Anda di halaman 1dari 14


Broad Model Approach:

An Integrative Approach in the Discovery of Why Some Students Perform Well in a Classroom

Setting but Not a Clinical Setting and How to Help Them Succeed

Melissa Del Real

Eastern Oregon University



This essay is the culmination of my past work in IS 301 for my capstone project to earn

my Bachelors Degree in Integrative Studies. In my previous essays, I posed a complex problem

and discussed its importance, relevance, multidisciplinary facets and possible approaches for

solutions. In the next series of essays, I will go into more detail regarding this complex problem,

the absolute need for a multidisciplinary approach and, in the later essays, the strengths and

weaknesses of each of the involved disciplines.

STEP 1: Define the Problem or State the Research Question

The complex problem that I am going to be discussing is, why do students who perform

well in a classroom setting have trouble performing well in a clinical (mock real-life clinic)

setting and how can we, as instructors, help them?

Medical programs are rigorous and demanding programs that students often struggle

through. This is something of no surprise because the medical field is a very difficult,

meticulous, and technique sensitive area of study. A simple mistake could be the difference

between life and death for a patient; for this reason, the training of medical professionals is one

that is strict, exact and seemingly unforgiving. Unfortunately for many situations in medicine,

there is no gray; it is black or it is white. Likewise, with many medical programs, they require

their students to pass their classes with a 75% or higher to continue on. If they cannot earn that

grade, then they simply cannot continue in the program. The reason for this is not to be cruel and

unforgiving, on the contrary, the faculty are preparing the students for the future. In the case of

most medical boards and exams, the student has to pass with a 75% proficiency or higher, if they

cannot do so, then they will not earn their license or certifications (Chemeketa Dental Assisting

Program Handbook, 2016, p.8). Yes, they can be granted the opportunity to retake, but this will

cost the student time and money. However, even with the opportunity to retake, the simple fact

remains, if the student does not know the information, they may fail again. This is the reason for

why educators set the 75% standard for their programs, so that the students can begin to prepare

themselves for the benchmarks that lie ahead.

The complex problem that I have chosen to investigate looks into why some students,

who do well in the lecture (written) portions of medical programs have trouble in the clinical

(mock real-life clinic) portions of the program. Medical programs are composed of two parts; the

lecture portion, or didactic, is where students listen to lectures, take notes, participate in in-class

activities and ask questions in order to supplement their textbook readings. They are also

expected to take tests and quizzes and write essays. The other part found in medical programs is

what is called the clinical portion. This is where the students will perform what they have

learned in lecture. Often times they will do this in a mock-clinic that is designed to simulate a

real-life medical setting. The clinical portion involves using motor skills in the application of

cognitive learning rather than simple study skills. I have explained the two portions of a medical

program to clarify the fact that I will be limiting the scope of this study to why students who do

well in lecture have difficulties in the clinic.

As instructors, we want to see our students succeed. Any good instructor wants the best

for their students. The medical field is booming and we need more trained professionals every

day. Unfortunately, the pool of qualified medical professionals is lacking. To give one example,

in the Willamette Valley Area, there is a shortage of dental assistants. So much so that for the

first time in over 20 years, major companies like Kaiser Permanente and Willamette Dental are

offering sign-on bonuses of $1,000 dollars in addition to very competitive hourly wages and

benefit packages for any dental assistant who is willing to come to work at their company

(Chemeketa Dental Advisory Meeting, 2017). If medical programs are losing students due to

incompetency clinic, then they are not able to satisfy the needs of the community, which is what

the program is there for in the first place. Not only this, but also, in the case of the student,

failing a program means that they have spent time, money and resources that they will not get

back. Many times, failing a program can be a blow to their confidence and set them back so

much financially that they must join the work force and postpone returning to school

sometimes indefinitely. Therefore, failing out of a medical program is not something that is

desirable for the student, for the college, or for the medical community. While some students

perform poorly in all aspects of their studies, there are other students who seem to only be failing

in one aspect. Unfortunately, in a medical program, this one aspect is enough for them to fail out

completely. This is why when a student who would otherwise be considered a good student

(because they are passing their lecture portions) fails in clinic, it is both sad and puzzling to their


STEP 2: Justify Using an Interdisciplinary Approach

The answer to this question is one that involves insights from many different

perspectives. In fact, the intricacy of this topic embodies the very essence of a complex problem.

