Exploration and practice of comprehensive clinical rotation internship for undergraduate dental students

Abstract

Background

University-based programs should aim to teach dental students about practice procedures to gain insight into day-to-day activities. This study introduces a newly established comprehensive dental professional curriculum, including an additional 9-week comprehensive rotation internship program.

Methods

All dental students from the Department of General Dentistry II under Peking University School and Hospital of Stomatology (PKUSS) who completed a specialized internship in the five research areas (endodontics, periodontics, prosthodontics, oral and maxillofacial surgery, and pediatric dentistry), including an additional 9-week comprehensive rotation, were invited to participate in the survey (total n = 253 in years 2022–2024). Utilizing the complete sample population, we distributed the questionnaire electronically via WeChat. Descriptive statistics were employed to analyze the distribution of responses. The Chi-Square test was utilized to assess potential differences in response patterns between genders and between academic programs.

Results

The response rate was 98.8% (n = 250/253). A total of 70.4% of students believed that a 9-week comprehensive rotation was necessary to improve the program. 76.8% thought it was essential to introduce the dental comprehensive specialty. 75.6% felt that the dental comprehensive specialty internship should last longer, and 83.2% believed that it helped them develop comprehensive diagnostic and treatment thinking abilities. No significant differences were observed in the responses between male and female students (p > 0.05). However, 5-year program students demonstrated significantly higher preference rates for both comprehensive rotation (80.3% vs. 59.32%; p < 0.001) and dental comprehensive specialty internship (82.58% vs. 70.34%; p = 0.011) compared to 8-year program students. Furthermore, a significantly higher proportion of 5-year program students reported improvement in their prosthodontic competence following the training (45.45% vs. 27.97%; p = 0.004).

Conclusion

The comprehensive rotation model was effective in helping students establish comprehensive diagnostic thinking and train multi-specialty clinical skills. Further exploration and improvement are needed to effectively leverage the advantages of multi-specialty training in the comprehensive teaching clinic.

Introduction

Clinical internships are crucial to dental education, combining medical theoretical learning with clinical practice. One of the primary benefits of internships is gaining hands-on experience in a real-world setting. It is important not only as a link to dental education but also as an approach that significantly enhances the ability of dental students to engage in practical work and reach professional quality.

In recent years, dental schools worldwide have been actively exploring and innovating their clinical internship models to better align with the evolving demands of the profession [1, 2]. Internationally, two primary clinical education models dominate: the comprehensive care model and the traditional departmental model. In the traditional model, undergraduate students rotate through various dental departments, receiving clinical supervision from instructors specializing in one discipline at a time. This approach has been characterized as prioritizing students’ educational needs over the holistic dental needs of patients. In contrast, the comprehensive care model integrates clinical training across all specialties within a single clinic setting. This patient-centered approach not only facilitates comprehensive and timely dental care for patients but also enriches students’ educational experiences by exposing them to a broader range of clinical scenarios [3, 4]. However, this model demands a higher level of responsibility from students and may present challenges in managing the complexity of diverse patient cases.

Globally, the predominant training model for clinical internships in medical education emphasizes comprehensive diagnosis and treatment. Nevertheless, significant variations exist among institutions regarding internship structures, including the choice of training bases, duration, faculty involvement, content, and organizational arrangements [1, 3,4,5,6]. In China, dental students typically commence their clinical internships during the fourth or fifth year of undergraduate study, often following a rotational system across various dental specialties [8, 9]. This model aims to provide students with a broad exposure to different areas of dentistry, fostering a well-rounded understanding of the field.

Department of General Dentistry II under Peking University School and Hospital of Stomatology (PKUSS) was established in 2008. As a teaching base, it has undertaken the task of clinical rotation internships for fifth-year students in the five-year and eight-year dental programs for 16 consecutive classes. Establishing a comprehensive clinic enhances the overall teaching cohesion, allowing patients to receive comprehensive treatment within the department. As one of the early-established comprehensive teaching clinics in China, the Department has undertaken significant clinical internship teaching, accumulating rich teaching experience. However, current clinical teachings mainly follow a specialized rotation model based on the standardized training of fundamental theories and skills. Overall understanding and comprehensive analytical abilities of oral diseases among medical students remain relatively weak due to a lack of training in this area.

