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American Journal of  Physical Education 
and Health Science (AJPEHS)

Self-Perceived Competence in Clinical Skills Among Fresh Graduates of  Karachi
Pakistan - A Comparative Study

Syed Ahmed Ali1*

Volume 2 Issue 2, Year 2024
ISSN: 2992-9679 (Online) 

DOI: https://doi.org/10.54536/ajpehs.v2i2.3392
https://journals.e-palli.com/home/index.php/ajpehs

Article Information ABSTRACT

Received: July 05, 2024

Accepted: August 13, 2024

Published: November 23, 2024

Students’ development as effective dental practitioners are based on their happiness and self-
awareness with their ability to conduct various dental operations. This study evaluated the 
self-perceived competence level among fresh dental graduates who are currently completing 
their house jobs in different dental institutes in Karachi, Pakistan. This was a descriptive, 
cross-sectional study, conducted in January and February 2022. Data was collected from 
a total of  330 fresh graduates working as house officers in six different dental colleges in 
Karachi. The participants were asked to fill out the questionnaire, after acquiring informed 
consent. The mean overall score was 75.75/100 + 11.60. Most of  the participants had a 
firm grip on 18 out of  24 clinical procedures while bitewing radiographs and production of  
mechanically sound cast partial denture (CPD) were two items that most of  the participants 
lacked. The cognitive skills in part B were absent in most of  the participants. House officers 
were able to perform clinical duties confidently during their house job while there was a lack 
of  interest shown in performing cognitive responsibilities which showed that there is room 
for improvement. The findings of  this study could be applied to dental schools in Pakistan 
in uplifting their clinical and cognitive skills to make them better clinicians, as multiple dental 
schools participated in this survey. The effects should be assessed carefully as the reported 
competence is self-perceived, not clinically proven.

Keywords
Competence, Clinical Skills, 
Dental Skills, Fresh Graduates, 
House Officers

INTRODUCTION
‘Dental education’ is meant to train students in developing 
clinical skills to perform basic dental procedures, and to 
have an understanding of  the general dental concepts 
with emphasis on the inclusion of  certain attributes and 
behaviors needed in becoming a competent clinician 
who can function as part of  a dental team (PMC, 2021). 
Students’ satisfaction and self-awareness regarding their 
skill and competence in performing different dental 
procedures form the basis of  their growth as successful 
clinicians in the field of  dentistry. An understanding of  
how well they can manage dental patients during the 
basic level of  their house job period determines how 
much the dental education of  their undergraduate years 
at the institute has prepared them for a successful dental 
career. Fresh graduates should have the basic knowledge, 
conduct, and skills that could facilitate their house job to 
equip them with the training necessary for independent 
dental practice down the road (Qazi et al., 2021).
Normally, dental colleges of  Pakistan follow a PMC-
approved BDS curriculum and house job structure 
that is determined by the National Medical and Dental 
Academic Board (PMC, 2021). Apart from the theoretical 
assessments, this BDS curriculum also requires students 
to be skilled in certain dental procedures by performing 
a specific number of  procedures as per the quota of  the 
individual university (Majeed & Tirmizi, 2019). During the 
past few years, some changes have been observed in the 
medical education system. The replacement of  the Pakistan 
Medical & Dental Council (PM&DC) by the Pakistan 

Medical Commission (PMC) is one such change that has 
exerted a huge impact on the dental curriculum. Also, 
the change in affiliation of  private dental institutes from 
Karachi University to Jinnah Sindh Medical University 
has reshaped the pattern of  examinations (Majeed et 
al., 2020; Naqvi, 2021; Wikipedia, 2021). Furthermore, 
the world fighting the COVID-19 pandemic in the last 
few years has caused many difficulties for the dental 
institutes of  Pakistan in clinical teaching of  students. The 
implementation of  online learning, modifications of  the 
infection control practices, and closure of  dental OPDs 
resulted in great deficiencies in the clinical skills teaching 
of  third and final-year students (Ali et al., 2017; Mat Yudin 
et al., 2020). Considering the aforementioned changes in 
the dental education methodology and curriculum, there 
is a need to evaluate their effects on the competence and 
learning of  fresh graduates of  Pakistan to identify the 
areas for modification in the teaching strategies. There 
are few studies (Ali et al., 2017; Mat Yudin et al., 2020; 
Qazi et al., 2021) that have been published regarding the 
self-perceived preparedness of  the fresh graduates. These 
have used a previously validated dental undergraduates’ 
preparedness assessment scale (DU-PAS) to evaluate the 
BDS graduates. This scale has been used internationally 
as a tool for the aforementioned evaluation (Ali et al., 
2017; Qazi et al., 2021). The present study has used 
the same validated DU-PAS scale to evaluate the self-
perceived competence level among house officers of  
different dental institutes in Karachi. To the best of  our 
knowledge, only one such study has been done previously 

