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The next patient interaction is logical, essential, and largely done intuitively.To design and test a succinct learning guide for student guidance and student-faculty interaction in conceptualizing the next patient interaction.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.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.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.

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

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.

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.

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.

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.

The aim of this study was to develop and evaluate a learning strategy using critical thinking to teach dental students how to assess the risk of rapid oral health deterioration (ROHD) among elderly patients. A learning guide was developed using risk factors identified in the literature and the steps that expert faculty members apply in their clinical decision making, summarized in a set of ten steps. A new system of labeling risk was developed for the elderly population, which correlates the level of risk with the amount of disease. Participants in the study were all 91 fourth-year dental students in two subsequent classes who took part in a five-week Geriatrics and Special Needs Clinic rotation in the spring of 2015 and 2016. The students were introduced to the ROHD concept and asked to use the guide in a presentation during their rotation. The students were graded on an A, G, or M scale (Applied concept, Grasped and applied concept, or Missed application of concept). Students were also asked to assess their learning experience, and their answers were thematically grouped and analyzed. For eight of the ten steps, at least 93% of the students were graded A or G. The exceptions were the steps about developing a communications plan, which was missed by 23.1%, and self-assessment, which was missed by 30.8%. Interexaminer agreement on students' applying (A + G grades) versus missing the step was moderate or high on six of ten items. Nearly all the students (98.7%) considered assessing the risk of ROHD an important or very important skill. In this study, a learning strategy to teach dental students how to assess the risk of ROHD among elderly patients was developed and successfully implemented.

To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21st Century."

The aim of this study was to seek the views of a national sample of dental educators regarding the importance of learning domains in dental education, their defined outcomes of those domains, and their perceived effectiveness of their schools in guiding learning in those domains. The study defined the educational domains important for training future dentists as knowledge, technical skills, critical thinking, ethics, social responsibility, and interprofessional education/practice (IPE/IPP). A survey of members of the American Dental Education Association (ADEA) Special Interest Group on the Scholarship of Teaching and Learning was conducted in 2017. In addition to reporting their demographics, participants were asked to rate and rank the importance of each learning domain as well as answer open-ended questions. Of the 89 respondents (response rate 12.5%), 31% were course directors, and 48% had been dental faculty members for more than ten years. Knowledge was ranked as the most important domain, followed by critical thinking, technical skills, clinical decision making, ethics, problem-solving, social responsibility, and finally IPE/IPP. When rating the absolute importance of these domains in the training of dental students, the respondents gave all but IPE/IPP and social responsibility the highest rating. Knowledge and technical skills were rated highest for respondents’ confidence in defining student outcomes with similar high ratings for their confidence in guiding this learning. There was little consensus concerning a definition of critical thinking, and a third of the respondents were uncertain of specific learning outcomes for it. Participants expressed even less confidence in defining outcomes for ethics, IPE/IPP, and social responsibility. This baseline information will be used for a future in-depth study to aid in the development of strategies for articulating outcomes, guiding learning, and assessing performance in U.S. dental schools.

This project, utilizing a seldom-used approach to dental education, was designed to define the desired characteristics of a graduating dental student; convert those characteristics to educational outcomes; and use those outcomes to map a dental school’s learning and assessment programs, based on outcomes rather than courses and disciplines. A detailed rubric of the outcomes expected of a graduating dental student from this school was developed, building on Commission on Dental Accreditation (CODA) standards and the school’s competencies. The presence of each characteristic in the rubric was mapped within and across courses and disciplines. To assess implementation of the rubric, members of two faculty committees and all fourth-year students were asked to use it to rate 1) the importance of each characteristic, 2) the extent to which the school teaches and assesses each, and 3) the extent to which each counts toward overall assessment of competence. All thirty-three faculty members (100 percent) on the committees participated, as did forty-six of the fifty-five students (84 percent). The groups gave high scores to the importance of each characteristic, especially for knowledge and technical competence (then separate categories but merged in the final rubric) and for self-assessment, as well as the extent to which they are being taught and assessed. Respondents most commonly named critical thinking as the area that should be emphasized more. Mapping the curriculum and creating its related database allow the faculty and administration to more systematically coordinate learning and assessment than was possible with a course-based approach.

Much progress has been made in the science of caries risk assessment and ways to analyze caries risk, yet dental education has seen little movement toward the development of frameworks to guide learning and assess critical thinking in caries risk assessment. In the absence of previous proactive implementation of a learning framework that takes the knowledge of caries risk and critically applies it to the patient with the succinctness demanded in the clinical setting, the purpose of this study was to develop a model learning framework that combines the science of caries risk assessment with principles of critical thinking from the education literature. This article also describes the implementation of that model at one dental school and presents some preliminary assessment data.

This opinion article applauds the recent introduction of a new dental accreditation standard addressing critical thinking and problem-solving, but expresses a need for additional means for dental schools to demonstrate they are meeting the new standard because articulated outcomes, learning models, and assessments of competence are still being developed. Validated, research-based learning models are needed to define reference points against which schools can design and assess the education they provide to their students. This article presents one possible learning model for this purpose and calls for national experts from within and outside dental education to develop models that will help schools define outcomes and assess performance in educating their students to become practitioners who are effective critical thinkers and problem-solvers.

