Campus Spotlight: The University of Texas School of Dentistry at Houston

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 patient management."

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 otherwise."