Educational models for dental instruction

The lecture method is still the most widely used instructional strategy in dental school classrooms. However, in combination with other interactive learning tools, this format can become a more effective strategy for teaching.

Adding interactive elements to the lecture induces more student involvement and creates a more effective learning environment. Without student participation during a lecture, a student becomes a passive receptacle for bits of information with little chance for deeper understanding or higher level of thinking.

Lecture alone provides information from the instructor’s point of view and doesn’t allow the student to interact with the instructor or with each other. Without this interaction there is minimal feedback about whether the student understands the material being presented. When a student learns passively, concentration may be impaired, information is quickly forgotten, and students are less likely to be able to apply concepts during later application of problem solving.

So why do we continue this archaic practice of lecturing? First of all, most of us were trained that way, and like in parenting, we often revert to our own past experiences. The lecture is an easy way to disseminate material to a sizeable group, to maintain control, and is non-threatening to students.

Fortunately, there are some simple “variations on a theme”, some added elements that can transform a passive (and boring) lecture into a more effective and stimulating form of learning for both the student and the teacher. An excellent way is to add interactive teaching strategies that involve the students in the learning process. By including questions, brainstorming, discussion, and case studies the student becomes involved and connected to the instructor and to other students.

Instructional strategies that engage students in the learning process stimulate critical thinking and a greater awareness of other perspectives. However, the size of the audience will determine how much interaction can take place. Obviously, smaller classes more easily allow for a more interactive structure, but consider a large audience that breaks out into smaller groups to consider some questions, and then reconvenes for a discussion led by the instructor. Even simply posing questions to a large group to stimulate discussion, instead of the continuous delivering of info-bytes, surely is an improvement to the age-old lecture format.

Planning on the part of the instructor is imperative. Silberman (1990) suggests five approaches to maximizing students’ understanding and retention during lectures: Use an opening summary, present key terms, offer examples, use analogies, and use visual backups. The approaches a lecturer can use to keep students interested and involved is limited only by the instructor’s imagination. Needless to say, being enthusiastic about the topic as well as having a sense humor keeps the students engaged.

So, dust off your lesson plans, infuse them with some creativity, energize your students to become involved, and let’s turn this tired format into a motivating and effective form of learning.

References

Hurst JW. The Over-lecturing and Understanding of Clinical Medicine. 2004; 164 (15): 1605-8.

Clegg VL. Teaching Behaviors Which Stimulate the Student. Kansas State University, Center for Faculty Evaluation and Development. Sept.1985.

Williams G., Lau A. Reform of undergraduate medical teaching in the United Kingdom: A triumph of evangelism over common sense. 2004; 329(7457): 92-4.

Cashin WE. Improving Lectures. Kansas State University Center for Faculty Evaluation and Development. Sept.1985.

Active learning: Pathway to higher-level thinking

Active learning can best be described as a process whereby students engage in higher-order thinking tasks, such as analysis, synthesis, and evaluation. In short, anything that students do in a classroom other than merely passively listening to an instructor’s lecture can be defined as active learning. Reading, writing, discussing, role-playing and problem solving are a few examples of active learning.

Studies show that students prefer strategies promoting active learning to traditional lectures. Although the mastery of content is comparable in both styles (passive and active learning), active learning is preferred by students and provides greater results on transfer tests when students apply what was learned at a later time.

Perhaps the greatest strength inherent to the active learning format is the opportunity for the development of critical thinking skills. Also, as compared with the traditional method of lecture/intermittent testing, there can be a more immediate feedback to the instructor as to the students level of understanding of the material being presented.

Weaknesses associated with active learning seem to be associated with the belief that active learning is an alternative to, rather than enhancements of, professors’ lectures. Specific obstacles can be limited class time, large classes, and the lack of needed equipment or resources, but these challenges are not insurmountable given some creativity and flexibility on the teacher’s part. Some professors fear a loss of control, lack the necessary skills, or fear they will be criticized for teaching in unorthodox ways. Through refinement of lesson plans, and improvement in instructor evaluations, many of these concerns will lessen with time.

The strategy of active learning works best when the teacher is keenly familiar with the subject matter and the lesson is structured and well-planned. A new role of learning coach or guide, instead of as simple lecturer, must be thought out. One must also reconsider the testing format to better align with the teaching method.

