Reflective writing in dental education to improve critical thinking and learning: A systematic review.

The Commission on Dental Accreditations states that "graduates must be competent in the use of critical thinking and problem-solving." With this in mind, dental education programs continually strive to enhance and deepen these skills by incorporating effective instructional strategies into the curriculum. To do this, predoctoral dental education has used a variety of techniques including problem-based learning, OSCEs, and standardized patient activities. Another technique, while less popular but potentially more effective if done well, is reflective writing. This study aimed to assess the effect of reflective writing on students' critical thinking skills and learning in dental education programs. Two database searches conducted between 2000 and 2019 resulted in 317 articles after the initial screening. Ultimately, 13 articles met inclusion criteria. The following recurring factors were identified for inclusion in dental education reflective writing initiative: reflective writing interventions, reflective writing instructions, writing prompts, evaluation frameworks, and negative perceptions of reflective writing. In answering the key aim of this review, 12 of the 13 studies determined that reflective writing had a positive impact on students' critical thinking, judgment, and/or learning. Key findings included positive effects on student growth in reflection, learning through reflective writing, reflection skills, self-assessment, critical thinking, clinical reasoning, problem solving, and motivation to change after evaluated experiences. The review indicated that dental education programs, which implemented reflective writing as an assessment tool within the curriculum as a means of developing and deepening critical thinking skills and learning were by and large successful in this effort.

Self-Assessment: A Review of the Literature and Pedagogical Strategies for Its Promotion in Dental Education.

PURPOSE: In response to several publications drawing attention to self-assessment and revised Commission on Dental Accreditation standards that state graduates should possess and demonstrate the ability to self-assess, dental hygiene and pre-doctoral dental programs find themselves searching for ways in which to incorporate self-assessment practices into the curriculum. Research indicates that students are often not familiar with self-assessment strategies nor are they effective at self-assessment upon entering professional programs. Therefore, students must be taught strategies to self-assess and be given opportunities to practice and refine these skills. Opportunities to develop and demonstrate self-assessment skills can be incorporated across the curriculum at the classroom level and at the global level. Both the A.T. Still University Arizona School of Dentistry and Oral Health and the University of Missouri-Kansas City School of Dentistry utilize a capstone portfolio project to incorporate self-assessment throughout the curriculum. By combining artifacts from their dental and dental hygiene school experience with reflective writing essays, students can demonstrate attainment of program competencies. As more faculty members and students become involved and engaged in assessment strategies such as portfolios, they are also gaining a greater appreciation for the value of self-assessment.

Validity and reliability of portfolio assessment of student competence in two dental school populations: a four-year study.

The purpose of this study was to empirically investigate the validity and reliability of portfolio assessment in two U.S. dental schools using a unified framework for validity. In the process of validation, it is not the test that is validated but rather the claims (interpretations and uses) about test scores that are validated. Kane's argument-based validation framework provided the structure for reporting results where validity claims are followed by evidence to support the argument. This multivariate generalizability theory study found that the greatest source of variance was attributable to faculty raters, suggesting that portfolio assessment would benefit from two raters' evaluating each portfolio independently. The results are generally supportive of holistic scoring, but analytical scoring deserves further research. Correlational analyses between student portfolios and traditional measures of student competence and readiness for licensure resulted in significant correlations between portfolios and National Board Dental Examination Part I (r=0.323, p<0.01) and Part II scores (r=0.268, p<0.05) and small and non-significant correlations with grade point average and scores on the Western Regional Examining Board (WREB) exam. It is incumbent upon the users of portfolio assessment to determine if the claims and evidence arguments set forth in this study support the proposed claims for and decisions about portfolio assessment in their respective institutions.

Perceived influence of community oral health curriculum on graduates' dental practice choice and volunteerism.

The purpose of this study was to determine if A.T. Still University Arizona School of Dentistry and Oral Health (ASDOH) curricular content regarding community oral health has influenced graduates' dental practice choice and volunteering activities in their communities. At ASDOH, the community oral health curriculum consists of three components: 1) coursework in public health resulting in a certificate or master's degree in public health; 2) service-learning activities in the Dentistry in the Community series of course modules, wherein students plan and implement community projects; and 3) community-based clinical rotations of approximately ninety-five days during the fourth year. To accomplish the purposes of the study, a survey was sent to ASDOH alumni who graduated between 2007 and 2010. Of the 208 graduates contacted, ninety-four responded (45.2 percent). Of those who responded, 85 percent reported that the community oral health curriculum influenced their practice choice, and 76 percent reported that they volunteer. Additionally, 58 percent of the respondents reported that the amount of dental school debt they had incurred affected their career plans and professional decision making.

Critical incidents, successes, and challenges of community-based dental education.

In 2006, the Arizona School of Dentistry & Oral Health at A.T. Still University (ATSU ASDOH) implemented an intensive community-based education program for its inaugural fourth-year students called the Integrated Community Service Partnerships (ICSP) program. As part of the ICSP program, students spend half of their clinical experience (approximately ninety-five days) in rotations at four or five community-based clinics. More than sixty clinics in Arizona and throughout the country serve as rotation sites. ATSU ASDOH conducts focus groups with all fourth-year students prior to graduation for program improvement and research. The purpose of this study was to characterize critical incidents students identified as instrumental to learning, as well as successes and challenges of the program. Qualitative data from the 2009 and 2010 focus groups were analyzed, including a total of 104 students. The types of critical incidents students chose to describe in the focus groups involved patient factors, contextual factors, and interpersonal factors. While students believed their ICSP program external rotation experiences were fundamental in their clinical and professional development, they also noted challenges associated with this intense community-based education program.

Implementation of portfolio assessment of student competence in two dental school populations.

The purpose of this article is to describe the process and procedures involved in the implementation of portfolio assessment at two dental schools. Portfolios can be defined as a purposeful collection of student work that involves reflection in which students identify gaps in their knowledge and abilities and develop strategies for correcting those gaps. Framed within the current context of dental education and the calls for change in the ways dental students are taught and assessed, these two dental schools embarked upon an assessment strategy aimed at engaging students in self-directed learning and self-assessment. Where one school chose the implementation of programmatic portfolios based on all program competencies, the other school implemented portfolio assessment around specific program competencies not typically captured easily with traditional assessment measures such as ethics and ethical decision making. In a competency-based dental curriculum in which competence has been defined as the ability to accurately self-assess, it makes sense that strategies aimed at developing the skill of self-assessment should be the goal of every dental education program.

The Arizona model: a new paradigm for dental schools.

The traditional method for the delivery of didactic instruction and patient care in dental schools has come under fire from a number of sources over the past several years. The American Dental Education Association and others have outlined numerous issues impeding the swift progression of student learning through the dental curriculum. Declining state revenues allotted to dental education, the increasing shortage of dental faculty, and the management of student learning in an already overcrowded dental school curriculum have led to the investigation of strategies that address solutions to these and other shortcomings in the current milieu of dental education. To address these deficiencies, strategies for change have been suggested. This article describes the development, implementation, and assessment of a new dental school that addresses these and other challenges to the education of today's dental student, thus creating the Arizona Model. Following seven years of operation, outcomes analysis at the Arizona School of Dentistry & Oral Health has shown positive trends in controlling educational costs, a shift to a modular curriculum, increasing student clinical experiences, and, consistent with the mission of the school, producing dentists who are well prepared for dental public health service.