Final Reflection Paper: Developing ProblemSolving Abilities to Achieve Competency Standards in Dental Hygiene Curriculum

Lori J. Drummer University of Illinois ~ Springfield

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

EDL 543 Instructional Design December 2001

INTRODUCTION Currently, there are approximately 140,000 licensed dental hygienists in the United States.1 A dental hygienist is a licensed, preventive oral health professional who has graduated from an accredited dental hygiene program in institutions of higher learning. Dental hygiene accreditation is a formal, voluntary, nongovernmental process that establishes a minimum set of national standards that promote and assure quality in educational institutions and programs and serves as a mechanism to protect the public. 2 Dental hygiene accreditation standards are mandated and authorized by the Commission on Dental Accreditation within the American Dental Association. The standards address many areas including: a. b. c. d. e. f. g. Institutional effectiveness Student admission Curriculum management and assessment Curriculum content Faculty Facilities Health and safety provisions

The largest and most involved section of the accreditation process is the Educational Program standard. This standard focuses on admissions, curriculum management, instruction, curriculum content and patient care competencies.

DENTAL HYGIENE PROGRAM ASSESSMENT PROCESS The assessment process for accredited dental hygiene programs is quite extensive. Dental hygiene programs have program goals and objectives along with defined program competencies. The program must develop a formal assessment and management plan to demonstrate achievement of the goals, objectives and competencies. 2

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

Assessment mechanisms can be process or end product evaluation. The assessment can range from traditional classroom pen and paper tests, to comprehensive activities, to hands-on performance examinations. The assessments are completed at various stages of learning to show an increase in student competency level. The difficult task in designing the curriculum and assessment management plan is to determine and establish valid and appropriate performance standards which ultimately produce educated, problemsolving health professionals. The question to the answer is, How well must students perform? In assessment design, the performance standards follow logically from the achievement target. 3 Once the guidelines were set regarding the knowledge base necessary for students to successfully pass the National and Regional Dental Hygiene Board Examinations, the determination of how well they perform needed to be decided. Once that was outlined, programs needed to assure that students could achieve those levels through completion of a two-year curriculum. We do this through the Curriculum Assessment and Management Plan. Numerous mechanisms need to be designed. The most helpful aspect of this course were the course materials focusing on mapping the curriculum, creating problem-solving abilities through evidence based learning and authentic assessment and evaluation of those abilities. MAPPING THE CURRICULUM We need evidence of learning to find out if we are effectively meeting our targeted goals for the student. 4 Both tangible products and observed performances can serve as the basis for assessing student growth. 5 The mapping project completed for this course (appendix item) helped me to focus on the course content, how to assess student achievement and which program competencies were addressed in the topic. The mapping project also demonstrated how continued review is necessary. During session three of this course, I reflected on several points, which I have carried into my current teaching position and academic strategies. When we ask the question, What will you actually teach versus what the curriculum says, the process of merging teachers together stepby-step begins. Coordinating instruction among teachers assures that the necessary materials are taught without extreme redundancy or without lack of materials. Using the school calendar is a common link between teachers. It allows us to think of our curriculum in terms on sections or components vs. one big chunk of curriculum. Mapping gives 3

