Sim and Lee: Increase in dental hygienists’ competency and self-directed capacity after capstone design course on community dental hygiene

Seon-Ju Sim[1]Sun-Mi Lee[2]


Objectives: This study aimed to verify the effect on students’ competency and self-directed capacity after a capstone design teaching method with community dental hygiene class. Methods: The study participants were 34 dental hygiene students taking a 4-year community dental hygiene course at a university located in City C. The research tool consisted of 52 questions on major competency and 20 questions on self-directed capacity. Results: After the capstone design class, overall dental hygienists’ competency increased (p<0.05), and competencies of clinical dental hygiene and community health promotion showed a high increase (p<0.001). As a result of analyzing the increase in dental hygienists’ competency according to self-directed learning ability, the group with low self-directed capacity showed high improvement in clinical dental hygiene competency and community oral health promotion competency. Conclusions: This study confirmed that the capstone design course in community dental hygiene improved students’ competency and self-directed capacity, and suggests that it is an excellent teaching method for training competencies required for future society.



In the evolving landscape of dental care, dental hygienists are expected to possess a diverse range of competencies. Dental hygiene education incorporates various learning and teaching methods to cultivate the skilled workforce demanded by industry 4.0 [1,2]. The educational paradigm is shifting toward emphasizing problem-solving abilities through creative and original thinking. Additionally, there is a growing emphasis on self-directed learning methods that encourage learners’ voluntary participation, as opposed to traditional lecture-based teaching [3].

Competencies are intrinsic characteristics that manifest as observable and measurable behaviors aimed at achieving individual and organizational performance [4]. With the advent of industry 4.0, university education is increasingly focusing on nurturing individuals who possess not only knowledge but also core competencies such as problem-solving, creativity, communication skills, and personality [5]. The dental field is also advocating for a competency-based education system to prepare individuals capable of performing in clinical settings. In 2012, the United States highlighted the significance of dental hygienists’ competencies by proposing standards for dental hygiene education accreditation and evaluation [6]. In Korea, previous studies have underscored the importance of competency-based education by redefining the competencies essential for dental hygienists as “integrated and comprehensive problem recognition and problem-solving skills, attitudes, and behaviors that incorporate professional values” [7]. Bae et al. [8] suggested 8 core competencies and 52 specific competencies that dental hygienists should achieve.

In recent years, many universities have introduced capstone design classes to develop a range of practice-oriented competencies. The term “capstone” originates from architecture, where it refers to a stone placed at the top of a wall or building. In the academic context, it represents a process where students create innovative works based on their accumulated knowledge [9]. The adoption of capstone design classes in universities has expanded from engineering majors in one university to multiple disciplines across many universities, including medicine and humanities, as a course centered on solving various field-based problems [10,11]. To systematize capstone design classes for nursing students, a qualitative study involving a small number of students who experienced the capstone design was conducted. The study reported that students’ communication skills, teamwork skills, spontaneity, and problem-solving skills improved [12]. In dental hygiene, the application of the capstone design method to oral health education was reported to enhance students’ understanding of subject knowledge and communication skills [2]. Several studies have documented the effectiveness of capstone design courses in improving learners’ academic performance, problem-solving skills, communication skills, interpersonal skills, learning satisfaction, and self-efficacy [11‒13].

The significance of capstone design pedagogy in dental hygiene as a comprehensive design education program has been emphasized to prepare students for the competencies required by the industry. Dental hygiene education should aim to equip students with the necessary knowledge, attitudes, skills, and values to address a variety of clinical problems, thereby, preparing them to become competent dental healthcare professionals [14]. Dental hygienists play a crucial role in promoting oral health among the population by providing education, coordinating dental care, delivering preventive dental services, and offering administrative support to individuals and communities affected by oral diseases. Moreover, they are expected to plan, implement, and evaluate oral health promotion projects to address community oral health issues [15].