1 Section of  Dentistry, Department of  Surgery, The Aga Khan University, Karachi, Pakistan
* Corresponding author’s e-mail: ahmed.musaddiq@aku.edu



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Am. J. Phys. Educ. Health Sci. 2(2) 68-75, 2024

in Pakistan in 2018 regarding the same but it was done 
before the COVID-19 pandemic so the present study will 
also compare the results with that study to evaluate the 
effects of  the changes in the dental education over the 
last few years on the self-perceived competence levels of  
the fresh graduates (Qazi et al., 2021).
The aim of  conducting this study was to evaluate the self-
perceived competence level in performing clinical skills, 
appropriate conduct, and certain cognitive attributes 
among the fresh dental graduates who are currently doing 
their house jobs in different dental institutes in Karachi, 
Pakistan.

MATERIALS AND METHODS 
It was a descriptive, cross-sectional study conducted in 
January and February 2022. The sample was comprised 
of  house officers from six different dental colleges in 
Karachi including Dow International Dental College 
(DIDC), Dow Dental College (DDC), Dr. Ishrat-ul-Ebad 
Khan Institute of  Oral Health Sciences (DIKIOHS), 
Karachi Medical & Dental College (KM&DC), Altamash 
Institute of  Dentistry & Medicine (AIDM) and Jinnah 
Postgraduate Medical Centre (JPMC). Data collection 
started on the 18th of  January 2022 and ended on the 
10th of  February 2022, lasting 24 days. House officers 
who gave their written informed consent with ages 
ranging between 20 to 30 years were included in the study 
and are working in one of  the aforementioned institutes 
of  Karachi. House officers who hadn’t completed their 
dental education (BDS) from Pakistan, graduates below 
20 or above 30 years of  age, and not working in the 
mentioned institutes of  Karachi were excluded. The 
study consisted of  330 participants in total (38 study 
participants from DIDC, 102 from KMDC, 39 from 
AIDM, 37 from JPMC, 48 from DUHS, and 69 from 
DIKIOHS). The institutional review board approved the 
study (AIDM/RDRC/12/2021/03). The convenience 
sampling technique was used with sample size calculation 
done by using the Cochran formula in which the known 
population size was taken as 3557 as a rough estimate 
(Commission, 2021a, 2021b; GD, 1992). 
The permission of  the author of  the DU-PAS scale 
to use the said scale was obtained via email. Tangible 
questionnaires were distributed among the house officers 
of  the aforementioned dental colleges. The questionnaire 
consisted of  three sections: an informed consent section, 
a supplemental participant information section, and the 
validated preparedness assessment scale section. The 
Scale was originally prepared in the United Kingdom 
via specific studies and methods and was reviewed for 
its lexical and grammatical appropriateness by a team of  
ten dental scholars in Pakistan (Ali et al., 2017; Mat Yudin 
et al., 2020; Qazi et al., 2021). This scale is used for the 
assessment of  the clinical skills, appropriate professional 
conduct, and the attributes that are required or expected 
from a fresh dental graduate. It consists of  50 questions 
that are split into two parts- A and B. Part A evaluates self-