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

a sense of structure and coordination. Within the variety of disciplines within a college setting, many of my dental hygiene students must complete corequisite general education (GE) courses in order to continue within the dental hygiene program. The GE courses have direct correlation to the dental hygiene courses. Each semester, my program evaluates the topics taught in each course and how those topics overlap within the curriculum. We also evaluate and render the occurrence of opposite extremes, which occur when faculty are either too rigid with curriculum guidelines or they become too loose and vague. I have seen this amongst my own colleagues. Some faculty stick to the course reference files (course outline filed with the Illinois Community College Board) while others almost appear as if they have no plan prior to walking into the classroom. I just faced a situation regarding the latter with one of my faculty. My suggestion was to develop and distribute topic objectives and a lecture outline to the students prior to each class. This would give her classroom setting (which is managed in a discussion-type forum vs. lecture-type format) a bit more formality and focus to help keep the discussion on track. In order to control or limit the amount of extreme opposites that may be experienced amongst our colleagues, I feel planning, coordination, mapping, etc are key. Open communication and decision making as a team are extremely important. Mapping will help to eliminate or at least minimize polarization tendencies because communication will help to put everyone on the same page. It will also incorporate input from all teachers so everyone will (should) take ownership for the curriculum. Mapping makes continued review of the course or curriculum unproblematic. My map of the DHY 117 Dental Anatomy course within the dental hygiene program curriculum utilized numerous problem-solving skills to demonstrate thinking abilities of the students and achievement of course/program goals, objectives and competencies. DEVELOPING PROBLEM SOLVING ABILITIES Developing assessment and evaluation mechanisms can be difficult and rather labor intensive in nature. The article by T.F. Fennimore and M.B. Tinzmann, What is a Thinking Curriculum? helped to organize my thoughts regarding evaluation of my students and the evaluation of their problem solving abilities. During the course, I reflected on several points. Learners acquire a substantial and organized body of knowledge, which they can use fluently to make sense of the world, solves problems, and makes decisions. They can also evaluate the limitations 4

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

of their knowledge and their perspectives on the world. Learners feel capable and continually strive to acquire and use the tools they need to learn for self-determination skills. Learners have a repertoire of thinking and learning strategies that they use with skill and purpose to think about and control their own learning and guide their learning of new content. Learners are able to view themselves and the world from perspectives other than their own, including perspectives of people from different cultural backgrounds. The Thinking Curriculum teaches all of these characteristics in all students. Traditional curriculum does not do this. The focus of this new way of thinking and teaching is to view contrast and process differently. However, the two must be taught together to prepare the student for real world situations. The importance of developing these characteristics through these new ideas is to create a student who has the abilities to problem-solve and use cognitive thinking skills in the work place. 6 In dental hygiene, we have incorporated evidencebased (EB) teaching into the curriculum, much like the thinking curriculum format does, as a way to develop the above-mentioned characteristics. EB practice integrates individual clinical expertise with the best available external clinical evidence obtained from systemic research or in the case of the student, didactic courses and research completed during the courses. It is also a process of life-long, problembased learning. In this process, the student learns to incorporate patient care requirements with the best scientific evidence available regarding diagnosis, prognosis, therapy, and treatment. With this method, the student learns to convert clinical problems into answerable questions, efficiently find the best information with which to answer the question, critically appraise the evidence for its validity, apply the results of the appraisal in clinical practice and constantly evaluate the performance of the treatment. The students learn to bring the scientific evidence learned in the didactic courses into the clinic setting which mimics a real world situation where they must problem solve based on the documentation recorded during the dental hygiene examination process. The student learns to individualize patient care. My curriculum map of the dental anatomy course demonstrates how the didactic evidence-based information can easily be incorporated into a problem-based, clinical situation. The assessment mechanisms designed for this course focus on the evidence and how this evidence can be utilized in a real world or clinical situation. The skills developed by the student demonstrates how the student must conform to the anatomical features of individual teeth, which ultimately differ from patient to patient. Developing an EB curriculum accomplishes the same point as a Thinking Curriculum because the end result is students developing skills to become self-directed, problem-based, adult learners who can recognize gaps in their knowledge; pose well 5

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

formulated, answerable, clinical questions; locate the best available information; critically appraise it; and integrate the results with their clinical, real world experiences and expertise. AUTHENTIC EVALUATIONS FOR ASSESSING DENTAL HYGIENE PROGRAMS Creating real world situations within the dental hygiene curriculum must incorporate assessment of knowledge, skills and development . 7 Evidence based curriculum that develops problem-solving skills demands competency assessment mechanisms. Competency assessment of health professionals should involve performance assessments. A component of performance assessment is authentic assessment.8 Authentic assessment replicates the real world challenges or work place setting. Since competence is not a general trait but is dependent on the patient case or the situation, authentic assessment is most appropriate for decision-making about the skill level of the health professional. 9 CONCLUSION: COURSE REFLECTION The Instructional Design course has closed the loop as they say in the development of the dental hygiene curriculum within my program by guiding me through steps of designing and assessing curriculum sequence. Once mapping of the curriculum is complete, developing problem solving abilities within the students will ultimately achieve the goal of educating competent health care professionals through the use of authentic assessment and creating real world situations in the academic setting.

