Because I’m still in school, I have a lot of opinions on clinical evaluations. Our first semester of school, it seemed we had a competency evaluation every week. We would then get these forms back, and see what we missed points on, but I know there were times that I thought “cool, I missed points on this but have no idea what it means so I don’t know how to fix it.” For this reason, I think it is very important for students to be evaluated more than once. I also think it is MORE important that the instructor explain to the student after the competency to how to fix their mistakes. That gives them the opportunity to make corrections for the next competency. Now getting a 24/26 on a competency seems good and it is passing, but think of a competency on the explorer. Those two missed points could be on not sinking far enough into the col (-1 point) and not exploring the line angle (-1 point). If the student doesn’t know how to fix this, they will keep missing these points on competency exams but still passing. When they have multiple evaluations, one of the evaluators might say the right thing to fix this. Every evaluation is a shot to improve, so it benefits the student to have these opportunities.

I don’t think students should know they are being evaluated. Not only does it provoke nervous, but it makes the student concentrate more on their technical skills. I know I paid more attention to doing things the way I was taught when I was being evaluated. In the beginning of hygiene school, you have not made your own modifications yet so all you have is exactly the way you were taught. At that point, nerves are the reason students should not know. As a senior in my last semester, I have changed the way I do things, such as where I fulcrum when I probe the upper right. When I was doing my competency, I remembered the way we were taught, and focused on fulcruming on my finger while they were watching. It felt awkward because I had made this change a long time ago and had gotten used to my way. If I didn’t know I was being evaluated, I would have done it the way I had changed to and missed that point. Not that missing a point is a positive thing, but if the instructor had seen me do it my way, and I was missing a probe depth, she could have suggested an adjustment. I just think it is best not to know so your true skills are reflected.

Nervous students are going to be nervous, especially in the beginning of hygiene school. Instructors can try to calm these nerves just by being friendly and approachable. A simple smile can positive attitude can make a student smile and help them relax. I know I was always more confident in myself when I had an instructor that I knew was helpful and easy to work with. Also, instructors should be able to ask students if they have any questions before they start. This gives the student a chance to clarify anything confusing, and I know it helped me relax.

Starting out, students know very little (if any) about clinical dental hygiene. The skills taught in the classroom are by the book, and are taught the way they are because they’ve been proven effective. In the early stages, this classic dental hygiene should be reinforced by clinical instructors. Not only does it focus on effective ways to instrument, but also proper ergonomics. It is so important to use these to prolong a dental hygiene career, or the student will be headed for early retirement. However, clinical instructors have experience in the real world. They have learned little tricks to get that one stubborn piece of calculus or access a difficult area. One of my clinical instructors, after I had tried other instruments with her watching, told me to use the 204s on the lower anteriors. Now I just have another tool in my book to try to be sure I get every last bit. I think students need to practice the way they were taught in the classroom for the first year or so, and then they can learn modifications (different instruments, extra oral fulcrum, etc.). These would definitely be ‘modifications’, not changes. Students should be encouraged to keep the same form, technique, and ergonomics, while using a little trick. It is not wrong, just different. In the handbook, it talks about how part-time clincal instructors can provide a “real-life laboratory” experience for students because they are still in private practice.

To introduce these without negating what was taught in class, they could just explain what makes their modification work. Explain why they learned what they were taught, but also add why their modification was not taught. Going back to the 204s on the lower anteriors.. If there is a piece of calculus just under the contact on a patient with very healthy tissue, this may be the only way to access it. After asking what instruments the student tried, the clinical faculty could point out that the thickness of the 6/7 does not allow the clinician to get all the way there. They could explain that because the 204s has a thinner end, it is better for access. They would also need to point out that it is specifically designed for the posteriors, but this was a modification for certain circumstances that helps.

In my experience, the clinical faculty has offered great tricks. It is nothing I have changed permenantly, but always another tool up my sleeve when I’m having trouble. Each faculty member may do something different, and it just takes one of those to make a world of difference to the student.

Mentioned in both readings, the Principles of Questioning are important in the clinical setting. It is important to keep the question simple, but also provoke thought. Questions should be easy to understand but also try to assess what the student knows. As the article said, questions should test student’s preparation, provoke interest, and strengthen learning. The on-line lecture discussed waiting for students to take in the question and develop and answer. I also thought it was important when this was mentioned in the article to wait for multiple students to form an answer to the question before calling on someone. In huddle, our instructors seem to take the answer from the first person who knows it. I’m always sitting there thinking, “DARN! I could have gotten that!” As I was reading through the book and the article, I was thinking of the questions my instructors ask. Most of them follow these guidelines, but sometimes they are so busy that they ask yes or no questions. As the readings mention, they should add explain or why to the end of those.

As far as the lesion on the buccal mucosa, I would ask questions that are purposeful, clear, brief, natural, and at the ability level of the student. I would also try to pull from different levels of Bloom’s Taxonomy:

1. Did you notice anything of concern on the head and neck exam? (A question many of our instructors begin with)

2. How did you describe the buccal mucosa? (thought provoking)

3. What information about the lesion should be recorded? (student should be at the ability level to answer this and analyze the lesion)

4. What are some possible causes of the lesion? (evaluation of findings)

5. (assuming the patient remembers biting his cheek 2 days ago) How long should we wait for this to heal before it becomes of concern? (simple, has a direct answer)

6. If you were the patient, what are some things you could do to help it heal or alleviate the pain? (thought provoking and personal)

I thought it was a helpful reminder in the article to ask questions at the students’ ability levels. I am a practicum student in the first year dental student pre-clinic course. I was helping students the other day by checking in medical histories and vitals, and helping them take impressions. When checking in medical histories, I noticed that many of them had their patients classified as ASA I when they were taking birth control pills. I pointed out that this would make them an ASA II, and asked if they knew why. Something that seems so simple to me as what would be a red flag for birth control, isn’t as obvious to new students. Eventually I told them, and they seemed to remember that.

If only critical thinking were easy..

As a student, I find that we are learning great technique. This is something I plan to keep with me throughout my entire career. It is important to have proper technique or you are making your job harder on yourself. Proper technique allows efficiency in the short run and lasting career in the long run.

I agree with the quote. As I study for my boards, I know I am just memorizing things with the goal of remembering it for the test. I don’t think I am actually learning it, and am sure I will forget most of it after the test. I have dental decks that I study while I wait for patients to show up, and my instructors can’t answer many more of the questions than me. Education is what sticks with you, while other topics are only learned to pass a board exam.

It is important to teach both facts and critical thinking. As said in the article from this week, critical thinking is about gathering information, reasoning out relevant information, and coming to an appropriate conclusion. It also involves being open-minded to alternative solutions and working with others to come up with the best decision. THIS IS WHAT OUR PROFESSION IS ABOUT. I can’t count how many times patients did not want the best recommendation for the situation. This challenges me to work with the patient, my instructor, the dentist, and the periodontist to offer alternative options and explain the consequences of refusing optimal care. We also need to teach facts because some things are the way they are, and they are not changing. This is the case with Pharmacology, for example. Certain drugs affect certain organs. We need to know these as facts to avoid possible drug interactions. I believe they are both equally important.