Manual Dexterity and Self-Perceived Competence as Predictors of Performance in Dental Skills Assessments: A Cross-Sectional Study

Manual Dexterity and Self-Perceived Competence as Predictors of Performance in Dental Skills Assessments: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Manual Dexterity and Self-Perceived Competence as Predictors of Performance in Dental Skills Assessments: A Cross-Sectional Study Himesha Wadasinghe, Isuri Anuradha Thoradeniya, Sumudu Rasnayaka, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9355784/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background As clinical dental procedures demand a high level of precision and motor control manual dexterity is considered a fundamental component in dentistry. In addition to manual dexterity, a dental student's perception of their level of skill may also influence their learning outcomes. This study aims to evaluate the correlation between manual dexterity, self-perceived skill levels and performance at skills-based assessments of dental undergraduates. Methods This cross-sectional study involved 114 dental undergraduates in their 3rd year in 2023/2024 at the University of Peradeniya, Sri Lanka. Each participant completed a self-administered, structured, Likert-type questionnaire which assessed their self-perceived skill level in seven dental procedures. They also completed two manual dexterity tests; the Purdue Pegboard Test and the O’Connor Tweezer Test under direct vision and indirect vision (with use of mirror). Statistical analysis was carried out to assess the correlations between parameters. Results Among the study participants, 71.93% (82 students) were females and 85.96% (98 students) were right-handed. The results of the manual dexterity tests placed the participants within the normal range of healthy adults. A weak correlation was found between some manual dexterity test scores and self-perceived skill levels (Purdue pegboard test non-dominant hand under direct vision p 0.034, O’Connor Tweezer Test under direct vision p 0.032). No statistically significant correlation was found between self-perceived skill levels and skill-based assessment scores. Multiple regression analysis identified weak positive correlations between manual dexterity and Class II cavity preparation on mannequin and teeth setting on a simple hinge articulator. (adjusted R² of 0.046 and 0.117). Conclusion Within the limitations of this study, performance at skill-based assessments of dental undergraduates was found to be associated with their manual dexterity while no association was observed between self-perceived skill levels and performance at skill-based assessments. These findings suggest that incorporating interventions aimed at enhancing manual dexterity of dental students can improve their clinical skills. Further studies with different student samples are needed to confirm these findings. manual dexterity self-perceived skills dental education skill-based assessment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Background Dental education combines proficiency in theoretical knowledge with the development of fine manual skills ( 1 ). In most countries, students enroll in dental schools directly after secondary education through a selection process that typically includes written examinations and, in some cases, interviews. An undergraduate dental curriculum generally spans across five years which covers pre-clinical, para-clinical and clinical domains in dentistry ( 2 ). To thrive in the field of dentistry, dental undergraduates must possess strong academic ability alongside core attributes, such as empathy and social skills. Additionally, they need to develop a high level of manual dexterity, spatial skills and practical capabilities ( 3 , 4 , 5 ). The ultimate goal of undergraduate dental education is to prepare students for dental practice, enabling graduates to transition smoothly from university to independent practice. A significant portion of the dental school curriculum is focused on supporting students to master the technical skills required in dentistry ( 6 ). Manual Dexterity refers to the ability to synchronize visual signals with muscle movements that are essential for specific motor activities ( 7 ). There are two types of dexterity: fine and gross. Fine dexterity involves the ability to manipulate objects using the tips of the fingers, while gross dexterity encompasses broader and less precise movements of the hand and fingers ( 8 ). Research indicates a significant relationship between fine dexterity, visual search skills, and motor speed ( 9 ). It has been shown that dexterity can be developed through learning, training, and practice ( 7 ). To perform patient treatment safely and effectively, dental practitioners must demonstrate exceptional manual dexterity and spatial awareness, as dental procedures require surgical precision while working inside the oral cavity with limited visibility and while using a mirror ( 4 ). Even a slight mistake may lead to serious harm to the patient or adversely affect the treatment outcome ( 4 ). However, developing the level of manual dexterity required for dentistry can be challenging, particularly during the preclinical phase, which requires students to acquire a new and precise skill set ( 1 ). In this context, several dental schools have incorporated manual dexterity testing as part of their selection process ( 3 ). Various tests and instruments have been developed to assess hand function, quality, and performance during manual tasks ( 10 ). These tests are often used by occupational therapists to test hand skills, evaluate fine motor impairment in wounded patients, and assist patient selection for vocational guidance ( 6 ). Dexterity tests will provide information about the quality and speed of hand performance. The Purdue Pegboard Test, Minnesota Manual Dexterity Test, Box and Block Test, and Functional Dexterity Test have been recommended as part of dexterity and hand function studies ( 10 ). The Purdue Pegboard Test (PPT) and the O’Connor Tweezer Test (OTT) are widely recognized in healthcare related fields, particularly in dentistry, as valid and reliable tools for assessing manual dexterity ( 11 ). Previous studies have demonstrated that the OTT and PPT and as well as modified versions of both tests accurately predicted dental students’ manual dexterity and are responsive to changes following manual dexterity training ( 12 ). Self-perceived skill, is an individual's perception of how well he or she can perform a given task ( 13 , 14 , 15 ). Although self-perceived skill does not always reflect the person's actual abilities, it has a significant impact on whether the individual will proceed with a given task ( 14 ). Various factors such as a students' grades, their individual characteristics such as the general sense of self-efficacy, their level of involvement in clinical practice, instructional approaches, observation and feedback from faculty, and the setting for learning can influence an individual's perception of skill ( 15 ). As a result, an individual may possess the essential skills, but due to various reasons, they may lack confidence in their ability to complete a specific procedure. It is important to distinguish between a student’s ability to perform a task and their perception of skill as well as the relationship between the two as students with low level of perceived skill might show delayed development of skills and those with higher levels of perceived skill may harm a patient by attempting tasks above their range of ability ( 13 ). Studies have identified that improving students' self-perception regarding their skill level should be a key goal of dental education ( 14 ). Although numerous studies have examined the association between manual dexterity and dental students’ performance ( 6 , 12 ), as well as the relationship between self-perceived skill levels and performance ( 14 ), the literature remains sparse regarding the association between manual dexterity and self-perceived skill levels. This study, carried out among a group of dental undergraduates at the University of Peradeniya, Sri Lanka, aims to contribute to the current body of literature by investigating the association between manual dexterity, self-perceived skill and performance at skill-based assessments. Understanding these correlations will allow us to identify possible areas for improvement in dental education and provide guidelines for faculty regarding incorporation of manual dexterity training to enhance self-perceived skill levels and in turn the students' clinical performance. Methods This study was conducted as a cross-sectional analytical study among third-year dental undergraduates at the University of Peradeniya, Sri Lanka. Ethical approval for the study was obtained from the Ethics Review Committee of Faculty of Dental Sciences, University of Peradeniya (ERC/FDS/UOP/UG/2025/22). The survey was carried out in accordance with the Principles of the Declaration of Helsinki (2008), and the participants provided informed written consent before participating in the study. The inclusion criteria for the study were defined as dental undergraduates in the 3rd year (5th semester) during 2024 while students who have differed from a previous batch or who had undergone training programmes in addition to the dental curricula were excluded. Assessing self-perceived skill level Each participant was requested to fill in a self-administered questionnaire which consisted of two sections. The questionnaire underwent content validity assessment prior to use. The first section was designed to collect demographic data including gender and dominant hand. The second section comprised seven Likert-type questions requiring students to indicate their self-perceived skill levels across seven selected dental procedures (Given in the box below). Responses were recorded on a four-point scale: low, moderate, high, and very high. 1. Performing a class II cavity preparation on mannequin 2. Performing a class II cavity preparation in a patient 3. Periodontal debridement on a mannequin 4. Periodontal debridement in patient 5. Setting teeth on a simple hinge articulator 6. Administration of local anesthesia to a mannequin 7. Administration of local anesthesia to a patient Manual Dexterity Tests The participants then completed two manual dexterity tests: the Purdue Pegboard Test and O’Connor Tweezer Test. Both tests were performed under direct and indirect vision. Purdue Pegboard Test (PPT) Developed in 1948 by Joseph Tiffin, the PPT is a neuropsychological and vocational assessment tool that measures manual dexterity, fine motor skills, and bimanual coordination through timed tasks of placing pegs and assembling small parts ( 12 , 16 ). In this study a Lafayette Instrument company (Model 32020A) PPT instrument was used (Fig. 1). A higher score in the PPT indicated higher manual dexterity. Figure 1 . The Lafayette Instrument company (Model 32020A) Purdue Pegboard Test Instrument The PPT includes four key tasks: 1) insertion of pins into the test board holes using the dominant hand for 30 seconds, 2) insertion of pins into the test board holes using the non-dominant hand for 30 seconds, 3) insertion of pins into the test board holes using both hands simultaneously for 30 seconds and 4) using both hands to assemble nuts and bolts (assembly task) for 60 seconds (Fig. 2 ). The number of pins placed/ assembled within the given time is recorded as the score. Modification of the PPT was done as described by Lugassy et al. (2018) ( 12 ). Direct vision to the PPT board was blocked using a black shield and participants were asked to visualize the board through a mirror placed in front when performing the tests (Fig. 3 ). O'Connor Tweezer Test (OTT) The OTT is a timed assessment measuring manual dexterity, requiring subjects to place small pins into holes on a board using tweezers. It is used to assess fine motor skills for jobs needing precision, like hair grafting or dental work, with a high score indicating better aptitude for precise, small-object manipulation ( 17 ). The results are used to provide objective data for job screening or tracking rehabilitation progress. For this study, a Lafayette Instrument company (Model 32022) OTT instrument was used (Fig. 4). A lower score in the OTT indicated a higher manual dexterity. Figure 4:​​ The Lafayette Instrument company (Model 32022) O’Connor Tweezer Test Instrument As the PPT, participants were asked to carry out the OTT under both direct and indirect vision (Fig. 5 ). For the direct vision test, participants performed the test while looking directly at the board and the tweezers while for the indirect vision test, the board was covered and mirror vision was used as described for the PPT ( 12 , 16 ). For each test, participants are required to pick up one pin at a time using tweezers and place it into the designated holes, filling the board row by row. The total time, measured in seconds required to fill all 100 holes, is recorded as the score. Relevant instructions were given before each test by a single researcher. Individuals