Posted: May 15th, 2022

Dentistry

Introduction
As a Dental Core Trainee in the Oral Surgery department of a Dental Hospital, I often teach dental students who are in their first year of school. My schedule usually calls for me to work at the “Student Extraction Clinic” twice a week. This involves supervising small groups of second- to fourth-year dental undergraduates (usually four to six students) as they perform simple dental extractions on patients who have already made an appointment or who called the department earlier that day because they were having problems after their surgery. When there are no patients scheduled for the clinic, the students would meet for tutorials on topics in oral surgery that are appropriate for their level of study. In addition, before students can use a certain clinical technique on real patients, they have to pass a number of clinical competency tests.
Part A of this assignment is a critical analysis of how local anesthetic was taught in a practical tutorial to four dental students in their second year.

Part A: A critical analysis of how local anesthetic (LA) is taught to dental students in their second year of college
Activities for learning
Most dental procedures need someone who knows how to use local anesthetic. So, if a college student wants to be a safe beginner after graduation, they need to know how to do this skill well. Students should learn about local anesthetic early on in their studies so that they feel more comfortable and don’t need as much help later on when they have to use it.
A practical tutorial called “Local Anaesthetic for Dentistry” was planned and given to four second-year undergraduates in a small group setting over the course of two hours. Before going to their patient clinics, the students had heard lectures on this topic and had access to online resources, such as videos showing how to do things.
The main goal of this teaching session is for them to put together what they already know and practice using LA on phantom heads before they are ready to do the procedure on real patients under supervision in the clinic.
Four students gave feedback on a learner evaluation sheet [Appendix 3] that was made anonymous. The responses of all four students are shown in Appendix 4.
Taking a close look
The lesson plan for this teaching session [Appendix 1] was made based on Gagne’s nine teaching events (Gagne et al., 1992). This model is based on how people process information and gives a good structure to a teaching session by using pre-planned teaching events that help students learn what they are supposed to (Khadjooi et al., 2011). It helped set clear expectations for both the teacher and the students in a methodical way, which helped the teaching session go more smoothly as a whole.
The learning outcomes, which were given at the beginning of the tutorial and listed in order of the session’s events, showed the students in a clear and precise way what they could expect to learn and get out of the tutorial (Jenkins & Unwin, 2001). Bloom’s Taxonomy of learning (Bloom et al., 1956) was used to organize them. This is a way to help people learn by building on what they’ve already learned and moving from lower to higher cognitive processes. This then helps to set up a deep way of studying and solidifies what you’ve just learned (Adams, 2015). The learning goals for this session were also made to meet the needs of the “UK National Curriculum for Undergraduate Oral Surgery” (ABAOMS, 2016), which aims to improve student learning so they can graduate successfully and put patient safety first. On a theoretical level, it was assumed that the students had reached the “knowledge” and “understanding” stages of learning about local anesthetic from previous lectures and materials. This session’s learning goals still focused on the lower levels of Bloom’s Taxonomy, since the students were asked to remember what they had already learned and were being taught the topic for the first time in a practical way.
Légaré et al. (2015) pointed out that clinical learning objectives often focus on the lower levels of the taxonomy, which doesn’t help improve clinical performance. But in this lesson plan, the learning outcomes focused on the lower levels of cognitive learning because the students were learning a new practical skill. Even though Bloom’s Taxonomy has been criticized in some ways, it is still used a lot in clinical education. The results helped make this lesson plan, its tasks, and the development of students’ cognitive learning skills fit together (Armstrong, 2010).
The use of quizzes and case scenarios was liked by learners, as shown in Appendix 4. Students liked that it made the session more fun and interactive, and their tutors liked that it helped them see how much they had learned and understood up to that point. Using interactive teaching styles and changing them up during this small-group teaching session helped students stay focused and remember what was talked about (Steinert, 1996). This backs up the constructivism learning theory, which says that the teacher should act as a guide, helping students build new knowledge from their own active processes and past experiences. It also supports individualized, student-centered learning (Kaufman, 2003). This practical was a long session, and a break helped students and teachers pay more attention and avoid getting too much information at once (Pacheco, 2020). One of the learners said in their feedback [Appendix 4] that another short break could be added to future sessions to help this even more, like before their competency exam.
But for students to get the most out of these interactive parts, they need to review the learning materials and lectures they have already seen. Some students didn’t study before coming to this practical session, and it showed in how engaged they were with certain questions. In the future, it might be helpful for the lecturer to tell the students at the end to look over these resources again before their patient clinics. So, it can help students figure out what they need to learn before their LA practical and competency test. This encourages self-directed learning, which is one of the “Principles of Adult Learning” (Knowles et al., 1998).
