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As a clinical instructor my focus would be to have a great rapport with the students. We all want to have instructors that are knowledgeable and competent, but hopefully that comes with their years of experience working in a clinical setting. But having the rapport with students makes it a positive learning environment for the students. By rapport I am referring to being approachable, providing non-judgmental constructive criticism, and being available. If we as instructors give a student a low grade and not be available to explain what was wrong or be confrontational with the student when they’re questioning the situation, then this can cause a tense clinical atmosphere which can discourage students. We need to have a good rapport with the students so that they can come to us with the understanding we will explain what improvements are needed without discouraging.

In the article Students’ Perceptions of Effective Classroom and Clinical Teaching in Dental and Dental Hygiene Education the author’s quote was dead on: “Instructors can have a potentially greater influence on dental and dental hygiene students’ learning in clinic than in classroom settings.” The clinical instructors have the benefit of the one-on-one student interaction during evaluations. If the students have a bad rapport with an instructor, then it will make for a tense appointment and an overall frustrating clinical experience.

Students are not here for instructors to take out their anger and frustrations. They are in school for a higher education and need the support of instructors to get through. There are times when a firm hand is needed, but the student’s must know that the firm hand is there for their benefit and not their detriment. This is where the positive rapport between instructors and students is crucial so that students can willingly approach the instructor for constructive feedback  no matter the circumstance.

Ethics & Liability In Clinical Teaching

I have been told by my former instructors that teaching dental hygiene is very rewarding. Like any career there will be ups and downs, but they say the pros far outweigh the cons. When becoming an instructor my biggest fear is being involved in a legal situation the I am not directly responsible for. In chapter 10 of HCT the author pointed out that “as a faculty member, you may be involved [in a legal action] simply by virtue of your student’s involvement in a patient care situation.” I can cope with a legal situation that I would be directly responsible for such as letting a student proceed with treatment without having the patient take a pre-med if needed. Our instructors always preached not to put ourselves as students and them as the faculty in a legally compromising situation.

Another concern after reading this chapter is being careful not to become involved with personal issues with a patient such as any medical or psychological matters. I understood that instructors needed to be careful when discussing personal matters with students, not fraternizing, and not getting too close outside of the educational aspect. But the author advised that “significant conflicts of interest may develop if you enter into a therapeutic relationship with your students.” So we have to be mindful not to get personally caught up in a students personal struggles. It is easy to get caught up in advising a student what to do, especially if they’re facing similar issues we may have had. As the author mentioned, we need to refer the student to college/university’s support services for these matters.

Before starting as a clinical instructor I will need review guidelines that have in regards to dealing with difficult students, personal matters, and protocols for legal matters. It’s apparent that clinical instructors need to report all issues to the program director, but we need to discuss what the instructors are empowered to do for any given issue.

Diversity

Hygiene2007

Stark State College – Dental Hygiene Class of 2008

When I was younger I used to think that diversity only referred to race. But as I’ve gotten older and learned more I realized it included gender, religious backgrounds, and age. To me diversity means a mixture of individuals from different ethnic groups, gender, age, religious beliefs in one community or even workplace. I like Michael’s definition in his Access article “What Does Diversity Mean to You?” His definition is “the ability to coexist…peacefully and non-violently, despite differences.” This is exactly how I define my class pictured above.

Our hygiene class is the most diverse our school has had even up to now. We had a VERY close-knit group. Everyone got along and the instructors would always comment on how close we all were and how well we worked together. The age of the classmates ranged from 20 – 45 years old. Ethnicity – there was myself, African-American male; one Caucasian male; one African-American female; one Asian female. The rest were Caucasian females. Our program director is an African-American female and we had a Caucasian male instructor. So it seemed the program was going to become more diverse until we saw the following classes. Before graduating the male instructor asked me and the other male student about ways to increase the enrollment for males in the program. We were both at a loss for words because we didn’t have an answer. One barrier we talked about was the job opportunities. Most adult male students attend Stark State for a career change to better themselves and their families. If they look into the program and the field and see that the job opportunities are not promising then they do not enroll. I was one who changed careers to become a dental hygienist. I worked in the computer field after getting my first degree; got laid-off from the Hoover company and had trouble finding a decent job. The computer job I did find had no room to advance and it was repetitive and uneventful. So a friend of mine, who is a nurse, told me to look into dental hygiene. I looked into it and completed the observation hours required for application and saw that it was a career I’d enjoy. I was single with no kids at the time so I was able to take the risk of changing careers regardless of the job opportunities. After graduating I was fortunate enough to find a job.

