a. Case studies and Case analyses
Case studies and Case analyses are utilized in the several courses to support integration of the basic, biomedical and behavioral sciences into the clinical sciences and, beginning in the D1 Summer, to provide opportunities for students to apply these concepts as they will in clinical practice—that is, to support their critical thinking in the course of patient care.
In the D1 and D2 years, the biomedical sciences core courses and key foundation sciences courses, establish a knowledge base of the methods of logical inquiry and reasoning and early skill development.
Through these courses students become familiar with the principles of evidence-based medicine and the bidirectional relationship between oral and systemic health. Through several case studies integrated within the foundation science and biomedical science courses, they learn to apply these concepts to solve clinical problems. Student performance on the case study reports, an important element in these courses, serves as a vehicle for the first feedback students receive relating to their ability to evaluate the medical and dental literature and to integrate new knowledge into patient care.
Skill-building in evaluating the medical and dental literature is further supported by interactive classroom discussions, clinico-pathologic cases (CPCs) and case analyses in didactic courses in Oral Medicine (DENT 615), Special Care Dentistry (DENT 703), Special Dentistry-Hospital Dentistry, DENT 704 Special Care Dentistry-Geriatric Dentistry, DENT 822 Special Care Dentistry-Pediatric Dentistry), Oral Pathology (DENT 623A/B Diagnostics Sciences II/III, and DENT 711 Diagnostic Sciences IV) and Oral Surgery (DENT 613 Principles of Oral Surgery and DENT 740 Clinical Rotation Oral Surgery) and the Clinical Head and Neck Anatomy course (DENT 730) in the D2 and D3 years.
In DENT 532/542 Cariology I and II, students are required to perform a caries risk assessment on a simulated case, and to develop a treatment plan, based on a review of the literature, analysis and a ranking of the options based on the evidence and justify their preventive treatment recommendation based on the level of supporting evidence.
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b. Simulation exercises
To support development of critical thinking skills in specific settings, simulation exercises are utilized in the following courses:
- DENT 518&519 Behavioral Science I & II
- DENT 522 Comprehensive Care Clinic
- DENT Oral Health Promotion, Healthcare Systems and Policy 529
- DENT 532 Cariology I
- DENT 655 Dental Profession and Practice
- DENT 626 Applied Nutrition
- DENT 755 Professionalism and Practice
In the D1 year the clinical and behavioral science core courses:
- DENT 518 & 519 Behavioral Science I & II
- DENT 522 Comprehensive Care Clinic
- DENT 532 Cariology I
Coordinate content to allow students to apply critical thinking skills in the completion of treatment plans on three simulated patients.
In 2015, in DENT 529, Oral Health Promotion, Healthcare Systems and Policy and DENT 655, Dental Profession and Practice, students completed an exercise in designing a health insurance plan. This was a capstone activity in the residential MOOC (massive open online course) that students participated in with other University of Michigan students on campus for the first time in 2015. This experience helps to prepare students to understand and influence the US healthcare system.
Other simulations include a diet analysis and treatment plan that students create for themselves in DENT 626 Applied Nutrition; a comprehensive care and dental treatment plan for a clinical geriatric patient in DENT 704 Geriatric Dentistry; and DENT 755 Professionalism and Practice, a dental practice management simulation completed by students in groups. In each of these simulations, students are encounter and respond to real-life problems that a dentist would need to solve, and receive formative feedback on their performance.
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c. Critically appraised topics (CATs) and literature review
Students are introduced to the principles of evidence based dentistry in DENT 502 Evidence Based Dentistry, beginning in the D1 Summer and then, in the D1 Fall and Winter in DENT 524a/b Pathways, they learn to critically appraise a topic based on a focused review of the literature. Students select a topic and present their critical appraisals (CATs) in pairs in the DENT 524B course in the D1 Winter. Students in DENT 524C Pathways-Leadership utilize the scientific method as a group to investigate a CAT and report as a group in manuscript format. The CAT from the Class of 2018 was an abstract accepted for presentation at the University of Michigan Health Professions Education Day 2015. Some students create an extended CAT, or a case-CAT for their Pathways project. In several biomedical, behavioral, and clinical sciences courses, students are required to access the scholarly literature and critically evaluate information they retrieve, beginning in DENT 502 Evidence Based Dentistry in the D1 Summer and Fall. Students also complete and EBD exercise in DENT 750 Interdisciplinary Periodontal Therapy in the D3 year.
