What is the one thing you would focus on to make yourself a great clinical instructor?

I think there are many things I would like to focus on to make myself a great clinical instructor. But the one thing I would focus on first especially as a new clinical instructor will be to know my program/institutions policies, expectation, behavior roles, coursework deadlines so I know what is expected  of me. This will help me know and understand what students have been taught in lecture and preclinic so I can help the development of students skills with realistic expectation of students knowledge while doing this with sensitive communication, so that students feel respected and their opinions valued. All this will help me build a good rapport with the student so that they can come to me with questions they might have in clinic which is one of the characteristic mentioned in this weeks reading for effective teaching.

what things are you able to do to make a great educational experience for students?

The things I should be able to do to make a great educational experience for students is to observe and listen to students while in the clinic, answer any questions and just take the time with students so they completely understand what I am saying or demonstrating to them in clinic. For example if I see a student struggling with a particular instrument I will complement him/her first on what he/she is doing right before correcting him/her right away by doing it myself and have the student watch me because this will help the student learn that instrument better. I can also make myself available and be organized so I can make a great experience for student as mentioned in chapter 11 reading for this week.

If I am offered a position as clinical instructor in a dental hygiene program, the  two things I will be most concern about are patient and student safety and also not to enter into an educational dispute because of my evaluation of a student’s performance. In regards to safety, I will be most concern about patient’s care when  safety is  going to be compromised. An example will be like when a student is trying to proceed with scaling and root planing on a patient who needs premed and he/she did not ask and actually made sure the patient has taken their premed before the appointment. Or a student is trying to proceed with scaling and root planing on a patient who is on an anticoagulant therapy but did not further check with the patient what his /her INR value is within the last 24-73 hours. Normally no alteration is required if the INR value ranges from (2-4) but some alterations is required if  the INR value is  > 4 and even a contraindication when the INR value is > 5 because there is a need to refer to the patients physician for adjustment of the anticoagulant therapy but if this was not checked and the INR value was actually > 5 and something happens to the patient  both the student and instructor  can be held liable. So as an instructor you are concern and  do not want something like this to occur under your watch or happen in general. These are things that my instructors were big on and made sure we checked and understand why we should  check and the implications to  both the patients and us.

Secondly, I will not want to enter into an educational dispute because of my evaluation of a student’s performance so I will be also very concern about faculty calibration. I will want to know and understand how their clinical instructor are calibrated  and if this calibration clearly describes what is correct or what is wrong and identifies what performance receives which grade so it is easy to clearly document what grade and feedback you give to our students for good grades and for failing students to show that the student has received feedback about their difficulties and actions that were taken to help the student improve. I  This is important because as a clinical instructor you can be involved in a legal action by a failing student disputing a grade or a clinical evaluation outcome. Also it helps you understand your responsibilities and accountability are. This can be supported by this weeks reading from HTC by Gardner. chapter 10 pg. 187-189.

I will like to know what  my institutions polices  and programs police, expectations, behavior, roles coursework deadline so that I can follow them and also enforce them. Thus maintaining an educational distance from my students yet friendly and approachable that students can come to me with their questions. I will also like a meeting with my program director and program’s legal counsel so I have an open communication line with them for any questions or concern I may have regarding responsibility and accountability in the future.

After reading the article, post your reaction to the article. Do you agree with the article do you disagree and Why?

After reading the article “Moving Toward Clinical Faculty Calibration ” by Mary E Jacks, I do agree and disagree with some of her position on some issues affecting clinical faculty calibration. Clinical faculty Calibration is very difficult to completing  achieve because of our own differences as hygienist or clinical faculty every one does things a little different from each other. How every it is important we work towards getting some kind of faculty calibration. According to the lecture and reading of this week, clinical faculty calibration is important for a variety of reasons like maintaining fairness, to make sure all students are graded the  same on same performance and to make sure faculty have the same expectation of student, the same expectation of what is passing or failing grade and to keep the clinic running smoothly and providing standard of care and  patient care. I agree with her in some issues she addressed like fairness and consistency. She said calibration is consistent exploring technique to determine if the student has been successful in removing all detectable calculus, create fairness as faculty need to establish routine that is consistent with what students learn in pre-clinic and not their “own”method of exploring. Because if not so this can create confusion about grading for student and different expectation from students with different faculty members which we know can cause problems with learning, critical thinking and problem solving. In addition I also agree with her on the position to demonstrate techniques while student watch. I can relate with that because I am a visual learner and this helps makes the information stick. Also the fact that we all have our strength and weaknesses and our preferences of what aides or tools to use while we deliver this information make for the fact that clinical faculty can not teach exactly the same way, but our combinations creates a good learning environment. I also agree that there should be faculty training so that every one is in the same page with things like grading and is the key to eliminating confusion amongst faculty and creating an even playing field for every one.

