Self-assessed preparedness of final-year dental students and dental interns in Poland: a multi-institutional study

Abstract

Background

Dental education requires the mastery of theoretical knowledge, practical skills and social competence to provide patients with appropriate medical care. Our cross-sectional study aimed to assess the self-reported preparedness of final-year dental students and dental interns at all ten dental universities in Poland.

Methods

We used the validated questionnaire “Dental Undergraduates Preparedness Assessment Scale” (DU-PAS), which consisted of 50 items divided into two sections: section A (24 items associated with clinical manual skills) and section B (26 items related to cognitive and behavioural features). The online survey was addressed to final-year dental students and dental interns (recent graduates) from all Polish universities. Depending on the academic centre, the Google link was disseminated via year groups in social media and/or emails.

Results

In our survey, 1281 respondents participated, including 739 students and 542 interns. The overall response rate was 71.6%. Most participants were females (75.1%). For most evaluated aspects, the increase in their mastery was significant for interns compared to students. Most interviewees declared independence in collecting a complete medical history and conducting a dental examination, as well as effective removal of caries and conservative reconstruction of teeth with aesthetic materials. However, they also most often had no experience in undertaking bitewing radiographs and providing prosthetic crowns. Students and interns did not significantly differ in their confidence in the application of evidence-based dentistry and interpretation of research findings for clinical practice, as well as their approach to treating children and the inappropriate behaviour of their colleagues. On the other hand, both groups assessed their preparedness to refer patients with suspected oral cancers the worst. Moreover, significant differences were observed in DU-PAS scores regarding gender and education stage. Males and interns scored significantly higher self-esteem overall, as well as separately in manual skills and social competencies.

Conclusions

Our study provides the first detailed evaluation of final-year dental students and interns in Poland, highlighting areas for improvement and guiding educational reforms to enhance future dentists’ independence. Despite some areas needing significant changes in the academic approach, a considerable proportion of assessed procedures demonstrated satisfactory outcomes.

Introduction

Dentistry is a medical field that requires a harmonious integration of manual skills, theoretical knowledge, and practical experience [1]. Each of these components plays a pivotal role in ensuring that dental professionals would deliver high-quality care to their patients. While manual dexterity is crucial for executing precise procedures, theoretic clinical knowledge provides the foundation for accurate diagnosis and treatment planning. Additionally, the experience sharpens clinical judgment, refines technical skills, and enhances the ability to manage complex cases effectively [2, 3].

Dental schools are responsible for providing education for young undergraduate dentists. Manual skills are obtained by preclinical training, during which students practice techniques in a simulated environment before transitioning into real-life patient care. However, manual proficiency alone is thought to be insufficient, and in numerous cases, applying theoretical knowledge is critical for appropriate decision-making in clinical settings [4].

Directive 205/36/EC of the European Parliament states that dental students must complete at least five years of full-time training and follow a curriculum designed to ensure they are competent to practice dentistry. However, in some countries like France, Italy, and Romania, the undergraduate dental program is extended to six years [5]. Dental training in Poland consists of ten semesters of education for five years. The first two years of dental education consist of theoretical and preclinical training. Clinical training that includes patient care usually begins after the fourth semester and lasts for the remaining six semesters. This training includes Restorative Dentistry, Paediatric Dentistry, Endodontics, Prosthodontics, Orthodontics, Dental Surgery, Maxillofacial Surgery and Periodontics [6].

Having finished the course, newly graduated dentists, by the law of the European Union, are allowed to begin their practice; however, in Poland, the graduates are obligated to complete a mandatory year of postgraduate internship and pass the Medical-Dental Final Examination in order to receive a full dental license [5, 7, 8]. A dental postgraduate internship in Poland bridges academic training and professional practice, allowing dental graduates to enhance their clinical skills under the supervision of an experienced dentist while managing real-world scenarios. During this period, graduates encounter diverse clinical cases, develop decision-making abilities, and integrate feedback from preceptors into their practice whilst following a strict internship program. For the postgraduate internship, graduates are employed in facilities that provide training in various fields of dentistry. Additionally, the Regional Medical Chamber is responsible for delivering lectures on topics such as medical ethics, medical law, and patient communication [7]. Having finished the postgraduate internship, graduates receive the full dental license required to freely practice dentistry in Poland; however, they can continue their training through the non-mandatory residency training [9]. Polish dental specialties are similar to those in the rest of the world with various differences depending to the compared countries [10, 11].

Today, dental education is offered at ten Polish universities: Medical University of Bialystok, Jagiellonian University Medical College in Cracow, Medical University of Gdansk, Medical University of Silesia in Katowice, Medical University of Lodz, Medical University of Lublin, Poznan University of Medical Sciences, Pomeranian Medical University in Szczecin, Medical University of Warsaw and Wroclaw Medical University [12]. While all these universities adhere to general standards for teaching dentistry established by the Polish legislators and the European Parliament [5, 6], the individual curriculums may differ between institutions.

To evaluate whether the dental education system adequately prepares students for future dental practice, conducting studies assessing students’ and interns’ confidence within the field is essential. By evaluating their performance, dental undergraduates could reflect on their skills and knowledge and also address weaknesses [13]. A previously conducted survey by Rajan et al. has proven that Australian dental students reported high self-assessed confidence in physical examination of patients, establishing a diagnosis and conducting procedures of preventative care (fissure sealants, preventive resin restoration, scaling and polishing), caries management, restorative care in anterior and posterior teeth and periodontal diseases management. Lower self-assessed confidence was observed in more complex procedures such as managing medical emergencies, oral oncology and pathology, oral surgery, prosthodontics, orthodontics, and paediatric dentistry [14]. Ghaemi-Amiri et al. have shown that dental schools in Iran should enhance students’ clinical competence by promoting stronger relationships with instructors, expanding hands-on clinical training, and encouraging greater interest in the field [15].

