Working Approaches to Educational Strategies and Courses
Recommended Educational Methods
In addition to traditional lectures, educators recommend a combination of educational methods of instruction, including rotations, seminars, workshops, role-playing, and experiential learning to prepare future practitioners.
So that students will not view the off-site rotations simply as an opportunity to hone clinical skills, they need assignments that encourage reflection on their experiences to reinforce their lessons from the field.1
The 15 Dental Pipeline schools use the various courses and strategies described below to meet their educational goals. All dental schools are invited to submit information on their behavioral sciences, public health, cultural competency training, and clinical education courses and strategies.
Below are some of the various courses and strategies currently used by dental schools:
Communications Skills, CUMC
Communication Skills - Introduction to the Patient (D6851) and Dental Interviewing (D7851), Columbia University School of Dental Medicine
The teaching of communication skills is included as a part of two courses in the Behavioral Science course sequence. Fundamental communication skills are taught in the second year followed by a dental interviewing course, with video taping assignments in the third year. In the second year course, Introduction to the Patient, students learn the fundamental communication skills necessary to the psychosocial aspects of patient care.
In the course, Dr. Lynn Tepper, who serves as the course director, stresses the distinction between the reflexive and reflective attitude in interactions with patients. The former is automatic, knee-jerk reactions to patients unrelated to the provision of humane health care; the latter thoughtful interaction based on the individual students understanding of their interpersonal habits with patients. Students learn tools to assist them such as communicating through non-verbal cues, and explore patient relationships through the viewing of video presentations of patient commentary.
There are two practical assignments to assist students to learn about communication skills. In the second year, after the didactic sessions, students complete an Assistantship Project. This consists of second-year students teaming-up with an assigned third or fourth year students, and observing the student dentist-patient interaction. In small groups with a precepting faculty member, the second year students discuss the interaction they observed and critique it in relation to what they had been taught in class.
The second course, Dental Interviewing, involves a practice-based assignment, occurring in the third year, to further develop the knowledge and skills for effective interpersonal communication in the dental setting. Students videotape one initial patient encounter. Students select a 5 to 10 minute segment of the videotape for a presentation to a small group of their classmates. In addition to an oral presentation, students complete a written in-depth description of their patient encounter that includes a self-analysis of his/her interaction. Students are urged to reflect on their interaction with the patient and to observe what happened, what could have happened or what should have happened, e.g. They are urged to learn from their mistakes. With their classmates and two faculty members - a dentist and a behavioral scientist - their presentation and videotape are discussed.
To read a Student Self Analysis click here.
To view the video clip of a student/patient interview, click here.
For more information, contact Dr. Lynn Tepper at Columbia University, School of Dental Medicine.
Cross Cultural Communications Skills, UCONN
Cross Cultural Communication Skills, University of Connecticut School of Dental Medicine
University of Connecticut Dental students receive joint instruction with medical students in the basic and behavioral sciences during the first two years of the curriculum. A 132-hour course entitled Human Development and Health uses lectures and small group learning sessions to address (1) health and the health care system, (2) health and health behavior across the life span, (3) health law and ethics, (4) clinical epidemiology, and (5) the biopsychosocial perspective on health and illness. Knowledge gained in this course provides students with requisite knowledge for patient-instructor cross cultural communication rotations in Years 2 through 4 of the curriculum.
Cross cultural communication rotations at the University of Connecticut use a patient-instructor methodology. Patient-instructors are individuals from the community who are drawn from diverse racial, ethnic, and socioeconomic groups. They are trained extensively to portray a fictional patient with a specific history and presentation. The fictional patient case history is written to include a chief complaint, medical and dental histories, and cultural characteristics that are likely to broaden students’ communication skills. Challenging cultural characteristics may include English as a second language, insurance status, use of alternative healing strategies, beliefs about oral health, or attitudes toward health care providers.
Students conduct clinical interviews with the patient-instructors and are aware that the encounter is simulated and is being evaluated. Each patient-instructor evaluates the content and the process of the interview. Then the patient-instructor gives the student immediate, individualized, and detailed feedback about his/her interviewing skills, interpersonal style, and ascertainment of information specific to that case. The patient-instructor rotation is proctored by clinical dental faculty and behavioral science faculty who debrief students after their participation.
The goals and for the patient-instructor rotations differ by year. In Year 2, students interview three patient-instructors (1/2 hour each). These cases offer the student the chance to practice basic interviewing skills. Students receive detailed, individualized feedback; however, students do not receive a grade per se. In Year 3, students interview four new patient-instructors. These cases offer the student the chance to practice higher level interviewing and counseling skills with patient-instructors who present communication challenges. Again, students receive detailed, individualized feedback but are not graded. In Year 4, students interview four new patient-instructors who present more difficult communication challenges. In this final experience, the student is evaluated and must pass as a requirement for graduation.
Widely used in medical schools and in a few dental schools, the patient-instructor model has been shown to be an effective mode of instruction for students to refine communication skills. The patient-instructor rotations at the University of Connecticut School of Dental Medicine are currently being implemented in a step-wise fashion across each year of the curriculum.
Course Instructor:
Julie Wagner, Ph.D.