In the book Introduction to Interdisciplinary Studies, the definition of a complex problem is one

that has multiple parts and that each part is studied by a different discipline (Repko, Szostak, &

Buchberger, 2017). The complex problem that is the topic of my studies cannot simply be

addressed from the technical medical program vantage point; if this were to be the case, both the

explanation and solution would be limited. The simple answer for why a student performed

poorly on a test could be that they did not study. However, in clinic, performance is not merely a

reflection of how well a student can retain information. It involves much more. This aspect of

more is what requires an interdisciplinary approach. There could be countless reasons as to

why a studious student seems to blank in the clinical setting. To name just a few, it could be due

to outside pressures such as family, finances, and personal conflict. These issues could call upon

the discipline of psychology to investigate further into their effect on a students ability to

perform. Another possible explanation could be the students own bodys stresses and internal

struggles physically inhibit their abilities in clinic. This issue would be more related to the

discipline of physiology. The point is that it is not just a matter of the students ability to study

well, like the medical career technical discipline might expect and has expected up until now.

The solution to this unanswered question remains as important as ever. As mentioned in

the above section, when students fail, they lose money, time, confidence, and the prospect of

working in a field that contributes to society. Therefore, it is important to find the reasons

causing students to underperform in a clinical setting so that they may succeed in all aspects of

their program and ultimately earn their degree or certificate.

STEP 3: Identify Relevant Disciplines

The complex problem of why a student performs well in the lecture, or classroom setting,

but not the clinic, or hands on, setting is one that could involve a number of different disciplines.

The first and most obvious discipline is that of Health Sciences, a career technical field, because

they clinic they are in is based in a Health Sciences medical program. Aside from that, other

potential disciplines could include education, psychology, physiology, biology, and

communications. A few, but not all, potential interdisciplinary fields could include cognitive

neuroscience, and biological psychology. In regard to the education field, it could be that the

student is not understanding the way the clinic instructions are given versus how instructions are

given in the lecture classes. Scholars from the education field may look to different teaching

strategies to suit different learning styles and not only learning styles, but they also strive to

teach in ways that help promote retention. Psychology, physiology and biology would probably

approach the problem from the bodys reactions. Is the student too stressed? Is the stress of their

body causing them to perform poorly? Are there outside sources in their family or personal life

that have caused the student to lose focus in clinic? In the communication field, scholars might

presume that the student knows exactly what they need to do on the clinical check-off but they

cannot communicate effectively enough in order to pass. This list of potential disciplines is not

exhaustive and this complex problem could likely apply to many other disciplines, however,

there are certain disciplines that I have found to be most relevant to this problem.

The disciplines of psychology and physiology are two that I have focused my studies on

for this complex problem. The first will be discussed in more detail in the following section of

this essay. These two disciplines had extensive research that could apply to this problem. Other

disciplines had some research but not as much, and not as high of quality as these two that I have

chosen. The second reason that I chose these two disciplines is that they are congruent with

student feedback. Because I work in a medical program where I see students fail clinical check-

offs, I get to talk to students after theyve failed and they usually have an explanation for why

they think theyve failed. Many times, the reason they give are similar to those that apply to the

psychology and physiology disciplines. Their intentions were good, they studied, but when it

came time for the clinical check-off, they were overcome by emotions or stress and they could

not do what they had practiced. This is why I felt that these two disciplines were the best to focus

on for the discussion of this complex problem.

STEP 4: Conduct a Literature Search

Further research into different disciplines has reinforced the fact that this complex

problem is truly an interdisciplinary one. For example, a peer reviewed journal article from the

education discipline discusses middle school student difficulties with retention in certain virtual

science laboratories versus physical laboratories (Chiu, DeJaegher, & Chao, 2015). In fact, this

study confirms that combining virtual and physical labs has the potential to promote science

learning (Chiu et al., 2015). This article can be beneficial to the complex problem that I am

researching because the classroom experiences that the article discusses could be likened to the

lecture portion of medical programs and the physical lab could be likened to the clinical

portion of medical programs. This research study found that physical labs that are supplemented

with virtual labs can promote better learning; this, then, poses the question, could virtual labs be

implemented into medical programs? If virtual labs were to be implemented, maybe they could

help students who were struggling in the physical clinic. This is one example of an insight that

has been contributed by the education discipline.

While many of the disciplines mentioned in the STEP above could apply to the complex

problem, in reality the most relevant disciplines are psychology and physiology, and their

insights speak for themselves. For example, psychological effects such as family problems can

be a contributor to a students failure. They may be dealing with problems at home but the

emotional baggage that goes along with these problems does not stay at home, they may

unintentionally bring their worries with them to class. An online stress management website

states that, emotional stress can make you seem scattered and unable to focus (Brinser,

2007). A student who is unable to focus would not perform well in a check-off, even if they were

doing well prior to their home problems. By looking at the problem through a psychological

standpoint, it is evident that stress impacts students mentally.