perception regarding clinical competence and consists 
of  24 questions and part B assesses professionalism, 
communication skills, and cognitive skills that are required 
for success in dentistry (Ali et al., 2017) and it contains 26 
questions (Pakistan, 2021). The responses from parts A 
and B were graded as follows: 0 for ‘no experience’, 1 for 
‘with help’, and 2 for ‘on my own for part A and 0 for ‘no 
experience’, 1 for ‘Mostly’, 2 for ‘Always’ for part B (Qazi 
et al., 2021).
After all the questionnaires were filled and submitted, 
all the data was entered into the Statistical Package of  
Social Sciences (SPSS) software for statistical analysis. 
Descriptive statistics in addition to the overall DU-PAS 
scores and their mean and standard deviation were also 
calculated for comparative purposes. The p-value was 
kept at 0.05 at a confidence level of  95%. 

RESULTS AND DISCUSSION
Results
A total of  330 house officers aged ranging from 22 to 
28 years were approached to fill out the questionnaire. 
51 (15.54%) participants were male and 279(84.54%) 
were female (Table 1). The mean of  the overall scores 
was 75.75 + 11.60. The highest score was 100 and the 
lowest was 16. Most of  the participants were of  24 years 
of  age followed by 23 years (Table 1). The majority of  the 
house officers were from KMDC and DIKIOHS (52.73 
%). The participants from government dental colleges 
of  Karachi were 206 (62.43 %) and 124 (37.58 %) from 
private medical colleges (Table 2).
Table 3 shows part A of  the preparedness assessment 
scale that evaluates clinical skills which signifies that more 
than half  of  the participants felt they could perform 
about 18 of  the 24 clinical procedures on their own. 
The procedures that most participants (more than or 
equal to 90 %) felt confident in doing on their own were 
obtaining a complete medical history from their patients 
(item A1), obtaining valid consent from their patients 
before starting treatment (item A11), and removing 
dental caries effectively (item A16). Conversely, the only 
two procedures that were significantly (more than 35 %) 
regarded by the participants as having no experience with 
were taking bitewing radiographs (item A5) and providing 
mechanically sound cast partial dentures (item A22). 
Table 4, on the other hand, represents part B of  the 
preparedness assessment scale which shows that more 
than half  of  the participants reported feeling always or 
mostly confident in almost all of  the mentioned skills. 
However, the items that were significantly reported 
(more than or equal to 20%) to having no experience 
with were: evaluating new dental materials and products 
using an evidence-based approach (item B33), referring 
patients suspected of  having oral cancer (item B30), and 
interpreting research results that could affect their dental 
practice (item B34) and using an evidence-informed 
approach in their clinical practice (item B35).



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Table 1: Demographic values of  the population
Variable Frequency Percentage
Age Group
22 15 4.54 %
23 110 33.33 %
24 129 39.09 %
25 62 18.78 %
26 12 3.63 %
27 1 0.30 %
28 1 0.30 %
Gender
Male 51 15.54%
Female 279 84.54%

Table 2: Participants from Government and Private dental colleges
Variable Dental College Frequency Percentage
Private Sector AIDM 39 11.82 %

DDC 45 13.64 %
DIDC 40 12.12 %

Total 124 37.58 %
Government Sector JPMC 32 9.70 %

KMDC 105 31.82 %
DIKIOHS 69 20.91 %

Total 206 62.43 %

Table 3: Part A of  the DU-PAS
Item Question No experience 

(%)
With 
help (%)

On my 
own (%)

A5 I am able to undertake bitewing radiographs 44.5 42.4 13
A21 I am able to provide crowns using principles of  tooth preservation 23.6 38.8 37.6
A22 I am able to provide mechanically sound cast partial dentures 36.1 40.3 23.6
A4 I am able to undertake periapical radiographs 17 27 56.1
A20 I am able to perform endodontic treatment on mutli rooted teeth 

appropriately
19.1 38.8 42.1

A7 I am able to assess the treatment needs of  patients requiring orthodontics 18.8 51.8 29.4
A23 I am able to provide a mechanically sound full denture 13 37.6 49.4
A8 I am able to formulate a comprehensive treatment plan which 

addresses all treatment needs of  my patients
3 40.3 56.7

A11 I am able to obtain a valid consent from my patients prior to 
undertaking any treatment