A questionnaire study by Baaij et al. on the self-assessment on endodontic treatment showed students’ confidence increased with the number of completed root canal treatments; however, retreatments of previously treated canals and root canal treatments in distal teeth were negatively associated with confidence and effectiveness [16]. Also, their self-efficacy in endodontics increased within the first year after graduation [17]. A similar study was conducted by Davey et al., in which 49% of the participants expressed a lack of confidence in performing a root canal treatment on single-rooted teeth, whilst 74% expressed difficulty with root canal treatment on multirooted teeth [18].

Therefore, this study focuses on the self-assessment practices of dental students and graduates during their postgraduate internships in Bialystok, Cracow, Gdansk, Katowice, Lodz, Lublin, Poznan, Szczecin, Warsaw and Wroclaw. It explores future dentists’ perception of their own eligibility to work as independent dental professionals and their competency to choose judicious treatments for particular conditions, considering patients’ overall health status. The investigation is crucial for shaping dental education policies and ensuring that graduates are appropriately prepared to meet the demands of their profession [19].

Materials and methods

Survey participants

Representatives from all academic dental centres in the country were invited by originators from Poznan University of Medical Sciences to participate in the study, and all of them accepted the invitations: Medical University of Bialystok, Medical University of Gdansk, Medical University of Silesia (Katowice), Jagiellonian University– Medical College (Cracow), Medical University of Lublin, Medical University of Lodz, Pomeranian Medical University (Szczecin), Medical University of Warsaw and Wroclaw Medical University. The survey was addressed to final-year dental students and dental interns (recent graduates).

Questionnaire form and dissemination

The validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) [14], with 50 items divided into two sections, was used as a questionnaire. Section A consists of 24 items associated with clinical manual skills whose mastery levels are measured on a three-point scale: 0– no experience, 1– with help and 2– independently. Section B has 26 items related to cognitive and behavioural features, measured on a similar three-point scale: 0– no experience, 1– mostly and 2– always. The cumulative score is 100 points.

The form was prepared in its original English version and made available online as a Google form. Polish dental students are required to achieve a B2 + level of English, including specialist language. The link to the form was sent to all academic centres in Poland by the Poznan coordinator (K.N.). Depending on the centre, the link was disseminated via year groups in social media and/or emails.

In the form, the purpose and scope of the study were explained to the participants. They were informed about the necessity of expressing consent to participate in the survey with the possibility of withdrawal at any of its stages. Participation in the study was voluntary. The form was active from June to mid-August 2024, so this represents the very end of undergraduate studies and the end of the internship. Participants received reminders every 3 weeks.

The survey results were anonymous without the possibility of identifying individual respondents. Outside the DU-PAS questionnaire, participants only indicated their gender, academic centre, and status (student/intern). The collected database is available only to the research team. As a survey study, it did not require the opinion of the bioethics committee in Poland (Poznan University of Medical Sciences Bioethics Committee decision no. KB-455/24 of June 19, 2024).

Sample size calculation

The overall population of final-year students and recent graduates was 1,790 (from all 10 Polish dental universities). Assuming a 99% confidence interval and a 5% margin of error, the acceptable number of respondents is 485. This minimal sample size was calculated using the Raosoft calculator (http://www.raosoft.com/samplesize.html).

Statistical analysis

The distribution of responses to the DU-PAS questionnaire was compared using Pearson’s Chi-squared test. On the other hand, the answers converted into points were compared using the corresponding nonparametric tests– in the case of two groups using the Mann-Whitney test.

Reliability analyses of the overall questionnaire and both sections were based on internal consistency using Cronbach’s alpha coefficient.

The statistical analysis was performed using Statistica Software, version 13.3 (StatSoft, Cracow, Poland). The level of statistical significance was set at α = 0.05.

Results

Characteristics of respondents

One thousand two hundred eighty-one respondents, including 739 students and 542 interns, participated in the survey. The overall response rate was 71.6%– for students, 80.0% and for interns, 64.1%. Most respondents were females, corresponding to the gender ratio in dentistry in our country (3 F:1 M). Table 1 presents the demographic data with the number of participants from each academic centre. For the reliability of the questionnaire, Cronbach’s alpha was 0.92 (for sections A– 0.85 and B– 0.90).

Table 1.

Characteristics of respondents (n = 1281)

	n	%
Gender
female	962	75.1
male	319	24.9
Education
students	739	57.7
interns	542	42.3

Comparisons of clinical manual skills (DU-PAS section A) between students and interns

The distribution of responses in terms of manual skills by final-year students and interns is shown in Table 2. For most assessed skills, the increase in their mastery was significant for interns compared to students. Out of 24 available skills, only in 4 of them, more than 85% of students declared independence. They involved collecting a complete medical history (92.96%) and conducting a dental examination (85.39%), as well as effective removal of caries (85.39%) and conservative reconstruction of teeth with aesthetic materials (87.01%). For interns, a level of independence above 85% was obtained for nearly half of the tested skills. The students’ mastery of the previous four skills mentioned increased significantly to a percentage above 91%. Other skills that increased significantly among dental interns include prescribing and interpreting dental radiographs (88.93% and 85.98%), performing root canal treatment on single-rooted teeth (85.24%), performing non-surgical tooth extractions (86.16%), as well as obtaining informed consent to the proposed procedure and conducting comprehensive treatment in the appropriate order (87.45% and 85.42%). On the other hand, nearly half of the respondents in both groups had no experience in applying amalgam fillings. A significant percentage (above 20%) also had no experience in undertaking bitewing radiographs and providing prosthetic crowns.

