The Use of a Learning Outcomes Approach To Re-design A 4

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Dr Christine McCreary – Assignment for PGDTLHE 05/06 Year Dental Surgery Module

Background

The use of learning outcomes to redefine module DS 4001comes at an opportune time. This module was first developed in 2000 at the time of modularisation within the dental school and has not been revised or changed to any great extent since then. Existing problems with the module content relate to the rather arbitrary inclusion of the medicine and surgery course content as part of this module and the very general description of the module learning objectives. As this part of the course has major on-going repercussions for the graduating dentist’s professional practice it is important that the dental student should have a clear overview of what is required of them.

The UCC dental school has a strong affiliation with the ADEE (Association for Dental Education in Europe) and this organisation has been instrumental in engaging with the dental schools throughout Europe and encouraging changes including modularisation and the learning outcomes This module is the student’s first real introduction to oral surgery and emergency dentistry which will account for a significant proportion of their work as a practising general dental practitioner. During the fourth year they should get to take teeth out for the first time on see various oral surgical procedures “live” patients, they should – some simple some more complicated and they should, by the end of the fourth year have developed their skills to an extent where they are beginning to be competent at independent practice Given the demands on curricular time each student attends only one clinical session each week in the dental surgery clinic and also has one weekly lecture during the fourth year. The students generally enjoy the practical experience associated with this module but are very aware that in terms of hours allowed in the timetable that they do not have enough time to develop their skills in this area. There have been issues for recent graduating students in terms of their ability for independent practice in this particular area. The current vague terminology in the module descriptor does nothing to direct the student to what is essential and to what is desirable in terms of their learning.

Learning outcomes V Learning objectives

The main difference between learning outcomes and learning objectives is that the use of learning outcomes moves the centre of emphasis away from the teacher and closer to the student who must take more responsibility for their own learning. The process of identifying learning objectives defines what it is the teacher wants the student to learn. If we want the learning experience to be learner centred then proponents of learning outcomes suggest that we should be looking at endpoints or outputs and the learner may get to that position by various routes. Using the knowledge that students have different approaches to learning and employ a variety of learning styles we can design the learning outcomes to direct the student to achieve a clear understanding of the desired endpoint regardless of the route used to arrive there. This involves al the elements of “Bloom’s taxonomy, the cognitive, the affective and the psychomotor particularly in a course such as dentistry were the doing is as important as the knowledge or understanding. In the doing in a professional course such as dentistry the student can demonstrate progression upwards in Bloom’s taxonomy particularly if the learning outcomes direct them to do so.

Using learning outcomes in redesigning a 4th year dentistry module

Experts in the field of medical education have published widely about the use of learning outcomes in various professional courses with much of the published work relating to the medical undergraduate curriculum. There have been some papers published in relation to the use of learning outcomes in dentistry. The original “three circle” model devised by Harden has been modified by Harden and dental colleagues 2,3 to be applied specifically to the dental undergraduate curriculum. This model has been adopted as a template for change by the General Dental Council (GDC) in the UK and will also form the basis of documentation relating to the undergraduate dental curriculum in this country emanating from the Dental Council in Ireland. This considers three essential dimensions of the work of a practising dentist. These relate to what the dentist is able to do – “doing the right thing”, how the dentist approaches their practice – “doing the thing right” and the dentist’s acting as a professional “the right person doing it” This approach is detailed diagrammatically in the accompanying diagram below.

The three key tasks relating to dentistry were identified as: •Clinical information gathering •Treatment planning •Treatment procedures Harden recognised that these tasks represent the practical aspects of patient care but also that the dentist brings much more than practical skills to the patient encounter. These elements were included in the second circle and included the application of basic science, clinical reasoning and judgement, communication ability and the health promotion/advocacy role as well as attitudinal and ethical responsibilities and information processing. The outer circle complements and unites the two inner circles in the overarching concept of the dentist as a professional.

Re-designing module DS 4001

Original module – objectives To develop clinical skills in minor oral surgery To familiarise dental students with general surgical principles To teach knowledge of all major medical diseases and practical approach to those diseases To teach knowledge of all major medical diseases and practical approach to those diseases which may present to the dentist Original module –content 1. Local analgesia, radiographic technique, patient assessment, minor oral surgical procedures, oral therapeutics.

2. Shock, wound healing, infections, prophylactic and therapeutic use of antibiotics, venous and lymphatic disease, arterial disease, head and neck cancer, principles of radiotherapy, principles of fracture management, burns, skin grafting, skin cancer, melanoma, history taking, clinical examination and assessment of head and neck.

3. Major medical diseases, diseases which may influence dental treatment Redesigned module – learning outcomes These outcomes relate to: i) information gathering that a 4th year student should be capable of ii) clinical skills that should be developed by the end of the 4th year module 1.Obtain and record accurate and comprehensive medical/dental and social histories from patients exercising judgement in relation to the questions and demonstrating empathy and communication skill with the patients. Present and discuss 3 of these with your instructor.

2. Interpret the significance of the history and develop appropriate treatment plans and differential diagnoses, being cognisant of patients needs and wishes. Obtain informed consent for all treatment plans and demonstrate awareness of when it is appropriate to refer patients. 3. Deliver effective local anaesthesia in the mandible and maxilla and identify the appropriate agents that may be used. Perform at least 10 local anaesthetic administrations and evaluate your performance with your instructor.

4. Identify the appropriate armamentarium and techniques for simple extractions in the maxilla and mandible. Perform at least 10 extractions and evaluate your performance with your instructor.

5. Summarise the different oral radiographic techniques employed in general dental 6.

practice. Take at least 10 radiographs and evaluate them with your instructor.

Become familiar with the various biopsy techniques and when each of these is indicated 7. Demonstrate proficiency in CPR .

Redesigned module - content: Diagnosis – revision and development of history taking and interpretation Oral radiology – continued experience in the taking and interpretation of radiographs Local anaesthesia – revision of theory and technique

Summary

– development of clinical skills in this area The use of learning outcomes in the design and implementation of the dental undergraduate curriculum in UCC gives the curriculum planners the opportunity to look at the module descriptor with fresh eyes. Using a template such as the “three circle” model allows clear thinking on the part of the planner and makes material transparent for the student. Learning outcomes encourage the intelligent use of Bloom’s taxonomy and emphasise the hierarchy of learning which we now believe is so important in the fostering of lifelong learning skill development.