Conceptualizing patient interactions eliciting empathy, compassion, reflection, and social projection: A model with analysis.

OBJECTIVES: Conceptualizing the next patient interaction is logical, essential, and largely done intuitively with limited literature. The first objective is to elicit student thought experiences to four questions. The secondary objective is to classify responses for respective questions and to review faculty assessments. METHODS: Forty-two students completed the exercise in the first clinical prosthodontics experience after a simulation course, in the fall of 2023. Four open-ended questions were 1) differentiation from the ideal, 2) desired outcome(s), 3) self-capabilities, and 4) consequences/prognosis. Nine different faculty assessed the exercise. RESULTS: 100% of students responded to all four questions and 83% of responses were judged by faculty to grasp the concept in the question. The authors categorized responses into natural categories for each question. Authors separately assigned responses to categories. The agreement rate was 90%. Little to no overlap in responses was observed among the four questions. The sequence of questions led students to thought experiences from empathy in Question #1, to compassion in Question #2, and to self-reflection in Question #3 to social projection in Question #4. CONCLUSIONS: The main objective was met by engaging students in thought-provoking responses to questions the experienced clinician asks of every patient encounter. The exercise elicited different kinds of thought experiences on four topics. The format was succinct with acceptance by students and faculty. The project has progressed from a concept some years ago to a recent pilot to full implementation with the current project. The next steps will be refinement and follow-up in some years. The project follows an emulation model for critical thinking.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model.

INTRODUCTION: Clinician empathy can improve patient outcomes, but the literature is scant on patient-based, student-led experiences to demonstrate the projection of empathy in patient interactions. PURPOSE/OBJECTIVES: (1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience. METHODS: Eleven standardized patients assessed 80 D3 students using a 4-point interval scale on 19 behavioral criteria in four domains: Initiation (four criteria); Health History and Caries Risk (four criteria); Treatment Planning (six criteria); and Communication Skills (five criteria). Standardized patients also provided qualitative feedback. RESULTS: Standardized patients completed all 1520 interval scales on the rubric and 94% of 320 open-ended entries. Students performed well. Of the 1520 criterion interval scales, 1242 (81.7%) were rated "excellent." Wilcoxon signed-rank tests revealed Initiation scores (Mean [M] = 3.82, Standard deviation [SD] = 0.28) and Treatment Planning scores (M = 3.82, SD = 0.36) were significantly higher than Health History Scores (M = 3.75, SD = 0.34; p < 0.05). Qualitative feedback also was overwhelmingly positive for Treatment Planning and more equivocal for Health History. CONCLUSIONS: The emulation model for students to demonstrate observable aspects of empathy is viable as both a learning guide and evaluation rubric in a standardized patient format. The next steps include the development of a succinct skillset for reinforcement in the patient setting and continued discussion on what best captures core observable aspects of empathy.

Integrating patient-centered caries management in dental education-A practical approach.

Caries management is undergoing an evolution in dental education. This is part of a larger change in thinking focused on the person/patient as well as procedures to bring health to people. This perspective attempts to tell the story of the dental education culture regarding caries management from perspectives of evidence-based care; caries as a disease of a person, not only a tooth; and the management of high-risk and low-risk individuals. Culturally and organizationally, the integration of basic, procedural, behavioral, and demographic perspectives for dental caries has happened at different rates for some decades. The involvement of students, teaching faculty, course directors, and administration is essential in this process.

Conceptualizing the next patient interaction: A clinical skillset using an emulation model in critical thinking.

