Two critical thinking models-probing questions and conceptualization-adding 4 skillsets to the teacher's armamentarium.

Critical thinking is ubiquitous in patient care. One track for critical thinking develops skillsets emulating the thought process of the master clinician using probing questions and has been offered in treatment planning, literature search, and critique, risk assessment in caries and geriatrics, technology decision-making, EBD, and IPP. This paper offers 2 additional critical thinking skillsets following this emulation model in social work and ethics. Conceptualization, another form of critical thinking, is also ubiquitous in health care, yet almost no literature exists to guide learning and assess performance on conceptualization. This paper introduces for discussion 2 examples of conceptualization-"How and how much does this situation differ from the ideal?" and "How does the student/practitioner conceptualize the outcome prior to the imminent procedure?" -used continually by the practitioner in patient care situations. The result is 4 additional critical thinking skillsets at different stages of development in the armamentarium for the teacher.

Periodontal treatment needs in the Medicaid patient population: a retrospective study in a US dental school.

OBJECTIVES: The aim of this study was to use electronic health records (EHRs) from a US dental school clinic to retrospectively investigate associations between periodontal treatment needs and insurance type in a newly insured adult Medicaid population. We hypothesized that newly insured Medicaid patients, covered by the Iowa Dental Wellness Plan (DWP), would display greater need for treatment than patients with other sources of financing. METHODS: A retrospective chart review of EHRs of patients at the University of Iowa College of Dentistry and Dental Clinics (UI COD) from 2014 to 2016 was completed. The outcome of interest whether or not a new patient was indicated for scaling and root planing (SRP) based on clinical examination. Logistic regression models analyzed associations between treatment need and source of financing, adjusting for known periodontal disease risk indicators. RESULTS: A total of 1,259 patient charts were evaluated. SRP was indicated for 56 percent of all patients. Patients with DWP coverage had significantly greater unadjusted odds of being indicated for SRP than privately insured individuals (OR = 1.47, P = 0.009). However, this association did not remain significant after adjusting for known risk indicators. CONCLUSIONS: Although individuals enrolled in DWP were not significantly more likely to need treatment than individuals with other sources of financing when adjusting for risk indicators, their demonstrated clinical need was higher than privately insured adults. Public benefit programs could anticipate greater burden of periodontal need in low-income populations due to increased prevalence of risk factors in this population.

Preventive dental care among Medicaid-enrolled senior adults: from community to nursing facility residence.

OBJECTIVE: The primary objective of this study was to determine whether the utilization rate of preventive oral health care services while senior adults were community-dwelling differed from the rate after those same senior adults were admitted to nursing facilities. A secondary objective was to evaluate other significant predictors of receipt of preventive oral health procedures after nursing facility entry. METHODS: Iowa Medicaid claims from 2007-2014 were accessed for adults who were 68+ years upon entry to a nursing facility and continuously enrolled in Medicaid for at least three years before and at least two years after admission (n = 874). Univariate, bivariate and multivariable analyses were conducted. RESULTS: During the five years that subjects were followed, 52.8% never received a dental exam and 75.9% never received a dental hygiene procedure. More Medicaid-enrolled senior adults received ≥1 preventive dental procedure in the two years while residing in a nursing facility compared to the three years before entry. In multivariable analyses, the strongest predictor of preventive oral health care utilization after entry was the receipt of preventive oral health services before entry (p < 0.01). CONCLUSIONS: The strongest predictor of receipt of dental procedures in the two years after nursing facility entry was the receipt of dental procedures in the three years before entry while community-dwelling. This underscores the importance of the senior adult establishing a source of dental care while community-dwelling.

Outcomes mapping: a method for dental schools to coordinate learning and assessment based on desired characteristics of a graduate.

