Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : ZC28 - ZC34 Full Version

Effects of COVID-19 Lockdown on Clinical Practice among Undergraduate Dental Students in Tamil Nadu- A Survey


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52893.16230
Abirami Vetriselvan, S Elakiya, Srivatsa Kengasubbiah

1. Junior Resident, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India. 2. Junior Resident, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India. 3. Professor, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Abirami Vetriselvan,
Junior Resident, Department of Oral and Maxillofacial Surgery, Thai Moogambigai Dental College and Hospital, Golden George Nagar, Mogappair,
Chennai-600107, Tamil Nadu, India.
E-mail: abiramiv99@gmail.com

Abstract

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic had not only developed as a key challenge to public health all around the world but also instigated physical and mental constraints on the healthcare professionals especially on the education of dental students with the sudden switch from traditional teaching methods to e-learning platforms thereby shutting all means of clinical experiences.

Aim: To assess the effects of lockdown on clinical practice among undergraduate dental students in Tamil Nadu, India.

Materials and Methods: A cross-sectional observational study was done among undergraduate dental students in Tamil Nadu, India, from June 1, 2021 to July 1, 2021, using convenience sampling method to yield a total of 510 responses for a self-administered online questionnaire that aimed at evaluating the consequence of lockdown on clinical practice. Statistical Package for the Social Sciences (SPSS) version 19.0 was used to analyse the data.

Results: A total of 510 responses (mean age: 21.72±2.2827 years; 323 female and 187 male) were analysed in the present study. Majority of the students felt that COVID-19 lockdown had a negative impact on clinical exposure. Inspite of following infection control measures, only 35.1% of students felt imperative to practice during pandemic. With over 82.7% of patient flow reduced due to fear of disease spread. 85.1% revealed being stressed in completing clinical quota in a short duration. Further questions on prospects in improvising their clinical knowledge; showed 45% recommending e-workshops, 29.4% opting for video demonstration followed by 22.2% on exposure to Objective Structured Clinical Examination (OSCE) to compensate for the loss of clinical practice.

Conclusion: New teaching protocols have to be adopted taking into account the changing aspects of the pandemic to improve their wellbeing, overcome mental stress and to enhance the sustainability of dental education. Focus on video demonstrations, lectures provoking their clinical reasoning, simulations on phantom heads and conducting workshops enhancing preclinical skills as well as following appropriate safety protocols must be implemented.

Keywords

Coronavirus disease-2019, Dentists, Education, Infection control, Online system, Pandemic

Novel Coronavirus disease (COVID-19) is a highly contagious viral infection caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) first observed at Wuhan City, China in December 2019 that caused significant economic and social breakdown across the world (1). Later, World Health Organisation (WHO) declared COVID-19 outbreak a global pandemic threat that can seriously increase morbidity and mortality over a wide geographic area on 11th March 2020 (2). It was recognised that this highly infective virus spreads through direct and indirect modes such as respiratory droplets, nasal droplets, direct contact of surfaces or indirect contact (fomites) or even through saliva (3).

Among various healthcare professionals, it is evident that dentists are at a higher risk of acquiring and spreading the disease due to close exposure to aerosols and infected droplets from patient’s oral cavity (4),(5). The swift spread of the COVID-19 pandemic disease forced several countries to impose overnight restrictions, lockdowns, curfews; home isolation measures and protocols, social distancing norms, closure of schools, universities and shifts in the existing educational system to e-learning and distance learning systems (6). Hattar S et al., reinforces that the sudden shift from traditional methods of teaching to e-learning and distant learning has created a greater challenge among the dental students especially at the undergraduate level (7). Although new technologies with simulation and virtual reality techniques are gaining more interest, still the direct in person experience is one that cannot be simply replaced by virtual teaching platforms (7). Consequently, COVID-19 outbreak has negatively impacted the activity of dental professional as well as dental educational institutions on a larger scale and several routine dental clinical practice have been suspended owing to the risk of cross-infection during dental treatment (8).

