Evaluation of Dental Education Strategies - Essay Example

Introduction: The educational strategies in different fields demand different methods so that they are effective. Though there are vast research works in many educational fields, the research in the field of dental education has been limited in number. Dental education is with respect to two contexts namely classroom teaching and clinical teaching. Any professional education aims to identify the best educational method that would help the students to acquire expert knowledge and practice including critical thinking and self-directed learning and practice. According to Schonwetter et al (2006, a), “In far too many professional programs like medicine, dentistry, dental hygiene, and nursing, effective teachers are produced by happenstance rather than design”. Since the initiative of reforms in medical education, clinical education has faced greater expectations. After the UMCISS (Undergraduate Medical Curriculum Implementation Support Scheme) and the Tomorrow’s Doctors (GMC, 1993), the medical and dental education demanded new teaching – learning methods with more formal instructional design and delivery. In professional education like medical and dental education, the common teaching strategies include that of role model, small or large group interactions, lectures, one to one teaching, brainstorming, computer aided case studies and patient model exercise. Among these methods, for clinical teaching, the preferred teaching methods are role model, one to one instruction, small group discussions and patient model assessment. This case study involves the analysis of these clinical teaching methods and tries to identify the best practice. Aim and objectives of the case study: The aim of this case study is to determine the most effective method of teaching in dental education. The objectives of the study are to analyse The effective teaching qualities like enthusiasm, individual attention to students, group discussions, one to one direct teaching, organisation of content to be delivered, exams, rapport with students, encouragement, expected outcome of the student. To discuss the kolbs learning cycles. Conduct a survey among the students to collect their opinion about different teaching strategies. Based on the survey feedback from students, this case study aims to identify the most effective teaching method. Thus the single major aim of this case study is to find out the best teaching method in dental education – whether is it one to one direct teaching? or is it small group discussion teaching? Context of the case study: According to Schonwetter et al (2006 b), in professional education like medical, dental and dentistry, the knowledge acquired by practise and the technical skills learnt form the basis for effective education. The teaching – learning processes and the teaching strategies for medical and dental education are unique. Medical education: The General medical Council, in an article, “The Doctor as a teacher” (1999), discusses that “expectations of those who provide a role model by acting as clinical or educational supervisors to junior colleagues…..(and)..to those who supervise medical students, as they begin to acquire the professional attitudes, skills and knowledge they will need as doctors” (p.1). The article also states that the teaching skills need to be developed by a doctor and he / she should be a competent teacher. The following personal attributes are quoted for a competent and committed medical teacher by Judy and Carol (1997), commitment to profession, enthusiasm, sensitive to needs of students, inculcating the required professional attitude within the students, developing practical teaching skills, interest in serving as doctor as well as a teacher, openness to peer review and change his or her teaching, ability to implement formal assessment of medical students and trainees. In a practical situation, the view of a critique would be that even if a teacher has all these attributes, the teaching learning process may not be successful if the participation by student is limited. According to Michael Eraut (1992), the different kinds of knowledge required for professional education are Propositional knowledge, Personal knowledge and Process knowledge. For a competent doctor – teacher with all these pre requisites, the transfer of knowledge in teaching context occurs naturally without any self - enrichment. For a less competent doctor - teacher, “a heavily teacher-centred approach may be most appropriate …when the knowledge base is weak and skills are limited. Later, a more learner centred approach can be adopted as experience builds. It is a matter of knowing not just what to teach but when to teach it.” says Peyton (1998, a). He also adds that in medical education, rather than relying on an individual’s knowledge a team approach would work well. In the context of multi professional learning, he quotes that “Doctors must be prepared to teach and learn, not only within their own profession, but also across disciplines” (Peyton , 1998 b). The different ways of medical teaching include didactic teaching, case based small group discussions, class room discussions, large group discussions, computer simulations, role play, lecture presentations and tutorial sessions. In spite of all these, a critical view is that, an in depth knowledge and practical skills in clinical aspects would be the prime requirement and the most essential knowledge. Dental education: The