CHAPTER I

INTRODUCTION

A. Background of the Study

One of the most serious challenges that dental educators face today is

improving the learning environment and increasing the level of student satisfaction

with the curriculum. Dental profession is often taught by expert clinicians who, for

the most part, have limited or no prior formal teaching training. Clinical instructors

play a significant role in student learning in this field, but more information is

needed on which instructor characteristics best promote student development.

Demonstrating the core attributes of character, competence, and communication

will leave a lasting and positive influence on students, especially at the early stages

of their professional careers. There is growing awareness that learners' responses

to and views of their educational experiences are important in modifying the

educational process. It is worthwhile for dental professionals, in whatever

educational capacity they serve, to periodically reflect on their own positive and

negative attributes as educators and to refocus and improve their teaching efforts.

It is the responsibility of dental professionals to use the best available evidence on

effective teaching skills to effectively educate future generations of oral healthcare

professionals. Effective teaching behaviors have been studied in various arenas in

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higher education, however, there is limited research documenting effective

teaching behaviors in dentistry. And because of this, we need rubrics that can help

dental educators distinguish between good and bad learning outcomes.

Several studies (mentioned in RRL) indicate that most students favor a

clinical instruction where the relationship between students and clinical teachers is

amicable and developed within a mentoring approach. It also calls for engaging

enthusiastically in the delivery of the subject-matter including discussion of

protocols and demonstration of procedures before, during and after the clinical

session. Interactivity during those sessions is perceived as crucial. Feedback is

seen as a very important contributor to professional learning as well as having

evaluation strategies that rely on meaningful self-reflection. Working in groups is

also a well-appreciated approach since students have the opportunity to exchange

discipline insights as their learning progresses. Finally, clinical skill competence is

a factor that came strongly in the above studies as well as the need for having

clear instructional objectives before any learning session commences.

The quality and effectiveness of university education are of major

concern to university administrators (Devlin and Samarawickrema, 2010).

Recently, some dental schools in Saudi Arabia have proposed the use of a new

curriculum based on a student-centered, rather than teacher-centered, approach.

This curriculum is designed to promote self-learning and lifelong learning. Patient

cases are used in a collaborative learning model, such as one employing problem-

based learning (PBL), as a central focus to provide relevance to the topics covered

in lectures, seminars, and laboratory courses (Rahman, 2011).

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The various teaching methods used in medical and dental schools

include lectures, small-group teaching, and laboratory sessions. PBL, a small-

group teaching approach, requires students to use information to solve a problem,

which is more effective than learning by reading or listening. In this approach,

students are more active and thus can develop a variety of skills, such as

teamwork, problem formulation, information finding, discussion and explanation of

new information to others, decision making, and conclusion formulation (Polyzois

et al., 2010, Wood, 2004, Onyon, 2012). PBL is now used in many higher-

education institutes globally, and it has been shown to be superior to more

traditional methods (Dennick and Exley, 2004).

PBL was introduced to replace traditional teaching methods in health

care schools. PBL has spread throughout the world to institutes such as the

University of New Mexico in the United States and University of Limburg at

Maastricht in the Netherlands. The implementation of PBL expanded steadily

during the 1970s and 1980s, and a large number of medical schools had approved

PBL as an essential part of their curricula by the 1990s. It is currently implemented

in many areas of health education, such as dentistry, pharmacy, and nursing, in

universities worldwide (Polyzois et al., 2010).

A study by Talwar and Weilin (2005) identified qualities that both full-

and part-time dental educators perceived important in an effective teacher. Their

findings suggest that, for didactic instruction, clear organization was most

important. A comparison between full- and part-time instructors demonstrated

differences in perceived lecturing skills as most important for the former and clear
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organization and subject knowledge as most critical for the latter. Moreover,

women dental educators valued basic lecturing skills as most important, whereas

men perceived organization and subject knowledge as critical. This study of

classroom instruction demonstrates the importance of organization, lecture skills,

and basic knowledge. It may also reflect a difference in gender paralleling

orientation: female instructors may show more people-oriented behaviors,

whereas male instructors might be demonstrating more task-oriented behaviors.

