Professional Documents
Culture Documents
n regard to dental education, it has been suggested that the clinic is the learning environment to which all our students aspire,1 requiring the transfer of knowledge from the basic
sciences to the clinic by tuning and restructuring of
knowledge.2 How learning and teaching best occur
in this environment for the preparation of dental students to advance to independently provide patient
clinical care is an important central business of dental educators and clinical supervisors alike.
The learning environment of the clinic or hospital is a challenging area for both teacher and student. In this setting, the student is a trainee clinician
responsible for patient care, and the clinic is both a
patient care facility and a learning environment. In
clinic, students are expected to demonstrate diverse
competencies simultaneously, including a range of
skills, broad knowledge base, professionalism, and
empathic ethical behavior. Recent reports in dental
education point to the value of the early introduction
of students to the clinical environment, largely be-
December 2005
cause of the demonstrated value of contextual learning and the facilitation of integration of knowledge
from basic to clinical sciences.1 Clinical teaching
typically involves the supervision of a trainee clinician by an experienced clinician, and as a consequence, clinical education usually involves a range
of teaching modes. Clinical supervision may be defined as the provision of monitoring, guidance, and
feedback on matters of personal, professional, and
educational development in the context of patient
care.3 The student/clinical teacher relationship has
also been suggested to mirror the therapeutic alliance that exists between patient and physician because it represents an educational alliance.4
Clinical teaching in medical education has been
extensively examined.5 Effective medical clinical
teachers are considered to be those who have empathy, are capable of providing support, exhibit flexibility, and have the ability to gauge student development, in addition to being interpretive, focused,
and practical.3 Effective supervision of learners in-
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Methods
Two student focus groups were conducted in
2003 during a teaching semester to provide background for development of the questionnaire. The
focus group discussions explored student ideas and
perceptions about clinical teaching in dentistry. Volunteers for each of the two focus groups came from
students enrolled in the new curriculum for the Bachelor of Dentistry (B.Dent.) program and from students enrolled in the older curriculum for the Bach-
1378
elor of Dental Surgery (B.D.S.) program at the Faculty of Dentistry, University of Sydney. These programs are described in detail elsewhere.11,12 Briefly,
the B.D.S. program was a five-year, discipline-based
program featuring a range of teaching styles such as
lectures, seminars, and case-based learning. The
B.Dent. program, which commenced in 2001, is a
four-year competency-based program using problembased learning (PBL) throughout the program. Clinical teaching styles used in both B.D.S. and B.Dent.
programs are similar; dental clinician teachers provide close supervision of students in both.
One focus group consisted of four B.D.S. students; the other focus group consisted of four B.Dent.
students. Each focus group discussion was one to
three hours in length. This number of participants,
which allowed discussion to proceed efficiently, reflects recommendations for composition of participatory focus groups.13 The focus group participants
identified several aspects of clinical teaching that
were united into three themes and that together were
structured into a set of questionnaire statements used
for data collection. These three themes were 1) the
teacher/student relationship, 2) educational theory
applied to dental clinical teaching, and 3) skills important for dental clinical practice. An example of a
questionnaire item in the theme of educational
theory applied to dental clinical teaching was the
following: small group teaching, such as tutorials,
are valuable to the development of dental clinical
skills. Questionnaire statements grouped into this
theme were those that reflect evidence-based teaching practice and are applicable in a broad range of
teaching, such as PBL teaching and formal lectures.
Items presented in the other two themes of the questionnaire were constructed to be more uniquely relevant to the type of teaching that occurs within dental clinical sessions, when student clinicians complete
patient care, such as clinical demonstrations of patient care and clinical interactivity. An example of a
questionnaire item in the theme of the teacher/student relationship was the following: empathic guidance from the clinical supervisor supports student
preparation for independent practice of clinical dentistry. The final theme explored in the questionnaire
was the range of skills required for clinical practice,
namely decision-making skills, technical finemotor skills, communication skills, broad knowledge
base, critical appreciation of evidence-based practice, and skills in self-assessment and self-confidence.
An example of a questionnaire item in this theme
was the following: whilst many skills are impor-
Results
Comparisons of teacher and student perceptions of clinical teaching styles in regard to ten aspects of the clinical teacher/student relationship are
shown in Table 2. The data presented there and in
Tables 3 and 4 represent the mean scores of the student and faculty respondents based on the six point
rating scale. In describing the results, we will also
report the percentages of students and faculty who
agreed or disagreed with various survey items. However, the response percentages are not displayed in
the tables to simplify data presentation. None of the
December 2005
comparisons between results for teachers and students in this theme were statistically significant.