primary goal of dental education is to develop a practitioner who can function efficiently without supervision. This independent functioning of a dental practitioner depends on his ability to identify the patient’s need, make therapeutic decisions based on the available options, evaluate the treatment and assess themselves. The practitioner would acquire these skills by proper training and mentoring. Olesen.V. (1979) and Hendricson and Kleffner (1998), say that the dental practice becomes more responsible and successful by the availability of a mentor who acts as a coach as well as a role model. The most common belief for expertise, in any profession is that the seed must be sown in the earliest stage of learning, in dentistry it is in the stage of teaching. The requirement of critical thinking in dental practice greatly depends on certain educational strategies (Chenoweth.L., 1998). In a practical situation, I have experienced that being a role model has more impact on the learning process. The literature related to dental education are pronounced in journals like European journal of Dental Education and Journal of Dental Education. Though there are many emerging research in this area, most of the studies lack a theoretical framework on the perceptions of the students with respect to the teaching methodologies, says Kernan et al. (2000). Dental education needs to be assessed in different situations including class room teaching, clinical teaching and laboratory teaching. Though there are few research works for the effective teaching methods inside a classroom for dentistry and dental hygiene, the available literatures say that factors like rapport, organisation, enthusiasm, subject knowledge, availability for students, clarity, and empathy are more important for successful classroom teaching (Perry, 1997). Teaching in the laboratory mainly concerns group discussions with practical exposure to dental practice. Clinical teaching draws the instructor closer to the student with more clear clinical instructions. This clinical teaching involves continuous communication and has the potential of greater influence of the instructor on the students. This leads to more effective instruction delivery in clinical teaching as compared to classroom or laboratory teaching. In their study, Talwar and Weilin (2005), say that while women educators considered availability and positive feedback as important, men educators considered being a role model as more important. From a critique’s view, it could be seen that both aspects are necessary for a good teacher and in the perspective of the students, the clinical instructor is expected to have good interpersonal relationship, clinical competence, approachability, availability, positive professional behaviour, punctuality, and consistency. When these factors are taken care of, dental education would prove to be fruitful. Teaching - Learning Process: The teaching and learning process constitutes the aspects of preparation for teaching, delivering lectures, teaching and learning in groups, explaining the concepts, group dynamics, small group discussions, managing the groups, one to one direct teaching, seminars, case based discussions and learning, computer based learning and clinical instructions. The aim of the teaching process is to simulate the learning process within the students that would enable critical thinking and correct decision making. The perspective of identifying the factors that influence effective teaching and the correlation of these factors has not been emphasised so far in dental education research. These influencing factor may again differ in different teaching strategies. Hence amongst the different teaching strategies, the most effective method can be identified by analysing the influencing factors. According to Feldman.K.A. (1989), these factors include, clarity in teaching, impact of the instructions, inculcating interest in the course, organised way of subject delivery, encouraging group discussions, encouraging questions, expressive skills of the faculty, clear course objectives, enthusiasm of the faculty, course material provided to students, supplementary material given to students, additional teaching aids used by the instructor and finally the respect to students and their feedback. These factors have been confronted by other major researchers like Kolb. According to Kolb (1984), learning in medical education is much more of ‘learning by doing’ and ‘learning by observation’. He adds that a reflective practitioner becomes an expert by constantly updating his ideas from past experience. His model for experiential learning theory has four stages namely, concrete experience, reflective observation, abstract conceptualisation, active experimentation. He discusses about the combined effects of these stages as accommodating, diverging, converging and assimilating. Figure. 