Table 3 is based on the SPD and thus represents the intended curriculum (35, 37) in compulsory courses, which means that principles for the programme are given. For Table 3 we have chosen only the courses that specifically address academic or professional literacy in their objectives.
Table 3
Courses in the Study Programme in Dentistry with objectives related to academic or professional literacy.
Semester
|
Focus on profession
|
Focus on academia
|
1st semester
a. To become a dentist 1, 7,5 credits
b. Scientific introduction, 3 credits
|
Communication between patients and care-givers (a)*
Practical training in writing patient record (a)
Differences between private and professional conversations (a)
|
Scientific articles and their structures (b)
Introduction to library (b)
|
2nd semester
a. To become a dentist 1, 7,5 credits
|
Communication between patients and care-givers (a)
Practical training in writing patient record (a)
Differences between private and professional conversations (continues) (a)
|
|
3rd semester
c. Clinical Odontology 1, 24,5 credits
|
Documentation (reading and writing patient records) (c)
|
|
4th semester
c. Clinical Odontology 1, 24,5 credits
d. To Become a Dentist 2, 1,5 credits
|
Documentation (reading and writing patient records) (c)
Ethical rules and considerations (d)
|
Ethical rules and considerations (d)
|
5th semester
e. To become a dentist - Teamwork, 1,5 credits
|
Communication in teams (dentist with nurse, dentist with dental hygienist, dentist with dental technician) (e)
|
|
6th semester
f. To become a dentist 3, 3 credits
g. Degree Project in Odontology, 30 credits
|
Communication psychology (f)
Motivational interviewing (f)
|
Introduction to thesis-writing (g)
Ethical rules and considerations (g)
Discussion of study design and methods (g)
|
7th semester
g. Degree Project in Odontology, 30 credits
h. Children's and adolescents’ dentistry, 22,5 credits
|
To communicate with children and adolescents (h)
|
Academic writing:
Ethical rules and considerations (g)
Discussion of study design and methods (g)
Database searches including strategies, critical review (g)
|
8th semester
g. Degree Project in Odontology, 30 credits
h. Children's and adolescents’ dentistry, 22,5 credits
i. Clinical Odontology 5, 10,5 credits
|
To communicate with children and adolescents in the clinical setting (h)
To communicate with children and adolescents in a community setting (h)
Patient history (anamnesis taking and writing) (h, i)
|
Academic writing:
Ethical rules and considerations (g)
Discussion of study design and methods (g)
Database searches including strategies, critical review (g)
Half-time presentation
|
9th semester
g. Degree Project in Odontology, 30 credits
j. Clinical Odontology 6, 11,5 credits
k. Oral Surgery, 4,5 credits
l. Geriatric Dentistry, 4,5 credits
|
Patient history (anamnesis taking and writing) with young adults, adults, and elderly patients (j, k, l)
|
Academic writing:
Ethical rules and considerations (g)
Discussion of study design and methods (g)
Database searches including strategies, critical review (g)
Writing of degree thesis in odontology (g)
|
10th semester
g. Degree Project in Odontology, 30 credits
k. Oral Surgery, 4,5 credits
l. Geriatric Dentistry, 4,5 credits
m. To Become a Dentist 5, 3 credits
n. Clinical Odontology 7, 12,5 credits
|
Patient history (anamnesis taking and writing) with young adults, adults, and elderly patients (k, l)
Administration and regulations within the field of odontology (m, n)
Strategies for life-long learning and career-planning (m)
To analyze and judge performed treatment, as well as need for referral (n)
To set revision-plans (n)
|
Academic writing:
Ethical rules and considerations (g)
Discussion of study design and methods (g)
Database searches including strategies, critical review (g)
Writing of degree thesis in odontology (g)
Presenting degree thesis in odontology (g)
Oral and written critical review of peer’s degree thesis in odontology (g)
|
* Letters in brackets refer to courses listed in the column Semester
|
Based on the SPD the intended curriculum include professional literacy skills such as; a) oral and written communication with patients in different ages; b) oral and written communication with other medical professions; c) writing patient records; d) judging the patient specific needs (a prerequisite for all following points); e) writing referrals; f) writing prescriptions, g) writing treatment-/revision-plans; h) writing clinic specific text such as career-planning, clinical structure, budget, delegations etc.; i) reading and interpreting the professional meaning of laws and regulations; j) reading and interpreting ethical rules and considerations with the patient in focus; k) reading and interpreting patient documentation (records, plans, referrals etc.); l) reading and interpreting clinic specific text. For the oral communication the students are expected to use the specific language taught at the different courses during the SPD. However, they are also expected to be able to alter their language in relation to different groups of patients, different professional collaborators as well as the society.