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

REFERENCES 1. United States Department of Health and Human Services, Human Resources and Services Administration, Bureau of Health Professionals, National Center for Health Workforce Information and Analysis, State Health Workforce Profiles, December, 2000. 2. Policy Statement, Education/Accreditation 2-89, American Dental Hygienists Association. 3. Wiggins, G (1998) Educative Assessment. Jossey-Bass Publishers: San Francisco 4. Jacobs, H (1997) Mapping The Big Picture. Association for Supervision and Curriculum Development: Alexandria 5. Jacobs, H (1996) Mapping The Big Picture. Association for Supervision and Curriculum Development: Alexandria 6. Fennimore, T., & Tinzmann, M (1990) What is a thinking curriculum. North Central Regional Educational Laboratory. pp.1, 3. 7. McCann, A., Campbell, P., & Schneiderman, E (2001) A performance examination for assessing dental hygiene competencies. Journal of Dental Hygiene. 75 (4) 291-304. 8. Palomba C., & Banta, T (1999) Assessment Essentials. JosseyBass Publishers: San Francisco 9. McGaghie, W (1993) Evaluating competence for professional practice. Educating Professionals. Jossey-Bass Publishers: San Francisco.

Lori J. Drummer EDL 543 Instructional Design

University of Illinois ~ Springfield Fall 2001

APPENDIX

CONTENT AUGUST
Introduction of the teeth Development and eruption of the Teeth

SKILLS
a). Identify dental arches by name and by quadrant and sextant number and individual teeth by name and number b). Describe the stages in tooth and root development c). Describe normal eruption patterns of primary and permanent teeth

ASSESSMENTS
a). Observations while working with typodont models. b). Written quizzes c). Identification of randomly chosen teeth in preclinic lab by instructor d). Verbal participation during classroom discussion

ESSENTIAL QUESTIONS
a). How are the anatomical features and characteristics of the teeth related to their function? b). Does the development of the tooth and root relate to any physiological conditions or events? c). How do the eruption patterns effect the alignment or dental health of the teeth? a). Does the form and function of the primary teeth simulate that of the permanent teeth? b). How does the occlusion, alignment and contact of the teeth relate to each other? c). How does the form and function of the teeth relate to periodontal health? d). How does the form and function of the periodontium relate to the form and function of the teeth? e). How do alterations in tooth form effect the health of the periodontium? Core

DOMAINS

DDPCS*
C.7 C.12 HP.4 HP.6 CI.2 PC.3 PC.4 PC.10

Health Promotion and Disease Prevention Community Involvement Patient Care

SEPTEMBER

Physiology of the primary and permanent dentition Physiology of the periodontium

a). Discuss the form and function of primary and permanent teeth b). Describe and identify various aspects of occlusion, alignment and contact of the primary and permanent teeth c). Identify anatomical aspects of the permanent and primary teeth; Curve of Wilson and Curve of Spee d). Discuss the function or the curvature of teeth with regard to periodontal health/disease e). Identify curvatures of the periodontium: proximal contact area, interproximal space, embrasure space, labial/buccal contour, curvature of CEJ f). Identify the various parts of the periodontium: attached gingival, free gingival, interdental gingiva

a). Observations while working with typodont models. b). Written quizzes c). Identification of occlusal classifications in preclinic lab to instructor d). Verbal participation during classroom discussion e). Completion of accurate gingival description in a lab setting on a patient.