Active student participation, like the teaching methods in Appendices 1 and 2, can increase their motivation to learn, help them get used to using deeper thinking processes, and contribute to lifelong learning (Raes et al., 2020), which is an important trait of a safe, competent dentist. All of the students took part in the discussion because they didn’t have to worry about being embarrassed if they gave a wrong answer and shy people weren’t left out of the conversation. But to improve learning even more in future classes, students could work in pairs instead of answering, say, case scenarios on their own. A collaborative discussion and social interaction with their peers (a combination of constructivism and social learning theory) could encourage students to take a more active role in their learning (Merrill, 1991) and help to smooth out any inconsistencies in the educational material through student-centered problem solving based on their own previous learning (Trullàs et al., 2022). By working together instead of alone to reach a common goal, which Holton and Clarke (2006) called “reciprocal scaffolding,” they can get help from the experience of their peers and move closer to their “zone of proximal development” (Vygotsky, 1978). On the other hand, this learning would go better if an expert peer helped out instead (Stone, 1998).
Walker and Peyton’s (1998) adaptation of Peyton’s four-step approach was a good way for the tutor to teach this practical skill of local anaesthetic. People liked that they were broken down on how to do different LA procedures well and that they were given time to practice [Appendix 4]. In the first two steps of Peyton’s plan, students watched their tutor show them how to use a phantom-head model. Bandura’s Social Learning Theory from 1977 talks about how modeling and observational learning are effective ways to teach in healthcare. Not only does it save money and time for the tutor, but watching a successful procedure can also help a student feel more confident in his or her own abilities (Kaufmann & Mann, 2014). This can help them feel better about themselves and give them more motivation to reach the learning goals. By putting an expert activity into their long-term memory, they can easily remember the desired result and use it as a point of reference for their own learning (Kaufmann & Mann, 2014). In future LA tutorials, it might be helpful to make an illustrated, step-by-step procedure handout that the students can use to follow along with the expert demonstrations and refer back to when they do their own work. This will not only be good for people who learn best by seeing (Qutieshat, 2018), but breaking down procedures into step-by-step guides can also help reduce cognitive overload (Shibli & West, 2018).
The students were able to learn this new procedure skill on time and do it well. By linking to the learning goals of the session using Peyton’s method, all of the students met these goals and passed their LA competency tests on the first try. Simulation-based learning is used when phantom head models are used. This was a good way to teach local anesthetic because it not only gave the students a safe place to learn before they went to the clinic, but it also let them practice the procedures over and over again. But the tutor might also want to think about having students show each other how to inject LA in future sessions (using water instead of LA drug). This would give students more real-world experience with practical skills while still letting them learn in a safe environment. LA can be scary for students at this early stage of their careers, so a student-to-student model could help them feel less nervous and more confident when they do LA on a real clinical patient in the future (Qutieshat, 2018).
Before taking their competency test, students were able to practice LA techniques with a partner. This part of the lesson plan had the most time allotted to it. This was enough for students to use the phantom-head model as many times as they wanted to get better. At this point, the only thing that needed to be done to improve the students’ work was to move their chairs, which shows that Peyton’s 4-step approach and the lesson plan have been working so far. This new role of the tutor as a facilitator is in line with Vygotsky’s theory of the “Zone of Proximal Development,” which says that students learn more when they get help from an expert than if they don’t get any help (Kaufman & Mann, 2014). Since this was a new practical skill for the students, making sure the tutor was available to help if needed was a good idea. Having 1 tutor for every 4 students was a good small group size in the time allotted to learn this skill, which led to more independent learning.

Conclusion
Small group practical tutorials, like the one we talked about, are a good way to teach because they put the focus on the students and encourage active participation and independent learning (Hedge & Singh, 2011). The lesson plan and strategies used fit the different ways that students learn and gave them a good learning experience, as shown by the fact that they passed their competencies. Pre-clinical skills tutorials on phantom-head models make it easier for students to move from school to patient clinics by helping them learn good skills and build their self-confidence and independence as learners (Stelzle et al., 2011).
The lesson plan is a good way to teach a new procedure because it is based on Gagne’s events of instruction (Gagne et al., 1992). It serves as a flexible resource that can be used to help plan and adapt other dental practical skills. Walker and Peyton’s (1998) approach to teaching procedures is also useful, but Giacomino et al(2020) .’s research shows that it works best when used with a small number of people, like in this teaching session.
Overall, the students’ comments about this class were positive. Even though this session went well, future tutorials and practical topics could use more changes. The key to success, though, is careful planning of each teaching session and for the tutor to be a knowledgeable, approachable role model. This will help students pay attention and take part fully.