If I was offered a position as a clinical instructor, I would focus on patience. I like to consider myself a pretty patient person however when I feel myself being pressed for time, or expect something to be known I expect understanding of a subject. I would focus on patience because I know for myself I learn better when I have a patient and understand instructor that is willing to explain and walk me through an area that I am not competent on. Before I come back to work as a clinical instructor I want to gain some real world experience so that I can incorporate my knowledge into the student educational setting.

Some things that I would be able to do to make a great educational experience for students would be, to relate to them as a student, bring current practices into their clinical experiences and bring my passion for the field of dental hygiene. Just as attitudes rub off on those around you, I feel the same goes for passion of the field of dental hygiene. An instructor that is enthusiastic and passionate about what they do, radiates the same effect, it makes students want to achieve greater things and strive to learn and become the best hygienist possible. This is my goal for when I become a clinical instructor, I don’t just want to be good; I want to be the best in order to mold the best.

So I just got offered a position as a clinical instructor at a dental hygiene program, the two things that I am most concerned about are, knowing the educational institutions policies, what is required of the students and of me as a new instructor. Secondly; who is held responsible when legal actions are brought up?

As a new instructor I know that there is a lot to learn and know to insure that you are following all the rules and procedures. By knowing the policies I know what is expected of the students and also what they are looking to me for. I want to know the rules and boundaries of my position so that there is no misunderstanding of my role. Although as a new instructor it may be difficult to give the needed feedback due to wanting to be liked, it is imperative that you start off approachable yet state what you expect out of your students. As a new instructor I would want to discuss with other instructors how they started their clinical instructor career and if they had any tips for success.

My second concern is that of legal actions. I found this interesting to read about. I had just assumed that any legal issues would be a concern of the school, not a specific instructor. This concerns me because we live in a time where everyone wants to sue everyone. I would think that someone trying to sue a university would be thinking, money, money, money. So if this lawsuit also had my name on it, I would be thinking that I would lose everything. I would want to know who is held liable in the situation of a legal lawsuit. Do I need malpractice insurance? Am I covered by the educational institution? Do I need extra malpractice insurance taken out on myself, since I’m in an educational program working with students? This insurance issue would be taken care of immediately and before I would start working.

Although our duty is to ensure that safe, high quality care is provided to our patients we need to do our homework first and make sure we know what we expect out of our students to provide optimum care. And; as an instructor we take care of ourselves by protecting our assets and family’s with malpractice insurance to insure that we are safe from lawsuits.

The term “diversity” in my mind is used broadly to refer to many demographic variables, including, race, religion, color, gender, national origin, disability, sexual orientation, age, education, geographic origin, and skill characteristics. I like how Michael defined diversity, “Diversity to me means to coexist. Coexistence means multiple groups purposely living together peacefully and non-violently, despite differences in ethnicity, religion, gender, sexual orientation and politics.” I feel that diversity has given this country its unique strength, resilience and richness. So why is it that the field of dentistry, particularly dental hygiene lacks diversity? Like many professions it takes time to break free of the gender and race stereotype. Hygiene has been predominantly a Caucasian, and female driven career for as long as time will tell. How do we break this mold? Is it possible? I personally think that it has a lot to do with exposure. In areas that are vastly diverse, maybe not so well off, limited access to care, these are the people not getting the dental attention. With out this exposure, the young adult population is not even given the chance to think of the dental field as a career choice for their future. Many dental students right out of school have these expensive loans to pay off and want to go to areas where they know they are going to profit and make money. There needs to be more programs that offer to aid in tuition reimbursement for these lower income areas so that the profession of dentistry is seen in these diverse neighborhoods and to help in advertising the dental career paths for those who may otherwise not think twice about dentistry and dental hygiene. The saying “Out of sight, out of mind,” comes to mind when I think about diversity in the dental field. I say put dentistry in front of them and watch the diversity levels change.

Calibration, Calibration, Calibration! Is there really such a thing? I feel that this is the most difficult aspect of clinical teaching. I know in our clinic there are some instructors who no matter how great we think we have done removing calculus, they always make you go back over something; when you know other instructors would agree that you did a great job. I found it interesting in one of the articles they thought part time instructors worked too fast. I actually feel that it’s an advantage to the students to have someone with the private practice experience to keep you on your toes and to learn to become time efficient. I understand that in a school environment we need to learn the proper techniques and it takes time, however with experience come quickness, not necessarily sloppiness. No two patients have the same degree of calculus which makes calibration hard to achieve in my eyes.

An aspect of calibration that I never thought about was the faculty assessments at the end of the semester. This can have its benefits as long as there are uniform complaints from the students about calibration. This is the perfect time between semesters, to work on faculty calibration, or to work with a specific faculty member about their technique.

