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Critical Issues in Dental Education |
Key words: qualitative research, critical incident technique, dental education
Submitted for publication 07/22/07; accepted 11/10/07
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Abstract |
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 TopAuthor information Abstract Qualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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This article aims to 1) give an overview of qualitative research; 2) describe a qualitative research tool—the critical incident technique (CIT); and 3) address the CIT’s applicability in dental education. A companion article in this issue of the Journal of Dental Education presents an example of the application of the CIT used to assess dental students’ experiences in pediatric dentistry.2
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Qualitative Research |
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TopAuthor informationAbstractQualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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While many authors present the differences between quantitative and qualitative research, pitting one "versus" the other, perhaps an alternative and less exclusionary approach is more valuable: quantitative and qualitative research, in fact, complement one another. The complementary attributes of quantitative and qualitative research are presented in Table 1
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The Critical Incident Technique |
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TopAuthor informationAbstractQualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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There is nothing new about observing humankind. Since ancient times, writers have used their observations of people to inspire their work. Some of these writers must have used detailed notes or relied on an unusual ability to recall events from memory. Of course, this type of anecdotal evidence would not stand up to today’s rigorous scientific demands. But by establishing a set of procedures for collection and analysis of data, researchers can become alchemists capable of "turning anecdotes into data."1
The CIT began its life as an offshoot of the Aviation Psychology Program of the United States Army Air Forces in World War II.11 At the time, the Air Force evaluation reports for pilots consisted of clichés and stereotypes such as "lack of inherent flying ability," "unsuitable temperament," and "in-sufficient progress." The new program that Flanagan helped to develop focused instead on factual reports given by competent observers to produce an objective definition of effective or ineffective behaviors demonstrated by pilots.
The program begot a series of studies analyzing issues such as failure in learning to fly, failures of bombing missions, the problem of combat leadership, and the planning and design of cockpit instruments and controls.11 This was the first true systematic effort to gather and analyze specific incidents of effective or ineffective behavior with respect to a designated activity, that of flying. The emphasis on events that made the difference between success and failure—the "critical incidents"—provided an objective rather than ambiguous list of requirements for the activity at hand. These "critical incidents" are analogous to the anecdote. However, being more defined in terms of scope and collected in such a manner as to allow for analysis, they are more appropriate for objective research.
After World War II, extension and development of the technique by Flanagan and his students at the University of Pittsburgh’s Department of Psychology in the late 1940s and early 1950s led to the use of the CIT in other occupational groups and activities. In 1954, Flanagan published a scholarly article on the CIT,11 describing the origins of the procedure, its present form, and its uses. This article outlined "a flexible set of principles which must be modified and adapted to meet the specific situation at hand." Five basic steps were described: 1) identifying general aims; 2) planning; 3) collecting the data; 4) analyzing the data; and 5) interpreting and reporting the results.
Step 1: Identifying General Aims
Pertinent research questions must be identified prior to undertaking any type of research. Examples of research questions have included such diverse issues as the following:
Step 2: Planning
The following areas must be addressed at the planning stage:
Step 3: Collecting the Data
With good planning, the data collection is simplified. Observed incidents are reported and recorded for later analysis. The observations should be recorded as close as possible to the time when they occurred. Memory is improved if the observers know in advance that they will need to make the reports. If full and precise details are given, the report can be assumed to be accurate. Central to the CIT is the trust placed in the observer to make accurate reports. This trust should work both ways, and a guarantee of anonymity for the observers is usually required.
Reports can be made through individual or group interviews, through questionnaires, or through record forms. The choice of collection method will depend upon the situation to be observed, time available, and other logistical factors. In many situations, the best option will be the standardized individual interview, which will allow for best explanation of the aims of the study and clarification of ambiguities in the reports. Audio or video recording of interviews allows for analysis to occur later.
The size of the sample is difficult to determine in advance. Theoretically, sampling should continue until saturation is reached, i.e., a point at which the addition of new incidents contributes no new information for the analysis. However, time and logistical constraints may require that a predetermined number of incidents are collected. Over 100 incidents are generally accepted to be a reasonable figure for analysis.20
Step 4: Analyzing the Data
The purpose of analyzing the data is to summarize and describe the data to allow it to be used for practical purposes. The aim is to increase the usefulness of the data without sacrificing comprehensiveness, specificity, or detail.11 The steps can be summarized as follows:
Step 5: Interpreting and Reporting
Any potential for bias in the first four steps should be reviewed at this stage, and limitations of the research should be identified. However, the researcher should not dodge his or her responsibility in evaluating the results. The original researcher is best poised to reconsider the original research aims, make the necessary evaluations of the data, and report the value of the results.
In reporting the research, the methods of data collection and analysis must be completely transparent and clearly described. This is the only way that a reader will be able to judge whether or not the conclusions are supported by the data.
