Structured Microskill Stepwise Progression for Undergraduate Tooth Extraction: A Randomized Mixed-Methods Study

Abstract

Objectives To evaluate whether a structured microskill stepwise progression model improves procedural competence and reduces performance variability in undergraduate tooth extraction training compared with traditional apprenticeship-based teaching. Methods This randomized mixed-methods pilot study allocated 40 fifth-year dental students (1:1) to traditional apprenticeship teaching or a microskill stepwise progression model during an 8-week oral surgery rotation. The intervention divided tooth extraction into nine stages, requiring five targeted observations and five successful supervised performances before progression. End-of-rotation competence was assessed using a modified Direct Observation of Procedural Skills (DOPS) scale by two blinded examiners. Between-group differences and score variability were analysed using Welch’s t test and the F-test. Questionnaires and qualitative feedback explored learner and instructor perceptions. Results Baseline theoretical examination scores were comparable between groups. Inter-rater reliability for the total modified DOPS scores was good (ICC = 0.86; 95% CI, 0.74-0.93; P < .001). The intervention group achieved higher modified DOPS scores than the control group (94.60 ± 3.97 vs 88.25 ± 6.41; mean difference, 6.35; 95% CI, 2.94-9.76; P < .001; Cohen’s d = 1.19) and lower score variability (F = 2.616; P = .042), with a narrower score range (87-100 vs 75-96). Qualitative findings suggested clearer progression and more consistent competence development. Questionnaire findings were exploratory; four item-level differences remained significant after Benjamini–Hochberg correction. Conclusions The microskill stepwise model was associated with improved tooth extraction performance and reduced variability in assessed procedural competence compared with traditional teaching. This mastery-oriented approach may support more structured supervision and more consistent educational readiness in oral surgery training. Clinical relevance This framework helps educators organize undergraduate tooth extraction training using procedure-specific stages, supervised-performance thresholds, and documented progression criteria. It may promote consistent standards and transparent entrustment decisions, but should be adapted to local case availability and supervisor workload.