In a journal article entitled “A controlled trial of active versus passive learning strategies in large group setting”, Haidet et al. (2004) concluded a reduced amount of time spent in teacher-driven content delivery by 50 percent covered the same amount of content with no detrimental effects on knowledge acquisition. Further education and developmental psychology research, no doubt, will continue to add to our understanding of enhanced learning through active learning methods.

Barak M, Rafaeli S. Online question-posing and peer- assessment as means for web-based knowledge sharing in learning. International Journal of Human-Computer Studies. 2004; 61(1): 84-103.

Haidet , Morgan RO, O’Malley K, Moran BJ, Richards BF. A controlled trial of active versus passive learning strategies in a large group setting. Advances in Health Sciences Education. 2004; 9(1): 15-27.

Peer-assisted learning: Collaboration is key

Understanding the relationship between teaching and learning is critical in any educational setting. Within professional education, this dynamic generally relates to the adult learning process. Growth, especially in adult learning, involves both the assimilation and application of knowledge. This type of growth requires instruction beyond just the presentation of predefined bodies of knowledge. Active involvement in the learning process encourages students to develop and apply knowledge as part of a decision-making process.

Collaborative or cooperative learning is an interactive teaching strategy that engages students in small group interaction and collaboration. Peer-assisted learning (PAL) is an example of collaborative learning that involves active and interactive mediation of learning through other learners who are not professional teachers. PAL compliments professional teaching and allows students to learn themselves while assisting others in the learning process. Students involved in this type of cooperative scheme are able to support each other in learning, and in doing so, learn more themselves

The most widely recognized method of PAL is peer tutoring. This strategy often targets skill gains, although more recently, peer tutoring has been used in developing higher order thinking skills. Peer modeling, another form of PAL, focuses on group members imitating a behavior demonstrated by a peer model. Peer assessment is a type of PAL that arranges for peers to evaluate the learning process and outcomes of others, and provide feedback that allows a learner to improve performance.

While the reliability of feedback from peer assessment may be less than that of teacher assessment, it is usually more immediately available than instructor feedback and may aid in correcting a problem before it is too late. Students involved in peer assessment have also been shown to improve skills in evaluating their own work. All forms of PAL emphasize the communication skills of both tutor and learner, and in doing so, help to further develop those skills.

Within the health care field, the majority of PAL research has been in medical and nursing education. In these areas, PAL is often referred to as peer mentoring, peer tutoring, or peer coaching. PAL utilized in a clinical setting permits increased personal interaction, thus offering more opportunity for demonstration, practice, and immediate feedback, which are essential in psychomotor skill development. Research by Goodfellow and Schofield (2001) reviewed peer tutoring at Sheffield University’s medical school and determined that junior students felt significantly more capable in performing clinical examinations after tutorials, and that senior students reported benefits from the review of basic skills during preparation for tutoring sessions

Although PAL yields many positive benefits, potential negative effects must be recognized. Mismatched personalities, perceptions of disinterest, and lack of tutor or mentor expertise have been sited as problems leading to negative experiences (Eby et al. 2004).

Still, collaborative and cooperative learning strategies allow students to develop problem-solving skills and social skills necessary to work with others. PAL is one example of collaborative learning; however, the apparent success of PAL within medical and nursing education support the use of this strategy in dental and dental hygiene education as well.

References

Brownstein L, Rettie CS ,George CM. A programme to prepare instructors for clinical

Duschner JEB. Peer learning: A clinical teaching strategy to promote active learning.

Eby L, Butts M, Lockwood A, Simon S. Protégés negative mentoring experiences: Construct development and nomological validation. Personnel Psychology 2004; 57: 411-47.

Field M, Burke J, Lloyd D, McAllister D. Peer-assisted learning in clinical examination [Letter to the editor]. The Lancet 2001; 363: 490-1

Glass N, Walter R. An experience of peer mentoring with student nurses: Enhancement of personal and professional growth. Journal of Nursing Education 2000; 39(4):155-160.

Goodfellow PB, Schofield E. Peer tutorials amongst medical students [Letter to the editor]. Medical Education 2001; 35: 1001-2.