The cultivation of comprehensive diagnostic and treatment thinking in dentistry primarily focuses on the clinical direction of general dentistry, emphasizing patient-centered care, providing comprehensive, continuous prevention and treatment services for common oral diseases, and maintaining oral health. Dental schools worldwide have been actively reviewing, modifying, and implementing evidence-based, patient-centered, comprehensive care curricula, encouraging integrated learning methods [4]. Over the years, the dental clinical internship model in China has introduced new opportunities and challenges for dental professionals aiming to improve their comprehensive diagnostic and treatment thinking. Several domestic institutions have explored comprehensive internship models constantly in China [7,8,9,10]. This model emphasizes comprehensive clinical skills and patient-centered care. However, several comprehensive models reported in China share similarities with our existing teaching framework, wherein students undergo rotations across various specialties within a comprehensive clinical setting. So far, no unified model or standard exists for standardized comprehensive internship training. Thus, exploring and establishing a training system for comprehensive dental diagnosis and treatment professionals is necessary.

Hence, the aim of this study is to introduce a newly established comprehensive dental professional curriculum, which includes an additional 9-week comprehensive rotation internship program and new-established dental comprehensive specialty. Based on the proposed model, we hypothesize that: (1) The new internship model will improve students’ clinical competence in each specialty. (2) Students participating in the model will demonstrate superior comprehensive thinking. (3) There is little response difference between students. These hypotheses will be tested through an anonymous questionnaire survey which conducted among students after the internship to evaluate the comprehensive internship teaching model, thus laying the foundation for establishing comprehensive diagnostic thinking and teaching models in dentistry.

Materials and methods

Comprehensive rotational internships

Teaching arrangement for comprehensive rotational internships

After completing specialized internships in Endodontics, Periodontics, Prosthodontics, Oral and Maxillofacial Surgery, and Pediatric Dentistry, students gained essential knowledge and skills in diagnosing and treating prevalent diseases. Subsequently, they underwent a 9-week comprehensive rotational phase, which included an internship in the newly established Dental Comprehensive Specialty, where they were given the opportunity to provide comprehensive care, including thorough oral examinations, comprehensive treatment planning, multi-disciplinary dental treatments, and overall oral health management. In the Dental Comprehensive Specialty program, students are trained to manage a wide range of clinical cases, including tooth extractions, restorative treatments for caries and non-carious hard tissue defects, root canal therapy for anterior teeth and premolars, scaling and root planing, restoration of tooth defects, and the fabrication of both simple fixed and removable partial dentures [8]. During this time, students continued their internship programs in the six specialties, with each specialty taught by dedicated instructors. A high-ranking general dentistry instructor was overseeing the teaching. The instructors for each specialty were consistent, and students rotated between specialties, which allowed patients to receive multi-disciplinary treatment within the same clinic.

Preparations before comprehensive rotational internships

From 2011 to 2018, PKUSS cooperated with the Eastman Institute for Oral Health at the University of Rochester, USA, to train internationally qualified general dentistry educators. The teaching clinic has four faculty members certified by the Advanced Education in General Dentistry (AEGD) program, acting as key general dentistry educators. Since 2012, twelve faculty members have earned medium professional titles. In 2014, the clinic launched its “comprehensive registration”, emphasizing one-stop service for patients.

Before the comprehensive rotational internship, a faculty mobilization meeting was held to clarify the teaching objectives and to outline the teaching content. The rotational internship aimed to help students develop comprehensive diagnostic thinking and clinical skills. The pre-clinical teaching content included theoretical courses on comprehensive diagnostic thinking and training, studies on collecting and organizing comprehensive cases and nationally awarded exemplary comprehensive cases as demonstrations. The clinic’s comprehensive teaching case database was also available for clinical teaching to ensure smooth teaching operations.