1. Kolbes learning cycles (courtesy: kolb (1984). ) A critical view in this context is that, these combinations need to be practically proved by some feedback from students and further research. This case study intends to do this as part of evaluation of dental education strategies. Thus the teaching - learning process in medical or dental education must provide opportunities for students to gain experience by reflection, practice, feedback from patients. Various teaching methodologies: Wehrli, G., Nyquist, J.G. (2003), discuss the various teaching methodologies for classroom setting and clinical setting. For the classroom setting, he proposes the following methods brainstorming – where various ideas are generated and final judgement is after many valid ideas, case based small group discussions – specific problem solving strategy by discussion among a group of 5 to 10 members, problem based learning – posed to the problem, the learners work out hypotheses and mechanisms to solve the problem, computer simulation – medical interpretation of data, examination of patient conditions and to find out the effect of drugs, Demonstrations – learner learns by observation, Competitive learning – application of principles are initiated by drills and feedback, Individual study – the learner learns on his own with the aid of computer or world wide web, Large group discussions – stimulates critical thinking on a broader scale with multiple ideas and specific resolutions, Lecture / presentations – didactic presentation of concepts to a large group with additional audio visual aids for teaching, Role play – specific to a clinical scenario, Tests / assessments – provides insight into the learning and thinking ability of a learner. From the view of a critique, these many methods can be condensed into two or three categories as many of them have certain common features. For the clinical setting, Wehrli, G. and Nyquist, J.G. suggests, One to one or percepting – direct interaction between the students and the instructor by sequences of questions, demonstrations, giving instructions. In medical education instructions during ward visits or bedside rounds are typical examples of this category of teaching. Also he adds Role model – learners learn by listening and observing the regular duties of instructors, from which they learn diagnostic and problem solving skills. Also this method influences the ethical and attitudinal aspects of the students and finally, Standardised patients – feedback based system where the patient role is enacted and the reaction and behaviour of the treating student learner is studied. In practical situations, a critique would feel that standardised patients method is seldom practiced, whereas small group discussions may be more adapted. Teaching strategies: According to Chapman and Sonnenberg (2000), the best teaching or medical practice strategy that would help the students in critical thinking and problem solving have been based on observation, analysis of decision making steps and clear clinical reasoning. The educational strategies that improve critical thinking, are seen to be Frequent questioning that induces case analysis, rationale for action plan, thinking of alternative approaches, predicting the outcome. Listening to the opinion of expert practitioners for problem analysis. Referring to previous case or problem situations and correlating them to present situation. Training students to undertake assignments that provide practical experience of problem analysis and decision making. Elton (1977) has modelled the teaching – learning techniques into three main categories namely mass instruction, individualised instruction and group learning. In mass instruction, the faculty controls the instruction process and uses traditional lecture notes, lab classes and audio video aids. In the individualised instruction the faculty guides the student by one to one interaction. In group discussions, the faculty acts as the facilitator and the course delivery is by means of seminars, exercises and other group activities. Also, group discussions are more relevant to clinical situations. This method or teaching strategy enables active participation of the learners. As a critique, I feel that the last two categories are more relevant to effective teaching strategies. Hence my case study is based on these two categories – one to one teaching and small group discussions. Comparative discussion of one to one and group discussion methods: Based on the critical review of the related literatures, the successful methods for clinical teaching are seen to be one to one instructions and group discussion methods. In one to one teaching, the instruction is delivered by the faculty to the learner by direct interaction. The method of course delivery may be demonstration, giving instructions, observing and evaluating a learner, guidelines on problem solving, giving feedback about student’s performance. The advantages of one to one teaching as described by an article of The University of New Mexico school of medicine (www.som.unm.edu ) , “Actively involves learner in a natural work environment. Allows for an individualized approach tailored to specific needs of the learner. Provides opportunity for role modelling, demonstration, and observation of appropriate professional habits and attitudes. Provides practice to build skills and problem solving in real situations with expert supervision, guidance, and the opportunity for continuous feedback. Can foster teamwork and cooperation. Promotes development of verbal communication skills.” The major disadvantages are “ Relies heavily on the preceptor being a good role model and having effective teaching, questioning, and feedback skills. Can be hampered by personality Conflicts. Can be time-consuming.”