Reinarz AG, White ER. New directions for teaching and learning: Beyond teaching to mentoring. San Francisco, CA: Jossey-Bass. Vol. 85. 2001.

Sobral DT. Cross-year tutoring experience in a medical school: Conditions and outcomes for student tutors. Medical Education 2002; 36:1064-70.

Topping KJ, Ehly SW. Peer assisted learning: A framework for consultation. J Educ Psychol Consult 2001; 12(2): 113-32.

Wadoodi A, Crosby JR. Twelve tips for peer-assisted learning:A classic concept revisited. Medical Teacher 2002; 24(3): 241-4.

Case studies: studying the real deal

Preparing a student to problem solve through various scenarios in the safety of a preclinical setting builds confidence with novices to the clinical setting.

A teaching method that employs the in-depth review of case studies has been the foundation for professional training in schools of business, law, and medicine and has instilled a growing interest among educators of other fields. Exploring a variety of case studies can help achieve integration of didactic knowledge to the clinical setting.

As will be later contrasted to problem based learning in which definitive conclusions are not necessarily reached, case study methods do have a similar foundation: the initial presentation of a problem.

Some limitations to the case method of teaching have been identified. Facts are not systematically transmitted as during a traditional lecture format. Therefore, preparation for solving a case must ensure that an adequate knowledge base of the subject matter is intact. Ideally, the case method should supplement other teaching methods to allow for a more comprehensive presentation and understanding of subject matter.

References:

Merseth, K. Cases, Case Methods, and the Professional Development of Educators. ERIC Digest. 1994.

Buckley P., Hudson, J.N. An evaluation of case-based teaching:Evidence for continuing benefit and realization of aims. Advanced Physio. Edu. 2004; 28:15-22.

Kleinfeld, J. The Case Method in Teacher Education: Alaskan Models. ERIC Digest. 1990

Computer technology and learning: getting with the times

First, we must define what is meant by computer assisted learning (CAL). The use of computer technology in education runs the gamut from a student working individually on a project that is presented on a CD/DVD, to being a part of a live on-line classroom experience that includes a web cam, live chat, and all of the bells and whistles that electronic media has to offer. Let’s throw out a couple terms for definition. Synchronous learning refers to one such “live” interaction, an “electronic classroom experience”, if you will. Asynchronous learning refers to when a student works off-line during a time of his or her own choosing, perhaps reviewing electronic material prepared by an instructor, or interacting with classmates through postings and resonses. For the case in point, what is presented here is simply an overview of how technology may be thought of as offering yet another strategy for diverting our efforts away from a more traditional, passive learning model.

In 1987, the AAHE first published “Seven Principles for Good Practice in Undergraduate Education” by Art Chickering and Zelda Gamson in which they distilled findings from decades of research on the undergraduate experience. In summary, good practice in undergraduate education includes:

encourages contact between students and faculty,
develops reciprocity and cooperation among students,
encourages active learning,
gives prompt feedback,
emphasizes time on task,
communicates high expectations, and
respects diverse talents and ways of learning.

Computer-assisted learning lends itself beautifully to each of the seven principles.

E-mail and chat rooms, because of the ease and convenience, enhances interaction. Whether that communication is between a student and an instructor, student-student interaction, or an instructor with an entire class, communication can grow far beyond that which occurs within the lecture hall.

Students can post assignments and give and receive feedback from their peers. The technology allows for far greater student interaction outside of class time, and the benefits of student mentoring is widely documented.

Who ever fell asleep during a live on-line event? Synchronous learning may focus a student’s attention more than if they same student felt lost in a lecture crowd. Asynchronous learning can be done during a time of a student’s own choosing, perhaps even increasing the likelihood that a student will comply, and if it is through active learning, may even learn more effectively. The beauty of the technology is that a teacher’s imagination is the only limit to the application of active learning. A PowerPoint presentation, for example, could be posted that includes links out onto the Web where information related to any given topic is just about limitless. Interactive formats abound. If you can dream it up, it can be done.

Whether it is students giving feedback to other students, or instructors giving feedback to students, due to the ease in access, questions can be posed as they arise, assignments can be posted and instantaneously available for review, and an instructor can solicit and dispense information as to the level of understanding that a student may have sooner than is traditionally available during a lecture/test format.

