The use of student journals in problem-based learning

Through the looking glass: a review of the literature surrounding reflective practice in dentistry

Reflection is an essential component of the learning process that helps to elicit deeper learning. In healthcare, this uses experiential activities to produce knowledge that compels the clinician to change their practice. Deep reflection allows one to explore emotions associated with challenging learning experiences, empowering reinterpretation of these experiences and removing barriers to further learning. Reflection is a key requirement of dental education at all stages. This paper aims to explore the existing literature on reflective practice in dentistry and identify areas for further research to improve reflective practice within dentistry.

Traditional methods of reflecting through written means are not facilitating the deep reflection which is desired. A systematic overhaul of reflective practice is suggested, involving a shift away from structured written reflections. There is little evidence to inform the most appropriate format for reflective practice in dental education. There is a need for further research to determine the effectiveness of reflective practice in dental education, particularly as a move away from structured written reflection to more creative reflective opportunities are encouraged. Greater exploration of barriers to reflection in dentistry is indicated, with consideration to how these may be overcome and a need to engage regulatory bodies in system-wide changes.

Reflection is an essential aspect of the learning process, with deep reflection eliciting deeper learning.

Deep reflection is desirable for learners at all stages, from undergraduate students to experienced clinicians, as it allows exploration of the emotions associated with the learning experience, removing barriers to learning and supporting wellbeing.

Further research to explore the barriers and facilitators to deep reflection in dentistry is indicated in order to support the planning and implementation of a systematic overhaul of current and often ineffective methods of reflection.

Creation and pilot testing of cases for case-based learning: A pedagogical approach for pathology cancer diagnosis

Background

Case-based learning (CBL) is an established pedagogical active learning method used in various disciplines and defined based on the field of study and type of case. The utility of CBL for teaching specific aspects of cancer diagnosis to practising pathologists has not been previously studied in sub-Saharan Africa.

Objectives

We aimed to pilot test standardised cancer cases on a group of practising pathologists in sub-Saharan Africa to evaluate case content, clarity of questions and delivery of content.

Methods

Expert faculty created cases for the four most commonly diagnosed cancers. The format included mini-cases and bullet cases which were all open-ended. The questions dealt with interpretation of clinical information, gross specimen examination, morphologic characteristics of tumours, ancillary testing, reporting and appropriate communication to clinicians.

Results

Cases on breast, cervical, prostate and colorectal cancers were tested on seven practising pathologists. Each case took an average of 45–90 min to complete.

Questions that were particularly challenging to testers were on:

Specimens they should have been but for some reason were not exposed to in routine practice.

Ancillary testing and appropriate tumour staging.

New knowledge gained included tumour grading and assessment of radial margins. Revisions to cases were made based on testers’ feedback, which included rewording of questions to reduce ambiguity and adding of tables to clarify concepts.

Conclusion

Cases were created for CBL in Kenya, but these are applicable elsewhere in Africa and beyond to teach cancer diagnosis. The pilot testing of cases prepared faculty for the actual CBL course and feedback provided by the testers assisted in improving the questions and impact on day-to-day practice.

Class Experience of the Students on 『Pregnancy, Delivery and Puerperium』 Nursing Course through Flipped Learning: Mixed Method Research

PURPOSE

The purpose of this study was to examine the applicability of a flipped learning course in Women's Health Nursing for nursing students.

METHODS

A total of 200 senior nursing students participated in flipped learning class of pregnancy, delivery and postpartum area, which included team-based learning and self-reflection for 8 weeks. One group pre-post test design was adopted and the changes in learning motivation and satisfaction were examined. In addition, reflective journals of the students were analyzed by making a qualitative content analysis.

RESULTS

Students showed a significant increase in score of learning motivation in the posttest (t=-4.47, p<.001). They had a mean of 3.90 in learning satisfaction out of possible five points. As a result of content analysis, three themes were selected: 'Improved attitude toward active learning', 'Burden caused by excessive workload', and 'Valuing to the team-based activity' To be specific, six sub-themes were selected, with three positive and three negative categories: 'improved class attention and understanding', 'positive class participation by preparing lessons in advance', 'peer interactions through discussion', 'A lot of time and effort consuming', 'stress caused by the burden of preparing lessons', and 'difficulties in cooperative activities'.

