HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Masella, R. S. Search for Related Content PubMed PubMed Citation Articles by Masella, R. S.

Confronting Shibboleths of Dental Education

Key words: active learning, evidence-based best practices, lockstep curriculum, parochialism, professional ethics, shibboleth, student-centered learning, teacher-centered learning

Submitted for publication 04/25/05; accepted 06/11/05

	Abstract

Top Abstract Current educational shibboleths Conclusion References

 
Shibboleths are common expressions presented as indisputable truths. When used in educational discussions, they reflect "motherhood and apple pie" viewpoints and tend to bring debate to a halt. Use of shibboleths may precede a desired imposition of "locksteps" in educational programming and are easily perceived as paternalistic by recipients. Nine shibboleths are presented as common beliefs of dental faculty and administrators. Evidence contradicting the veracity of the "obvious truths" is offered. The traditional "splendid isolation" of dentistry contributes to parochialism and belief in false shibboleths. Sound principles of higher and health professions education, student learning, and dental practice apply to dental education as to all health disciplines. Student passivity in dental education is not the best preparation for proficiency in dental practice. The master teacher possesses a repertoire of methodologies specific to meeting defined educational objectives. Active learning experiences bear close resemblances to professional duties and responsibilities and internally motivate future doctors of dental medicine. The difficulty in achieving curricular change leads to curricular entrenchment. Dentistry and dental education should not trade their ethical high ground for the relatively low ethical standards of the business world. Principles of professional ethics should govern relationships between dentists, whether within the dental school workplace or in practice. Suggestions are made on how to confront shibboleths in dental school settings.

When used in the context of deliberations on weighty matters of dental education such as curriculum change, shibboleths may carry great force. At committee meetings, the shibboleth-wielder is actually firing a "clean kill" verbal missile against his or her "opponent" and staking a nonnegotiable claim to the high ground of discussion. While such statements by prominent faculty or administrators are meant to convey all-consuming wisdom and necessary foundational truths on which to build, on a deeper level they may indicate personal need to be wrapped in an impregnable defensive wall. But regardless of motivation, recipients should recognize shibboleths for what they are: effective control devices.

Whatever the debate, use of shibboleths as conceptual anchors may indicate a desire to impose the first in a series of locksteps. Additionally, when one party acts to decide "the truth" for another party based on their private understanding of truth, shibboleths may encourage paternalism. In turn, paternalistic views may damage interpersonal relationships.³

	Current Educational Shibboleths

Top Abstract Current educational shibboleths Conclusion References

 
1. Knowledge of terminology is the first requirement for student learning.
The need for "terminology first" is perceived as a core truth and garners general agreement among many dental educators. As the argument goes, before serious learning takes place, students must first know essential terms. The belief is often part of a broader perspective that students can only be taught and learn dentistry "in steps": after terminology must come study of states of health, followed by states of disease, and finally by clinical care.⁴ The concept provides near-perfect justification for traditional, high-control, teacher-centered learning.

Successful use of problem-based learning (PBL) in dental education appears to contradict the primacy of learning lingo first. New PBL-exposed dental students regularly define terms while engaged in case research. "Learn as you go" appears to work quite well with PBL students.^5–9 Besides, electronic or paper medical dictionaries are not just dental student desktop items, but standard issue for all lifelong learners. Regardless of professional status, dedicated students learn new words all the time.

The predicament of the "lockstep" curriculum also illustrates the power of labels over faculty and administration. "Predoctoral" students are by definition helpless in varying degrees: they need to be led, given instructions, and loaded with "facts." They often act immaturely. That first- and second-year dental students could act the role of doctors, and develop professional communication skills and basic professional demeanor from dental school day one, is a reach too far for the shibboleth-holder.⁴

On the opposite pole, new "postdoctoral" students are considered much more capable and can be treated like colleagues and given significant responsibilities. They are encouraged to participate in student-centered learning. This "difference in abilities" exists despite the mere weeks that separate one label from the other. What a needless delay in the professional development of bright and capable predoctoral students!

2. Only dentists truly understand dental education.
Dental education undeniably possesses curricular content not found in other health professions. Theory and technique of operative and restorative dentistry are but one example. But unique content does not equate with stand-alone teaching and learning methods or philosophies of education.