were allowed to have a brief rest in between tests. All tests were scored by one calibrated researcher and conducted in a comfortable, calm, and quiet environment to ensure optimal concentration and safe participation. Skill-based assessments Marks scored by each student at three assessments; class II cavity preparation on a mannequin, teeth setting on a plane line articulator, and periodontal debridement on a mannequin were collected from the examination department. Statistical analysis Descriptive statistics were used to summarize manual dexterity scores, self-assessed skill levels, and results of skill-based assessments. Charts like bar graphs and box plots were used to highlight key trends and distributions within the data. Correlation analysis was used to examine relationships between variables. Pearson’s correlation was used to examine the association between continuous variables, such as manual dexterity and performance scores. For ordinal data, such as self-perceived skill level, Spearman’s correlation was used. The self-perceived skill level of the seven essential clinical skills was added together to create a composite score, which served as an overall indicator of the students perceived skill level. Finally, multiple linear regression was used to quantify the predictive value of manual dexterity and self-perceived skill levels on performance at assessments, using a significance level of 0.05 to ensure meaningful results. Results Demographic Information The study involved 114 third-year dental undergraduates from the University of Peradeniya. The sample was predominantly female (71.93%), with males constituting 28.07%. The majority of participants were right-handed (85.96%), while 14.04% were left-handed. Self-Perceived Skill Level The majority of students rated themselves as having a moderate to high self-perceived skill level (2 or 3) in procedures performed on mannequin. For those procedures performed on patients, students showed low to moderate ( 1 – 2 ) levels of self-perceived skill. Students also rated themselves as having low to moderate skill levels in teeth setting on an articulator (Table 01 ). Table 01 Self-perceived skill level of students at seven dental procedures Class II cavity preparation on extracted tooth Low Moderate High Very High 14.8% 40.9% 37.4% 7% Periodontal debridement on mannequin 22.6% 40.9% 30.4% 6.1% Administration of Local Anesthesia to mannequin 21.7% 37.4% 32.2% 8.7% Setting teeth on a plane line articulator 33% 42.6% 18.3% 6.1% Class II cavity preparation on patients 36.5% 47% 13% 3.5% Periodontal debridement on patients 42.6% 38.3% 14.8% 4.3% Administration of Local Anesthesia to patients 49.6% 31.3% 15.7% 3.5% Level of Self Perceived skills is given as low, moderate, high and very high. Percentage of students who selected each response is provided. To obtain an overall view of students’ perceived skills, a composite score was calculated by summing the scores of the seven individual items. This approach provided a more comprehensive assessment of the students’ general self-perceived skill levels and facilitated comparison across participants. The internal consistency of this composite measure was evaluated using Cronbach’s Alpha, which yielded a value of 0.867, indicating good reliability. The total self-perceived skill level ranged from 7 to 28, with a mean of 14.22 (SD = 4.44). The distribution showed a slight positive skew (Skewness = 0.645) and a relatively normal kurtosis (0.317), suggesting that while most participants clustered around the middle of the scale, a few reported higher perceived competences (Fig. 06 ). Comparison of self-perceived skill levels between genders Manual Dexterity Manual Dexterity was evaluated using two standardized test instruments, and descriptive statistics were performed for results of each. Purdue Pegboard Test When using PPT under direct vision with the dominant hand, the students showed a mean score of 15.08 with an SD of 2.04, reflecting moderate variability in performance amongst participants. Under the same conditions, the non-dominant hand yielded a mean score of 13.79, indicating slightly lower proficiency. The assembly task under direct vision produced a mean score of 37.38. The mean scores of the sub-tests done under indirect vision were comparatively lower than those done under direct vision (Table 02 ). A greater variability was observed in the assembly tasks (both under direct and indirect vision), suggesting that coordinated hand movements are comparatively more challenging, whereas the other subtests demonstrated lower variability under both visual conditions. Table 02 Descriptive statistics of PPT under direct and indirect vision. Test Minimum Maximum Mean SD Skewness Kurtosis Testing under direct vision Dominant Hand 7.0 20.0 15.079 2.0357 -0.577 1.606 Non-dominant Hand 9.0 20.0 13.789 1.9024 -0.077 .495 Both Hands 8.0 16.0 11.439 1.6511 0.266 .099 Assembly Task 13.0 51.0 37.377 5.9472 -0.583 1.633 Testing under indirect vision Dominant Hand 3.0 13.0 8.947 1.8618 -0.148 .155 Non-dominant Hand 3.0 12.0 7.763 1.9339 -0.323 − .356 Both Hands 1.0 8.0 4.412 1.6553 0.008 − .661 Assembly Task 10.0 35.0 22.675 5.0088 -0.346 .344 Mean: Average, SD: Standard Deviation O’Connor Tweezer Test The results of the OTT demonstrated a non-uniform distribution, suggesting considerable variability in students’ performance and a deviation from normal distribution (Table 03 ). Greater inconsistency was observed in tasks performed under indirect vision, reflecting higher variability. Table 03 Descriptive statistics of OTT under direct and indirect vision Test Minimum Maximum Mean SD Skewness Kurtosis Direct vision 4.14 14.34 5.8468 1.30965 3.051 15.916 Indirect vision 0.46 15.54 4.2573 3.13516 1.514 2.572 Mean: Average SD: Standard Deviation A paired t-test revealed that in all PPT and OTT sub-tests, the results of the direct and indirect tests showed statistically significant differences, with the direct method having the higher mean value (Table 04 ). The highest mean difference is seen in the assembly task, highlighting the effect of indirect vision on coordinated movement. Table 04 Paired t-test comparing direct and indirect vision Test Mean Difference p-value Purdue Pegboard Dominant Hand 6.132 0.000 Purdue Pegboard Non-Dominant Hand 6.026 0.000 Purdue Pegboard Both Hands 7.026 0.000 Purdue Pegboard Assembly task 14.702 0.000 O’Connor Tweezer Test 1.589 0.000 p < 0.05 was taken as significant. Comparison of the manual dexterity between genders Box plots were used to compare manual dexterity test scores between genders. In all tests, both genders showed almost similar distributions with females performing slightly better in the PPT and males in OTT (Fig. 08 ). Performance at Skill-Based Assessments Box plots were used to visualize the distribution of marks for the three skill-based assessments: class II cavity preparation on a mannequin, setting teeth on a plane line articulator and periodontal debridement on a mannequin. Box plots indicated few outliers and a balanced spread of scores. Male and female students had similar distribution of marks in periodontal debridement and class II cavity preparation assessments, with nearly identical medians and ranges. (Fig. 9 ). In the teeth setting, females demonstrated a higher median than males. There was no statistically significant difference in marks between males and females. Correlation between self-perceived skill level and manual dexterity variables Spearman’s correlation was used to examine the correlation between total self-perceived skill level and manual dexterity test scores. A few sub-tests of both PPT and OTT showed a weak correlation with the total self-perceived skill level (Table 05 ). Table 05 Results of Spearman’s correlation analysis for correlation of total self-perceived skill level with manual dexterity subtests. Manual Dexterity Sub test Spearman’s correlation (ρ) p-value Purdue pegboard test under direct vision Dominant Hand 0.044 0.639 Non-dominant Hand 0.199 0.034 Both Hands 0.189 0.045 Assembly Task -0.035 0.709 Purdue pegboard test under indirect vision Dominant Hand 0.062 0.513 Non-dominant Hand 0.1 0.290 Both Hands -0.108 0.251 Assembly Hask 0.01 0.919 O’Connor Tweezer test under direct vision Direct Vision -0.201 0.032 Indirect Vision -0.059 0.534 p < 0.05 was considered as significant Correlation between marks scored at skills-based assessments and manual dexterity test scores Pearson correlation analysis was conducted to explore associations between marks scored at skills-based assessments and scores of the manual dexterity sub-tests (Table 06 ). Some of these sub tests demonstrated a weak but statistically significant correlation with class II cavity preparation and setting teeth on an articulator. Table 06 Results of Pearson's correlation analysis for correlation of assessment marks with manual dexterity test performance. Manual Dexterity Tests p-values Class II cavity preparation on mannequin Setting teeth on a simple hinge articulator Periodontal debridement on mannequin Purdue Pegboard Test under direct vision Dominant Hand 0.010 0.010 0.930 Non-dominant Hand 0.258 0.258 0.720 Both Hands 0.106 0.106 0.244 Assembly Task 0.075 0.075 0.910 Purdue Pegboard Test under indirect vision Dominant Hand 0.950 0.950 0.579 Non-dominant Hand 0.011 0.011 0.559 Both Hands 0.058 0.058 0.635 Assembly Task 0.175 0.175 0.749 O’Connor Tweezers Test Direct Vision 0.012 0.012 0.599 Indirect Vision 0.004 0.004 0.094 p < 0.05 was taken as significant Correlation between marks scored at skill-based assessments and self-perceived skill levels The relationship between students’ self-perceived skill levels and their marks in skills-based assessments were examined using Spearman’s correlation. Self-perceived skill level did not demonstrate a significant correlation with marks obtained in any of the skill-based assessments considered in this study (Table 07 ). Table 07 Results of Spearman's correlation analysis for correlation of assessment marks with self-perceived skills. Self-Perceived Skills Skills-Based Assessment marks (p-values) Class II cavity preparation on mannequin Setting teeth on an articulator Periodontal debridement on mannequin Individual variable 0.250 0.121 0.620 Total 0.639 0.167 0.742 p < 0.05 was taken as significant Multiple regression analysis To identify predictors of students' performance at skills-based assessments, three stepwise multiple linear regressions were conducted using manual dexterity scores and self-perceived skills as predictors for each skill-based assessment that was analyzed in this study. Class II cavity preparation on mannequin An adjusted R² of 0.046, suggested that the model explained a small portion of the variability in assessment performance. The significant predictors in the model were OTT under indirect vision (β = -0.549, p < 0.05), indicating that faster times (i.e., better performance) in this task is associated with better performance at class II cavity preparation. Setting teeth on an articulator An adjusted R² of 0.177, suggested that the model explained a small portion of the variability in assessment performance (17.7%). The significant predictors in the model were PPT non-dominant hand under indirect vision (β = 0.133, p = 0.013), OTT under direct vision (β = -0.173, p = 0.031) and OTT under indirect vision (β = -0.078, p = 0.023), indicating that manual dexterity plays a significant role in students’ performance at teeth setting on an articulator. Periodontal debridement on mannequin No predictors are significant, indicating that neither manual dexterity measures nor self-perceived skill levels significantly explained the variance in students' performance at periodontal debridement on a mannequin. Discussion Manual dexterity and self-perceived skill can be considered as essential competencies in dental education, determining student performance and professional growth. These attributes not only affect the acquisition of technical skills but also influence confidence, motivation, and clinical decision making, thereby playing a crucial role in shaping educational outcomes and readiness for future practice. By analyzing both the physical skills necessary for executing precise motor tasks and the students’ confidence in their abilities, the research attempts to reveal the complex nature of clinical competence and its implications for dental education and assessment methodologies. The sample of students that were selected for this study were 3rd year dental undergraduates. The study was carried out before commencement of their clinical appointments. Prior to the study, the students had undergone multiple preclinical tasks that are believed to influence manual dexterity. These included carving teeth in plaster, cavity preparation on mannequins, construction of custom tray and construction of wax record blocks. When comparing the reference values given for healthy adults with the scores of PPT and OTT of these students' while using the dominant hand under direct vision, (PPT 15.92 vs 15.08, OTT 6.10 vs 5.84), it can be observed that the manual dexterity levels are comparable ( 16 ). This finding suggests that preclinical tasks may not play an important role in improving manual dexterity when considering performance of the dominant hand in direct vision. However, it was interesting to see that they performed better in the PPT assembly task when compared with reference values (37.38 vs 32.97), which could suggest the development of coordinated hand movements and hand-eye coordination with preclinical practice. This finding was supported by Lugassy et al who suggested that students may demonstrate better skills in integrated motor actions than in single tasks, indicating improved performance in activities that require bilateral coordination and sequential motor planning ( 12 ). As expected, a significantly better performance was seen in tasks under direct vision than indirect vision which was comparable to previous studies ( 12 ). Lugassy et al., attributed this finding to the additional cognitive demand, hand-eye coordination and visual feedback required by indirect vision as well as the loss of depth and spatial accuracy and increased performance anxiety associated with indirect vision ( 12 ). Future research may explore whether continued clinical exposure and targeted preclinical exercises can enhance students’ proficiency in indirect vision tasks over time. The better performance of females at the PPT can be attributed to the fact that females typically exhibit higher fine motor coordination, having smaller finger sizes anatomically, excelling in skillful repetition, and learning quickly ( 6 , 12 , 18 ). Males are disadvantaged in this task as they typically have larger fingers and find it difficult to pick up thin pins. The present study found that scores of OTT under indirect vision significantly predicted the performance in Class II cavity preparation and that the performance in PPT using non-dominant hand under indirect vision and OTT under both direct and indirect vision were significant predictors for setting teeth on an articulator. Temel et al. also found a strong positive correlation between the results of 9-hole peg test (direct vision) and the grade point average of class II cavity preparation in a sample of 121 dental students ( 19 ). It is interesting to note that scores of indirect tests acted as significant predictors for the teeth setting task despite it being performed under direct vision only. Similarly, Lugassy et al. reported that a logistic regression model could predict students’ performance in Class I cavity preparation and Class I restoration on a mannequin with 74% accuracy, using PPT scores when using both hands under direct vision and OTT scores under indirect vision ( 12 ). However, in a study where he assessed the correlation between scores of the manual dexterity tests and the Perceptual Aptitude Test (a test used as part of dental school admission process designed to assess spatial visualization and perceptual skills), Gansky et al. concluded that since manual dexterity tests are not considered when calculating their class grades, students may not put forth their best effort into them ( 20 ). Therefore, it is important to consider that the observed correlation between manual dexterity test scores and skill-based assessment marks may have been influenced by students’ limited engagement or motivation during the manual dexterity tests. The relationship observed between manual dexterity and performance in skills-based assessments raises important considerations for dental student selection processes. While the inclusion of manual dexterity assessments in admissions could help identify candidates with strong baseline psychomotor abilities, reliance on such measures alone may be problematic, as dexterity can be significantly improved through training. Therefore, selection processes should adopt a balanced approach rather than using these factors as strict exclusion criteria; they may be more appropriately utilized to identify students who could benefit from early support and development programs. When considering self-perceived skill levels, students in the present study reported relatively higher confidence in mannequin-based activities compared to procedures performed on patients. This may be attributed to the fact that these students had not yet commenced clinical training, and therefore had limited exposure to real patient scenarios, which often involve greater complexity and uncertainty. A study conducted in Iran concluded that the level of confidence in performing clinical skills is positively correlated with the number of patients seen during practical sessions ( 21 ). Students may exhibit higher levels of self-perceived skill in mannequin-based simulations as they occur in a controlled setting, in the absence of dynamic physiological response, limited interpersonal interactions, and no emotional engagement. Therefore, the levels of self-perceived skills can be expected to increase with the clinical experience of the students. Students reported higher levels of self-perceived skills in performing Class II cavity preparation and periodontal debridement on mannequins. This finding aligns with a study conducted in the same setting by Wanigasooriya et al in 2004 which reported that students expressed higher confidence in managing caries and periodontal diseases ( 22 ). Similarly, Meisha and Al-Dabbagh stated that students exhibited highest self-perceived skill levels at periodontics while lower levels were reported for prosthetics ( 23 ). However, it is interesting to note that in the study by Wanigasooriya et al students showed the highest level of confidence in extraction of fully erupted teeth using forceps, while in our study, the lowest level of confidence was shown for administration of local anesthesia ( 22 ). This difference may be influenced by the differences in the academic year, level of clinical exposure, and overall clinical practice between the samples used in the two studies. The result of the present study indicates that performance at skills-based assessments did not show a significant correlation with the students’ self-perceived skill levels. The lack of correlation suggests that simply fostering confidence may not directly translate into improved technical outcomes. Therefore, educational strategies should focus on helping students develop accurate self-assessment skills through guided reflection, formative assessments, and constructive feedback. However, in contrast, a study involving senior dental students in the Faculty of Dentistry, King Abdulaziz University, Saudi Arabia found a statistically significant, weak positive correlation between self-perceived skill levels and grades at clinical assessment at the beginning of their senior year ( 23 ). It is noteworthy that differences were observed in self-perceived skill levels between male and female students. Males reported higher self-perceived skill levels than females, even though females showed better performance when compared to males in some assessments. Similar trends of gender differences in performance and self-perceived skills have been observed in the medical and other STEM fields ( 24 , 25 ). Bochatay, N., et al. found that while both genders performed well in simulated interventional radiology settings, self-assessed skill levels of females tended to be more in line with their actual performance, reflecting different approaches to self-evaluation rather than differences in skills ( 26 ). Such differences further highlight the potential disconnect between perceived and actual ability. These findings emphasize the importance of fostering accurate self-assessment and providing feedback to ensure that all students develop appropriate confidence aligned with their true skill level. This may be done by objective skill development through structured preclinical training, simulation exercises, and repeated practice. However, Meisha and Al-Dabbagh reported contrasting findings where in their study, female dental students showed higher levels of self-perceived skill levels than their male counterparts ( 23 ). Meisha and Al-Dabbagh also suggested that students who have confidence in their academic abilities believe they can gain the necessary skills, while academically challenged students often expect failure before attempting skills-based assessments ( 23 ). Providing students with opportunities to reflect on their clinical skills and encouraging self-assessment can help them identify their strengths and weaknesses, ultimately enhancing their competencies ( 23 ). By aligning students’ self-perception with their actual competence, educators can promote more effective learning, reduce over confidence or lack of confidence, and support the development of both technical proficiency and professional self-awareness. A significant correlation between manual dexterity scores and self-perceived skill levels was seen in this study. This suggests that students may possess a reasonable degree of insight into their psychomotor abilities. This alignment indicates that individuals with higher manual dexterity are more likely to perceive themselves as competent, reflecting a degree of accurate self-assessment. However, given that self-perceived competence did not correlate with actual assessment performance in this study, it is important to interpret this relationship cautiously, as confidence in ability does not necessarily translate into clinical proficiency. It is important to note that this study has several limitations that need to be considered when interpreting the findings. The sample was exclusively taken from the University of Peradeniya, meaning that the findings may not apply to dental students at other institutes and may affect overall generalizability. The cross-sectional design limits the ability to establish causal relationships between manual dexterity, self-perceived competence, and performance. Additionally, variability in assessment methods and potential examiner bias could impact the reliability of performance outcomes. The absence of longitudinal follow-up also restricts insight into how these factors may change over time with training and experience. Despite these limitations, the study has several notable strengths. It adopts a comprehensive approach by examining both objective (manual dexterity) and subjective (self-perceived competence) factors in relation to dental skills performance. This dual perspective provides a more holistic understanding of the determinants of clinical skill acquisition. Sampling bias was reduced by including the entire population of third-year dental undergraduates at the University of Peradeniya. This study was conducted in a standard setting and using well-recognized manual dexterity test tools. Furthermore, the findings contribute to the existing body of literature by highlighting the limited role of self-perceived competence as a predictor of performance, thereby emphasizing the importance of objective assessment and evidence-based educational practices. Future research should focus on longitudinal designs to better understand how manual dexterity and self-perceived competence evolve over time and influence performance across different stages of dental training. Given the lack of correlation between self-perceived competence and actual performance found in this study, further investigation is needed to explore factors that affect students’ ability to accurately self-assess, such as feedback quality, reflective practices, and educational environment. Additionally, interventional studies could examine the effectiveness of targeted training programs aimed at improving both psychomotor skills and self-awareness. Expanding the scope to include other potential predictors, such as visual–spatial ability, cognitive factors, and stress or anxiety levels, may also provide a more comprehensive understanding of the determinants of clinical skill acquisition. Conclusion The manual dexterity of third-year dental undergraduates was comparable to that of healthy adults, with female students demonstrating better performance than male students. Weak positive correlations were identified between manual dexterity and selected skills-based assessments, including Class II cavity preparation and teeth setting on a simple hinge articulator. However, no significant relationship was observed between self-perceived skills and performance in these assessments. Although this study provides important insights into the influence of manual dexterity and self-perceived competence on dental skills performance, further research is necessary to explore additional contributing factors. Such efforts may support the continued development of evidence-based approaches to enhance dental education and student outcomes. Abbreviations PPT Purdue Pegboard Test OTT O'Connor Tweezer Test Declarations Ethics approval and consent to participate This study was approved by the Ethics Review Committee of Faculty of Dental Sciences in University of Peradeniya (Research Project No. ERC/FDS/UOP/UG/2025/22). Participation was voluntary and informed written consent was taken prior to the data collection. Consent for publication Not applicable Funding Not applicable Author Contribution H.W. contributed to conceptualization and designing of the study as well as data collection and analysis and was a major contributor in writing the manuscript. I.A.T. contributed to conceptualization and designing of the study as well as data collection and analysis. S.R. contributed to conceptualization and designing of the study and supervision of the data collection and analysis and was a major contributor in reviewing the manuscript. I.P.T. contributed to conceptualization and designing of the study and overall supervision as well as reviewing the manuscript. All authors read and approved of the final manuscript. Acknowledgement The authors gratefully acknowledge the statistical support provided by MrA.L.J.Bandara and the Physiotherapy Unit of Teaching Hospital Peradeniya for allowing them to use the PPT for the study. Data Availability The datasets generated and/or analysed during the current study are not publicly available due to participant confidentiality and ethical restrictions related to the sharing of de-identified survey data but are available from the corresponding author on reasonable request. References Mittal P, Jadhav GR, Pawar M, Banerjee S, Wangaskar S, Di Blasio M, et al. Impact of self-assessment on dental student’s performance in pre-clinical conservative dentistry course. BMC Oral Health. 