Valekar SS et al., had shown that undergraduate dental students constantly undergo academic and professional stress such as fear of inability to understand the desired knowledge in due time, fear of infection, burden of increased content of curriculum, clinical anxiety, fear of making poor choice of profession, lack of professional growth, fear of helplessness to be paid (9). Subsequently, Loch C et al., stated that undergraduate students also fears that online e-learning platforms along with closure of dental practices would cause extreme impacts on all these factors and impair their clinical competence due to pandemic (10).

Several studies have been published in the recent years eliciting the psychological status of students during pandemic but this study illustrates the struggles faced by students during clinical practice resuming after attending e-teaching modes for months with loss of clinical exposure due to lockdown [8-10]. The present study aimed at assessing the effects of lockdown on clinical practice among undergraduate dental students in Tamil Nadu and the ability to apply the theoretical knowledge gained in online platform while dealing with patients.

Material and Methods

The present cross-sectional observational study was done among undergraduate dental students in Tamil Nadu from June 1, 2021 to July 1, 2021. This study utilised non probability convenience sampling method that yielded information from 510 individuals. All the respondents provided informed consent, and the data were collected anonymously. Ethical clearance for the study was obtained from the Institutional Review Board at Dr.M.G.R. Educational and Research Institute, Chennai, (certificate no. Dr.MGRERI/TMDCH/EC/2020-21/009 dated 22/04/2021) prior to the circulation of survey questionnaires to the candidates. An informed consent was obtained via Google forms in accordance to the protocols and principles under the purview of Helsinki Declaration (1964 and later) before the respondents volunteered to participate in the survey. The participants were assured that their e-mail ids and personal details will be maintained under complete confidentiality by the researcher.

Inclusion criteria: Undergraduate dental students who had recently passed out/currently studying in any dental college in Tamil Nadu, those of third year, final year and current intern batch, recently passed out batch of interns of academic year 2019-2020, who were able to understand and respond in English language were included in the study.

Exclusion criteria: Subjects who are not willing to participate and those who had not filled the questionnaire survey completely were excluded from the study.

Sample size calculation: A preliminary survey was conducted among 30 subjects and the estimated sample size was 498 with margin of error at 5% and 95% confidence level. Non probability, convenience sampling technique was employed that yielded responses from 510 dental practitioners out of 700 survey forms sent across various online platforms for this observational study with a cross-sectional design.

Questionnaire

The required information was collected through published scientific articles pertaining to the objective of the study using thorough search in electronic database like PubMed, EMBASE, Cochrane Library and Google Scholar by the authors independently (7),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24),(25). Self-administered structured questionnaire comprising 40 questions (Table/Fig 1) in English language was prepared and evaluated by a panel consisting of professors of various clinical specialties in dentistry belonging to the institute and a statistician. The questionnaire had a combination of close ended questions (Yes/No) followed by questions of linear rating scale as well as open ended questions eliciting the mental status, physical constraints as well as economical hurdles faced on account of pandemic during their clinical practice after the lockdown. The survey was done through Google forms ensuring that all the participants were informed about the purpose of the study. The questionnaire was validated and standardised using a test study among 30 samples showing adequate internal consistency with a Cronbach’s alpha value of 0.7.

Statistical Analysis

Responses recorded among the selected population group were evaluated by frequency distribution and descriptive analysis using Microsoft Excel. On statistical evaluation, it was observed that 42.2all 510 samples were valid for the study with Cronbach’s alpha reliability score being 0.861 (Significant score). Statistical Package for the Social Sciences version 19.0 (SPSS Inc., Chicago, IL, USA) was used to analyse the data.

Results

On analysis of the given data the mean age of the study population was observed to be 21.72±2.2827 years of age ranging between 18-27 years of age. On evaluation, a total of 323 female (63.3%) and 187 male (36.7%) respondents were present.