I have heard some people speculate that some minorities have limited access to dental care, therefore they do not have encounters with dental professionals to consider it as a career option. I can see where that can be slightly accurate, but there are some minorities that don’t see lawyers, engineers, architects, etc but they hear about these fields as career options in middle school and high school.

Increasing diversity in dental hygiene can be difficult but not impossible. One way to accomplish this is for academic advisors to encourage those who are unsure of a career path to look into dental hygiene. I start my practicum experience in academic advising this summer. Hopefully I can encourage a few potential students to look into dental hygiene and share my experiences. Another way to increase awareness for the dental profession would be to have dental boards hire hygienists and dentists (at least part-time) to speak with their schools (especially diverse areas) often to speak to students about their oral health, access to care, and career options in the dental field. I think this would increase students awareness about becoming dentists and hygienists. The more dentists there are the more hygienists can be employed.

Faculty Calibration

Faculty calibration will always be difficult to achieve for dental hygiene clinical educators. The mix of experience educators and newer faculty can make calibration difficult. In the article “Moving toward Clinical Faculty Calibration” by Mary E. Jacks, she focused more on the concept of calculus detection by the faculty. Mary pointed out that “seasoned faculty continue to perform the instrumentation skills the same way the students learned, reinforcing the slow and deliberate strokes.” While the new faculty are still in private practice mode and go about it much faster. This concept was true in my clinical experience because the faculty members with years of teaching were slower in showing us how to detect calculus, while the newer members were faster and tried to incorporate different techniques. In my opinion both were very effective. It was a nice mix of fundamentals and alternate methods that we could use. Even if instructors show different techniques, it is important to provide the same instructions for delivering information. This is where faculty training comes in.

Faculty training is a must for all phases of clinical hygiene, not just calculus detection. The information provided to students must be consistent whether it’s for the extra/intra oral exam, patient education, calculus detection, or instrumentation. Nothing can be more frustrating to a student than the perception that the staff is not on the same page. When multiple students discuss this perception and agree upon it then they feel the perception is closer to reality. The student evaluations of the staff should be taken seriously by the staff after each semester. The program director should review these with that staff to determine if there is a consistent problem with grading.

Every staff member is obviously different so there are going to be different methods to educating students. All hygiene schools should or do have a grading system when assessing calculus removal. The problem occurs where instructors interpret the grades differently or have a different method of detecting calculus that results in a lower grade. The instructors need to thoroughly explain and show the student what they’re missing so that they can properly detect and remove the calculus  the next time.

Accreditation

When first reading through the accreditation requirements on section 2-16, I was a initially concerned with the statement, “Graduates must be competent in assessing the treatment needs of patients with special needs” and geriatric patients. I immediately thought back to my curriculum and said to myself that we weren’t required to see special needs or geriatric patients in clinic. But as I continued reading under Examples of evidence to demonstrate compliance it said “direct and non-direct patient contact assignments, and off-site enrichments experiences.” We had community experiences at the Stark County MRDD and elderly assisted living facilities. These were fun experiences where we got to provide oral hygiene instructions to these individuals. Many of them do not get regular company or have speakers, so they were always excited when we arrived. I didn’t realize it was a requirement for accreditation to have these experiences. I just assumed it was part of the curriculum that the faculty created to get us involved in the community and to give us volunteer ideas after graduation.

Accredited

I wasn’t aware about the faculty to student ratio for clinic. 3-6: “The faculty to student ratios for preclinical, clinical, and radiographic clinical and laboratory sessions must not exceed one to five.” I always thought that our faculty was short staffed so they weren’t able to have more than two instructors in clinic. If they ever told us about this ratio, then I never heard it. It was frustrating at times waiting for 30 minutes for a check. But I see for accreditation purposes it was required to work this way.

Accreditation is extremely important for dental hygiene. While in school many of us would wonder why we had to do certain assignments. Reading over these requirements makes you appreciate and understand the rigorous curriculum we had. Working with the public and treating patients is crucial. The educational institution should be required to adhere to these standards in order to accept students. I don’t understand how some colleges are able to exist without needing to be accredited, nor understand why someone would attend a non-accredited institution. The institutions need to demonstrate compliance to show that they are providing an accredited standard of higher education.