Although the classroom findings help to identify effective teaching

behaviors in the general college classroom and may be generalizable to dentistry

classrooms, one needs to appreciate the qualitative difference in content and

teacher-student interaction as one explores effective teaching in the clinic — a very

different setting than the college classroom. Moreover, the clinical setting

compounds the closer proximity of instructor to student, coupled with close and

continuing communication with clinical instructors, which results in the teaching

style and rapport that instructors have with students. Thus, instructors can have a

potentially greater influence on dental students’ learning in clinic than in classroom

settings. Studies on effective clinical teaching tend to focus on different

stakeholders: dental educators, both perceptual and anecdotal reflection data;

senior dental students’ perceptions; and third- and fourth-year dental students’

clinical instructor evaluations. Dental educators generally perceived effective clinic

instructor qualities to include constructive feedback and availability. For third- and

fourth-year dental students, interpersonal relations skills, availability, and

instructor-student relations were valued as being most important in a clinical

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instructor. Coupled with these effective clinic teaching behaviors was the ability to

maintain conditions for clinical learning, communicate with patients and students,

and demonstrate the instructor’s clinical competence and positive professional

behavior for students to model.

In dental education context of Mindanao Medical Foundation College

(MMFC), clinical teaching and learning has been less extensively examined.

Students' perceptions are so critical and important because they provide insight

into the factors that hinder teaching and learning in clinical practice and can

suggest approaches for improvement and can develop assessments to measure

clinical teaching effectiveness, to create criteria for the hiring and promotion of

clinical faculty and development, instructor training and evaluation, to plan for

future curriculum development, and create a foundation for future research. The

findings of this study can provide guidance in developing undergraduate dental

education, as teachers are being prepared to enter the teaching environment.

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B. Review of Related Literature

The study of dental students’ and clinical teachers’ perceptions on their

educational environment has become prominent in the last decade. Students and

clinical teachers—due to the interaction with a variety of forces and variables within

the clinical setting—can provide vital information and data characterizing the

instructional scenery and hence enhancing the quality of student experience.

Various studies have been carried out to characterize what quality teaching in

dental education is about including setting professional standards that can be used

as references for good practice. The research described below reveals a diversity

of instruments and variables used to explore dental students’ perception of

effective clinical dental teaching. Such assortment makes it difficult to follow

specific traits to raise conclusions accordingly. However, it is apparent from the

literature discussed below that there is a trend to discuss both the personal

qualities of effective teachers and clinical supervisors as well core competencies

in line with similar studies conducted across the other health professions.

Litzelman, Stratos, Marriott and Skeff8 conducted a study among 1,581

medical students who had previously evaluated 179 clinical teachers through

questionnaire data. The statistical validation of the questionnaire used in the study

yielded seven categories revealing distinct indicators of quality clinical teaching.

These seven categories were: establishing a positive learning climate, control of

the teaching session, communicating goals, promoting understanding and

retention, refining techniques for evaluating learning objectives, teachers’

feedback for further improvement and promoting self-directed learning. A study

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using the same instrument, the Stanford Faculty Development Program Clinical

Teaching questionnaire, was conducted by McGrath, Wai Kit Yeung, Comfort and

McMillan9 involving 148 dental students.

A qualitative study involving 175 dental and dental hygiene

undergraduate students examined their reasons for nominating their teachers to

teaching excellence awards. Schonwetter, Lavigne, Mazurat and Nazarko10

classified student responses into seven categories of effective teaching and by

classroom and clinic setting. These categories included: individual rapport,

organization, enthusiasm, learning group interaction, examinations and

assignments, and content breadth. At the classroom, setting organization and

rapport were the most valued attributes whereas at the clinic setting rapport was

the most favored quality.

Fugill using a combination of focus group interviews and questionnaire

surveys found that dentistry students value having quality feedback from their

educators, constant demonstrations of clinical procedures, the integration of

theoretical and practical knowledge as well as supporting learning styles leading

to student autonomy and self-assessment.

In responding to a questionnaire study, 619 dental students identified

‘breadth of interest’ and ‘meaningful experience’ as more favorable attributes in

their course experience, according to a study carried out by Henzi, Davis,

Jasinevicius and Hendricson. The scale ‘breadth of interest’ items referred to ‘the

faculty’s ability to address areas of interest outside the field of dentistry’. In turn,

the ‘meaningful experience’ scale items stood for ‘the degree to which structured
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learning activities were seen as relevant of the practice of dentistry and individual

items addressed the relationship between basic science and clinical experience’.