On the other hand I disagree with her on the notion that seasoned faculty are better than new faculty from private practice because seasoned faculty are slow and demonstrate deliberate strokes, while new faculty uses fast exploratory technique which makes them grade differently than seasoned and slow faculty “which happens often” and cause confusion for students because supposedly no one has explained to the “new and fast” the educational theory behind slow and deliberate strokes. I do not believe there is a clear cut line that new faculty are always fast or seasoned faculty are always slow or that being slow makes faculty calibration improve. And also this does not mean there is always a different in the information delivered but could be a difference in the technique used to deliver this information because we are all different.

During my dental hygiene school days, most of my focus was to pass and graduate from the program and  I did not focus on the details of accreditation, but I knew my institution’s dental hygiene program was nationally accredited. This accreditation document has made me realize how strict the accreditation process is and how good my institution was adhering to these policies and practices. It also made me realize how difficult it could be for every school to come up with their own accreditation standards or all of the proper documentation to prove that the institution is correctly following all of these regulations without the accreditation standard for the dental hygiene education program guideline documents.

2-6; Curriculum: “The dental hygiene program must define and list the competencies needed for graduation. The dental hygiene program must employ student evaluation methods that measure all defined program competences; These competencies and evaluation methods must be written and communicated to the enrolled students”. The evaluation methods used in my school’s dental hygiene program include process and end-product assessments of dental performance as well as a variety of objectives testing measures. The program also gave us detailed written information on each skill and test to be done via competences which at the time I did not know was part of the accreditation standard for dental hygiene education program and so it is interesting to know and understand why things were done in a particular way in hygiene school. Also on 2.14 states, “The number of hours of clinical practice scheduled must ensure that students attain clinical competences and develop appropriate judgement. Clinical practice must be distributed throughout the curriculum” explains why the clinical hours increased as students progress towards attainment of competencies.  Clinical times increased from twice a week for pre-clinic to daily clinic in the second year. I always knew it was to make students achieve a competent level before graduation in to the real world to practice dental hygiene but did not realize it was also for accreditation purposes.

Another thing I found interesting after reading the ADA accreditation standards section 2-18 which states that ” A patient pool should be available to provide patient experience in all classification of periodontal patients including both maintenance and those newly diagnosed”. This is because during my dental hygiene school days it was not the case. I was responsible for finding and bringing my own patient to meet the various clinical requirements and this was very stressful because if you did not find a patient, you will not complete these competencies and you were blamed for not completing them and marked as down time which you had to make up or eventually fail if the down time requirement was not met. That left us wasting valuable time trying to find patients, be it at home or at school instead of actually learning or working with the patients in the clinic. Today my school has a  patient pool available for present students which has alliviated the problem.

Also on 2.16: “Graduates must be competent in providing dental hygiene care for the child, adolescent and geriatric patient.” At Sinclair, we had outside clinics which we used, like the Good Neighbors House where we treat special need patients of all facets. We also had a good student-faculty ratio in both clinic and labs, which makes sense why this is so.

My overall impression after reading this week’s articles “The ADA Accreditation Standard” and the “Core Competences article” is a sense of appreciation and pride to know, the profession of dental hygiene adheres to strict and high standards thereby producing competent hygienists who play an integral role in assisting patients to achieve and maintain optimal oral health.

