Background

The university setting is an important place for learning and is indispensable to the edification of oral health students. In the university setting, oral health students come across a variety of learning experiences. Many oral health students may feel overwhelmed, stressed, anxious, nervous and awkward during various stages of their university program, particularly during clinical experiences. In comparison, Sharif and Masoumi1 explored the clinical practice experiences of nursing students and discovered that learning that occurs in the clinical environment presents challenges that may cause students to experience increased stress and anxiety.

Several other studies2-14 have also examined and reviewed the effects of interpersonal skills learning, in particular emotional intelligence (EQ), stress management, communication skills and leadership skills among various healthcare students and professionals. All studies reached similar conclusions reporting that social and emotional (or interpersonal) skills are of significant importance to academic, clinical, personal and professional success. The findings of such studies are transferrable to oral health education and clinical practice demonstrating that in addition to clinical competencies, students must have adequate non-clinical skills to manage their university programs and, more specifically, their professional clinical encounters.

The Macquarie Dictionary defines development as: (1) the act, process or result of developing; (2) evolution, growth and expansion and (3) a fact or circumstance bringing about a new situation.15 The experiences of oral health students and their descriptions of interpersonal skills learning and development may assist educators of oral health to expand curricula and bring about change that may better prepare students for personal, professional and clinical success.

Interpersonal skills

Interpersonal skills is a broad term applied to the use of personality, verbal and non-verbal interactions between people. Although definitions and explanations of interpersonal skills vary, they share common threads. They are closely linked to human interaction and contribute substantially to establishing high-quality caring relationships with patients.5 Interestingly, until quite recently, the predominant belief at the policy level, in education at all levels and in workforce settings was that cognitive abilities or cognitive intelligence (IQ) were the skills that most mattered.16

However, the belief that IQ was the determinant of excellence and success began to change during the 1990s, with the publication of Daniel Goleman's book - Emotional Intelligence: Why it can matter more than IQ.17 Goleman scientifically challenged the notion that EQ, a primary component of interpersonal skills, is a genetic given that cannot be changed by life experience and that our destiny in life is largely fixed by these aptitudes.17 Bradberry and Greaves18 also note that EQ taps into a fundamental element of human behavior that is distinct from ones' intellect. They further comment that there is no known connection between IQ and EQ; IQ cannot predict EQ. Cognitive intelligence is predetermined, it is the ability to learn and is fixed from birth. Emotional intelligence, however, is a flexible skill that can be learned.18

In their meta-analysis, Arthur et al.19 examined the relationship between specified (interpersonal skills) training design and evaluation features and the effectiveness of training in organizations. Their results suggested a medium-to-large effect size for organizational training.19 Further meta-analysis of longitudinal studies showed interpersonal skills, such as self-confidence, warmth, self-control and emotional stability, tend to increase with age, particularly in young adulthood but continuing through middle and old age.20 In keeping with Arthur et al.'s findings, there is now a rapid acceptance and expansion of the notion that in healthcare, personality matters.20 Multiple studies have also contributed to its importance; the results demonstrating that non-cognitive skills are not fixed predetermined traits rather traits that can and should be learned and developed.2,3,6,16,21-25

Oral health student experiences

The core space of every health system is occupied by the unique encounter between one set of people who need services and another who have been entrusted to deliver those services.26 The patient experience is determined by the way they are treated (not necessarily clinically) by the provider. The truth is that not everyone is naturally good at handling relationships and collaboration. It takes a lot of understanding, compromises, sacrifices and effort.27 Although it is true that some people are naturally more emotionally intelligent than others, a high EQ can be developed.18 Oral health, as with all other health science programs, focuses heavily on technical cognitive-laden skills due to the scientific nature of the program.27 However, non-technical or interpersonal skills such as EQ, communication, understanding, relationship building, critical thinking, patient and self-education, motivation and ethics, to name a few, are also vital components of an oral health students' learning experiences. Without interpersonal skills, it is possible that a students' personal and professional success may be questionable.

Findings of a recent Canadian study into the preparedness of newly graduated oral health practitioners suggested that graduates were not appropriately prepared for the transition from student to practitioner, with all participants reporting a struggle to work within the dental hygiene concept of client-centered care while trying to serve dentists who were focused on maximizing dental hygiene revenue.28 Similar studies have also concluded that participants felt underprepared by their dental education with deficits in exposure to and understanding administrative skills, communication and managing situations beyond the (routine) clinical scope of practice.29-31 As evidenced by these studies, interpersonal skills as a branch of learning may not yet have been adequately integrated in the oral health curriculum.

The reviewers undertook a preliminary search of MEDLINE (PubMed), CINAHL and Google Scholar. To the best of the reviewers' knowledge, no current or underway systematic reviews were identified on this or a similar topic. The rationale for conducting this review is to contribute to the body of knowledge of interpersonal skills learning and development at the student level. The results of this review may provide insight to assist educators to further develop and integrate interpersonal skills learning into the oral health curriculum.

Inclusion criteria

Types of participants

The current review will consider studies that include undergraduate oral health students. The range of participants includes all oral health, and/or dental hygiene and/or oral health therapy students independent of their level of study. There will be no limitations regarding the age, gender or ethnicity of participants.

Phenomena of interest

The current review will consider studies that investigate oral health students' experiences of interpersonal skills learning. Studies that reflect oral health students' comprehension of or attitudes toward professional communication, EQ and leadership skills learning will also be included.

Context

The current review will consider studies that investigate student education experiences at any level of their undergraduate program. This review will consider studies conducted in oral health programs in university settings.

Types of studies

The current review will consider studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Descriptive qualitative studies that describe the experience or the effects of the experience will also be considered.

Search strategy

The search strategy aims to find both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of MEDLINE (PubMed) and CINAHL will be conducted, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. A second systematic search, using all identified keywords and index terms, will then be undertaken across all included databases. Third, the reference list of all identified reports and articles will be searched for additional studies. Due to differences in education systems and delivery of information, only studies published in English will be considered for inclusion in this review. Databases will be searched from their inception.

The databases to be searched include: CINAHL, MEDLINE (PubMed), EMBASE, PsycInfo and Web of Science.

The search for unpublished studies will include the following databases and websites:

Google Scholar and WorldWideScience.org.

Organization webpages to be searched will include:

World Health Organization (WHO), Institute for Health Care Improvement (IHI), National Centre for Healthcare Leadership (NCHL) and Health Workforce Australia (HWA).

Initial keywords to be used will be:

Students OR Undergraduate Students

AND

Learning Experience OR Attitude OR Emotion OR View OR Feeling OR Understanding OR Opinion OR Perception

AND

Oral Health OR Oral Health Therapy OR Oral Health Therapist OR Dental Therapist OR Dental Hygiene OR Dental Hygienist

AND

Interpersonal Skills OR Communication OR Emotional Intelligence OR Leadership OR Professional Knowledge OR Professional-Patient Relations OR Person-Centred Healthcare OR Curriculum OR Training

Assessment of methodological quality

Papers selected for retrieval will be assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer.

Data extraction

Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-QARI (Appendix II). The data extracted will include specific details about the phenomena of interest, populations, study methods and outcomes of significance to the review question and specific objectives. If required, authors of primary studies will be contacted for missing information or to clarify unclear data.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI-QARI. This will involve the aggregation or synthesis of findings to generate a set of statements that represent that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. These categories are then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the findings will be presented in narrative form.

Appendix I: Appraisal instruments

QARI appraisal instrument

Appendix II: Data extraction instruments

QARI data extraction instrument

References