2024;24(1):593. Anzor Khaniev Z, Nikolaevna AA. Professional Dental Education in the Modern Russian Federation: Current Status and Prospects. Strides Dev Med Educ. 2024;21(1):92–8. Sim MY, Tan LF, Adam L, Loch C. No one is born with it: Australasian dental students’ perceptions of learning manual dexterity. J Dent Educ. 2023;87(1):60–9. Building manual dexterity skills: Health Professions & Prelaw Advising Guidebook: Indiana University Bloomington [Internet]. Indiana.edu. 2020. Available from: https://guidebook.hppla.indiana.edu/dental-medicine/building-manual-dexterity-skills.html Pérez-Chicharro M, González-Olmo MJ, Nieto-Moraleda C, Obeso-Benítez P, Martínez-Piédrola RM, Sánchez-Herrera-Baeza P et al. Improving dental students’ dexterity and strength: an intervention study. BMC Med Educ. 2025;25(1). Saeed M, Alfarra MBQ, Abdelmagied MH, Hadi K, Aljafarawi T, Al-Rawi N, et al. Comparative Analysis of Manual Dexterity of Dental Students at Ajman University following One Academic Year of Preclinical Training Sessions: A Longitudinal Cohort Study. Eur J Dent. 2022;17(4):1179–88. Neves TDC, Menegazzo VP, Novo JPD, Wajngarten D, Garcia PPNS. Dexterity Testing in Dental Students. J Adv Med Med Res. 2020;127–35. Shahar RB, Kizony R, Nota A. Validity of the Purdue Pegboard Test in assessing patients after traumatic hand injury. Work. 1998;11(3):315–20. da Silva MBB, da Silva ECF, Bispo MEF, da Nogueira S, de Leal T. JC, Mendes FA dos S. Association between cognitive performance and manual dexterity in patients with Parkinson’s disease. Physiotherapy Res Int. 2024;29(4). Gonzalez V, Rowson J, Yoxall A. Development of the Variable Dexterity Test: Construction, reliability and validity. Int J Ther Rehabil. 2015;22(4):174–80. Causby R, Reed L, McDonnell M, Hillier S. Use of Objective Psychomotor Tests in Health Professionals. Percept Mot Skills. 2014;118(3):765–804. Lugassy D, Levanon Y, Pilo R, Shelly A, Rosen G, Meirowitz A et al. Predicting the clinical performance of dental students with a manual dexterity test. Conejero JA, editor. PLOS ONE. 2018;13(3):e0193980. Gilmour ASM, Welply A, Cowpe JG, Bullock AD, Jones RJ. The undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff. Br Dent J. 2016;221(6):349–54. Panagiotidou E, Lillis T, Fotopoulos I, Kalyvas D, Dabarakis N. Evaluation of Self-Perceived Confidence and Competence in Oral Surgery among Final Year Undergraduate Students in Greece. European Journal of Dentistry [Internet]. 2023;18(01):360–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10959612/ Momeni Danaei S, Azadeh N, Jafarpur D. General Self-Efficacy and Self-Perceived Confidence of Dental Students in Performing Orthodontic Clinical Skills. Educ Res Med Sci. 2018;7(2). Levanon Y, Lugassy D, Pilo R, Nassar R, Mhana A, Maria Z, et al. Assessment of the modified O’Connor Tweezer Dexterity and Purdue Pegboard test for use among dental students. J Dent Educ. 2023;87(4):533–9. Brandy DA. The O’Connor Tweezer Dexterity Test as a Screening Tool for Hiring Surgical Hair Restoration Assistants. Am J Cosmet Surg. 1995;12(4):313–6. Peters M, Servos P, Day R. Marked sex differences on a fine motor skill task disappear when finger size is used as covariate. J Appl Psychol. 1990;75(1):87–90. https://doi.org/10.1037/0021-9010.75.1.87 . Temel UB, Hepdenı ̇ Z, Ö.K. and, Eroglu E. Determination of correlation among 9-Hole PEG test scores and preclinical performances of Second-Year students of a faculty of Dentistry,' Süleyman Demirel Üniversitesi. Sağlık Bilimleri Dergisi. 2023;14(1):22–8. Gansky SA, Pritchard H, Kahl E, Mendoza D, Bird W, Miller AJ, et al. Reliability and Validity of a Manual Dexterity Test to Predict Preclinical Grades. J Dent Educ. 2004;68(9):985–94. Momeni Danaei S, Azadeh N, Jafarpur D. General Self-Efficacy and Self-Perceived Confidence of Dental Students in Performing Orthodontic Clinical Skills. Educ Res Med Sci. 2018;7(2). Wanigasooriya N. Student self-assessment of essential skills in dental surgery. Br Dent J. 2004;197(S5):11–4. Meisha DE, Al-dabbagh RA. Self‐confidence as a predictor of senior dental student academic success. J Dent Educ. 2021;85(9):1497–503. Sylvain Bodard D, Bouzid, Ferré VM, Carette C, Kivits J, Nguyen Y et al. Impact of gender on self-assessment accuracy among fourth-year French medical students on faculty’s online Objective Structured Clinical Examinations. BMC Med Educ. 2024;24(1). ‌Wrigley-Asante C, Ackah CG, Frimpong LK. Gender differences in academic performance of students studying Science Technology Engineering and Mathematics (STEM) subjects at the University of Ghana. SN Social Sci. 2023;3(1). ‌Bochatay N, Ju M, O'Brien BC, van Schaik SM. A Scoping Review of Interprofessional Simulation-Based Team Training Programs. Simul Healthc. 2025;20(1):33–41. 10.1097/SIH.0000000000000792 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Apr, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 16 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 13 Apr, 2026 Reviewers invited by journal 13 Apr, 2026 Editor assigned by journal 13 Apr, 2026 Editor invited by journal 10 Apr, 2026 Submission checks completed at journal 10 Apr, 2026 First submitted to journal 10 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9355784","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":625990482,"identity":"c74bfdcc-064f-4f4e-8764-14c5bf6ec054","order_by":0,"name":"Himesha Wadasinghe","email":"","orcid":"","institution":"University of Peradeniya","correspondingAuthor":false,"prefix":"","firstName":"Himesha","middleName":"","lastName":"Wadasinghe","suffix":""},{"id":625990483,"identity":"71e44446-ddb2-476d-86c3-a8201f82941e","order_by":1,"name":"Isuri Anuradha Thoradeniya","email":"","orcid":"","institution":"University of Peradeniya","correspondingAuthor":false,"prefix":"","firstName":"Isuri","middleName":"Anuradha","lastName":"Thoradeniya","suffix":""},{"id":625990484,"identity":"2c26060b-90a8-4297-a4e3-13aa92d57c79","order_by":2,"name":"Sumudu Rasnayaka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABIElEQVRIiWNgGAWjYDADCQbmAxIgBh+YAwLsbIS0sCUAVRowsMG1MBPUwmNAnBb52Ycffy6oOSwv2X7m442PO/7IszHwHrxdwGAnD9SSgE2Lwbk0M+kZxw4bzubJ3Ww584yBYRsDX7L1DIZkwwZmtgNYtfAwmDHzsB1mnMeQu02at82AsY2Bx0yah4E5gYGZvQGrw3rYP3/m+XfYfh7/m2fSf9sM7KFa6nFqYTjDYwA0/HDibIkcNmnGNoNEqJbDQC04HHaGp0yaty89eeaMZ8aWvW3GyW3MQL/wGBw3bMPhfaDDNn/m+WZtO+N88sMbP9vkbPvZew/e5qmoludnbzPA6jAIaEZiM/OAbGdgIBCRdcgcHvxqR8EoGAWjYMQBABAuT1IPhAKkAAAAAElFTkSuQmCC","orcid":"","institution":"University of Peradeniya","correspondingAuthor":true,"prefix":"","firstName":"Sumudu","middleName":"","lastName":"Rasnayaka","suffix":""},{"id":625990485,"identity":"d1b2fc2a-804d-448e-ab16-8cc0f36f612b","order_by":3,"name":"Indika Priyanthi Thilakumara","email":"","orcid":"","institution":"University of Peradeniya","correspondingAuthor":false,"prefix":"","firstName":"Indika","middleName":"Priyanthi","lastName":"Thilakumara","suffix":""}],"badges":[],"createdAt":"2026-04-08 10:50:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9355784/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9355784/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107587583,"identity":"2135931b-34c0-4134-89fd-cfdb7d31540b","added_by":"auto","created_at":"2026-04-23 02:16:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":339643,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Lafayette Instrument company (Model 32020A) Purdue Pegboard Test Instrument\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/e142a46b057896574d4ffe9e.jpeg"},{"id":107705575,"identity":"02433d8a-82b4-46a3-bc9e-0f97370ffb7a","added_by":"auto","created_at":"2026-04-24 09:13:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1990090,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePPT performed by a right-handed participant. A. inserting pins using dominant hand B. Inserting pins using non-dominant hand C. Inserting pins using both hands D. Assembly task\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/094ad7afedba0aa324f641c6.png"},{"id":107587585,"identity":"9a7e5c72-0bbf-4e85-9bf2-54dce6926eac","added_by":"auto","created_at":"2026-04-23 02:16:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1981139,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eRight-handed participant performing assembly task with PPT instrument modified for indirect vision\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/fc8e1ecb3d02dde8b79d38fc.png"},{"id":107706316,"identity":"d85d5656-40c5-4aae-b1ed-5ef5198b958a","added_by":"auto","created_at":"2026-04-24 09:17:52","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":532912,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eThe Lafayette Instrument company (Model 32022) O’Connor Tweezer Test Instrument\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/f2d6746540ec96e1d7524874.jpeg"},{"id":107706327,"identity":"08b42576-42a9-45bb-88f2-c898b4928b7b","added_by":"auto","created_at":"2026-04-24 09:17:53","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":961755,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eOTT performed by a right-handed participant. A. direct vision B. indirect vision\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/19c35d2cee41d6ea425d5019.png"},{"id":107587588,"identity":"afd3e30a-1062-44fb-9030-b9adc7ffe53d","added_by":"auto","created_at":"2026-04-23 02:16:42","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":10680,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFrequency distribution of Total self-perceived skills\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/e3f8247399048a5057871d6d.png"},{"id":107706496,"identity":"3f6aba51-dd64-4f45-8541-aa1712151eb4","added_by":"auto","created_at":"2026-04-24 09:18:11","extension":"jpeg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":325440,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eBox plot of Total self-perceived skills between genders.