First of all, how is it already week 5?! Anyways..

I am amazed that anyone that knows anything about clinical teaching and student requirements could ever say ‘clinical instructor’ and ‘supervisor’ are synonyms. I strongly disagree that clinical teaching is supervision. Yes, supervision of students by clinical instructors is legally required, and students are practicing under the instructors’ licenses. However, clinical teaching is much more.

Clinical teaching provides a new learning opportunity and environment each day. As students see different patients, new challenges and concerns present themselves. Clinical instructors are there to help students develop the best plan of action for each patient, and guide them along the way. From the dissertation report “Students’ Perception of Important Teaching Behaviors in Classroom and Clinical Environments of a Community College Nursing and Dental Hygiene Education Program”, the researcher concluded that students ‘valued instructors that created a safe environment for trial and error’. Students want to be challenged and encouraged to engage in critical thinking, but also want to know they are able to make mistakes. Instructors act as mentors in this sense, and give students an outlet to come to with questions without fear of judgement.

Clinical instructors also bring the ‘real-life’ aspect into the clinic and teaching setting. These instructors have been in private practice, working directly with patients, which is still new to students. Instructors have learned more effective techniques and have tips to help students be more successful. I will never forget when an instructor told me to use the 204S on the lower anteriors. I could not help but think this was wrong, because that is not what the book says. In reality, it was much more effective than any other instrument I was trying to use in the area. That day changed my life as a hygienist, and my love for the 204S began.

The cognitive domain is all about acquisition of knowledge and learning. It relies on the thought process to recall information. In the clinical setting, it is important to draw on what students already know and the facts they have learned. We need to draw in didactic course material, and help students apply it to clinical practice. For example, students look at radiographs in the classroom and learn what decay looks like on an x-ray and such. When they take radiographs on their patients, it is important for instructors to review the x-rays with the students and help interpret them, rather than just grading them and sending the student on in their appointment. Instructors can draw on the fact that students know decay appears as radiolucent triangles, and can ask the student if they see any decay. The same principles go for evaluating bone health, which they learn in their perio courses.

The affective domain deals with feelings and emotions. In a dental hygiene program, students are under a large amount of stress, and we know they are balancing other issues with their school work. As instructors, we can take these kinds of things into consideration to help the students be successful. In a didactic setting, instructors can be flexible with assignment due dates or such. If students already have 2 midterms on one day, instructors are often understanding of the stress level and studying required, and offer to move their due dates. In a clinical sense, instructors can also take this into consideration. As a student, I had a very rough day in clinic and had missed many areas of tarter at my final check. I knew I performed poorly. Instead of just giving me a bad grade and moving on, the instructor took the time to figure out what was going on. She knew that kind of performance was not typical of me, and knew something else was going on. She talked to me and gave me some advice, and told me she knew I was better than that and would be fine in the future. I really appreciated this from her. No, she did not feel bad for me and grade leniently. She did her job as an instructor, but also embraced her role as a mentor.

The psychomotor domain involves the development of motor skills from simplistic to expert and mastery level. In dental hygiene, the skill aspect of the profession is extremely important. Without strong movement skills, a hygienist can not properly perform their tasks. When reading the article about teaching psychomotor skills, I really liked the whole-part-whole teaching. I did not know the name of it or that it was a teaching technique, but I have seen it done before. It makes a lot of sense. Students get an overview first, then an explanation, then a chance to see the different steps combine to an effective movement. For example, students are taught how to assemble a syringe. As instructors, we can show how to assemble with some discussion, then break it down and point out specific actions like aspirating, then show it again. CIE chapter 10 also discusses many effective techniques for clinical instruction, such as demonstration, questioning, and listening. As clinical instructors, it is our job to properly demonstrate how to talk to patients, positive attitudes, and clinical skills. We also want to encourage students to ask questions, but also ask them questions. Listening is also an important aspect of clinical teaching. Students will say things quickly, and we will have multiple students at once. We need to keep track of the different patients and what is going on in each appointment.