Mary as mentioned in this case scenario # 1,  is described as a good student who seems to always be on the ball in clinic, has a great attitude and good rapport with her patients. She checks the patient’s medical history, vital signs, and blood pressure. Everything was okay and she reported her findings to the instructor and also mentioned  to the instructor  that the patient had a total knee replacement six months ago, but failed to mention anything about antibiotic prophylaxis and wants to start with her periodontal assessment. I will approach this with her by first giving her a positive feedback or reinforcement on what she has done right like checking  the BP, patient’s vital signs, her good attitude, the good rapport she has built with her patient, as well as mentioning that the patient had a total knee replacement six months ago. Then I would correct her by asking her questions that will lead her to further investigate the situation of the total knee replacement without giving her the answer. This is a technique known as reinforce and correct observed behavior, which is presented in our article reading “Twelve tips for giving feedback effectively in the clinical environment”. Examples of the questions could be: Tell me more about the total knee replacement six months ago? Are there any recommendations given by the patient’s surgeon before any dental procedures?. This will help her remember to further mention to me if the patient has taken his/her antibiotics prophylaxis before the appointment, in case she forgot to initially mention that when she reported to me earlier with the other findings or she failed to recognize that the patient needed  antibiotic prophylaxis before  any dental procedures because of the total knee replacement six months ago. Base on her answer, it will be clear to identify if she  did check on that but just forgot to mention it to the instructor,  or did not ask about the pre-medication or failed to recognize patient needed to take that before any procedure could be done. At this point, if she did not ask, I will point it out to her. On the grading aspect I think it will depend on if she failed to recognize the fact that the patient needed pre-medication  and did not take it before the appointment, or if she just forgot to mention it while reporting but recognized that the situation needed pre-medication and that the patient actually took it that day one hour before the appointment. I will give her a fail grade on the medical history portion if she did not recognize and investigate the pre-medication situation and also actually making sure the patient took the pre-medication because this action shows a gap in knowledge and can compromise a patient’s health and safety and also has a legal complications if something happens to the patient. But I will take some points off if she just forgot to mention it.

In case scenario # 2 with Ben: There is  a complete gap in knowledge because of the errors in calculus detection and removal. There is also some discrepancy in  his self assessment because Ben was asked by the instructor “How did the scaling go?” and  he said, “I think it went well and I only had a little problem with some crowding in the lower anterior, but I feel confident that everything is good.” However, there were seven pieces of readily detectable pieces of calculus the instructor found during the check. In this situation, I will correct him immediately because this is a teachable moment so the student can learn from his mistakes. I will ask him to show me what instruments he used in the different areas of the mouth and how he explored each area of the mouth where the calculus was missed. This will give me an opportunity to see what he is doing wrong and if the problem is exploratory or instrumentation I will address it accordingly. I will sit and demonstrate the correct technique and make him see and feel the pieces of calculus I found. After that, I will let him go back and remove the areas of calculus that he missed and then re-evaluate his performance again. After the clinic is over for that day, I will also have a post clinic conference with him to solicit his perspective on the problems in clinic today and develop a plan to address the problems. The plan could be re-evaluating his detection and removal skills on his next patient, but not a competency. On the grading aspect, I will give him a failing grade because there was clearly a gap in calculus removal and detection as well as his self-assessment of his work. Self-assessment reveals application of knowledge, skill mastering and critical thinking, which is a very important part of the evaluation process.

In conclusion, even though giving feedback and grading can be very difficult for instructors for various reasons, it is still a very important part of  assessing learning achievement. Benchmarking students’ progress is essential, as evidence from our chapter reading and the article reading  “Giving feedback in clinical settings” show. This article states that “Feedback is the cornerstone of effective clinical teaching. Without feedback, good practice is not reinforced, poor performance is not corrected, and the path to improvement not identified”.

1 Should students know they are being evaluated? why and why not?

2 Should students have to pass more than once? why or why not?

3 What strategies could instructors use to help students who are incredibly nervous during a competency exam?

Competency can be very stressful for students because they are still learning new skills and techniques that they have not yet mastered and are not quiet confident  and proficient in. Yes, I do believe students should know they are being evaluated because it provides motivation for students to learn by preparing for the exam. But especially extrinsic learners, who are motivated by external factors like grade and consequences of failure, it  does provide a greater motivation  to learn. Another reason students should know they are being evaluated is because it provides feedback so students can learn more efficiently and also have the instructor answer all the questions they might have before the commpetency exam. Thus enhancing understanding and reduce nervousness by eleviating some of the pressure students may feel.

Should students have to pass competencies more than once? why or Why not?