( www.som.unm.edu). Small group teaching has 5 to 10 participants. The major concern is the communication skills and focused learning of the participants. In medical scenario small group teaching can be in a clinical office or in bedside rounds or even in ambulance. Steinert (1996) describes, “small group teaching offers students an opportunity to discuss and refine their understanding of complex issues, to problem solve and apply their knowledge to new situations, and to reflect on their attitudes and feelings.” The method of teaching also paves way for self-directed learning, humanism, closer contact with instructor, communication skills. The critical view according to me in this context is that the student must also be enthusiastic and confident in expressing his or her opinion. The prime requirement in group discussion is the requirement for proper seating arrangement so that the participants have direct eye contact with each other. Dennick and Exley (1998) categorize small group discussion into problem based learning, focused discussion, role play and student – led seminars. In focused discussion, the instructor proposes the case situation and the rest of the group discusses on the problem. The case situation can be framed by the faculty prior such that it can “capture real life situations in which a professional (representing the students who are training to adopt similar professions) confronts a dilemma common to the discipline.”(Armstrong, 2004). Additional teaching aids like hand outs and video clippings could be used to stimulate the discussion. The advantages of focused discussions is that they are case based and it enables learner to gain clinical experiences from past situations. The weakness of focused method is that the proposed case may not be relevant to the learner’s experiences. Problem based learning (PBL) is similar to focused discussion, but is more cased oriented or problem oriented. The case information is unfolded to a small group of members (4 to 6 in number). The students discuss the case history, probable physical examinations that could be useful and the data from clinical tests. Based on these discussions, the students identify the actual problem and then they go for the strategies for solving that problem. Generally, the students acquire different roles as leader, scribe, reader and participant. At each stage each role is taken by a student so that he or she has the experience of all the roles. The learning objectives are frequently researched by feedback. The advantage of problem based learning is that it develops critical analysis of a specified problem and inculcates the talent of problem solving within the learner. The faculty just facilitates the discussions and concludes the discussion. The faculty has less control and has less opportunity to impose his or her view onto the learner. This enables self-learning, which is considered to be more effective. Seminars and role play are few traditional methods in small group discussions. Thus small group discussions lead to new concepts, application of the concepts, case based analysis, team projects and patient based discussions. According to an article published by the University of New Mexico School of medicine (www.som.unm.edu), the major advantages of group discussions are “ Actively involves participants and stimulates peer group learning. Helps participants explore pre-existing knowledge and build on what they know. Facilitates exchange of ideas and awareness of mutual concerns. Promotes development of critical thinking skills. Develops leadership, teamwork, communication, and collaboration skills. Promotes higher levels of thinking (application, synthesis, evaluation) versus simple memorization.” The major disadvantages are “ Can potentially degenerate into off-task or social conversations. Can be a challenge to ensure participation by all, especially in larger groups. Can be frustrating for participants when they are at significantly different levels of knowledge and skill. Can be unpredictable in terms of outcomes. Increases potential for interpersonal Conflicts. Can be time-consuming.”(www.som.unm.edu). Evaluation of the case study: This case study intends to evaluate students’ experience in dental education (Orthodontics). Case study method for research work seems to be the best method of research as it enables the analysis of the exact research scenario. Although researchers like McMurray et al (2004), quote that qualitative and quantitative research methods are common. The case study method proves to be more reliable when it is supported by qualitative or quantitative data. Along with case study, if the research is supported by literature evidences, than the research proves to be valid. This research work happens to follow this strategy with sufficient literature, as already discussed in previous sections and a case study in the dental clinical scenario. The literature discussed so far, are from reputed journals like Journal of dental Education, Medical Educator, American Journal of Pharmaceutical Education, Academic Medicine, European Journal of Dental Education, Journal of Nursing Education. The case study for this research work has been based on the feedback collected from the students. The sample space and sampling method: Sample space refers to the number of people who had been chosen for the feedback or survey. The sample space for any research work has to be sufficiently large for the research to be valid. The sampling method is the selection procedure for the survey. The sampling method must ensure that most appropriate participants (those who have sufficient knowledge about the case situation) are selected for the feedback. The different sampling methods include, area sampling, focused groups, cluster sampling, systematic sampling, random sampling. For