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The Critical Incident Technique in Health Care Research |
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TopAuthor informationAbstractQualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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Nursing and Medicine
In a review of the CIT in nursing research, Kemppainen identified several reports that used the CIT to examine patients’ experiences in health care settings, nurse-patient interactions, and patient responses to illness and health care treatment.13 Keatinge demonstrated the technique’s versatility in three different clinical settings and discussed the ability of the method to encourage nurses to reflect on their practice.12 This "reflection-on-action" is also described by Schön in his theories of learning22 and focuses on the cyclical process of professional learning by reflection on experiences, followed by changes in practice, then by further reflection.
In medicine, Altmaier et al. used the CIT to identify effective and ineffective behaviors and develop categories of noncognitive characteristics to aid selection of anesthesiology residents.15 This use of the CIT in medical education research most closely parallels Flanagan’s original studies identifying critical requirements for Air Force pilots and combat leaders. Effective teaching behaviors of family medicine preceptors were examined by Goertzen et al. and contribute to an evidence-based approach to teaching.16
Dentistry
Dentists were one of the first occupational groups to be evaluated using the CIT. This work was carried out by one of Flanagan’s students at the University of Pittsburgh.23 In this study, reported in 1949, critical incidents were obtained from three sources: patients, dentists, and dental school instructors. The incidents were analyzed and classified into four main aspects of the dentist’s job: a) demonstrating technical proficiency; b) handling patient relationships; c) accepting professional responsibility; and d) accepting personal responsibility. This research pertaining to the critical requirements for professional competence for dentists was put into action by the university, and a battery of selection and proficiency tests were developed by the university’s School of Dentistry.
More recently, Victoroff and Hogan’s 2006 report of students’ perceptions of effective learning experiences in dental school used the CIT as part of a multifaceted curriculum assessment strategy.5 Their investigation aimed to approach curriculum change from a positive perspective, by building on the strengths of the established predoctoral dental curriculum at Case Western University. Fifty-three dental students generated 128 learning incidents, which were collected through one-on-one interviews with a fellow student. The incidents were analyzed, and a list of themes developed. The results identified three key areas related to effective learning experiences. These themes were instructor characteristics, characteristics of the learning process, and learning environment. Subcategories were identified within the three themes. The results are presented using quotes from the interviews, which brings life to the results and gives a voice to the students’ experiences. In their discussion, the authors note that the CIT is a useful method of gathering feedback from students for purposes of curriculum evaluation, but do not propose any other uses for the technique in the field of dental education.
At the University of North Carolina, students were required to complete two community-based rotations and write a "reflection essay" upon completion of the rotations.24 The students were asked to describe a specific event (the critical incident) and reflect on the personal and professional implications that flowed from it. The resulting essays were analyzed using content analysis to summarize, code, categorize, and interpret the data. Three major themes emerged: personal and professional growth, enhanced awareness, and commitment to service. As with Victoroff and Hogan’s data, subcategories were identified within the major themes.5 Again, the results are illustrated using direct quotes from the essays. This use of the raw data to give meaning to the results is common in qualitative research. It enables the reader to see the breadth and depth of the results obtained and makes for engaging reading. The authors of this investigation note that the process encouraged reflection by students, a benefit also noted in the nursing literature.
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Use of the CIT in Dental Education Research |
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TopAuthor informationAbstractQualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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There are a variety of uses for the incidents/events/episodes once they have been collected. Many are analyzed, as suggested by Flanagan, and results are produced that can be further developed and interpreted so that they can be used for practical purposes. In other situations, the incidents are not analyzed so rigorously, but instead used as the basis for further discussion in a more ad hoc manner. One example of this is an investigation into learning experiences that used incidents provided in written form by dental students as the basis for group discussions, while medical students at the same university were given individual feedback on their written reports.25
As a flexible set of principles, the CIT is a suitable research method in many aspects of health care and health care education. In the field of dentistry, examples of possible applications are patient care evaluation, dental education strategy evaluation, faculty development, and pre- and postdoctoral student selection. There are precedents in the nursing and medical literature for the CIT in each of these applications.12–17 Within each of these four areas lies a vast amount of untapped, complex information that could be "decoded" using a flexible technique such as the CIT.
Robert Elliott, a leader in qualitative research, reminds us that, "ultimately, the value of any scientific method must be evaluated in the light of its ability to provide meaningful and useful answers to the questions that motivated the research in the first place."3 Qualitative research and the critical incident technique will not provide the answer to all of our questions, but perhaps are another tool in the researcher’s kit. The CIT is highly focused on providing solutions to practical problems. Perhaps it will help to throw some much-needed light on some of the challenges faced by dentists and educators related to patient care, dental education strategies, faculty development, and student selection.
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Acknowledgments |
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Author Information |
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TopAuthor informationAbstractQualitative researchThe critical incident techniqueThe critical incident technique...Use of the cit...References |
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REFERENCES |
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