As in traditional models, an on-line format can include appropriate assignments, due dates (that are time and date stamped upon submission), and can contain syllabi with information to the student as to what is being expected and by when.

Don’t let the fancy format fool you. All the bells and whistles are no substitution for good teaching. At the heart of it, a teacher still has to set the tone for high standards, be clear about what is expected from the students, be clear about the feedback given to the students, and inspire a desire for learning. The teacher can set the stage using good organization, professional presentation of materials, and conducting informative and well-controlled synchronous experiences.

References

Chickering AW. Gamson ZF. Seven principles for good practice in undergraduate education.

Educational Technology. 2003; 43 (4): 57-8

Miltenoff, P. Integrating Streaming Media to Web-based Learning: A Modular Approach. Syllabus 2000. v4 (1) p58-61.

Batchelder, John Stuart. Rachal, John R. Efficacy of a Computer-Assisted Instruction Program in a Prison Setting: An Experimental Study. Adult Education Quarterly 2000; 50 (2): 120-33.

Problem based learning (PBL): A student-centered approach

For an overview of PBL used at the Queen's University School of Medicine in Canada see:

In 1995, the Institute of Medicine (IOM) produced a report that called for an increased alignment of the dental profession with the medical profession and the reassessment of dental education to produce graduates who are better equipped at working in the rapidly changing world of the 21^st century. One answer to the call for educational reform has been problem-based learning (PBL), an inquiry-based teaching strategy that places the student at the center of directing his or her own learning. PBL first emerged in health care education in the 1960’s and has been utilized extensively in medical curricula ever since, but only more recently in dental education. Although problem-solving and case-based learning exercises are commonly used in traditional education models, the difference between “authentic PBL” and these exercises is that problem solving leads to a solution, where PBL leads to identifying new areas of learning, and ultimately understanding, but not necessarily arriving at a definitive solution.

There are three essential components to PBL. First, like in the learning cycle method of instruction, “the problem always comes first”, that is, students first encounter a learning objective through a process of discovery. Problems are developed by curriculum organizers and are facilitated by a faculty member. The problem is first analyzed by the student who must identify the content needed to understand the problem, and then research what is necessary to learn the material. Content is never provided before a student can critically think about what is required to analyze the problem. The second component of PBL is that students do not work independently but rather in small groups of about 6-8 students with a faculty facilitator who plays a key role as coach in guiding the efficient functioning of the group. The group functions to facilitate learning in all of its members through self- and peer evaluation that occur throughout the learning process. The group provides a safe learning environment where individual members help each other to learn the material; the added social benefit of learning to work in a group environment is apparent.

At the heart of PBL are three conditions that are known to facilitate learning: (1) the idea that prior knowledge is used in understanding new information, (2) that recall and application are enhanced if learning takes place in an environment that resembles the situation where it will be applied (simulation), and (3) that information is understood better if students are asked to elaborate on the information that is being learned through answering questions, teaching others, thinking critically about a problem, etc. Traditional methods tend not to accommodate these conditions as evident in the following common characteristics of traditional dental curricula:

There are three main educational objectives that are central to a problem-based learning approach: (1) to acquire deeply understood knowledge, integrated from a wide scope of disciplines, that facilitates recall and application (2) to instill effective clinical problem solving, self-directed learning, and team/interpersonal skills (3) to foster a desire to continually learn throughout the lifetime of one’s career.

Because most students travel through a traditional curriculum throughout their lives, few have experience in true self-directed learning. Once faced with this new learning style students become frustrated in wanting to know exactly what is expected of him or her, instead of having to synthesize, with the help of the group, what is needed to be learned. Until the group becomes efficient at this new process of first identifying what is needed to be learned, and then learning it, students may spend an inordinate amount of time “re-inventing the wheel”, until they appreciate that this process of discovery is the learning. The student admissions process, that currently rewards those who excel in traditional learning environments, may need to be re-evaluated to become more selective of those who show the ability to adapt to this new learning style.

