Mary Jacks is imagining things in a perfect world. She has some good points, but also some very far-fetched ideas. She focuses a lot on the difference between ‘seasoned and slow’ vs. ‘new and fast’. This is definitely a problem in the clinics, and i’ve noticed it as a student. I do tend to enjoy working more with the ‘new and fast’ intructors, especially now that I’m graduating. I am working at a quicker pace and keep my appointments moving, and I appreciate faculty who can facilitate that. I had a ‘seasoned and slow’ instructor just last week that I had to go tooth by tooth and give her recession levels and she asked if I tested the integrity of the sulcular lining with air. We went slower like this in our first semester when we were still learning to measure recession and test the lining, but now I am confident in my ability to measure recession and I checked the integrity of the sulcular lining with the probe during assessments. I appreciate when I can point out areas of interest to the instructor, discuss them and have them assess the areas as well, and move on. I do notice I ask the ‘new and fast’ instructors to check my scaling.

Looking at her article, Mary Jacks wants every instructor to use the same instrument, seating position, and sequence. To me, that is just ridiculous and impossible. Some schools do not even teach certain explorers, like Ohio State and the pigtail. I’d never heard of it until I started studying for boards. The same seating position? Operators sit where they are most comfortable and have the best access. The same sequence? No way. I don’t know how that would be helpful in calibrating, as long as every surface of every tooth is explored.

I agree that sometimes students need to watch and observe to learn visually. However, there is little need for a student (especially one in the later days of the program) to watch every move in the mouth by the instructor. If they instructor finds a missed spot or several spots of calculus, then it could be valuable to pull over the student so they can watch, then switch positions. If the student just needs to be checked out and is confident in their scaling on the patient, they can be using this time more wisely, such as writing progress notes.

Her final point also hit a nerve: “when students are happy, everyone in the clinic is happy..” This doesn’t sit well with me. Isn’t the focus of clinic on the patients? Small sentence but it just stuck out to me.

While reading through these requirements for accreditation, I was able to picture how Ohio State complies to all of them. Since it only happens once every 7 years, as stated in one of the articles, it was interesting to see the whole process. We could tell our instructors were stressed but trying not to show it.

The thing that surprised me the most was Section 4-4 in the ADA Accreditation Standards article-Extended campus facilities. I know OSU does a great job with collaborating with other facilities to give us the best opportunity possible. I did not realize there were set standards that had to be met with all of these. I thought we made our own little contract and it was not that big of a deal. To go as far as requiring 2 year notice for termination of a contract is really in depth.

Other things are such minor details as well, like requiring office space. I thought that would be in an instructor’s contract or set by the program director. When we were going through the accreditation process, we had an idea of what they were looking for, but WAY more intense. No wonder it was stressful! I guess not too many of these really ‘surprise’ me, because I think, “Oh, ok. That’s why we have that” or “We meet this standard by…”. For example, 3-6 states that the student to instructor ratio cannot exceed 5 to 1. We never have more than a 5 to 1 ratio or we bring in another instructor. If we exceed this and have 2 instructors with 3 students that have patients, one instructor can go beack to the office.

To sum it up, the most surprising thing about the accreditation standards to me is the amount of detail. They extend from admission, to clinical and didactic instruction, to post-graduate life. These standards truly are thorough.

Mary forgot to mention something that could cause a life-threating disease if not addressed. Both articles this week mention giving feedback immediately or shortly after, but this issue needs to be questioned immediately before the student moves on. Because Mary does usually excel in clinic, I may think she just forgot to mention it to me and got ahead of herself in our discussion. I would ask Mary if there was anything else significant about the answers on the health history. This does give her the idea that there is, but it is acceptable because she either asked the patient or did not ask. If she can reply something to the effect of telling me what time, how many milligrams, what type of pre-med, I would be confident that she did ask and just looked over it in mentioning it to me. For this, I would probably give her a below expectations (going off of OSU’s grading). She did not meet my expectations, because that is one of the first topics a student learns in their first semester. If she failed to ask the patient about the pre-med or failed to realize a knee replacement needed a pre-med, I would have to give her a below standard of care. Because pathogens can cause such serious problems, it would be the standard of care to cause no harm to the patient. After the appointment, I would talk to Mary about the consequences of no pre-med and why I gave her the grade I did. I would try to do that in a ‘feedback sandwich’ that the article calls it, or the oreo effect as I have heard. I may tell her she was very professional with her patient, then tell her about why I graded her as I did, and end with another positive such as great perio assessments. Like the second article says, I may ask her to self-evaluate first to see how she thinks she performed. Another tip in the same article is to make sure I have clarified any questions she may have. This is very important and can be a great learning experience.

Ben… oh boy.

Let’s evaluate this like Ben is in his first semester of clinic. I would start by asking if he explored after he scaled. If he said yes, I would give him another chance and remind him to explore slowly with a light grasp. I would watch as he did this and give him any feedback, so that it is done in a timely manner, like mentioned in the first article. I would then point out areas for him to explore and feel to make sure he feels it and knows what he is looking for. I would give him the chance to remove the rest of the deposits. I would give Ben a meets expectations in this case. Although seven is a lot of spots, this is a great learning opportunity. If this is his first semester in clinic, he may have never really felt calculus until now. I know it took me a LONG time to be able to feel calculus. I just scaled and scaled and hoped it was all removed.

Now, if Ben is in his last semester, this is a completely different story. I would still send Ben back to the spots he missed and make sure he could feel them. I would then have him remove them and sit down and re-check. I would not give him a second chance without penalty. Because he is about to be on his own in private practice, I would have to give him a below standard of care. It can be harmful to the patient to leave that many pieces of calculus.

In either scenario, I would use the Pendleton Model with Ben. I would have him state some of his positives for the day, and give him some of mine. I would then have him critique himself, and I would then give my negative feedback. This would have to be done in proper terms and in small bits, as the article says. I would not mention too many negatives at once and try to end on a positive note.