By Nicole Fauteux
If teaching students to think critically is challenging,
assessing the development of this skill over time can be downright
elusive. Nevertheless, one dental hygiene program has implemented
an approach that is winning converts on the same campus.
For many years now, educators at the University of Texas School
of Dentistry at Houston (UTSD) have incorporated a series of
clinical case studies in the dental hygiene curriculum to help
students develop critical thinking skills. More recently, the
program introduced a mechanism that allows students to demonstrate
how those skills are developing across time: the eportfolio. (For
more on the development of this assessment for use in dental
hygiene, see our
profile of Dr. Cynthia Gadbury-Amyot).
Before implementing the eportfolio, the faculty sat down and
scrutinized each course, looking for segments that lent themselves
to creating artifacts appropriate for a portfolio. Prof. Donna P.
Warren-Morris and her colleague Prof. Ann O. Wetmore, now at
Eastern Washington University, then developed a detailed rubric for
evaluating the portfolio as a whole. Among the artifacts the
portfolio should optimally contain, the rubric specifies "a variety
of documents that provide irrefutable evidence to demonstrate
learning, significant evidence of critical thinking, insight, and
serious commitment to growth and learning ... ."
According to Prof. Warren-Morris, evidence of critical thinking
primarily resides in the portion of the portfolio where students
reflect on the case studies they choose to present.
"At first they are just telling us what they did," she reports,
"but as they progress, they're critically evaluating why they did a
procedure this way, why they chose preventive therapy, so there's
more depth, more rationale, more evaluative thinking."
The faculty also evaluates critical thinking by looking at the
procedures and therapies students choose to use with their
patients. They expect to see care become more appropriate as the
students progress through the curriculum.
The dental hygiene program's use of the eportfolio has not gone
unnoticed in other corners of the dental school. After observing
dental hygiene students use their portfolios to chronicle and
reflect on their experiences with community-based education, Dr.
Richard D. Bebermeyer, Chair of the Department of General Practice
and Dental Public Health, invited Prof. Warren-Morris to present
the students' work at his departmental retreat.
Dr. Bebermeyer and his colleagues were impressed by what they
saw and by the portfolio's potential for measuring overall
competency. With the subsequent introduction of the new Commission
on Dental Accreditation (CODA) standards on critical thinking and
evidence-based dentistry, Dr. Bebermeyer concluded, "the portfolio
seemed like the right thing to do."
Last year the dental school got the ball rolling by introducing
a portfolio in its second year pre-clinical operative dentistry
course. Students learned to use the new tool by writing
self-assessments and uploading photos of their operative
preparations on ivorine or plastic teeth. This fall the school will
expand its use of portfolios to a first-year course, Foundational
Skills for Clinic. Students will engage in more reporting, writing,
and reflective learning by assessing their introduction to the
clinic in areas such as cardiopulmonary resuscitation (CPR),
infection control, and chairside assisting.
Dr. Bebermeyer plans to build from there. He sees great
potential for integrating the portfolio throughout the curriculum
as his colleagues in dental hygiene have done.
"We will be dropping some competency exams into the portfolio,"
he says, "but I want it to be more. I want it to be cases and
essays and videos. My goal is for the students to be able to
demonstrate overall competency, and that includes critical
thinking, the practice of evidence-based dentistry, ethics, and
Engaging students in critical thinking is clearly just one of
many uses for the portfolio-in dental hygiene as well as in
dentistry. Nevertheless, Prof. Warren-Morris believes that
portfolios, in combination with case studies, are especially well
suited to promoting and documenting the evolution of student
thinking. "Just the mere fact that students spend time reflecting
on the care they've given by putting it into a case study, there's
learning that occurs in that process that wouldn't have occurred