My original idea to drive change in my organization is still something I want to do. My vision is to see a day when dental hygienists actively collaborate with other healthcare providers to improve health outcomes for their patients. Some examples would be: a hygienist discussing high blood pressure readings with a patient’s primary care physician or referring a patient to get screened for diabetes because the patient hasn’t healed well after periodontal therapy. There are so many health conditions that manifest themselves in the mouth; it’s important to realize that oral care is a healthcare specialty. After all, the mouth is connected to the body. Why are dentistry and healthcare seen as separate entities?
I can envision hygienists, nurses, dieticians, and other professionals working together to help patients achieve good overall health.
My idea for interprofessional collaboration would start with professional education. This would begin in the classroom, where students from different disciplines would take courses together with the goal of getting them accustomed to communicating with each other and collaborating on case studies. The research thus far indicates that blended learning would be an ideal vehicle to accomplish this.
With this goal in mind, I want to start with a smaller, more manageable piece of the puzzle. I think small changes are necessary before big changes can be successful. My focus right now is to take one of my classes, Radiography, and turn it into a blended course. Once I can show our PD and Academic Dean how successful it can be, we can move toward converting more classes and eventually achieve assimilation of different disciplines into blended courses that they take together. It will be double blended: blending different types of students in online blended courses! I’m excited for our future…
In reviewing the literature, it is clear that blended learning offers many benefits: for students, but also for the institutions that offer this teaching modality. There are different models of blended learning in which the learner spends various blocks of time learning online and in a brick-and-mortar classroom. Used properly, it allows for deeper learning of the material. Students enjoy the flexibility of taking part of their courses online, but with the added benefit of face-to-face interaction with the instructor and other students in the classroom. Blended classrooms are meant to engage and motivate students, and the research supports this finding. However, if a blended learning model is to be adopted successfully, it is important to investigate and learn from others who have integrated technology in a learning environment. This literature review discusses what blended learning is, how it can benefit our students, and potential pitfalls in its implementation.
The Four Basic Models of Blended Learning
Blended learning is defined as a “formal education program in which a student learns: at least in part through online learning, with some element of student control over time, place, path, and/or pace, at least in part in a supervised brick-and-mortar location away from home; and the modalities along each student’s learning path within a course or subject are connected to provide an integrated learning experience” (Christensen, 2015). Blended learning integrates both face-to-face and online teaching modalities, creating a cohesive learning experience. These hybrid approaches can foster independent learning and collaboration, as well as facilitate better communication among students and between students and instructors (Horizon Report, 2016). Christensen divides blended learning into four main categories: Rotation, Flex, A La Carte, and Enriched Virtual. The Rotation model includes four sub-models: Station Rotation, Lab Rotation, Flipped Classroom, and Individual Rotation (Christensen, 2015).
The Rotation model is where students rotate through learning modalities on a fixed schedule, at the discretion of the instructor. It includes an online component. Learning modalities may include group assignments, full-class instruction, traditional paper-and- pencil assignments, tutoring. It mostly takes place in the brick and mortar classroom, except for homework. The flipped classroom approach is a well-known subcategory of the rotational model, where learners participate in online learning and receive the primary content off-site. They then attend class where they participate in teacher-guided learning activities, practice, and projects (Christensen, 2015).
The Flex model describes a course in which online learning is the “backbone”, and students have a customized schedule among learning modalities. Students learn mostly on campus, except for homework. The teacher is on-site and provides support as needed (Christensen, 2015).
The A La Carte model is a mixture of online and brick-and-mortar classes. The student will take some classes completely online which accompanies his or her experiences at the school or facility. This differs from taking courses completely online because a full-time online schedule is not considered a “whole school experience” (Christensen, 2015).
Finally, in the Enriched Virtual model, most of the learning occurs online, on the student’s schedule. It differs from online classes because there are some required face-to-face meetings with the instructor of the course (Christensen, 2015).
How Students Learn
Before analyzing different methods and technologies used in teaching, it is vital to have a solid understanding of how students learn. In How Learning Works, Ambrose, Bridges, DiPietro, Lovett, and Norman (2010) list seven research-based principles for effective teaching. One of the principles is how prior knowledge can help or hinder learning. When previous knowledge of a topic is inactive, insufficient, inappropriate, or incorrect, it hinders learning. On the other hand, when activated, sufficient, appropriate, and correct, it helps learning. They explain how teachers often overestimate students’ prior knowledge, thus building new knowledge on a shaky foundation (Ambrose et al, 2010, pg. 12)
Students participating in a blended learning environment have the advantage of learning the foundational knowledge at their own pace, online. This allows for deeper learning to take place while in the classroom. In 2005, one study at Pennsylvania State University Berk’s College, a chemistry class was conducted as a blended course. Realizing that students needed certain foundational knowledge to understand more advanced topics and participate in critical thinking, the faculty built online guides with resources for the students. The end result of this blended design increased student engagement, retention, and nearly doubled pass rates (Amaral & Shank, 2010).
Another important factor in learning is engagement and motivation. Motivation is key in learning outcomes. If students do not find the course material interesting or relevant, they might see little value in mastering the subject matter, or engaging in behaviors that facilitate deeper learning (Ambrose et al, 2010, pg. 69).
Blended learning does not imply that educators should not teach and emphasize certain core knowledge, skills, and dispositions in students, but that to successfully accomplish these goals, schools should be “intrinsically motivating” (Horn & Staker, 2014).
A study at the University of Massachusetts followed the 5-year results of conducting a chemistry class in the traditional way vs. a blended format. The research found that the blended format increased student engagement. This led to more active learning in class and resulted in a net test score increase of 12% over the traditional classroom model. A review of 20 studies, funded by the Bill & Melinda Gates Foundation, showed similar results, indicating that blended learning increases student engagement, motivation, and ultimately student success (Horizon Report, 2016, pg. 18).
Experience shows that blended classrooms enhance student learning and retention; it further engages the students using digital learning materials such as podcasts, interactive multimedia tutorials, and videos (Amaral & Shank, 2010).