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d. Clinical huddles and discussion with faculty in the course of patient care, including comprehensive treatment planning
In the clinics, our students demonstrate their treatment planning skills during their daily patient care activities and in pre- and post-treatment huddles in periodontics, during which they receive documented formative feedback on their critical thinking in regards to treatment planning and understanding of the treatment they plan to provide that day. They are more formally assessed for these competencies during their clinical Test Cases (DENT 720 and 820 Comprehensive Care Clinic; DENT 747 and 743A/B Pediatric Dentistry and Clinical rotation Pediatric Dentistry; DENT 745 Clinical rotation Orthodontics; DENT 740 and 840 Clinical rotation Oral Surgery), and the D4 Oral Medicine Competency examination.
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e. Grand Rounds presentations
In the Grand Rounds courses, DENT 710 and DENT 810, during which D3 and D4 students from each of the four VIC’s interact with faculty members, students prepare and present clinical cases/scenarios which illustrate a “clinical conundrum”. Students are expected to demonstrate an in-depth current understanding of oral and systemic disease processes relevant to the individual patient, as well as knowledge of the most current therapies for treating/managing these diseases and the impact of specific diseases on oral health treatment choices. The student presenters must provide responses to queries by faculty and peers that are evidence-based, current, and clinically appropriate. Student performance in this exercise is assessed by their peers and faculty who attend the case presentation. Grand Rounds provide students the opportunity to both practice and to demonstrate “on their feet” critical-thinking and problem-solving skills. Following their presentations, students and faculty members question the student presenters extensively about many aspects of the conundrum, including patient assessment and diagnosis; treatment planning; treatment choices, alternatives, and outcomes; and ethical and behavioral aspects of the case, as well as the underlying biological mechanisms relevant to conditions affecting the patient. A student peer is assigned to each case to begin the questioning. Each presenter assesses his/her own performance, as well as the performance of his/her peers. (See Appendix 2-5c. Competency assessments and rubrics for the CODA standards of competency, Standard 2-9, for a copy of the grading rubric for Grand Rounds.)
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f. SWOT analysis of overall competency
Every semester in DENT 720 and the DENT 820 Comprehensive Care Clinic, all D3 and D4 students are required to assess their own knowledge, skills and progression towards competency in the school’s defined competencies, based on multiple sources of feedback, including results of test case competency assessments, faculty feedback and daily evaluations, and to identify their strengths, weaknesses, opportunities for improvement as well as any threats to their continued progression (a meta-reflection). Based on these assessments, the student develops an individualized learning plan for the next semester. A faculty member who has worked extensively with the student over the past semester, also independently performs this SWOT analysis, and the two analyses are compared. This provides opportunity for further assessment. This assessment is used by the student and his or her VIC director to assess the student’s overall progression and attainment of competency together with the results of other assessments of individual competencies. (See samples of student SWOT analyses, available on site.)
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g. Reflective self-assessment and essays
Reflective essays are utilized to support deeper learning and integration in multiple areas in our curriculum. Reflective essays are used to enhance learning that occurs in clinical rotations DENT 522 Comprehensive Care Clinic, DENT 620 Comprehensive Care Clinic, DENT 741 Clinical Rotation Hospital Dentistry, DENT 757 Community Based Dental Education and DENT 857 Community Based Dental Education and supplemental learning opportunities in the Pathways program and Professionalism and Dental Practice (DENT 855).