Content arrangement for comprehensive rotational internships

The core of the comprehensive rotational internship is grounded in fundamental knowledge and skills, emphasizing the standardization of basic operations and the development of comprehensive diagnostic thinking. It also includes strict requirements for process organization and teaching methods. The internship lasts nine consecutive weeks, totaling 315 h (4.5 days per week are dedicated to clinical practice and 0.5 days to advanced clinical problem-solving courses, including interdisciplinary and humanistic theory courses).

The teaching clinic offers internships across the six specialties: Endodontics, Periodontics, Prosthodontics, Oral Surgery, Pediatric Dentistry, and Dental Comprehensive Specialty. The teacher-to-student ratio is 1:4–1:5, with one teacher supervising 4–5 students. Various teaching formats include daily summaries, mini-lectures, literature reviews, case presentations, clinical demonstrations, end-of-course assessments, and case displays. Teachers are responsible for monitoring every stage of the patient reception process, ensuring thorough oversight at each step. Typical cases are demonstrated using microscopes, surgical demonstrations, and digital restoration demonstrations. Additionally, medical ethics, patient communication, and other humanistic concepts are integrated throughout the teaching process, fostering a learning environment focused on ethical and professional development.

The teaching model of the dental comprehensive specialty internship is shown in Fig. 1. During dental comprehensive specialty internship, the new patients are comprehensively examined. Then, under the guidance of instructors, dental students formulate comprehensive treatment plans and provide multi-disciplinary care, documenting the comprehensive medical records according to standard protocols. Faculties oversee each critical step. After daily internships, discussions and summaries are held, where instructors and students analyze and summarize clinical issues encountered during the day, review foundational knowledge, reflect on problems in the diagnostic process, and identify common issues and areas for improvement in techniques, procedures, and patient communication. The instructors organize multi-disciplinary case discussions for complex cases to establish and cultivate comprehensive dental thinking and clinical skills among students. Following the completion of their comprehensive dental specialty internship, students underwent a multi-dimensional evaluation process comprising three key components: (1) continuous daily performance assessments, (2) structured clinical reasoning exercises, and (3) comprehensive case-based presentations. This integrated assessment approach was designed to thoroughly evaluate both clinical competencies and diagnostic reasoning skills across various clinical scenarios.

Fig. 1

Teaching model of dental comprehensive specialty internship

Questionnaire survey

This study was approved by the Institutional Review Board of Peking University School and Hospital of Stomatology (PKUSSIRB), according to the Helsinki Declaration (Approval number: PKUSSIRB-2024105199). A waiver of written informed consent was granted, and verbal consent was obtained from all participants after they were fully informed about the study purpose and procedures. Participation of the study objects was entirely voluntary and completely anonymous.

The development of questionnaire followed a rigorous, multi-stage process to ensure its validity and reliability. Initially, the questionnaire was conceptualized and drafted through structured focus group discussions involving domain experts in dental education. Subsequently, it underwent comprehensive content validation by an independent panel of eight experts in the field, who evaluated the relevance, clarity, and appropriateness of each item. This validation process yielded a content validity index (CVI) of 0.89, exceeding the recommended threshold of 0.78 for establishing excellent content validity. The final version of the questionnaire employed a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) to quantify respondents’ perceptions, allowing for nuanced measurement of attitudes and experiences while maintaining response consistency. The questionnaire was designed based on two aspects: the arrangement of comprehensive rotations and the internship in Dental Comprehensive Specialty, with four items under each aspect, evaluated with Very Satisfied, Satisfied, Neutral, Somewhat Unsatisfied, and Very Unsatisfied. Besides basic demographic information, the questions regarding the comprehensive rotation arrangement included four items: the necessity of the 9-week comprehensive rotation, its duration, self-assessment of clinical ability improvement, and the impact on clinical skills development in each specialty. Regarding the internship in Dental Comprehensive Specialty, the four items focused on the need for rotational training, the duration of the training, the influence on developing comprehensive diagnostic thinking, and the impact on self-assessed clinical ability improvement.

