Best Practices in Dental Education 2004 by eatit762


									  Best Practices in
  Dental Education

American Dental Education Association
Center for Educational Policy and Research
    1625 Massachusetts Avenue, NW
                Suite 600
          Washington, DC 20036
           Phone: 202-667-9433
      Best Practices in

Innovations in Curriculum
    Dental Education 2004
Best Practices in Dental Education 2004: Innovations in Curriculum                                         65

                                  Baylor College of Dentistry
 Non-Graded Clinical Evaluation of Dental Students in a Competency-Based Education Program

Baylor College of Dentistry previously used a numerical grading system to evaluate the daily clinical
performance of students. As the curriculum changed into a comprehensive, clinical competency-based
approach the limitations of this evaluation method became evident. The system was highly subjective,
difficult to calibrate, susceptible to individual faculty bias, fostered leniency in grading, and offered
limited feedback to students. Therefore, an evaluation system was constructed to identify and document
student clinical performance that was based upon demonstrated competency or the need for
improvement. Daily evaluation of clinical procedures was non- graded, and course grades were based on
progress exams only.

Several quality assessment forms were developed to convert each clinical procedure into sequentially-
arranged key steps. When each clinical procedure was performed, a specific assessment form was
initiated as part of the preoperative record. As the procedure progressed, faculty input was provided on
the technical and non-technical aspects as well as the critical steps that predicted success or failure of the
procedure. The faculty then discussed their observations with the student and recorded any deficiencies
on the clinical evaluation forms as suggestions for improvement. The assessment form was given to the
student immediately to provide written feedback and then processed into a database. Cumulative
information formed a real-time competency profile that faculty used to track student performance over
time and across disciplines. Similar profiles and trends of individual faculty assessment were recorded
and retrievable from the database.


The effectiveness of the Non-Graded Clinical Evaluation System was evaluated in several ways. An
initial focus group of entering fourth- year students was conducted after the end of the summer pilot
(n=9, summer 2002). At the end of the first year of the new grading system, satisfaction surveys were
administered to the students (n=90) and the faculty (n=19). In addition, the grade distributions from the
traditional grading system (2002) were compared to the grade distributions from the Non-Graded
Clinical Evaluation System (2003). In the initial focus group, the students reported that they preferred
the new system and that the grading was less subjective. They said they received more faculty feedback
and felt more comfortable asking questions. At the end of the first year of implementation, the majority
of fourth- year students reported that:
     • the new system provided a better learning environment (79 percent);
     • interactions with faculty had improved (78 percent);
     • clinic was less stressful (72 percent);
     • more comments were received from faculty (67 percent).

These results were supported by the faculty survey. T-test analysis demonstrated that the grade
distribution for the new system was significantly different from the traditional grading system, that is,
fewer high grades (p .001). All these results support the continuation of the Non-Graded Clinical
Evaluation System.
66                                                 American Dental Education Association


Dr. Mohsen Taleghani
Chair, Department of General Dentistry
Baylor College of Dentistry
Texas A&M Health Science Center
3302 Gaston Avenue
Dallas, TX 75246
Phone: 214-828-8414
Fax: 214-828-8952
Best Practices in Dental Education 2004: Innovations in Curriculum                                   67

                                     Columbia University
                                    Interactive Curriculum Map

The four-year predoctoral curriculum has been mapped to a single page. The courses have been
vertically grouped and color coded as biomedical/biomedically based, social/behavioral, and clinical. In
addition, several "bridge courses" and the "capstone courses" in the fourth year have been depicted
graphically to show their interdisciplinary nature. The curriculum map has been added to the school's
webpage where it enables students and faculty to see at a glance the sequence of the various components
of the curriculum and their relationships.

The curricular map may be used to visualize the contribution of the different courses in the curriculum
to the gradual acquisition of the school's stated competencies. From an attached list of competencies a
competency may be selected, which will show all courses that contribute to that competency highlighted
on the map. Each course on the curricular map has been converted to a "hot spot" so that a click on the
course will bring the viewer directly to the related course webpage. Each webpage carries information
concerning the course's contribution to the school's competenc ies, course objectives, a course outline,
and other course-related materials.


The curriculum map has been in use for almost two years. In addition to the information that it makes
available to faculty and students at the click of a mouse, it has proven to be a successful curriculum
management tool.

For example: the associate dean for academic affairs and the curriculum committee have used the map to
analyze at a glance what courses contribute to the same competencies. As a result, in the past y  ear,
several small first-year courses have been merged into a single, more efficient course that better
emphasizes the development of those competencies. Another example is the implementation of an
improvement in course sequencing.