CONCLUSION

This study supports and confirms that the flipped learning can be a creative instructional model of positive teaching-learning strategy in clinical nursing courses to enhance students' learning motivation.

First reflections: third-year dentistry students' introduction to reflective practice

INTRODUCTION

To develop both professionally and personally, health professionals need to build essential skills in reflective practice. Educators generally agree that these skills should be developed as part of curricula for health professional students. The aims were to introduce reflective practice to third-year dentistry students and to evaluate the students' self-perceived reflective skills before and after their reflective activities.

MATERIALS AND METHODS

Using a written questionnaire, third-year dentistry students' perceptions of reflective practice were gathered before and after their first clinic placement. Students also completed two reflective writing pieces about their clinical placements.

RESULTS

The students' reflective writing pieces were allocated into one of the three categories: non-reflector, reflector and critical reflector. Content analysis of students' perceptions of reflective practice revealed nine themes. Eight main themes emerged from students' suggestions for improving their reflective abilities.

DISCUSSION AND CONCLUSION

Issues around the assessment of reflective writing are discussed, and students' suggestions for improving their reflective abilities are presented.

Oral health students' perceptions of clinical reflective learning--relevance to their development as evolving professionals

CONTEXT

A clinical professional should be a reflective practitioner, however reflective learning and deliberate clinical reflections have not traditionally featured in dentistry or dental hygiene programs. To the authors' knowledge, there are no studies exploring the perceptions of oral health students to reflective learning and clinical reflective practices.

AIM

This study determined student perceptions of clinical reflective learning and its relevance to their clinical and professional development.

METHODS

Reflective learning was embedded as a topic in the curriculum of the University of Queensland Bachelor of Oral Health program, within the discipline of dental hygiene practice. Reflective practices were integrated with clinical practice, and were linked with assessment requirements. Students' perceptions of clinical reflective learning were obtained via quantitative and qualitative analyses of sequenced questionnaires. Computer-assisted thematic analyses of the students' reflective journals, reflective essays and summary notes from in-class group discussions validated students' perceptions.

RESULTS

Students (n = 17) perceived clinical reflective learning as relevant, and useful for consolidating their clinical learning and accelerating their professional development. In particular, students gained insights about their strengths and weaknesses, thought more deeply about what they were doing in the clinic, and unpacked difficult concepts.

CONCLUSION

Students views of clinical reflective learning in this program were positive. They believed that the deliberate reflective process assisted their clinical learning and professional development.

The educational effects of portfolios on undergraduate student learning: a Best Evidence Medical Education (BEME) systematic review. BEME Guide No. 11

INTRODUCTION

In recent years, the use of portfolios as learning and assessment tools has become more widespread across the range of health professions. Whilst a growing body of literature has accompanied these trends, there is no clear collated summary of the evidence for the educational effects of the use of portfolios in undergraduate education. This systematic review is the result of our work to provide such a summary.

METHODS

We developed a protocol based on the recommendations of the Best Evidence Medical Education (BEME) collaboration. Citations retrieved by electronic searches of 10 databases were assessed against pre-defined inclusion/exclusion criteria by two independent reviewers and full texts of potentially relevant articles were obtained. Studies were identified for inclusion in the review by examination of full text articles by two independent reviewers. At all stages, discrepancies were resolved by consensus. Data relating to characteristics of the student population, intervention, outcome measures, student design and outcomes were collected using a piloted data extraction form. Each study was assessed against 11 quality indicators designed to provide information about how well it was designed and conducted; and against the Kirkpatrick hierarchy as modified for educational settings. Comparisons between different groups were carried out using the Kruskal-Wallis test (non-parametric ANOVA) or the Mann-Whitney U test as appropriate.