Another aspect to the psychological approach to this problem is the ability to recall

information. A check-off requires memorization of steps in sequence and the ability to imitate an

action that was previously seen performed by the instructors in their demo. In medicine, the

order in which materials or instruments are utilized is crucial to the end result; therefore, if a

student cannot remember the steps of a check-off (which are designed to emulate real life

medical procedures), they will not be able to pass the class. In the book, Handbook of Stress

Neuropsychological Effects on the Brain, Cheryl Conrad states intrinsic stress [...] at extremely

high levels can have adverse effects on memory-related processes (2011). A student who is

severely stressed will not be able to recall the order of which a check-off is to be performed.

The literature research found from the physiology discipline fits the complex problem

just as well as insights from the psychology discipline. By dictionary definition physiology is

relating to the way in which a living organism or bodily part functions. To approach the

problem in this sense would be to acknowledge that stress not only affects students mentally (as

in the case of the psychology discipline) but also physically, which pertains to physiology.

Check-offs are tests in which students have to physically show that they can perform tasks that a

normal medical professional is responsible of on a daily basis. If a student is affected physically,

this may hinder their ability to perform well on a check-off. According to WebMD, stress can

lead to physical symptoms including headaches, upset stomach, elevated blood pressure, chest

pain (2016). If a student were to be experiencing these types of symptoms during a check-off

this would no doubt affect their physical performance. Feeling nervous before an exam, test, or,

in this case, check off, is a normal occurrence; however, if the student experiences more than just

the normal pre-test jitters, and it becomes a constant, prolonged feeling of stress, other

physiological problems may arise. A second theory of the physiological discipline can be

illustrated by this quote from The Mayo Clinic, the long-term activation of the stress-response

system and the subsequent overexposure to cortisol and other stress hormones can disrupt

almost all your body's processes (2016). Long term stress, caused by entering the clinic and

having to perform physical tasks on a weekly basis for 10 weeks at a time, could be what is

causing students to underperform in clinic.

STEP 5: Critically analyze the disciplinary insights into the problem and locate their

sources of conflict

When looking at multiple perspectives, there are always sources of conflict or varying

opinions. The point of looking at a problem from multiple disciplines is to gain the insights of

various sources from different vantage points. While the pro to this action is to gather more than

one perspective, a con is that at times these perspectives can diverge or even contradict each

other. According to the textbook, it is almost a certainty that when comparing different

disciplinary insights on the same subject, [] they will conflict at one or more points (Repko et

al., 2017, p. 314). However, it is an essential part of integrating multiple disciplines to identify

these conflicts and understand their differences.

To begin with, it is important to understand the key elements of the most important

disciplinary insights. The psychology discipline views the problem of a student underperforming

in clinic purely from a mental standpoint. The insights observed focused on stress being the key

principle as to why students do not perform well on tests. For example, according to Cheryl

Conrad (mentioned in the section above), stress at extremely high levels can have adverse

effects on memory-related processes (2011). The research from the psychology standpoint holds

firm that a students underperformance is due to internal struggles that distract them come test

time. A student who is stressed, no matter how well-prepared, will have difficulty performing on

a clinical check-off. The physiology discipline acknowledges that stress not only affects students

mentally (as in the case of the psychology discipline) but also physically. Feeling nervous before

an exam, test, or, in this case, check off, is a normal occurrence; however, if the student

experiences more than just the normal pre-test jitters, and it becomes a constant, prolonged

feeling of stress, other physiological problems may arise. These problems could be things such as

headaches, upset stomach, elevated blood pressure, chest pain (Goldberg, 2016).

While both disciplines view the reasons for poor performance as something mental, the

physiology discipline sees the mental problems and looks one step further. The physiology

discipline expands on the psychology disciplines assumptions by explaining body processes in

more depth. Both disciplines agree that the problem is something that is internal and out of the

students control, for the most part. However, the discipline with the conflicting insight is the

education discipline. The insights from that discipline mainly focus on the teaching style as the

root of the students problem. The assumptions of the education insight look more to the

instructors as the means of improvement. Referring back to the insights from the education

discipline in the above sections, they implied that students may be more successful if physical

clinical situations could be supplemented by other labs, such as virtual ones (Chiu et al., 2015).