In the present study, as described in (Table/Fig 2), depicts the frequency and percentage of each response for questions of Section A (Yes/No) questioning the steps taken by the institute and individual in the safety measure followed and the aspects related to patient flow. Section B (Linear Rating Scale) elicits the perception and degree of acceptance of undergraduate students towards the pandemic scenario as was observed that the majority of the participants (99%) feel COVID-19 lockdown had an impact on clinical practice exposure. The measures taken by their respective institutes on account of pandemic had been questioned revealing that 80.8% maintain a record of the temperature and oxygen saturation for all individuals including workers entering the campus on a daily basis. About 65.9% of institutions have conducted COVID-19 infection control protocol awareness programs and encouraged students in taking up certified courses in reinforcement of clinical practice during COVID-19.

(Table/Fig 3) illustrates the responses to open-ended questions that demanded the reasons behind various hurdles faced in treating patients, completion of quota and applying the theoretical knowledge into practical use. Fear of exposure to COVID-19 (30%) was the response by most when questioned regarding the problem faced in clinical practice due to COVID-19. A 35.5% of the students felt that conducting free dental camps can increase the patient flow and thus compensate the loss in clinical experience, while 24.11% felt that reducing the treatment charges to benefit the people from various social strata could help.

Discussion

Coronavirus Disease-2019 transmissions are associated with the release of respiratory droplets by coughing, sneezing, and through aerosol route. Due to the nature of dental procedures and the large number of droplets and aerosols generated during dental treatment associated with close contact with patients, several standard protective measures and guidelines have been adopted in daily dental clinical work to prevent the spread of COVID-19 (11),(12). (Table/Fig 4) illustrates the comparison of the responses attained in the present study with other studies (7),(9),(10),(13),(14),(15),(17), (19),(20),(21).

About 65.9% of institutions conducted COVID-19 Infection Control Protocol awareness programs, 71.8% follow adequate safety measures during the radiographic examinations and 55.7% prefer separate rooms for performing aerosol generated procedures in institutions similar to those of Loch C et al., Meng L et al., and Ge ZY et al., as mentioned in (Table/Fig 4) (10),(15),(16). Coulthard P believe that the use of the PPE kits can be useful during dental practice to limit the spread of aerosol and aerogenic infections caused during dental practice (17).

Apart from the restraints of cross-infection, another hurdle faced during clinical practice was the restrictions in transport facilitation. Deshmukh SV and Iosif L et al., observed that limited transportation due to the lockdown enforced in most countries to control the spread of the pandemic created a negative impact on the patient flow as well as the difficulty in mobilisation of dental professionals across the city for work (18),(19).

As a solution for reduced transmission of disease, Personal Protective Equipment (PPE), head caps, protective goggles, double surgical masks or N95, disposable surgical gowns, special foot-wears, and protective screens are essential while working in dental teaching and clinical environment (20),(21). Apart from the health-related issues, 85.1% feared the completion of clinical quota in a short duration and recommend (90.6%) supplementary workshops to gain better hands on clinical practice. This was similar to the study by Kharma MY et al., illustrating as high as 85% of the individuals with stress level (>7 in a score of 0-10) attributed to concerns about clinical experiences and research experience, and other factors such as employment predictions (22).

On evaluation of their perception on a linear rating scale about 56.9% of the students had rated 3 out of 5 when questioned if confident while approaching a clinical case at present when compared to prelockdown period by applying the knowledge gained from online classes during practice efficiently. In order to improve the clinical practice and gain knowledge, about 45% recommend organising webinars, 29.4% opted for video demonstration followed by 22.2% on exposure to OSCE to compensate for the loss of clinical practice and also suggests frequent workshops and hand-on exercises (35.5%) for better clinical practice. Coulthard P, Jiang Z et al., Chang TY et al., and Hung M et al., in their respective studies observed that students were experiencing higher levels of stress and feel their clinical education has impacted on a larger scale (17),(23),(24),(25). From these observations, it is evident that proper protocols should be established for the safety of students at institutions and to overcome the problems which could be created due to travel restrictions for both students and patients seeking dental treatment. Thus, adapting adequate precautionary measures as per government and WHO, Centers for Disease Control and Prevention(CDC), Americans with Disabilities Act (ADA) guidelines will protect the dentist as well as prevent cross contamination of the infection.

