1 Overview of evidence-based orthodontics
Evidence-based medicine is a problem-based medical education model. Compared with the traditional medical education model, evidence-based medicine pays more attention to the cultivation of innovative ability and lifelong self-study ability. Starting from solving practical clinical problems, it puts forward a set of theories and methods to find problems in clinical practice, find the best available evidence, evaluate and comprehensively analyze the obtained evidence and application results, and thus guide the diagnosis, treatment and prognosis of diseases. As an important branch of evidence-based medicine, evidence-based orthodontics aims to apply the principles and methods of evidence-based medicine to the field of orthodontics and guide the clinical practice of orthodontists, emphasizing both clinical experience and the best research foundation. Only by combining experience and evidence perfectly can we provide more effective and safer correction methods for malocclusion patients. For example, how to choose tooth extraction and non-tooth extraction in orthodontic treatment? Is the treatment of skeletal Angle Class Ⅱ malocclusion in adolescent growth and development a choice of growth improvement, fixed correction or surgical treatment in adulthood? What is the relationship between orthodontic treatment and temporomandibular joint disease and periodontal disease? These are the clinical problems that orthodontists face every day. On the one hand, the choice of treatment scheme depends on the analysis of patients' clinical data, such as model and cephalometric analysis; On the other hand, it is necessary to combine patients' subjective wishes with doctors' clinical experience. However, these factors may have some deviations and lack of scientific verification. Only when randomized clinical controlled trials are conducted under feasible conditions and then systematically evaluated, the conclusions and treatment schemes obtained in this way are relatively scientific and effective. Looking for the most valuable evidence from the vast amount of information, judging the authenticity and quality of the evidence, and making appropriate treatment plans for patients are the only way to cultivate the independent thinking and innovative thinking ability of orthodontic graduate students. Evidence-based orthodontics provides us with a brand-new clinical teaching concept, which can effectively guide students to solve clinical problems and provide quality medical services.
2 Orthodontics professional degree graduate training characteristics
Orthodontics is a clinical discipline of stomatology, which studies the etiology, mechanism, diagnosis, prevention and treatment of malocclusion. It is one of the most dynamic subjects in stomatology in recent 30 years, with relative independence and particularity. In the undergraduate study stage of stomatology, orthodontics course has few hours, the teaching content is mainly the theory and application of specific treatment techniques, and the experimental teaching has little contact with theory and clinic, so clinical practice is generally not arranged. Therefore, it is unlikely for undergraduates to master the treatment of orthodontic malocclusion cases and carry out routine clinical work independently. They need to further study orthodontics through further study or postgraduate education after graduation, mainly through postgraduate education to cultivate their clinical and basic research ability in orthodontics. In 2009, in order to change the traditional postgraduate training mode which focuses on theoretical knowledge, the state adjusted the postgraduate enrollment structure and increased the enrollment ratio of professional degree graduates, aiming at cultivating more high-level applied talents to meet social needs. Orthodontics is a very practical subject, which requires high clinical ability. The training goal of postgraduate students majoring in orthodontics is to cultivate professionals with clinical practical working ability, innovative thinking ability and problem-solving ability. Under this background, only by adopting new learning methods and introducing evidence-based medicine education mode can we cultivate qualified graduate students majoring in orthodontics and continuously promote the sustainable development of clinical professionals in orthodontics.
3 evidence-based orthodontics education mode under the new learning mode
The new learning model emphasizes autonomous learning, cooperative learning and inquiry learning. Autonomous learning is the foundation, and real cooperative learning and inquiry learning must also be autonomous learning. The thinking mode of evidence-based medicine can be summarized as follows:
(1) according to the patient's medical history, signs and various auxiliary tests, put forward the problems to be solved in the diagnosis, treatment and prognosis of the disease;
(2) according to the need to solve the problem to retrieve the existing relevant evidence;
(3) Strictly evaluate the authenticity and clinical value of research evidence according to the principles of clinical epidemiology and evidence-based medicine;
(4) Using research evidence and combining clinical professional knowledge and patient selection to guide medical decision-making;
(5) Comprehensive evaluation of the above measures. The thinking mode of evidence-based medicine can fully mobilize students' enthusiasm and initiative, so that students can truly become the subject, protagonist and master of learning, get rid of passive acceptance, positive thinking and logical thinking. For graduate students majoring in orthodontics, under the new learning mode, evidence-based orthodontics education mode can follow the following steps.
3. 1 raises clinical questions
The tutor puts forward clear questions according to clinical cases, such as whether functional correction will cause damage to temporomandibular joint and cause temporomandibular joint disorder? As far as evidence-based practice is concerned, it is probably the most difficult to ask the right questions. A good question usually follows Picot's principle. P (patients) refers to patients, and we should make clear the specific patient groups to be studied; I (intervention) refers to clinical intervention, and what diagnosis and treatment measures we take; C (comparison) refers to clinical comparison, which we use to compare and evaluate the efficacy of intervention; O (results) refers to the choice of results and what clinical or laboratory indicators we use to evaluate the efficacy of intervention. The questions raised by PI-CO principle are very clear, which helps us to search all clinical experiments in a specific range, and then get the answers to specific questions and apply them to patients with specific conditions.
3.2 Retrieval of relevant evidence
Instruct graduate students to search related documents systematically. Functional appliances, orthodontics, temporomandibular disorders. Use Pubmed, MEDLINE or Cochrane database and Chinese full-text database to search and establish corresponding stations.
3.3 Evaluation of evidence
Instruct students to evaluate the authenticity, reliability and practicability of the obtained documents. Generally speaking, clinical studies designed according to RCT principles are of high quality and reliable. For example, aiming at the theme "Is functional orthodontics a risk factor for TMD?" By consulting relevant literature, the level of clinical evidence was graded and systematically evaluated, and useful information and data were extracted from it. By analyzing the advantages and disadvantages of different diagnostic criteria of TMD and the reasons why functional orthodontics affects TMJ, it is judged whether functional orthodontics will become a risk factor of TMD.
3.4 Develop corrective strategies
Guide students to re-integrate the obtained information, evaluate the current situation, put forward corresponding countermeasures for the problems that need to be solved, and finally form a valuable written summary, which can be a special summary.
3.5 to guide clinical practice
Guiding clinical practice with the results of induction and summary is the most important step in the practice of evidence-based medicine. The principle is to make the best clinical decision based on scientific, important and feasible evidence, combined with personal experience and patients' treatment needs, which is helpful for students to broaden their clinical and scientific research ideas. In short, under the new learning mode, the application of evidence-based medicine education mode has broken the authoritative position of tutors in traditional teaching, changed the simple teaching mode of "giving and receiving" in the past, and taught students to acquire knowledge actively. At the same time, in the activities of case preparation, question design, participation in discussion and answering questions, the tutor urges himself to keep learning, consult literature and update his knowledge, and can be inspired by the discussion with students, so as to really learn from each other.
;