Other Benefits of Blended Learning
A critical component of blended learning is reduced seat time. Students are free to pursue their education on their own schedules, which is a very attractive draw for many adult learners (Morrison, 2013). Colleges and Universities are increasingly offering online courses for students to address financial and time constraints, and issues of balancing work and family obligations. In fact, 32% of students surveyed in a study by JISC indicated that technology influenced University choice (Horizon Report, 2016, pg. 18). Morrison (2013) explains that “blended learning develops a skill set for students that otherwise would not be possible in exclusive face-to-face instruction. Skills include digital citizenship, information management skills, self-directed learning, and web research and collaboration skills.”
Finally, a benefit for the learning institution is the ability to manage facility resources more efficiently and allows for the teaching of many more students in a term (Morrison, 2013).
Teaching a Blended Class
In 2010, Resta insisted that we need to prepare teachers to teach in online and blended learning environments. Online courses and blended courses have grown exponentially in recent years and is projected to continue well into the future. Unfortunately, few teachers are learning to teach online classes. “Twenty-first century educators must get training and experience in online and blended learning environments as part of their educator development programs so that they master the skills to teach in such environments” (Resta, 2010).
Teachers must understand what students are trying to accomplish and what experiences are needed to help them accomplish those goals. Then, the teacher must assemble the right resources and integrate them in the right way to deliver those experiences (Horn & Staker, 2014). Done well, this learning style preserves the benefits of the old way (traditional classroom), and provides new benefits: personalization, access, equity, and cost control (Horn &Staker, 2014). This is particularly important to adult learners who have specific goals, but feel limited by the traditional classroom due to work schedules or other obligations.
Applications for Healthcare
One of the most critical elements of a healthcare program is to teach students interpersonal communication skills and interprofessional collaboration. Good communication skills with patients and other healthcare professionals is stressed in all types of programs to ensure that patients understand their health conditions, treatment options, and the risks and benefits of those options. It is also vital that healthcare professionals from different disciplines work together to ensure optimal patient care and reduce the possibility of errors that may result due to lack of communication between professionals regarding the care of a patient. A study was published using a course at East Tennessee State University that uses a blended learning model specifically for increasing communication skills of healthcare providers with their patients and other providers. It is a 2-credit course, titled Communication Skills for Health Professionals. The course combines online learning modules with 3-hour face-to-face group sessions. The students who take this course come from the medical, nursing, pharmacy, and psychology disciplines. At the time of the study, the students taking the course were medical and pharmacy students. The lessons include topics such as rapport building, active listening, and interprofessional communication skills. The research concluded that the blended model was very successful in teaching these skills, as evidenced by pre- and post-skill assessments. Some limitations noted in the article are the fact that the study was limited to only one learning institution, and the focus was on oral communication; written communication was not assessed (Hess, Hagemeier, Blackwelder, Reid, Ansari & Branham, 2016). I would also include the fact that this course was not compared with similar all online or all face-to-face courses as a major limitation, even though the blended course was deemed successful.
In another study undertaken in Universities in Uganda, Sweden, and South Africa, the blended learning model was piloted in healthcare fields including clinical research, pharmacology, obstetrics, epidemiology, and health systems research. The courses included structured learning material, recordings of synced sessions, guides to self-directed activities and communication tools online. In the classroom, synchronous learning occurred in the form of lecture, discussions, demonstrations, and labs. At the end of the study, 94% of the students surveyed said they would recommend the blended course to someone else. They generally felt supported during and between the synchronous sessions, collaborated with each other, engaged in active learning (individualized assignments), maintained high expectations for learning, and felt that the blended model showed respect for diverse talents and ways of learning (Protsiv, Rosales-Klintz, Bwanga, Zwarenstein & Atkins, 2016).
Lessons from Failures
One of the problems with incorporating technology such as with a blended model, is when the focus is on the technology, and not in the paradigm shift that needs to occur with learning. A huge improvement that occurs with a blended model is the ability to move students toward the higher levels of Bloom’s taxonomy; the students can learn the bulk of the foundational knowledge and its applications at home, then work on more project-based activities in the classroom that result in deeper learning at the analysis, evaluation, and creation levels. An example of focusing on technology was discussed in “ICT in Innovative Schools”. A Greek teacher mentioned that the children are more excited to type a paper on the computer, which is great because the kids are more engaged, but it is simply swapping one mode of doing something with another. This type of change doesn’t result in the paradigm shift needed in education. Another example would be having students take an online multiple-choice test. No deeper learning is occurring solely with the addition of technology. The focus must be on the learning, using technology as an adjunct. In the same article, the authors noted a different strategy used in Finland and Japan, where the focus was based on learning how to take responsibility for their own learning (ICT in Innovative Schools, n.d.). The focus on technology can seem progressive but can be the same old teaching methods, just dressed up. Consider: “One of the most popular headlines these days is about school systems celebrating the adoption of 1-to-1 programs. But the fact that a district has a 1-to1 program tells us nothing about what kind of teaching and learning is happening in schools” (Fagnani, 2014).
Another potential failure in implementing blended learning would be a lack of preparedness in following guidelines prescribed by our IT department or software company for the online portion of the class. Whatever software we would use (Blackboard, Moodle, etc.) would require that protocols are followed and training is provided. A glaring failure of this was the Los Angeles iPad initiative in which Apple’s deployment guidelines were not followed, leading to a “hack” of the iPads (Chambers, 2014).
Professional development is also key. In her article, “Rolling out Blended Learning”, Fagnini (2014), stresses using instructors who are familiar with technology to slowly start implementing blended learning in their classrooms. Some instructors will be hesitant to pilot a blended course due to lack of technology skills. The more knowledgeable instructors can help the others when they are ready to try a blended model for their classes.
This highlights the important success factor of teacher collaboration. Often, teachers feel that their work is in the classroom, and not in collaborating with other teachers. This was one of the problems faced by an Oakland, CA school where over half their students were failing English. Once strong leadership stepped in, teacher collaboration was promoted, and a blended learning model helped those students excel. In fact, two years later, nineteen percent of those students scored as “advanced” in English. Prior to this, that number was zero (Roscoria, 2012).
After reviewing the literature, the blended learning approach seems promising. The research has shown that it can help students learn their material more deeply, and can engage and motivate learners. It has been shown in several studies that students’ test scores are ultimately better in a blended learning environment vs. a traditional classroom. It extends flexibility to the working adult and/or parent who may not have a schedule that permits him or her to attend classes in a traditional setting. Blended learning can save resources for the school, and allow for more students to be reached in a given term, but it also allows for face-to-face interaction with the teacher that some students may need or want.