Patient-Instructor Faculty Advisory Committee:
Sarita Arteaga, DMD, Assistant Clinical Professor, Department of Prosthodontics and Operative Dentistry; Joseph D’Ambrosio, DMD, Associate Clinical Professor, Department of Oral Diagnosis; Cynthia Hodge, DMD, MPH, MPA, Associate Dean of Community and Outreach Programs; Effthimia Ioannidou, DMD, Assistant Clinical Professor, Department of Periodontology; Carol Pfieffer, PhD, Associate Professor and Director, Clinical Skills Assessment Center; Susan Reisine, PhD, Professor and Head, Department of Behavioral Sciences and Community Health; Julie Wagner, Ph.D., Assistant Professor, Department of Behavioral Sciences and Community Health
Click here to view a video of the patient-instructor/dental student interaction.
Curriculum Development, WVU
Curriculum Development, West Virginia University School of Dentistry
One of the most complex tasks the Dental Pipeline schools has faced is to revise their curriculum to prepare students for 60 days of senior year rotations in community sites. Each of the 15 dental pipeline schools has approached this task in a different manner. In at least one school, the University of Illinois Chicago, the Dental Pipeline program has become integral to a revision of the entire curriculum. Other schools have decided to revise existing curriculum to assure the proper learning prior to the senior year rotations.
The West Virginia University School of Dentistry approached this task in a thorough way, which may be of assistance to others as they attempt to revise what most call the “overcrowded” dental curriculum. WVU followed a three-step approach:
- Survey all course directors to determine whether, and to what degree, six areas of social and behavioral science topics are included in their courses. The areas surveyed were the behavioral sciences, culture, ethics, gender, geriatrics and special care. A brief paper-and-pencil survey was developed, and completed by the director for each course. Follow-up interviews were conducted with selected faculty as needed to gather additional information.
- Determine where voids and overlaps (some of which are useful) exist based on the survey, comparing content to existing national dental and other health sciences guidelines detailing cultural competency and other behavioral science curriculum areas.
- Create a list of topics that need to be covered and identifying the sequence in which this information should be presented, and in which courses it should be contained.
WVU appointed a Behavioral Sciences Subcommittee of the Curriculum Management Committee. Among other tasks, it helped to develop the survey, and to collect and analyze this information. Presently, this group is making recommendations about curriculum changes.
Additionally, faculty development activities were conducted to provide a knowledge base for the infusion of cultural competency topics in the curriculum. These events include:
- All-day campus and field faculty retreat focusing on Pipeline and Building Communities
- Lunch and Learn sessions for faculty
- Visits from rural community dentists and consumers
- National speakers in the area of ethnic minority health
- Through its Dental Pipeline project, WVU also brought in two outside consultants who prepared curriculum recommendations for the school to consider. Consultants are scheduled for annual follow-up visits.
As a result of this process, WVU decided on an “Infusion Model,” revising the didactic curriculum to include new course information, consistent with their existing model of including general behavioral sciences content in the curriculum. The curriculum map they created from the survey found that 36 of 43 courses covered one or more of the six areas. However, they found voids and the subcommittee has identified a list of topics to be covered. They have identified 24 courses in which additional topics needs to be included. Some of the additional topics will be substitute for existing topics and others will be added. WVU currently is devising an evaluation of the Infusion Model.
For further information, contact Dr. Christina DeBiase (Chair, Curriculum Management Committee; Assistant Dean for Curriculum and Instruction), Dr. Dan McNeil (Chair, Behavioral Sciences Subcommittee; Professor of Psychology), or Dr. Shelia Price (Project Director of the WVU Pipeline Project; Associate Dean for Admissions, Recruitment and Access).
Dental Ecology, UNC
Dental Ecology 400, The University of North Carolina at Chapel Hill School of Dentistry
The Dentistry in Service to Communities (DISC) programs include didactic course work and a choice of extramural rotations from in-state, out-of-state, and international sites. In addition to the rotations, the didactic courses include interactive activities in which students reflect afterwards in writing and in group sessions on their experiences in order to understand how their experiences changed them. “In the absence of reflection, a service experience will merely constitute an event…. By reflecting on their experiences students develop personally and professionally.”2
In the written part of the exercise, senior students are asked to write a Critical Incident Essay:
“Each week of the rotation, note on the Critical Incident Report at least one significant incident that occurred in your work. These “critical incidents” could be events that challenged you personally or that caused you the greatest difficulty, discomfort, or pressure. They could be events or situations that you observed but in which you did not play an active role and they may be positive or negative in their outcomes.
In a two-page essay, first briefly describe when and where the event occurred and who was involved, then write about the significance of the incident for you, personally and/or professionally.”
Student essays are grouped around three themes:
- Personal and professional growth in
- self-awareness
- communication issues
- challenging assumptions and stereotyping
- Enhanced awareness of
- complexity of patients’ lives
- ethical dilemmas
- complexity of dental care
- Commitment to providing quality care and making a difference in a patient’s life.
When students return from their extra-mural rotations, six or seven students meet with an experienced facilitator for a two-hour session to analyze how the critical incidents have affected them.
Click on the link below to read samples of two students’ critical incident essays:
Critical Incident Essay 1
Critical Incident Essay 2
For more information, contact Dr. Eugene S. Sandler at the University of North Carolina School of Dentistry.