In the near future, plans are to add information about the contribution of each lecture toward the
development of the school's competencies and thus improve the curricular map even further as a
curriculum management tool.
68                                                                           American Dental Education Association

              Curriculum overview. Bridge courses: dark gray. Capstone courses: light gray.

                                    Advanced Restorative Clinical Practice
                                                         Clinical Practice in Endodontics

                                                                                                                              Capstone year 4
                                                         Clinical Practice of Periodontics
     Area of                                             Practice of Pediatric Dentistry
     Concentration                                       Clinical Practice of Orthodontics
                                                         Oral Radiology Clinic
                                                         Extramural Hospital Rotation
                                                         Child Abuse Recognition/Reporting

                                                         Senior Interdisciplinary Series
                                               Advanced Diagnosis and Treatment Planning
                                    Clinical Cancer Training                            Geriatric Dentistry

                                                                                                                              Preclinical-clinical continuum 3
                                               Basic Diagnosis and Treatment Planning
     Area of                                                   Clinical Practice                       Intro to Clinical
                                    Facial Pain
     Concentration                                                       Operative Dentistry                       Practice
                                                                         Prosthodontics                Tobacco Cessation
                          Clinical Oral Pathology/Medicine                                             Spanish
                          Basic Oral & Maxillofacial Surgery             Pediatric Dentistry
                                                                         Periodontics                  Ethics
                          Oral Radiology Clinic                                                        Dental
                          CPR/Medical Emergencies                                                             Interviewing
                                                               Preclinical                             Oral Health Care
                                                                          Implantology                           Delivery
                                                                          Pediatric Dentistry          Practice

     Local Anesthesia / Pain and Anxiety Control                           Cariology
                       Physical Diagnosis                                    Preclinical
                                                                              Operative Dentistry
                       Pathophysiology                                        Prosthodontics

                                                                                                                              Foundation year 2
                                                                              Periodontics                to the
                                                                              Endodontics                 Patient
     Pharmacology                          Intro to Oral &                    Orthodontics
     Molecular/Cellular Pathology             Maxillofacial Surgery           Esthetic Dentistry
     Immunology                            Oral Radiology II                  Dental Materials
     Microbiology/ Infectious              Oral Pathology

              Oral Histology, Growth and Development
                                                                                                                              Foundation year 1

                                                        Preclinical Introduction to
                                                                                                Health Promotion
                                                        Patient Care I                          Nutrition
     Sciences Basic to the Practice of Dentistry        Oral Radiology I                        Substance Abuse
     Clinical Human Anatomy
     Human Development                                  Dental Anatomy and Occlusion
     Neural Science
                                                        Scientific Inquiry and Decision Making in Dentistry

          Biomedical Sciences                        Clinical Sciences                 Social & Behavioral Sciences
Best Practices in Dental Education 2004: Innovations in Curriculum                      69


Dr. Letty Moss-Salentijn                        Dr. John L. Zimmerman
Associate Dean, Academic Affairs                Assistant Dean, Information Resources
Columbia University                             Columbia University
School of Dental and Oral Surgery               School of Dental and Oral Surgery
630 West 168th Street                           630 West 168th Street
New York, NY 10032                              New York, NY 10032
Phone: 212-305-8334                             Phone: 212-305-8334
Fax: 212-305-7134                               Fax: 212-305-7134
Email:                        Email:
70                                                              American Dental Education Association

                                  Medical College of Georgia
                    Bioclinical Seminars to Facilitate Clinical and Basic Sciences

These seminars are offered to the freshmen and sophomore dental students. The freshmen course
consists of 12 contact hours, six hours in the fall (first) semester and six hours in the summer (third)
semester. Each seminar is two hours. The second course has 17 contact hours and is presented to the
sophomore students in the fall and spring semesters.

Case reports and clinical problems pertinent to the basic science courses currently or previously taught
are prepared with questions or learning issues and are given to the students at least two weeks prior to
the seminars. The student is expected to search for the answers by consulting the literature, his or her
lecture notes, the Internet, and his or her colleagues or instructors. On the day of the seminar, the first 20
minutes are devoted to the presentation of the case report while the remaining 1.5 hours are spent by the
small group of seven to eight students in the presence of two faculty moderators, one of whom has
clinical training, in discussing the learning issues pertinent to the case.


The major course outcome is that the student becomes a self- learner and a problem solver and can apply
basic science concepts to the diagnosis and treatment of oral and perioral diseases.