Dental students’ perceptions of their teachers through focus groups

were examined by Sweet, Wilson and Pugsley.13 Students were able to articulate

a variety of characteristics that makes clinical teaching special for their learning

such as the provision of opportunities where they learn through varied cases under

professional guidance. They also valued the learning by doing, developing their

psychomotor skills and working with other students. Students also appreciate the

debriefing component of the clinical session where they could discuss techniques,

procedures or alternative ideas.

C. Review of Related Studies

Foreign Studies

A qualitative study exploring the opinions of 300 students and

professionals on the characteristics of effective classroom teachers was carried

out by Jahangiri and Mucciolo. While students favored content design,

organization and development, dentists and physicians valued more speaker self-

confidence and expertize in delivering information. The study also showed that

both groups highly appreciate the elements of expertize in delivering information

and speaking style as teaching quality characteristics. A major limitation of the

studies reviewed above is the lack of the curriculum and logistics elements that

also explain the quality of the student experience. Ignoring the rich interactions
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among instruction, curriculum and logistics fails to recognize the richness and

complexity of the dental educational environment. Certainly, teaching

effectiveness takes place along with other situated variables situating learning

within a socio/cultural context. Dental academics, as any other educators, are

restricted by syllabus philosophies, content and educational resources, as well as

by logistics issues associated with teaching at health facilities.

Local Studies

A research study about teaching strategies conducted in University of

Mindanao by San Jose, Ph.D. (2015), concluded that strategies partly and wholly

dependent on the students’ needs and the teachers’ knowledge, experience, and

expertise. Nunan (1991) reiterated that “there never was and probably never will a

strategy for all”. This idea of Nunan is supported by Kappler (2001) who pointed

out that teaching does not solely rely in accessing a checklist of skills but rather in

understanding the strategies to adopt with different learners, in different curricular

conditions and in different cultural settings. It is suggested that innovations of the

existing effective teaching strategies must be enhanced to achieve desired

learning outcomes among the leaners. The study found out that teachers

commonly used the reporting strategy in teaching the lessons while the students

found lecture strategy to be effective in facilitating their learning.

.
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D. Statement of the Problem

The study aims to determine the effectiveness of classroom and dental

clinical teaching of Mindanao Medical Foundation College as perceived by dental

clinical students.

Specifically, the objectives of the study aim to answer the following

questions:

1. What are the demographic data of the respondents? In terms of:

1.1. Age

1.2. Gender

1.3. Clinical level

2. What are the perceptions of dental clinical students about the dental clinical

teaching in Mindanao Medical Foundation College?

3. What are the perceptions of dental clinical students about the classroom

teaching in Mindanao Medical Foundation College?

4. What are the dental clinical students’ opinions on the qualities and attributes

of an effective dental teacher?

5. What are the effective teaching and learning activities in clinical setting in

Mindanao Medical Foundation College?

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E. Research Framework

Theory Base

Thomas and Galambos (2004) argue that students are regarded as

consumers of higher education. University students’ satisfaction is important to

institutional success in that effective institutions have satisfied ‘customers’

because this satisfaction supports the enrolment of additional students or

‘customers’. Ratings of student satisfaction are becoming more transparent and

readily available. As a result, most universities around the world are constantly

looking at how to improve the satisfaction of students at their institution.

University students' satisfaction with their institution has individual,

institutional and social implications. From an institutional point of view, satisfied

students are more likely to continue in their studies (retention) and are more likely

to succeed academically and this is likely to enhance the financial position and

reputation of the institution. Satisfied students also make effective public relations

agents. High student satisfaction helps in attracting and retaining high achievers

who in turn increase the reputation and standing of the university.

Maintaining and improving students’ satisfaction has been considered

an important goal of education and universities (Orpen, 1990), with the assumption

that student satisfaction is indicative of institutional effectiveness (Barton, 1978).

A key factor of student satisfaction is the quality of the teaching staff. As a result,

the use of student rating scales as an evaluative component of their teaching

system has increased. The majority, if not all, teaching staff at most universities
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have been required or expected to administer some type of teaching evaluation

form to their students during each course offering for some time (Seldin, 1993).

Clinical teaching in medical education has been extensively examined.

Effective medical clinical teachers are considered to be those who have empathy,

are capable of providing support, exhibit flexibility, and have the ability to gauge

student development, in addition to being interpretive, focused, and practical.

Effective supervision of learners involves problem-solving by students and

instructors together, along with feedback, reassurance, and theory-practice linking.