In the article “Students’ Perceptions of Effective Classroom and Clinical Teaching in Dental and Dental Hygiene Education”, the authors found that students want instructors to have individual rapport. They want instructors to make them feel welcome and be accessible outside of the classroom. They also want instructors to be organized and prepared. It also states that, “Given these context-specific dynamics, rapport as defined by creating an open and trusting learning environment, highlighting tone-setting, facilitating, and role modeling were viewed as critical responsibilities for effective clinical teaching.” I strongly agree with these findings. I want an instructor that is approachable, but also knowledgeable. It is important to have a strong skill set and mental sharpness, but not be too intimidating. I thought many of the dental instructors had the intimidating factor when I was in school. I want instructors to foster a learning environment where I feel I can be open with questions, have a good vibe, and a role model instructor.

Clinical Teaching vs. Didactic Teaching

There are many differences between the traditional classroom setting and the hands-on clinical setting. Even between the classroom and the lab, we see many differences. The biggest difference to me is the interaction level. Although didactic teaching is changing, most classrooms are still structured with students sitting in desks while the instructor presents material, and they take notes. In the clinical and lab settings, students are up moving around, seeing and touching instruments, talking to patients, and actually seeing the material from didactic courses come to life. It gives them a first sense of real-life application. These two environments appeal to different types of learners. Some people will learn best from seeing and hearing material in the didactic courses, and some will prefer to be hands-on in the clinic/lab. Another difference is the way students prepare for what setting they will be in. Students often think they can come into a classroom setting with a lack of sleep or think they can just sit quietly or browse the internet during the presentation. In a clinical setting, this is far from opposite. Each patient is different, and will present with a different situation. Students must be ready to use their critical thinking and draw on what they have learned in the didactic courses to make effective decisions for each patient.

However, there are also some similarities. When you are in the hygiene program, you are surrounded by the same students in both the clinic and the classroom. This may give some students a sense of comfort, knowing they can turn to their classmates for answers or advice in either setting. At Ohio State, many didactic instructors are also clinical instructors, so the personnel can feel similar. Both settings take preparation, just of different natures. In either setting, students should be actively engaged and ready to learn.

Change can be hard for anyone to deal with, no matter what age, background, gender, race, etc. No one wants change to happen, because things are comfortable. However, it is necessary to keep up with changes to provide the best care for patients, and ensure hygienists have top knowledge.

Changes in technology are typically more difficult for older individuals, who did not grow up with technology at their fingertips. Younger adults (and even kids) tend to grasp these changes and even be excited about them. It is hard for large institutions (like Ohio State) to incorporate technology changes due to size, cost, and environment. The school is working to go digital with radiographs, but it has been a long process. It is not practical to put a computer in each operatory, and the building is not set up for that. However, I think we can address this by exposing students to digital software when possible. There are a few clinics within the school that are digital, so if students could rotate through those, they would at least have some knowledge of the system. There are also outside rotations, such as the Columbus Health Department, that use digital software. Even when students cannot be hands-on with this, it is important to educate them on different systems and how they have changed.

Research is key for students and graduates to stay up to date with the changes in treatment recommendations. In school, students learn what is effective at that time. As more research is conducted, recommendations and guidelines change, and they will continue to do so. We must instill in students the importance of continuing to investigate these changes, so they have a drive to do so when they are on their own. Just recently, the ADA changed their guidelines on pre-medications and when they are necessary. This directly affects patient care, and it is important to notice such changes.

As we encounter the changes in student population, we must work to bridge the gap between all students for successful learning. As the book states, nontraditional students come in many different forms. We often think of age and race, but there are others: gender, commuters, part-time students, and parents (Clinical Instruction and Evaluation: A Teaching Resource, pg. 24).

The nontraditional type of student that stuck out most to me was the (often single) parent. When a person is both a parent and a student, they have a lot of life to balance. Both are two major jobs, and they may even work a job on top of that. This reminds me to practice patience with all students. Life happens. Things come up. I can be flexible in any necessary situation. I know instructors have to be careful with this not to get taken advantage of, but extenuating circumstances do occur.

As instructors, we need to appeal to all types of learns, whether students need to hear the material, see it drawn out, or touch/feel it for themselves. The more opportunities we provide for students to see the same material, the better success and retention. I have used this example before, but say we are teaching a student about Arestin. Some students are going to want to hear about how to place it, and hear those descriptive words. Other students need to see the diagram and step by step images of how to place it. Other students need to hold the syringe in their hand and place the tip in the syringe. If we can have all students do all three activities, we can hope to get that ‘click’ we are looking for.