Teachers of the traditional method need to rethink their role as lecturer to become, instead, facilitators of learning. They must first select problems that will encompass desired learning objectives, but then exercise patience while the students themselves come up with those learning objectives and the resources for teaching themselves the material. In order to gain support from entrenched traditional faculty for such a drastic change in the way they teach, each must understands and be dedicated to the true value of problem-based learning. Much faculty development and support is needed to instate such a change.

Changes in curriculum need to be made. It takes time for each learning group to go through the process of PBL, and this time, approximately 2 hours per problem per week, must be accounted for in a densely packed curriculum. Finally, changes in the method of assessment must be made to reflect the manner in which the material was learned. That is, a student cannot be expected to perform well on traditional method of testing, namely regurgitation of memorized material, if the focus during the presentation of the material was on problem solving. In a PBL environment, assessment most commonly takes the form of competency assessment, in which a student demonstrates his or her ability to pull together knowledge from a wide variety of disciplines to solve the problem at hand.

Currently, there are a few dental schools that have successfully transitioned to full PBL, and several that employ some degree of PBL in their curricula. The emphasis from the national accreditation process is on continuing to move toward true PBL environments. Future education research will reveal if this approach results in better-equipped dental practitioners for which the IOM study calls.

Finchman AG, Shuler CF: The Changing Face of Dental Education: The Impact of PBL. J Dent Ed 2001; 65(5):406-20

Simulation: Technology enhances learning

Simulation technology allows the practice of a complex technical skill in a safe environment and has been used in the training of professionals in many fields. In aviation, pilots are able to simulate in-flight emergencies as well as routine flight situations. In medical schools, simulation is used in such areas as emergency medicine, surgery, nursing, and medical transport. It is especially useful when teams of operators are training together such as those preparing for practice in an operating room. One of the most common examples of learning through simulation that health care professional and lay people have experienced is cardiopulmonary resuscitation training (CPR). In dentistry, some benefits to simulation training in dental and dental hygiene schools include a smoother transition from the pre-clinic to the clinic setting, practice of proper ergonomics, practice in patient chart documentation, and improved learning through demonstration. When such skills as proper instrument use and mirror positioning can be learned in the pre-clinic, less time has to be dedicated to these skills in the clinic, and more time can be dedicated to the cognitive aspects of patient care.

In dentistry, simulation clinics began to make their appearance in U.S. dental schools in the early 1990’s. Prior to that, students practiced tooth preparation in plastic or extracted teeth mounted in models that were placed on a bench top or in rudimentary patient position simulators. Today, most of the advanced technology simulation clinics include sophisticated patient manikins together with some form of electronic media display. Some dental schools, such as the University of Pennsylvania, include computer tracking of handpiece movement. Patient manikins have the ability to simulate jaw, head and neck positions, and many have the capability of providing water spray through the handpiece as occurs in a dental operatory. Most simulation clinics are equipped with a multimedia display system in which lecture, slides, video/DVD and live demonstration can easily be provided by an instructor. This provides a vast improvement over traditional methods in which a student often had difficulty seeing the material that was presented in the laboratory setting.

Few studies on student performance and simulation have been done to date. However, a review of the literature shows that results on practical exams may not necessarily improve with the use of simulation technology over standard laboratory methods, but that student satisfaction is greatly improved. Clancy, et. al. (2002) conducted a three-year study at the University of Iowa College of Dentistry in which three dental school classes with varying degrees of experience with a simulation clinic were tracked. Some students received none, one or two years in the simulation clinic and were asked to prepare teeth on the bench top and in a simulation patient and then fill out a questionnaire. Results showed that students with more bench top experience performed better on the bench top, whereas students with more experience with the manikin scored equally well in both environments. The performance between the groups was not significantly different. According to the questionnaire, all students felt adequately prepared for clinical experience regardless of the environment in which they were trained.

Teaching through the use of simulation does not require a new approach in basic teaching methodology; it is a form of active, hands-on learning. However, the learning process does seem to be enhanced and may prove to be especially helpful for students with lower-end ability (Buchanan 2001). The formation of a new ADEA Section on Clinic Simulation this year demonstrates the increasing trend among U.S. dental and dental hygiene schools toward incorporating simulation-based training in their curricula.