This key concept conflicts with the physiological and psychological concepts in that they are

directing the problem more towards the teaching method versus the person being taught. If a

disciplinarian from each area were to give their insights regarding this complex problem, it is

likely that the psychology and physiology disciplinarians would find common ground because

their epistemological bases are similar whereas the disciplinarian from the education field might


Disciplinary Tables
Author Disciplinary Thesis Assumptions Theory Key Method Phenomena Authors Bias
Perspective Name Concept(s) Addressed
Conrad Psychology Intrinsic Stress is the Adverse Stress is a Clinical Effects of That stress is the
stress at cause of Effects dynamic testing stress on the only internal
extremely memory of Stress factor in human body factor occurring
high problems memory in the subject;
levels can capacities inadequate
have Stress is the memory
adverse main cause for Stress is not performance
effects on poor just a feeling could be due to
memory- performance but a trigger additional factors
related for more
processes symptoms

Author Disciplinary Thesis Assumptions Theory Key Method Phenomena Authors Bias
Perspective Name Concept(s) Addressed
Mills, Physiology Stress Frontal lobes Stress Frontal Clinic Physical Stress is the
Reiss, & hormones are important Hormones lobes are observation effects of only physical
Dombeck can decrease to judgment Affect integral to stress on the factor
the functions Frontal filter out human body accountable
of neurons in Hippocampus Lobes irrelevant for poor
both the affects information performance
hippocampus decision and to use
and the making judgment to
frontal lobe solve
area Stress is the problems

Author Disciplinary Thesis Assumptions Theory Key Method Phenomena Authors

Perspective Name Concept(s) Addressed Bias
Chiu, Medical When Different Superiority Students Direct Learning Authors work
DeJaegher, Sciences students teaching of virtual may need to observation retention in virtual labs
& Chao have environments labs be reached
difficulties produce in different
with different ways for
retention learning optimal
it may be results success
due to
learning in
a physical
instead of
a virtual

STEP 6: Reflect on how using an interdisciplinary approach has enlarged your

understanding of the problem

After researching and analyzing this complex problem over the course of these essay

assignments, I have come to realize that my thoughts and original assumptions were incorrect.

Coming from a career technical, highly specialized medical programs view, when students

failed it was always due to under preparation. Forcing myself to view the problem from multiple

disciplines showed me that there are a number of reasons why students struggle in school. These

reasons can vary from academic abilities to personal problems outside of school to involuntary

body responses. After completing research from the epistemology from each individual

discipline, I have come to see that each discipline has their distinct and very valid assumptions,

theories and insights.

There is much merit in the insights of each discipline and those that study and set their

focus solely for their discipline. However, what surpassed my appreciation for the diligence that

a single disciplinarian can contribute to a problem is how much an interdisciplinarian can

contribute to a solution of a complex problem. In the case of the complex problem that is the

subject of this essay, a single discipline would have given a solution by fixing either the student

or the teaching method. However, an interdisciplinary approach has given us solutions by

addressing the problems that the student is experiencing both internally, externally, and possibly

with the delivery and comprehension of the teaching method.

Viewing problems and situations from an interdisciplinary perspective is not just a skill

that proves useful in the classroom. This is a skill that I will take on to my everyday life both

professionally and personally. Viewing anything from a one-sided approach is often frowned

upon. In arguments or discussions, many times you are urged to put yourself in the position of

the opposing side; interdisciplinary thinking is just that. It is not only viewing things from the

opposing side, but it is viewing things from all sides. If I continue to use this style of problem

solving outside of the classroom, I will be giving myself an advantage of not only being more

open minded, but also finding better, more thorough and comprehensive solutions.


Blackwell Handbooks of Behavioral Neuroscience: Handbook of Stress, Volume Vol. 2 :

Neuropsychological Effects on the Brain. (2011). Hoboken, GB: Wiley-Blackwell.

Retrieved from

Brinser, L. (2007). Psychological Effects of Stress. Psychological Stress Is Real! Retrieved from

Chemeketa Community College. (2016). Dental Assisting Program Handbook. Salem, OR.

Chemeketa Dental Advisory Meeting. (2017, October). Dental assisting advisory committee

minutes. Quarterly meeting held at Chemeketa Community College, Salem, OR.

Chiu, J. L., DeJaegher, C. J., & Chao, J. (2015). The effects of augmented virtual science
laboratories on middle school students' understanding of gas properties. Computers &
Education, 85, 59-73. Retrieved from
Goldberg, J., MD. (2016). The Effects of Stress on Your Body. WebMD. Retrieved from

Mills, H., PhD., Reiss, N., PhD., & Dombeck, M. Ph.D. (2008). Mental And Emotional Impact

Of Stress. Retrieved from


Repko, A. F., Szostak, R., & Buchberger, M. P. (2017). Introduction to interdisciplinary studies

(2nd ed.). Thousand Oaks, CA: SAGE Publications, Inc.