Self-directedness is a process through which learners diagnose their own learning needs, set goals, identify learning resources, create learning strategies, and evaluate learning outcomes [16]. It is emphasized to enhance nursing students’ clinical practice skills and adaptability to the fast-paced healthcare environment [17]. Similarly, self-directedness is emphasized for dental hygiene students, as it positively impacts their ability to navigate the rapidly changing dental healthcare landscape and perform various tasks [18,19]. Self-directedness is closely related to problem-solving skills [20] and is considered an important ability for capstone designing in that it involves analyzing the current situation, identifying problems, solving them, and evaluating the results [18].

Community dental hygiene is a course design to prepare dental hygienists to meet community needs. Community dental hygiene classes in American universities have been reported to develop students’ capabilities as professionals who can promote oral health among local residents by planning and evaluating projects [21]. In the case of G university in Korea, students reported improved confidence in their problem-solving and teamwork skills after their community dental hygiene practicum course [1]. However, dental hygiene curricula in Korea rarely include capstone design classes and there is a lack of research related to the role of dental hygienists. Therefore, this study aimed to verify the effects of students’ dental hygienist competencies and self-directedness on planning, implementing, and evaluating a community-based capstone design oral health promotion project as part of the dental hygiene curriculum.


1. Participants

Written informed consent was obtained from the participants who expressed willingness to participate in this study. The study population was selected from 60 dental hygiene students enrolled in a 4-year community dental hygiene course at a university located in C City. Of them, 34 students who were evaluated on dental hygienist competency and self-directedness before and after the course were enrolled, and data were collected from April 26 to June 21, 2023. This study was approved by the Institutional Review Board of Baekseok University (BUIRB-202304-HR-006).

2. Methods

(1) Instruments

(1) Dental hygienist competencies

Dental hygienist competencies can be defined as behaviors that incorporate the professional values of dental hygienists, and Bae et al. [22] proposed 8 core competencies and 52 behavioral indicators. This study used a survey developed based on the detailed competencies developed by Bae et al. [22] and finalized through expert consultation [23]. The questionnaire comprised eight core competencies: ethical decision-making, professional conduct, communication, clinical dental hygiene, hospital management, dental practice, evidence-based decision-making and problem-solving, and community and health promotion. The definitions of the eight core competencies are shown in (Table 1). For the 52 behavioral indicators, a 5-point Likert scale (1‒5) was used, with a higher score indicating a higher level of competency. Unclear statements were explained by the researcher in detail. Internal consistency reliability was measured for 52 competencies. The internal consistency (Cronbach’s α) for the overall scale was high at 0.980, and the internal consistency of the 8 core competencies was also high (Table 1).

(2) Self-directedness

Self-directedness was measured using an instrument developed to measure nursing students' self-directed learning abilities [14,15,24]. The content validity of the instrument was established through a literature review in the first stage and a Delphi study in the second stage. Then, an exploratory factor analysis was conducted on university students to verify construct validity. The reliability of the scale was analyzed to finalize the 20-item questionnaire. The internal consistency (Cronbach’s α) was 0.920, and the internal consistency (Cronbach’s α) in this study was 0.985.

Table 1

The definitions and the reliability of dental hygienists’ competencies

(2) Methods

B university evaluates the appropriateness of its capstone course each semester in accordance with the four conditions for accreditation under the University Information Disclosure Accreditation: 1. Recognition of the capstone course as a regular course, 2. capstone design in the course name, 3. provision of lab fees for developing prototypes, and 4. outcomes. Community Dental Hygiene and Practice is a major course with a capstone design at B university with client-specific oral health promotion projects developed as a prototype; it has been annually certified by the Curriculum Accreditation Center. In the 15-week class, students identify the needs of the local community, plan a customized oral health promotion project, implement the project, and evaluate it. Dental hygienists’ competency and self-directedness were evaluated twice before and after the capstone design oral health promotion project, and the evaluation was conducted from April 26 to June 21, 2023. Data from a total of 34 students were used for the final analysis.

