Education for Health

GENERAL ARTICLE
Year
: 2016  |  Volume : 29  |  Issue : 2  |  Page : 119--123

Reflective learning in community-based dental education


Suryakant C Deogade1, Dinesh Naitam2,  
1 Department of Prosthodontics, Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
2 Department of Dentistry, Government Medical College, Akola, Maharashtra, India

Correspondence Address:
Suryakant C Deogade
Flat No: 502, Block-D, Apsara Apartment, South Civil Lines, Pachpedi Road, Jabalpur - 482 001, Madhya Pradesh
India

Abstract

Background: Community-based dental education (CBDE) is the implementation of dental education in a specific social context, which shifts a substantial part of dental clinical education from dental teaching institutional clinics to mainly public health settings. Dental students gain additional value from CBDE when they are guided through a reflective process of learning. We propose some key elements to the existing CBDE program that support meaningful personal learning experiences. Methods: Dental rotations of «SQ»externships«SQ» in community-based clinical settings (CBCS) are year-long community-based placements and have proven to be strong learning environments where students develop good communication skills and better clinical reasoning and management skills. We look at the characteristics of CBDE and how the social and personal context provided in communities enhances dental education. Results: Meaningfulness is created by the authentic context, which develops over a period of time. Structured reflection assignments and methods are suggested as key elements in the existing CBDE program. Strategies to enrich community-based learning experiences for dental students include: Photographic documentation; written narratives; critical incident reports; and mentored post-experiential small group discussions. A directed process of reflection is suggested as a way to increase the impact of the community learning experiences. Discussion: We suggest key elements to the existing CBDE module so that the context-rich environment of CBDE allows for meaningful relations and experiences for dental students and enhanced learning.



How to cite this article:
Deogade SC, Naitam D. Reflective learning in community-based dental education.Educ Health 2016;29:119-123


How to cite this URL:
Deogade SC, Naitam D. Reflective learning in community-based dental education. Educ Health [serial online] 2016 [cited 2019 Dec 12 ];29:119-123
Available from: http://www.educationforhealth.net/text.asp?2016/29/2/119/188752


Full Text

 Background



Community-based dental education (CBDE) shifts a substantial portion of dental clinical education from dental school clinics to community-based health settings. It deals with dental and oral health care, economic-political and socio-cultural aspects of oral health and disease, and prepares students who collaborate with various community organizations for improving community oral health. More students are being instructed by health-oriented and community-based dentists who practice in a larger social context, including community hospitals and clinics, nursing homes and private practices. For developing countries, the approach of CBDE in dental curriculum needs to be promoted in order to tackle the challenges of unattended dental disease in populations with limited resources. This article provides a background to CBDE, reviews the literature on dental student programs geared specifically to CBCS, and discusses the various methods of reflective learning within CBDE.

Reflective learning in CBDE

An experiential learning is a process by which the learner reflects on his or her individual experience and renders significance and meaning from such reflection. [1] It is increasingly popular as a pedagogical tool and approach to contribute to students' development. Experiential learning can prompt learners to gain new insights and understanding about themselves and their surrounding environment. It is characterized by a cycle of having a concrete experience (e.g., an encounter with a patient), reflecting on that experience as it unfolds, formulating conceptualizations and generalizations from the experience, and testing those generalizations and concepts in other situations. [2] It can also help learners or students develop professional knowledge acquisition, critical thinking, problem-solving and clinical problem-solving skills, lifelong professional learning as well as a stronger service ethic. [3],[4] CBDE is a type of experiential learning in the branch of dentistry that provides students with powerful clinical opportunities in community settings. It provides learners with a meaningful, relevant and authentic educational experience. [5] Experiential education is not simply about sending students to a community-based clinical setting, but also through this experience helping them expand their appreciation and understanding of the larger social, economic and cultural determinants of dental health care and delivery of oral care. [6],[7] Experiential education improves students' clinical and professional skills that can be used in community settings. Community-based dental experiences provide students both a closer and broader view of their patients within varied social contexts and settings than they typically can get in dental school clinical encounters. [5],[7]