Limitation(s)

This study was done on an online platform using self-administered structured questionnaires on account of the pandemic situation leading to the lack of accountability and veracity of the response due to absence of an interviewer.

Conclusion

Coronavirus Disease-2019 has had a deleterious impact on the clinical practice among undergraduate students as well as their intellect in applying their theoretical knowledge practically. The pandemic has trained every professional to cope with restraints and hurdles, lest the field of education has had the necessity to utilise newer teaching programs. Majority of the participants (99%) felt COVID-19 lockdown had an impact on clinical practice exposure.

Most of the students felt that conducting free dental camps can increase the patient flow and thus compensate the loss in clinical experience. Video demonstrations live clinical training programs, workshops on infection control protocols, practice on simulations like phantom heads alongside psychological counselling and motivational therapies at regular intervals will aid in improving their clinical application as well as to overcome mental stress and fear to enhance the sustainability of dental education.

It is the responsibility of the institute to follow strict safety protocols by the provision of necessary equipment to the practitioners as well as avoid demanding increased treatment charges on account of pandemic, which inadvertently prevents the patients from availing dental services. Further studies must be taken up to evaluate newer teaching methods and incorporating counselling sessions regularly in the curriculum to encourage the students to cope with the inevitable impacts of COVID-19 successfully.

References

1.
Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: Challenges for global health governance. JAMA. 2020;323(8):709-10. [crossref] [PubMed]
2.
Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-73. [crossref]
3.
Khurshid Z, Asiri FYI, Al Wadaani H. Human Saliva: Non invasive fluid for detecting novel coronavirus (2019-nCoV). Int J Environ Res Public Health. 2020;17(7):22-25. [crossref] [PubMed]
4.
Ahmad FA, Karimi AA, Alboloushi NA, Al-Omari QD, AlSairafi FJ, Qudeimat MA. Stress level of dental and medical students: Comparison of effects of a subject-based curriculum versus a case-based integrated curriculum. J Dent Educ. 2017;81(5):534-44. [crossref] [PubMed]
5.
Karia R, Gupta I, Khandait H, Yadav A, Yadav A. COVID-19 and its modes of transmission. SN Compr Clin Med. 2020;2:1798-801. Doi: 10.1007/s42399-020-00498-4. [crossref] [PubMed]
6.
Zitzmann NU, Matthisson L, Ohla H, Joda T. Digital undergraduate education in dentistry: A systematic review. Int J Environ Res Public Health. 2020;17(9):3269. [crossref] [PubMed]
7.
Hattar S, AlHadidi A, Sawair FA, AbdAlraheam I, El-Ma’aita A, Wahab FK. Impact of COVID-19 pandemic on dental academia. Students’ experience in online education and expectations for a predictable practice. Research Square. 2020 https://doi.org/10.21203/rs.3.rs-54480/v1. [crossref]
8.
Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological aspects and psychological reactions to Covid-19 of dental practitioners in the Northern Italy Districts of Modena and Reggio Emilia. Int J Environ Res Public Health. 2020;17(10):3459. [crossref] [PubMed]
9.
Valekar SS, Phaphe SA, Sarode KR. Mental status of dental students during lockdown due to covid-19 pandemic-a cross sectional study in western Maharashtra. Journal of Evolution of Medical and Dental Sciences. 2021;10(8):532-36. [crossref]
10.