0.6 8.5 90.9

A12 I am able to carry out patients' treatment sessions in an appropriate 
order

2.7 23 74.2

A15 I am able to perform non-surgical periodontal treatment using 
appropriate methods

4.5 18.2 77.3

A9 I am able to provide a range of  treatment options to my patients 
based on their individual circumstances

1.5 26.4 72.1

A3 I am able to prescribe appropriate dental radiographs 2.7 15.8 81.5
A14 I am able to administer inferior dental nerve blocks effectively 1.2 9.4 89.4
A10 I am able to explain the merits and demerits of  various treatment 

options to my patients
0.9 11.8 87.3



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Item Question No experience 
(%)

With 
help (%)

On my 
own (%)

A13 I am able to prescribe drugs to my patients appropriately 1.5 23.3 75.2
A18 I am able to restore teeth with amalgam fillings appropriately 7.9 13.6 78.5
A24 I am able to undertake non-surgical tooth extractions appropriately 1.2 11.5 87.3
A2 I am able to undertake a comprehensive, clinical oral examination 0.9 10.6 88.5
A6 I am able to interpret common findings on dental radiographs 1.2 15.5 83.3
A16 I am able to remove dental caries effectively 0.6 8.8 90.6
A17 I am able to restore teeth with tooth colored fillings appropriately 2.4 10.6 87
A19 I am able to perform endodontic treatment on single rooted teeth 

appropriately
9.4 19.7 70.9

A1 I am able to obtain complete medical history from my patients 0.6 5.8 93.6
A5 I am able to undertake bitewing radiographs 44.5 42.4 13
A21 I am able to provide crowns using principles of  tooth preservation 23.6 38.8 37.6
A22 I am able to provide mechanically sound cast partial dentures 36.1 40.3 23.6
A4 I am able to undertake periapical radiographs 17 27 56.1
A20 I am able to perform endodontic treatment on mutli rooted teeth 

appropriately
19.1 38.8 42.1

A7 I am able to assess the treatment needs of  patients requiring orthodontics 18.8 51.8 29.4
A23 I am able to provide a mechanically sound full denture 13 37.6 49.4
A8 I am able to formulate a comprehensive treatment plan which 

addresses all treatment needs of  my patients
3 40.3 56.7

A11 I am able to obtain a valid consent from my patients prior to 
undertaking any treatment

0.6 8.5 90.9

A12 I am able to carry out patients' treatment sessions in an appropriate 
order

2.7 23 74.2

A15 I am able to perform non-surgical periodontal treatment using 
appropriate methods

4.5 18.2 77.3

A9 I am able to provide a range of  treatment options to my patients 
based on their individual circumstances

1.5 26.4 72.1

A3 I am able to prescribe appropriate dental radiographs 2.7 15.8 81.5
A14 I am able to administer inferior dental nerve blocks effectively 1.2 9.4 89.4
A10 I am able to explain the merits and demerits of  various treatment 

options to my patients
0.9 11.8 87.3

A13 I am able to prescribe drugs to my patients appropriately 1.5 23.3 75.2
A18 I am able to restore teeth with amalgam fillings appropriately 7.9 13.6 78.5
A24 I am able to undertake non-surgical tooth extractions appropriately 1.2 11.5 87.3
A2 I am able to undertake a comprehensive, clinical oral examination 0.9 10.6 88.5
A6 I am able to interpret common findings on dental radiographs 1.2 15.5 83.3
A16 I am able to remove dental caries effectively 0.6 8.8 90.6
A17 I am able to restore teeth with tooth colored fillings appropriately 2.4 10.6 87
A19 I am able to perform endodontic treatment on single rooted teeth 

appropriately
9.4 19.7 70.9

A1 I am able to obtain complete medical history from my patients 0.6 5.8 93.6
A5 I am able to undertake bitewing radiographs 44.5 42.4 13
A21 I am able to provide crowns using principles of  tooth preservation 23.6 38.8 37.6
A22 I am able to provide mechanically sound cast partial dentures 36.1 40.3 23.6
A4 I am able to undertake periapical radiographs 17 27 56.1
A20 I am able to perform endodontic treatment on mutli rooted teeth 

appropriately
19.1 38.8 42.1



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Item Question No experience 
(%)