I would like to read more about the different models of blended learning and the pros and cons of each; this would give me a better understanding of what would work best in a career college setting, where a large amount of the learning is hands-on in a lab or clinic setting. It seems that blended learning would work very well for didactic courses, especially considering that adult learners come from a wide range of experiences and foundational knowledge. As more colleges and universities adopt this style of teaching, it will become a standard that many students will benefit from- and even expect.
Before piloting a blended course, it is important to learn from the mistakes of others and avoid making those same mistakes. The most important factor is to keep the focus on the learning, and to strive for learning at the higher levels of Bloom’s Taxonomy. When the focus is on the technology, the learning is simply a dressed-up version (and more expensive) of the same style of learning that was employed previously. Following IT’s instructions and the instructions of our chosen software will be critical to avoid mistakes such as in the Los Angeles iPad initiative. Blended learning has so many advantages, it is clearly worth initiating. I am confident that utilizing a blended format for a health care program, such as dental hygiene, will benefit our students and the future patients they will serve.
Amaral, K.E. & Shank, J. (2010). Enhancing Student Learning and Retention with Blended Learning Class Guides. Educause. Retrieved from http://er.educause.edu/articles/2010/12/enhancing-student-learning-and-retention-with-blended-learning-class-guides
Ambrose, S., Bridges, M., DiPietro, M., Lovett, M., & Norman, M. (2010). How Learning Works. 7 Research-Based Principles for Smart Teaching. San Francisco, CA: Jossey-Bass.
Chambers, B. (2014). L.A. cancels iPads-in-the-schools program: a failure of vision, not technology | Macworld [Web log post]. Retrieved from http://www.macworld.com/article/2599988/lausd-ipad-cancellation-is-a-failure-of-vision-not-technology.html
Christensen, C. (2015). Blended Learning Definitions. Clayton Christensen Institute for Disruptive Innovation. Retrieved from http://www.christenseninstitute.org/blended-learning-definitions-and-models/
Fagnani, S. (2014). Rolling out blended learning. District Administration, 50(8), 69
Hess, R., Hagemeier, N. E., Blackwelder, R., Rose, D., Ansari, N., & Branham, T. (2016). Teaching Communication Skills to Medical and Pharmacy Students Through a Blended Learning Course. American Journal Of Pharmaceutical Education, 80(4), 1-10.
Horizon Report. (2015). Higher Education Edition. Retrieved from http://cdn.nmc.org/media/2015-nmc-horizon-report-HE-EN.pdf
Horizon Report. (2016). Higher Education Edition. Retrieved from http://cdn.nmc.org/media/2016-nmc-horizon-report-he-EN.pdf
Horn, M. & Staker, H. (2014). Blended Learning is About More than Technology. Retrieved from http://www.edweek.org/ew/articles/2014/12/10/blended-learning-is-about-more-than-technology.html
ICT in Innovative Schools. (n.d.). Retrieved from http://www.oecd.org/site/schoolingfortomorrowknowledgebase/themes/ict/41187025.pdf
Morrison, D. (2013). Is Blended Learning the Best of Both Worlds? Retrieved from https://onlinelearninginsights.wordpress.com/2013/01/17/is-blended-learning-the-best-of-both-worlds/
O’Byrne, W. I., & Pytash, K. E. (2015). Hybrid and Blended Learning. Journal Of Adolescent & Adult Literacy, 59(2), 137-140. doi:10.1002/jaal.463
Protsiv, M., Rosales-Klintz, S., Bwanga, F., Zwarenstein, M., & Atkins, S. (2016). Blended learning across universities in a South-North-South collaboration: a case study. Health Research Policy & Systems, 141-12. doi:10.1186/s12961-016-0136-x
Resta, P., & Carroll, T. (2010). The Summary Report of the Invitational Summit on Redefining Teacher Education for Digital-age Learners. Retrieved from http://redefinete. achered.org/sites/default/files/SummitReport.pdf?q=summitreport
Roscorla, T. (2012, July 11). Collaboration, Leadership Key in Oakland, Calif., School Turnaround. Converge.
In Carol Dweck’s quest to change our mindsets from fixed to growth, she lists four steps to enlist positive self-talk that will train us to stop labeling ourselves and start growing:
Step 1: “Learn to hear your fixed mindset ‘voice’”. Look at how you approach challenges, setbacks, and criticism. When you face a challenge, do you worry that you’ll be “a failure” if you fail? Do you quit easily when you hit a setback because you want to keep your dignity? Do you get angry when people give you criticism; do you hear them saying “you’re not capable” when they’re actually offering constructive criticism that could make your work better?
Step 2: “Recognize that you have a choice. How you interpret challenges, setbacks, and criticism is your choice”. Instead of focusing on your beliefs that you either have talent, or you don’t, interpret these things as opportunities for growth.
Step 3: “Talk back to it with a growth mindset voice”. Change your fixed mindset by rephrasing how you approach a challenge, setback, or criticism. Instead of saying “Are you sure you can do it? Maybe you don’t have the talent”, say “I’m not sure I can do it now, but I think I can learn with time and effort”.
Step 4: “Take the growth mindset action”. Accept challenges, learn from mistakes, and think of criticism as a tool for growth.
This growth mindset is important if we want to reach our full potential. In “The Power of Belief- Mindset and Success”, Eduardo Briceno argues that the way we think influences our efforts. I can relate to this argument by looking at biology. All traits have a genetic and an environmental component. Oftentimes, the environmental component is just as strong or stronger than the genetic component. Take for instance, height: it isn’t a set characteristic. Children will grow taller if given the best nutrition; conversely, a poor diet can stunt growth. Even love and affection from others influences how well a baby thrives. We can’t change the genetic component, but we can set up the right conditions for growth. This is why we need to stop focusing on intrinsic talents or our perceived intelligence because they are not fixed, as some would think. They can be influenced and developed. Dweck and Briceno aren’t saying that anyone can become president if they just put their minds to it. That would be an oversimplification- like saying that if I feed my 2-year old enough vegetables, he’ll be 7 feet tall- not likely with both parents under 5’9”. This isn’t some cliché “just-adopt-a-positive-attitude…I think I can I think I can” self-help idea, as Alfie Kohn asserts in his article, “The ‘Mindset’ Mindset”. Carol Dweck is saying that the growth mindset is the right environment for success, for reaching our own potential.