Loch C, Kuan IB, Elsalem L, Schwass D, Brunton PA, Jum’ah A. COVID-19 and dental clinical practice: Students and clinical staff perceptions of health risks and educational impact. Journal of Dental Education. 2021;85(1):44-52. [crossref] [PubMed]
11.
Pereira LJ, Murata RM, Pardi V, Mattos FF. Streamlining the dental care during COVID-19 pandemic: Updated clinical recommendations and infection control management framework. Brazilian Oral Research. 2021;35:e046. https://www.scielo.br/j/bor/a/53qbVn5FMFPbbbQd4V8yPKg/?lang=en&format=pdf. [crossref] [PubMed]
12.
Peng X, Xu X, Li Y, Cheng L, Xuedong Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int. J. Oral Sci. 2020;12:9. Doi: 10.1038/s41368-020-0075-9. [crossref] [PubMed]
13.
De Vos J. The effect of COVID-19 and subsequent social distancing on travel behavior. Transp Res Interdiscip Perspect. 2020;5:100121. https://doi.org/10.1016/j.trip.2020.100121. [crossref] [PubMed]
14.
Sinjari B, Rexhepi I, Santilli M, Chiacchiaretta P, Carlo PD, Caputi S. The impact of COVID-19 related lockdown on dental practice in central Italy- outcomes of a survey. International Journal of Environmental Research and Public Health. 2020;17(16):5780. [crossref] [PubMed]
15.
Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res. 2020;99(5):481-87. [crossref] [PubMed]
16.
Ge ZY, Yang LM, Xia JJ, Fu XH, Zhang YZ. Possible aerosol transmission of COVID-19 and special precautions in dentistry. J Zhejiang UnivSci B. 2020;21(5):361-68. [crossref] [PubMed]
17.
Coulthard P. Dentistry and Coronavirus (COVID-19)—Moral Decision-Making. Br Dent J. 2020;228(7):503-05. [crossref] [PubMed]
18.
Deshmukh SV. Mental health of dental professionals during COVID-19 pandemic. Journal of the International Clinical Dental Research Organisation. 2020;12(2):85.
19.
Iosif L, Tâncu AMC, Didilescu AC, Imre M, Galbinaşu BM, Ilinca R. Self-perceived impact of COVID-19 pandemic by dental students in Bucharest. International Journal of Environmental Research and Public Health. 2021;18(10):5249. [crossref] [PubMed]
20.
Gallagher JE, Johnson I, Verbeek JH, Clarkson JE, Innes N. Relevance and paucity of evidence: A dental perspective on personal protective equipment during the COVID-19 pandemic. British Dental Journal. 2020;229(2):121-24. [crossref] [PubMed]
21.
Villani FA, Aiuto R, Paglia L, Re D. COVID-19 and dentistry: Prevention in dental practice, a literature review. International Journal of Environmental Research and Public Health. 2020;17(12):4609. [crossref] [PubMed]
22.
Kharma MY, Koussa B, Aldwaik A, Yaseen J, Alamari S, Alras H, et al. Covid-19 pandemic and challenges of dentistry: Assessment of anxiety and stress among dental students to return to training in dental college in COVID-19 Era. European Journal of Dentistry. 2020;14(Suppl 1):S86. [crossref] [PubMed]
23.
Jiang Z, Zhu D, Li J, Ren L, Pu R, Yang G. Online dental teaching practices during the COVID-19 pandemic: A cross-sectional online survey from China. BMC Oral Health. 2021;21(1):01-09. [crossref] [PubMed]
24.
Chang TY, Hong G, Paganelli C, Phantumvanit P, Chang WJ, Shieh YS, et al. Innovation of dental education during COVID-19 pandemic. Journal of Dental Sciences. 2021;16(1):15-20. [crossref] [PubMed]
25.
Hung M, Licari FW, Hon ES, Lauren E, Su S, Birmingham WC, et al. In an era of uncertainty: Impact of COVID-19 on dental education. Journal of Dental Education. 2021;85(2):148-56. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/52893.16230

Date of Submission: Oct 16, 2021
Date of Peer Review: Jan 03, 2022
Date of Acceptance: Jan 18, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 19, 2021
• Manual Googling: Jan 17, 2022
• iThenticate Software: Feb 02, 2022 (12%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
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