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Critical Issues in Dental Education |
Key words: peer tutoring, academic careers, recruitment
Submitted for publication 08/29/06; accepted 01/05/07
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Abstract |
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While multiple strategies to recruit and retain dental school faculty are being developed and implemented,6 immediate solutions are required so that effective classroom and clinical instruction can be maintained. One potential approach could be to utilize fourth-year dental students (4DS) as instructors in preclinical laboratory courses. The purposes of this investigation were to evaluate whether 4DSs could be utilized as effective instructors in a two-semester morphology and occlusion preclinical lab course and whether such an experience would encourage these students to pursue a career in dental education.
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Materials and Methods |
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The instructor’s role, whether student or faculty instructor, was to supervise, give feedback, and evaluate daily projects for his or her group. Prior to each laboratory session, the course director met with the instructors and had a discussion over the project of the day. The foci of the discussion included explanation of the project and its objectives; criteria for evaluating the student outcome; and an explanation of what constituted ideal, acceptable, and standard not met for each criterion. The same discussion was repeated by the course instructor with the students at the beginning of every lab session, aided by a live demonstration using a camera projector. Additionally, the instructors’ role included participation in grading final examinations.
At the end of each semester, standard School of Dentistry course evaluation forms were mailed to the 1DSs, who voluntarily evaluated the instructors on each of six criteria: 1) contribution to student knowledge, 2) ability to create a positive learning environment, 3) ability to communicate effectively, 4) availability, 5) fairness in grading, and 6) overall teaching effectiveness of the instructor. The scale provided for a rating on each criterion was "poor (1)," "fair (2)," "average (3)," "good (4)," or "excellent (5)." Additionally, a short survey was attached to the evaluation forms in which 1DSs were questioned on their reactions to having 4DSs as their instructors in the preclinical labs. At the end of second semester, 4DS instructors were also mailed a short questionnaire soliciting information regarding their reactions to this teaching experience and whether it might have influenced the future course of their professional activities, particularly whether it might have motivated them to consider some role in dental education. Included with the mailed evaluations and questionnaires were instructions requesting the instructor to complete and return the form in the return envelope within a two-week period. No other student identifiers were used. Two weeks after the initial mailing, follow-up reminder emails were sent to students.
The data contained in the returned evaluations and questionnaires were evaluated via SPSS statistical software (v. 12.0.2, SPSS Inc., Chicago, IL). Ratings for both instructor groups—student and faculty instructors—were compared using nonparametric Wilcoxon matched pairs signed rank test, 
level of .05. Descriptive statistics were used to describe students’ responses to questionnaires.
To assess teaching effectiveness, first-year dental students’ final examination scores in each of the two preclinical labs were compared using an independent t-test. These examinations consisted of two waxing exercises and an objective structured clinical exam (OSCE) in the fall semester, plus a face-bow transfer with mounting casts in maximum intercuspation position exercise and another OSCE in the winter semester. To ensure that evaluators were blinded as to whether the student they were evaluating had a faculty or a senior student instructor for the semester, 1DSs were randomly assigned, by the course instructor, a number from 1 to 95 and were requested to use this number as an identifier on their exams. The grading of both OSCE exams was done by comparing students’ answer sheets with an answer key prepared by the course director. As for the waxing and mounting exercises, raters received one-hour calibration training prior to grading. The foci of the training included explanation of the criteria on the grading forms for each project, the test to use for each criterion when applicable (what instrument to use and how), and an explanation of what constituted ideal, acceptable, and standard not met for each criterion. This was aided by project samples selected from students’ previous practical examinations representing various ranges of acceptability for the criteria. Throughout the calibration training session, there was opportunity for questions and debate. Raters were then randomly divided into groups of three, and each group was given approximately a third of the class test projects to be evaluated. First, each rater independently evaluated the final project, and when done, evaluations from each instructor were compared. Any discrepancies among the raters were discussed, and a resolution sought.
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Results |
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provides descriptive data for freshman students’ evaluation of both 4DS and faculty instructors for each criterion. Frequency distributions and medians were virtually identical for both groups, with no statistically significant difference (p>.05) for any criterion. For both instructor groups, the median on each criterion was a rating of "good."
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displays mean examination scores, expressed in percentage, in each semester of the course for first-year students supervised by faculty and by 4DSs. In the fall semester morphology lab, the average final exam scores for students instructed by faculty and 4DSs were 86.2 percent (SD 6.7) and 86.3 percent (SD 5.6), respectively. In the winter semester occlusion lab, mean scores for students instructed by faculty and 4DSs were 88.6 percent (SD 7.3) and 89.8 percent (SD 6.9), respectively.
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provides descriptive data for 1DS reactions to having senior dental students as instructors. Approximately 42 percent of the 1DSs felt more comfortable with faculty member instruction, and 16.3 percent felt deceived by having 4DSs as their instructors. Yet 62.8 percent agreed or strongly agreed that they would be willing to serve as a future student instructor.