References

American Dental Education Association Sections and Special Interest Groups: http://www.adea.org

Buchanan JA, Gluch J, Stewart D. Use of virtual reality-based technology in teaching dental operative procedures. J Dent Educ 2000; 64(3): abstract 202

Buchanan JA. Use of simulation technology in dental education. J Dent Educ 2001; 65(11):1225-31

Clancy JM, Lindquiest TJ, Palik JF, Johnson LA. A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results. J Dent Educ 2002; 66(12): 1331-7

Friedrich MJ. Practice makes perfect: risk-free medical training with patient simulators. JAMA 2002; 288(22): 2808, 2811-2

Service learning: learning by doing

Progressive educator, John Dewey in his classic book, Experience and Education in 1938, challenged the reigning pedagogy and justified education based on learning by doing.Today, evidence has revealed that learning through experience and reflection has a legitimate place in education and lends to the outcome of new skills. Service learning combines experiential learning with community service. According to the National and Community Service Trust Act of 1993, service learning can be defined as a method whereby students learn and develop through active participation in organized service that is conducted in and meets the needs of the communities.Service learning can take three forms: independent study; field-based academic courses combining seminars with off campus internships or research; and fieldwork assignments that include field exercises incorporated into lecture or discussion courses. In dentistry and dental curricula, service learning is best incorporated into community-based practice experiences, where students gain first-hand knowledge of people and communities, and are introduced to patient and community care beyond the classroom and school clinics.

Service learning is based on the premise that students need to integrate knowledge and skills through experience, practice, and reflection. This integrative format addresses key competencies required in dental and dental hygiene education. These competencies include patient and community-centered care; oral health promotion; assessing patient goals, values and concerns; and managing a diverse patient population, including special care patients.

The strength of service learning includes providing students with “real life” practice experiences, often in underserved population groups. From this comes an enhanced knowledge of the complexities of patient care. This includes not only the delivery of direct patient care, but a better understanding of the need for effective patient communication skills, with an enhanced awareness of the complexities of patient’s lives and how it may affect the care being rendered. Through service learning, students participate in complex decision making processes that may be needed when treating more vulnerable populations that are often seen in a community-based practice. Students face preconceived assumptions and stereotypes of various population groups, and experience a sense of civic responsibility and commitment to community service.

Service learning includes a reflective process that prompts learners to gain new insights and understanding about themselves and their environment. Research reveals that authentic and relevant service learning can lead to an increase in skill development, self-confidence and motivation to make a lifetime commitment to community service.

The weaknesses of service learning may include the innate disparities associated with community-based rotations as compared to a more tightly controlled school clinic. It is difficult to control a student’s quantitative and qualitative patient care experience. And, because of the great variety in teaching ability of the attending dentists, the quality of the education and the outcome of the patient care provided by students could vary significantly.

Time away from family for both students and faculty could be a factor if service learning takes place outside the local area. Increased education costs may be incurred in the need for additional faculty at an off-campus site, an increase in liability coverage for the institution, and increased faculty time spent in gaining and drafting agreements between the student, the institution, and the community-based setting.

In addition, if the service learning does not include some aspect of formal reflection or follow-up, the impact to learning may be severely affected as premature conclusions by students could be drawn, or as valuable teaching opportunities are missed.

If implemented well, service learning reinforces the value of public service and enhances academic studies. Because “real world” experiences are emphasized, service learning lends a better understanding of the complexities that students will face in professional practice upon graduation. As competency-based education is integrated into all dental and dental hygiene programs in the future, service learning is a teaching strategy worth consideration for inclusion in the dental curriculum.

References

Fenwick TJ. Experiential Learning:A theoretical critique from 5 perspectives. Information Series No. 385. ERIC Clearinghouse on Adult, Career, Vocational Education, Center on Education and Training for Employment, College of Education, Ohio State University. Columbus, OH; 2001.

Wittmer DP. Business and community: Integrating service learning in graduate business education. J Bus Ethics. 2004;51:359-71.

Skelton J, Mullins MR, Kaplan AL, West KP, Smith TA. University of Kentucky Community-based field experience: Program description. J Dent Educ 2001;65:1238-42.

Mofidi M, Strauss R, Pitner LL, Sandler ES. Dental students’ reflections on their community-based experiences: The use of critical incidents. J Dent Educ 2003; 67:515-23.