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/31596875084ecb2ba4bad60f.jpeg"},{"id":107587590,"identity":"bd3aa737-7c1d-4b43-af46-34fc8114044d","added_by":"auto","created_at":"2026-04-23 02:16:42","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":35121,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eBox plots showing distribution of manual dexterity scores based on gender. A. Purdue Pegboard Test (Dominant hand)- Direct vision B. O’Connor Tweezer Test- Direct vision\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/51a873b192f2e2f3c5307574.png"},{"id":107705627,"identity":"266e324e-d120-4bb2-8bc3-dfab931dffd2","added_by":"auto","created_at":"2026-04-24 09:13:59","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":75251,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eBox plots showing distribution of marks scored at skill-based assessments based on gender. a) Class II cavity preparation b) Setting teeth on an articulator c) Periodontal debridement on mannequin\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/b1715c4fe5860999e511ef1c.png"},{"id":107709088,"identity":"2e7c9683-a022-4385-9139-23514c50309b","added_by":"auto","created_at":"2026-04-24 09:34:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6673557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9355784/v1/2ce4f9ac-fe55-407c-b94b-d718820149b9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Manual Dexterity and Self-Perceived Competence as Predictors of Performance in Dental Skills Assessments: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eDental education combines proficiency in theoretical knowledge with the development of fine manual skills (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In most countries, students enroll in dental schools directly after secondary education through a selection process that typically includes written examinations and, in some cases, interviews. An undergraduate dental curriculum generally spans across five years which covers pre-clinical, para-clinical and clinical domains in dentistry (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). To thrive in the field of dentistry, dental undergraduates must possess strong academic ability alongside core attributes, such as empathy and social skills. Additionally, they need to develop a high level of manual dexterity, spatial skills and practical capabilities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The ultimate goal of undergraduate dental education is to prepare students for dental practice, enabling graduates to transition smoothly from university to independent practice. A significant portion of the dental school curriculum is focused on supporting students to master the technical skills required in dentistry (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eManual Dexterity refers to the ability to synchronize visual signals with muscle movements that are essential for specific motor activities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). There are two types of dexterity: fine and gross. Fine dexterity involves the ability to manipulate objects using the tips of the fingers, while gross dexterity encompasses broader and less precise movements of the hand and fingers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Research indicates a significant relationship between fine dexterity, visual search skills, and motor speed (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It has been shown that dexterity can be developed through learning, training, and practice (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo perform patient treatment safely and effectively, dental practitioners must demonstrate exceptional manual dexterity and spatial awareness, as dental procedures require surgical precision while working inside the oral cavity with limited visibility and while using a mirror (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Even a slight mistake may lead to serious harm to the patient or adversely affect the treatment outcome (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, developing the level of manual dexterity required for dentistry can be challenging, particularly during the preclinical phase, which requires students to acquire a new and precise skill set (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In this context, several dental schools have incorporated manual dexterity testing as part of their selection process (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious tests and instruments have been developed to assess hand function, quality, and performance during manual tasks (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). These tests are often used by occupational therapists to test hand skills, evaluate fine motor impairment in wounded patients, and assist patient selection for vocational guidance (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Dexterity tests will provide information about the quality and speed of hand performance. The Purdue Pegboard Test, Minnesota Manual Dexterity Test, Box and Block Test, and Functional Dexterity Test have been recommended as part of dexterity and hand function studies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The Purdue Pegboard Test (PPT) and the O\u0026rsquo;Connor Tweezer Test (OTT) are widely recognized in healthcare related fields, particularly in dentistry, as valid and reliable tools for assessing manual dexterity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Previous studies have demonstrated that the OTT and PPT and as well as modified versions of both tests accurately predicted dental students\u0026rsquo; manual dexterity and are responsive to changes following manual dexterity training (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-perceived skill, is an individual's perception of how well he or she can perform a given task (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Although self-perceived skill does not always reflect the person's actual abilities, it has a significant impact on whether the individual will proceed with a given task (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Various factors such as a students' grades, their individual characteristics such as the general sense of self-efficacy, their level of involvement in clinical practice, instructional approaches, observation and feedback from faculty, and the setting for learning can influence an individual's perception of skill (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). As a result, an individual may possess the essential skills, but due to various reasons, they may lack confidence in their ability to complete a specific procedure. It is important to distinguish between a student\u0026rsquo;s ability to perform a task and their perception of skill as well as the relationship between the two as students with low level of perceived skill might show delayed development of skills and those with higher levels of perceived skill may harm a patient by attempting tasks above their range of ability (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies have identified that improving students' self-perception regarding their skill level should be a key goal of dental education (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough numerous studies have examined the association between manual dexterity and dental students\u0026rsquo; performance (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), as well as the relationship between self-perceived skill levels and performance (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the literature remains sparse regarding the association between manual dexterity and self-perceived skill levels.\u003c/p\u003e \u003cp\u003eThis study, carried out among a group of dental undergraduates at the University of Peradeniya, Sri Lanka, aims to contribute to the current body of literature by investigating the association between manual dexterity, self-perceived skill and performance at skill-based assessments. Understanding these correlations will allow us to identify possible areas for improvement in dental education and provide guidelines for faculty regarding incorporation of manual dexterity training to enhance self-perceived skill levels and in turn the students' clinical performance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was conducted as a cross-sectional analytical study among third-year dental undergraduates at the University of Peradeniya, Sri Lanka. Ethical approval for the study was obtained from the Ethics Review Committee of Faculty of Dental Sciences, University of Peradeniya (ERC/FDS/UOP/UG/2025/22). The survey was carried out in accordance with the Principles of the Declaration of Helsinki (2008), and the participants provided informed written consent before participating in the study. The inclusion criteria for the study were defined as dental undergraduates in the 3rd year (5th semester) during 2024 while students who have differed from a previous batch or who had undergone training programmes in addition to the dental curricula were excluded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAssessing self-perceived skill level\u003c/h2\u003e \u003cp\u003eEach participant was requested to fill in a self-administered questionnaire which consisted of two sections. The questionnaire underwent content validity assessment prior to use. The first section was designed to collect demographic data including gender and dominant hand. The second section comprised seven Likert-type questions requiring students to indicate their self-perceived skill levels across seven selected dental procedures (Given in the box below). Responses were recorded on a four-point scale: low, moderate, high, and very high.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Performing a class II cavity preparation on mannequin\u003c/p\u003e \u003cp\u003e2. Performing a class II cavity preparation in a patient\u003c/p\u003e \u003cp\u003e3. Periodontal debridement on a mannequin\u003c/p\u003e \u003cp\u003e4. Periodontal debridement in patient\u003c/p\u003e \u003cp\u003e5. Setting teeth on a simple hinge articulator\u003c/p\u003e \u003cp\u003e6. Administration of local anesthesia to a mannequin\u003c/p\u003e \u003cp\u003e7. Administration of local anesthesia to a patient\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eManual Dexterity Tests\u003c/h3\u003e\n\u003cp\u003eThe participants then completed two manual dexterity tests: the Purdue Pegboard Test and O\u0026rsquo;Connor Tweezer Test. Both tests were performed under direct and indirect vision.\u003c/p\u003e\n\u003ch3\u003ePurdue Pegboard Test (PPT)\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cp\u003eDeveloped in 1948 by Joseph Tiffin, the PPT is a neuropsychological and vocational assessment tool that measures manual dexterity, fine motor skills, and bimanual coordination through timed tasks of placing pegs and assembling small parts (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In this study a Lafayette Instrument company (Model 32020A) PPT instrument was used (Fig.\u0026nbsp;1). A higher score in the PPT indicated higher manual dexterity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1\u003c/b\u003e. \u003cem\u003eThe Lafayette Instrument company (Model 32020A) Purdue Pegboard Test Instrument\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe PPT includes four key tasks: 1) insertion of pins into the test board holes using the dominant hand for 30 seconds, 2) insertion of pins into the test board holes using the non-dominant hand for 30 seconds, 3) insertion of pins into the test board holes using both hands simultaneously for 30 seconds and 4) using both hands to assemble nuts and bolts (assembly task) for 60 seconds (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The number of pins placed/ assembled within the given time is recorded as the score.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eModification of the PPT was done as described by Lugassy et al. (2018) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Direct vision to the PPT board was blocked using a black shield and participants were asked to visualize the board through a mirror placed in front when performing the tests (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eO'Connor Tweezer Test (OTT)\u003c/h3\u003e\n\u003cp\u003e \u003c/p\u003e \u003cp\u003eThe OTT is a timed assessment measuring manual dexterity, requiring subjects to place small pins into holes on a board using tweezers. It is used to assess fine motor skills for jobs needing precision, like hair grafting or dental work, with a high score indicating better aptitude for precise, small-object manipulation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The results are used to provide objective data for job screening or tracking rehabilitation progress. For this study, a Lafayette Instrument company (Model 32022) OTT instrument was used (Fig.\u0026nbsp;4). A lower score in the OTT indicated a higher manual dexterity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 4:​​\u003c/b\u003e \u003cem\u003eThe Lafayette Instrument company (Model 32022) O\u0026rsquo;Connor Tweezer Test Instrument\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs the PPT, participants were asked to carry out the OTT under both direct and indirect vision (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e5\u003c/span\u003e). For the direct vision test, participants performed the test while looking directly at the board and the tweezers while for the indirect vision test, the board was covered and mirror vision was used as described for the PPT (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). For each test, participants are required to pick up one pin at a time using tweezers and place it into the designated holes, filling the board row by row. The total time, measured in seconds required to fill all 100 holes, is recorded as the score.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eRelevant instructions were given before each test by a single researcher. Individuals were allowed to have a brief rest in between tests. All tests were scored by one calibrated researcher and conducted in a comfortable, calm, and quiet environment to ensure optimal concentration and safe participation.\u003c/p\u003e\n\u003ch3\u003eSkill-based assessments\u003c/h3\u003e\n\u003cp\u003eMarks scored by each student at three assessments; class II cavity preparation on a mannequin, teeth setting on a plane line articulator, and periodontal debridement on a mannequin were collected from the examination department.