Dr. George S. Schuster
Ione and Arthur Merritt Professor
Chair, Oral Biology and Maxillofacial Pathology
Medical College of Georgia School of Dentistry
1120 Fifteenth Street
Augusta, GA 30912
Phone: 706-721-2991
Fax: 706-721-3392
Best Practices in Dental Education 2004: Innovations in Curriculum                                     71

                               Nova Southeastern University
               The Use of a Standardized Soap Carving -Test and the Virtual Reality
                      Dental Simulator as a Predictor of Psychomotor Skills

Dental schools in the United States no longer use a soap or chalk-carving component as part of the
Dental Aptitude Test, nor do they use it in individualized application packets. The carving exercise was
removed from use a number of years ago. In addition, courses to develop or measure psychomotor skills
are not part of the predental curriculum requirements. There are no effective measurements to ascertain a
minimal level of psychomotor skill of the entering freshman.

Nova Southeastern University College of Dental Medicine, Department of Restorative Dentistry, is
planning a five-year study to determine innate psychomotor skills utilizing two separate modalities. The
first modality is a standardized soap-carving exam. The second modality is a virtual reality dental
simulation system. The baseline data from both of these studies will be compared to the student’s
psychomotor performance in the pre-clinical laboratory courses and clinic over the length of their dental
educational experience.

The Department of Restorative Dentistry has implemented the soap-carving test as a supplemental
curricular innovation into the first year dental curriculum. This exam is similar to the model used in the
Canadian Dental Association’s Dental Aptitude Test and is taken by each member of the first-year class
during their first week of classes. This test serves to establish baseline data for each student’s
psychomotor skills upon entering the pre-clinical curriculum. Each first year student is provided a
standardized soap-carving kit that includes a manual with instructions, five pieces of soap, two knife
blades, one knife handle, one standard metric ruler, and one permanent felt marker.

Under faculty supervision, each student has exactly 30 minutes to complete the soap-carving test. A
standardized double-blind grading criterion with calibrated faculty is used to grade every carving and
minimize subjectivity. A second soap-carving test is given to these same students upon the completion
of their first semester pre-clinical curriculum. The same faculty grade both soap-carving tests.

Nova Southeastern University College of Dental Medicine recently acquired several virtual reality
dental simulation units (DentSim™, DenX Advanced Dental Systems Ltd. Australia). There are multiple
potential uses of this system in dental education. Advantages of the system include: use of 3-D
technology in pre-clinical and clinical education; objective and immediate feedback for the student and
instructor; faculty standardization; practice for licensure exams and licensure remediation; and
institutional research. The system is currently being used with first-year dental students in order to
enhance the early development and measurement of psychomotor skills. Skills developed by the students
include the correct use of the high-speed handpiece and rotary cutting instruments as well as early
exposure to indirect vision and dental ergonomics.

In addition, early in the freshman year each dental student is also assigned to rotate through the Virtual
Reality Dental Simulation Lab (VRDS Lab) in order to perform tooth preparations on a simulated
patient. As the student performs a tooth preparation, the virtual reality camera reads the position of the
handpiece in relation to the typodont tooth. This information is simultaneously transferred to the
database. The student is then able to immediately compare his or her performance with the pre-
72                                                          American Dental Education Association

programmed “optimal” tooth preparation. Each student completes the preparations on the assigned teeth.
The virtual reality dental simulation system then maintains the objective, student-specific performance


The student’s performance in the preclinical laboratory courses and clinic will be tracked during the
student’s dental education. This information will be compared to the performance on the soap-carving
exams as well as the grades on the VRDS tooth preparations. These results will be evaluated to
determine their value as a measurement and predictor of the innate psychomotor skills of the dental
school applicant.


Dr. Robert A. Uchin
Nova Southeastern University College of Dental Medicine
3200 South University Drive
Office of the Dean, Room 7310
Fort Lauderdale, FL 33328
Phone: 954-262-7312
Fax: 954-262-1782
Best Practices in Dental Education 2004: Innovations in Curriculum                                      73

                         University of California at Los Angeles
                              Clinical Applications of Quality Assurance

The purpose of the course is to provide fourth year dental students with a challenging, practical, clinical
application of quality assurance methods. A case-based learning format is used to facilitate the
transition to the independent professional. After an introduction to Quality Assurance (QA) of clinical
care, students may work in teams with a faculty coach or independently to understand the components of
quality assessment and apply the information gained in developing a quality assurance program that can
be readily adapted to private practice.