While resistant faculty and administrators "dismiss as preposterous the thought that principles of educational psychology and methodology can serve a [dental] faculty,"⁴ it is abundantly clear that sound principles of higher and health professions education, student learning, and dental practice transcend individual disciplines. For example, dentists serve admirably as university presidents, medical center chief executives, and public health specialists. Nondentists render yeoman’s service as dental educators, researchers, and leaders. This shibboleth manifests the parochialism of some dental educators, fed by the traditional "splendid isolation" of dentistry and, as Hendricson and Cohen recognize, the "hesitancy to deviate from the technical focus of dental [education], [and] narrow conceptualization among administrators and faculty as to what constitutes learning and teaching."⁵

3. These students are the worst. I failed 60 percent of them. I don’t take any excuses or guff. Students need to be punished for irresponsibility.
A wise educator observed that "for as long as there have been teachers there are those who feel that students should come to them better prepared, or that students are not what they used to be. Complaint will not change the fact that a student is what he [or she] is."⁴ Another respected teacher noted millenia ago that "the bad teacher’s words fall on his pupils like harsh rain; the good teacher’s, as gently as the dew" (Talmud, Ta’anith, 7a).

It bears mention that maximum student learning depends on good interpersonal relationships among faculty, administration, and students. Faculty and administration should always model the professionalism inherent in successful practice. In health education and care, there is no substitute for treating people with dignity. In fact, learning suffers in an environment that arouses strong student emotions such as fear, anger, or frustration. Regarding the teacher, "It is as much what he is while he does it, as what he does, that influences the learner" (italics added).^4,10 Who the teacher is profoundly impacts student learning.

When a large percentage of a dental school class fail any course, it is embarrassingly obvious that the teacher has failed, not the students. In this case, the real problem that students must endure is teacher incompetence.

A slight variation on this theme justifies "teaching by terror" to prepare students for realities of dental practice and to optimize student performance. Proponents state that a cruel, dog-eat-dog world awaits the graduate. But we are humans, not animals. Instillation of fear and use of intimidation are elements of Soviet-style management inappropriate to contemporary health education and care.

Teacher performance is also greatly influenced by a less obvious factor: his or her own needs. Like everyone else, a teacher has a very personal self-image he or she would like to project to others. Attack on that image is a serious matter; student failure to learn may be viewed as a threat to professional competence and image. In consequence, the teacher may build barriers between himself or herself and students to protect the image, including "impatient dismissal of comments which suggest incomplete understanding; intolerance of conflicting points of view; demand for conformity to established patterns; ridicule of those who think differently; or authoritarian dicta."⁴ Such unfortunate behaviors satisfy the teacher’s needs rather than the learner’s and are not designed with maximum student learning in mind.

4. Active learning techniques cannot be used in large classrooms.
The research shows that yes, they can.^10–12 As Jerold Apps observed, "Within formal educational programs led by teachers, everyone can share in the teaching, just as everyone, including the teacher, shares in the learning" (italics added).¹⁰ While dividing predoctoral classes into faculty-mentored groups of five to eight students is labor-intensive, it is no great task to create small student groups within large classes and assign group projects for class presentation. A detailed course syllabus containing learning objectives, project protocols, timelines, and student/faculty responsibilities is essential. Student classroom participation, work with peer groups, literature searching, professional presentation, peer feedback, and self- and peer-assessment are hallmarks of dental practice, active learning, and lifelong learning.

With students placing their budding doctor personae on the line, motivation to succeed is abundant. The appeal in small-group active learning is derived from personal, internal needs and goals, not to external factors such as multiple choice examinations, grades, and class rank.

Large classes or the number of course hours do not change the basic fact that learning, at its core, is a highly personal activity. A teacher may teach to a full class, but the individual student is responsible for learning. Regardless of instructional mode, teaching’s raison d’être is to facilitate individual learning. As Winston Churchill famously observed, "I hate to be taught, but I love to learn."¹³ The learning that matters most to aspiring doctors is done personally in the quest of "becoming a doctor." Seminal research by McKeachie,¹⁴ Minter,¹⁵ Bloom,¹⁶ and Siegel¹⁷ concludes that the most effective instruction is "tailored to the needs, capabilities, and histories of individual learners."¹⁷

The teacher’s ability to incorporate new techniques into a "growing repertoire" of methodologies and then select the most effective ones to meet specific educational objectives "is a competence that separates the professionals from the amateurs in education."¹¹

5. Dental students prefer lectures to interactive classes.
Research states the opposite.¹¹ Adult learning principles are widely accepted in higher education. They state that adults wish to take responsibility for learning in concert with peers, mentors, and teachers. Adults also value the learning gained through self-direction and problem-orientation as more effective than the results of passive learning.¹¹ Author Noam Chomsky sums up the teacher-mentor’s role: "We should not be speaking to, but with."¹⁸

Like faculty, students also have comfort zones and may find security in the familiar. Resistance to innovation and the unknown are common human traits. Yet students must acknowledge and fully assume personal responsibility for learning dentistry.