With 
help (%)

On my 
own (%)

A7 I am able to assess the treatment needs of  patients requiring orthodontics 18.8 51.8 29.4
A23 I am able to provide a mechanically sound full denture 13 37.6 49.4
A8 I am able to formulate a comprehensive treatment plan which 

addresses all treatment needs of  my patients
3 40.3 56.7

A11 I am able to obtain a valid consent from my patients prior to 
undertaking any treatment

0.6 8.5 90.9

A12 I am able to carry out patients' treatment sessions in an appropriate 
order

2.7 23 74.2

A15 I am able to perform non-surgical periodontal treatment using 
appropriate methods

4.5 18.2 77.3

A9 I am able to provide a range of  treatment options to my patients 
based on their individual circumstances

1.5 26.4 72.1

A3 I am able to prescribe appropriate dental radiographs 2.7 15.8 81.5
A14 I am able to administer inferior dental nerve blocks effectively 1.2 9.4 89.4
A10 I am able to explain the merits and demerits of  various treatment 

options to my patients
0.9 11.8 87.3

A13 I am able to prescribe drugs to my patients appropriately 1.5 23.3 75.2
A18 I am able to restore teeth with amalgam fillings appropriately 7.9 13.6 78.5
A24 I am able to undertake non-surgical tooth extractions appropriately 1.2 11.5 87.3
A2 I am able to undertake a comprehensive, clinical oral examination 0.9 10.6 88.5
A6 I am able to interpret common findings on dental radiographs 1.2 15.5 83.3
A16 I am able to remove dental caries effectively 0.6 8.8 90.6
A17 I am able to restore teeth with tooth colored fillings appropriately 2.4 10.6 87
A19 I am able to perform endodontic treatment on single rooted teeth 

appropriately
9.4 19.7 70.9

A1 I am able to obtain complete medical history from my patients 0.6 5.8 93.6

Table 4: Part B containing questions regarding cognitive and communication skills
Item Question No experience 

(%)
Mostly 
(%)

Always 
(%)

B33 I am confident to evaluate new dental materials and products using 
an evidence-based approach

30 57 13

B30 I feel confident referring patients suspected with oral cancer 23.6 53.6 22.7
B34 I am confident to interpret the results of  research which may 

influence my practice
35.5 50.3 14.2

B35 I use an evidence-informed approach in my clinical practice 25.2 53.3 21.5
B44 I maintain accurate records of  my clinical notes 10.3 59.1 30.6
B42 I am able to manage the behavior of  children to enable appropriate 

dental treatment
9.1 68.8 22.1

B49 I feel able to raise concerns about inappropriate behavior of  my 
colleagues

14.8 55.5 29.7

B41 I feel confident managing anxious patients with appropriate 
behavioral techniques

6.7 64.8 28.5

B38 I feel confident to address barriers to effective communication with 
patients appropriately

7.3 59.4 33.3

B32 I have sufficient knowledge of  scientific principles which underpin 
my dental practice