This study employed a complete enumeration sampling method. A total of 253 dental students, 101 males and 152 females (85 students from the class of 2017, 80 students from the class of 2018, and 88 students from the class of 2019) from the Department of General Dentistry II under PKUSS who were from 8-year program and 5-year program were all invited. All participants were informed and consented to participate in the study. The questionnaire was administered to the entire cohort of participants (n = 253) during the final week of the internship program through a secure electronic survey platform, with distribution facilitated via the widely-used WeChat messaging application to ensure timely and efficient data collection. Instructions were provided uniformly, and the respondents anonymously filled out the survey.

Statistical analysis

All statistical analyses were conducted using SPSS version 26 software (SPSS, IBM Corporation, Chicago, IL, USA). Questionnaire responses were summarized using frequency counts and percentages. Descriptive statistics were employed to analyze the distribution of responses for each questionnaire item. The Chi-Square test was utilized to assess potential differences in response patterns between genders (male vs. female) and between academic programs (5-year program students vs. 8-year program students). All statistical tests were two-sided, with a p-value of < 0.05 considered statistically significant.

For the statistical analysis, the responses were grouped as follows: “Very Necessary” and “Somewhat Necessary” were combined as Necessary, “Neutral” was treated as Neutral (not included in the statistics), and “Somewhat Unnecessary” and “Very Unnecessary” were combined as Unnecessary. Similarly, “Very Satisfied” and " Somewhat Satisfied” were combined as Satisfied, and “Somewhat Unsatisfied” and “Very Unsatisfied” were combined as Unsatisfied. “Much improved” and “Somewhat improved” were combined as Improved; “Somewhat Reduced” and “Much Reduced” were combined as Reduced.

Results

A total of 250 dental students completed the survey questionnaires altogether, for an overall response rate of 98.8% (n = 250/253), including male 39.6% (n = 99/250) and female 60.4% (n = 151/250), respectively. Among these, 70.4% believed adding a 9-week comprehensive rotation was necessary, while 11.2% thought it unnecessary (Fig. 2a). Moreover, 46.4% of the students believed increasing the duration of the comprehensive rotation internship was necessary, while 14.4% disagreed (Fig. 2b). In addition, 65.6% of the students felt their clinical skills improved after the internship was completed, while 4.4% felt their clinical skills had not improved (Fig. 2c; Table 1). Also, 76.8%, 80.8%, and 70.0% of the students believed that their critical thinking and clinical skills in diagnosis and treating disease in periodontics, endodontics, and oral surgery, respectively, were further improved through the comprehensive rotation (Fig. 3; Table 2).

Fig. 2

Evaluation of the necessity, duration, and improvement in clinical competence of the 9-week rotation internship program. (A) The necessity of adding a 9-week program. (B) The necessity of increasing the duration of the 9-week program. (C) Evaluation of satisfaction with improvement in clinical competence

Table 1 Descriptive distribution of necessity, duration, and overall effect evaluation of 9-week comprehensive rotation

Fig. 3

Effect of 9-week rotation program on improving clinical competence in each specialty

Table 2 Cross-tabulation of the effect of a 9-week comprehensive rotation program on the improvement of clinical competence in each specialty

Evaluation results for Dental Comprehensive Specialty are shown in Fig. 4; Table 3. A total of 76.8% of the students believed that it was necessary to add Dental Comprehensive Specialty, while 7.6% thought it was unnecessary (Fig. 4a). In addition, 75.6% of the students believed it was necessary to increase the internship duration, while 8.0% thought it was unnecessary (Fig. 4b). Also, 60.8% of the students were satisfied with the improvements in clinical skills from the comprehensive specialty, while 5.2% were unsatisfied (Fig. 4c). Moreover, 83.2% of the students believed the Dental Comprehensive Specialty internship helped them develop comprehensive diagnostic and treatment thinking, while 16.8% thought it did not (Fig. 4d).