this case study, the focused group is more appropriate as it would involve the students in the clinical learning environment. The students involved in this case study are dental therapists and dental nurses who undergo clinical teaching from an orthodontist (myself). Total number of students would be a maximum of four at any group. These set of students form the sample space for this study and they are involved in clinical learning process. Data collection method: In any research work the data collected from the participants has to follow a specific method. The data collected may be qualitative data or quantitative data. In either case the data collection tool is a questionnaire. According to Ian Brace (2004), a questionnaire is “the medium of communication between the researcher and the subject, … In the questionnaire , the researcher articulates the questions to which he or she wants to know the answers and, through the questionnaire, the subjects’ answers are conveyed back to the researcher.” The qualitative method of data collection is in the form of interview. Mostly the answers are recorded or written down by the researcher if it is an oral interview. If the interview is in written format, then the participants are allowed to write the answers in the questionnaire. The qualitative answers (data) are more descriptive in nature and provide freedom for expression for the participant. The researcher presents a pre-defined, structured set of questions to the participants. The participants are required to answer these questions in their own words. In verbal method, the interview may be conducted over phone or in person. In written interview, a questionnaire with proper instructions is provided to the participants and the participant is expected to write his answer or opinion below the question. The quantitative data are in discrete form and are designed to provide specific answers to the questions. This method of data collection is always in written format, where the participant chooses a specific option defined by the researcher. This method has questions that have multiple choices in the form of options. The participant has to choose any one option for a specific question. For this study, the data collected is in qualitative form. The qualitative questions are designed to follow specific rules so that the data or answers collected from the students are valid. These rules include – clear instructions to participants about the research scenario, proper sequencing of the questions so that the ideas are correlated well, different combinations of questions such that all areas of research are covered, open questions that enable free expression of thought, specific questions that target a specific research problem so that in depth analysis of the situation can be done. The questionnaire for this case study is as follows, 1. Which teaching method is beneficial in your perspective? 2. Is small group discussion more useful than one to one teaching? 3. Is one to one teaching more useful than small group discussion? 4. Do you get enough chance to express yourself in one to one teaching? 5. Do you get enough chance to express yourself in small group discussion? 6. Does the small group discussion environment allow you to think on your own? 7. Does one to one teaching environment allow you to think on your own? 8. Do you have opportunity to get opinion of other students in one to one teaching? 9. Do you have opportunity to get opinion of other students in small group discussion? 10. Is there scope for applying your ideas to the case situation (clinical situation) by small group discussion? 11. Is there scope for applying your ideas to the case situation (clinical situation) by one to one teaching? Based on the concepts of kolb’s learning cycle, 12. Which method of teaching (one to one or small group discussion) provides concrete experience? 13. Which method of teaching (one to one or small group discussion) induces reflective observation? 14. Which method of teaching (one to one or small group discussion) leads to abstract conceptualisation? 15. Which method of teaching (one to one or small group discussion) enables active experimentation? The qualitative answers from the students have been collected and recorded. Critical analysis of the data: From the above questions, it can be seen that the participants might have answered in either positive sense or negative sense (similar to yes or no.. sense) for many of the questions. This fact can be utilised to analyse the data (opinion) of the participants’. For the first question, Which teaching method is beneficial in your perspective? The answer could be either one to one teaching or small group discussion or few might have answered weirdly (in neither sense). Finding the percentage of participants for each case and plotting a chart it was found that 40% of them had the opinion that one to teaching is good, 50% of them have said that small group discussion is beneficial and other are half minded and their opinion is not defined clearly. This can be represented graphically as in figure. 2. for the percentages in Table 1. q1  one to one teaching small group discussion undefined 40 50 10 Table. 1. Data for question 1. Figure 2. Chart for question 1. Considering the second and third questions, Is small group discussion more useful than one to one teaching? And Is one to one teaching more useful than small group discussion? The percentages and corresponding graphs are q2  q3 yes no undefined yes no undefined 50 40 10 40 40 20 Table. 