(1) Design of a capstone design community dental hygiene course

The capstone design community dental hygiene course is design to identify the oral health status of the target population in a real-world setting, plan, implement, and evaluate a customized oral health promotion project, and then present the outcomes in a capstone competition. In developing a site-specific oral health promotion project, the students were encouraged to develop the necessary competencies of dental hygienists through creative and collaborative methods in the process of diagnosing and solving problems. Sites were selected based on community needs and included preschools, daycare centers, elementary schools, welfare centers for the disabled, nursing homes for older adults, and corporate offices.

(2) Implementation of a capstone design community dental hygiene course

The course was offered in the first semester of 2023 and was a 15-week, 3-hour lab class. Through this course, students engaged in self-directed and active learning, and each team consisted of about 4‒5 members. The teams received feedback from the instructor every week to reflect on their oral health promotion projects. The entire course was centered on the introduction of capstone design community dental hygiene, identification of community needs and status, project planning to solve the problem, project implementation, project evaluation, and capstone product competition; the lesson plan for each week is shown in (Table 2).

(3) Data analysis

This study was analyzed using SPSS WIN/PC 23.0. Dental hygienists’ competencies were presented as mean and standard deviation. The differences in each variable according to the characteristics of the participants were analyzed using paired t-test and independent sample t-test, and the reliability of the instruments was calculated using Cronbach’s α. All statistical significance levels were set at 5%.


(1) Increased dental hygienist competency and self-directedness after the community dental hygiene capstone design course

The overall dental hygienist competencies increased after the capstone design class (p<0.001), with greater improvements in clinical dental hygiene and community and health promotion competencies (p<0.001) (Table 3). Self-directedness increased after the community dental hygiene capstone design class (p<0.001) (Table 4).

(2) Dental hygienist competency based on learner self-directedness

The study examined dental hygienist competencies according to learner self-directedness at the beginning of the study and

Table 2

Lecture schedule with the capstone design method

found that overall dental hygienist competencies were higher in the self-directed group. The sub-competencies of professional behavior, ethical decision-making, evidence-based decision-making and problem-solving, communication, clinical dental hygiene, dental practice, hospital management, and community and health promotion were all higher (p<0.05) (Table 5).

(3) Increased dental hygienist competency based on self-directed learning after capstone design class

The group with low self-directed learning showed greater improvements in clinical dental hygiene competencies and community and health promotion competencies (p<0.05) (Table 6).


The purpose of this study was to assess the impact of a community dental hygiene course with a capstone design pedagogy on dental hygienist competencies and self-directedness, as well as to examine the relationship between self-directedness and dental hygienist competencies. The findings indicated an overall increase in dental hygienist competencies following the capstone design

Table 3

Improvement of dental hygienists’ competency level after capstone learning class
Table 4

Improvement of self-directed capacity after capstone learning class
Table 5

Dental hygienists’ competency level according to self-directed capacity in baseline
Table 6

Improvement of dental hygienists’ competency level according to self-directed capacity after capstone design class

class, particularly in clinical dental hygiene and community health promotion competencies. Additionally, self-directedness improved after the capstone design class, with higher levels of dental hygienist competencies observed in students who had higher self-directedness at the baseline.

The study revealed a significant enhancement in various dental hygienist competencies post-capstone design class, particularly in clinical dental hygiene competencies and community and health promotion competencies. Particularly, professional behavior, ethical decision-making, evidence-based decision-making and problem-solving, communication skills, clinical dental hygiene skills, dental practice skill, hospital administration skills, and community health promotion skills were improved significantly (p<0.001). These competencies align with those valued in industry 4.0, suggesting that capstone design pedagogy is an effective approach for preparing dental hygienists for the future healthcare workforce. The improvement was particularly notable in clinical dental hygiene competencies and community health promotion competencies. Although some dental hygiene students have reported an increase in clinical practice and communication skills after a capstone design clinical dental hygiene course [25], this study is more meaningful because it analyzed and measured the overall improvement of dental hygienist competencies after a capstone design course. Community dental hygiene is a course in which dental hygiene students work in groups to identify community needs, survey the community, diagnose oral health conditions, plan and implement oral health promotion projects for the community, and evaluate such projects. In every session, students communicated and collaborated with their teammates and utilized their competencies as dental hygienists to carry out oral health promotion projects. Feedback from the instructor was also provided at each session, and students monitored their oral health promotion projects to ensure effective implementation and progress in meeting their goals. Such a process is believed to cultivate creative problem-solving, communication, and collaboration skills that are emphasized in modern society.