Fig. 4

Evaluation of the necessity, duration, and improvement of clinical competence and comprehensive thinking from Dental Comprehensive Specialty. (A) The necessity of adding Dental Comprehensive Specialty to the program. (B) The necessity of increasing the duration of Dental Comprehensive Specialty. (C) Evaluation of satisfaction with improvement on dental comprehensive competence. (D) Evaluation of improvement on comprehensive diagnostic and treatment thinking

Table 3 Descriptive distribution of necessity, duration, and effect evaluation of dental comprehensive specialty internship

When stratified by gender, no significant differences were observed in the responses regarding 9-week clinical rotations and dental comprehensive specialty internship preferences between male and female students (Table 4). However, significant differences emerged when stratifying by academic program. Students in the 5-year program demonstrated significantly higher preference rates for both comprehensive rotation (80.3% vs. 59.32%; p < 0.001) and dental comprehensive specialty internship (82.58% vs. 70.34%; p = 0.011) compared to their counterparts in the 8-year program (Table 5). Furthermore, a significantly higher proportion of 5-year program students reported improvement in their prosthodontic competence following the training (45.45% vs. 27.97%; p = 0.004) (Table 5).

Table 4 Chi-Square test to assess potential differences between male and female (stratifying by gender)

Table 5 Chi-Square test to assess potential differences between 5-year program and 8-year program students (stratifying by academic program)

Discussion

Clinical internships are foundational to professional training, allowing medical students to integrate basic theory, essential knowledge, and fundamental skills through clinical practice. It is a transitional zone through which newly qualified physicians are integrated into team-based care. Department of General Dentistry II at PKUSS, as a teaching base, pioneered the establishment of a comprehensive teaching clinic in China. This setup allows students to undertake specialty internships in different areas of the comprehensive clinic [8]. During the specialty internship phase, students are guided by specialized doctors who standardize and refine their clinical operational skills. Simultaneously, the open nature of the comprehensive clinic strengthens inter-specialty connections, facilitates multi-specialty consultations and referrals for patients, enhances the overall coherence of the teaching process, and aids in completing comprehensive treatments within the department. This setup also helps students observe and understand complex, comprehensive cases, which to some extent promotes the development of students’ clinical comprehensive diagnostic thinking [8]. Several other domestic institutions have been exploring and practicing the comprehensive clinic teaching model in China. Ping et al. [9] and Hui et al. [10] have confirmed that compared to traditional departmental internships, students following the specialty teaching model within the comprehensive clinic can better consolidate theoretical knowledge and cultivate their clinical thinking abilities, thereby benefiting the enhancement of comprehensive analytical skills. However, even within a comprehensive clinic, this specialized training approach often lacks systematic training in comprehensive diagnostic concepts, making it challenging for students to integrate knowledge from various specialties. As a result, they may find it difficult to propose the most reasonable comprehensive treatment plans for patients with complex oral conditions, hindering the students’ abilities to comprehensively analyze and solve problems [11].

Herein, we propose a comprehensive rotational program, implemented after students complete their specialty internships in the comprehensive clinic and attain proficiency in foundational diagnostic knowledge and essential operational skills across various specialties, to address this issue. This model enhanced students’ abilities to analyze and solve problems comprehensively and to establish a holistic generalist perspective. During the comprehensive rotational program, students alternate their internships across six specialties (Periodontics, Endodontics, Prosthodontics, Oral Surgery, Pediatric Dentistry, and Comprehensive Dentistry), with patients following the medical students for rotational treatment. In particular, the Comprehensive Dentistry specialty emphasizes thorough oral examinations and phased comprehensive treatment planning for adult patients, aiming to help students develop comprehensive diagnostic thinking. This approach seeks to improve students’ comprehensive diagnostic and treatment capabilities while ensuring specialized and meticulous training in each specialty, thereby enhancing the effectiveness of the internship teaching. This program has been implemented over a three-year period, involving 253 dental students in a comprehensive rotation internship. Each rotation spanned nine consecutive weeks, with the majority of the time allocated to hands-on clinical practice. Following daily training sessions, instructors conducted summary discussions and delivered mini-lectures to reinforce key concepts. Simultaneously, students actively participated by presenting literature reviews and case reports, fostering an interactive and reflective learning environment. During the final week of the internship program, the questionnaire was administered to the entire cohort of participants using electronic survey links sent via WeChat to ensure timely and efficient data collection. From the results, an overall response rate was 98.8% (n = 250/253), with no significantly difference between male and female (98% vs. 99.3, p = 0.78).

