#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.
Making the student do a exploring competency right then is a great point. I didn’t consider that option. But that would allow the student to carefully detect the calculus and not rush through it. This will serve him well during the rest of his clinical education and into private practice.
I like the comment that you made about following up on his next patient. That really would show him that you are interested in him learning and growing!
I liked the point you raised about case scenario # 1 with Mary to follow up with her patient and check if the patient is aware of the fact that she needs pre-med before dental procedures. This is important because patient do not always know that and hopefully this action will help the patient ask follow up questions when she goes back to see her physician. And for Mary serve as an opportunity to learn. For case scenario #2 with Ben, I also agree with you that the situation needs immediate correction because it is a teachable moment.
Both of the grades you would give each student I feel was called for and backed up by your reasons. It’s going to be very hard to give any student a bad grade, but a student who is normally above average in clinic will be even harder I think. Everyone has an off day but like you mentioned it’s important to teach that there are some things you cannot forget in dental hygiene.
I like that you mentioned discussing what type of pre-med would be appropriate for the patient. Imagine if they were allergic to penicillin and they went and had a prescription for amoxicillin written for them. Big problems abound! This would also help solidify the information in Mary’s head and hopefully create some sort of flashbulb memory for her, so that she will be less prone to forgetting to ask about the pre-med in the future.
I like how you related your feedback to the end goal. All students want to graduate and get out and work. And relating your feedback to how that is helping the student accomplish the goal is a great technique.