In the Journal of Nursing Education article, they are specifically discussing age as the main difference in student population. I thought it was interesting that the majority of students from gen x and gen y preferred lecture compared to web-based learning. Typically, I would think the younger generation would prefer online information. Another point was found that no one prefers group work, and they do not need to see it be graded. This is something for instructors to consider, because group work is very common. From reading this article, it is apparent that the majority of students want structured, guided, face-to-face learning. Studies like this help instructors become more effective, and instructors can even poll their own classes. It is ok to make adjustments for each class. (Generational (Age) Differences in Nursing Students’ Preferences for Teaching Methods)

As we begin this journey into the world of clinical instruction, I am both excited and slightly nervous. I see myself beginning my teaching career in the clinic, so I look forward to learning how to be successful in this part of students’ education. I will begin my clinical teaching internship in January, so I hope to put what we learn this semester into action.

Roles of a clinical instructor:

1. A clinical instructor should serve as a resource for students.

    -Students are going to come across situations that they are not prepared for or know how to handle at this time in their education. An instructor should be available to guide students in the right direction to make evidence-based decisions. As an instructor, I would use the knowledge I have gained from my education and work experience, to help students realize what to do and why. This will help them in the future when they encounter similar situations. It is important to be a guide, rather than giving them the answer without leading them down the path.

2. A clinical instructor should be timely, organized, and prepared.

   -I think this role often gets overlooked in the clinical instructor role. From my experience, some instructors do not prepare themselves for clinic, and think preparation is more for didactic courses. In reality, clinical instructors need to prepare for their upcoming clinical sessions, and arrive on time.Clinical teaching requires extensive preparation. On page 51 of Clinical Instruction & Evaluation: A Teaching Resource, the author states, “The clinical instructor must have a working knowledge of the patients assigned to students, as well as a current understanding of healthcare problems likely to be encountered and the treatments, procedures, and policies that apply.” If a clinical instructor is not prepared by keeping up to date with current healthcare recommendations, they may not handle situations in the best way possible. For example, a patient may come in asking the thoughts on a new sensitivity toothpaste and if it works. For a student in their first couple months of clinic, this is overwhelming. The instructor must take on the responsibility of educating themselves on new projects, recommendations, and developments in the dental field.

3. A clinical instructor must be focused, prompt, and center their attention on the students and the patients.

   -This is an issue I noticed when I was in clinic, with both dental hygiene and dental faculty. I would ask for an area to be checked, but the instructors were discussing personal issues or browsing the web on their phones. It put me behind in my appointment, and if the patient noticed, probably looked unprofessional. I will make sure that the only delay of me checking one of my students is because I am working with another student.

I think one goal of clinical instruction is to help students think for themselves. Like I said earlier, instructors should be guides along the way. We want students to develop their own thoughts and opinions on how to handle situations. For example, most hygienists have strong feelings on how to treat periodontal disease, when to treat, what can wait, and timeframe for patients. These thoughts come from having a background knowledge, taking personal experiences, and considering the research. Instructors need students to think critically about each patient’s situation, and determine what is best on a case by case basis.

Another goal of clinical instruction is to develop strong patient communication skills. Many students struggle with verbiage, and how to discuss issues in language patients will understand. They have to display confidence, and get patients to want the treatment they need. Beyond this, some students struggle discussing things as simple as medical history. This gives them exposure to real life application.

As said in the text, clinical instructors play a role in helping students achieve their goals and objectives in didactic courses (Clinical Instruction & Evaluation: A Teaching Resource, pg. 43). It is the responsibility of the clinical instructor to know what students are learning in didactic courses, and help them relate this in real scenarios. It even suggests instructors sharing course outlines, materials, and text to ensure student success.

I think my strengths would be patient communication, and my background knowledge of hygiene. I feel that I have a strong case acceptance in private practice, and am well-versed when discussing major issues in lamest terms. My biggest weakness is that I do not appear as confident as I should. With my students this week, I kept having to remind myself that they are JUST beginning their hygiene careers, and have learned very little. I often had to stop myself and think, ‘they do not know what that means yet.’ It is hard for me to speak in terms they understand, and not talk over their heads. To fix this, I think it is a great suggestion from the textbook to review what they are learning in the courses, so I can keep up with what they have learned thus far.