CONCEPTUALIZING: The next patient interaction is logical, essential, and largely done intuitively. MAIN PURPOSE: To design and test a succinct learning guide for student guidance and student-faculty interaction in conceptualizing the next patient interaction. METHODS: In 2021 and 2022, faculty scored questions from 1-5: Recognize deviation from the ideal? Articulate how and how much the situation deviated? Gage consequences of the situation? Assess own capabilities? To what extent does the student have a clear grasp of the procedural outcome? Faculty were also given open-ended questions. RESULTS: Forty-eight reports were completed, 25 D3 and 23 D4. Three hundred thirty-five faculty entries were made in the questions calling for a 1-5 response out of a possible 336 responses. Statistically significant differences were noted. Students were better able to recognize the situation as different from ideal than to articulate how and how much the situation deviated. Students were better able to grasp how and how much this situation differs from the ideal than to assess own capabilities. D4 students were better able to recognize deviation from the ideal and to articulate how and how much the situation deviated than were D3 students. For open-ended questions, more students were scored as "Prepared" than were scored as "Unsure" and "Missed" combined. CONCLUSIONS: The exercise is seen as a succinct and constructive (nonjudgmental) path to guide the student's conceptualization of the next patient encounter before the encounter begins. Next steps will be incremental for wider use in a clinical teaching environment.

A tool for incorporating interprofessional perspectives into dental students decision-making: A 2-year follow-up on this learning outcome.

OBJECTIVES: To analyze student performance when using a sustainable teaching tool developed to guide learning toward interprofessional perspectives. METHODS: This study compiled data about D4 students' performance when using an interprofessional education (IPE) teaching tool reported previously in this journal, during their 5-week Geriatric and Special Needs Program rotation in the academic years 2018-2019 and 2019-2020. Ninety-two students were introduced to IPE concepts and teaching tools during their orientation. Students were then asked a question regarding the perspective of each healthcare team member and whether they would contact these healthcare team members for collaboration during the provision of oral care with regard to various patient cases. Students were scored on whether they answered the question about the perspective of each health care team member. The same two independent evaluators also noted whether the student thought each member of the health care team should be contacted. RESULTS: A majority (90.2%-95.7%) of dental students applied their knowledge to questions regarding each health care team member's perspectives. The profession that dental students most often indicated they wished to contact for collaboration was primary care providers (n = 70; 76.1%), followed by family caregivers (n = 54; 58.7%), and pharmacists (n = 46; 50.0%). The results of the interrater agreement between the two-faculty scoring students were between 86.7% and 100%. CONCLUSIONS: The teaching tool is sustainable and succinct. Students considered the perspectives of each health care team member at a rate above 90%, and the interrater agreement was high among the faculty evaluators. Students considered contacting primary care providers, family caregivers, and pharmacists more often than the other health care team members. We see this model as one approach to begin the articulation of learning outcomes for IPP.

Teaching Tool for Teledentistry Modeled with Pediatric Dentistry Residents.

Purpose: To present a patient interaction teaching tool for synchronous teledentistry visits following concepts in critical thinking and report on the viability, assessment and implementation of the tool in an academic pediatric dentistry clinic.
Methods: A teaching tool was derived from interviews with pediatric dental residents and clinicians. The tool contained six main sections and 26 steps. The main sections included: greeting, medical, dental and behavioral histories; airway assessment; treatment recommendations; behavioral modalities of treatment; and follow-up. A faculty member assigned each interviewer dichotomous values of yes and no for implementation of each step of the teaching tool.
Results: Six pediatric dentistry residents participated in a tool use demonstration with 21 patients. The purpose of each interview was to gain information for procedural treatment at the first onsite visit. All pediatric dental residents completed over 90 percent of the steps in each section. The interview duration ranged from eight to 29 minutes (median: equals 18 minutes). Eighteen of the 21 patients were scheduled for follow-up visits.
Conclusions: The emulation model for provisional treatment planning is viable for teledentistry. Pilot results showed students consistently completed over 90 percent of skillset steps and that this teaching tool serves as a framework for teledentistry appointments.

A national window on critical thinking by dental educators following an ADEA webinar.