These data also show that, in six of the ten aspects,
teacher and student groups showed a very similar
level and direction of agreement with the statements
listed. In the remaining four items, there were some
small differences between students and teachers. For
the statement providing clinical objectives for clinical sessions would support students preparation for
their independent practice of clinical dentistry, students neither agreed nor disagreed strongly, whereas
teachers tended to agree. Conversely, teachers neither agreed nor disagreed strongly with the statement
the passive involvement of the clinical tutor in teaching during clinical sessions, such as not readily completing the clinical procedure, assists student preparation for independent clinical practice, whereas
students tended to agree with this statement.
Comparisons of teacher and student perceptions of clinical teaching styles in regard to the application of educational themes are shown in Table
3. Two of the comparisons of results for teachers and
students in this theme were statistically significant.
Students and teachers expressed significantly different levels of agreement for the statement that there
was a clear link between theory and clinical practice
in the program (P<0.0029) and that a clinical log book
was valuable for the preparation for clinical practice
(P<0.0038). In regard to the theory/practice link, only
19 percent of teachers agreed, whereas 63 percent of
students agreed with the statement. In regard to the
clinical log book, students were divided in their view
of the merit of this learning aid (27 percent agreed,
21 percent disagreed), whereas a majority of teachers were in agreement (46 percent, with 14 percent
disagreement). These data also show that, in three of
the ten statements presented in this theme, teacher
and student groups showed a very similar direction
and level of agreement with the statements listed.
These three items were: the value of preclinical in-
Table 1. Comparison of teacher and student perceptions about the student/clinical teacher relationship
Response rate
Percentage female
Average age
Age range
Students
Teachers
76%
(n=45)
Approximately 69%
(n=21)
69%
52%
23.7Y
37.8Y
21-33Y
24-78Y
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Table 2. Comparison of teacher and student perceptions about the student/clinical teacher relationship
Questionnaire Statement
Teachers
Median Mean S.D.
Students
Median Mean S.D.
Significance
2.0
0.4
2.0
0.5
NS
2.2
0.3
2.6
0.2
NS
2.7
0.1
3.0
0.1
NS
1.6
0.6
2.5
0.5
NS
2.9
0.1
2.3
0.2
NS
1.6
0.8
1.6
0.7
NS
1.9
0.3
1.9
0.4
NS
2.0
0.3
1.9
0.2
NS
3.7
0.6
2.8
0.7
NS
2.3
0.3
2.5
0.2
NS
1380
Discussion
The learning environment of the clinic challenges the roles and responsibilities of both the
learner and the clinical teacher substantially. The
clinical teacher can be seen as role model, assessor,
confidante, and facilitator for the student clinician.
Valuable supervision is characterized by joint participation in decision making, shared vision, open
access, and creative tension. Positive effects of these
interactions can be seen in improved patient outcomes6 and student recognition of teacher effectiveness. In light of this, a mission for dental education
ideally includes the enhancement of the educationcare delivery relationship, even greater patientcenteredness, comprehensive care experiences, and
teaching and learning reform encouraging reflective
clinical practice.
Table 3. Comparison of teacher and student perceptions in regard to the application of educational theory in dental
clinical teaching
Questionnaire Statement
Teachers
Median Mean S.D.
Students
Median Mean S.D.
Significance
1.5
0.7
1.7
0.8
NS
2.4
0.9
3.0
0.8
NS
3.4
0.5
4.2
0.5
NS
2.2
0.6
2.5
0.4
NS
3.3
0.3
2.3
0.2
SP<0.0029
2.6
0.9
2.3
0.5
NS
2.3
1.0
2.4
1.4
NS
2.3
1.3
2.9
1.5
NS
3.2
0.7
3.4
1.5
NS
2.9
0.3
3.7
0.2
SP<0.0038
1.8
1.0
2.1
0.9
NS
The current study explored student and clinical teacher views of clinical teaching from three
areas: the clinical teacher/student relationship, the
application of educational theory in dental clinical
teaching, and skills important for dental clinical practice. An overall significant level of alignment of
views held by students and teacher was seen in the
data presented. This common view of students and
teachers in so many areas was unexpected and probably reflects the very close and cohesive relationship between clinical teachers and students fostered
in that setting. It may also reflect the strong influence of teachers on students views. The intensity of
the clinical environment may reinforce the tendency
of teachers to teach in a way that has been perceived
successful in terms of patient outcome and service
needs in their own experience. It may also reflect a
tendency of teachers to recognize and adopt a style
December 2005
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Table 4. Comparison of teacher and student perceptions in the theme of skills important in dental clinical practice
Questionnaire Statement
Teachers
Median Mean S.D.
Students
Median Mean S.D.
Significance
1.6
0.3
1.6
0.4
NS
b. Fine-motor
2.0
0.4
2.1
0.5
NS
c. Communication
1.6
0.4
1.5
0.3
NS
2.0
0.5
2.2
0.5
NS
2.2
0.2
3.0
0.2
SP<0.0013
f. Self-assessment
1.9
0.5
2.5
0.6
NS
g. Self-confidence
2.2
0.4
2.1
0.2
NS
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December 2005
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