The unique aspect of this course is the integration of a student-learning objective with the management
of the clinic. During their fourth year, each dental student is required to conduct a structure and process
evaluation of one of the clinics at the school. Each student reviews three patient records selected at
random using a standardized evaluation instrument provided by Delta Dental of California. Each
student also designs and participates in the design and implementation of an evaluation of a team-
selected aspect of the clinical operation. All findings are discussed in the course along with

The last component of the process involves input related to quality that is provided directly to the
administration. Data from all of the teams are collated and organized into a single report and are directed
to the Clinic Director. Some issues are managed directly by the Clinic Director; however, more
complex issues are directed to the Patient Care Committee, the Environmental Health and Safety
Committee or the Outcomes Committee for their review. These committees review all matters,
formulate recommendations, disseminate the recommendations to the administration and conduct
monitoring post implementation.


The students’ QA reports make a difference. The chart audits, quality assurance profiles, and reports are
studied by the Patient Care Committee. The Committee acts on the information and students are notified
of the outcomes of their work. Examples include:
    • the narrative report was sent to the director of the specific clinic involved and a response was
        requested. The directors responded and changes were implemented;
    • identified problems and recommendations were forwarded to the relevant committee of the
        School of Dentistry, for example, the Health and Safety, Curriculum, or Expedited Care

Action has been taken. Examples of corrective measures that are in progress include:
   • the Health and Safety Committee, worked with the campus Environmental Health and Safety
       staff to develop operational guidelines for proper collection and disposal of scrap amalgam;
   • automatic film processors have been ordered for the second- and third- floor general clinics;
   • the Curriculum Committee is currently reviewing all clinical rotations. The Expedited Care
       Clinic is working on ways to improve the efficiency of patients entering the system.
74                                                          American Dental Education Association

Students receive periodic updates on the progress of their recommendations and are encouraged to re-
evaluate some of the problems that they identified in order to determine if the corrective measures have
been successful.


Dr. Kathryn Atchison
Associate Dean for research and Knowledge Management
University of California, Los Angeles School of Dentistry
Room 53-038 CHS, Box 951 668
Los Angeles, CA 90095
Phone: 310-825-6544
Fax: 310-794-7734
Best Practices in Dental Education 2004: Innovations in Curriculum                                       75

                                   University of Connecticut
                                            Critical Thinking

One of the first changes to be implemented during the recent curriculum revision at the University of
Connecticut School of Dental Medicine was the introduction of a new program, Critical Thinking in
Dentistry (CTiD). This education innovation was first conceived in 1999 to address several concerns in
the current curriculum. The areas to be addressed included increasing the integration of the basic
medical sciences with the dental sciences, emphasizing the relevance of the basic medical sciences,
incorporating the basic sciences into the clinical program, and transitioning the students to think like
practicing dentists rather than as dental students.

CTiD was structured as a two-phase program that would encompass the entire four-year dental school
experience. Phase one consists of maintaining participation in the correlated medical problem-solving
seminars of the basic medical science curriculum for first-year students. In this phase of the program
students learn to work cooperatively in small groups, formulate questions and learning issues, develop
concept maps, and search the literature (both print and web based).

Phase two of CTiD introduces a different student seminar concept. Each seminar group consists of two
to four students from each of second-, third-, and fourth-year classes. One of the purposes behind
placing students from different class years into the same seminar group is to enhance the clinical
treatment teams and improve communication between classes. A combination of problem-based and
case-based learning is the teaching format for the seminars. To reinforce relevance and provide “real
                                       rs have been recruited from the local dental community. The
community dentist is paired with a full-time School of Dental Medicine faculty member. Thus, seminar
discussions are not only “real world” relevant, they are expected to be evidence-based.

At the beginning of each academic year, students are instructed in the elements of critical thinking.
Students are not only expected to critically evaluate the scientific literature, but also evaluate lecture
material and differing expert opinions. The current emphasis is on articulating assumptions and
recognizing different points of view.

Four to five cases are presented each academic year. Each case evolves over two to four sessions
depending on the complexity. Many of the cases are based on patients being treated within the student
practices, and several have been contributed from the community dentists. Each case is designed to
contain four learning elements – medical issues, dental issues, socio-economic issues, and legal/ethical
issues. Within each case students identify the problems and develop their learning issues, which are
then discussed at subsequent seminar sessions. A concept map (comprehensive treatment plan)
integrating all of the issues is the end product of each case.

Students are evaluated through a variety of methods. Facilitators evaluate each student twice during the
year for seminar participation and the student’s ability to demonstrate the principles of critical thinking.
As an end of year project, each of the seminar groups develops a “new” CTiD case from one of the
patients in their patient family. The cases must contain the four elements. The students present their
cases to a larger forum and they are evaluated on their group presentation and an evidence-based
76                                                             American Dental Education Association

comprehensive treatment plan. The final evaluation consists of a written examination, which is a critical
thinking evaluation of an article from the dental literature using a standardized format.


