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.