While cultural background, gender, visual and auditory processing ability, and age may influence student learning preferences, the best research evidence and common sense tell us that passivity in dental education and proficiency at dental practice do not mix.^11,12

Whatever the immediate curricular goals, the ultimate purpose of dental education is to create behavior characteristic of a dentist. The more that dental student learning mimics professional practice, the more closely students identify with and highly value such learning. Active learning experiences bear important resemblances to professional duties and responsibilities, while much of passive learning does not. In words written forty-three years ago by George Miller of Harvard Medical School, "The evidence is overwhelming that students make the transfer of biomedical science information and techniques [to dentistry] more readily if its relationship to the ultimate goal [professional practice] is established from the start."⁴

Lecturers often spend considerable effort impressing as well as informing students. The hardest transition for an experienced lecturer "may be keeping quiet and allowing his students to learn."⁴ While a teacher’s "urge to tell" may be overwhelming, we "teach more by teaching less."¹⁰

6. You can’t be a good researcher and a good teacher.
Dental school teaching generally plays a secondary role in career success, research and publication being prime movers. While the reverse may be true at a limited number of institutions, for the majority, to be "only" a teacher may be regarded as "distinctly second rate."⁴

Ernest Boyer reminds us, though, that the researcher’s work assumes meaning through application of teaching.¹⁹ One surmises then that teaching is a natural and necessary complement to university-based research. Problems arise with the myth that "anyone can teach" and the presumption of naturally endowed teaching ability that is bestowed upon individuals when they are awarded a doctoral degree. These help devalue teaching.

Perhaps the greatest difficulty lies in the ever-present conflict between the faculty’s professional needs of research, publication, and peer presentation and the learning needs of students. Traditional institutional valuation strongly encourages faculty attention to the former at the expense of student interests. There is obviously a pressing need at many institutions for increased valuing of teaching. As with everything, willingness to teach and teacher performance are influenced by rewards. Rewards can take the form of salary, prestige, and promotion, but must take tangible form.

When this door is fully opened, research faculty and new hires may view teaching as an equally worthwhile, desirable career component, instead of as a dead end. After all, excellent teachers and researchers share many values and abilities. In addition to intellectual honesty, confidence, and open-mindedness, these values include commitment to preparation, creativity, ability to organize, effective communication, and personal passion.

7. "We’ve always done it this way; we’ve never done it that way."
A variation on this theme is "don’t throw out the baby with the bath water." Change is difficult to come by. Winston Churchill bespoke the truth that "the winds of change are blowing and we lean into them with equal measures of anticipation and dread."⁵ Tradition is a powerful institutional presence: one consequence is that teachers teach (and assess!) as they were taught. Malcolm Knowles stated that "teachers who only know how to teach adults as they themselves were taught in school tend to be ineffective in most situations."¹¹ Teacher-centeredness, fear of losing turf and power, and wish to preserve departmental fiefdoms contribute to the ample resistance that accompanies proposals for curricular change. The result is that health professions curricula tend toward entrenchment.^12,20 A prime reason for dental school accreditation is to promote curricular refreshment and minimize curricular senescence.²¹ Yet despite remarkable innovations at some dental schools, most wind up keeping the baby and the bath water. A recent study by Kassebaum et al. documents that 86 percent of North American dental school curricula remain discipline-based with virtually no use of PBL or other interdisciplinary course structures despite decades of encouragement to move away from the silo, or fiefdom, approach to dental education.²²

8. Noble ideals about teaching and leadership are okay in books, but the real world of dental school faculty and administration does not work that way.
Business world ethics have taken a tremendous hit in recent years with revelations of executive misconduct. Dentistry has received its share of bad press about ethical problems.²³ For the survival of contemporary dentistry, though, dental school educational and employment standards must be far above those of business. Despite the "politics" of dental education and business aspects of practice, dentistry should never trade its firm ethical underpinnings for the low ground of fleeting advantage.

"This is how the system works" is not a valid answer to lapses of professional ethics in the dental school work environment. "Harsh reality" explanations are excuses for unprofessionalism. Fear, intimidation, and dishonesty from dentist to dentist represent unprofessional conduct, regardless of setting. The same is true when prospects for individual career advancement in dental school trump professional courtesy to colleagues.