Table 2.

Detailed percentage results for section A of DU-PAS with the comparison between final-year students and interns

	students			interns
I am able to:	no experience	with help	independently	no experience	with help	independently	p-value
obtain a complete medical history from my patients	1.76	5.28	92.96	1.11	4.43	94.46	0.489
undertake a comprehensive, clinical oral examination	1.76	12.85	85.39	0.74	7.75	91.51	0.003*
prescribe appropriate dental radiographs	1.49	19.48	79.03	1.48	9.59	88.93	< 0.001*
undertake periapical radiographs	14.88	33.70	51.42	9.78	25.46	64.76	< 0.001*
undertake bitewing radiographs	26.93	29.36	43.71	21.03	31.92	47.05	0.053
interpret common findings on dental radiographs	2.17	24.90	72.93	0.74	13.28	85.98	< 0.001*
assess the treatment needs of patients requiring orthodontics	9.88	45.33	44.79	7.75	38.38	53.87	0.005*
formulate a comprehensive treatment plan which addresses all treatment needs of my patients	4.06	47.36	48.58	1.48	35.05	63.47	< 0.001*
provide a range of treatment options to my patients based on their individual circumstances	3.52	38.29	58.19	1.85	31.18	66.97	0.003*
explain the merits and demerits of various treatment options to my patients	2.30	23.00	74.70	0.74	15.31	83.95	< 0.001*
obtain a valid consent from my patients prior to undertaking any treatment	2.30	19.08	78.62	0.74	11.81	87.45	< 0.001*
carry out patients’ treatment sessions in an appropriate order	1.62	25.58	72.80	2.58	12.00	85.42	< 0.001*
prescribe drugs to my patients appropriately	15.16	48.44	36.40	4.98	36.90	58.12	< 0.001*
administer inferior dental nerve blocks effectively	6.09	24.90	69.01	2.77	12.91	84.32	< 0.001*
perform non-surgical periodontal treatment using appropriate methods	3.52	20.30	76.18	2.58	16.24	81.18	0.098
remove dental caries effectively	1.08	13.53	85.39	1.48	6.08	92.44	< 0.001*
restore teeth with tooth-coloured fillings appropriately	2.17	10.83	87.01	2.21	4.99	92.80	< 0.001*
restore teeth with amalgam fillings appropriately	45.74	15.42	38.84	47.97	9.04	42.99	0.003*
perform endodontic treatment on single rooted teeth appropriately	4.46	29.50	66.04	3.14	11.62	85.24	< 0.001*
perform endodontic treatment on multi rooted teeth appropriately	13.94	54.40	31.66	7.20	46.12	46.68	< 0.001*
provide crowns using principles of tooth preservation	28.82	43.44	27.74	30.44	39.67	29.89	0.398
provide mechanically sound cast partial dentures	10.69	55.62	33.69	13.84	47.23	38.93	0.010*
provide mechanically sound/safe and functioning full dentures	8.93	53.45	37.62	10.89	49.81	39.30	0.325
undertake non-surgical tooth extractions appropriately	1.49	26.93	71.58	2.40	11.44	86.16	< 0.001*

*significant differences for Pearson’s Chi-squared test

Comparisons of cognitive and behavioural features (DU-PAS section B) between students and interns

Table 3 presents the distribution of responses regarding cognitive and behavioural competencies. Interns were not significantly different in terms of their confidence in the application of evidence-based dentistry and interpretation of research findings for clinical practice, as well as their approach to treating children and the inappropriate behaviour of their colleagues. The highest-rated competencies among students included protecting patient privacy (68.20%) and maintaining professional relationships with the patients (66.04%), as well as being aware of continuous professional development (67.79%) and proper communication with colleagues (66.42%). Similarly, in interns, the same four social features were assessed highest with significant percentage increases in self-esteem (74.91%, 76.20%, 76.57% and 77.68%, respectively). On the other hand, both groups evaluated their preparedness to refer patients with suspected oral cancers the worst, although there was a significant increase in interns.

Table 3.

Detailed percentage results for section B of DU-PAS with the comparison between final-year students and interns