In my Learning Philosophy, I make a statement that seems obvious: “The whole point of education should be to help the students learn- and learn deeply”. Unfortunately, many schools and teachers fail to create an environment where learning reaches its full potential. Kids who are praised for being “smart” are actually hindered in the learning process because they develop a fixed mindset and feel like they have to maintain that perception. They challenge themselves less to ensure that they will succeed. They give up easily and think that because they’re smart, they shouldn’t need to put effort into their work. They don’t like criticism and feel threatened by the success of others. This is counterintuitive in a culture that tells us we have to praise our kids so they’ll have good self-esteem. The key is in praising effort and not labeling kids- even if it’s positive labeling. It leads to wanting to look smart, and it actually hinders learning. When we praise efforts, we’re encouraging a growth mindset. People with a growth mindset believe that intelligence and talents can be developed. They embrace challenges, don’t give up, see effort as a pathway to mastery, and learn from criticism because it helps them grow. One of the things I can do to encourage a growth mindset is to be careful with my criticism: if a student hasn’t done a good job on an assignment, or doesn’t “get it”, I will let them know that they’re not there yet. The simple word, yet, implies that it’s possible to get there; it just requires more effort.
Our current educational system focuses heavily on what students know (standardized testing) instead of what they can do with what they know. The latter requires a need to know how to learn because information is constantly changing and growing in breadth. This is why it’s critical to cultivate a growth mindset in the digital age. In my article, Creating a Significant Learning Environment, I touch on ways to create the conditions for deeper learning. Imagination, play, and questioning are central to cultivating a passion for learning. In combination with encouraging a growth mindset, I want students to realize their potential is way beyond what they may imagine.
Encouraging a growth mindset in adult learners is going to require more than simply praising their efforts. They’ve had too many other outside influences that shape how they see themselves and how much they think they can do. Shifting their coursework away from a solitary focus on foundational knowledge that includes application, integration, human dimensions and caring, and learning how to learn is going to help create that significant learning environment. I outline my ideas for implementing authentic learning in my BHAG and also in Understanding by Design; they’re slightly different approaches to designing a course, but both are useful. I also plan on introducing my students to Carol Dweck’s work so they can understand what kind of mindset they dwell in, and hopefully make changes if necessary.
Creating the right environment for learning is no easy task. It flips traditional ideas of classroom learning on its head and turns it into something different- something far better. Many people don’t like change, so knowing that there will be opposition will require perseverance, something that can’t be done with a fixed mindset. I realize that my innovation plan is a huge goal. I have told myself that it might be too big to pull off. That kind of thinking is giving up before I have even begun because I don’t want to be seen as a failure- even if it’s only in my own mind. I need to change my thinking and say to myself “I have this huge dream that will only be successful if I’m willing to try. I may not be ready now, but I can progressively work towards success.” That kind of thinking will drive effort and ultimately, success.
Dweck, C. (2006). Mindset: The new psychology of success. ISBN 978-0-345-47232-8. New York: Random House Publishing Group.
Dweck, C. (2010). How can you change from a fixed mindset to a growth mindset? Retrieved from http://mindsetonline.com/changeyourmindset/firststeps/index.html
Harapnuik, D. (2013). Fixed Vs Growth Mindset= Print Vs Digital Information Age. Retrieved from http://www.harapnuik.org/?p=3627
Kohn, A. (2015). The “Mindset” Mindset. Retrieved from http://www.alfiekohn.org/article/mindset/
TEDx. (2012). Eduardo Briceno: The Power of belief- mindset and success. [Video file]. Retrieved from https://www.youtube.com/watch?v=pN34FNbOKXc&feature=youtu.be
Tucker, C. (2014). Fixed vs. Growth Mindsets: Activity 7.4. [Video file]. Retrieved from https://www.youtube.com/watch?v=-x6WeupKgVE
Last week, I explored backward design by using Fink’s 3-column table and my BHAG. For this assignment, I experimented with Understanding by Design, a similar, but much more detailed model for backward design. I appreciate both methods, as they are focused on outcomes. UbD makes a point to ensure that the curriculum is focused on deeper learning, not just recall of information or pointless (although engaging) activities.
After working with both models, I strongly prefer Fink’s 3-column table with my BHAG over UbD. It’s clear, simple, and outcome-focused. It can be used as an overview for an entire course and also for individual class meetings.
That being said, UbD helped me understand how to effectively design a course. These processes can be used not only to design courses, but I imagine I can apply them to my Innovation Plan as well. I can develop learning outcomes for Dental- Medical Collaborative Care and use backward design to incorporate the activities necessary across all dental hygiene courses.
Here is my UbD plan for Dental Radiography:
|Stage 1: Identify Desired Results|
- Learners will investigate the concepts of electromagnetic radiation and how X-radiation is used in dentistry.
- Learners will practice radiography skills and trouble-shoot errors.
- Learners will analyze how taking quality radiographs aids in proper diagnosis for their patients.
- Learners will analyze the importance of safety for themselves and their patients.
- Students will investigate new technology in radiography and how it can improve upon current modalities.
What essential questions will be considered?
What understandings are desired?
|What is X-radiation and how is it different from other forms of radiation?
How is X-radiation used for medical and dental purposes?
What are the criteria for clinically acceptable dental radiographs?
How can errors be identified and corrected?
How do we ensure safety for ourselves and our patients when working with X-radiation?
What will dental radiography look like in the future?
|Students will understand that…
There are different energies associated with different types of electromagnetic radiation.
Natural background radiation exists, comprising about half of human exposure to radiation.
Man-made dental X-rays are short wavelength, high energy forms of ionizing radiation.
Good radiographic technique and skill are vital in order to minimize retakes and produce quality, diagnostic radiographs.
Without the aid of radiographs, many conditions such as periodontal disease, caries, abscesses, cysts, and impacted teeth could remain undetected. Radiographs assist in earlier diagnosis which greatly improves treatment outcomes.
The American Dental Association has guidelines for prescribing radiographs that align with the concept of ALARA (As Low as Reasonable Achievable) that stresses evaluating each individual’s needs for X-rays.