I do think students have to pass competencies more than once at least in the very beginning of the program when every thing is still very new because practice makes perfect especially in a discipline like dental hygiene. The more you practice a particular competency the better you get at it. This reinforces the notion that intelligence is incremental and can be developed. Another reason why competencies should be passed more than once is that certain competencies are difficult. An example would be scaling and root planing due to the complexity that each individual patient brings or tenacousness of the tarter, patients medical history, age and how long the tarter has been there makes this procedure challenging. Tarter that has been on the teeth for a long time is generally more difficult to remove. Also competencies like periodontal assessments  and dental charting  that are taught in the first year of the program, these competencies need to be taken more than once to make sure students do not forget what they have learned earlier in the course and to master and also to build on the existing knowledge.

What strategies could  instructors use to help students who are incredibly nervous during a competency exam?

Instructors could help students who are incredibly nervous during a competency by providing mutliple opportunities for evaluating assessment of learning and also by lowering the overall importance of any one competency thereby lowering students anxiety. This makes the student feel safe that even if they perform poorly in one competency exam, he/she can make up with the next exam and still pass the class. It generally helps when students take more than just the traditional midterm and final exam, because it helps students understand and familiarize themselves on how the instructor sets his/her competency exams. The student will also see what the exam will actually look like, what kind of questions or any special procedures prior to the exam, if it was not already clear the first time. Instructors could also help nervous students by communicating their own positive attributions about the students capabilities to learn, which can motivate the student and reduce nervouness during competency exams.

Should clinical faculty only reinforce what is taught in class or text books? How could a clinical faculty member introduce different techniques without negating what students were taught in the classroom or pre-clinic?

I think clinical faculty should not only reinforce what was taught in classroom or textbooks but should include other learning opportunities as they arise but at certain points during the program. For example at the beginning of the program, faculty should teach facts and knowledge from textbooks and classroom because this is the bases on which the rest of the knowledge or practice is going to build on. During pre-clinic  the faculty should teach students proper instrumentation, fulcrum and ergonomics techniques from the textbook to make sure these competencies are mastered before any modifications can be introduced, as they will inevitably come because every patient and circumstances will be different and will need to be treated as a unique  case or individual. The article reading from the “Preceptor handbook” solidify this position by saying “Flexibility is the an important key to coaching and role modeling.”  In pre-clinic during instrumentation I was taught to use the scaler  6/7 straight for anterior teeth which I did until I mastered that instrument. But later on the instructor also taught us S204s can also be used for anterior teeth but that did not come until the first instrument 6/7 was mastered. In the clinic, my instructor allowed me to use the S204s a posterior instrument in certain situations and on different patients for anterior teeth which is a different instrument without negating what I was taught in the classroom or pre-clinic.

How could a faculty member introduce different techniques without negating what students were taught in the classroom or pre-clinic?

I believe the key to that is by allowing the student master the basic skills and technique and be competent in that before any modifications can be introduced. Also, the clinical faculty can observe the student’s performance and modify techniques as need be in different situations.  For example, I was taught to place the patient in a supine position before starting treatment but in case of a medical condition the instructor also introduced a different technique to stand and perform treatment without negating what I was taught in pre-clinic or the classroom instead it demonstrated the principle of coaching to be flexible in your approach to accommodate the particular situation in question.

“While checking in the intra/extra you noticed a lesion on the buccal mucosa. The student has not mentioned it to you and you have not looked at the intra/extral oral exam page yet. What question do you ask and why do you ask that question? What follow up question might you ask? Remember to follow the principles introduced in the readings and discuss how your questions follow those principles”.

I will ask questions that focus on promoting learning and helping students organize their thinking so that they can develop an awareness of where there are deficits in data. I Will also ask questions that are clear so students know what I mean and also adapt to the level of the class so the questions are tailored to the kind of students in the class. Examples of some of the questions are:

Analyse your findings if any from the intra/extra oral examination you completed.

How would you explain/describe your findings if any from the intra/extra oral examination you completed.

I asked these questions because it tells me if the student remembered to do the exam in the first place. It also allows me to investigate/search for the information and to synthesize what has been learned by the student. For example, in the “Developing Question Skills” article reading, it said the use of questioning skills is essential to systematic investigation in any subject area. The questions I asked above “Analyse/ Explain/ Describe your findings if any from the intra/extra oral examination you completed” require the student to solve the problem through systematic examination of facts/knowledge and application of critical thinking to assess what is present  or not present in the patient’s mouth.These questions balance facts and are thought-provoking. In doing so it demonstrates what the student knows about how normal or abnormal tissue looks like from previous lectures on oral anatomy and pathology.