Relative to doctor conduct, Bruce Peltier stated, "The need for honesty is clear, [along with] its central importance in health care. Once you lie to someone, you change your relationship forever."²⁴ With dental faculty or practicing dentists, lying changes a collegial relation to one of "player-playee . . . , where one person manages the perceptions of the other to prevent the real nature of the relationship from being revealed."²⁴

Dental student perceptiveness allows easy recognition of gamesmanship substituting for professional courtesy, and lying and dishonesty as a modus operandi of dental school leadership. When students associate degradation of truth with dentistry, the profession is wounded in its heart. In the face of operational immorality, ethics courses or exhortations to lofty ideals are meaningless. If students look on the dishonesty of a senior dentist as a green light for similar behavior in practice, great harm must befall dentistry’s public trust.

9. "Those who can, do; those who cannot, teach; those who cannot teach, teach teachers."⁴
The teacher models used in faculty development programs should of course represent the best an institution can provide. On a different level, appreciation and use of humor are healthy adaptations to demands of dental school teaching and employment and effective learning adjuncts, if properly carried off.¹² They also help students cope with the frequent stresses of dental education. May pleasant attitudes, abundant smiles, and more than occasional laughter be part of dental school life and common professional attributes of graduates.

	Conclusion

Top Abstract Current educational shibboleths Conclusion References

 
There are dental educators who desire change and those who fear change. Change agents should be aware of common methods used to thwart educational innovation, such as reliance on shibboleths. Wielded in committee, shibboleths are deadly verbal cruise missiles meant to stop debate, conceptually decapitate perceived opponents, and impose pre-ordained outcomes.

Many educational shibboleths are unsupported by research evidence. Unfortunately, there is no statute of limitations on systematic wrongs that prevents their repeated use. Promulgation of false shibboleths may be perceived as paternalistic and may also promote the placement of educator interests above those of students.

Both traditionalists and innovators should ground curricular decisions in sound research evidence. This is a challenge given the curricular entrenchment common in health professions education. Basic issues in teaching and learning may be taken for granted or neglected by faculty and administration but surely deserve regular scholarly revisitation.

For the sake of improved educational outcomes, it is incumbent on educators to promptly identify, and confront the veracity of, proffered shibboleths. This may be accomplished by voicing the following observations:

1. Let’s see the evidence for that statement. Evidence-based care is coin of the clinical realm. Likewise, in examining what works and what doesn’t work in dental education, it is prudent and reasonable to request scholarly, non-anecdotal documentation. This includes research published in peer-reviewed dental and nondental educational journals and texts.
   
2. What does student performance tell us about this approach? Have research studies been performed within the institution that shed light on program validity? What comparisons can be made with extra-institutional studies of similar or identical programs? How do our students fare relative to those of other dental schools in standardized test results such as the National Board Dental Examinations and regional and state licensure examinations?
   
3. Curricular senescence is not an option: are we complying with the mandates of accreditation in adopting this policy? Does the policy promote educational excellence or a move toward mediocrity? The Commission on Dental Accreditation (CODA) specifically encourages application of active learning experiences through alternative methodologies and cross-disciplinary course development and implementation.²¹ Relegating active learning to the sidelines in favor of the passive status quo will likely not endear the institution to CODA.
   
4. Given the institutional mission of creating caring, clinically proficient, ethical, and lifelong learning practitioners, does this program promote student behavior characteristic of this practicing dentist model? Does it prepare graduates for assumption of the professional duties and responsibilities outlined in the college’s strategic plan and specified in its list of student competencies?
   
5. What’s the problem with putting students first? This approach appears to favor dental educators more than it does students.
   
6. If this curriculum strives to develop student abilities in self- and peer-assessment and self-directed learning, if promotion of lifelong learning is an institutional goal, and if effective professional communication and leadership are identified as essential to successful practice, then why are we doing it this way? The professional literature and common sense seem to suggest another course.
   

While many things mold the dental school learning environment, "the major artisan for student learning is the teacher whose work penetrates to unnumbered patients who [someday] profit or suffer from encounters with [his or her] students." This responsibility is too heavy to allow shibboleth-wielding false prophets to trump educational best evidence and impose dated concepts of dental school teaching and student learning.

