The role of observational research in improving faculty lecturing skills: A qualitative study in an Italian dental school

BACKGROUND

This pilot study is based on observational research of lecturing skills during the annual Oral Medicine course at the Milan Dentistry School.

AIMS

Our goals were to explore how teachers exhibited desirable lecturing skills, to observe how their attitudes and lecturing skills affected students' attention and thereby learning, and to provide feedback.

METHOD

We prepared a structured observational grid divided into four categories: explaining, questioning, visual aids, and lecturer attitude. The grid was filled in by a participant, nonactive researcher.

RESULTS

Two main types of lecture were observed: "traditional" and "interactive". Both of these can result in a high level of attention among students. Among the categories, only "lecturer attitude" appeared to affect student attention. In particular, the skills of "speaking aloud" and "sustaining verbal communication with vocal inflection" appeared to have the greatest impact on lecturer attitude. The data were then presented blindly to the five lecturers, who were able to identify their own lesson.

CONCLUSIONS

Our grid proved to be a valid instrument although it was very expensive. When integrated with other strategies for improving lecturing, such as student scoring, peer evaluation, and microteaching, observational research can be a cost-effective method to stimulate guided reflection and to improve the lecturing skills of faculty members.

Differences in clinical grading associated with instructor status

PURPOSE

The purpose of this study was to determine whether the clinical evaluation of pre-doctoral students is associated with instructor status. The hypothesis was that there would be no association between instructor status and clinical evaluation grades.

MATERIALS AND METHODS

Retrospective analysis of pre-doctoral clinical evaluations for class II amalgams, class III composites, and periodontal scaling and root planing was performed. The grade averages were based on a rank scale. Descriptive statistics were computed to summarise the predictor and outcome variables. Bivariate statistics were computed to evaluate any associations between the predictors and outcomes. Multiple linear regression models were computed to evaluate the simultaneous effects of multiple predictors on clinical evaluations.

RESULTS

The study sample consisted of 238 class II amalgams, 246 class III composites, and 675 scaling and root planings which occurred between August 2003 and June 2005. The procedure averages for these procedures were 1.8 +/- 0.67, 1.8 +/- 0.66 and 2.1 +/- 0.56 respectively. The management averages were 2.0 +/- 0.63, 1.5 +/- 0.58 and 1.4 +/- 0.54 respectively. In bivariate analyses, faculty status was associated with treatment averages for all three procedures.

CONCLUSIONS

Faculty status was associated with treatment score for all three procedures evaluated. Full-time faculty gave the best grades for restorative procedures. For periodontal procedures, part-time faculty gave the best grades. More studies are warranted to elucidate the nature behind these differences.

Short- and long-term effects of training on dental hygiene faculty members' capacity to write SOAP notes

Calibration among faculty is challenging to achieve and maintain. In this study, calibration refers to the training process by which standardization of chart documentation in a SOAP note format was achieved. In the SOAP format, chart entries by health care providers are written in the following categories: Subjective data, Objective data, Assessment, and Plans. The primary training "effect" or outcome that was measured in this study was the capacity of faculty members to write a SOAP note that adhered to prescribed standards for chart documentation. This study was conducted to assess the short-term effects of training and determine whether faculty members' capacity to write appropriately constructed SOAP notes could be sustained for one year. Eight dental hygiene faculty members at the University of Minnesota participated in a pre-training assessment in which they prepared a SOAP note based on a patient case, completed a training session on writing SOAP notes, and completed a post-training test shortly after training that also consisted of writing a SOAP note based on a patient's case. One year later, a follow-up test, similar to the pre- and post-tests, was conducted. Each component of the SOAP note was compared and scored against a gold standard benchmark score of 29 that represented the number of items that should have been included in an ideal SOAP note in the estimation of the investigators, based on chart documentation guidelines of the University of Minnesota Dental Hygiene Division. The mean score for the pre-test was 18.25 (SD=2.82), which represented 63 percent of the benchmark gold standard score of 29. The post-test mean score immediately after training was 24.63 (SD=2.13; 84.9 percent of the benchmark score), and the one-year follow-up mean score was 22.75 (SD=1.83; 78.4 percent of the gold standard benchmark). From the pre-test to the post-test administered in close approximation to the SOAP note training, faculty members' approximation of the gold standard benchmark increased by 35 percent, or 6.28 points, and from the post-test to the follow-up test one year subsequently, approximation of the benchmark score decreased by approximately 1 percent or 1.88 points. Friedman's test indicated that the differences in mean scores for the pre-test, post-test, and follow-up test were significant. The Sign test was used for post hoc tests; alpha was adjusted using Bonferroni's procedure. Conclusions support a hypothesis that faculty capacity to write a SOAP note that adheres to standards can be increased through training and that the effects can be maintained over a period of approximately one year.