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises reflecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite specific examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

The educational application of critical thinking has increased in the last twenty years with programs like problem-based learning. Performance measurement related to the dental student's capacity for critical thinking remains elusive, however. This article offers a model now in use to measure critical thinking applied to patient assessment and treatment planning across the four years of the dental school curriculum and across clinical disciplines. Two elements of the model are described: 1) a critical thinking measurement "cell," and 2) a list of minimally essential steps in critical thinking for patient assessment and treatment planning. Issues pertaining to this model are discussed: adaptations on the path from novice to expert, the role of subjective measurement, variations supportive of the model, and the correlation of individual and institutional assessment. The critical thinking measurement cell consists of interacting performance tasks and measures. The student identifies the step in the process (for example, chief complaint) with objective measurement; the student then applies the step to a patient or case with subjec- tive measurement; the faculty member then combines the objective and subjective measurements into an evaluation on progress toward competence. The activities in the cell are then repeated until all the steps in the process have been addressed. A next task is to determine consistency across the four years and across clinical disciplines.

This resource was created to support faculty assessment of dental student performance in the predoctoral comprehensive care clinic. This resource consists of an instructor's guide, the quarterly student evaluation by faculty form, the quarterly student self-evaluation form, and the criteria for the final course grade. At approximately 10 week intervals, each faculty member that has worked with the student in clinical patient contact completes the quarterly evaluation form, noting a subjective assessment of each student's current status with regard to each of the six domains and adding written comments regarding the student's strengths and weaknesses, as well as suggestions for professional growth. At the same point in time, the student will complete the quarterly student self-evaluation form and submit it to the group leader. The group leader compiles all the evaluations of the faculty; student progress is discussed together amongst faculty in faculty conferences each 10 weeks throughout the course. After each faculty conference, the group leader provides students with formal face-to-face individual feedback regarding current grade status, perceived strengths, shortcomings, and suggestions for professional growth. At these meetings, the group leader and the student also review the student's self-evaluation form, with particular focus on how this self-evaluation compares with the faculty assessments. The forms and protocols included here were developed and refined specifically for use in the Family Dentistry program at the University of Iowa College of Dentistry. These assessment tools were created to guide learning, reinforce learning, and to support dental student evaluation in the predoctoral comprehensive care clinic. The forms and protocols presented here have been in use in our clinical program since 2007. They are reviewed and refined annually, and have proven to be effective in achieving our objectives.

Introduction Assessment of students' learning should not only focus on whether the student has achieved the competencies necessary to advance, but should also guide learning, assisting learners throughout their educational experience in developing the knowledge, skills, attitudes, and values considered important at their stage of learning. This material was created to support daily faculty assessment of dental student performance in the predoctoral comprehensive care clinic. Methods The resource consists of the instructor guide, a table of criteria for daily feedback for professional development, and the daily feedback for professional development form. Utilizing these criteria and this form, formative evaluation is recorded and communicated to the student as feedback following each clinic session. Evaluation of performance is focused on diagnosing student deficiencies, reinforcing strengths, planning strategies to address the educational diagnosis, and observing the outcome of the interventions. Results The forms and protocols presented here have been in use in at The University of Iowa College of Dentistry's clinical program since 2007. They are reviewed and refined annually, and have proven to be effective in achieving our objectives. Discussion We have found this protocol to be very effective in initiating and facilitating constructive formative dialog between clinical faculty and fourth-year dental students in our comprehensive care clinic. Reflection on these recordings has also been useful in supporting decisions on the quarterly and final evaluation of our fourth-year students in the Family Dentistry clinic.

Dear Dr. Brown: Attention to the issue of access to dental care within the dental education community has so far been a bit like the blind people and the elephant: it seems very different depending on which part of the animal one touches. The purpose of this letter is to offer one approach to

Myelinated and unmyelinated nerve fibres were counted and myelinated axons were measured in juxta-apical cross-sections of human primary and permanent canines and incisors. Fully-developed human primary canines had significantly more myelinated axons than permanent canines, but the number of unmyelinated axons was similar. Permanent incisors had significantly more myelinated nerve fibres entering the apex than did primary incisors, but the number of unmyelinated nerve fibres was similar. Primary canines and incisors lost nerve fibres early during resorption; evidence of degenerating myelinated axons was scant. A significant linear correlation existed between numbers of myelinated and unmyelinated axons for primary incisors and canines. The myelinated axon circumference was similar for primary and permanent teeth. Permanent teeth tended to have smaller groups of unmyelinated axons.

Axons from pulps of fully developed primary and permanent teeth were processed for electron microscopy, counted and measured for cross-sectional area and circumference. These measurements were totalled for each specimen and experimental groups were compared statistically. Permanent teeth contained a significantly greater myelinated and unmyelinated innervation. However, primary teeth contained a higher proportion of unmyelinated axons. Considering the tooth weight as an indication of the amount of tissue innervated, no significant differences were found in amount of innervation between primary and permanent teeth. Therefore, innervation density appears the same, while relative proportions of fibre types are not. Fibre-size analyses suggested that myelinated axons in permanent tooth pulps were more irregular in shape. It is concluded that differences exist between the innervation patterns of primary and permanent teeth. These differences may be relevant to tooth sensitivity. A significant positive linear correlation was found between amounts of myelinated and unmyelinated innervation in primary teeth. This suggests predictability of unmyelinated innervation quantities from more easily determined myelinated innervation quantities.