Facilitating dental student reflections : using mentor groups to discuss clinical experiences and personal development

Despite the consensus on the importance of reflection for dental professionals, a lack of understanding remains about how students and clinicians should develop their ability to reflect. The aim of this study was to investigate dental students’ and mentors’ perceptions of mentor groups as an instructional method to facilitate students’ reflection in terms of the strategy’s learning potential, role of the mentor, group dynamics, and feasibility. At Ghent University in Belgium, third- and fourth-year dental students were encouraged to reflect on their clinical experiences and personal development in three reflective mentor sessions. No preparation or reports afterwards were required; students needed only to participate in the sessions. Sessions were guided by trained mentors to establish a safe environment, frame clinical discussions, and stimulate reflection. Students’ and mentors’ perceptions of the experience were assessed with a 17-statement questionnaire with response options on a five-point Likert scale (1=totally disagree to 5=totally agree). A total of 50 students and eight mentors completed the questionnaire (response rates 81% and 89%, respectively). Both students and mentors had neutral to positive perceptions concerning the learning potential, role of the mentor, group dynamics, and feasibility. The mean ideal total time for sessions in a year was 99 minutes (third-year students), 111 minutes (fourth-year students), and 147 minutes (mentors). Reported reflective topics related to patient management, frustrations, and practice of dentistry. Overall mean appreciation for the experience ranged from 14.50 to 15.14 on the 20-point scale. These findings about students’ and mentors’ positive perceptions of the experience suggest that mentor groups may be a potentially valuable strategy to promote dental students’ reflection

Studying self-efficacy beliefs in medical education

AbstractThe aim is to identify a relevant framework to study self-efficacy in relation to the impact of medical education curricula. In medical education research, self-efficacy beliefs have mostly been studied in relation to their impact on the mastery of communication competencies and clinical skills. Few studies are available – in the medical domain – that centre on a broader range of medical curriculum competencies, the way self-efficacy improves self-regulated learning, how self-efficacy affects motivation, provides study support, how self-efficacy boosts the career development of students and, how self-efficacy influences social and emotional support of students

Competence profiles in undergraduate dental education : a comparison between theory and reality

Background: Competence profiles are purposed to provide a blueprint in support to develop and/or benchmark the learning outcomes of undergraduate dental curricula. This study aims to investigate whether a competence profile as proposed by academic- and clinical experts is able to represent the real clinical reality. Methods: A questionnaire was developed including questions about gender and age, perception about required competences, and educational organisation and was distributed among Flemish dentists via email and on paper during a symposium. The data was analysed using descriptive statistics, Chi-square and non-parametric Mann-Whitney U-tests. Results: A total of 312 questionnaires were completed (=6.5% of dentist population, with similar gender and age characteristics). All competences in the European competence profile were rated between 7.2 and 9.4 on a 10-point scale. In dentists under 50 years, females rated the importance of identifying/managing anxiety and abnormal patient behaviour; and promoting/improving oral health as significantly higher than males. In dentists of 50 years and above, females rated 8 competences significantly higher than males, including obtaining/recording a complete history; identifying/managing anxiety and abnormal patient behaviour; obtaining/interpreting radiography; identifying temporomandibular and associated disorders; identifying orthodontic needs; awareness of own limitations/when to refer; managing dental urgencies; and basic-life-support/defibrillation. Clinical practice management was most frequently reported as additional competence to address in dental education. Furthermore, the respondents suggested an undergraduate dental curriculum based on 34% theoretical education, 26% preclinical skills training, and 40% clinical education and 86% agreed with a duration of 5 years. Finally, the respondents also illustrated the dynamic nature of dentistry including a reduction of amalgam fillings, a shift from individual practice to group practices, an increased administrative load, and more assertive patients. Conclusion: Findings in the present study suggest the validation of the proposed competences for graduating European dentists within the clinical reality of dental professionals in daily practice. Nevertheless, the results have also demonstrated heterogeneity regarding gender and age within the dentist population and emphasised a continuously evolving dental profession and required competences. Hence, to maintain high quality of dental care, a strategy should be developed in which dental curricula are continuously benchmarked against an evolving clinical reality

Factors confounding the assessment of reflection: a critical review

BACKGROUND: Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection. DISCUSSION: We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection. SUMMARY: To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered

Assessment of reflection in undergraduate health sciences education

Reflection is increasingly considered as an important attribute for health care professionals in the life long provision of high quality of care. Consequently, health sciences education has adopted the ability to reflect as a competence to be achieved, based on the premise that reflection can be fostered. Empirical evidence, however, that supports reflection in professional practice and education is scarce, and consensus about how to introduce and assess reflection in practice and education remains elusive. This dissertation aims to develop a valid and reliable method for the assessment of reflection in undergraduate health sciences education. A line of research is described in five chapters, each reporting on a research project executed in the period 2007-2011 at Ghent University. In chapter 1 four important barriers to the assessment of reflection were identified, 1. Diversity of definitions, 2. Lack of agreed standards to interpret results, 3. The metacognitive nature of reflection which prevents direct observation and 4. The influence of multiple internal and external contextual factors. In search for solutions a comprehensive model based on the common elements in widely quoted models and theories was developed. It describes reflection as a metacognitive process retrospective to experiences characterised by 1) the awareness of this experience, one’s own and others’ thoughts and essential aspects in this experience 2) reflective inquiry to analyse the experience within a personal frame of reference and 3) the development of new perspectives to be implemented in future actions. As an approach to the subjective nature of reflections it was suggested to distinguish between the process and the content when assessing reflection. Whereas the subjective nature of the content of reflections forms a barrier for comparison, the elements in the process are generic. Furthermore the situation that triggered was identified as an important factor in reflections. To aid assessors with interpreting reflections it was proposed to look for a feasible method to provide them with a perspective on the situation that triggered the reflection. In search for a feasible method to visualise the triggering situation, cases were investigated to simulate real practice situations to trigger clinical reasoning in undergraduate dental education (chapter 2). Cases have the advantage of offering a safe environment while challenging students with course related clinical problems. Results indicated that both, students and supervisors, acknowledged cases as a valuable instrument of instruction, stimulating rich meaningful discussions and effective clinical case solving. The format of the cases (whole patient case description vs. description of one case element) did not result in different learning outcomes. Findings of the described study in chapter 2 grounded the development of a scoring method for reflection based on video-cases and the Student Assessment of Reflection Scoring rubric (StARS®) (chapter 3). Undergraduate medical students were presented interactive video-cases, displaying a simulated patient consulting a physician with a problem from a physician’s perspective, that were interrupted with questions gauging students’ thoughts. After having completed the case itself, students were asked to reflect, guided by six questions, directing the students’ reflections towards the model described in chapter 1. These reflections were assessed, using StARS®. Analysis identified StARS® scores to demonstrate acceptable psychometric properties concerning the ability to discriminate between students, inter- and intra-rater reliability and case-specificity. It was suggested to use this feasible method for summative assessment and to provide feedback on specific elements in the process of reflection. In chapter 4 the implementation of reflection assessment in a portfolio-based undergraduate dental course on oral health promotion and community dentistry is described. In this course the ability to reflect on real life experiences (while executing a oral health promotion project in a local organisation) was a competency to be acquired through portfolio learning. Reflection was defined according to the model in chapter 1 and a scoring grid was developed to match this definition. Linear regression analysis demonstrated that the reflection scores obtained with this method were significantly predicting the scores of the other competences to be acquired in the course. Finally the relation between reflection and student performance (case-solving) in undergraduate medical education was investigated (chapter 5). The case-solving scores (answers to the questions posed during the video-case interruptions) and the StARS® scores from chapter 3 were brought together with the main indicators for case solving described in literature including knowledge (progress test score) and consultations skills (score on a consultation course) in a multivariate regression analysis. In a model with knowledge and consultation skills, reflection scores proved to be a small but significant predictor for student case-solving

Contemporary undergraduate implant dentistry education: a systematic review

Introduction: Consensus reports recommend that students upon graduation should possess a significant level of knowledge and competences in implant dentistry, including basic competences in diagnostics, treatment planning, restorative and straightforward surgical- as well as maintenance procedures. In response, undergraduate curricula need to comprehensively integrate implant dentistry. This narrative review explores educational programs in terms of competences, related research and barriers or reflections, regarding the implementation within undergraduate curricula. Materials and methods: Publications (2008-2013) were systematically searched in WOS, Pubmed and ERIC and independently screened by two authors encompassing four stages: removal of duplicates, title and abstract screening and full-text reading. Inclusion criteria encompassed implant dentistry in undergraduate education. Results: Finally 37/420 papers were included. Detailed information regarding program content, participants’ number, staff input, logistics/funding issues is scattered. Theoretical education is predominant and preclinical/clinical training is minimally offered, often in elective programmes. However, selected straightforward cases treated by undergraduates, yield positive outcomes with low failure rates, few complications, high patients’ satisfaction and students’ appreciation. Barriers to implement implant dentistry include funding issues, limitations in time or staff availability/competence and lack of suitable patients. Overcoming these barriers is worthwhile as experienced-based implant education affects future practice in that well-informed students propose more restorative alternatives to their patients. Conclusion: Although implant denstitry is increasingly integrated in undergraduate curricula, challenges remain in developing strategies to implement existing competence profiles and the extent of experience-based education. In support of further advancement, universities should report comprehensively and structurised on their implant programmes to allow comparison and reproduction

Reflective group discussions about clinical experiences to facilitate reflection in undergraduate dental education

Aim: Despite the consensus about reflection as an important competence for dentists, it remains unclear how reflection should be educated in undergraduate dental curricula. This 'free stage' is about an approach to implement reflection using reflective discussion groups about clinical experiences. Materials and Methods: Two years ago reflective group discussions were introduced in year 3 of the undergraduate dental curriculum at Ghent University (=first student-experience with treating patients). This initiative was purposed to 1. stimulate student-reflection about clinical experiences (and about their individual development as a future dentist), 2. to provide students a forum to express and discuss their inner feelings, thoughts, anxieties, etc. Students were divided in small groups (n=8) that gathered 3 times a year. The groups stayed together during year 3, 4 and 5 (=years of clinical education). Only participation was compulsory. No formal preparation or reports were required. Each group had a mentor with the task to 1. create a safe environment for students to open up, 2. frame discussed clinical experiences and 3. facilitate students to reflect (deeper) by asking questions (how, why, etc.). Before each session the mentor received a scenario (e.g. the first patient encounter, the ideal dentist, critical incidents) with open-ended questions to initiate the discussion. Students, however, were also free to introduce their own topics. Results: The first reaction from both students and mentors were positive. During this 'free stage' the reactions from both 3 and 4 year students will be discussed as well as the experiences of a mentor, who is also co-presenting. Conclusions: This 'free stage' will describe the use of reflective group discussions to stimulate reflection in undergraduate students related to their clinical experiences. Furthermore the outcome will be reported to finally initiate a discussion with the audience about how to educate students to become reflective practitioners in dentistry