The other article I found interesting how they taught one group to detect calculus by following a specific sequence. This article pointed out how calibrating a group of hygienist is difficult. There wasn’t much difference between the control and the experimental group. I do believe that instructor appear to be more calibrated when they follow the same sequence as what we were taught when learning to explore. Whether this is true or not, I know that I feel better about my technique when I see them using the same sequence and not bouncing around the mouth.

Last year at OSU, I had the luxury of being apart of the feedback part of the accreditation process. The Dental Hygiene Program was making sure that all their i’s were dotted and their t’s were crossed. The hygiene programs course load and clinical practices were being looked into to assure that everything met the accreditation standards.

After reading this weeks articles, I was pleased to find out that I had known the majority of the information provided.

2-6 The dental hygiene program must define and list the competencies needed for
graduation. The dental hygiene program must employ student evaluation methods
that measure all defined program competencies. These competencies and
evaluation methods must be written and communicated to the enrolled students.

2-6: We are given detailed information on each skill and task that needs to be understood through competencies.

2-14 The number of hours of clinical practice scheduled must ensure that students attain clinical competence and develop appropriate judgment. Clinical practice must be distributed throughout the curriculum.

2-14: I knew that as we progressed through the program we would be required to be in clinic more, however I did not know the specific number of hours we were required to complete each week for junior and senior year. This one made me stop and think. I know that Columbus State uses our facility to treat patients, but are they utilizing it enough to meet accreditation standards?

2-16 Graduates must be competent in providing dental hygiene care for the child, adolescent, adult and geriatric patient. Graduates must be competent in assessing the treatment needs of patients with special needs. 

2-16: At OSU we have so many opportunities to treat a variety of patients of all ages and needs. We also have a rotation at the Nisonger Dental Clinic that treats special needs patients. We are so fortunate here at OSU to have all these clinics at out fingertips.

3-6 The faculty to student ratios must be sufficient to ensure the development of competence and ensure the health and safety of the public. The faculty to student ratios for preclinical, clinical and radiographic clinical and laboratory sessions must not exceed one to five. Laboratory sessions in the dental science courses must not exceed one to ten to ensure the development of clinical competence and maximum protection of the patient, faculty and students.

3-6: I was aware of the student to faculty ratio when in clinic, however I never knew that there was a ratio of one to ten when in a laboratory session. There was always more then one faculty member in lab with us, I just never realized even though we were not treating patients we still need a student teacher ratio.

I can see and understand why the accreditation process is strict with their rules and guidelines. Not every hygiene program can make the cut to become accredited. It makes me proud to say that in May I will graduate from an accredited hygiene program after reading the specifics that go on behind the scene, to be able to call them a Nationally Accredited Dental Hygiene Program. These articles were so insightful.

#1. I would immediately bring up her need for antibiotic prophylaxis as soon as the student recommended going on with treatment. This is a big deal that could negatively compromise the patient. Even thought the student is normally on top of her game, this is something that we can not let slip. After bring up the need for pre-med, I would ask her if her patient is aware of the need for a pre-med, since she just had the replacement six months ago? If not, how would you go about discussing the need for a pre-med with your patient? What antibiotic pre-med would and should we recommend for this patient? At the end of the appointment, I would pull the student over to discuss the daily grades that I had inputed for her for the day. Establishing a respectful learning environment is key when it comes to communication. Through direct observation I know that the student is usually on top of her game, however; I would explain to her that slipping on recognizing that her patient needed pre-med would not only be detrimental to the patient but also to her as a hygienist. If the patient became medically compromised due to the dental cleaning and was the direct result of the dental hygienist treating her without a pre-med then she could be held responsible. Hopefully by giving a below standard of care grade for clinic will make her more aware of the protocol needed for other future patients. This will help reinforce and correct any detrimental behaviors.

#2. For Ben I believe that this situation would require an immediate on the spot explorer competency. I would base feedback on my direct observation of his skills. After exploring and have him show me his technique. I would watch and critique his instrumentation skills. After watching and making any adjustments to his technique, I would ask him to go around again and remove any remaining calculus deposits. I would make sure that he felt the deposits that I had felt and give him time for removal. At the end of the clinic session I would explain why I gave him a below standard of care. I would explain nicely that this is what the program is all about, and that by learning the proper techniques now will help him excel in private practice. In this situation i would make sure that I conclude with an action plan. I would let him know that the next patient we would reevaluate his detection and removal skill, not as a competency but as a self reflection of his skills.

