictly meeting 1 Results unclear/inappropriate analysis
the inclusion criteria. 0 No results/entirely inappropriate analysis
One article (5) was written in Japanese and English translation of the
article was only available for the abstract; this paper was hence excluded
Score Reference to literature
leaving 10 papers in the inclusion group.
The search history was saved on the OVID platform and repeated during 5 Systematic review – properly conducted
December 2007; A citation search was performed on the inclusion 4 Extensive review of relevant literature
group, yielding one further publication (6) and resulting in the inclusion 3 Brief review of wider literature
group of 11 journal articles discussed in this review. 2 Reference to related articles only
1 Reference to few articles/references not directly relevant
0 None/irrelevant
Appendix 2: scoring criteria
Score Acknowledgement of limitations
Score Clarity of question(s)
5 Fully acknowledges all limitations and impact on findings
5 All explicitly stated, clear and relevant 4 Acknowledges key limitations and impact on findings
4 Clear and relevant 3 Acknowledges few key limitations impacting on findings
3 More implied than explicit 2 Misses several key limitations impacting on findings
2 Unclear/communication is only one of several questions 1 Misses essential limitations
1 Unclear, not apparently relevant 0 None
0 Entirely absent and irrelevant

Score Indication of future directions

Score Participants
5 All participants explicitly accounted for and appropriate
4 All participants appropriate
3 Appropriate subject group
2 Subject group mixed
1 Of questionable value/relevance
0 Entirely inappropriate
5 Thorough, relevant indication of further research rationale
4 Broad discussion of future direction with methodology
3 Indication of future direction limited to outcome measure
2 Brief indication of future research based on findings
1 Brief suggestion of future research requirements
0 None

Score Validity of conclusion

Score Confounders/noise
5 Unlikely to affect outcome, all acknowledged
4 Unlikely to affect outcome, some acknowledged
3 May affect outcome but acknowledged
2 May affect outcome not acknowledged
1 Certain to affect outcome
0 Too much to make findings valid
5 Unquestionably valid
4 Clearly supported by findings
3 Apparently valid with minor flaws
2 Needs confirmation by further study
1 Validity highly questionable given limitations of study
0 Not valid based on study faults/inconclusive

Eur J Dent Educ 14 (2010) 69–78 ª 2010 The Authors. Journal compilation ª 2010 Blackwell Munksgaard 77
Communications skills in dental education Carey et al.

Score Value of conclusion

5 Wide ranging for practice/understanding/research

4 Validation of a novel area of practice
3 Novel validation of pre-existing tool
2 Re-validation of existing practice/negative result
1 Of little value
0 None

78 Eur J Dent Educ 14 (2010) 69–78 ª 2010 The Authors. Journal compilation ª 2010 Blackwell Munksgaard