	students			interns
	no experience	mostly	always	no experience	mostly	always	p-value
I feel I can manage peoples’ expectations of their treatment	3.38	69.15	27.47	0.73	57.20	42.07	< 0.001*
I feel able to motivate my patients to encourage self-care for their dental needs	1.62	46.96	51.42	1.11	37.08	61.81	0.001*
I recognise my personal limitations in clinical practice	1.76	40.73	57.51	1.48	29.89	68.63	< 0.001*
I feel comfortable asking for help from supervisor or colleague if needed	2.57	44.11	53.32	2.77	29.52	67.71	< 0.001*
I am able to refer patients with complex treatment needs appropriately	4.46	38.71	56.83	1.85	33.02	65.13	0.002*
I feel confident referring patients with suspected oral cancer	28.82	43.85	27.33	21.96	42.80	35.24	0.002*
I reflect on my clinical practice in order to address my learning needs	5.41	43.71	50.88	2.03	39.11	58.86	< 0.001*
I have sufficient knowledge of scientific principles which underpin/support my dental practice	6.50	57.91	35.59	5.35	50.74	43.91	0.010*
I am confident to evaluate new dental materials and products using an evidence-based approach	14.48	43.30	42.22	12.18	41.33	46.49	0.245
I am confident to interpret the results of research which may influence my practice	9.47	46.96	43.57	9.59	47.05	43.36	0.996
I use an evidence-informed approach in my clinical practice	7.17	40.87	51.96	4.05	36.72	59.23	0.008*
I feel I can manage to communicate effectively with my patients	1.76	38.84	59.40	1.85	29.89	68.26	0.004*
I provide opportunities for my patients to express their expectations from dental treatment	4.06	34.64	61.30	1.48	31.36	67.16	0.008*
I feel confident to address barriers for effective communication with patients appropriately	4.46	47.77	47.77	4.43	39.30	56.27	0.009*
I feel confident to communicate potential risks of operative procedures to patients	4.74	39.78	55.48	1.48	32.10	66.42	< 0.001*
I feel confident to communicate appropriately with my colleagues	1.48	32.10	66.42	2.40	19.92	77.68	< 0.001*
I feel confident managing anxious patients with appropriate behavioural techniques	9.20	51.69	39.11	2.77	54.06	43.17	< 0.001*
I am able to manage the behaviour of children to enable appropriate dental treatment	8.80	55.48	35.72	6.09	58.67	35.24	0.167
I am able to fulfil my responsibilities as an effective member of the dental team	3.38	44.66	51.96	4.24	32.84	62.92	< 0.001*
I maintain accurate records of my clinical notes	5.95	40.87	53.18	5.35	34.69	59.96	0.053
I am able to work within the constraints of clinical appointment schedules	8.25	50.34	41.41	2.77	43.91	53.32	< 0.001*
I take responsibility for my continuing professional development	3.25	28.96	67.79	1.48	21.95	76.57	0.001*
I am aware of my legal responsibilities as a dental professional	2.71	36.94	60.35	2.03	26.20	71.77	< 0.001*
I restrict my relations with my patients to a professional level	3.51	30.45	66.04	1.48	22.32	76.20	< 0.001*
I feel able to raise concerns about inappropriate behaviour of my colleagues	16.91	40.87	42.22	17.53	37.64	44.83	0.500
I take appropriate measures to protect patient confidentiality	3.38	28.42	68.20	1.48	23.61	74.91	0.010*

*significant differences for Pearson’s Chi-squared test

Comparisons of DU-PAS summary scores

Moreover, considering the comparisons of the DU-PAS summary scores, significant differences were found in terms of gender, stage of education and university (Table 4). Males scored significantly higher overall, as well as separately in self-assessment of manual skills and social competencies. Similarly, dental interns reported significantly higher self-esteem overall and in both separate sections.

Table 4.

Comparisons of DU-PAS scores by gender and education stage

	Section A		Section B		Overall
	Median	IQR	Median	IQR	Median	IQR
Gender
female	38	33–43	39	31–47	76	66–88
male	40	34–44	41	33–48	81	69–90
p-value	0.037*		0.040*		0.007*
Education
students	37	32–43	39	30–46	74	64–87
interns	41	35–45	42	33–48	81	69–91
p-value	< 0.001*		< 0.001*		< 0.001*

*significant differences for Mann-Whithey test

Discussion

This study investigates the preparedness of participants for independent clinical practice, highlighting their strengths and weaknesses while proposing recommendations to improve undergraduate dental education in Poland. The DU-PAS scale, a comprehensive tool, was employed to assess preparedness in key clinical skills, scientific knowledge, and affective attributes such as communication, professionalism, and evidence-based practice. Significantly, this study is the first to provide a detailed evaluation of final-year dental students and interns in Poland, offering insights into areas needing improvement and guiding potential educational reforms.

Respondents’ overall level of preparedness in our study was reported as a median. Among students, the median score was 74, while for interns, it was 81. Compared to other studies reporting means, our results are higher than those documented in Pakistan for final-year students (mean score 61.10 [20], and 65.60 [21]), and comparable to those from the United Kingdom (mean score 74.00) [22] and Oman (74.6) [23]. However, they are lower than the scores reported in Saudi Arabia (mean score 80.63 ± 12.13 [24], and 79.08 ± 12.15 [25]), Malaysia (79.56) [26], and Turkiye (75.68 ± 12.49) [27].

Interestingly, the study from Oman carried out during the height of the COVID-19 crisis indicated a preparedness level of 74.6% among final-year students, notwithstanding the difficulties introduced by the pandemic [23]. Similarly, data from Malaysia during the pandemic (74.2 ± 14.7) [28] also showed comparable preparedness levels. However, findings from Pakistan during the same period revealed a lower overall preparedness (61.10) [20]. In our study, the COVID-19 pandemic likely influenced the results in both groups (students and interns) since the respondents experienced significant pandemic-related restrictions during their studies. This issue was also highlighted by Pandarathodiyil et al. [28], who noted that the pandemic compelled dental schools to shift predominantly to online teaching strategies, such as case-based learning and virtual simulations, to make up for the reduced clinical hours [29, 30]. Despite these adjustments, online learning was unable to fully substitute for practical clinical training, raising notable concerns among both students and educators about meeting the essential requirements for academic progression and graduation.