To date, feedback from students and facilitators has been very positive. Students enjoy the input from
the community facilitators as to the relevance of the didactic curriculum in the care of real patients.
Community facilitators also enjoy these seminars and see it as a form of continuing education.

The downside of this curriculum innovation is that it is labor and space intensive. Each seminar group
consists of approximately ten students and each seminar group requires at least two facilitators. There
needs to be a sufficient number of small classrooms to cond uct several seminars simultaneously.
Fortunately, our medical/dental school has been refurbished to support problem-based learning. In
addition, most of the supporting documents for each case (photos, radiographs) are computer based. The
seminar rooms need to be equipped with web- linked computers to access the supporting documentation
and accomplish computer searches during each of the seminar sessions.

One of the goals of this project is to enable students to identify better a wide variety of problems
surrounding the care of their patients and to be able to seek out evidence-based answers where they are
available. The hope is that students will be able to reconcile differing opinions among colleagues,
specialists, and the literature when a variety of treatment options are presented. By actively
participating in the critical thinking process, students and facilitators can apply these principles to other
areas of their life.


Dr. Michael T. Goupil
Assistant Dean, Dental Student Affairs
Director, Critical Thinking in Dentistry
University of Connecticut Health Center
School of Dental Medicine
263 Farmington Avenue
Farmington, CT 06030
Phone: 860-679-4003
Fax: 860-679-1702
Best Practices in Dental Education 2004: Innovations in Curriculum                                      77

                                    University of Louisville
           The Use of Live, Standardized Patients in the Evaluation of Skills in Physical
               Diagnosis and Patient Assessment for Second-Year Dental Students

In conjunction with the facilities and personnel available through the University of Louisville’s Alumni
Center for Medical Education, Standardized Patient Clinic, the School of Dentistry developed and
implemented an object-structured clinical examination (OSCE) using live, standardized patients (SPs) as
part of the final examination for the Oral Diagnosis/Oral Medicine I course in May 2003. This course
primarily teaches physical diagnosis, patient assessment, and dental management of medically
compromised patients to second- year dental students. This SP-OSCE represented the first use of live,
standardized patients in our dental school’s curriculum.

The SP-OSCE consisted of two original clinical cases developed specifically for this examination by
dental school faculty, who were also directly involved in the training and validation of the SPs
participating in both of these cases.

For each of the two SP cases, each student was allowed 20 minutes of SP contact during which time they
were expected to perform a complete patient medical/dental history evaluation, and measure and record
the patient’s vital signs. The student was then allowed an additional 90 minutes outside of SP contact to
write a problem-oriented medical history summary and a medical history narrative for the patient, as
well as any medical consultation they deemed necessary for the patient. The students were evaluated on
wide array of various behavioral and clinical skills and competencies by both the SPs and clinical
faculty involved with the examination.


Evaluation of the results of the SP-OSCE were significant in that students who successfully achieved
passing grades in written, didactic examinations did not always demonstrate a satisfactory level of
competency when those same topics or skills were assessed on the SP-OSCE. Therefore, it is believed
that the SP-OSCE format may be a better indicator of the actual clinical performance capabilities of
students and the attainment of competency for certain curricular topics than written, didactic

Also, the SP-OSCE was very well received by the participating students. There was nearly unanimous
agreement by the students that the examination was a valuable part of their clinical education and that
the use of standardized patients should be implemented throughout the dental curriculum wherever it is
deemed beneficial and feasible to do so.

This has prompted the dental program’s curriculum committee to explore ways in which SPs can be
further utilized in clinical dental education. One particular proposal under investigation is the use of SP
encounters in conjunction with METI electronic human patient simulators in the education of dental
students in the recognition and management of medical emergencies that occur during dental treatment.
78                                                       American Dental Education Association


Dr. F. John Firriolo
Associate Professor and
Director, Division of Diagnostic Sciences
University of Louisville School of Dentistry
501 South Preston St.
Louisville, KY 40292
Phone: 502-852-1236
Fax: 502-852-3526
Best Practices in Dental Education 2004: Innovations in Curriculum                                    79

               University of Medicine and Dentistry of New Jersey
            Continuous Quality Improvement Program (CQI)—Beyond Accreditation