There is preliminary evidence that effective clinical teaching in medicine may have

a positive impact on patient outcomes. For example, Fallon et al. found that patient

outcomes improved when direct supervision of the student clinician is combined

with focused feedback.

In a dental education context, clinical teaching has been less

extensively examined, for example, by O’Connor et al. Effective clinical instruction

in dentistry is associated with meeting teaching responsibilities, behavior

conducive to clinical learning, technical competence, and work enjoyment. The

ability to motivate students, explain difficult concepts, display interest in the

subject, show compassion and caring, and be proactive was also highly rated by

students in a study reported by Chambers et al. Clinical teaching in dental

programs is supported by a range of educational modalities supporting patient care

such as large group (e.g., lectures), small group (e.g., tutorials), collaborative (e.g.,

PBL), clinical case-based, interactive (e.g., role play), simulation, and computer-

assisted modalities. The perceived value of these modalities to clinical teaching

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and learning in dentistry can be considered in the light of making efficient use of

teaching resources, being able to objectify clinical sessions, facilitating

development of professional attributes, sharing common clinical concerns, and

affording a degree of individual student interaction.

Conceptual Framework

The conceptual model for our study is depicted as follows:

INPUT PROCESS OUTPUT

Effectiveness as
Classroom and Questionnaire perceived by
Dental Clinical Dental Clinical
Teaching Students
Strategies in Descriptive
MMFC Survey
Feedback

Figure 1. The Conceptual Framework of the Study

Figure 1 shows the conceptual paradigm of the study. The independent

variable in the study, which does not depend on or affected by the state of any

variable, is the Classroom and Clinical Teaching strategies at MMFC.

The dependent variable is the dental clinical students’ perception of the

effectiveness of the classroom and dental clinical teaching strategies in MMFC.

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F. Significance of the Study

The ultimate goal to be achieved from identification of effective teaching

qualities is improvement in clinical and classroom teaching for dentistry program

in Mindanao Medical Foundation College. This contribution to the body of

knowledge of effective and ineffective clinical instruction can suggest approaches

for improvement and can develop assessments to measure clinical teaching

effectiveness, to create criteria for the hiring and promotion of clinical faculty and

development, instructor training and evaluation, to plan for future curriculum

development, and create a foundation for future research. The findings of this

study can provide guidance in developing undergraduate dental education, as

teachers are being prepared to enter the teaching environment.

G. Scope and Delimitation of the Study

The study involves 80 dental student clinicians enrolled at Mindanao

Medical Foundation College, R. Castillo St, Agdao, Davao City, during the school

year 2019 – 2020. The selection of respondents are random and are only limited

to dental students in 31, 32, 41 and 42 clinical level.

The study is delimited to the teaching strategies the dental clinicians’

perceived to be effective and helpful.

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This study will be conducted with limited amount of financial resources

and time framework.

H. Definition of Terms

To attain a clear understanding of this work, the following terms are

defined:

Classroom and Clinical Teaching in this study is the concerted

sharing of knowledge and experience in the classroom and clinical setting, which

is usually organized in dental discipline and, more generally, the provision of

stimulus to the psychological and intellectual growth of a dental student.

Clinical Instructor / educator are responsible for providing effective

instruction and assessment during clinical practice trainings of undergraduate

dental medicine students in the classroom, lab, clinics, and hospital and

community facilities.

Dental clinicians in this study are students enrolled in the dentistry

program of MMFC who are on their 5th and 6th years and have clinics time on their

syllabus. This includes the 31, 32, 41, and 42 dental clinical level.

Effectiveness is the state of being effective. The term effective means

producing a desired effect. Effectiveness as used in this study refers to a positive

result of classroom and clinical teaching strategies as perceived by the dental

clinicians.

Likert scale is a rating scale, a psychometric scale commonly involved

in research that employs questionnaires. It measures how people feel about

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something. It includes a series of questions that you ask people to answer, and

ideally 5-7 balanced responses people can choose from. It often comes with a

neutral midpoint.

Student Perception of teaching and learning in the study is a student

thoughts, understanding, beliefs and interpretation of the effectiveness of teaching

strategies in the dental medicine course.

Student Satisfaction is defined as the favorability of a student’s

subjective evaluation of the various outcomes and experiences associated with

education. (Oliver & DeSarbo (1989) cited in Elliott & Shin (2002).
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