The interns in our study demonstrated an adequate level of preparedness, with a median score of 81, which was higher than that of students. However, Polish interns scored slightly lower compared to the mean score for interns in Saudi Arabia (83.87 ± 14.42) [24]. It is noteworthy that the sample sizes in our study, compared to other referenced studies, included a significantly larger number of subjects.

Our findings suggest a solid overall preparedness among participants, as evidenced by the independence demonstrated in more than half of the 24 evaluated skills by 85% of interns. Among students, independence was observed in only four skills at this level. This discrepancy highlights the critical role of hands-on, practical training in fostering confidence among respondents. During internships, there is a heightened emphasis on applying knowledge in practical contexts, which may explain the observed differences.

The response rates to the questionnaire in our study were satisfactory, with 71.6% for students and 80% for interns, resulting in a total participation rate of 1281 out of 1790 eligible respondents. These rates compare favourably to those reported in similar studies from other countries - in our study, the response rate achieved is higher than those reported in studies conducted in Malaysia [28], which observed an overall response rate of 30.6% (combined for students and interns), and Saudi Arabia [24], which reported a combined response rate of 60.3%. However, in the latter study, the response rate differed significantly between groups, with students achieving 74.9% and interns only 45.4%. Comparable results to our findings among students were observed in a study from Pakistan [21], which reported a response rate of 72%. In contrast, higher response rates were noted in Malaysia (83.05%) [26] and Saudi Arabia (92.15%) [25].

Clinical manual skills (DU-PAS section A) in students

Polish dental students reported feeling well-prepared in collecting a complete medical history (92.96%) and conducting dental examinations (85.39%), as well as in effectively removing caries (85.39%) and restoring teeth conservatively with aesthetic materials (87.01%). These findings align with similar studies conducted in other countries. For instance, in Malaysia, the ability to effectively remove dental caries was among the highest-rated skills, with comparable scores of 86.3% [28] and 86.9% [26]. Higher results were reported in Saudi Arabia, with scores of 91.5% [25] and 91.2% [24].

The ability to obtain medical histories was less frequently reported by Malaysian students (83.2%) [28] than Polish students. However, Malaysian students demonstrated the highest independence in restoring teeth with tooth-coloured fillings, scoring 87.6% [28], comparable to the Polish cohort (87.01%). Similarly, in the United Kingdom, restoring teeth with aesthetic materials was among the skills students felt most prepared for [22].

In Oman, over 80% of final-year dental students demonstrated the capacity to independently perform comprehensive clinical oral examinations and accurately interpret a variety of radiographic modalities. Notably, this study was conducted during the COVID-19 pandemic, which may have significantly impacted the findings. While clinical procedures necessitating direct patient interaction were likely curtailed due to pandemic-related restrictions, the interpretation of radiographs may have been feasible through remote or simulated environments without patient presence. The authors posited that students’ confidence in these fundamental skills was attributable to prior clinical training in pre-pandemic years, during which they engaged extensively in these procedures under close supervision. In contrast, during the same period, Malaysian students exhibited lower levels of preparedness in conducting comprehensive clinical oral examinations (72.4%) and interpreting radiographs (71.2%) [28]. However, their performance in these domains was still relatively satisfactory.

In the current study, Polish students demonstrated superior proficiency in conducting dental examinations (85.39%) compared to prescribing appropriate radiographs (79.03%). Similarly, a survey conducted in the United Kingdom [22] reported that students displayed greater confidence in performing initial patient assessments but were less assured in tasks related to prescribing and interpreting dental radiographs.

The ability to administer inferior dental nerve blocks was one of the highest-rated skills among Saudi students, with scores of 87.7% [24] and 91.5% [25]. Turkish and British students also rated their preparedness in this procedure highly. However, Polish students reported a lower score (69.01%), suggesting a potential need for Polish dental schools to enhance training in this area, given the significant difference from other countries.

Polish dental students demonstrated some gaps in their clinical preparedness. Nearly half of the respondents in both groups reported no experience applying amalgam fillings. In comparison, approximately 18.1% of students in Saudi Arabia [25] also reported a lack of experience in this procedure, making it the second most commonly cited skill deficit in their study, with the most common being the ability to provide mechanically sound, safe, and functional full dentures (23.4%). Similarly, a survey by Javed et al. [24] conducted in Saudi Arabia found that the highest percentage of respondents reporting no experience, at 24.9%, was related to applying amalgam fillings, a result encompassing both students and interns. This trend may be attributed to the declining emphasis on amalgam fillings in modern dentistry, where resin-based composites (RBCs) have replaced mainly amalgam as a restorative material. Consequently, Polish dental schools have significantly reduced or entirely eliminated clinical training in applying amalgam fillings, leading to limited student proficiency in this area.

Additionally, a substantial proportion of Polish students (over 20%) lacked experience in undertaking bitewing radiographs and providing prosthetic crowns. The proportion of respondents with no expertise in bitewing radiography in the present study is considerably lower than the 66.9% reported in a study from Pakistan [21] but similar to findings from Turkiye, where 21.3% of students reported no experience [27]. However, this percentage is higher compared to Saudi Arabia, where only 1.3% [24] and 4.3% [25] of students reported a lack of experience in this area. Interestingly, Malaysian students excelled in this domain, with 89.8% demonstrating independence in performing bitewing radiographs [26].