Improving the quality of clinical teaching in a restorative clinic using student feedback

INTRODUCTION

A large proportion of the undergraduate curriculum is spent within Restorative Dentistry at the University of Liverpool. As well as supportive "phantom head" courses the undergraduates receive significant amounts of teaching within the clinics themselves. In 2004, to help inform the clinical tutors as to their areas of strengths and weaknesses, undergraduates were invited to complete an anonymous questionnaire on the quality of teaching they received from their clinical supervisors. This process has been repeated subsequently in 2005 and 2006.

METHOD

A 19 parameter questionnaire, employing a 5-point Likert scale and space for open comments, was circulated to every clinical undergraduate student. Questionnaires were returned anonymously and all data collected by one researcher. Descriptive statistical analysis was performed and the staff provided with individual feedback within the context of the overall departmental profile. The pooled data from each of the years was then compared to determine if any changes had occurred. Statistical analysis used Kruskal Wallis tests to determine whether these were statistically significant.

RESULTS

Although the range varied, median scores of 4 (agree) were gained for each question each year. Following statistical analysis 18 of the parameters showed a statistically significant improvement (P < 0.05) between 2004 and 2006 with only one remaining constant throughout.

CONCLUSION

It would appear that the use of a questionnaire based feedback system can result in a tangible and demonstrable improvement in the delivery of clinical teaching.

The state of the art in evaluating the performance of assistant and associate deans as seen by deans and assistant and associate deans

This study explores the little-understood process of evaluating the performance of assistant and associate deans at dental colleges in the United States and Canada. Specifically, this research aimed to identify the methods, processes, and outcomes related to the performance appraisals of assistant/associate deans. Both deans and assistant/associate deans were surveyed. Forty-four of sixty-six deans (66.7 percent) and 227 of 315 assistant/associate deans (72.1 percent) completed surveys with both close-ended and open-ended questions. In addition, ten individuals from each group were interviewed. Results indicate that 75-89 percent of assistant/associate deans are formally evaluated, although as many as 27 percent may lack formal job descriptions. Some recommended best practices for performance appraisal are being used in a majority of colleges. Examples of these best practices are having at least yearly appraisals, holding face-to-face meetings, and setting specific, personal performance objectives/benchmarks for assistant/associate deans. Still, there is much room to improve appraisals by incorporating other recommended practices. Relatively high levels of overall satisfaction were reported by both assistant/associate deans and deans for the process and outcomes of appraisals. Assistant/associate deans rated the value of appraisals to overall development lower than did deans. Qualitative data revealed definite opinions about what constitutes effective and ineffective appraisals, including the use of goal-setting, timeliness, and necessary commitment. Several critical issues related to the results are discussed: differences in perspectives on performance reviews, the importance of informal feedback and job descriptions, the influence of an assistant/associate deans' lack of tenure, and the length of service of deans. Lastly, recommendations for enhancing performance evaluations are offered.

A few good faculty

Faculty shortages have been in concern in dental academia for the past several years. The American Dental Education Association has taken the lead in bringing this issue to the forefront of dental education, creating initiatives that begin to turn academia into a worthwhile career option for dentists. Income opportunities, faculty development, lifelong learning and job satisfaction must all be addressed, in order to fill vacancies and avoid high turnover. Contemporary dental education needs faculty who don't just want a job: they need to want to create a career out of teaching. How we provide inspiration and preparation for these individuals throughout their careers is critical to dentistry's success.

Characteristics of effective classroom teachers as identified by students and professionals: a qualitative study

This qualitative research study identified criteria for teacher quality preferences as perceived by current and past students. A two-question, open-ended survey asking what qualities learners liked most and least in a teacher/presenter was given to two groups: students (Group A) from medicine, dentistry, and related residency programs; and dentists and physicians (Group B) who had graduated at least three years previously and who attended a minimum of two days of continuing education courses in lecture format each year. A total of 300 subjects provided 2,295 written responses. Descriptive words within the responses were coded and grouped according to similar relationships, resulting in the emergence of twenty-one defined categories that were further refined into three core categories: personality, process, and performance. Results showed that the two groups appear to have different preferences in teacher/presenter characteristics. For Group A (students), the categories of content design, content organization, and content development were at the forefront of their preferences. Group B (professionals) overwhelmingly favored elements of speaker self-confidence and expertise. Both groups highly valued expertise and speaking style. These findings can be used to develop curriculum, enhance faculty members' teaching skills, and plan continuing education programs.

