So let’s say that you have been offered a position as a clinical instructor at a dental hygiene program. You are really excited for this new opportunity. What are the two things that you are most concerned about? Why are you concerned about these issues. What more would you want to know before starting a position as a clinical instructor? Hopefully some of you will find yourself in this situation soon, and you never know when you’ll have to look back at all the things you have learned in your career.

The first thing I would be concerned about and want to know more before accepting the position would be the opportunity for advancement. If this was a part-time position, I would want to know if this could develop into full-time, or if it was full-time clinical, if there was the possibility of a didactic position as well. This issue is important to me because I want to be full-time and work with students both in the classroom and in clinic. I would want to teach a course that I could then work with my students during clinic to apply what I taught. As we discovered earlier in the course, I am a visual learner and I think  that would be the best way I could teach. I would be best at showing students things in the mouth through demonstration. I would not mind starting part-time and working in private practice, but eventually I would want re-evaluated for a full-time with didactic position.

Another thing I would be concerned about would be respect from the students. Even with a couple years of clinical experience, I would still be young and quite close to the students in age and experience. I have been in this situation as a student, and it was difficult. I would be concerned that I would be too harsh and critical trying to make the point that I am faculty and I need respect. I want students to be able to come to me with questions, but at the same time respect me as faculty and not a ‘friend’.

Something else I would like to know is how a typical clinical day runs. Do they have a meeting before it starts? After? When do students check in? I would need some time to observe in the clinic and get used to how things run. Ideally I will be back at OSU eventually, and I would know the basics. However, things change and I would need updated.

Like chapter 10 of HCT says, it is important for all faculty to know the policies and procedures, and inforce them. I would be sure to familiarize myself with them and comply with all rules set forth in the program.

When most people think of diversity, they think of different races or ethnicities. Gender, age, socioeconomic status, etc. are often forgotten. I guess diversity to me means difference. Not inequality, but different from average. Just like in my hygiene class, the 3 males are not unequal, just different from the rest of the class.

I think dental hygiene lacks diversity because of sterotypes. This is sterotypically a women’s profession, because men are supposed to be the doctors and dentists, and women in a lower position. Same with nursing as a women’s profession. However, this is changing. There is no reason for either of these to be considered a women’s profession. A career in dental hygiene is enough to support yourself finacially and be comfortable. It is nothing to be looked down upon, but more looked up to.

To increase diversity in dental hygiene, we have to marked diversity. Whenever you see an ad for either a dental hygiene program or a dental product, it is most often a young, Caucasian female with bright white teeth. Why not a different race? Why not a male? THERE IS NO REASON. We just have to market this better.

Icreasing diversity is important. As chapter 8 of the handbook points out, our patients are becoming increasingly diverse, so we hould too. It will help us as a profession better understand our patients, their needs, and their expectations.

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.

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.

VARK confirmed what I already know-I am a multimodel learning. I scored highest in kinesthetic and second in visual. I love to be hands on with certain things, especially dental hygiene clinical skills. I like to try things for myself. I like to be shown things first, then play around on my own for it a bit. When I’m studying for didactic classes and my board exam, I prefer to read the information and write it down. Luckily I have a photographic memory, so when I write it down, I can picture the page where I wrote it while I take the test. This comes in SO handy.

I know that I am not an aural learner at all. Sitting in lectures is pointless for me and it is so hard to pay attention. Most instructors read straight from the slides, which I learn nothing from. I go home and teach myself the entire lesson. I cannot learn something by hearing it. I think it goes in one ear and out the other.

Learning styles are definitely real. Like someone else said, they may not be hard-wired and learning different things in different styles may be very common. If instructors can cater to all learning styles, they should have successful students.