What key knowledge and skills will students acquire as a result of this course?
|Students will know…
Key terms: electromagnetic radiation, X-radiation, radiograph, kilovoltage peak (kVp), milliamperage (mA), developer, fixer, safelight, digital sensor, bitewing, periapical, occlusal, panoramic, Cone Beam Computed Tomography, ALARA
What radiation is and how it can produce images on film
Different types of radiographic projections
The differences between analog and digital radiography
How X-radiation affects biological tissues and the importance of safety and precautions
The ADA guidelines for prescribing dental radiographs
Future trends and new technology in radiography
|Students will be able to…
Decide which radiographs are appropriate for different situations
Take, develop, and mount diagnostic dental X-rays
Use digital imaging to obtain radiographs
Assess their skills and make corrections in technique as needed
Use proper safety precautions for themselves and their patients
Interpret dental radiographs
Research new technology that will likely be used in dental radiography in the future
|Stage 2: Determine Acceptable Evidence|
What evidence will show that students understand?
|Project and presentation: using the learner’s choice of media, they will address and discuss safety concerns. Examples may include: PPE, dosimeters and lead aprons, calibration of machines/ quality control, radiographs on cancer patients, biological effects of radiation, Osteoradionecrosis, non-medical/dental sources of radiation, minimizing re-takes and unnecessary exposure
Project: based on their research, learners will imagine their ideal radiography operatory for the future. They will include:
The type of technology they want to incorporate and why
What brands they prefer
How it will benefit the patients
How it will benefit the dental practice
What other evidence needs to be collected in light of Stage 1 Desired Results?
|Graded sets of radiographs, Chapter minute papers, pre- and post-class Kahoot quizzes, Midterm exam and Final exam
Student Self-Assessment and Reflection:
|Learners will assess the radiographs they take in class for acceptability, based on the criteria for diagnostic radiographs
Learners will identify their errors and explain how to correct them
Learners will discuss in class and share their experiences as dental assistants or dental patients, and how they will do things differently after this course
|Stage 3: Plan Learning Experiences|
|1. Ask the students “Can people become radioactive when they are exposed to X-rays?”H
2. Learners will read assigned chapters in their textbook, Essentials of Dental Radiography for Dental Assistants and Hygienists for each class meeting. W
3. Instructor will give a pre-class Kahoot quiz on the reading material (not graded; no point value) E
4. Instructor will present material at each class meeting, encouraging student discussion, interaction and participation E
5. Instructor will give the same Kahoot quiz at the end of class to help with retention of the material and to practice questions that will cover the same material on the Midterm and Final E
6. Lab: hands-on practice with taking X-rays on Dexter: traditional film and digital sensors; all types of projections. T E
7. Students write a daily journal entry on their successes and how they can improve R E
8. Practice developing films in the darkroom E
9. Practice mounting radiographs E R
10. Practice using Dexis and Dentrix software O E
11. Discuss case studies: compare poor quality radiographs with good ones, noting what can be diagnosed from each film E R
12. Discuss personal experiences in dental offices regarding X-ray protocols R W
13. Review the ADA guidelines for prescribing dental radiographs. Discuss why some offices allow insurance to dictate how many and what type of X-rays are taken on patients. Discuss the ethics of this practice and ALARA R E
14. Research current technology for dental offices and possibilities for future technology E R
Learning Activities Key:
What learning experiences and instruction will enable students to achieve the desired results? How will the design
W = Help the students know Where the unit is going and What is expected? Help the teacher know Where the students are coming from (prior knowledge, interests)?
H = Hook all students and Hold their interest?
E = Equip students, help them Experience the key ideas and Explore the issues?
R = Provide opportunities to Rethink and Revise their understandings and work?
E = Allow students to Evaluate their work and its implications?
T = Be Tailored (personalized) to the different needs, interests, and abilities of learners?
O = Be Organized to maximize initial and sustained engagement as well as effective learning?
Wiggins, Grant; McTighe, Jay. Understanding by Design, Expanded 2nd Edition (Page 22). Association for Supervision & Curriculum Development. Kindle Edition.
Dental hygienists are expected to know how to take diagnostic radiographs and how to interpret them. Dentists will expect them to be able to discuss findings with the patient for educational purposes. Although dental hygienists cannot legally diagnose pathology, they need to have an understanding of normal anatomy and how to recognize pathology including, but not limited to: periodontal disease, caries, periapical pathology, cysts, and other abnormalities of teeth and bone. Their ability to interpret the radiographs and educate the patient is critical so that they can collaborate with the dentist and patient to create a treatment plan that will result in quality care for the patient.
The Radiography course I teach is an undergraduate level class that meets twice a week: 3 hours in a live classroom setting and 3 hours of lab. With 24 students in the class, the lab is divided into A and B groups, consisting of 12 students in each lab. We have Wi-Fi in the classroom, enabling the students to access pertinent websites or participate in online class activities and games. In the lab, we have a Dexis digital sensor for taking radiographs and a digital panoramic X-ray machine. The practice management software we use is Dentrix, which is compatible with Dexis. All digital X-rays are uploaded to the patients’ digital charts for ease of flipping back and forth between the X-rays and other data such as periodontal probe readings or intraoral camera pictures.
The class combines both theoretical and practical learning. The theoretical learning occurs mostly in the classroom and the practical learning occurs mostly in lab. One of the important changes in our field is the introduction of 3-D imaging (primarily Cone Beam Computed Tomography) that is predicted to become a common addition to dental offices in the future. It will improve our ability to view the tissues and subsequently improve treatment. Dental radiography is in the middle of a transition from film-based radiography to digital imaging. CODA (The Commission on Dental Accreditation) requires that we teach both, and it’s a good practice because there are still dental offices in the area that haven’t switched to digital imaging systems.
The students I teach come from varied backgrounds. They are all adult learners, but the ages range from the early 20’s to the mid 40’s. Many of them have experience as dental assistants; this can work for or against them. Sometimes they have bad habits that need to be identified and corrected so they can learn better ways of doing things, but also so they don’t spread their bad habits to other classmates. They come from different socioeconomic groups and cultural backgrounds, but they all share the common goal of becoming hygienists. Many are military veterans.