During the first year of Dental Hygiene school I believe that all students should be aware that they are being evaluated. This ensures that the student has a definite grasp of the instrument and how and why it is used. The second year students however, should know the fundamental and be able to preform the proper techniques without a doubt. If not remediation is needed, and fast!

Although instrument competencies are nerve wracking, I do believe some instrument competencies should be performed more than once. Instruments like the explorer and the probe are very important for the hygienist to know like the back of their hand. We must be able to detect calculus and measure proper sulcus and pocket depths when evaluating a patient. Instruments that I believe can be conducted once and done, are the universals, gracies and sickles. If the student is proficient in detecting calculus, but there is a problem removing it we know that there is a deficiency in their removal skills. This is when I would recommend a second competency using a specific instrument that should target the calculus. When an instructor finds and area of missed calculus, they can ask question like, what instrument would you use to access this area? How do you use it? And, let me see your technique? Not all calculus is easy to remove, this second competency remediation can be a helpful  tool to revisit or learn different techniques by the clinic instructor for tenacious calculus.

Students are always going to be nervous, there is no way to get around that. As an instructor the best thing you can do for a student is be approachable. Allow the student to take their time to reduce nerves and shaking. Confidence comes with time. We must be positive and reenforce that clinic is a learning environment, if students didn’t need direction we would be living in Alabama and not in Ohio.

To answer the question of whether or not faculty should only reinforce what is taught in the classroom or textbooks, I would say, yes and no. However in order for this to be acceptable the clinic staff have to be calibrated to accept alternate methods of techniques and instrumentation. We have to teach the universal methods; we want to teach students proper ergonomics, stroke techniques and fulcrum placements. Once they are competent on the basics, I feel that supplemental techniques should be allowed as long as they remain ergonomically correct. Lets say you are observing a student scaling the linguals of the upper left quadrant, she looks as thought she is having a hard time and keeps adjusting herself and the mirror to help with visibility. She turns to you and states “I just cant get this area.” Do you continue to let her struggle because that’s the way the book says you have to scale the area or do you recommend another option? You recommend another way. In the Preceptor Handbook it described the coaching process as “changing strategy to address changing situations.” I agree with this 100%. By demonstrating changing her position to the seven o’clock position, having the patient raise her chin and turning to the left, she now has direct vision and can obtain a solid fulcrum.

There are many other techniques that can be altered, specific posterior instruments used on the anterior, specific anterior instruments used on the posterior, polishing first to remove heavy plaque, etc.

The main thing you want to do as a clinical instructor is:

1. Make sure the student has a solid understanding of the basic information taught and can demonstrate the skills competently in clinic.
2. Reinforce that alternate methods can be helpful however, in some cases the universal method may be the only way to access calculus, so don’t rely on alternative methods to work 100% of the time.
3. Ergonomics, Ergonomics, Ergonomics! Remind your students they must keep this in mind if they want to have a long successful career.
4. Lead by example.

   

After reading the chapter on Clinical Teaching Strategies and Techniques and the article on Developing Questioning Skills I had to sit back and think. Clinical instructors get pulled in so many directions, they have to observe, intervene when needed, give feedback and support development of professional skills. Not only do they do this for an individual student, but rather multiple students at a time. In our clinic at OSU the ratio is 5/1, five students per one clinical instructor. Students really have to come to clinic with their game face on and be prepared for clinic. I found it interesting and was surprised when I read that the normal wait time for a question is One Second! To me that doesn’t allow much time for a student to digest the question to reply with an answer before the instructor spits out an answer. However I can see how and why this would happen in a busy clinical setting.

So how can we go from asking the wrong questions like asking questions on specific information to asking the right questions in order to promote learning? Simple follow the Principles of Questioning and allow students time to answer.

In the scenario of the lesion noted on the buccal mucosa, I would ask.

• How would you describe the lower lip?- Factual and thought-provoking question
• How does his health history tie into your findings?- Extracting question
• If this was in your mouth how would you address the lesion and what would you do?-Personalized question
• Under what circumstances would this need to be evaluated by the Pathologist?-Stimulate Critical Thinking and Encourage Lengthy and sustained answers
• What oral health recommendations would you recommend?- Simple question
• How can we communicate the severity/ lack of concern to the patient about our findings?- Partnership question

We need to make sure that we ask the approipate open ended questions to promote learning and give more than five seconds to receive a response. Some students are rapid firers when it comes to answering questions and others need to digest the question a bit before responding, and that’s okay. As instructors even though time is of essence, we need to extend the classroom knowledge into the clinical setting to make sure each student can relate the information. This goes back to the other week when we where describing what makes a Great Clinical Instructor and many of us said Patience!!! It all ties together.