Both Malaysian studies also reported high levels of student independence in performing non-surgical periodontal treatment using appropriate methods, with 83.0% in the survey by Pandarathodiyil et al. [28] and 89.3% in another one by Yudin et al. [26]. In contrast, only 76.18% of Polish students in the present study reported independence in this skill, indicating a comparatively lower level of preparedness in periodontal procedures. This situation may result from limited patient awareness about the importance of periodontal care in Poland, which may reduce the number of cases available for student practice, hindering the development of practical skills. Furthermore, periodontal procedures are technically demanding, precise instrumentation techniques which may be challenging to fully develop within the constraints of preclinical training. This is compounded by the relatively lower emphasis placed on periodontics compared to other specialties, such as restorative dentistry or endodontics, further restricting clinical exposure and confidence-building opportunities.

Prosthodontic procedures demand high precision and carry significant operator responsibility. Furthermore, the limited duration of preclinical training, combined with the need for individualized supervision– particularly in cases involving fixed prosthodontics– presents additional challenges to developing confidence in performing such treatments. The irreversible nature of procedures, such as tooth preparation for fixed prostheses, the necessity for meticulous accuracy, and the involvement of external contributors like dental technicians reduce the operator’s full control over the treatment process, potentially affecting the final outcome. Similar findings have been reported in previous studies, underscoring this as a persistent challenge in dental education [31–35]. In research conducted by Javed et al. [24] in Saudi Arabia, the lowest scores for preparedness were recorded for clinical prosthodontic procedures. Our study corroborates these results, as Polish students frequently reported requiring assistance with prosthodontic procedures, including providing mechanically sound cast partial dentures (55.62%) and full dentures (53.45%). These tasks also exhibited the lowest levels of independent performance, falling below 40%. As anticipated, providing crowns using principles of tooth preservation proved more challenging for students. This procedure exhibited the lowest level of independent performance among the prosthodontic procedures included in DU-PAS section A, with only 27.74% achieving independence.

Other procedures for which Polish students indicated significant reliance on supervision included performing endodontic treatment on multi-rooted teeth (54.40%), appropriately prescribing medications (48.44%), formulating comprehensive treatment plans addressing all patient needs (47.36%), and assessing treatment needs in orthodontics (45.33%). Notably, orthodontic training in Poland focuses primarily on the clinical diagnosis of malocclusions rather than on developing treatment plans, which might explain the relatively low confidence in this area. This aligns with the findings by Javed et al. [24], who noted that low confidence in assessing orthodontic treatment needs among undergraduate dental students is frequently highlighted in the literature. A recent scoping review [36] emphasised substantial variations in orthodontic curricula worldwide. As the primary role of general dentists in orthodontics involves recognising orthodontic issues and referring patients to specialists, it is crucial for undergraduate curricula to emphasise the development of skills necessary for assessing orthodontic treatment needs [37, 38]. Similarly, a study in Oman by Nalawade et al. [23] revealed that only 41.4% of students felt confident in evaluating orthodontic treatment needs, reflecting the global inconsistency in orthodontic curricula, learning objectives, teaching content, and assessment methods [39].

Polish students reported low confidence in their ability to prescribe medications, a finding that aligns with data from Turkiye [27]. The practice of prescribing medications such as analgesics, antimicrobials, and various locally applied treatments is integral to clinical dentistry, highlighting the need for comprehensive training in this area. Despite its importance, deficiencies in prescribing skills among dental and medical students are well-documented in the literature [40–42]. This issue may stem from the fact that pharmacology is often taught early in dental education as part of the basic sciences, typically by medical faculty. As a result, students may struggle to connect this theoretical knowledge to clinical applications, particularly during their clinical training years [43]. Therefore, dental educators should consider adopting innovative teaching approaches to enhance students’ ability to prescribe medications effectively in clinical practice.

In our study, students reported significantly lower confidence in performing endodontic treatment on multi-rooted teeth (31.66% independently) compared to single-rooted teeth (66.04% independently). Similar trends have been observed in other studies, such as Mat Yudin et al. [26] in Malaysia, where the percentages were higher for both single-rooted (82.4%) and multi-rooted teeth (44.1%). Conversely, research conducted in the UK [22] revealed comparable confidence levels for single-rooted teeth (76.6%) but a strikingly lower rate for multi-rooted teeth (8.1%). Additionally, in the UK study, performing endodontic treatment on multi-rooted teeth was identified as the second most commonly reported procedure with no experience (51.6%), following the undertaking of bitewing radiographs (66.9%). Similarly, findings from Turkiye [27] indicated unsatisfactory confidence levels in endodontic procedures, prompting researchers to highlight this as a significant concern. In Saudi Arabia, Javed et al. [24] reported that 45% of students and interns required assistance with multi-rooted endodontic procedures, while Almahdi et al. [25] found that around 40% of students expressed similar difficulties. These results underscore students’ widespread challenges in mastering endodontic treatments for multi-rooted teeth.

The limited clinical exposure and the intricate, multi-step nature of endodontic procedures, particularly for multi-rooted teeth, contribute to these difficulties. Factors such as complex root anatomy, restricted procedural access, challenges in rubber dam application, and technical requirements for radiography and canal preparation are well-documented barriers [20, 26, 44–46]. However, the comparatively higher proficiency in single-rooted endodontics, as observed in certain studies [47], indicates that structured guidance and progressive clinical experience can enhance student competence. To address these challenges, targeted strategies should be implemented, including increased clinical hours dedicated to autonomous practice [48], expanded use of simulated learning environments, and structured instruction in advanced diagnostic and therapeutic technologies [47, 49]. These approaches aim to bolster student confidence and proficiency in executing complex endodontic procedures, ultimately bridging the gap between theoretical knowledge and practical application.