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize manual dexterity scores, self-assessed skill levels, and results of skill-based assessments. Charts like bar graphs and box plots were used to highlight key trends and distributions within the data. Correlation analysis was used to examine relationships between variables. Pearson\u0026rsquo;s correlation was used to examine the association between continuous variables, such as manual dexterity and performance scores. For ordinal data, such as self-perceived skill level, Spearman\u0026rsquo;s correlation was used. The self-perceived skill level of the seven essential clinical skills was added together to create a composite score, which served as an overall indicator of the students perceived skill level. Finally, multiple linear regression was used to quantify the predictive value of manual dexterity and self-perceived skill levels on performance at assessments, using a significance level of 0.05 to ensure meaningful results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Information\u003c/h2\u003e \u003cp\u003eThe study involved 114 third-year dental undergraduates from the University of Peradeniya. The sample was predominantly female (71.93%), with males constituting 28.07%. The majority of participants were right-handed (85.96%), while 14.04% were left-handed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSelf-Perceived Skill Level\u003c/h2\u003e \u003cp\u003eThe majority of students rated themselves as having a moderate to high self-perceived skill level (2 or 3) in procedures performed on mannequin. For those procedures performed on patients, students showed low to moderate (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) levels of self-perceived skill. Students also rated themselves as having low to moderate skill levels in teeth setting on an articulator (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e01\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 01\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSelf-perceived skill level of students at seven dental procedures\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eClass II cavity preparation on extracted tooth\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVery High\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e40.9%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e37.4%\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontal debridement on mannequin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e40.9%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e30.4%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministration of Local Anesthesia to mannequin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e37.4%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e32.2%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSetting teeth on a plane line articulator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e33%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e42.6%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass II cavity preparation on patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e36.5%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e47%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriodontal debridement on patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42.6%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e38.3%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministration of Local Anesthesia to patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e49.6%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e31.3%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eLevel of Self Perceived skills is given as low, moderate, high and very high. Percentage of students who selected each response is provided.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eTo obtain an overall view of students\u0026rsquo; perceived skills, a composite score was calculated by summing the scores of the seven individual items. This approach provided a more comprehensive assessment of the students\u0026rsquo; general self-perceived skill levels and facilitated comparison across participants. The internal consistency of this composite measure was evaluated using Cronbach\u0026rsquo;s Alpha, which yielded a value of 0.867, indicating good reliability.\u003c/p\u003e \u003cp\u003eThe total self-perceived skill level ranged from 7 to 28, with a mean of 14.22 (SD\u0026thinsp;=\u0026thinsp;4.44). The distribution showed a slight positive skew (Skewness\u0026thinsp;=\u0026thinsp;0.645) and a relatively normal kurtosis (0.317), suggesting that while most participants clustered around the middle of the scale, a few reported higher perceived competences (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e06\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eComparison of self-perceived skill levels between genders\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eManual Dexterity\u003c/h2\u003e \u003cp\u003eManual Dexterity was evaluated using two standardized test instruments, and descriptive statistics were performed for results of each.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePurdue Pegboard Test\u003c/h2\u003e \u003cp\u003eWhen using PPT under direct vision with the dominant hand, the students showed a mean score of 15.08 with an SD of 2.04, reflecting moderate variability in performance amongst participants. Under the same conditions, the non-dominant hand yielded a mean score of 13.79, indicating slightly lower proficiency. The assembly task under direct vision produced a mean score of 37.38. The mean scores of the sub-tests done under indirect vision were comparatively lower than those done under direct vision (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e02\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA greater variability was observed in the assembly tasks (both under direct and indirect vision), suggesting that coordinated hand movements are comparatively more challenging, whereas the other subtests demonstrated lower variability under both visual conditions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 02\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDescriptive statistics of PPT under direct and indirect vision.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSkewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eKurtosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eTesting under direct vision\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.495\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.9472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTesting under indirect vision\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.6553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.0088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eMean: Average, SD: Standard Deviation\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eO\u0026rsquo;Connor Tweezer Test\u003c/h2\u003e \u003cp\u003eThe results of the OTT demonstrated a non-uniform distribution, suggesting considerable variability in students\u0026rsquo; performance and a deviation from normal distribution (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e03\u003c/span\u003e). Greater inconsistency was observed in tasks performed under indirect vision, reflecting higher variability.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 03\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDescriptive statistics of OTT under direct and indirect vision\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSkewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eKurtosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.30965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15.916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.2573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.13516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eMean: Average SD: Standard Deviation\u003c/h2\u003e \u003cp\u003eA paired t-test revealed that in all PPT and OTT sub-tests, the results of the direct and indirect tests showed statistically significant differences, with the direct method having the higher mean value (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e04\u003c/span\u003e). The highest mean difference is seen in the assembly task, highlighting the effect of indirect vision on coordinated movement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 04\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePaired t-test comparing direct and indirect vision\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean Difference\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Non-Dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Both Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Assembly task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO\u0026rsquo;Connor Tweezer Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as significant.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the manual dexterity between genders\u003c/h2\u003e \u003cp\u003eBox plots were used to compare manual dexterity test scores between genders. In all tests, both genders showed almost similar distributions with females performing slightly better in the PPT and males in OTT (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e08\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePerformance at Skill-Based Assessments\u003c/h2\u003e \u003cp\u003eBox plots were used to visualize the distribution of marks for the three skill-based assessments: class II cavity preparation on a mannequin, setting teeth on a plane line articulator and periodontal debridement on a mannequin. Box plots indicated few outliers and a balanced spread of scores. Male and female students had similar distribution of marks in periodontal debridement and class II cavity preparation assessments, with nearly identical medians and ranges. (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e9\u003c/span\u003e). In the teeth setting, females demonstrated a higher median than males. There was no statistically significant difference in marks between males and females.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation between self-perceived skill level and manual dexterity variables\u003c/h2\u003e \u003cp\u003eSpearman\u0026rsquo;s correlation was used to examine the correlation between total self-perceived skill level and manual dexterity test scores. A few sub-tests of both PPT and OTT showed a weak correlation with the total self-perceived skill level (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e05\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 05\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eResults of Spearman\u0026rsquo;s correlation analysis for correlation of total self-perceived skill level with manual dexterity subtests.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual Dexterity Sub test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpearman\u0026rsquo;s correlation (ρ)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePurdue pegboard test under direct vision\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.045\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePurdue pegboard test under indirect vision\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Hask\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eO\u0026rsquo;Connor Tweezer test under direct vision\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect Vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect Vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered as significant\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eCorrelation between marks scored at skills-based assessments and manual dexterity test scores\u003c/h2\u003e \u003cp\u003ePearson correlation analysis was conducted to explore associations between marks scored at skills-based assessments and scores of the manual dexterity sub-tests (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e06\u003c/span\u003e). Some of these sub tests demonstrated a weak but statistically significant correlation with class II cavity preparation and setting teeth on an articulator.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 06\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eResults of Pearson's correlation analysis for correlation of assessment marks with manual dexterity test performance.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eManual Dexterity Tests\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ep-values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass II cavity preparation on mannequin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSetting teeth on a simple hinge articulator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeriodontal debridement on mannequin\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Test under\u003c/p\u003e \u003cp\u003edirect vision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.720\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.910\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ePurdue Pegboard Test under\u003c/p\u003e \u003cp\u003eindirect vision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-dominant Hand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoth Hands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssembly Task\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eO\u0026rsquo;Connor Tweezers Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect Vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect Vision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as significant\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eCorrelation between marks scored at skill-based assessments and self-perceived skill levels\u003c/h2\u003e \u003cp\u003eThe relationship between students\u0026rsquo; self-perceived skill levels and their marks in skills-based assessments were examined using Spearman\u0026rsquo;s correlation. Self-perceived skill level did not demonstrate a significant correlation with marks obtained in any of the skill-based assessments considered in this study (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e07\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 07\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eResults of Spearman's correlation analysis for correlation of assessment marks with self-perceived skills.