Giving Feedback and Grading

Giving negative feedback and bad grades cannot be easy for instructors. Although, I think I had a few instructors that enjoyed giving bad grades. Some instructors do not want to see the student demoralized by giving a bad grade or negative feedback, so they may lean on giving them a better grade than what they deserved. Positive and negative feedback is a must for an educational institution and the workplace because we all make mistakes and need to learn from the mistakes. “Without feedback, good practice is not reinforced, poor performance is not corrected, and the path to improvement not identified”  (Giving Feed in Clinical Settings article by Cantillon and Sargeant). This statement is very accurate, regardless of how we may perceive the feedback.

In the first scenario, I say to Mary, “You did well in reviewing the patients medical history in mentioning the vitals, knee replacement, and blood pressure. What other medical considerations do you need to make in regards to the patients medical history?” Hopefully she thinks about what she just told me in regards to his knee replacement and realizes that he will most likely need a pre-med antibiotic, or at least need a medical consult form from his physician. If she states she is not sure of any other considerations, then I will explain to her about asking the patient if the premed was taken. If the patient took the premed, then I would sign for radiographs and let her proceed with the perio assessment. I would give Mary an ‘F’ for the medical history portion because discussing the premed is a critical part of the patients medical concerns. It should be mentioned to the instructor when discussing the medical history. This grade would make her be more mindful when reviewing the medical history, especially for those needing the premed antibiotic.

"Higher Learning" movie- 1995. Student (Omar Epps) not happy with feedback/grade given by Professor (Laurence Fishburne).

Student (Omar Epps) not happy with feedback and grade given by Professor (Laurence Fishburne) and wants an explanation. “Higher Learning” (Columbia Pictures- 1995)

In the second scenario, the instructor was having a bad day from start. Leaving the cell phone at home, not dressing properly and dealing with a busy, overloaded clinic. I would have to take a deep breath and focus on remaining professional. Ben felt confident about his scaling, although he did acknowledge he had some trouble on the lower anterior due to the crowding. In noticing the amount of calculus remaining, I would ask Ben, “How did you assess the calculus removal?” I would have him look over my shoulder and spray air on the lower anterior to show him the calculus left on the teeth. I would ask him to list the teeth where he can visibly see the calculus. “A feedback session should be viewed as a two-way conversation in which the learner plays an important role in assessing his/her own performance (Krackov 2011).” Ben would be able to see for himself that his scaling was not effective in this area and that I was not being unfairly critical of his work. This form of feedback is one of the tips (Tip 1) in Twelve tips for giving feedback effectively in the clinical environment by Ramani and Krackov.  I would give Ben the grade according to the rubric/grading scale. I’d write a comment on his grade sheet to complete a self-evaluation form on that particular calculus check. This would allow him to reflect on his performance as he writes it down.

Providing negative feedback and bad grades are not easy, but it is a necessity in helping students learn from  mistakes and improve their performance.

Competency Evaluations

The students should know they are being evaluated during the first semester of hygiene school, particularly in the fundamentals course. They will need to pass the competencies in order to proceed to the actual clinical course the following semester. Once the students are in clinic they should be aware that they can be graded for a competency at anytime, but not a scheduled competency. They instructor should be able to catch the student off-guard to make sure the student is following the fundamentals learned. If the competency is scheduled, then the student will be focusing on the instrumentation just to pass. So the actual competency evaluation will be more effective if the student is unaware of the evaluation. This process will determine if the student is competent working with a patient rather than only working for a grade.

One of my local anesthesia competencies. Fall 2007.

One of my local anesthesia competencies. Fall 2007. Stark State College (North Canton, OH)

The students should have to pass competencies more than once, but not all instrument competencies. For example, the student should have to pass a curet instrument and a scaler each semester, but not all curets and not all scalers.  If a student fails an instrument, then they should be required to have a scheduled competency to verify that they know the proper techniques for all those types of instruments (i.e. scalers or curets). The instructors should monitor the students instrumentation so that they do not negate the fundamentals learned. The students will use advanced techniques as their education progresses, but they need to be occasionally  checked to make sure they are using those fundamentals.

Students will always have some nervousness when an instructor is watching them. The instructors should remind students during each huddle that there is a chance each student can be graded for a competency. Just remind the students to focus on their patient and not be concerned with a competency grade when an instructor is watching.