It is noteworthy that a significant portion of Polish dental students (≥ 75%) reported feeling prepared to work independently in only 7 out of 24 areas in the DU-PAS Section A. This could be attributed to overly extensive curricula that encompass technically advanced fields of dentistry (e.g., prosthodontics), where acquiring confidence and proficiency may require more time. Additionally, the low scores may reflect limitations in available equipment and a smaller number of patients seeking treatment in specialties other than restorative or pediatric dentistry. Furthermore, the low salaries of academic staff increasingly discourage young dentists from staying in academia, contributing to a shortage of clinical instructors. This, in turn, may negatively impact the quality of students’ practical education.

Clinical manual skills (DU-PAS section A) in interns

For most of the assessed skills, interns demonstrated a significant improvement in mastery compared to students. While fewer than 85% of students reported independence in 20 out of 24 evaluated skills, interns achieved independence levels above 85% in nearly half of these competencies. Skills that showed particularly notable improvement among interns included prescribing and interpreting dental radiographs (88.93% and 85.98%, respectively), performing root canal treatments on single-rooted teeth (85.24%), conducting non-surgical tooth extractions (86.16%), obtaining informed consent for proposed procedures (87.45%), and executing comprehensive treatment plans in the correct sequence (85.42%).

The structured framework of the one-year internship in Poland, which includes specific rotations in various dental specialities, likely contributed to these improvements. A significant portion of the internship is allocated to oral surgery, conservative dentistry, and endodontics, potentially explaining the enhanced independence observed in these domains compared to students.

Similar findings were reported in a study conducted in Malaysia by Pandarathodiyil et al. [28], even during the COVID-19 pandemic. The authors noted a consistent increase in interns’ independence across all assessed skills compared to students. They attributed this improvement to the continual application of theoretical knowledge in clinical practice, emphasising that clinical competence naturally develops when theoretical concepts are consistently translated into practical skills. This was particularly evident in procedures such as tooth crown preparations and administering inferior dental nerve blocks, where interns demonstrated greater confidence and comfort.

However, despite these advancements, interns in our study, like students, faced challenges in prosthodontic procedures, particularly in providing prosthetic crowns. This is likely the result of issues previously mentioned regarding students (irreversible procedures, lack of preparedness, and high operator stress). Additionally, a significant lack of experience was observed in applying amalgam fillings (47.97%) and performing bitewing radiographs (21.03%). Nevertheless, each of these skills showed measurable improvement among interns compared to students, highlighting the progressive nature of skill acquisition during the internship period. The internship plays a crucial role in bridging the skills gap.

Cognitive and behavioural features (DU-PAS section B) in students

The highest-rated cognitive and behavioural competencies (section B of DU-PAS) among students included protecting patient privacy (68.20%) and maintaining professional relationships with the patients (66.04%), as well as being aware of continuous professional development (67.79%) and proper communication with colleagues (66.42%).

Similar findings were reported in other studies, such as those conducted in Malaysia [26]. While the aforementioned skills and proficiencies often reflect individual characteristics of the respondents (such as the ability to maintain professional relationships with patients and effective communication with colleagues), the high ratings for protecting patient privacy and awareness of continuous professional development may indicate thorough training in data protection and a clear understanding of the distinctive nature of dental education. Moreover, these results highlight the emphasis placed on fostering an awareness of the need for lifelong learning within the profession.

The results of our study indicate that while a significant majority of Polish dental students demonstrated strong communication skills with colleagues, raising concerns about inappropriate behaviour among peers posed a notable challenge. This observation aligns with findings from studies conducted in the United Kingdom [22] and Pakistan [21]. For instance, Ali et al. [22] reported that students were generally confident in routine communication with patients and colleagues. However, addressing communication barriers and reporting inappropriate behaviours were areas of lower confidence. These deficiencies may stem from limited exposure to real-world clinical scenarios, suggesting the potential benefits of incorporating simulated scenarios to enhance student experience and confidence in these professional competencies.

Another critical concern identified in our study relates to preparedness for referring patients with suspected oral cancers. In our cohort, 28.82% of students reported no experience in this area, while only 27.33% felt adequately prepared. These findings are consistent with global reports highlighting similar deficiencies among dental students [21, 22, 50]. For example, Javed et al. [20] noted that despite Pakistan’s high incidence of oral cancer, students there frequently reported inadequate preparation for recognising and referring suspected cases, a problem attributed to inconsistent teaching and limited clinical exposure to oral cancer patients. Studies from the United Kingdom, Malaysia, and Saudi Arabia have also reported analogous shortcomings in this domain [20, 23, 27].

The lack of clinical exposure to oral cancer patients and insufficient structured training in specialist settings appear to be common barriers to developing these critical competencies. For instance, Javed et al. [24] emphasised that structured clinical placements in oral and maxillofacial surgery, alongside case-based discussions and problem-solving sessions, could bridge these gaps and bolster confidence [20]. Similarly, Altan et al. [27] underlined the importance of incorporating hands-on experience in specialist clinics to familiarise students with diagnosing, managing, and referring oral cancer cases.

A significant number of students in our study reported difficulties in managing patients’ expectations regarding their treatment. This issue has been consistently identified as one of the primary weaknesses among dental students in previous studies [21, 22, 25, 26, 28]. These findings highlight a recurring challenge in dental education, emphasising the need for enhanced training to equip students with the skills required to address and align patient expectations with realistic treatment outcomes effectively.