This will be my third time teaching this class. I have 13 years of practical experience gained by working in clinical practice. I love teaching this class because it’s challenging, fun, and very applicable to the profession of dental hygiene. My strengths are in giving the students real-world examples, hands-on activities, and breaking down difficult topics (chemistry, physics) in a way that makes it easier to understand. Students often comment that they can tell I love what I teach. I’m glad I can share my passion with them and hopefully instill it.
Questions for Formulating Significant Learning Goals
A year (or more) after this course is over, I want and hope that students will know how to safely take quality diagnostic radiographs, interpret them, and be able to discuss findings with their patients and dentist.
Learners will need to know:
- scientific concepts of X-radiation,
- how X-rays affect film or a digital sensor,
- safety concerns working with radiation,
- how to position film holders,
- how to take radiographs,
- how to correct errors,
- how to interpret radiographs
- how to discuss findings with the patient and doctor
- future technology and its applications
Learners will need to use critical thinking when they interpret radiographs. They will be using their knowledge from other classes such as Dental Anatomy and Oral Pathology to evaluate whether they are viewing normal anatomy or pathology on a film, and list possible diagnoses.
They will use creative thinking when they complete assignments in lab; for instance, one assignment is to create a comic strip depicting the journey of a film through a processor.
They will also use practical thinking when solving issues such as error correction when a film is rendered undiagnostic, or working with challenging patients.
Students should be able to make connections between the physics of short-wavelength radiation and how it affects human cells to why it is important to take safety measures when working with X-radiation. They should also be able to take the knowledge of using analog film and apply some of the same techniques when working with digital sensors. They should understand that although there are different digital systems available, they work in a similar way. They should be able to use their knowledge of radiographic anatomy and pathology to be able to explain radiographic findings to others.
The information in this course ties into all the other courses in the dental hygiene program. Their class on Periodontology will help them understand the bone loss they may be viewing on a radiograph. Anatomy class teaches them landmarks on a skull that they can translate into a picture on a radiograph. Oral Pathology teaches them about cysts, inflammatory lesions, and even manifestations of systemic diseases that can be seen on radiographs. Clinic classes that teach them about gathering assessments, creating treatment plans, and working with people also tie in to radiography.
The knowledge the students gain in my class will be used extensively, on a daily basis, in their work lives.
Human Dimensions Goals
Students will learn that they can take great radiographs that will make them an asset to any dental practice. Students will learn whether or not they have good interpersonal skills, and how to improve them.
Students will learn to work as a team, doing group projects in class. They will learn how to effectively interact with patients and make them feel comfortable. They will learn about their role in interacting with the dentist and how to intelligently discuss findings on radiographs and differential diagnoses.
I hope students will understand the importance of empathy for patients, and learn to cultivate it. I hope they will be ethical in their use of radiation: minimizing re-takes and not taking X-rays too frequently just because insurance covers them. I want them to remember to place the welfare of the patient above profit.
I want the students to know they are welcome to use search engines in class or at home to better understand any information they don’t quite “get”. They might be lacking some foundational knowledge that would help them understand certain topics- especially when they’re learning about chemistry and physics.
I want them to work together and learn from their peers, dentists, hygienists, and dental assistants.
In order to become self-directed learners in this course, they will need to align class objectives with what they are studying. They will need to create a plan to read their chapters before class and attend classes and labs.
My Big Hairy Audacious Goal is: By the end of this course, my students will be able to take excellent radiographs, know how to interpret them, and how radiographs are integrated into total patient care.
Using Fink’s Self-Directed Guide for Designing Courses for Significant Learning, I created a table that links learning outcomes, learning activities, and assessment activities for my Dental Radiography class:
|Learning Outcomes||Learning Activities||Assessment Activities|
Learners will investigate the concepts of electromagnetic radiation and how X-radiation is used in dentistry.
|Read Essentials of Dental Radiography for Dental Assistants and Hygienists
|Chapter minute papers
Pre- and Post-class Kahoot quizzes
Learners will practice radiography skills and trouble-shoot errors.
|Lab: hands-on practice with taking X-rays on Dexter: traditional film and digital sensors.
Learners will practice developing their own films and mount them correctly. Using Dentrix, they will practice digital radiography and navigate the software.
|Learners will assess their own radiographs for acceptability and determine ways to correct any errors
X-ray grading by teacher
Learners will analyze how taking quality radiographs aids in proper diagnosis for their patients
|Discussions using case studies; learners will discuss examples of poor quality radiographs and compare them with good quality radiographs, noting what can be diagnosed from each film.||Learners will create their own case studies that demonstrate differences in diagnosis based on good or poor radiographs.|
|Human Dimension/ Caring
Learners will analyze the importance of safety for themselves and their patients.
|Discussions including personal experiences in different types of offices.
Review the ADA guidelines for radiography. Compare and contrast ideal prescription of radiographs and why some offices allow insurance to dictate how often radiographs are taken and what type.
Discuss the ethics of applying ALARA and the need for prescription of radiographs on a case-by case basis as needed.
|Project and presentation: using the learner’s choice of media, they will address and discuss safety concerns. Examples may include:
PPE, dosimeters and lead aprons
Calibration of machines/ quality control
Radiographs on cancer patients
Biological effects of radiation
Non-medical/dental sources of radiation
Minimizing re-takes and unnecessary exposure
|Learning How to Learn
Students will investigate new technology in radiography and how it can improve upon current modalities
|Learners will research current technology available for dental offices and possibilities for future technology.||Project: based on their research, learners will imagine and create their ideal radiography operatory for the future. They will include:
The type of technology they want to incorporate and why
What brands they prefer
How it will benefit the patients
How it will benefit the dental practice
The wonderful thing about teaching radiography is that the students get to practice their skills throughout the dental hygiene program, after the actual radiography class ends. I have many opportunities to continue guiding them with real-life examples of challenges and solutions to problems with anatomy or patient management. They continue to use their skills as part of total-patient care, and they get opportunities to learn from the dentists and other instructors in the clinic. Radiography is definitely a skill they will remember, as they will use it every day in their career as dental hygienists.