Reflective learning helps students bridge the distance between thought and action, theory and practice, knowledge and authority, and ideas and responsibilities. Reflection as a mode of inquiry is central to experiential learning and is central in service-learning. Without reflecting on one's activity, the student sometimes cannot make the connection between what they learn in the classroom and their future practices, and the potential impact of community-based learning is thereby lost. [8] Reflection in learning opens the possibility for personal growth and professional development, helping students to not come to premature conclusions about patients and their needs. Reflection in formal learning allows students to define problems and consider possible solutions, thus serving as a catalyst to greater understanding and developing potential solutions and more informed action. [9]

The foundation for community-based learning for dental students

The ongoing worldwide problem of inadequate access to oral health care, combined with a growing commitment to greater diversity among dental undergraduates, has led to a renewed examination of how dental education prepares students to work with diverse patient populations. Questions have been raised about the location, timing and content of instruction that prepares dental students to provide oral care for underserved populations. The literature suggests that compared to dental undergraduates trained solely in traditional settings, students learning in CBCS demonstrate the same competencies but also appreciably greater clinical productivity and higher on-time graduation rates. [10] Based to some degree on lessons learned from community-based medical clerkships, [11],[12],[13] a growing number of dental schools have turned to dental rotations in publicly funded, community-based clinics. Introducing students to these opportunities in the early years of their education appears to shape how they define their careers and their ethical re­sponsibilities. The outcomes of longitudinal integrated clinical clerkships and clinical placements for students, clinicians and society have been positive. [14] Dental rotations or 'externships' in CBCS helps students gain stronger communication skills and better clinical reasoning and management skills.

When moving beyond the walls of the dental school, students need more education in communication skills, professionalism and cultural awareness beyond the usual and indispensable technical skills. [15],[16],[17] CBDE provides intellectual and interdisciplinary benefits enhancing students' understanding and enriching their experience in delivering clinical oral and dental care in communities. [18] The students can be placed for their extramural rotations at various publicly owned, underserved sites in diverse communities, including prisons, nursing homes, psychiatric hospitals, veterans' hospitals, institutions for persons with severely impaired cognitive functioning, and community health centers. Such sites allow students to observe and learn about different patient groups and varied practice approaches. [19]

Supporting students working in community settings

Some dental schools offer a preclinical social, behavioral and community sciences curricu­lum oriented towards preparing dental students to work effectively in, and with, diverse com­munities. [20] The still developing mindset and skills of students prior to entering the community makes them open to different cultures and views. Informed by the social and behavioral sciences, students can observe how a dental professional responds to the social and ethical environment of the community-based dental practice. Observing dental professionals' behavior with the public, patients, other professionals and staff contributes to their reflective learning. Students' knowledge about the organization of care delivery and the social, ethical and political concerns that affect oral health care across all clinical settings is foundational. [21] Reflective methods including written and photographic journals and scrapbooks, reflective essays, detailed logs of daily activities with patients, and evaluation help students consolidate CBDE learning. [22] Having them attend final reflective sessions facilitated by faculty associated with their program provides opportunities to reinforce community-based learning experiences. [23] Even during their community placements, their learning can be enriched by reading fiction or nonfiction literature that explore issues of community relevance. [19]

The basic clinical technical skills students have may not be sufficient for an excellent CBDE experience, so sites meeting the instructional needs of students must be prepared. Some dental schools conduct competency tests before students are sent from school's clinics to CBCS. Other schools consider the community sites as the places for students to develop clinical skill and proficiency. However, some schools to not guarantee the clinical proficiency of students before their CBCS placements. Therefore, preceptors at the externship sites must know the abilities of students being posted at CBCSs to make appropriate clinical case selections and to anticipate their needs for supervision. The students placed at CBCSs should give their preceptor an accurate picture of their clinical strengths and weaknesses; to help the faculty best facilitate their learning and growth. Preceptors should have a way to report to the school on students' performance, judgment and clinical ability. Students should be instructed to call their school if they experience problems in the field site, allowing the school to ensure quality control in the educational process and that students are working in a truly patient-centered settings. [19]