Core Health Promotion and Disease Prevention Community Involvement Patient Care

C.7 C.12 HP.4 HP.6 CI.2 PC.3 PC.4 PC.7 PC.8 PC.10

*DDPCS: Defined Dental Hygiene Program Competency Statements

APPENDIX

CONTENT OCTOBER
Permanent Maxillary and Mandibular Incisors Permanent Maxillary and Mandibular Canines Permanent Maxillary and Mandibular Premolars

SKILLS
a). Give a general description of all teeth in question; form and function. b). Compare the differences between partner teeth; i.e. central vs. lateral incisor, 1st premolar vs. 2nd premolar, upper vs. lower c). Describe variations found in each tooth in question. d). Give specific characteristics of each tooth from each surface; i.e. mesial, distal, buccal/facial/ lingual, occlusal/incisal. a). Give a general description of all teeth in question; form and function. b). Compare the differences between partner teeth; i.e. 1st molar vs. 2nd molar, vs. third molar, upper vs. lower c). Describe variations found in each tooth in question. d). Give specific characteristics of each tooth from each surface; i.e. mesial, distal, buccal/facial/ lingual, occlusal/incisal e). Give a general description of dento-osseous structures.

ASSESSMENTS
a). Observations while working with typodont models. b). Written quizzes c). Identification of specific teeth in preclinic lab chosen by instructor d). Verbal participation during classroom discussion e).Tooth drawing assignment

ESSENTIAL QUESTIONS
a). How does the form and function of the Maxillary teeth differ from the Mandibular teeth? b). How does the form and function of a tooth effect the form and function of the partner tooth? c). How do each of the five tooth surfaces differ from each other on the same tooth and how do they differ from each other on partner teeth? a). How does the form and function of the Maxillary teeth differ from the Mandibular teeth? b). How does the form and function of a tooth effect the form and function of the partner tooth? c). How do each of the five tooth surfaces differ from each other on the same tooth and how do they differ from each other on partner teeth? d). How do the dentoosseous structures effect the form and function of the teeth? Core

DOMAINS

DDPCS*
C.7 C.12 HP.4 HP.6 CI.2 PC.3 PC.4 PC.7 PC.10

Health Promotion and Disease Prevention Community Involvement Patient Care

NOVEMBER

Permanent Maxillary and Mandibular Molars Dento-Osseous Structures

a). Observations while working with typodont and skull models. b). Written quizzes c). Identification of specific teeth in preclinic lab chosen by instructor d). Verbal participation during classroom discussion e).Tooth drawing assignment

Core Health Promotion and Disease Prevention Community Involvement Patient Care

C.7 C.12 HP.4 HP.6 CI.2 PC.3 PC.4 PC.7 PC.10

*DDPCS: Defined Dental Hygiene Program Competency Statements

10

APPENDIX

CONTENT DECEMBER
Dento-Osseous Structures Continued The TMJ, muscles and teeth and their function

SKILLS
a). Identify anatomical landmarks of the skull. b). Describe the function of components of the alveolar bone. c). Describe the articulation of the Temporomandibular joint (TMJ). d). Describe the function of craniomandibular articulation. e). Describe the muscle function of the mandible with regard to TMJ movement f). Describe the seven components of the functional anatomy of the TMJ.

ASSESSMENTS
a). Observations while working with skull models. b). Written quizzes c). Identification of dento-osseous structures in preclinic lab chosen by instructor d). Verbal participation during classroom discussion e). Examination and description of TMJ function on a patient in a lab setting.

ESSENTIAL QUESTIONS
a). Do the anatomical landmarks of the skull relate to the form and function of the teeth? b). How does the health of the alveolar bone relate to or effect the teeth? c). How does the form and function of the teeth effect the articulation of the TMJ? d). Does muscle function of the TMJ effect the function of the dentition? e). What functional components of the TMJ effect the form and function of the teeth? Core

DOMAINS

DDPCS*
C.7 C.12 HP.4 HP.6 CI.2 PC.3 PC.4 PC.7 PC.10

Health Promotion and Disease Prevention Community Involvement Patient Care

*DDPCS: Defined Dental Hygiene Program Competency Statements

11