RESULTS

Electronic searches yielded 2,348 citations. A further 23 citations were obtained by hand searching of reference lists. About 554 full articles were retrieved and assessed against our inclusion criteria. Of the 69 studies included in our review, 18 were from medicine, 32 from nursing and 19 from other allied health professions, including dentistry, physiotherapy and radiography. In all professional groups, portfolios were used mainly in the clinical setting, completion was compulsory, reflection required and assessment (either formative, summative or a combination of both) the norm. Three studies used electronic portfolios. Whilst many studies used a combination of data collection methods, over half of all included studies used questionnaires, a third used focus group interviews and another third used direct assessment of portfolios. Most studies assessed student or tutor perceptions of the effect of the use of portfolios on their learning. Five studies used a comparative design, one of which was a randomized controlled trial. Studies were most likely to meet the quality indicators relating to appropriateness of study subjects, clarity of research question and completeness of data. However, in many studies, methods were not reported in sufficient detail to allow a judgement to be made. About 19 of the 69 included studies (27%) met seven or more quality indicators. Across all professions, such 'higher quality' studies were more likely to have been published recently. The median 'quality score' (number of indicators met) rose from two for studies published in 2000 or earlier to seven for studies published in 2005 or later. Significant differences were observed between the quality scores for studies published in or before 2000 and those published between 2001 and 2004 (p = 0.027), those published in or before 2000 and those published in 2005 or later (p = 0.002) and between all studies (p = 0.004). Similar trends were seen in all professional groups. About 59 (85%) of the included studies were assessed at level 1 of the modified Kirkpatrick hierarchy (i.e. 'participation' effects, including 'post hoc' evaluations of student perceptions of the effects of keeping a portfolio on their learning). About 9 (13%) of the studies reported direct measurement of changes in student skills or attitudes and one study reported a change in student behaviour. The main effects of portfolio use identified by the included studies were: Improvement in student knowledge and understanding (28 studies, six at Kirkpatrick level 2 or above), greater self-awareness and encouragement to reflection (44 studies, seven at Kirkpatrick level 2 or above) and the ability to learn independently (10 studies, one at Kirkpatrick level 2). The findings of higher quality studies also identified benefits in these areas. They reported improved student knowledge and understanding, particularly the ability to integrate theory with practice, although a correlation with improved scores in other assessments was not always apparent. Greater self-awareness and engagement in reflection were also noted, although some studies questioned the quality of the reflection undertaken. Higher quality studies also suggest that use of portfolios improves feedback to students and gives tutors a greater awareness of students' needs, may help students to cope with uncertain or emotionally demanding situations and prepares students for postgraduate settings in which reflective practice is required. Time commitment required to collate a portfolio was the major drawback identified. In two of the studies, this was found to detract from other clinical learning.

CONCLUSIONS

At present, the strength and extent of the evidence base for the educational effects of portfolios in the undergraduate setting is limited. However, there is evidence of an improving trend in the quality of reported studies. 'Higher quality' papers identify improvements in knowledge and understanding, increased self-awareness and engagement in reflection and improved student-tutor relationships as the main benefits of portfolio use. However, they also suggest that whilst portfolios encourage students to engage in reflection, the quality of those reflections cannot be assumed and that the time commitment required for portfolio completion may detract from other learning or deter students from engaging with the process unless required to do so by the demands of assessment. Further work is needed to strengthen the evidence base for portfolio use, particularly comparative studies which observe changes in student knowledge and abilities directly, rather than reporting on their perceptions once a portfolio has been completed.

The evaluation of an approach to reflective learning in the undergraduate dental curriculum

Students in higher education are being encouraged to become active, independent and life-long learners. The use of progress files has been endorsed to encourage this approach. A portfolio intended to fulfil the role of a progress file and to promote student-centred learning and reflection was introduced as a central component of the revised undergraduate degree at the Glasgow Dental School in 2004. This article evaluates its role in promoting reflection. Students following the Bachelor of Dental Surgery (BDS) programme completed three written reflections per year using structured proformas, and discussed them with their mentor and mentoring group. Their views of the portfolio and of reflection were gathered using a five-point Likert scale. In BDS1 2004-5, 84% completed a questionnaire, as did 89% in BDS1 2005-6 and 99% in BDS2 2005-6. Most students did not enjoy reflecting (a finding commonly reported elsewhere) or feel that reflection identified their learning needs. It appears that students disliked writing reflections, rather than reflecting per se. In contrast, they took a positive view of mentor group discussions and of having a mentor, both essential components of the portfolio model described. Comparisons of BDS1 2004-5 and BDS2 2005-6 data suggest that students are becoming more comfortable with reflection. The data provide some limited encouragement that students are beginning to acquire the skills which will enable them to reflect purposefully in their professional lives, although it will be some years before this assertion can be substantiated.