	Footnotes

 
Dr. Masella is Associate Professor, Department of Orthodontics, College of Dental Medicine, Nova Southeastern University. Direct correspondence and requests for reprints to him at the Department of Orthodontics, Nova Southeastern University, College of Dental Medicine, 3200 S. University Dr., Fort Lauderdale, FL 33328; 954-262-7397 phone; 954-262-1782 fax; rmasella{at}nsu.nova.edu.

	REFERENCES

Top Abstract Current educational shibboleths Conclusion References

 

1. Bacharach M, Gametta D. Trust in signs. In: Cook KS, ed. Trust in society. New York: Russell Sage Foundation, 2001.
2. Chambers DW. Lying through your teeth. J Am Coll Dent 2004;71(2):7–13.
3. Brammer LM. The helping relationship: process and skills. Englewood Cliffs, NJ: Prentice-Hall, 1973.
4. Miller GE, Abrahamson S, Cohen IS, et al. Teaching and learning in medical school. Cambridge: Harvard University Press, 1962.
5. Hendricson WD, Cohen PA. Oral health care in the 21^st century: implications for dental and medical education. Acad Med 2001;76(12):1181–206.[Medline]
6. Hoad-Reddick G, Theaker E. Providing support for problem-based learning in dentistry: the Manchester experience. Eur J Dent Educ 2003;7:3–12.[Medline]
7. Barrows HS. The essentials of problem-based learning. J Dent Educ 1998;62:630–3.[Medline]
8. Shuler FC, Fincham AG. Comparative achievement on the National Dental Board Examination Part I between students in problem-based learning and traditional educational tracks. J Dent Educ 1998;62(9):666–70.[Medline]
9. Schmidt HG, Machiels-Bongaerts M, et al. The development of diagnostic competence: a comparison between a problem-based, an integrated, and a conventional medical curriculum. Acad Med 1996;71:658–64.[Medline]
10. Apps JW. Teaching from the heart. Malabar, FL: Krieger Publishing Company, 1996.
11. Knowles MS. Using learning contracts. San Francisco: Jossey-Bass Publishers, 1986.
12. Senge P, Cambron-McCabe N, Lucas T, et al. Schools that learn. New York: Doubleday, 2000.
13. Blake R, Louis WR, eds. Churchill: a major new assessment of his life in peace and war. New York: W.W. Norton, 1993.
14. McKeachie WJ. Research in teaching at the college and university level. In: Gage NL, ed. Handbook of research on teaching. Skokie, IL: Rand McNally, 1963.
15. Minter JW. The individual and the system. Boulder, CO: Western Interstate Commission for Higher Education, 1967.
16. Bloom BS. Learning for mastery. In: Evaluation comment. Los Angeles: Center for the Study of Evaluation of Instructional Programs, University of California, Los Angeles, 1968.
17. Siegel L. The contributions and implications of recent research related to improving teaching and learning. In: Milton O, Shoben EJ Jr, eds. Learning and the professors. Athens: Ohio University Press, 1968.
18. Chomsky N. In: Otero C, ed. Chomsky on democracy and education. New York: Routledge Falmer, 2002.
19. Boyer EL. Scholarship reconsidered: priorities of the professoriate. Princeton: The Carnegie Foundation for the Advancement of Teaching, 1990.
20. Abrahamson S. Diseases of the curriculum. J Med Educ 1978;53:951–7.[Medline]
21. Masella RS, Thompson TJ. Dental education and evidence-based educational best practices: bridging the great divide. J Dent Educ 2004;68(12):1266–71.[Abstract/Free Full Text]
22. Kassebaum D, Hendricson W, Taft T, Haden K. The dental curriculum at North American dental institutions in 2002–03: a survey of current structure, recent innovations, and planned changes. J Dent Educ 2002;67(9):914–31.
23. Schwartz B. A call for ethics committees in dental organizations and in dental education. J Am Coll Dent 2004; 71(2):35–9.[Medline]
24. Peltier B. Some observations on truth claims in a profession. J Am Coll Dent 2004;71(2):14–5.[Medline]

This article has been cited by other articles:

				K. R. Dalrymple, C. Wuenschell, A. Rosenblum, M. Paine, D. Crowe, H. C. von Bergmann, S. Wong, M. S. Bradford, and C. F. Shuler PBL Core Skills Faculty Development Workshop 1: An Experiential Exercise with the PBL Process J Dent Educ., February 1, 2007; 71(2): 249 - 259. [Abstract] [Full Text] [PDF]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Masella, R. S. Search for Related Content PubMed PubMed Citation Articles by Masella, R. S.