The Impact of Early Clinical Exposure on Competency Development in Dental Students: A Systematic Review and Meta-Analysis

Introduction and aims: Early clinical exposure (ECE) integrates students into clinical settings during theoretical learning, aiming to foster professional development. This systematic review aims to comprehensively evaluate the impact of ECE on the overall competency of dental students. Methods: A systematic literature search was performed in PubMed, EMBASE, Web of Science, Cochrane Library, and CNKI. Studies were screened based on the PICOS model, with basic characteristics and outcome data extracted. Methodological quality and risk of bias were assessed. Meta-analysis was conducted, and the standardised mean difference (SMD) and its 95% confidence interval (CI) were employed to evaluate the overall effect of ECE on dental education. Subgroup analysis and meta-regression were used to explore sources of heterogeneity. Sensitivity analysis was performed to test the robustness of the findings, and publication bias was assessed using Begg’s test and Egger’s test. Results: A total of 27 studies involving 2995 dental students were included. Meta-analysis demonstrated that ECE significantly improved the overall competency of dental students (SMD = 1.25, 95% CI = 0.83-1.66) whether in randomised controlled trials (RCTs) or nonrandomised studies of interventions (NRSIs). Subgroup analysis revealed a significant positive trend across multiple ECE types (real clinical settings, simulated clinical interactions and virtual environment learning), different competency domains, student levels, and disciplines. Conclusion: Current evidence suggests ECE may enhance dental students' competencies in theoretical knowledge, clinical skills and self-efficacy. However, due to substantial heterogeneity and the low certainty of evidence among the included studies, the current evidence should be considered suggestive rather than definitive and further high-quality research is warranted to validate and refine these findings. Clinical relevance: Early interaction and immersion in clinical settings may enhance the comprehensive competency development of dental students compared to traditional didactic approaches.