It’s vital that I structure my classroom as a learning environment, and not just a teaching environment. The difference is simple: in a learning environment, the focus is on the students and their learning. In a teaching environment, the focus is on the knowledge of the teacher. The whole point of education should be to help the students learn- and learn deeply. I think the common practice of having lecture as the primary source of instruction should be re-thought because it doesn’t always facilitate true deep learning. It leads to memorization of key points that the professor outlines in her Power Point presentation so the students can pass their tests. I am not saying that lecture is always a bad thing, but it shouldn’t be the emphasis of the class meeting. My goal as an instructor is to facilitate learning in the classroom. So, instead of constructing a teaching philosophy, I am outlining the basics of my learning philosophy. In my research, I discovered three key points that are very important to learning. They are foundational knowledge, learning to ask good questions, and passion.
Foundational knowledge is important at any grade level, in any course, but it is especially important in an accelerated healthcare program. In the dental hygiene program where I work, the information comes fast and furious. The students take pre-requisite courses that should help them build the foundational knowledge that they need for the dental hygiene program, but often there are gaps that still need to be filled. If a student still doesn’t understand the physiology of the pancreas, she will be even more lost when we dive into topics in diabetes. If a student learned something incorrectly, how can new knowledge be learned that needs to build on the previous knowledge? I like to begin class by asking the class questions about what they learned previously. We play Kahoots to help refresh their memories, and we go over topics that need to be revisited: usually physiology. The problem is I only have so much class time, and even after a review, some students are still in need of help with foundational knowledge. As I’ve learned more about blended learning, I realize that this could be an amazing tool to help students gain the foundational knowledge they may be lacking. If students spend some of the class face-to-face with peers and the instructor and some of the class online, they will have the time they need to review the online resources that can help them learn or re-learn the information they need.
I started thinking about how I learn the material before we discuss it in class. I realize that I never use our textbook as the only source of understanding the material, so why should I expect the students to do the same? I use Google constantly to find answers to my questions. If I need more clarification on a topic, I look at several online sources to find the answers. This is why it is so important to learn to ask good questions and to cultivate curiosity. I found a great resource for teaching students how to ask good questions. It’s a book called “Make Just One Change: Teach Students to Ask their Own Questions”. It made me realize that as teachers, in a “teaching environment”, we are the ones asking all the questions and students are spitting back answers. Deeper learning occurs when students, in a “learning environment”, can cultivate their curiosity by learning to ask good questions that lead to more questions. The book outlines the Question Formulation Technique: “Step 1: Ask as many questions as you can. Do not stop to discuss, judge, or answer the questions. Write down every question exactly as it is stated. Change any statements into questions. Step 2: Introduce the question focus. Step 3: Produce questions. Step 4: Improve questions. Students decide which questions are open-ended vs. closed-ended and discuss the advantages or disadvantages for each. Step 5: Prioritize questions and share with peers the rationales for choosing those questions. Step 6: Discuss next steps. Step 7: Reflect”. There is also a good video demonstrating the technique in a science class (Minigan, 2016). A student made an interesting comment at the end of the video: the technique not only allows a student to learn how to question, but it also helps to understand how other people think. By using the technique in small groups, the students learned how to collaborate with others and come up with even better questions together.
Passion or fun is also central to learning. Some information may seem dull, but it is necessary to understand (remember foundational knowledge?). Of course it’s ideal for students to pursue their passions, and if one is passionate about something, they will learn everything they can about what they love. I believe you can make almost any topic fun and interesting. In Gamify your Classroom, Farber (2015) introduces several games and ideas for lesson plans that integrate gaming and learning. Game-based learning can help make learning feel effortless- the way it should be! I also like to make the classroom more fun and interesting by adding creative hands-on activities. I supply the materials and some guidelines, and it’s truly amazing what the students come up with. I like to use food to help demonstrate lessons too. In Radiography class, we make backwards PB&Js when we learn the layers of an X-ray film. After this, the students never forget the sequence of the film layers: bread (base), jelly (adhesive), crunchy peanut butter (emulsion with silver halide crystals) and smooth peanut butter (protective layer). We make eukaryotic cells in the beginning of Oral Histology out of jello and candy; this helps them remember the organelles and their functions. Food is fun, games are fun, and learning should be fun too!
I still have a lot to learn as a teacher, or as Dr. Harupnuik has appropriately coined “learning facilitator”. I plan to learn along with my students and remember that I’m not an “expert” on dental hygiene; it’s something to continually strive for. I’m just a little further along on my journey than the students are. I plan on using my own learning philosophy to continue bettering myself as a teacher. Changes will continue to occur in education and healthcare, so I need to constantly learn how to improve by asking questions, gaining knowledge, and keeping my passion for learning alive.
Amaral, K.E. & Shank, J. (2010). Enhancing Student Learning and Retention with Blended Learning Class Guides. Educause. Retrieved from http://er.educause.edu/articles/2010/12/enhancing-student-learning-and-retention-with-blended-learning-class-guides
Ambrose, S., Bridges, M., DiPietro, M., Lovett, M., & Norman, M. (2010). How Learning Works. 7 Research-Based Principles for Smart Teaching. San Francisco, CA: Jossey-Bass.
Effective Use of Performance Objectives for Learning and Assessment. (2005). Teacher and Educational Development. Retrieved from http://ccoe.rbhs.rutgers.edu/forms/EffectiveUseofLearningObjectives.pdf
Farber, M. (2015). Gamify your Classroom. New York, NY: Peter Lang Publishing.
Lynch, J. (2016). What do I have my students do in class and why. Talk About Teaching and Learning. Vol 62. Retrieved from http://www.upenn.edu/almanac/volumes/v62/n24/talk-about-teaching.html
Minigan, A. (2016). The Question Formulation Technique in a High School Science Class. [Video file]. Retrieved from http://rightquestion.org/high-school-science
Rothstein, D. and Satana, L. (2011). Make Just One Change: Teach Students to Ask Their Own Questions. Harvard Education Press.
There are four quotes from Albert Einstein that I absolutely adore:
- “I never teach my pupils. I only attempt to provide the conditions in which they can learn.”
- “Imagination is more important than knowledge.”
- “It is the supreme art of the teacher to awaken joy in creative expression and knowledge.”
- “It is a miracle that curiosity survives formal education.”