Staff recruitment, development and global mobility

This paper considers issues that relate to staff recruitment, staff development and global mobility of dental academics. Published literature, which has a North American bias, is reviewed. Recommendations, which may be applicable world-wide, are made to address evident and pertinent areas of concern in terms of the availability of quality dental teaching staff in dental teaching institutions so as to sustain the global dental academic enterprise at appropriately high levels of achievement.

Barriers to scholarship in dentistry, medicine, nursing, and pharmacy practice faculty

There has been an increased emphasis on scholarly activities by health sciences faculty members given the importance of the promotion of public health over the last 50 years. Consequently, faculty members are required to place greater emphasis on scholarly activities while maintaining their teaching and service responsibilities. This increasing requirement of scholarly activities has placed great demands on clinical practice faculty members and it has made their management of clinical practice, teaching responsibilities, and expectations for promotion and tenure a difficult task. This retrospective literature review identifies barriers to the scholarship activities of clinical faculty members in dentistry, medicine, nursing, and pharmacy and discusses strategies for enabling faculty members to pursue scholarly activities in the current health science academic environment. The review indicates commonalities of barriers across these 4 disciplines and suggests strategies that could be implemented by all of these disciplines to enable clinical practice faculty members to pursue scholarly activities.

Quality assurance and benchmarking: an approach for European dental schools

This document was written by Task Force 3 of DentEd III, which is a European Union funded Thematic Network working under the auspices of the Association for Dental Education in Europe (ADEE). It provides a guide to assist in the harmonisation of Dental Education Quality Assurance (QA) systems across the European Higher Education Area (EHEA). There is reference to the work, thus far, of DentEd, DentEd Evolves, DentEd III and the ADEE as they strive to assist the convergence of standards in dental education; obviously QA and benchmarking has an important part to play in the European HE response to the Bologna Process. Definitions of Quality, Quality Assurance, Quality Management and Quality Improvement are given and put into the context of dental education. The possible process and framework for Quality Assurance are outlined and some basic guidelines/recommendations suggested. It is recognised that Quality Assurance in Dental Schools has to co-exist as part of established Quality Assurance systems within faculties and universities, and that Schools also may have to comply with existing local or national systems. Perhaps of greatest importance are the 14 'requirements' for the Quality Assurance of Dental Education in Europe. These, together with the document and its appendices, were unanimously supported by the ADEE at its General Assembly in 2006. As there must be more than one road to achieve a convergence or harmonisation standard, a number of appendices are made available on the ADEE website. These provide a series of 'toolkits' from which schools can 'pick and choose' to assist them in developing QA systems appropriate to their own environment. Validated contributions and examples continue to be most welcome from all members of the European dental community for inclusion at this website. It is realised that not all schools will be able to achieve all of these requirements immediately, by definition, successful harmonisation is a process that will take time. At the end of the DentEd III project, ADEE will continue to support the progress of all schools in Europe towards these aims.

Effectiveness of faculty training to enhance clinical evaluation of student competence in ethical reasoning and professionalism

This study evaluated the short- and long-term effectiveness of faculty training to enhance clinical evaluation of ethical reasoning and professionalism in a baccalaureate dental hygiene program. Ethics, values, and professionalism are best measured in contexts comparable to practice; therefore, authentic evaluation is desirable for assessing these areas of competence. Methods were the following: 1) a faculty development workshop implementing a core values-based clinical evaluation system for assessing students' professional judgment; 2) subsequent evaluation of the clinical faculty's use of core values for grading and providing written comments related to students' professional judgment during patient care for three academic years; and 3) evaluation of program outcomes assessments regarding clinical learning experiences related to ethics and professionalism domains. Results revealed the clinical faculty's evaluation of professional judgment during patient care was enhanced by training; written comments more frequently related to core values defined in the American Dental Hygienists' Association (ADHA) Code of Ethics; and faculty members reported more confidence and comfort evaluating professional judgment after implementation of this evaluation system and receiving training in its application. Students were more positive in outcomes assessments about their competency and learning experiences related to professionalism and ethics. This article shares one approach for enhancing clinical faculty's authentic evaluation of student competence in ethical reasoning and professionalism.

In the students' own words: what are the strengths and weaknesses of the dental school curriculum?

