Outcome: By the end of the first year, students will be highly skilled in the techniques used to search, retrieve, analyze, and critically evaluate the scientific literature (including journals such as Science, Nature, Cell, JAMA, NEJM, in addition to the dental literature).
Structure: This 2 unit course will consist of 2 two-hour sessions per week, including weekly small group workshops over the course of the prefall/fall quarter. One two-hour block is set aside for students to study independently, and is intended primarily for work in the library. The fourth hour provides time for students to meet with other members of their group to plan assignments and discuss findings.
Meetings: A one-hour session for the entire class will introduce the course, including the objectives and how the process will work. All other meetings will be facilitator-led sessions in 10 small groups of 8 students each. Periodically, 2 groups will meet together with both facilitators (one basic scientist, one clinician).
Structure: Students will meet in small groups of 8 for workshop sessions overseen by a faculty facilitator from either the basic sciences or the clinical sciences.
Facilitators will work in paired teams (1 basic scientist + 1 clinical scientist working with 2 groups of students), trading groups and sometimes meeting jointly as the term progresses. Every third or fourth week, the two groups will meet together with both facilitators. The purpose of this combined format is twofold. First, it offers an opportunity for faculty in the other four streams to participate, thus strengthening the vertical integration of courses taught concurrently. Second, it stresses the inherent connections between the scientific method and clinical dentistry by assuring that every student (and every facilitator) has the opportunity to see different perspectives at work and to assess the strengths of each. By working cooperatively, the facilitators in the team can demonstrate how the strengths of each perspective can be integrated by applying the scientific method when making clinical judgments.
Purpose and Content: In the prefall/fall term (assumed to consist of 14 weeks of classroom activity, as now), sessions will be designed to give students experience in applying what they have learned to solve practical problems of increasing complexity. One way to approach this would be through a clinical mega-case, which students would revisit periodically over several years, investigating questions and clinical problems of increasing complexity. We have discussed several possibilities; for example, one class might start off with diabetes (or another complex disease affecting several organ systems), by asking students why, as dental students, they are being asked to learn about diabetes. To address the question, students would be expected to learn how to search online sources such as Medline and compose a search strategy including diabetes and oral health (and other combinations of similar terms). We would expect them to find half a dozen reasons why dentists need to know about diabetes.
As the year progressed, in other assignments, students might be asked to retrieve particular kinds of studies (e.g. randomized controlled clinical trials, crossover trials), which would require them first to learn about these study designs and recognize them in their reading. Students would be asked to discuss how the various designs work, as well as their restrictions or limitations, and arrive at the best fit between design and hypothesis, together with the rationale for their conclusions. Students will also be asked to analyze individual studies and judge the reliability and strength of their results. Other assignments might be designed to demonstrate normal versus skewed distribution within a population, and students asked to discuss and demonstrate how these differing distribution patterns affect sampling methods and subsequent analysis of data.
As the term progresses, the workshop problems would become more challenging and complex, but still be designed to demonstrate relatively clear-cut choices that can be logically supported by what students have learned. The subject matter from which the problems are constructed would be suggested by instructors from the other four streams, so that students have the opportunity to apply the methods they are learning in this stream to the material being discussed in other courses. These connections will be strengthened by the participation of instructors from the other streams, and by the meetings conducted jointly by the basic and clinical facilitators every third or fourth week.
Assessment: A comprehensive examination for this stream at the end of the fall might consist of students defending one of a pair of papers selected to contrast a sound, well-reasoned study versus another study lacking these qualities. The test would be an essay of limited length (perhaps 750-1000 words, 3-4 typewritten, double-spaced pages), and each essay would be read and first graded independently by both members of the faculty team, who would then confer to arrive at a consensual grade for each of the 16 papers in their two groups. This would allow a balanced review of each studentâs work without placing an undue burden on any individual faculty member, as each would read and grade 16 essays. All participating facilitators would be expected to meet initially (and periodically throughout the quarter, as needed) to agree on standards for judging the essays, and the standards would be expected to reflect the principles taught and applied over the course of the quarter.
Interim assessments and the final course grade might incorporate some or all of the following:
- 1) Self-assessments and peer assessments: To become competent, enthusiastic lifelong learners, students need to learn and practice reliable self-assessment. This stream offers opportunities for students to practice both peer and self-assessments and assess their reliability by comparing their assessments with those of their peers and the facilitators. Students might begin by working together to define consensual criteria for these assessments (e.g. appropriate measures for assessing the quality and quantity of effort). Assignments might include short essays on an assigned topic, which would then be critiqued (written critique of 200-250 words) by another student. Both the studentâs own essay and the studentâs critique of anotherâs essay could be assessed by faculty facilitators and reflected in the course grade.
- Group dynamic: Students will be expected to work together effectively as a team and to participate in tasks such as dividing work equitably among members, being accountable to the group, and weighing different kinds of contributions. Students and facilitators may develop different models for evaluating and comparing the effort and participation of individual members within their groups. At a minimum, however, the facilitators must be able to identify group members who are falling behind or failing to keep pace so that appropriate corrective interventions can be planned.
- Individual assessments: More traditional methods (e.g. essays, responses to questions, performance on quizzes and exams) can be used to assess the performance of individuals. Individual assessments will also reflect the demonstrated reliability of self-assessments and results of peer assessments throughout the course.
The Scientific Method in Clinical Dentistry, II. In the winter and spring quarters, the course would continue as a directed reading course, meeting every week to discuss papers selected by the facilitators. Again, participation and periodic combined meetings that showcase both the expertise of basic and clinical science facilitators might prove the most productive approach.
As the course progresses, articles would be chosen to demonstrate more contentious and ambiguous issues, such as those where the available evidence is open to several interpretations, where no convincingly strong evidence exists, or where ethical dilemmas preclude straightforward studies. In the final weeks, students would be examining issues for which there is little or no sound evidence, where rigorous studies provide conflicting outcomes that cannot be reconciled without further investigation, and where ethical considerations complicate study design.
Assessment: A comprehensive final examination for the entire course sequence over the first year might consist of a take-home final exam where students are asked to propose an investigation of a clinically relevant problem or question (following the basic format of an Academic Senate grant proposal). They would be asked to state the problem that initiates the study, summarize the background and significance of the question, describe the working hypothesis, propose a study design (including appropriate methods for collecting and analyzing the data, although they would not be expected to produce preliminary data), define parameters for success or failure of the study, and discuss the limitations of the proposal. These essays (again, with a set maximum length) would be read by paired teams of faculty and graded as described above; in addition, each student could be asked to read and submit a critique of another studentâs proposal to add the dimension of peer assessment to the final grade.
References and Resources:
Our working group read and considered three books that could be useful in mastering the basic skills in the first year of this stream. The book we thought would be most useful was How to Read a Paper by Trisha Greenhalgh (BMJ Publishing Group, 1997).
Much of the content of this book is available on the web. If you would like to review it, the URL is http://www.ucl.ac.uk/primcare-popsci/uebpp/uebpp.htm#how.
Rev 5/14, 10/7, 10/13/98, 4/5/99