Problem-based learning in dental education: what's the evidence for and against … and is it worth the effort?

All Australian dental schools have introduced problem-based learning (PBL) approaches to their programmes over the past decade, although the nature of the innovations has varied from school to school. Before one can ask whether PBL is better than the conventional style of education, one needs to consider three key issues. Firstly, we need to agree on what is meant by the term PBL; secondly, we need to decide what "better" means when comparing educational approaches; and thirdly, we must look carefully at how PBL is implemented in given situations. It is argued that PBL fulfils, at least in theory, some important principles relating to the development of new knowledge. It also represents a change in focus from teachers and teaching in conventional programmes to learners and learning. Generally, students enjoy PBL programmes more than conventional programmes and feel they are more nurturing. There is also some evidence of an improvement in clinical and diagnostic reasoning ability associated with PBL curricula. The main negative points raised about PBL are the costs involved and mixed reports of insufficient grounding of students in the basic sciences. Financial restraints will probably preclude the introduction of pure or fully integrated PBL programmes in Australian dental schools. However, our research and experience, as well as other published literature, indicate that well-planned hybrid PBL programmes, with matching methods of assessment, can foster development of the types of knowledge, skills and attributes that oral health professionals will need in the future.

Reflective practice in the teaching of conservative dentistry to undergraduate dental students - perceptions derived from a pilot study using personal development diaries

The aim of this study was to explore final-year student perceptions to the use of personal development diaries (PDDs) and to compare the findings with an established system of competitive continuous assessment, using open display of score ratings displayed on a clinic notice board. Focus groups in conjunction with personal development diaries (PDDs) were used to investigate the teaching of conservative dentistry to senior dental undergraduates. Thirty per cent of the statements made reference to the positive aspects of PDDs, while a small percentage (6%) was negative. Nineteen per cent of the comments derived from the focus groups showed that the undergraduates disliked the open display of their marks on the conservation clinic notice board. This compared with only 2% who claimed that they enjoyed the competitive method. A further 22% of the comments related to the fact that open display of marks was stressful, whereas 3% were unaffected. Eighteen per cent of the responses indicated that clinical conservative dentistry was a stressful experience.

Interactive logbooks for medical students: are they useful?

OBJECTIVES

The use of logbooks in the education of medical undergraduate students is not well-established. Traditionally, logbooks are used simply as a means for students to document their activities. This report examines whether logbooks used as an interactive vehicle between students and tutors can assist both student learning and Faculty teaching.

METHOD

As part of the New Medical Curriculum implemented by the Faculty of Medicine, The University of Hong Kong, all third year students beginning their formal hospital and community health clerkships were given pocket-sized logbooks to document and monitor their learning activities. The logbooks were specially designed to mirror the activities of the teaching blocks, including bedside teaching, tutorials, teaching clinics, health care projects, and whole class sessions, etc.

RESULTS

At the end of each teaching block, effort, accuracy of the notes, appropriateness of the notes and the assessor's overall impression of logbook entries formed the basis of 20-point assessment. Randomly-selected logbooks were reviewed at the end of every rotation and compared with course outlines in order to evaluate if, according to the students' notes, the learning objectives were being met. Throughout each teaching block, the logbook process identified students who could benefit from counselling and/or remediation. The logbook feedback mechanism was immediate and therefore, remediation was timely and appropriate.

CONCLUSIONS

The logbooks were effective in 3 ways: logbooks were a means of continuous assessment of small group learning; logbooks encouraged immediate and ongoing interaction between tutors and students; and they provided a feedback loop for the evaluation of learning activities.

The reliability of logbook data of medical students: an estimation of interobserver agreement, sensitivity and specificity

OBJECTIVE

Logbooks are widely used in medical schools as an evaluation tool to assess students' progress towards objectives. To estimate whether students fill in their logbooks reliably, we measured interobserver agreement by comparing doctors' data and students' data.

METHOD

Completed logbooks were collected at two subdivisions of the department of Internal Medicine at the University Hospital of Groningen. The logbook contains 231 preprinted diseases. Doctors and students recorded the diseases they had encountered. Interobserver agreement, expressed by the Jaccard coefficient (J), was calculated for the complete set of diseases and for a subset of core diseases. To assess the kinds of errors which students made, sensitivity and specificity were determined.