Cultural awareness and preparation

Prior to providing dental care services to populations in need, CBDE programs require special academic and curricular preparation. [24],[25] Culture and income can be a barrier for many dental patients seeking oral health care. To increase the number of dental patients visiting CBCS and to provide patient-centered care, students need to learn how to interact and communicate effectively with their patients. Developing cultural understanding can improve students' rapport and cooperation with patients and promote understanding of ethical issues arising for patients of different cultural backgrounds. Of course, including cultural education for all dental students will benefit them and their patients. [26] Students need to learn less hierarchical and more dialogue-based collaboration with the patient about the goals, methods and desired outcomes of treatment. [27] Social science courses can be included in the basic science and clinical skills curriculum so that students learns how to combine the scientific principles and technical expertise of dentistry with what they learn about the patient's life history and behaviors and how these affect the clinical presentation and care outcomes. [25] Including humanity courses in dental education encourages students to view individual patients as people embedded in a dynamic community life, with multiple roles and responsibilities. [28] Cultural and social sciences are important for students and residents who will provide oral care in community-based populations. Also important is training in interpersonal and communications skills based on empathy, curiosity, intellectual flexibility, heightened awareness, and willingness to respect, listen, and learn from the patient. [27] The American Dental Education Association (ADEA) [29] recognizes the importance of understanding patients' cultural background in the delivery of oral health services and advises schools to include "cultural and linguistic concepts" in dental curricula. Training in culturally competent dental services is founded on the basic principles of self-awareness, respect for diversity, and sensitivity in communication. [30]

Communication skills and CBDE

Many dental schools in U.S. use various curricular approaches to teach communication skills to help bridge the cultural gap between patients and dental practitioners. [31],[32] The social science methodologies used in curricula include instruction in questionnaire design, interviews, clinically-based scenarios, simulated patients, role-playing, observation, journal writing, service-learning experiences combined with reflection, and photography. These approaches promote self-reflective analysis enriching cultural awareness and competence. [22],[23] Several "toolboxes" for teaching diversity and cross-cultural competence in health care have been developed and can be adapted to the particular needs in teaching dental students. [33] Toolboxes address topics like language, health belief systems, values and assumptions. [34] Various exercises involving role-play, case studies, critical incidents and videos can be effective in teaching cultural awareness, and instructors can be imaginative and flexible in using these techniques. Students can keep a written journal during their extramural clinical experiences, which provides a framework for their clinical observations and reflections. Many dental schools have tried the objective structured clinical examination (OSCE) to assess communication and cultural awareness skills in students. [19]

Reflection and self-awareness

CBDEs provide an excellent opportunity for students to build self-awareness. However, community-based experience one without evaluation and reflection may lose this benefit. Among other lessons, students can reflect on disparities between recommended ethical care and the services actually provided to economically and socially underserved patients. Reflection can be supported through critical incident reports, a critical incident essay, and a photographic scrapbook combined with a post-rotational reflective session. [22] It can help for students to be assigned logbooks, forms to complete, clear descriptions of expectations with due dates, and contact information for questions that arise. In critical incident reports, students record the most moving encounters they experience in a given week or rotation that challenged them personally or professionally. [23] Reflection helps the experiences within CBDEs promote long-term learning.

The impact of CBDE on dental students

Research demonstrates the broad impact of CBDE on dental students and on their developing positive attitudes and fostering career plans to work with underserved populations. [35],[36],[37] Nevertheless, some students view their cultural competency curriculum as inadequate and perceive themselves as not fully prepared to provide oral health care to minority patients. [36] Some have suggested using accreditation standards to improve and sustain a cultural competency curriculum and extramural community rotations. [38] Partnerships between dental schools and publically supported health centers offer opportunities to train dentists and simultaneously improve access to oral health care.

 Conclusions



CBDE offers substantial benefit in affecting the values and behaviors of dental students regarding the health care needs of underserved populations, and might make a dental career more attractive for students from more diverse backgrounds. Effectively integrating CBDE into a dental curriculum requires specific student preparation in cultural awareness, communication skills, and the social and behavioral sciences. Reflective components, evaluation and highly organized community-based experiences promote a positive student learning experience. CBDE can help orient students towards public service, engagement, ethics and the health of the public, and may also influence the values of the dental faculty.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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