 

Coaching and Role Modeling

The faculty should only reinforce information taught in classes or textbooks during the first clinic semester. Most programs spend their first hygiene semester teaching fundamentals involving terminology and instrumentation. The first clinic semester should focus on what was taught during fundamentals so as to not confuse the students. The following semesters should steadily increase advanced instrumentation/techniques as students get comfortable working with patients. The modifications definitely have a place in the clinical setting because not all patients are the same. The Preceptor Handbook described part of the coaching process as “changing strategy to address changing situations.” Therefore we need to modify some of the fundamentals learned to adapt to a particular patient’s needs.

The clinical faculty needs to be careful when introducing modified techniques to students so as to not negate the fundamentals that the student has learned. Introducing new techniques can be done on a case-by-case basis in clinic. For example: if a patient is having trouble being in a supine position, then the instructor can tell the student to set the patient in a semi-supine position and stand (if need be) while treating a patient.

Role modeling is critical component of the faculty, even when the faculty are not actively trying to be role models. The Preceptor Handbook also mentioned that “students will learn from our role modeling whether or not you purposefully present yourself as a role model.” The faculty must maintain a professional behavior when working with patients and students. This behavior is what the students will try to emulate, especially when working with difficult patients. The students know that they will encounter many difficult patients after graduating and working in private practice. So if an instructor has to speak with a difficult patient that a student has, then it is wise to be professional and speak in a manner that won’t make the situation more difficult. This would be a perfect learning tool for the student.

Questioning Skills

When checking an intra/extra oral exam for a student and I notice a lesion I would ask the student, “What have you noticed during your intra/extra oral exam for this patient?”  This is a broad question, but it will allow the student to explain most, if not all findings including areas of concern and areas of no concern. It will also allow me to see if the student uses correct terminology when describing the areas. This is one of the principles of questioning that Karron Lewis, Ph.D. listed involving encouraging “lengthy responses and sustained answers.” If the student says he/she found a lesion on the buccal mucosa, I would ask how would they describe the lesion and how was it documented.

If the student just says “nothing, everything looks fine”, then I would tell he/she to do the assessment again slowly and document everything found.

It is hard to avoid yes-no questions because these are easy to ask, but the author made a great point that “If you catch yourself asking a yes-no question, add “Explain”. This will prevent the student from giving a guess, allowing them to actually think about why the answer is yes or no. This type of questioning will effect the other students because they will see how the instructor questions, and the type of answers the instructor wants.

Many parents look for school systems rated high because these school systems put together a curriculum that makes the child think and actually understand the material rather than memorizing. The article mentioned that “education today aims at the creation of a ration being. A rational being does not merely possess an effective memory; he/she must be able to react to data.” This is the reason why dental hygiene board questions are framed to actually make us think through the problem, rather than just repeating information we may have memorized.

Critical Thinking

I have been practicing in private practice for almost 6 years and daily I refer back to information learned in school as a reminder for certain situations. I had multiple patients I would consider as difficult classifications in regards to perio conditions and heavy calculus. One instructor would tell me to use “exploratory strokes” in the difficult posterior areas when removing calculus so I could feel what I was trying to remove while scaling, instead of just scraping away hoping to remove it. The same instructor also recommended taking post-procedural bitewings to verify that the radiographic calculus has been removed. If there is still calculus on the xrays, then I am able to see the areas I am missing. This has definitely helped me when scaling on difficult DSRP patients. This situation is where I put some critical thinking to use when scaling. The Educational Strategies article mentioned that “critical thinking is 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.” So I compare and analyze the x-rays, and explore for calculus removal to verify that I have completed DSRP on a difficult patient.

The Albert Einstein quote is very true because it is impossible to remember everything learned in school. So it is important to keep up on current concepts through articles in dental hygiene literature and continuing education courses. Instructors always told us that we will always be students in some form.

It is very important to teach some facts, but not all facts in a science major because theories can evolve or change. Critical thinking and problem solving are both important qualities to have because not all patients are the same and we will encounter situations that we may have not seen in school clinic or covered in lectures. So we will need to develop critical thinking and problem solving skills to be able to handle unforseen occurrences. I feel critical thinking and problem solving are both equally important because critical thinking is needed for all situations requiring thinking, and problem solving strategies usually require critical thinking. As the article pointed out, problem solving is the “action-end” of critical thinking, therefore one quality is needed for the other.

The instructor that I mentioned in the Most Valuable Clinical Instructor blog felt problem solving and critical thinking was extremely important which is why she tested us  in front of patients. She was a genius in helping us to see that these skills will be needed on a daily basis.