On the point of what follow up question might you ask?  I will ask different questions in this situation depending  on the outcome of the intra/extra oral exam whether the student saw the lesion on the buccal mucosa or not. If the student saw the lesion my question will be:

How did you describe the buccal mucosa?

What recommendations will you give the patient concerning your findings?

How does the patients health history relates to  your findings?  But if the student did not see the lesion I might ask the following questions:

What areas did you evaluate  in the oral cavity during the intra/extra oral exam?

How did you examine the oral cavity during the intra/extra exam? In an attempt to have the student check, observe and appraise the buccal mucosa without me giving the answer out in case he/she forgot to do the exam.

In this last situation which ask me to: ” discuss how my questions follow those principles introduced in the readings.”

I think my questions follow the principles introduced in this week’s readings because it uses the higher level cognitive domain questions from Bloom’s Taxonomy like analyse (explain/discuss), evaluate, and synthesis. This encourages the student to critically think and problem solve  through systematic examination of knowledge learned  in the pre-clinic study of oral anatomy and oral pathology and transforms  the knowledge into clinical differential diagnosis of diseases and lesions of the oral cavity, is  the first step in successful management of a patient with an oral lesion. Another reason I believe my questions follow these principles introduced in the readings is because the questions evaluate/ examine the buccal mucosa puts the information together in a way that selects and use the appropriate knowledge to solve the problem. If the student identifies the lesion or in the case that the student does not identify the lesion that shows gap in the knowledge application which can be corrected so that the student can build good critical thinking and higher cognitive skills. For example, the article and chapter readings uses Bloom’s Taxonomy to classify questions in different levels of higher cognitive domain which support my questions and  require students to critically think and problem solve.

I still use some of what I learned in school to practice dental hygiene today. For example, in  school I was taught that during the process of calculus removal like  scaling and root planing, I must use an explorer and rads to check for calculus as I scale and  check for any calculus that was missed during the process. I was also taught to take rads after the procedure to make sure all the calculus was gone. I still practice this way today because  it happens automatically that I do not have to think about it. This can be supported by the Educational Strategies Article reading which states that:” knowledge is embedded in subconsciously retrieved memory and “pop” into consciousness without active retrieval when cueing stimuli are detected,” in this case calculus. I also do all the palpitations during the extra oral and intra oral exams the way I learned in school because most of us practice the way we were taught. At the beginning of my career the rads I took after scaling were to analyze and seek information that the calculus was gone which was part of critical thinking according to the reading from article b. But after 13 years of practice, I do this only on very challenging cases. For example, I had a patient last year whose calculus was very tenacious because she had not had any cleanings for 52 years.

“Education is what remains after one has forgotten what one has learned in school.”- Albert Einstein

I think this quote is true because no one can remember everything they have learned in school. When someone acquires the capacity or knowledge to function as entry-level  hygienist and with critical thinking and problem-solving skills learned, one can build upon that knowledge after school  and move into the next level of an expert .This is supported by the Educational Strategies reading for this week.

Yes, I think it is important to teach facts that are relevant to the discipline in question because facts give one the knowledge base needed to help identify what is going on with one’s patient. For example, in school when I was taught the facts about inflammation, my teacher explained that when inflammation is present I should be able to see redness, swollen tissue  and the patient should feel pain at the touch of my fingers. This factual knowledge helps me identify gingivitis when a patient has it. As a clinical instructor, students depend on you for knowledge that is new to them. Furthermore,since the professional is a role model the  student will watch and strive to emulate what he/she observe from you. It is also important to teach critical thinking and problem solving because when the student is out of school and in the real world, he/she will need these skills to tackle different circumstances and challenges that come with different patients to be successful in his/her career. Some of these skills are analyzing, applying standards, logical reasoning, information seeking and transforming knowledge. For example, in the reading from article b, critical thinking is defined as “the reflective process in which individuals assess a situation or evaluate data by using mental capacities characterized by adjectives such as compare, analyze, distinguish, reflect and judge;” therefore, these are very important qualities to have in order for a hygienist to be successful in his/her career.

Yes, we need both because these qualities are setting the standards for the profession. They are also setting the standard for which dental hygienists should practice.Thus, graduating hygienists are prepared for the challenges of the job. This will help  to improve the oral health of the public. Both are important.