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSelf-Perceived Skills\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSkills-Based Assessment marks (p-values)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClass II cavity preparation on mannequin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSetting teeth on an articulator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeriodontal debridement on mannequin\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual variable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was taken as significant\u003c/h2\u003e \u003cdiv id=\"Sec26\" class=\"Section4\"\u003e \u003ch2\u003eMultiple regression analysis\u003c/h2\u003e \u003cp\u003eTo identify predictors of students' performance at skills-based assessments, three stepwise multiple linear regressions were conducted using manual dexterity scores and self-perceived skills as predictors for each skill-based assessment that was analyzed in this study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eClass II cavity preparation on mannequin\u003c/h2\u003e \u003cp\u003eAn adjusted R\u0026sup2; of 0.046, suggested that the model explained a small portion of the variability in assessment performance. The significant predictors in the model were OTT under indirect vision (β = -0.549, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that faster times (i.e., better performance) in this task is associated with better performance at class II cavity preparation.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eSetting teeth on an articulator\u003c/h2\u003e \u003cp\u003eAn adjusted R\u0026sup2; of 0.177, suggested that the model explained a small portion of the variability in assessment performance (17.7%). The significant predictors in the model were PPT non-dominant hand under indirect vision (β\u0026thinsp;=\u0026thinsp;0.133, p\u0026thinsp;=\u0026thinsp;0.013), OTT under direct vision (β = -0.173, p\u0026thinsp;=\u0026thinsp;0.031) and OTT under indirect vision (β = -0.078, p\u0026thinsp;=\u0026thinsp;0.023), indicating that manual dexterity plays a significant role in students\u0026rsquo; performance at teeth setting on an articulator.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003ePeriodontal debridement on mannequin\u003c/h2\u003e \u003cp\u003eNo predictors are significant, indicating that neither manual dexterity measures nor self-perceived skill levels significantly explained the variance in students' performance at periodontal debridement on a mannequin.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eManual dexterity and self-perceived skill can be considered as essential competencies in dental education, determining student performance and professional growth. These attributes not only affect the acquisition of technical skills but also influence confidence, motivation, and clinical decision making, thereby playing a crucial role in shaping educational outcomes and readiness for future practice. By analyzing both the physical skills necessary for executing precise motor tasks and the students\u0026rsquo; confidence in their abilities, the research attempts to reveal the complex nature of clinical competence and its implications for dental education and assessment methodologies.\u003c/p\u003e \u003cp\u003eThe sample of students that were selected for this study were 3rd year dental undergraduates. The study was carried out before commencement of their clinical appointments. Prior to the study, the students had undergone multiple preclinical tasks that are believed to influence manual dexterity. These included carving teeth in plaster, cavity preparation on mannequins, construction of custom tray and construction of wax record blocks.\u003c/p\u003e \u003cp\u003eWhen comparing the reference values given for healthy adults with the scores of PPT and OTT of these students' while using the dominant hand under direct vision, (PPT 15.92 vs 15.08, OTT 6.10 vs 5.84), it can be observed that the manual dexterity levels are comparable (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This finding suggests that preclinical tasks may not play an important role in improving manual dexterity when considering performance of the dominant hand in direct vision.\u003c/p\u003e \u003cp\u003eHowever, it was interesting to see that they performed better in the PPT assembly task when compared with reference values (37.38 vs 32.97), which could suggest the development of coordinated hand movements and hand-eye coordination with preclinical practice. This finding was supported by Lugassy et al who suggested that students may demonstrate better skills in integrated motor actions than in single tasks, indicating improved performance in activities that require bilateral coordination and sequential motor planning (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs expected, a significantly better performance was seen in tasks under direct vision than indirect vision which was comparable to previous studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Lugassy et al., attributed this finding to the additional cognitive demand, hand-eye coordination and visual feedback required by indirect vision as well as the loss of depth and spatial accuracy and increased performance anxiety associated with indirect vision (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Future research may explore whether continued clinical exposure and targeted preclinical exercises can enhance students\u0026rsquo; proficiency in indirect vision tasks over time.\u003c/p\u003e \u003cp\u003eThe better performance of females at the PPT can be attributed to the fact that females typically exhibit higher fine motor coordination, having smaller finger sizes anatomically, excelling in skillful repetition, and learning quickly (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Males are disadvantaged in this task as they typically have larger fingers and find it difficult to pick up thin pins.\u003c/p\u003e \u003cp\u003eThe present study found that scores of OTT under indirect vision significantly predicted the performance in Class II cavity preparation and that the performance in PPT using non-dominant hand under indirect vision and OTT under both direct and indirect vision were significant predictors for setting teeth on an articulator. Temel et al. also found a strong positive correlation between the results of 9-hole peg test (direct vision) and the grade point average of class II cavity preparation in a sample of 121 dental students (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). It is interesting to note that scores of indirect tests acted as significant predictors for the teeth setting task despite it being performed under direct vision only. Similarly, Lugassy et al. reported that a logistic regression model could predict students\u0026rsquo; performance in Class I cavity preparation and Class I restoration on a mannequin with 74% accuracy, using PPT scores when using both hands under direct vision and OTT scores under indirect vision (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, in a study where he assessed the correlation between scores of the manual dexterity tests and the Perceptual Aptitude Test (a test used as part of dental school admission process designed to assess spatial visualization and perceptual skills), Gansky et al. concluded that since manual dexterity tests are not considered when calculating their class grades, students may not put forth their best effort into them (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Therefore, it is important to consider that the observed correlation between manual dexterity test scores and skill-based assessment marks may have been influenced by students\u0026rsquo; limited engagement or motivation during the manual dexterity tests.\u003c/p\u003e \u003cp\u003eThe relationship observed between manual dexterity and performance in skills-based assessments raises important considerations for dental student selection processes. While the inclusion of manual dexterity assessments in admissions could help identify candidates with strong baseline psychomotor abilities, reliance on such measures alone may be problematic, as dexterity can be significantly improved through training. Therefore, selection processes should adopt a balanced approach rather than using these factors as strict exclusion criteria; they may be more appropriately utilized to identify students who could benefit from early support and development programs.\u003c/p\u003e \u003cp\u003eWhen considering self-perceived skill levels, students in the present study reported relatively higher confidence in mannequin-based activities compared to procedures performed on patients. This may be attributed to the fact that these students had not yet commenced clinical training, and therefore had limited exposure to real patient scenarios, which often involve greater complexity and uncertainty. A study conducted in Iran concluded that the level of confidence in performing clinical skills is positively correlated with the number of patients seen during practical sessions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Students may exhibit higher levels of self-perceived skill in mannequin-based simulations as they occur in a controlled setting, in the absence of dynamic physiological response, limited interpersonal interactions, and no emotional engagement. Therefore, the levels of self-perceived skills can be expected to increase with the clinical experience of the students.\u003c/p\u003e \u003cp\u003eStudents reported higher levels of self-perceived skills in performing Class II cavity preparation and periodontal debridement on mannequins. This finding aligns with a study conducted in the same setting by Wanigasooriya et al in 2004 which reported that students expressed higher confidence in managing caries and periodontal diseases (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Similarly, Meisha and Al-Dabbagh stated that students exhibited highest self-perceived skill levels at periodontics while lower levels were reported for prosthetics (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, it is interesting to note that in the study by Wanigasooriya et al students showed the highest level of confidence in extraction of fully erupted teeth using forceps, while in our study, the lowest level of confidence was shown for administration of local anesthesia (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This difference may be influenced by the differences in the academic year, level of clinical exposure, and overall clinical practice between the samples used in the two studies.\u003c/p\u003e \u003cp\u003eThe result of the present study indicates that performance at skills-based assessments did not show a significant correlation with the students\u0026rsquo; self-perceived skill levels. The lack of correlation suggests that simply fostering confidence may not directly translate into improved technical outcomes. Therefore, educational strategies should focus on helping students develop accurate self-assessment skills through guided reflection, formative assessments, and constructive feedback. However, in contrast, a study involving senior dental students in the Faculty of Dentistry, King Abdulaziz University, Saudi Arabia found a statistically significant, weak positive correlation between self-perceived skill levels and grades at clinical assessment at the beginning of their senior year (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is noteworthy that differences were observed in self-perceived skill levels between male and female students. Males reported higher self-perceived skill levels than females, even though females showed better performance when compared to males in some assessments. Similar trends of gender differences in performance and self-perceived skills have been observed in the medical and other STEM fields (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Bochatay, N., et al. found that while both genders performed well in simulated interventional radiology settings, self-assessed skill levels of females tended to be more in line with their actual performance, reflecting different approaches to self-evaluation rather than differences in skills (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Such differences further highlight the potential disconnect between perceived and actual ability. These findings emphasize the importance of fostering accurate self-assessment and providing feedback to ensure that all students develop appropriate confidence aligned with their true skill level. This may be done by objective skill development through structured preclinical training, simulation exercises, and repeated practice. However, Meisha and Al-Dabbagh reported contrasting findings where in their study, female dental students showed higher levels of self-perceived skill levels than their male counterparts (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeisha and Al-Dabbagh also suggested that students who have confidence in their academic abilities believe they can gain the necessary skills, while academically challenged students often expect failure before attempting skills-based assessments (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Providing students with opportunities to reflect on their clinical skills and encouraging self-assessment can help them identify their strengths and weaknesses, ultimately enhancing their competencies (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). By aligning students\u0026rsquo; self-perception with their actual competence, educators can promote more effective learning, reduce over confidence or lack of confidence, and support the development of both technical proficiency and professional self-awareness.