This project, utilizing a seldom-used approach to dental education, was designed to define the desired characteristics of a graduating dental student; convert those characteristics to educational outcomes; and use those outcomes to map a dental school's learning and assessment programs, based on outcomes rather than courses and disciplines. A detailed rubric of the outcomes expected of a graduating dental student from this school was developed, building on Commission on Dental Accreditation (CODA) standards and the school's competencies. The presence of each characteristic in the rubric was mapped within and across courses and disciplines. To assess implementation of the rubric, members of two faculty committees and all fourth-year students were asked to use it to rate 1) the importance of each characteristic, 2) the extent to which the school teaches and assesses each, and 3) the extent to which each counts toward overall assessment of competence. All thirty-three faculty members (100 percent) on the committees participated, as did forty-six of the fifty-five students (84 percent). The groups gave high scores to the importance of each characteristic, especially for knowledge and technical competence (then separate categories but merged in the final rubric) and for self-assessment, as well as the extent to which they are being taught and assessed. Respondents most commonly named critical thinking as the area that should be emphasized more. Mapping the curriculum and creating its related database allow the faculty and administration to more systematically coordinate learning and assessment than was possible with a course-based approach.

Concepts in critical thinking applied to caries risk assessment in dental education.

Much progress has been made in the science of caries risk assessment and ways to analyze caries risk, yet dental education has seen little movement toward the development of frameworks to guide learning and assess critical thinking in caries risk assessment. In the absence of previous proactive implementation of a learning framework that takes the knowledge of caries risk and critically applies it to the patient with the succinctness demanded in the clinical setting, the purpose of this study was to develop a model learning framework that combines the science of caries risk assessment with principles of critical thinking from the education literature. This article also describes the implementation of that model at one dental school and presents some preliminary assessment data.

Integrating critical thinking and evidence-based dentistry across a four-year dental curriculum: a model for independent learning.

Introducing critical thinking and evidence-based dentistry (EBD) content into an established dental curriculum can be a difficult and challenging process. Over the past three years, the University of Iowa College of Dentistry has developed and implemented a progressive four-year integrated critical thinking and EBD curriculum. The objective of this article is to describe the development and implementation process to make it available as a model for other dental schools contemplating introduction of critical thinking and EBD into their curricula. The newly designed curriculum built upon an existing problem-based learning foundation, which introduces critical thinking and the scientific literature in the D1 year, in order to expose students to the rationale and resources for practicing EBD in the D2 and D3 years and provide opportunities to practice critical thinking and apply the EBD five-step process in the D2, D3, and D4 years. All curricular content is online, and D3 and D4 EBD activities are integrated within existing clinical responsibilities. The curricular content, student resources, and student activities are described.

Guiding dental student learning and assessing performance in critical thinking with analysis of emerging strategies.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises reflecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite specific examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

Development and evaluation of an interactive dental video game to teach dentin bonding.

Written and clinical tests compared the change in clinical knowledge and practical clinical skill of first-year dental students watching a clinical video recording of the three-step etch-and-rinse resin bonding system to those using an interactive dental video game teaching the same procedure. The research design was a randomized controlled trial with eighty first-year dental students enrolled in the preclinical operative dentistry course. Students' change in knowledge was measured through written examination using a pre-test and a post-test, as well as clinical tests in the form of a benchtop shear bond strength test. There was no statistically significant difference between teaching methods in regards to change in either knowledge or clinical skills, with one minor exception relating to the wetness of dentin following etching. Students expressed their preference for an interactive self-paced method of teaching.

A model for overview of student learning: a matrix of educational outcomes versus methodologies.

A concise overview of an institution's aspirations for its students becomes increasingly elusive because dental education has evolving emphases on priorities like critical thinking and adapting to new technology. The purpose of this article is to offer a learner-oriented matrix that gives a focus for discussion and an overview of an institution's educational outcomes. On one axis of the matrix, common educational outcomes are listed: knowledge, technical skills, critical thinking, ethical and professional values, patient and practice management, and social responsibility awareness. On the other axis, methodologies are listed: definition, cultivation strategies, measures (summative/formative, objective/subjective), institutional coordination, and competency determination. By completing the matrix, an overview of the process by which students reach these outcomes emerges. Each institution would likely complete the matrix differently and, ideally, with active discussion. While the matrix can first be used to establish "Where are we now?" for an institution, it can also be a starting point for more extensive matrices and further discussion. Vertical and horizontal analyses of the matrix provide a unique lens for viewing the institution's learning environment.