Proper discipline seems like it would be one of the most difficult things for an instructor to learn. All students make mistakes or have off days, and it is important to manage these is a correct and consistent way. Like Amy said, we hope this does not happen very often, but issues will arise, and need to be resolved quickly.
As instructors, we try to prevent potentially dangerous situations in the clinical setting. Like CIE Ch. 15 says, there are certain signals that should raise concern before the student even begins patient care. We should be on the lookout for students that do not know when to seek help, show up late, approach patients with uncertainty, or do not recognize their errors (pg. 364-365).
However, issues will still occur. Whether disciplining, failing, or removing students from clinic, it is important to do so in a private way. Remove the student from the patient and try to find an area to talk without being overheard. As CIE pg. 366 says, present the issues in a matter-of-fact manner, and be thorough in explaining why you are taking the disciplinary action that you are.
Students can be disciplined for many things. The first and probably one of the most common would be students constantly showing up late. Rules for this should be laid out in the course policy, and students should know tardiness is not acceptable. It affects other students, the instructors, and the patients. Students should be disciplined for negative attitudes, derogatory conversation, not following instructions, and any kind of shortcuts students take. I have these ‘shortcuts’ from my classmates. Students would have medical histories completed before the patient came back, or spot probe but fill in a complete perio chart. They try these shortcuts to cut down on time or finish early, but are not acceptable.
Failing a student in the clinic, as CIE Ch. 16 says, should not come as a surprise to the student. When I think of failing a student, I think of them performing below my minimum expectations for their experience level. For a senior student ready to graduate in the next month, it is not acceptable for them to leave a certain amount of areas of calculus. Again, this would be laid out in their handbook. For students seeing their first patient, there could be a little more flexibility. Students would also fail the clinic session if they do not show up. If they do not have a patient scheduled or their patient does not show up, I would expect them to find something productive to do during the clinic period, or they will fail the session.
Removing a student from clinic would be necessary when there is potential harm for the patient or the student. This can be as obvious as an intoxicated student, or as hidden as a student suffering a traumatic experience. If a student experiences the death of a family member, they may try to hide it and continue with the clinic session. However, they are not focused on the patient and this could cause harm. Another example, that I know from personal experience, is if a student has not had the proper vaccinations to be treating patients. I had not completed my HEP B series but was still seeing patients. I received an email stating if I did not present proof of vaccinations to the student health center within the next week, I would be removed from clinic and it could delay my graduation. Looking back, I understand that this was a danger to me and my patients.
I think the hardest student related challenge for me will be lazy students and bad attitudes. I do not do well with laziness, and I do not think it should be tolerated. I am a firm believer in always doing your best work, and taking pride in everything you do. If you are lazy, you are not doing your best and that should not be the goal. Effort is required to be successful in school, dental hygiene, and life, and that is one trait I hope to instill into my students.
Bad attitudes reflect negatively on everyone around them. We have talked about this multiple times at my office–when someone comes in with a poor attitude, it changes the attitudes of everyone around them. Eye rolling is one of my biggest pet peeves, and I will discipline students if they roll their eyes at me. I am giving my time and effort to make them a better student, and they can value my thoughts.
I had a student a couple weeks ago that was not giving me her best effort. We were placing x-ray films on DXTTR, the training model. The student attempted to place her first film and before I could guide her, starting saying she didn’t know what she was doing and couldn’t do it and wherever she put it was going to have to work because that’s where it was going. I was not prepared to handle this situation. I advised her to calm down and we would work together to find the proper placement. On the inside, I was a nervous wreck and was slightly frustrated with her attitude. I had to tell myself to be calm and remind myself she was just learning. That was the only difficult situation I have experienced so far.
Lauren,
I can relate to many of your thoughts. Disciplining or failing a student is difficult for me. I try to see positivity in everything but often as instructors we need to be firm. If not, we can easily guide or mislead students down the wrong path. Your example of short cuts is an excellent example of when consequences should occur. Without a thorough health history, we could potentially put the patient (or ourselves) at risk. Patients often don’t see the importance of their overall health in relation to the oral health so we must be aware and cognizant at all times. Discipline should be viewed as a measure to minimize mistakes.
When handling the situation with your student, you made sure to calm down the situation before it escalated. When students have a bad attitude or act in ways that may frustrate or anger the clinical instructor, it is always necessary to stay calm. Remaining calm will make the instructor stay fair in how they are analyzing and disciplining the situation. If an instructor does not keep their emotions in check during frustrating student situations, they can make the mistake of using their emotion to discipline, therefore, disciplining too harshly. As CIE mentioned, we may come to the point in a very frustrating student situation where we may want to remove them from the clinical session. However, we must keep our emotions in check and only use that level of discipline when it is warranted. When working with a student that continuously comes that clinic unprepared, it may come to the point where the instructor has had enough and would like to remove them clinic until they are prepared. CIE warns against this, however, and suggests that it is more beneficial to make the student go study rather than just sending them home. Ultimately, students may not always be able to keep their emotions in check, but we as instructors must.
I have noticed a problem with derogatory conversations in the clinic. I have had to give students 0’s for cursing and having inappropriate conversations. Like many clinics, our clinic is open with chairs side-by-side. Everyone can hear everyone. This is especially problematic for individuals whose voices really carry. Most inappropriate conversing that I have witnessed has been when students are treating people that they know. I have to remind them that they’re not at the bar having a drink together! They’re so comfortable with people they know that they forget they are in a professional environment. At my first job, I got reprimanded for saying the word “sucks” when talking to a patient. I was shocked. I felt that it was bizarre and ridiculous to discipline me for that. Just a few days ago, I was walking through the clinic and I overheard a student say “sucks” when talking to a patient. I immediately stopped in my tracks and cringed! Then, I remembered my own novice encounter with the word. In that moment, I felt that I had truly arrived as an instructor! Haha
It’s funny that you mention that Danielle. In that circumstance, you could (and probably did) use a “war story” to discipline the student. You could talk about how you didn’t think the word was a big deal but you actually were reprimanded yourself for using it at your first job. Although you are disciplining the student for being unprofessional, you are at the same time showing empathy and building rapport by sharing your experience. The student is likely to remember your story when they go to say “sucks” again. I cringe at even typing it!
Thanks for sharing your experiences with us Lauren. I am glad you are going through this course during your internship, as you can already start applying some of the information we are learning. Although the student came off as having a bad attitude, she may have just been frustrated with herself. It is easy to match her frustration in your situation, but I’m glad you were able to remain calm.