Self-directedness improved after the capstone design course. The significance of self-directedness in dental hygiene education has been emphasized to develop individuals with integrated thinking skills capable of handling various clinical situations [15]. The importance of self-directed learning lies in its aim to nurture problem-solving individuals who can independently direct their learning. At the baseline, students with high self-directedness exhibited greater dental hygienist competencies. Additionally, students with lower self-directedness at the baseline showed great improvements in dental hygienist competencies overall, but clinical dentistry and community health promotion competencies were the domains that improved significantly. This suggests that the capstone design-based community dental hygiene course significantly enhanced competencies in this group as they engaged in identifying, planning, implementing, and evaluating community projects. Given the importance of boosting academic achievement among students with lower self-directedness, the capstone design course is deemed an effective teaching method [18].

The capstone design course is a dynamic, creative, and self-directed learning process where learners analyze problems using foundational knowledge from their major and apply this knowledge to solve real-world issues, thereby, fostering individuals capable of adapting to the industry [10]. As oral health promoters, dental hygienists are expected to possess the ability to identify the needs of diverse communities and target populations, diagnose oral health issues, and propose oral health promotion projects through the planning, implementation, and evaluation stages of capstone design courses in college.

This study analyzed the outcomes of a capstone design class involving 34 students and 8 teams at B University. However, there are several limitations to consider. First, it is challenging to generalize that the results of the capstone design class activity will have the same effect on the entire dental hygiene department and all learners. Second, the results of this study were analyzed after the students participated in the oral health promotion project at the start of the semester, which may introduce some deficiencies in the study design, such as the homogeneity between groups and the establishment of a control group. Finally, this study did not account for the possibility that differences in understanding of curriculum content other than the capstone design course may influence learners’ self-directedness and dental hygienist competence. Despite these limitations, this study is significant as it is the first one to analyze the impact of the capstone design course on self-directedness and dental hygienist competence, building on studies that have highlighted the importance of industrial field experiences and community-based courses for professional learning [9,10]. Future studies are recommended to expand the analysis of capstone design courses in dental hygiene curricula by exploring the common characteristics and structural linkages of capstone design courses in other colleges.

This study confirmed the effectiveness of the capstone design community dental hygiene practicum in promoting learner selfdirectedness and dental hygienist competencies as well as in leading to marked improvements of dental hygienist competencies among students who exhibited low self-directed learning at the baseline.


This study applied a capstone design to a community dental hygiene class to investigate improvements in dental hygienist competencies and self-directedness, as well as to analyze differences in the improvement of such competencies according to the level of self-directedness. The key findings are summarized below:

1. Dental hygienist competencies and self-directedness increased after the capstone design-based community dental hygiene course compared to the baseline (p<0.001).

2. Overall dental hygienist competencies were higher in the high self-directedness group (p<0.05).

3. The improvement in clinical dental hygiene competencies and community and health promotion competencies was higher in the low self-directedness group (p<0.05).

Based on the findings that demonstrate improvements in dental hygienist competencies and self-directedness following a capstone design-based community dental hygiene course, this teaching method is recommended to develop competencies required in industrial workplaces in the industry 4.0 era.


Author Contributions

Conceptualization: SJ Sim, SM Lee; Data collection: SJ Sim; Formal analysis: SJ Sim, SM Lee; Writing-original draft: SJ Sim, SM Lee; Writing-review&editing: SJ Sim, SM Lee

Conflicts of Interest

The authors declared no conflicts of interest.



Ethical Statement

This study was approved by the Institutional Review Board of Baekseok University (BUIRB-202304-HR-006).




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