Continuous Quality Improvement (CQI) goes beyond the Quality Assurance (QA) Program mandated by
the American Dental Association Commission on Dental Accreditation (CODA). While a QA program
provides a system to inspect the quality of patient care, CQI seeks to prevent problems before they arise
by involving all aspects of the school. The first step taken by New Jersey Dental School was to create an
organizational structure within the dental school to identify opportunities for improvement, define
projects, conduct diagnostic and remedial journeys through data collection and discourse with all
interested parties, and to remain vigilant about maintaining our successes. The Quality Council (QC),
which has equal representation of administrators, faculty, staff, and students is the starting point.
Nominations for quality improvement projects are received and managed by the QC. The QC accepts
requests from any constituents and also identifies potential projects based on reviews of outcomes
assessment documents, survey results, and focus group summaries. The QC manages the process
through which ideas are assembled and sets priorities for action. The council can charge Quality
Improvement Teams (QIT) to address specific areas and it in turn can call meetings with a Quality
Ground Crew (QGC). QIT are cross- functional in nature and include personnel with appropriate
background and experience regardless of administrative status. QGCs are the cornerstone of the quality
improvement program as membership is limited to those persons with intimate knowledge of the daily
process so that their unique and valuable voices can be heard. QCGs report back to the QIT with
potential solutions so that the QIT can recommend an appropriate action plan to the council. The
council responds to QIT recommendations, evaluates requests for resource allocation, and reviews
progress on prioritized projects. Following a plan-do-check-act cycle, the process assures continuous
quality improvement.


Since the onset of the CQI program in 1998, QIT have been formed in the areas of patient charts,
accounting, standards of patient care, clinic enhancements, employee development, student ethics,
communication, and safety. An automated chart tracking system using bar code scanning was designed
and implemented to reduce the time associated with locating charts. The patient accounting team
created new processes to simplify reports and billing processes, including the adoption of payment plans
which were requested by patients, resulting in a 25 percent improvement in collections. In addition,
electronic billing is now being piloted to further enhance efficiency for patients and staff.

The New Jersey Dental Schools Standards of Patient Care team successfully creates, implements, and
monitors more than 50 indicators in the areas of general quality, credentials, utilization and
management, patient rights and responsibilities, record keeping, and preventive services. The team has
recently undertaken a complete review of all indicators including editing specifications and adding
indicators where new opportunities for improvement exist. Action plans for unmet indicators have been
implemented and system-wide changes have been enacted to assure compliance.

Enhancement of Quality of Work Life (QWL) was added to the school's strategic plan in addition to the
four components of our mission: patient care, research, education, and community service. Using a
QWL survey distributed to all faculty, staff, residents and students, baseline data has been collected to
80                                                          American Dental Education Association

determine what areas should be targeted. Based on this data, all faculty, staff, and students now have
email addresses and access to computers throughout the building to improve communication. Focus
groups have been held with faculty and staff to gather more information about their development needs
and new programs have been put into place to allow those needs to be met.

Our newest QIT, safety, has just begun collecting data using a school- wide survey to identify the most
important concerns while our oldest teams, patient charts and accounting, have completed their work for
the time being.

Structure for the CQI process alone is a necessary, but not sufficient, condition for success.
Commitment to the program by senior management is key and the necessity of the program is evident as
we continue to improve quality throughout the school using an evidence-based decision management


Dr. Pamela B. Matheson
Associate Dean of Planning and Assessment
New Jersey Dental School
Room B811
110 Bergen Street
Newark, NJ 07628
Phone: 973-972-586
Fax: 973-972-1568
Best Practices in Dental Education 2004: Innovations in Curriculum                                    81

                           Virginia Commonwealth University
                Integrating Computerized Patient Simulations into the Curriculum

There is no general agreement on how to choose appropriate technology and integrate it naturally into
the curriculum. Everyone is in agreement, however, that educational software is worthless if it cannot be
used and evaluated.

At Virginia Commonwealth University (VCU), Oral Pathology has always been taught as an illustrated
series of disease-oriented lectures integrated with textbook readings and some laboratory experience in
the microscopy of disease. Additionally, the School of Dentistry wanted to involve students immediately
with diagnostic skills and content within the context of patient interaction. The plan involved continued
use of the lecture portion of the course and introduction of a new practical application of the content
areas learned in the lectures. The School of Dentistry wanted an independent, self-paced, more life- like
format than the traditional “CPC-type” case presentation. Thus, the computerized patient simulation
provided an ideal vehicle to accomplish this goal. Learning initially by having to solve a simulated
patient’s problem links content and process to the context in which students will eventually practice.
Since the patient simulation authoring system, CASE STUDIES, was developed at VCU and available to
use, this system was used to build simulations. Initially, a CD-ROM was authored containing ten patient
simulations that represented conditions often found in practice and offered a variety of opportunities to
test information gathering, differential diagnosis, synthesis, and decision- making skills. The cases
included systemic disease and medication complications, issues with patient cooperation, and attitudes
toward care. The CASE STUDIES program allows authors to include patient dialog, physical and other
examinations, and common diagnostic tests and immediate questions to assess the reasoning behind
decisions. These simulations required students to demonstrate both patient interaction and diagnostic
process skills as well as knowledge of content areas. Students received their own personal copy of the
CD on the opening day of the course. The students had a schedule to complete each case so as to
distribute the 10 simulations over the entire semester. VCU subscribes to Blackboard™ and this web-
based tool was used to organize and provide access to several elements of the course.