Currently, the teaching model for clinical internships of dental students both domestically and internationally tends towards centralized teaching in comprehensive clinics [9,10,11,12,13,14,15,16]. However, most comprehensive treatment models in China are similar to our previous teaching model, based on specialized rotations within a physical comprehensive clinic. This approach involves specialized instructors guiding the teaching process, with little emphasis on a comprehensive faculty implementing a generalist diagnostic and treatment philosophy. Even so, the specialized rotation model within comprehensive clinics has been shown in numerous studies to have certain advantages, theoretical exam scores [9, 10, 17] and practical skills [10, 13, 17] of these students are generally higher than those who underwent rotations in specialized departments. Also, patients can complete (or almost complete) comprehensive dental treatment within one department, increasing their trust in the doctors and the department. However, specialized instructors tend to focus on their areas of expertise during teaching, often resulting in patients receiving multi-specialty treatment within the department without a comprehensive, coordinated, patient-tracking approach that offers the most reasonable overall diagnostic and treatment plan. Students also miss out on learning about the entire treatment process for patients [14].

Gong et al. [18] attempted to strengthen comprehensive training programs in integrated teaching, focusing on developing students’ abilities to analyze cases from multiple specialties and perspectives, formulate comprehensive treatment plans tailored to each patient, and follow the entire treatment process, which aligns with our proposed concept of integrated teaching. They found that, compared to the specialized group, students in the comprehensive group showed no significant advantage in professional skills but demonstrated significantly better case analysis abilities. However, in this study, students began comprehensive rotations without prior exposure to clinical reception and actual operations in various specialties, leading to a significant amount of time being spent familiarizing themselves with these aspects, thus reducing the time available for comprehensive training [18]. The specific qualifications of the teaching faculty were also not mentioned. The availability of internship opportunities and high-quality teaching faculty represent significant concerns for medical students [19, 20].

In Wu’s study [21], the comprehensive group reported longer independent operation time than the traditional one. Their confidence level related to comprehensive skills, such as arranging appointments and managing patients and procedures needing long treatment periods, such as molar endodontics, was higher. The traditional group showed higher confidence in more specialized surgical extractions and suturing. Praveen et al. [4] found that students under the comprehensive teaching model reported higher self-confidence in 22 clinical operations, including history recording, clinical examination, diagnosis, emergency management, and basic simple procedures like anterior teeth endodontics and subgingival scaling. In Karuveettil’s study, similar findings were corroborated, demonstrating that the new comprehensive model effectively enhances the development of proficient clinical skills and fosters the confidence necessary for independent practice among dental undergraduate students [22]. The faculties in these studies were still specialized professionals. In our study, medical students reported improved abilities in restorative and endodontic, periodontal, and surgical specialties, feeling more confident throughout the diagnostic and treatment process, which could be due to their solid foundation in specialized clinical skills and effective patient-doctor communication gained from prior specialized training. This background made students more adept at clinical reception skills and treatment operations during the comprehensive rotation. As internship practice opportunities and time accumulate, clinical skills will further improve, allowing more focus on developing a holistic, generalist approach and comprehensive analysis of complex cases.

In our study, the majority (83.2%) of medical students felt that the comprehensive internship strengthened their ability to comprehensively analyze cases, giving them more confidence in handling complex cases, which is consistent with findings by Hattar et al. and Dehghan et al. Hattar [15] noted that the comprehensive teaching model allowed them to effectively address patients’ needs and provide higher satisfaction. Furthermore, it positively influenced self-confidence, permitted greater exposure to clinical techniques and enhanced reasoning and analytical skills. Students in Dehghan’s study [3] accomplished more comprehensive dentistry with greater consistency of supervision from faculty in a more patient-centered environment than in the departmental model. However, Dehghan recommended rotating group leaders at least every six months. In our study, the additional comprehensive rotation and dental comprehensive specialty internship lasted only nine weeks due to time constraints. Most students (75.6%) desired to extend the duration, indicating high enthusiasm for the internship and confirming the success of adding dental comprehensive specialty. We also ensured that students received guidance from two general dental educators (one senior-ranking and one experienced medium-ranking dentist) to avoid a sole teaching perspective and optimize the learning experience.