Dental students have little input into the selection of course topics and subject matter included in their dental curricula. Curriculum requirements are framed by the Commission on Dental Accreditation, which has stipulated competencies and associated biomedical and clinical knowledge that must be addressed during dental school. Although these competency requirements restrict the variance of educational experiences, students are eager to share their views on the curriculum within the realm of their educational experience. The objective of this research project was to elicit the perspectives of dental students from a broad cross-section of U.S. and Canadian dental schools about their education. A total of 605 students (285 sophomores, 220 seniors, 100 residents) from twenty North American dental schools completed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis to communicate their perceptions of the curriculum. Students were also asked to provide their impressions of the overall quality of the educational program in an open-ended written format. The students' qualitative comments were then reviewed and categorized into key issues or themes. Resulting themes for each category of the Curriculum SWOT (C-SWOT) analysis were the following. Strengths: 1) clinical learning experience, and 2) opportunity to work with knowledgeable faculty. Weaknesses: 1) disorganized and inefficient clinical learning environment, 2) teaching and testing that focus on memorization, 3) poor quality instruction characterized by curricular disorganization, and 4) inconsistency among instructors during student evaluations. Opportunities: 1) develop strategies to provide students with more exposure to patients, especially early in the curriculum, and 2) opportunities to learn new technology/techniques. Threats: 1) cost of dental education, 2) students' concerns about faculty "brain drain," i.e., lack of sufficient numbers of dental faculty capable of providing high-quality instruction, and 3) questionable treatment of patients in the dental clinic as a consequence of pursuing procedural requirements. This report presents commentaries selected from 2,421 total responses that communicate students' perspectives related to C-SWOT themes. Students at seven schools in this study reported that they completed all or portions of the first two years of the curriculum in combined classes with medical students. Sophomore and senior students at these schools provided their thoughts on this curricular approach; these perceptions are also reported. Findings from this study are compared to results from a similar investigation of dental student perceptions conducted fifty years ago. We conclude that students participating in this study were positive overall about their learning experiences in dental schools, but identified several areas that appear to be problematic for many students at a variety of different schools including fundamental concerns about instructional quality in some areas of the curriculum. Academic program administrators in dental schools can use these findings to guide modifications that will enhance the overall dental education experience.

The state of the art in evaluating the performance of department chairs and division heads

This study explores the little understood process of evaluating the performance of department chairs/division heads in dental schools. Specifically, this research aimed to elucidate the methods, processes, and outcomes related to the job performance of department chairs/division heads. Forty-three deans and 306 chairs completed surveys with both close-ended and open-ended questions. In addition, ten deans and ten chairs were interviewed. Results indicate that 80 to 90 percent of department chairs are formally evaluated, although as many as 50 percent may lack job descriptions. Recommended best practices for performance appraisal--such as having at least yearly appraisals, holding face-to-face meetings, and setting specific, personal performance objectives/benchmarks for chairs--are being used in most schools. Still, there is much room to improve appraisals by incorporating other recommended practices. Overall high levels of satisfaction were reported by both chairs and deans for the process and outcomes of appraisals. Qualitative data showed some convergence of opinions about appraisals with the notable exception of informal feedback. We explore some implications of these results, especially as they relate to improving performance appraisals.

Renewing professionalism in dental education: overcoming the market environment

The most important mission of dental education is development of student professionalism. It is only within the context of professionalism that specialized knowledge and technical expertise find meaning. Altruism, integrity, caring, community focus, and commitment to excellence are attributes of professionalism. Its backbone is the obligation of service to people before service to self--a social contract. Professionalism can and should be acquired by targeted interventions, not as an assumed by-product of dental education. Top-down, rule-based professionalism is contrasted with its experience-based, mentor-mediated, socially driven counterpart. Moral principles are inherent in professional development and the professional way of life. Unfortunately, American society, including higher education, glorifies a market mentality centered on expansion and profit. Through formal and hidden curricula, dental schools send mixed messages to students about the importance of professionalism. Institutional consensus on professionalism should be developed among faculty, administration, and students through passionate advocacy and careful analysis of dentistry's moral convictions. The consensus message should communicate to stakeholders that morality and ethics "really count." Maximum student exposure to faculty exemplars, substantial service-learning experiences, and portfolio use are likely to enhance professionalism, which should be measured for every student, every semester, along with faculty and institutional assessment. Research reveals a significant relationship between levels of student moral reasoning and measures of clinical performance and shows that moral reasoning ability can be enhanced in dental students. Valid and reliable surveys exist to assess student moral reasoning. Documented student unprofessional behavior is a predictor of future state professional board disciplinary action against practitioners, along with low admissions test scores and course failures in the first two professional school years. ADEA Policy Statements recognize the importance of professionalism in student development. From day 1 of dental school, faculty and students should have no doubt as to what constitutes acceptable and unacceptable behavior in academic and clinical settings. With education and experience, dental students and dentists are likely to elevate their standards of professionalism.