11.2 67.9 20.9

B29 I am able to refer patients with complex treatment needs 
appropriately

9.1 59.1 31.8



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Discussion 
The results discussed in the aforementioned section 
reveal the current state of  the confidence level of  the 
house officers with regards to the skills they are expected 
to have as a dental graduate in order to lead a more 
successful career in dentistry (Qazi et al., 2021). These 
results indicate adequate experience with more than half  
of  the clinical skills listed in table A. The procedure which 
most of  the participants felt that they had no experience 
in was bitewing radiography (A5), which could be due to 
the fact that performing radiography isn’t normally taught 
in dental school (Qazi et al., 2021). As for how competent 
the participants felt regarding the cognitive skills- the 
most reported procedures (more than or equal to 25 
%) in part B of  the questionnaire for ‘no experience’ 
were all cognitive skills. This reflects weaknesses in the 
dental education system especially with regards to the 
significance of  research in dental practice. Despite these 
inadequacies, most of  the skills in which more than half  
of  the participants reported feeling completely confident 
with were affective and communicative in nature. This 
could indicate the potential for good teamwork and how 
the current model of  the education system might have 
contributed to its development. It also possibly indicates 
the existence of  a more patient-centric system that can 
communicate and fulfill the patients’ needs effectively. 
However, to create a more productive structure, more 
focus should be given to research and its inclusion in 
dental practice.
A similar study in Malaysia included its public universities 
and had an overall mean score of  79.56 and a standard 
deviation of  13.495 (Mat Yudin et al., 2020). Another 
similar study that was conducted in Pakistan in 2018 
that had utilized the dental graduates- preparedness 
assessment scale had compared its own results with the 

results of  the study that was done in the UK (Ali et al., 
2017). It had a mean overall score of  70/100 with a 
standard deviation of  11.7 (our study’s mean, in contrast, 
was 75.75 and standard deviation was 11.60) (Qazi et al., 
2021). Compared to the results of  this previous study, 
improvement and decline can be noticed in several areas 
in the results of  our study. For part A, there were about 
seven items that had indicated significant (more than 
20%) improvements via the percentages of  the scores in 
the ‘no experience’ or in ‘on my own’ columns: ability 
to formulate a treatment plan that addresses all patient 
needs (item A8), providing a range of  treatment options 
based on the individual patient’s circumstances (item A9), 
being able to explain the merits and demerits of  various 
treatment options to patients (item A10), being able to 
prescribe drugs appropriately to patients (item A13), 
being able to undertake a comprehensive oral examination 
(item A2), obtaining a complete medical history from 
patients (item A1) and being able to undertake bitewing 
radiographs (item A5). All other items of  part A indicated 
moderate improvement (less than or equal to 20%) in the 
aforementioned columns except for five items that had 
indicated an overall decline (percentage changes in ‘no 
experience’ compared with the changes in percentages in 
‘on my own’) in clinical output: being able to provide sound 
cast partial dentures (item A22), being able to provide 
mechanically sound full dentures (item A23), being able 
to restore teeth with amalgam fillings appropriately (item 
A18), being able to restore teeth with tooth colored 
fillings (item A17) and being able to perform endodontic 
treatments on single rooted teeth appropriately (item 
A19). Decrease in confidence in these procedures could 
be due to the impact of  the COVID-19 pandemic on the 
dental education system that, as mentioned previously, 
had resulted in online learning and clinical limitations 

B31 I reflect on my clinical practice in order to address my learning needs 5.5 57.9 36.7
B39 I feel confident to communicate potential risks of  operative 

procedures to patients
5.8 57.3 37

B45 I am able to work within the constraints of  clinical appointment schedules 3.6 63.3 33
B27 I recognize my personal limitations in clinical practice 6.4 44.8 48.8
B37 I provide opportunities for my patients to express their expectation 

from dental treatment
3.6 44.8 51.5

B47 I am aware of  my legal responsibilities as a dental professional 2.1 35.8 62.1
B50 I take appropriate measures to protect patient confidentiality 3 29.1 67.9
B25 I feel I can manage people's expectations of  their treatment 2.4 57.6 40
B26 I feel able to motivate my patients to encourage self-care for their 

dental needs
2.1 42.4 55.5

B28 I feel comfortable asking for help from supervisor or colleague if  needed 2.7 35.5 61.8
B36 I feel I can manage to communicate effectively with my patients 1.8 37.9 60.3
B40 I feel confident to communicate appropriately with my colleagues 1.2 34.5 64.2
B43 I am able to fulfill my responsibilities as an effective member of  the 

dental team
2.7 36.1 61.2

B46 I take responsibility for my continuing professional development 1.5 32.1 66.4
B48 I restrict my relations with my patients to a professional level 2.7 27.3 70