Albert Einstein understood how learning really occurs and how traditional education can squash it. Einstein’s passionate curiosity is what kept his learning alive. I’ve heard these quotes before, but the meaning didn’t click for me until I read “A New Culture of Learning: Cultivating the Imagination for a World of Constant Change”. The book describes how as educators, we need to make play, questioning, and imagination the foundation for a new culture of learning.
The book gives several examples of how gaming (play) cultivates imagination and connects people who can work together to learn and solve problems. The book argues that in a world where information is constantly changing, learning should be seen as an environment. One can combine online resources, the boundaries that define it, and the students, teachers, and information work together to shape each other in a meaningful way (Brown & Thomas, 2011).
The authors discuss the pitfall of the twenty-first century’s teaching model: that some facts may hold true, but change is occurring rapidly, and we need to embrace it rather than fight it. “In a world of near-constant flux, play becomes a strategy for embracing change, rather than a way for growing out of it” (Brown & Thomas, 2011). In discussing the imminent and necessary new culture of learning, three key principles are presented: “(1) The old ways of learning are unable to keep up with our rapidly changing world. (2) New media forms are making peer-to-peer learning easier and more natural. (3) Peer-to-peer learning is amplified by emerging technologies that shape the collective nature of participation with those new media.” (Brown & Thomas, 2011).
Some of the ideas I really want to bring to my classroom are:
- Teaching the students how to learn through constructing good questions
- Introducing more games in the classroom that reinforce the material and cultivate passion
- Encouraging peer-peer learning
In the chapter on “Inquiry”, it is explained that students learn best when they follow their passions. The problem is a lot of people don’t know what their passions are because they have never been encouraged to explore them. However, you can’t just tell students to follow their passions without constraints that allow them to act within certain boundaries. Brown and Thomas (2011) pose the idea, “What if, for example, questions were more important than answers?”. This is where Einstein’s passionate curiosity came into play. He never stopped asking questions. Each question would lead to another one. Students need to be taught to come up with good questions. We could play games in class where students are given a question, find answers to that question online, and then they have to construct new questions based on what they learned. That process would turn them into active learners instead of just passively listening to a teacher feeding them all the answers.
I’ve always noticed how much the students love playing games in class like Kahoot and Socrative, even though it’s based on the same old summative assessments. We spend a lot less time playing games than we do on lecture because “we have to get through the material”, but maybe they should be flip-flopped; we could spend more time playing and less time lecturing. As far as I know, there are no online games that are specific to dental hygiene. However, I could give them a treasure hunt to see how many intelligent questions and answers they can find on all types of websites- including message boards. There is a great website called HygieneTown that is rich with information on all kinds of hygiene topics; surely, the students will be able to find something they can be passionate about.
HygieneTown can also help with peer-peer learning. In the message boards, they can interact with hygienists at all levels: new and seasoned. Another forum could be online discussions where the students post questions to each other and help each other understand information that isn’t clicking for them. I think a search for interesting information that they care about, followed by a discussion where they share what they found would be very interesting and educational.
My innovation plan revolves around the goal of collaboration between hygienists and other healthcare providers. I think it’s important for healthcare professionals to know how to search for information in a world where they can’t possibly always know all the answers. Learning how to ask the right questions and how to search for answers will allow them to function at a high level in this constantly changing environment in healthcare. Maybe they can keep the doctors and nurses on their toes!
Brown J. S. & Thomas, D. (2011). A New Culture of Learning: Cultivating the imagination for a world of constant change. CreateSpace Independent Publishing Platform. ISBN 1456458884
Moncur, M. (2015). The Quotations Page. Retrieved from http://www.quotationspage.com/quotes/Albert_Einstein
I am a proud instructor at an accelerated dental hygiene program in San Antonio, Texas. I have worked here for almost two years, and have nothing but good things to say about our program director, faculty, clinic manager, and students. We work very hard to ensure the success of our students and it hurts when I hear accusations that suggest the contrary.
I have to admit that when Concorde opened a dental hygiene program, I initially didn’t like the idea. I had preconceived notions that an accelerated program could not produce quality hygienists. I heard gossip from other hygienists in our city. The program did not receive a warm welcome from the hygiene community.
However, my dream was to be a teacher. I had a Bachelor of Science degree, which was not enough to work at the university, but it was acceptable for teaching in an Associate degree program. With only two options in my city, I decided to take a look at Concorde. I was impressed.
After applying for a position as an instructor, I was hired on part-time. Initially I worked as a clinic instructor and assisted the clinic teacher in instrumentation labs. What I saw was the exact opposite of my initial perceptions of the program.
The clinic at Concorde is beautiful. It is very modern and well-appointed. We have digital sensors and a digital panoramic machine; we are in the process of installing laptops in all 12 operatories so the students can record their notes in Dentrix more easily. Our clinic manager has high standards for infection control and is exceptional at ensuring that we maintain thorough records of timely spore testing and that our equipment is working properly.
The curriculum is of the same quality as the program I graduated from in 2003. The students are engaged in the learning process, they’re smart and they work hard. The instructors create significant learning environments, ensuring that all learning styles are included in the instruction.
In my classes, I am constantly thinking of new ways to engage the students. In Oral Histology, we have a lab where the students use microscopes to study different tissues. We use creative materials; last week I had the students sculpt the muscles of mastication out of clay and they attached them to the appropriate origins and insertions on a plastic skull. The students complete table clinics, write papers, collaborate on group projects, practice their skills in clinic, and provide service to the community. The fact is our students succeed. We have very good pass rates on both the National Board and CRDTS. It may be an accelerated program, but it’s very student-centered and we have a great team of educators, so it works.
Most of our instructors have Master’s degrees or are in the process of obtaining them. I am working on my M.Ed. in Digital Leading and Learning; I plan on introducing more technology into the classroom to facilitate engagement and deeper learning. Concorde offers tuition reimbursement to encourage instructors to earn higher degrees. Actually, Concorde provides a lot of great benefits to its employees and I feel lucky to be a part of an organization where I truly feel valued.
So, to all the hygienists who have negative feelings about Concorde, I invite you to actually take a look at what we provide to our students. Recently, an article was published about another Concorde campus in California. The article contained multiple inaccuracies and sought to perpetuate the negative feelings that some hygienists have about accelerated programs. Don’t jump on the bandwagon without any personal experience. Most likely, if you have the same preconceived notions that I had, it’s because you haven’t seen our school or met the awesome students we serve.