Several items were needed to facilitate integrating the simulations into the course. These items
    • a Student Manual was written to present the goals, objectives, description, and features of the
       CASE STUDIES portion of the course;
    • supplementary readings – the Blackboard™ environment included links to supplementary
       information, such as papers or other readings for some of the simulations;
    • quizzes – a quiz was written for each of the ten simulations. Blackboard™ allows faculty to write
       quizzes that are graded automatically and entered into an “Online Grade Book.” Quizzes
       measured student’s grasp of the diagnostic process and content items;
    • discussion forums – an online discussion forum was posted for each of the ten cases. These
       allowed students to raise questions, problems, or generally discuss each simulation without being
       directly in the presence of other students. Faculty only monitored student discussions;
    • student evaluation – a 19-item student evaluation was constructed that was analyzed and
       recorded by Blackboard™. The evaluation measured both navigational/functional and
       diagnostic/content issues. A final item asked students to respond to the statement, “What I
       learned” from the simulation experience.
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Thirty- five out of 77 students turned in evaluations. VCU does not allow required student evaluations.
Analysis of average quiz grades showed steady improvement in student performance over the semester.
Students rated the CASE STUDIES portion of the Oral Pathology Course very well (average score of
8.83 out of ten on a scale where one = strongly disagree and ten = strongly agree). Functionality rated
very high (nine to ten). Blackboard™ was perceived as an effective environment (8.8 out of ten).
Student's perceptions of the skills they acquired were evaluated by having them rate their level of
agreement with written statements as noted below.

     Items rated > 9.0
     · Learned critical thinking skills
     · Enjoyed independent, self-paced learning
     · Understand how & what to ask about medical history items
     · Understand function of differential diagnosis

     Items rated 8.6-8.9
     · Comfortable with method of case analysis used
     · Understand questions to ask about the chief complaint & physical exam
     · Can link patient information to problem solving
     · Treatment planning process is clearer
     · Will try to formulate a differential diagnosis in clinic
     · Can use sequential approach to examination and diagnosis

The “discussion forums” were not rated because they were hardly used. The last evaluation question
asked students to respond to the statement: “What I learned.” Thirty- five evaluations included 135
written responses to this item. The top 3 responses in different categories are as follows:

     · Medications:
       1. Systemic implications of diseases and drugs
       2. Importance of drug interactions
       3. Medications may effect treatment
     · Questions and the art of questioning:
       1. The right questions to ask in different circumstances
       2. Proper phrasing of health assessment questions
       3. The process of question-asking that leads to diagnosis
     · Differential Diagnosis, Diagnosis and the Diagnostic Process:
       1. A sequential approach to examining and diagnosis
       2. Understand the differential diagnostic process better
       3. Appropriate circumstances to biopsy vs. smear vs. culture
     · History, and How to Take One:
       1. How to probe for information in medical history
       2. Look for discrepancies in medical history
       3. All medical history information is important
     · Treatment and Follow-up:
       1. How to plan treatment
       2. Follow-up is part of treatment
       3. Clinical management of pathological lesions
Best Practices in Dental Education 2004: Innovations in Curriculum          83

   · Other Information Learned:
     1. Improved computer skills
     2. How to use the index in the back of the textbook
     3. Study ahead of time
   · Specific Content Items Learned:
     1. Characteristics of specific pathologies
     2. The incidence and consequences of specific diseases
     3. Surgical removal of parotid may result in facial muscle paralysis
   · Thoughtful introspection:
     1. There are many things I still must learn
     2. Listen to my patients and be compassionate
     3. Consider many issues each time I meet a patient


Dr. Louis M. Abbey
Professor of Oral Pathology
Virginia Commonwealth University School of Dentistry
P.O. Box 980566
Richmond, VA 23298
Phone: 804-828-1778
Fax: 804-828-6234
84                                                             American Dental Education Association

                                   West Virginia University
                                          Curriculum Revision

The West Virginia University School of Dentistry is conducting a comprehensive review of its
curriculum. Those pre-doctoral students who enrolled in the fall 2002 (Class of 2006) were the first to
experience the “new curriculum.” The goals of the curriculum revision include:
    • to provide course content that is comprehensive and current and eliminate unwarranted
    • to integrate course theory with practice to enhance student learning;
    • to fulfill our mission by enabling students to perform appropriate clinical care/community
        service as early as possible in the curriculum;
    • to enable students to do more dentistry commensurate with their knowledge and training;
    • to sequence courses in a logical manner (ADPIE) by addressing how each discipline can
        contribute to the attainment of competencies that build upon one another;
    • to manage the needs of a family of patients through the team approach.