RESULTS

Logbook data of doctors and students are not fully consistent (mean J for the complete set of diseases was.23 and for the core diseases.36). The quality of the logbook data is high in the sense that students do not record many false identifications (mean specificity for the complete set of diseases and for the core diseases were.96 and.93, respectively); the quality is poor in the sense that students do not record all the diseases which could be seen at the department (mean sensitivity for the complete set of diseases is.36 and for the core diseases it is.51).

CONCLUSION

This study shows inconsistencies in recording diseases in a logbook by students compared with doctors. In particular the diseases which are present at a department are under-reported by students. Supervision and feedback are important mechanisms to optimize the students' use of (1) all diseases which could be encountered and (2) the logbook.

The development of undergraduate curricula in surgery: II. Generic surgery

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.

Clinical assessment in dental education: a new method

Among the many challenges that face modern dental schools is the development of appropriate assessment systems. The more litigious nature of modern education makes it important that the systems developed are transparent and can withstand the processes of legal challenge. Coupled with this demand for robust assessment is a growing demand from universities and health providers for dental schools to keep rigorous records of student clinical productivity. This brief review outlines a system developed at the School of Oral Health Sciences at the University of Western Australia. The system integrates both qualitative and quantitative assessment and uses criterion-based assessment as its foundation. Detailed analysis and real-time reporting mechanisms using a suite of personally written software tools is now possible. The system provides both students and staff with effective data to enhance the learning process.

Self-assessment in a problem-based learning curriculum in dentistry

The creation of sound self-judgement for students is an integral goal in any educational sphere. Student clinicians in dentistry must learn sufficient skills to be able to self-assess their performance very accurately, because after graduation, the nature of dental procedures means that others are seldom in a position to evaluate the quality of their work. Over recent years, the Department of Dentistry at the University of Adelaide has been developing a self-assessment procedure, initially as a pilot study in the subject oral diagnosis, and currently in all years of the course. This paper describes how self-assessment has been demonstrated to work initially in the pilot subject, and currently across the whole course. The paper also describes how the criteria for assessment and the levels of performance expected for each grade are established and how student performance is monitored. Finally, evidence is presented to indicate acceptance by the students of self-assessment as a valuable and integral part of their learning in dentistry.

Education in periodontology. A need for a new teaching model

The objectives of the present work were to elucidate faculty perceptions and effects on traditional teaching and the supplement of a problem-based learning model in periodontal education. Students and faculty members at one university were asked to respond to a battery of relevant questions in periodontology that had been previously discussed at two European academic workshops. Differences in responses were noticed both between faculty, students, and their responses as compared to responses given by participants at the European workshops. On several topics, faculty within the selected university held significantly different opinions. Thus lecture content and concepts may vary dependent on who gives the lecture and may not be consistent with the common interpretation of the scientific evidence. Responses given by those participating in the workshops indicated consensus. The study results suggest that students were able to extract appropriate conclusions from the scientific literature in the they were able to concede with an expert panel on specific issues studied. Students were however unable to convince other students, who had not participated in the specific activity, that their conclusions were consistent with the scientific evidence and different than what had been taught in class. In many cases, these conclusions differed from their previous perceptions obtained during traditional lectures. In conclusion, the present study suggests that problem-based learning activities should be introduced early in the curriculum to avoid bias in understanding which may occur when students have been previously exposed to information presented in standard lectures. The use of interactive teaching via internet is discussed.

Introducing Adelaide dental students to a problem-based learning curriculum

A course designed to introduce new students to a problem-based learning (PBL) curriculum in dentistry at the University of Adelaide is described. Australian students are admitted to the Adelaide dental course either directly from school (SL) or after one or more years of tertiary education (TT). The admissions process is designed to select academically able students who will flourish in a problem-based environment. Some international students (INT) are also selected through a modified admissions process. A 9-item questionnaire derived from frequently-asked questions from previous years was administered to the new students at the beginning and at the end of the introductory course, and each individual's responses before and after the course were compared. There was an increased number of positive responses (significant at P < 0.05 to 7 of the 9 items) after the course. Although the course appeared to be effective in familiarising new students with a PBL curriculum, many students were still uncertain about two items which commonly provoke anxiety, namely how to decide when to stop researching a topic, and how to balance group and solo learning.