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Dental hygiene educators develop innovative courses that simulate clinical situations. Two examples are case-centered seminars and computer-based patient simulations. Of the two, case studies are less costly and less labor intensive than computer-based simulations.

Banish the solitary all-nighter.

Instead, join with other hygienists for a group case study.

You might notice an improved ability to solve the daily problems encountered in the operatory.

Louellen Tatro Lusk, RDH

Dental hygiene educators develop innovative courses that simulate clinical situations. Two examples are case-centered seminars and computer-based patient simulations. Of the two, case studies are less costly and less labor intensive than computer-based simulations.

In addition, clinical case studies sponsored by local study clubs or state associations can meet a practitioner`s continuing education objectives.

Link between theory and practice

In educational settings, case studies bridge the gap between theory and practice. Students in the classroom explore the theory behind practice "concepts" in case resolutions. Practitioners, though, link their clinical practice to theoretical concepts.

McKeachie in Teaching Tips states that case studies are common in business and law courses (as well as for class sessions in other disciplines). He writes that the case study produces good student involvement and develops students` abilities to solve problems using knowledge, concepts, and skills relevant to a course.

Dental hygienists who practice case-study skills actively develop problem-solving skills, linking their clinical experience to a theoretical base.

A comparison with lectures

Case studies also offer increased student retention, recall, and use of information outside the classroom. In fact, Watson compared two classes taught by the case study method with a class taught by the lecture method. Both case study classes reported superior scores in terms of the students` abilities to apply concepts and use of information outside the classroom.

Dental students participating in a case-based learning model in orthodontics also said the learning experience was more enjoyable, less stressful, and a more effective way to learn than the lecture method.

Instead of the traditional lecture format, the case study approach can be used by practitioners for continuing education credits. The lecture format for continuing education purposes has been overused, and it creates a passive environment for learning, unlike case study methods which use interchange and interaction with a community of peers.

Critical reasoning skills

In addition to increased retention and interaction with colleagues, case studies have been shown to increase reasoning and critical thinking skills. Dental students who participated in a case-based learning model in orthodontics reported significantly higher levels of confidence after these seminars for each of the seven reasoning skills. This research signifies that case studies can be applied to other dental areas for developing better clinical reasoning skills.

The common features, according to Kurfis, a well-known author on this topic, are: active involvement, consultation with others, and a sense of responsibility for their own learning. The case-study encourages teaching practices which support critical thinking. The following are teaching practices and attitudes that support critical thinking:

- Critical thinking is a learnable skill (peers and instructors are resources).

- Questions are a point of entry into a subject.

- Courses or cases are assignment-centered rather than lecture or text-centered. Goals emphasize practicing learned information rather than simply acquiring it.

- Students collaborate to learn problem-solving and work in small groups.

Cases can be studied individually. However, there are advantages to the formation of study groups. A finding by Harvard`s Assessment Seminars and other subsequent studies indicate that students working outside the class in small study groups of four to six students do better academically. They are more engaged than students working alone or in large groups.

Form small groups

Kurfis states that small-group involvement also increases metacognitive thinking skills, which is how an individual determines when additional information is needed. Metacognitive knowledge is necessary for students to reason in a more complex manner and to develop intellectually.

Involvement in a group also creates a functionally important task while reducing isolation and alienation.

Again, findings suggest positive implications for the formation of study groups for the practitioner. Study groups formed for continuing education purposes or as part of a state or local dental hygiene meeting can also assist practitioners in becoming more involved and feeling less isolated in the dental hygiene community as well as increasing practitioners` metacognitive skills.

Designing your own course

Case studies can be devised by students. They can creatively provide an exercise for class discussion. Dental hygienists can also formulate cases that they have encountered in their clinical experiences. Scenarios involving ethics or pathological cases can be supplemented with slides that they could share with colleagues in a study group.

In fact, most postdoctoral DDS programs require dentists to present cases to colleagues in order to obtain diplomate status in a specialty. Of course, patient confidentiality should be adhered to, and written permission for photos should be procured. Signatures must be secured from patients to avoid confidentiality problems.

Cases can also be more structured, such as the ones organized by Dr. Joen Haring in RDH. An additional word of caution is that, if using printed cases, it is prudent and appropriate to get permission to use copyrighted material.

Dental hygiene practitioners can work in study groups of four individuals to resolve case scenarios. The small study groups should have ample time to present their assigned cases and findings to the larger group session. If study groups are formed on a local association level and self-crafted according to patients` cases, then separate sessions should be scheduled to share these cases with colleagues.

Moderator sets the pace

Whatever options are used, whether working with printed cases or with self-formulated scenarios, a facilitator is needed for several reasons. A facilitator should present an overview of the case study method.

A facilitator is also needed for the following functions:

- Organize reprinted cases that may be used.

- Obtain copyright permission.

- Assign or coordinate the participants in each group.

- Provide time and question guidelines for reporting cases.

- Submit slides for presenting to the large group.

The case study has been used with great success in the educational setting.

For the dental hygiene student, the case study procures student involvement, develops problem-solving abilities, and increases retention and understanding outside the classroom. The case study is an effective venue where practitioners can become involved, learn new material, and relate to professional colleagues.

Take the initiative or be a part of a study group in your local dental hygiene component meeting. It is an active, stimulating method for learning!

References will be furnished upon request.

Louellen Tatro Lusk, RDH, MA, is associate professor of dental auxiliary education at the University of Medicine and Dentistry of New Jersey`s School of Health Related Professions.

How about using RDH magazine for a case study?

As an instructor of oral pathology, I use the case study as a culminating and integrating experience for students. The last two classes of oral pathology are devoted to case studies. In addition, case studies could also be used after each unit of instruction.

I would like to share with other educators my adaptation of Dr. Joen Iannucci Haring`s case studies from RDH for the classroom.

First, I would like to briefly discuss some classroom advantages. One advantage is that students who are familiar with case studies may not be as intimidated by Dental Hygiene National Board Examination. Secondly, oral communication skills are promoted throughout case studies. Students present cases to a large group after solving the cases in a small group. A third advantage is that it facilitates collaborative learning. Students learn with their peers about problem resolution.

In preparation for the classroom, cut out the cases from RDH and paste or tape the question-and-answer sheets on separate pieces of paper. Label each sheet accordingly. I then coordinate an audiovisual slide with each case for students to present to the large group.

The following are the directions given to the students:

- There are to be no more than three students working on each case study.

- You will be given the Question Sheet of the case study in a small group.

- You will make a clinical diagnosis according to the material presented from the options on the Question Sheet.

a) You may seek information in any pathology textbook or reference source when working through this problem.

b) You also need to look up the distractors to be able to instruct the class when they respond by giving an incorrect answer.

- When your group has collectively come to a decision, one representative from your group will bring the Question Sheet to me to determine if your group made the correct diagnosis. If your group did make the correct diagnosis, then you obtain the Answer Sheet. If you did not make the correct diagnosis, then you must further research the case. I will often volunteer to assist any group that may be confused.

- Students will then read the Answer Sheet and will determine how they will present the case to the class. I instruct them that they also have slides so the large group can visualize the case being presented.

- When you present the material to the large group, make your peers tell you what they think the answer is and the reasons they chose that answer. The slides will be shown at the same time.

A professor`s role is to facilitate the group process, coordinate, and present the slides. It is a learning experience the students and I find enriching. It is a nice change from the traditional lecture format. By following the suggestions above, I am sure that you also will embrace the case study as a methodology for learning.

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