2. Data for question 2 and question 3. Figure 3. Chart for question 2 and question 3. For questions 4 and 5, Do you get enough chance to express yourself in one to one teaching? Do you get enough chance to express yourself in small group discussion? The data and graph are, q4  q5  yes no occasionally yes no occasionally 30 60 10 70 0 30 Table. 3 . Data for question4 and question 5. Figure 4 . Chart for question 4 and question 5. Considering questions 6 and 7, Does the small group discussion environment allow you to think on your own? Does one to one teaching environment allow you to think on your own? The data and the corresponding graph are, q6  q7  yes no undefined yes no undefined 80 10 10 50 30 20 Table. 4 . Data for question 6 and question 7. Figure 5. Chart for question 6 and question 7. Analysing questions 8 and 9, Do you have opportunity to get opinion of other students in one to one teaching? Do you have opportunity to get opinion of other students in small group discussion? The data and graph are found to be q8  q9  yes no sometimes yes no sometimes 30 40 30 90 0 10 Table. 5 . Data for question 8 and question 9. Figure 6. Chart for question 8 and question 9. For the next questions 10 and 11, Is there scope for applying your ideas to the case situation (clinical situation) by small group discussion? Is there scope for applying your ideas to the case situation (clinical situation) by one to one teaching? The data and graph are q10  q11  yes no occasionally yes no occasionally 40 30 30 20 50 30 Table. 6 . Data for question 10 and question 11. Figure 7. Chart for question 10 and question q11. Analysing questions q12 q13 q14 and q15 the data were found to be q12   q14   q15   q13   one to one small group discussion one to one small group discussion one to one small group discussion one to one small group discussion 40 60 70 30 80 20 20 80 Table. 7 . Data for question 12 to question 15. Figure 8. Chart for question 12 to question 15. Key findings: From the above critical analysis, the important points to note are, small group teaching is beneficial , Small group discussion is more useful, Small group discussion enables a student to express better, It enables thinking on own, get the opinion of other students, Small group discussion enables application of idea but one to one teaching does not, Small group discussion enables concrete experience , reflective observation and active experimentation. One to one teaching leads to abstract conceptualizations. Recommendations: Development of effective learning environment: Based on the case study it can be critically reflected that small group discussions is more effective method of teaching than one to one teaching. This method would lead to a learning environment where there can be peer group learning, exchange of ideas, collaborative work, chances to learn by experience, induces leadership and teamwork. Also it could be noted that this case study has checked the kolb’s learning cycle, and it is found to hold good. With these similarities, it can be recommended that small group discussion leads to effective teaching and it induces the psychological factors of feeling, watching, thinking and doing. Potential areas for improvement: The potential areas that would greatly improve the implementation of small group discussions are – Providing more relevant instructions to the students before start of discussion. Instruction and discussion encourages proper verbalization of the idea. More problem centred instruction and discussion. Constant feedback system for sustained improvement. More amiable physical environment. Good introduction of all students to each other. Framing open ended questions. Defining proper ground rules. Motivating assessment techniques. Conclusion: Effective teaching is a prime requirement in any professional education like medical and dental studies. This case study research has concentrated on the critical review of literatures related to effective teaching qualities of faculties, the kolbs learning cycle, the various teaching – learning processes. Thus the single major aim of this case study was to find out the best teaching method in dental education – whether is it one to one direct teaching? or is it small group discussion teaching? To answers this, a survey in the form of feedback from clinical students has been conducted with a defined questionnaire. The qualitative answers (data) have been documented. After analysis of the data, it was found that small group discussion was more effective than one to one teaching. According to the key findings, it could be recommended that small group discussion leads to effective teaching and it induces the psychological factors of feeling, watching, thinking and doing. Finally the potential areas of improvement have also been suggested. References “TEACHING STRATEGIES/METHODOLOGIES: Advantages, Disadvantages/Cautions, Keys to Success”. www.som.unm.edu retrieved 25 May 2012. Armstrong E. (2004), “Overview: Advantages of the case based approach.”, Pedicases.org. Boston: Harvard Medical School; http://www.pedicases.org/teaching/overview/approach.html. Retrieved 28th May 2012. DennickChapman GB, Sonnenberg F, eds. (2000), “Decision making in health care: theory, psychology and applications.” New York: Cambridge University Press. Chenoweth, L. (1998). ”Facilitating the process of critical thinking for nursing.” Nurse Education Today, 18, 281-292. 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