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

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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.

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