ADEA, Section on Dental Hygiene Education, Competency Development Committee. Competencies for entry into the profession of dental hygiene. J Dent Edu 2004; 68:745-9.

Strauss R, Mofidi M, Sandler ES, Williamson R, McMurtry BS, Carl LS, Neal EM. Reflective learning in community-based dental education. J Dent Educ 2003; 67:1234-42.

Mareck DG, Uden Dl, Larson TA, Shepard MF, Reinert RJ. Rural inter-professional service learning: The Minnesota experience. Acad Med 2004; 79:672-6.

Competency-based Education (CBE): Tying it all together

CBE is a model of educating and evaluating students based on the assumption that learning to become a professional is a process that occurs at differing levels of ability throughout a student’s educational career. Chambers and Glassman (1997) provide an overview of the four stages of learning: novice, beginner, competent, and expert. In dentistry, to become competent means that one is ready to begin practice independently, without the supervision found in the school setting. Although at the heart of dental and dental hygiene education are the fundamental concepts and psychomotor skills needed to perform treatment, a CBE model encompasses a broader focus that recognizes knowledge, experience, problem-solving ability, ethics, and the ability to self-assess, to name only a few of the essential elements to becoming an independent practitioner.

Although the concept of CBE was first introduced during the 1970’s, in 1993, the American Association of Dental Schools (now the American Dental Education Association), recommended a dental curriculum framework based on competencies—the skills needed for entry-level practice. In 1999, dental hygiene programs were called upon to define competencies and evaluation methods needed for graduation. DeWald and McCann (1999) describe a successful model for developing a competency-based curriculum in a dental hygiene program that begins with the process of re-examining program goals and evaluating existing curriculum. Hendricson and Kleffner (1998) describe four characteristics of CBE that include (1) defining and listing precise student outcomes, (2) designing curriculum to support the outcomes, (3) incorporating an interdisciplinary approach to developing and presenting curriculum, and (4) implementing an assessment process that approximates “real world” conditions, that is, has contextual relevancy for the practitioner.

When an institution undergoes the process of laying the framework for a competency-based curriculum, the program is impacted in profound ways. By examining existing curricula for alignment with newly stated competency goals, gaps and redundancies in the curriculum may be revealed and remedied. Faculty across the disciplines can work independently and collaboratively to evaluate which competencies they are teaching to, and can reinforce learning that has occurred elsewhere in the curriculum. A student’s clinical practice within dental and hygiene clinics can draw from a comprehensive knowledge base rather than a compartmentalized thinking that is reflective of the way that pre-clinical courses have traditionally been taught. Ultimately, a student who is ready to graduate will have a comprehensive knowledge base that is evaluated in a relevant way--in the proper context of patient care.

Traditionally, dental curricula have been presented in a manner that reflects the objective way in which dentists think (Chambers 1997). However, lectures, multiple choice exams and traditional methods for testing clinical skills have been shown through education research to be less than effective than other methods, beyond the scope of this paper, for assessing a student’s ability. There are some who resist the change of educational models based on a long-standing sense of independence or on perceived liability issues with regard to the documentation of student progress. However, with the leadership of the ADA, ADHA, ADEA and the accrediting bodies, and based on the mounting evidence from education research, it appears that dental and dental hygiene programs will continue to evolve and incorporate CBE as an effective way to train students to become dental professionals.

References

Chambers D., Glassman, P. A primer on competency-based education. J Dent Educ 1997; 61(8): 651-66.

ADA Commission on Dental Accreditation - Revised accreditation standards for dental hygiene programs. Jan 2000.

DeWald JP, McCann AL. Developing a competency-based curriculum for a dental hygiene program. J Dent Educ 1999; 63(11): 793-804.

Educational Models for Dental Instruction

The Lecture: An age-old teaching strategy

References

Active learning: Pathway to higher-level thinking

Peer-assisted learning: Collaboration is key

References

Case studies: studying the real deal

References:

Computer technology and learning: getting with the times

References

Problem based learning (PBL): A student-centered approach

Simulation: Technology enhances learning

References

Service learning: learning by doing

References

Competency-based Education (CBE): Tying it all together

References