Changes in the curriculum have occurred at all levels, beginning with the basic science courses. All
basic science course content and sequencing have been modified. A Basic Science/Clinical Scie nce
Subcommittee was established to increase the integration of theory and practice. A Behavioral
Science/Clinical Science Subcommittee was also formed with the same goal.

A review of the content and sequencing of all courses in the curriculum has been completed. Course
additions, modifications and deletions have been approved at the School and University Senate level.
Because the School of Dentistry’s new philosophy involves having students perform procedures shortly
after they learn them didactically, efforts have been made to sequence courses to accomplish this.
Existing preclinical courses have been modified and new introductory courses in preventive dentistry,
community dentistry and patient care have been developed to provide first-year students and second-
year students with planned learning experiences, thereby integrating theory with practice in a timely
fashion. Students are now prepared to enter the clinic one year earlier (in their sophomore year).

The Department of Restorative Dentistry includes Operative and Fixed and Removable Prosthodontics.
Content changes were made in Dental Anatomy and Dental Materials to be consistent with pre-clinical
and clinical instruction. All restorative courses are now arranged in categories (I-X) by semester to
reflect a building block with incremental steps toward the achievement of competency.


Regularly scheduled curriculum management and discipline-specific meetings are held to continually
ensure content is current and is sequenced properly, assessments of competency are in place, and
outcomes are analyzed as a catalyst for change.

Students have been very receptive to the innovations. They enjoy the opportunity to engage in patient
care earlier in their dental school curriculum. In addition, overall dental student clinical productivity has
Best Practices in Dental Education 2004: Innovations in Curriculum   85


Dr. Christina B. Debiase
Assistant Dean for Curriculum and Instruction
Director Division of Dental Hygiene
West Virginia University School of Dentistry
P.O. Box 9425
Morgantown, WV 26505
Phone: 304-293-4882
Fax: 304-293-4882
86                                                           American Dental Education Association

                                  West Virginia University
            Building the Next Generation of Culturally Aware Health Care Providers:
              A Collaborative Program for Entering Dental and Medical Students

The West Virginia University (WVU) School of Dentistry, in collaboration with the School of Medicine,
offers a joint diversity forum as part of its new student orientation program. This seminar serves to
build a community among future dentists and physicians while simultaneously engaging first- year dental
and medical students in critical thinking skill development exercises necessary for delivery of health
care to diverse groups. This immersion activity links diversity awareness with culturally competent

Realizing the value of diversity and cultural awareness, WVU implemented this program to exclusively
address diversity topics through dynamic, interdisciplinary discussion of clinically and academically
relevant vignettes. Small groups of dental and medical students examine case scenarios with guidance
by experts on diversity topics including culture, race, disability, sexual orientation, and socioeconomic
status. Panel leaders come from several units in the University, including the Office of Disability
Services and the Center for Black Culture and Research. A representative from a community health
agency also assists with this program.

Upon completion of this session, the first-year dental and medical students shall:
      • understand the University’s commitment to diversity/social justice as evidenced in both its
         mission statement and administrative structure;
      • have an awareness of demographic trends and its relevance to health care delivery and
      • recognize biases, stereotypes, and assumptions that are counterproductive to the delivery of
         health care;
      • have an awareness of barriers and solutions to effective communication in diverse
      • have had the opportunity to examine their own beliefs/values regarding various diversity
         issues; and
      • understand how their responsibilities as health professionals relate to diversity


This forum provides a setting for multidisciplinary, broad-scale discussion on diversity and its relevance
to health care delivery. Program evaluations demonstrate that students find this program helpful and
strongly support the inclusion of these topics in the dental and medical curricula.
Best Practices in Dental Education 2004: Innovations in Curriculum   87


Dr. Shelia Price
Associate Dean Admissions, Recruitment and Access
West Virginia University School of Dentistry
G-110 (H) Health Sciences North
P.O. Box 9407
Morgantown, WV 26506
Phone: 304-293-6646
Fax: 304-293-8561

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