Identification of competencies for effective dental faculty

A faculty of sufficient size and possessing the appropriate skills is critical to dental education. Faculty shortages have been identified, but little has been written about the skills and abilities necessary for dental faculty to be effective. This project identified consensus lists of competencies in the areas of teaching and research. A panel of dental education experts used a web-based Delphi method to refine competency lists. The final lists of competency statements were organized into foundational competencies that applied to all areas and several areas of major competencies that were defined by supporting competencies. The panel rated the importance of each competency statement for each of three dental faculty categories: 1) clinical teachers, 2) clinical scholars, and 3) research-intensive scholars. The identification of a consensus list of competency statements for effective dental faculty will facilitate the development of programs for faculty to attain and maintain these competencies. ADEA could play a coordinating role in this faculty development effort.

Faculty credentialing: a survey of forty-six U.S. dental schools

This study was undertaken in June of 2005 to evaluate the status of credentialing of clinical faculty in United States dental schools. A short survey on the process of credentialing was developed and emailed or mailed to all clinical deans. The survey contained a standard definition of health professional credentialing to which the respondent was to compare his or her school's procedures. Of the forty-six respondents, only 46 percent were conducting credentialing as defined on the survey. Recredentialing of clinical faculty was occurring in most of these schools; however, 23 percent did not report a process of recredentialing. Each institution required different items in its credentialing application: 95 percent required information on licensure; 86 percent, educational background; 67 percent, academic appointments; and 67 percent, specialty board status, among other items that were included at lower rates. Health status was only requested by 29 percent of the institutions. Only 34 percent of those institutions doing credentialing verified the data collected during the application process. Given the legal implications of adverse outcomes, prudent risk management calls for a strong credentialing program. Results of this survey indicate the need for an ongoing effort to standardize credentialing procedures among dental schools and to select appropriate data to be included in the process.

Students' perceptions of effective classroom and clinical teaching in dental and dental hygiene education

Effective teaching behaviors have been studied in various arenas in higher education. However, there is limited research documenting effective teaching behaviors in dentistry and dental hygiene. Our qualitative study attempts to define effective teaching in both the classroom and clinic for dentistry and dental hygiene students. A total of 175 dental and dental hygiene undergraduate students nominated a total of forty instructors for teaching awards, providing a total of 695 qualitative statements reflecting their teaching in two learning contexts: the classroom and the clinic. Seven categories of effective teaching qualities were identified: individual rapport, organization, enthusiasm, learning, group interaction, exams and assignments, and breadth. Based on the frequency of the themes, effective teaching in the classroom was best defined by organization and rapport, whereas in the clinic, rapport was the most frequently described behavior. Moreover, dentistry students perceived enthusiasm as an effective teaching quality more frequently than did dental hygiene students, whereas dental hygiene students provided more responses to learning. These findings can provide guidance in preparing undergraduate dental and dental hygiene educators to enter the teaching environment. The ultimate goal to be achieved from identification of effective teaching qualities, as determined in this study, is improvement in clinical and classroom teaching for dentistry and dental hygiene programs.

Rater reliability: short- and long-term effects of calibration training

The purpose of this investigation was to evaluate the immediate effects of calibration on inter-rater agreement to a gold standard (GS) and to determine whether the effects can be sustained over a ten-week period. Valid criteria for a Class II amalgam preparation, a three-point rating scale, and a grade form were developed. Three tests were administered: prior to calibration training, immediately following training, and ten weeks later. Each test consisted of faculty independently evaluating ten prepared teeth. Agreement with GS scores for most of the grading criteria improved as a result of training and did not deteriorate over time. The overall percent agreement was 54.5, 66.9, and 64.6 percent across test periods. The most impressive gains in agreement occurred when the criteria evaluated had a GS score of either "standard not met" or "ideal." There was very little gain when the gold standard score was "acceptable." It is concluded that, with training, inter-rater agreement with a gold standard can improve and such improvement is reasonably resistant to deterioration after ten weeks. Nevertheless, future training ought to consider the use of a mastery approach in calibration training to ensure that a satisfactory degree of agreement with the GS is obtained.