To investigate potential variations in responses among students, we performed stratified analyses based on gender and academic program. The analysis revealed no significant gender-based differences in students’ preferences for the 9-week clinical rotation and comprehensive dental professional internship (Table 4), aligning with our initial hypothesis. This finding suggests comparable levels of dedication and engagement in the internship process between male and female students.

However, significant disparities emerged when examining responses by academic program. 5-year program students demonstrated significantly higher preference rates for both comprehensive rotation (80.3% vs. 59.32%; p < 0.001) and comprehensive stomatology practice (82.58% vs. 70.34%; p = 0.011), compared to their 8-year program counterparts. This discrepancy may be attributed to the imminent career pressure faced by five-year program students, who must confront employment or further education decisions shortly after completing their internships. The urgency of these impending decisions likely motivates them to seek comprehensive training opportunities that enhance their clinical competencies and marketability.

Notably, a significantly higher proportion of 5-year program students reported improvements in prosthodontic competence following the training (45.45% vs. 27.97%; p = 0.004) (Table 5). However, a detailed examination of the data reveals that self-reported competency improvement in prosthodontics (37.2%) was substantially lower compared to other specialties (76.8%, 80.8%, and 70.0%, respectively) (Fig. 2). While these descriptive data preclude definitive statistical conclusions, they suggest that students generally perceive limited benefits in prosthodontic skill development during the rotation. This perception may be directly related to the scarcity of prosthodontic cases in our clinic, compounded by the limited time allocated to prosthodontics within the 9-week rotation period. The higher percentage regarding improvement in prosthodontic skills among 5-year program students may reflect their proactive approach in seeking clinical opportunities during the internship. These findings underscore the need for strategic improvements in our clinical training program, particularly in enhancing access to prosthodontic cases. Future teaching initiatives should focus on expanding the patient pool for prosthodontic treatments, thereby providing students with more comprehensive hands-on experiences and improving their diagnostic and therapeutic skills in this crucial dental specialty.

This program has certain limitations that should be acknowledged. The comprehensive model was implemented for a relatively short duration, spanning only three years, with each cycle lasting nine weeks. The limited study period restricts the ability to draw definitive conclusions, and further evaluation is necessary to assess the long-term outcomes and impacts on dental education. The condensed timeframe placed additional pressure on students to develop comprehensive thinking skills within a brief period. To address this challenge, it is essential to adopt a well-structured course design, incorporating pre-clinical training, a systematic curriculum, and robust assessment methods. Furthermore, the optimal duration of the internship component warrants further investigation, particularly in light of student feedback suggesting the need for an extended internship period.

On the other hand, this study is limited to evaluating the internship’s effectiveness solely through the lens of students’ self-assessment, which provides only preliminary evidence for the success of the new internship model. While existing research indicates a correlation between students’ confidence and their operational competence [23, 24], this also highlights the need for more objective measures of clinical proficiency in future studies to further validate the efficacy of the new model. It is important to note that clinical internships are not merely educational activities but also clinical practice. As such, patient satisfaction represents a critical yet overlooked metric for evaluation. This aspect was not addressed in our study, representing a notable limitation that should be considered in further research. Globally, in developed regions of dental medicine, the clinical workforce consists predominantly of general dentists (85%) with specialists (15%) in a “pyramid” structure [20]. Training for medical students should align with societal needs, prioritizing the education of competent general dentists as the mainstay of dental healthcare. Clinical internships for undergraduate dental students form the foundation of the entire dental education system. Most undergraduate students engage in general practice after graduation, making it socially significant to instill generalist thinking and enhance their comprehensive case analysis abilities early in their internship training.

Conclusion

This new comprehensive rotational internship program can improve diagnostic thinking and enhance their multi-specialty clinical skills in dentistry. However, further exploration and improvement are still required on the specific duration of the comprehensive rotation and the best way to integrate it with specialized rotations to maximize the potential benefits of comprehensive teaching clinics.