\u003c/p\u003e \u003cp\u003eA significant correlation between manual dexterity scores and self-perceived skill levels was seen in this study. This suggests that students may possess a reasonable degree of insight into their psychomotor abilities. This alignment indicates that individuals with higher manual dexterity are more likely to perceive themselves as competent, reflecting a degree of accurate self-assessment. However, given that self-perceived competence did not correlate with actual assessment performance in this study, it is important to interpret this relationship cautiously, as confidence in ability does not necessarily translate into clinical proficiency.\u003c/p\u003e \u003cp\u003eIt is important to note that this study has several limitations that need to be considered when interpreting the findings. The sample was exclusively taken from the University of Peradeniya, meaning that the findings may not apply to dental students at other institutes and may affect overall generalizability. The cross-sectional design limits the ability to establish causal relationships between manual dexterity, self-perceived competence, and performance. Additionally, variability in assessment methods and potential examiner bias could impact the reliability of performance outcomes. The absence of longitudinal follow-up also restricts insight into how these factors may change over time with training and experience.\u003c/p\u003e \u003cp\u003eDespite these limitations, the study has several notable strengths. It adopts a comprehensive approach by examining both objective (manual dexterity) and subjective (self-perceived competence) factors in relation to dental skills performance. This dual perspective provides a more holistic understanding of the determinants of clinical skill acquisition. Sampling bias was reduced by including the entire population of third-year dental undergraduates at the University of Peradeniya. This study was conducted in a standard setting and using well-recognized manual dexterity test tools. Furthermore, the findings contribute to the existing body of literature by highlighting the limited role of self-perceived competence as a predictor of performance, thereby emphasizing the importance of objective assessment and evidence-based educational practices.\u003c/p\u003e \u003cp\u003eFuture research should focus on longitudinal designs to better understand how manual dexterity and self-perceived competence evolve over time and influence performance across different stages of dental training. Given the lack of correlation between self-perceived competence and actual performance found in this study, further investigation is needed to explore factors that affect students\u0026rsquo; ability to accurately self-assess, such as feedback quality, reflective practices, and educational environment. Additionally, interventional studies could examine the effectiveness of targeted training programs aimed at improving both psychomotor skills and self-awareness. Expanding the scope to include other potential predictors, such as visual\u0026ndash;spatial ability, cognitive factors, and stress or anxiety levels, may also provide a more comprehensive understanding of the determinants of clinical skill acquisition.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe manual dexterity of third-year dental undergraduates was comparable to that of healthy adults, with female students demonstrating better performance than male students. Weak positive correlations were identified between manual dexterity and selected skills-based assessments, including Class II cavity preparation and teeth setting on a simple hinge articulator. However, no significant relationship was observed between self-perceived skills and performance in these assessments. Although this study provides important insights into the influence of manual dexterity and self-perceived competence on dental skills performance, further research is necessary to explore additional contributing factors. Such efforts may support the continued development of evidence-based approaches to enhance dental education and student outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePurdue Pegboard Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eO'Connor Tweezer Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study was approved by the Ethics Review Committee of Faculty of Dental Sciences in University of Peradeniya (Research Project No. ERC/FDS/UOP/UG/2025/22). Participation was voluntary and informed written consent was taken prior to the data collection.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.W. contributed to conceptualization and designing of the study as well as data collection and analysis and was a major contributor in writing the manuscript. I.A.T. contributed to conceptualization and designing of the study as well as data collection and analysis. S.R. contributed to conceptualization and designing of the study and supervision of the data collection and analysis and was a major contributor in reviewing the manuscript. I.P.T. contributed to conceptualization and designing of the study and overall supervision as well as reviewing the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the statistical support provided by MrA.L.J.Bandara and the Physiotherapy Unit of Teaching Hospital Peradeniya for allowing them to use the PPT for the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to participant confidentiality and ethical restrictions related to the sharing of de-identified survey data but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMittal P, Jadhav GR, Pawar M, Banerjee S, Wangaskar S, Di Blasio M, et al. Impact of self-assessment on dental student\u0026rsquo;s performance in pre-clinical conservative dentistry course. BMC Oral Health. 2024;24(1):593.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnzor Khaniev Z, Nikolaevna AA. Professional Dental Education in the Modern Russian Federation: Current Status and Prospects. Strides Dev Med Educ. 2024;21(1):92\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSim MY, Tan LF, Adam L, Loch C. No one is born with it: Australasian dental students\u0026rsquo; perceptions of learning manual dexterity. J Dent Educ. 2023;87(1):60\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuilding manual dexterity skills: Health Professions \u0026amp; Prelaw Advising Guidebook: Indiana University Bloomington [Internet]. Indiana.edu. 2020. 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Br Dent J. 2016;221(6):349\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePanagiotidou E, Lillis T, Fotopoulos I, Kalyvas D, Dabarakis N. Evaluation of Self-Perceived Confidence and Competence in Oral Surgery among Final Year Undergraduate Students in Greece. European Journal of Dentistry [Internet]. 2023;18(01):360\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC10959612/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC10959612/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMomeni Danaei S, Azadeh N, Jafarpur D. General Self-Efficacy and Self-Perceived Confidence of Dental Students in Performing Orthodontic Clinical Skills. 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Simul Healthc. 2025;20(1):33\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SIH.0000000000000792\u003c/span\u003e\u003cspan address=\"10.1097/SIH.0000000000000792\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"manual dexterity, self-perceived skills, dental education, skill-based assessment","lastPublishedDoi":"10.21203/rs.3.rs-9355784/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9355784/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAs clinical dental procedures demand a high level of precision and motor control manual dexterity is considered a fundamental component in dentistry. In addition to manual dexterity, a dental student's perception of their level of skill may also influence their learning outcomes. This study aims to evaluate the correlation between manual dexterity, self-perceived skill levels and performance at skills-based assessments of dental undergraduates.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study involved 114 dental undergraduates in their 3rd year in 2023/2024 at the University of Peradeniya, Sri Lanka. Each participant completed a self-administered, structured, Likert-type questionnaire which assessed their self-perceived skill level in seven dental procedures. They also completed two manual dexterity tests; the Purdue Pegboard Test and the O\u0026rsquo;Connor Tweezer Test under direct vision and indirect vision (with use of mirror). Statistical analysis was carried out to assess the correlations between parameters.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the study participants, 71.93% (82 students) were females and 85.96% (98 students) were right-handed. The results of the manual dexterity tests placed the participants within the normal range of healthy adults. A weak correlation was found between some manual dexterity test scores and self-perceived skill levels (Purdue pegboard test non-dominant hand under direct vision p 0.034, O\u0026rsquo;Connor Tweezer Test under direct vision p 0.032). No statistically significant correlation was found between self-perceived skill levels and skill-based assessment scores. Multiple regression analysis identified weak positive correlations between manual dexterity and Class II cavity preparation on mannequin and teeth setting on a simple hinge articulator. (adjusted R\u0026sup2; of 0.046 and 0.117).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWithin the limitations of this study, performance at skill-based assessments of dental undergraduates was found to be associated with their manual dexterity while no association was observed between self-perceived skill levels and performance at skill-based assessments. These findings suggest that incorporating interventions aimed at enhancing manual dexterity of dental students can improve their clinical skills. Further studies with different student samples are needed to confirm these findings.\u003c/p\u003e","manuscriptTitle":"Manual Dexterity and Self-Perceived Competence as Predictors of Performance in Dental Skills Assessments: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-23 02:16:34","doi":"10.21203/rs.3.rs-9355784/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-20T05:27:46+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"310083744970429572355166266661944250125","date":"2026-04-18T15:27:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-17T19:33:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210872322563568945435138579009918863149","date":"2026-04-16T12:01:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-14T01:56:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249461432131540673223306184833627287343","date":"2026-04-14T00:54:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-13T15:14:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-13T15:05:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T12:48:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-10T11:24:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-04-10T10:18:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6e4a9074-3798-4279-a69a-c719121bd50a","owner":[],"postedDate":"April 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T11:25:29+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-23 02:16:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9355784","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9355784","identity":"rs-9355784","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}