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h. Ethical dilemma resolution
This series of courses in the Professionalism and Practice sequence include DENT 501, Introduction to the Profession (D1 Summer); DENT 655, Dental Profession and Practice (D2 Winter); DENT 755a&b, Professionalism and Practice (D3 Fall and Winter), and DENT 855a&b Professionalism and Practice (D4 Fall and Winter). These course provide the foundation knowledge and skill development for ethical dilemma resolution and critical thinking for ethical decision-making. DENT 501, Introduction to the Profession, gives students an opportunity to explore the American Dental Association’s Principles of Ethics and Code of Professional Conduct, and the American Student Dental Association’s Code of Ethics in small group discussion sessions and relates these statements to the School of Dentistry’s Honor System (which incorporates these two Codes), again using case-based approaches. In another small group session, students explore the impact of lapses in professionalism in Dental and Medical school using evidence-based approaches. The second course in the “P and P” sequence is DENT 655, “The Dental Profession and Practice.” This course provides intensive practice in identifying and resolving ethical dilemmas that occur in dental practice, both in the dental school clinics and in a practice setting following graduation. The course offers students the opportunity to practice application of the principles of ethical decision-making and professional responsibility using several different frameworks (e.g., conflicting central values, conflicting duties, rights and responsibilities) to resolve several common ethical dilemmas. The students encounter and work through a series of dilemmas relating to the patient-dentist relationship (e.g., informed consent and patient confidentiality), dental insurance and reimbursement systems, professional obligations related to ethical codes, business best-practices in dentistry, the inherent conflicts between running a business and running a professional practice (e.g., conflicts of interest), professional responsibility related to the laws and regulations governing dental practice, conflicts between ethical and legal obligations and responsibilities in practice, and conflicts that arise as the result of the changing health care environment. In addition, a special session of the course is devoted to examining ethical dilemmas experienced by students in our comprehensive care setting. Thus, the course offers students the opportunity to engage in and intensively practice the application of the principles of ethical decision-making and professional responsibility in the academic, practice and practice management environments.
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i. Interprofessional team-based learning
Beginning in 2015, D3 students have participated with students in other healthcare profession programs in an interprofessional education course (DENT760 Health Professions IPE-Team-based Clinical Decision-Making). This course utilizes team-based learning (TBL) pedagogy. In this 14 week active learning format, students work together on teams with students from other health professional programs to resolve complex clinical problems (application exercises) requiring the perspectives and expertise of all team members to achieve an optimal patient outcome based on principles of evidence-based medicine. The purpose of the TBL experience is to support application of key concepts and the development of skills in critical thinking and decision-making in response to real-world problems.
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j. Pathways project-based inquiry
Students learn and apply principles of scientific inquiry and research in the Pathways program, which includes courses DENT 524, 624, 724 and 824. These courses provide a longitudinal experience in which students develop a project in Research, Leadership or Healthcare Delivery. In DENT 524, all students are introduced to the scientific method and the requirements for human subject research. In this course, all students complete the online PEERS compliance course for University of Michigan. They learn how to perform a critical appraisal of a patient care problem/question, including development of a PICO question, conducting a focused literature review, and evaluating the evidence, followed by analysis and judgment as to a final recommendation. Students in the Healthcare Delivery Pathway present a critically appraised topic in pairs in DENT 524b in the D1 Winter, and respond to questions from peers and faculty. These sessions are open to all faculty to attend. Subsequently, all students pursue a scholarly project in the Research, Leadership or Healthcare Delivery Pathway, working closely with a faculty mentor, either individually or in a small team, depending on the project. All students are required to submit a project proposal, outlining the aims, purpose, background, methods and materials and plan of analysis. They must complete the project, and produce a scholarly publication and/or presentation in time for Pathways Day in the D4 Winter. A final project report is also required. Some of these capstone projects are research projects conducted within the mentor’s lab; others are clinical or social science research conducted in the field (scholarship of discovery). And in some instances, in the Healthcare Delivery or Leadership Pathways, the projects represent other types of scholarship--dissemination of knowledge through publication in journals or on websites; service projects in the community; creation of programs or courses; development of inventions. These projects are evaluated by the faculty mentor and/or the course directors, and students receive feedback on their performance at several time points over the course of the program. They are also required to reflect on their own learning process and to develop a learning plan. These assessments are stored in the Pathways portfolio, and serve to provide formative feedback on critical thinking skills over the course of the project. Students must satisfy all requirements of the Pathways program in order to graduate from the pre-doctoral program.
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