A notable area of concern, consistently highlighted in numerous studies, involves the ability of students to evaluate new dental materials and products using an evidence-based approach [20, 24]. In our study, students demonstrated similar outcomes, with over 40% reporting they “mostly” or “always” utilised such an approach. These results are not alarmingly low, but they suggest a lack of confidence in adopting emerging techniques and materials in dentistry.

Exposure to advanced techniques and an independent pursuit of evidence-based knowledge often begins after graduation. Clinical practice post-graduation typically provides greater autonomy and access to modern technology, which may not always be available at medical universities during undergraduate training. Moreover, newly graduated dentists are often motivated by the potential consequences of failing to adhere to the most up-to-date medical standards. In contrast, undergraduate education focuses primarily on foundational skills, leaving limited opportunities to apply evidence-based methods extensively.

Previous studies have identified additional contributing factors [51–55]. Engaging students in research activities is desirable, but it is still often not the standard. As a result, students are not necessarily familiar with the methodology of research creation and its correct interpretation, which can significantly hinder the application of modern knowledge in practice [52]. To address this gap, many dental institutions have begun integrating research-focused components into their curricula, emphasising critical appraisal of literature and conducting research projects [24]. However, the impact of such initiatives often remains limited until students transition into clinical practice [51, 53–55].

Interestingly, our findings reveal that interns showed results similar to those of undergraduate students in evaluating new dental materials and products using evidence-based practices. This may stem from their reliance on supervisors during internships, reducing the perceived responsibility for independently adopting evidence-based approaches. Additionally, the short time since graduation may not have fostered a strong sense of urgency in incorporating the latest knowledge into daily practice. In Poland, the internship period often occurs in clinical settings affiliated with universities. These environments may mirror the materials and technologies used during undergraduate studies, offering limited exposure to advanced dental innovations. Consequently, interns may not experience significant opportunities to practice implementing evidence-based methodologies.

Globally, this challenge is well-documented. For instance, in Pakistan, evidence-based dentistry remains a critical area for development despite growing recognition of its importance over the past two decades [56].

Cognitive and behavioural features (DU-PAS section B) in interns

Interns did not demonstrate notable differences in confidence when applying evidence-based dentistry, interpreting research findings for clinical use, or managing inappropriate behaviour by colleagues. Similarly, both students and interns faced challenges in treating paediatric patients, with only modest improvements observed among interns.

The highest-rated competencies among students included protecting patient privacy (68.20%), maintaining professional relationships with patients (66.04%), awareness of continuous professional development (67.79%), and effective communication with colleagues (66.42%). Among interns, these same competencies were rated highest, with significant improvements noted in self-reported confidence: 74.91%, 76.20%, 76.57%, and 77.68%, respectively. However, despite these gains, the preparedness to refer patients with suspected oral cancers remained the lowest-rated competency in both groups. That said, interns did show a measurable improvement compared to students, underscoring the benefits of clinical exposure during internships.

In the context of global findings, similarly, the study by Pandarathodiyil et al. [28] from Malaysia highlighted improved confidence in communication and patient management among recent graduates compared to final-year students. This difference was attributed to the rigorous training and examinations required for graduation, as well as the natural progression of soft skills through patient interactions during clinical practice. Moreover, recent graduates experienced less disruption in clinical training due to COVID-19 restrictions, enhancing their ability to develop practical skills.

Study limitations

The main limitations of this study included the lack of standardisation when comparing data on the overall level of respondents’ preparedness with other studies, as our study utilised median scores properly, while studies from other countries often reported mean scores. Moreover, there are only a limited number of studies (especially from Europe) that address the issues presented in our research, which complicates the comparison of findings. Another complicating factor is cultural differences, which show that in some countries, people are less likely to admit to skills shortages, for example. Furthermore, response rates between academic centres differed (the highest represented by Poznan, Cracow and Warsaw), which could also cause the risk of bias. It is important to be aware that the self-assessment made by respondents is a subjective evaluation and the results obtained should be interpreted with appropriate caution.

Conclusions

Improving dental education and enhancing student outcomes can be achieved by focusing on targeted areas of clinical competence and professional development. Polish dental students generally felt well-prepared in fundamental clinical skills like caries removal and restoring teeth. Still, gaps remain in areas such as administering nerve blocks and prosthodontic procedures, where students showed lower levels of independence. In comparison, interns showed notable improvement, particularly in skills like prescribing radiographs and performing root canal treatments, reflecting the value of the internship structure and exposure to diverse dental specialities. However, challenges persist in the preparedness to refer patients with oral cancer and in applying evidence-based dentistry, where both students and interns reported insufficient confidence. To address these gaps, integrating more clinical exposure, simulations, and research-based training could significantly boost student competency and better prepare them for the evolving demands of modern dental practice.

Author contributions

Conceptualisation: KN; Data curation: KN, JJ; Formal analysis: KN; Investigation: KN, JJ, SK, SZ, DK, BK, JFR, AZ, RF, KS, KG, MS, NS, KB, SŁ, MJ, NM, BG, JA, KSM; Methodology: KN, JJ; Visualisation: KN; Writing - original draft: KN, JJ, SK; Writing - review & editing: KN; Supervision: KN.

Data availability

Data will be made available by the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki. The Bioethical Committee of the Poznan University of Medical Sciences approved this study on 19 June 2024 and waived the requirement for informed consent due to the study’s questionnaire nature (Decision no. KB-455/24).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.