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of  students in the essential clinical years (third and final 
years) of  their dental education (BDS) due to the closure 
of  colleges (Ali et al., 2017; Mat Yudin et al., 2020).
Part B, on the other hand, revealed a greater decline 
compared with Part A (Qazi et al., 2021). Twelve items 
indicated a lower self-perceived competence level 
(comparing changes in the ‘no experience’ column with 
the changes in ‘on my own’ column) than the previous 
study: confidence in interpreting research results that 
could influence their dental practice (item B34), feeling 
able to raise concerns about the inappropriate behavior of  
their colleagues (item B49), having sufficient knowledge 
of  scientific principles that underpin clinical practice 
(item B32), reflecting on clinical practice in order to 
address their learning needs (item B31), feeling confident 
in addressing the barriers to effective communication 
with patients appropriately (item B38), being able to refer 
patients with complex treatment needs appropriately 
(item B29), feeling confident in communicating the 
potential risks of  operative procedures to patients (item 
B39), recognizing personal limitations in clinical practice 
(item B27), feeling comfortable in asking for help from 
a supervisor or colleague if  needed (item B28), feeling 
that they can manage to communicate effectively with 
patients (item B36), feeling confident in communicating 
appropriately with colleagues (item B40) and restricting 
relations with patients to a professional level (item B48). 
These areas of  decline indicate a lack of  proper guidance 
and clinical experience and a poorer role of  research in 
the clinical practice of  dental students. However, all other 
items indicate an improvement and the most significant 
(more than 20%) improvement was in feeling able to 
fulfill responsibilities as part of  the dental team (item 
B43) (Qazi et al., 2021).
The aforementioned study of  2018 was the first study, to 
our knowledge, to have used the international DU-PAS 
in Pakistan. It was conducted over several months and 
had a larger sample size that was meant to represent all 
the house officers of  Pakistan (Qazi et al., 2021). Even 
though, one of  its weaknesses was that the sample was not 
large or diverse enough to be representative of  Pakistan, 
by using the DU-PAS scale, it had done what numerous 
studies were unable to do, to our knowledge, which is 
to give a slight representation of  where Pakistan lies in 
comparison to other countries in terms of  the proper 
standards of  dental education by using an internationally 
validated scale (Ali et al., 2017). For our study, its 
significance stems mainly from the fact that it had used 
this scale on a sizeable portion of  the population in the 
pre-COVID era in the time PMDC determined the dental 
education system instead of  PMC. 
Our study, in comparison to the aforementioned study, 
is stronger in terms of  the sample size (which consisted 
of  330 participants compared with 128 in the previous 
study) and variability as it includes six dental colleges 
instead of  just three (Qazi et al., 2021). However, since 
our sample was meant to represent all the house officers 
of  Pakistan, it lacked diversity as it only included house 

officers from the dental colleges located in Sindh. Also, as 
mentioned in the previous study as well, the relationship 
between self-perceived preparedness and competence 
is not always so direct (Qazi et al., 2021). Some studies 
(Barnsley et al., 2004; Colthart et al., 2008; Lai & Teng, 
2011) have been conducted to investigate the connection 
between these two and have discredited the association 
between them or have advised more studies to be done 
in order to be able to provide more clarity on the subject. 
Also, other types of  information bias may have played a 
role in the data that was collected especially due to the 
questionnaire’s length. 
Despite these limitations, this was a much-needed study 
in the COVID-19 era; in which students have been unable 
to acquire the experience they need and when even a less 
diverse study such as this one can prove to be valuable 
(Ali, et al., 2017; Mat Yudin et al., 2020). In addition, it can 
also be used for comparative purposes with future studies 
done on the same topic. This could then illuminate the 
areas in the education system that need to be modified 
and help lead to a future that’s better prepared to deal 
with the pandemic. 

CONCLUSION
Results of  the study indicated that most house officers 
had some confidence in performing clinical and affective 
skills. However, the skills mostly reported in part B as 
having ‘no experience’ were mainly cognitive skills. While 
improvements were noticed in comparing these results 
with a similar study conducted in 2018 in Pakistan, several 
areas of  decline in self-perceived competence levels were 
also revealed in terms of  certain clinical, cognitive, and 
affective skills. These declines could be due to recent 
changes, including the COVID-19 pandemic.

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