Further, the SPD include academic literacy skills such as; 1) strategies for database searches; 2) reading scientific articles, including analysis of their structure, and critical review of their quality; 3) reading and interpreting ethical rules and considerations for research; 4) writing, discussing, justifying their and their peer’s study design and methods; 5) writing their degree project in odontology; 6) orally presenting and defending their degree project in odontology; 7) critically review their peer’s degree project in odontology both orally and in writing. For the academic literacy they are expected to use the specific language taught during the course “Degree Project in Odontology”, but also a popular scientific language for the oral presentation of their project, i.e. to be able to adjust the language based on the context. If the project is not already approved by the Swedish Ethical Review Authority (SERA) the students have two options. The first is to do an application to SERA with help of their supervisor/-s. The second is to do a project where no ethical approval is warranted according to Swedish law (2003:460) (40), such as a systematic review including a meta-analysis, or a questionnaire-based study.
Dental literacy in the syllabuses for Orofacial pain and jaw function 1 and 2
The learning outcomes of the module OPJ 1 are that the student shall: 1) Have good knowledge of the jaw system's anatomy and function, the dental occlusion and the trigeminal system; 2) Have comprehensive knowledge of temporomandibular dysfunction (TMD), i.e. the conditions that can affect the jaw system; 3) Be able to perform a simplified clinical examination of the jaw system and its function; 4) Independently be able to take alginate impressions from the upper and lower jaw and perform bite registration in retruded contact position; 5) Be able to identify patients with orofacial pain and jaw disorders in a general dental care environment. The learning outcomes of the module OPJ 2 are that the student shall: 1) Show good knowledge of the clinical examination of the jaw system and its function; 2) Show good knowledge of treatment with occlusal appliances and physical therapies such as jaw exercises; 3) Independently be able to perform a simplified clinical examination of the jaw system and its function; 4) Under supervision, adjust and deliver an occlusal appliance and check its function; 5) Identify and handle patients with orofacial pain and jaw disorders in general dental care environment.
When it comes to OPJ 1 four of the five learning outcomes point at literacy-related professional knowing, that is terminology related to anatomy, physiology and pathology of the jaw system, i.e., the temporomandibular region, that will be used for communication with colleagues and other related professions, teachers, patients and between students during clinical situations. So, not only knowledge of terminology is sufficient but also communication related to the terminology, with expectations of becoming able to alter the terminology when communicating with e.g. colleagues as compared to patients. All literacy events in this module are based on reading (PowerPoints, handouts and course literature) and writing notes during lectures.
For OPJ 2, all learning outcomes point at literacy-related professional knowing. Complementary to the literacy events above, there is both a written instruction (a PowerPoint) at the online-accessible web-platform (Canvas; Instructure Inc., Salt Lake City, USA) as well as a possibility to use the handouts from the lectures that guides students step-by-step for how to adjust and deliver an occlusal appliance, how to do an occlusal analysis (interpret findings), a clinical TMD-examination as well as a follow-up of treatment with the delivered occlusal appliance. Furthermore, there is a video-clip available on their web-platform which demonstrates how to perform the TMD-examination. Finally, there is a physical demonstration for groups of six to eight students each of specific steps related to how to ow to perform the occlusal analysis, the TMD-examination as well as the adjustment and delivery of the occlusal appliance – some (but not all) students take notes during this demonstration. These two modules end with an online and on-site multiple-choice test consisting of five questions.
Dental literacy as established in teaching practices
All lectures followed a similar pattern: most slides were presented shortly, approximately one minute, sometimes even shorter. The teachers defined concepts and explained them based on characteristics of a normal (healthy) anatomy and physiology as opposed to deviances from this.
In general, the slides can be divided into three main types: a)academic content, that is information found in the course literature that student also can read and which is the basis for examination; b)integrated content, including information from the course literature that is related to the future profession through for instance complementary illustrations, or real patient cases; and c) professional content, that is practical application of the core-content.
