Olivia Sheridan

Like most clinical educators, my experience in both teaching and learning clinical dentistry reflects directly on my own training, not as a teacher, but as a clinical student. Much of what I incorporate in clinical teaching is modeling some of the effective methods in my own learning, being aware of some which were far less effective, and developing some that students have taught me through the years through their comments, reactions, and feedback. Although I am reflecting on clinical teaching experiences, I find that these strategies are universal in almost all teaching and learning interactions.

What I have learned, and what seems applicable in all teaching environments, are a few universal strategies. I read all of my evaluations at the end of the semester and let each class or group know that I have read them, thanking them for their candor. I also let them know how I intend to use suggestions, and appreciate the affirmation of what is working. Through the years there have been some truly excellent suggestions from students which would never have been realized without their feedback. When a new class or semester starts and I have made changes, I note with the new class that “this has changed” and why. 

Dental education is unique in that third-year students are responsible, under faculty guidance, for all of their assigned patients, including dental care, and also the financial and medical interpretation and supervision. The student’s experience has been limited to classroom learning previously, and they are reliant on that understanding of appropriate progress and outcomes, in real time and in the presence of their awake patients. This unique model of education also demands faculty engage in a process of reflection and re-evaluation of teaching effectiveness. Teaching and shaping critical thinking skills while simultaneously supporting the student and developing trust with the patient is complex. As a result, I always ask the students I have taught for feedback in the moment (Was that helpful? How can I relate this to what you know?) as well as in later group discussion. 

Giving constructive criticism varies from individual to individual, and always involves context. One of the most effective methods I have found starts before the student and I interact in the classroom or on the clinic floor. I meet with the students I will be working with and try and learn interesting facts about them (athletics, cooking, etc.) and what their motivations and interests are in the profession. I give better feedback when I know students as individuals in the same profession who have different goals and experiences than I do. When a prior meeting is not possible, I ask students to submit a paragraph in advance of the clinical rotation which gives a brief summary of special interests and goals that are important for them. I also use what the Dental School calls the “face page” to reinforce the names and faces of each student so I can use their name and interest/experiences as often as possible during teaching. Reinforcing how I see each student individually enables me to remember and refine each teaching interaction and build on it. I also find that students respond to guidance much more positively when it is directed to them specifically and reflects a conversation rather than isolated approval or correction.

Giving feedback, offering suggestions, and making corrections in the presence of the patient (or the presence of peers) present challenges when I hope to simultaneously encourage critical thinking and create trust in the patient while not adding to the stress of the student. My first approach is to allow that student to display the usually substantial knowledge base they have by asking questions such as “what are you currently learning/understanding about (this)?”; “when you saw/heard/read this, did it remind you of…?” Skillfully asking students to access what they know, answers the direct question, but also helps them formulate a thought process for future problem-solving and also elevates them in the patient’s and peer’s eyes by letting them demonstrate their knowledge as well as their previous experience.

Occasionally discussions and corrections are inappropriate to hold in the presence of others. For those times, my students and I have created what we refer to as “consult corner,” a physical location within the clinic where we cannot be observed or heard. In consult corner, no question or opinion is discounted and everyone withholds judgment. We pull apart the matter at hand: concerns about the patient, a procedure that went poorly and why, multiple interpretations of a fact and the relevance of each point of view. Anyone may call for a consult corner discussion at any time, and aside from sorting out the specific issue, students learn the value of critical thinking: it’s okay to seek other input, impossible to always know everything, and that everyone has personal limitations. We resolve patient interaction issues with discussion and create a detailed plan for subsequent interactions. In these consults I learnt: in what procedures students have less confidence, when there is a breakdown in patient relations, when students feel a lack of knowledge. Because there is no judgment, we can allow our vulnerability to enhance our understanding of each other and explore our individual abilities and weaknesses. Students are frequently stymied about some procedures and anxious that they don’t have the ability to understand the diagnostic needs and the technical assessments of their patients. As students make their way through the procedure or concept, they are often halted by mostly trivial setbacks and lose their confidence. When I see this occurring, I am reminded of my sometimes hysterical frustration at trivial setbacks in my use of new technology and my inability to move forward with technology I thought I had already mastered. This is one of many analogies I use in comparing their ease in the use of technology, versus, say, my ease in thinking about dentures, or whatever is their stumbling block. I try and create the expectation that we all have areas which intimidate us, but we also have resources to get through it. I also remind them that most of us understood and mastered the Krebs cycle and the autonomic nervous system, among other roadblocks, through sheer determination and persistence and the help of others.

Finally, I often share my own disasters and near disasters. “When I did this for the first time...” type stories resonate with those who are doing it for the first time. I remind myself that they haven’t seen the years it’s taken me to improve; they only see the results. I reinforce that I do get things wrong, and when I have down time, I can sometimes pull up cases that I would do differently, or diagnoses that I might reconsider. As part of the discussion (often in consult corner or my office), we talk about how it is okay to be wrong, but also important to acknowledge when you are wrong so you can work, individually or with others, to improve. I try and let them know that I also continue to learn, and it’s often from them.

Olivia Sheridan is a clinical professor in the division of restorative dentistry in Penn Dental Medicine. 

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This essay continues the series that began in the fall of 1994 as the joint creation of the College of Arts and Sciences, the Center for Teaching and Learning and the Lindback Society for Distinguished Teaching. 

See https://almanac.upenn.edu/talk-about-teaching-and-learning-archive for previous essays.