PURPOSE: Critical thinking is an essential skill for the dentist, yet little has surfaced to define the outcome, guide learning, and assess performance. On June 16, 2020, the American Dental Education Association (ADEA) sponsored a 1-hour webinar on Critical thinking with 600 attendees. To report input from a national cohort of dental educators responding to a model for critical thinking guidance. METHODS: Critical thinking concepts with explicit skillsets were presented. Attendees gave Likert responses on importance and confidence defining outcome. At the end of the webinar, attendees were asked in an open-ended format what their "take away" was. RESULTS: One hundred and five responded to a Likert scale question on how important critical thinking is, with 93% giving a 5. To the question on how well have you figured out how to define the outcome, guide learning, and assess performance, 53% gave a 3 and 21% gave a 2 (χ2  = 151; P < 0.01) From 121 "take away" responses, 79 reiterated the session's central theme with comments on emulating the thought process of the expert or articulating a skillset. In a separate classification of the same "take away," responses oriented to common domains of education nomenclature. No alternative critical thinking model for articulating the outcome, guiding learning, and assessing performance was evident in any of the 121 take away responses. CONCLUSIONS: Results are interpreted as an opportunity moment for dental education to collectively develop additional critical thinking models.

Student performance comparisons for a critical thinking skill set (technology decision-making) for classroom and remote (Zoom) facilitation.

A comparison of student learning in a critical thinking exercise for technology decision-making occurred with the onset of coronavirus and the switch from face-to-face to distance with Zoom. Literature on explicit critical thinking skill sets is scant in any format, including distance learning. While face-to-face and Zoom have similarities, seizing this opportunity for comparison can set the stage to determine soundness of distance learning in critical thinking on a preliminary basis. The learning outcome, learning guide and assessment instrument remained the same for the exercise in both formats; student teams presented analyses of different technologies with assessment by 2 faculty as before. Forty students had not completed the exercise when the coronavirus shut down occurred. Students performed at as high a level using virtual/Zoom as with face-to-face.

Implementation of an online treatment planning exercise focused on vulnerable patient groups.

The coronavirus disease 2019 (COVID-19) pandemic presented formidable challenges in our ability to impart in-person extra-mural clinical training, including the Geriatric and Special Needs Program, to a group of 20 fourth-year dental students. A new course delivery format was developed wherein students used a validated Rapid Oral Health Deterioration (ROHD) risk assessment tool to critically appraise clinical case information relating to a young adult with special needs. In the alternative virtual educational approach that was created, students applied an interprofessional practice concept leading to patient treatment planning outcomes. Providing adequate information, additional reading resources, a response template, clear instructions and a process-oriented assessment policy all ensured a good level of participation from students in the alternative learning format. An association was noted between students' staging of risk for ROHD and their subsequent recommendations for treatment.

Teaching rapid oral health deterioration risk assessment: A 5-year report.

PURPOSE/OBJECTIVES: The purpose of this study was to present a 5-year report about the outcomes of using a teaching tool that guides dental students through the thought process of the expert about how to assess the risk of rapid oral health deterioration (ROHD) among older adults and provide viable treatment alternatives. METHODS: A teaching tool was previously developed using ROHD risk factors identified in the literature and the steps that experts apply in their treatment decision making, summarized in 10 questions. During 5 years, 188 senior dental students were introduced to the teaching tool and asked to use the 10-question set to present a case they have treated during their Geriatric and Special Needs Program. Two evaluators were asked to grade the students on each question. Students were graded "G" if they answered the question and grasped the principles behind it, "A" if they only answered the question, or "M" if they missed the question. Additionally, the students were given a form to grade the importance of and comment on the exercise. RESULTS: More than 75% of the students had an A or G for most questions, agreement between the 2 evaluators was above 85%, and students' performances improved during the 5-year period. Additionally, 94.4% of the students considered the teaching tool as important or very important for the general dentist. CONCLUSION: The vast majority of the students had an A or G grade, examiner agreement was high, and the students appreciated the importance of this teaching tool for the general dentist.

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.

Caries Management Decision-Making: Diagnosis and Synthesis.

The purposes of this article are to (1) offer a critical thinking skill set in decision-making and synthesis for caries diagnosis, and risk-adjusted and personalized management based on emulating the intended activity of the expert, (2) offer patient/case scenarios for application of the critical thinking skill set, (3) compare and contrast the results of applying an algorithm and expert thought process approach to patient analyses, (4) offer characteristics of the person making decisions and synthesizing information, and (5) for patients with complex health and social histories, include perspectives from other health care team members.