A recurrent example of academic content was basic information about anatomy, physiology and pathology of the temporomandibular region. However, when it comes to professional content the most recurrent content was the importance of the patient communication, including the difficulty and necessity of relevant content from the patient history taking (anamnesis). But also, the difficulty in adapting the communication to authorities and other professions. The integrated content was found both in the PowerPoint-slides, but also by the questions asked by the students that induced a complementary explanation. Here the teacher used either the white-board (with additional text or illustrations) or patient cases to illustrate how the academic content could be translated to the future profession.
Students’ notes
The overall picture we identified was that they either 1) copied text from teachers’ PowerPoint-slides, 2) re-formulated text in teachers’ PowerPoint-slides, or 3) wrote complementing text (Table 4).
Table 4
Profiles for students’ types of notes.
Student
|
Exclusively
|
Dominating
|
Complementary
|
Mixed
|
1
|
|
Complementing text
|
Copied and re-formulated text
|
|
2
|
|
Complementing text
|
Re-formulated text
|
|
3
|
|
- Digital notes: complementing text
- Handwritten notes: copied text
|
Both: Re-formulated text
|
|
4
|
|
|
Re-formulated text
|
Copied & complementing text (equally distributed)
|
5
|
|
Complementing text
|
Re-formulated text
|
|
6
|
|
Complementing text
|
Re-formulated text
|
|
7
|
|
Complementing text
|
Re-formulated text
|
|
8
|
|
Complementing text
|
Re-formulated text
|
|
9
|
|
|
Re-formulated text
|
Copied & complementing text (equally distributed)
|
10
|
|
|
|
Copied text, re-formulated text and complementing text
|
As Table 4 illustrates none of the students used an exclusive profile type of notetaking. Patterns discerned for students separately is that student 1 had a majority of complementary notes, and a minor amount of copied and reformulated notes. Students 2, 5, 6, 7 and 8 demonstrated similar textual patterns in terms of a majority of notes with complementary character. These students had a few notes with reformulated text. Student 3 had both handwritten notes and digital notes. The handwritten notes were of copied character, while the digital notes were of complementary character. Re-formulations occurred in both handwritten as in digital notes but were few and related to copied text. Students 4 and 9 had similar amount of copied and complementary text, with a minor share of reformulated text. Student 10 had an equal amount of copied, reformulated and complementary text.
General patterns observed for the entire student group, in terms of handwritten notes was copied text from the teacher-constructed PowerPoint, and in terms of digital notes was complementary information. When the slides comprise figures or pictures, students tend to describe and explain them using own words. Less amount of text on slides may enable students to produce independent notes.
Complementary text that comprised teachers’ secondary experience, was discerned as main character of text in student notes. This may indicate that teachers’ secondary experience is an important informal complement in teaching. Same type of complementary text was recurrent in student notes and comprises medical/professional concepts within the specific subject matter. Concepts that students have encountered previously in training, are noted but in relation to the current subject matter. One example is the standardized clinical examination Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)(41), where a specific palpatory pressure of either 0.5 or 1.0 kg depending on structure, is warranted. Other examples were the assessment of degree of abrasion, and the normal range for mouth opening as well as laterotrusive and protrusive movements. This may indicate that students attempt to contextualize concepts to specific areas within the current subject matter.
Multiple-choice test
This test was constructed based on one question from each of the five core content areas.
For each core content four to seven questions were constructed, in total 28 questions in the database. The questions in the database are grouped according to subject and level of difficulty. One question from each group was randomly selected by the e-examination program (Canvas, Instructure, Salt Lake City, USA). Thereby, the students did not necessarily answer neither the same questions nor in the same order.
For each question there were from one to three correct answers. Some of the questions were text-based only (question and alternative answers), whereas others combined illustrations and text and/or numbers to identify specific anatomical structures (Figure 2). Some questions demanded students to judge for instance good or bad choices of treatment according to national guidelines.
For a pass, the students had to achieve 100% correct answers, but had unlimited attempts to perform the test. When analyzing the student performance, i.e., number of attempts to pass, the median (IQR; 25th percentile - 75th percentile) number of attempts was 13 (6 – 20). Two students passed after one attempt; one student needed 43 attempts.