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provides descriptive data on the questionnaire completed by 4DSs. While all five student instructors agreed or strongly agreed that the experience provided good exposure to teaching, that it reinforced their dental knowledge, and that they would encourage other students to participate in the future, only one participant agreed that the experience would influence his or her decision to consider teaching as part of a future career.
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Discussion |
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On the other hand, failing to recruit adequate numbers of faculty, particularly younger educators, fails to maintain the status quo. The debt load of new graduates makes it far more advantageous to enter private practice than dental education. Forty-five percent of dental students who completed their studies in 2000 had a debt exceeding $100,000.12 Further, most students enter a dental program intending to be in clinical practice. The percentage of graduates between the years 2001 and 2004 choosing academia as a career after graduation has been reported well below 2 percent, or fewer than 100 new graduates per year.2–5 With an annual need of 275–300 new faculty members, clearly the demand continues to exceed the supply of new dental educators.6,11 With minimal interest in pursuing a career in dental education among new members of our profession, the prognosis is alarming.
Between anticipated faculty retirements and current levels of faculty turnover, continued support for and development of faculty recruitment and retention programs remain essential to maintaining a quality dental education workforce. In the meanwhile, dental educators must determine how to maintain an effective instructional environment in the absence of sufficient faculty.
Some argue that some dental students might consider a career in dental education if they had exposure to the teaching enterprise during their four-year program.13,14 Others have suggested that perhaps a key to educating students about the rewards of academic dentistry may be to offer predoctoral teaching assistant opportunities.6
This study sought to provide such experience to senior students and to determine if the instruction provided by these individuals equaled the effectiveness of that provided by full-time faculty. The results showed that the two-semester teaching program in the first-year morphology and occlusion course maintained teaching effectiveness with senior dental students functioning as instructors. Evaluation of instruction was equivalent for both 4DSs and faculty from students’ perspective, and students’ performance on examinations at the end of each semester was virtually identical, regardless of supervision by students or faculty.
With the dual requirement to improve teaching quality while doing more with less, many professional schools have increased utilization of peer tutoring.15 Nursing, medical, pharmacy, and other professional schools have used this instructional method as a means to compensate for faculty shortages.15–18 There is considerable evidence supporting the positive effects of peer tutoring on examination scores, students’ satisfaction, and personal and professional development.19 It is thought that peer tutors can better understand the learning problems of fellow learners and provide instruction under a more active interactive and less authoritarian environment. Yet one disadvantage was observed from responses of freshmen: a small percentage (16 percent) felt deceived by having senior students as instructors, and about 45 percent favored having a full-time faculty. Students assume that the quality of tutoring from other students may be a great deal inferior to that from a professional teacher; therefore, the need for monitoring of student instructors and quality control through adequate instruction, calibration, and supervision should not be underestimated.
In addition to having positive effects on learners, peer tutoring affects student instructors as well. By assuming the responsibility of teaching their peers, students not only improve their understanding of course content as noted from seniors’ responses, but also develop communication skills, teamwork, leadership, confidence, and respect for their peers that are vital to developing professionalism early in their dental careers.19
Despite these advantages, the teaching program failed to persuade senior students to consider teaching as a professional career. Most of the participating senior students did not indicate that their interest in academia was piqued by this experience. It may be that the teaching program was designed to focus mainly on compensating for faculty shortages without placing sufficient emphasis on faculty recruitment. The program failed to portray the positive aspects of academic careers as a fair balance to the negative concerns of dental graduates regarding their debt loads. In surveys conducted to determine factors that influenced new faculty to choose academic careers, issues such as the working environment, educational resources and facilities, opportunities for faculty development, and the variety of work activity available in academia were all important positive influencing factors.20,21 Additionally, retirement and other benefits and the predictable stable source of income should be emphasized to potential faculty so they can appreciate the full picture of academic compensation versus private practice.21
As with any other survey, nonresponse bias seemed to be an associated limitation. With students being bombarded with course evaluations at the end of each semester, it is not surprising that the response rate to this survey was low (45.3 percent). As such, this study could provide a foundation for future studies aimed towards developing tutoring programs that act as a temporary solution to faculty shortages, while at the same time providing a more enduring solution through adopting specific strategies targeting recruitment of new graduates.
In conclusion, the use of this program may be of interest to seniors and could act as a temporary means to compensate for faculty shortage. Course effectiveness was maintained when five senior dental students served with five faculty members as lab instructors.
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Footnotes |
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REFERENCES |
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This article has been cited by other articles:
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  J. M. Roger, M. M.H. Wehmeyer, and M. S. Milliner Reflections on Academic Careers by Current Dental School Faculty J Dent Educ., April 1, 2008; 72(4): 448 - 457. [Abstract] [Full Text] [PDF]
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