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Self assessment: what it means to me as a student and practitioner.

Course Description

Self-assessment can seem such an ethereal concept, and yet it is at the heart of self-regulation, a privilege that the public bestows upon health care practitioners, and one that the American Dental Hygienists' Association advocates for the profession of dental hygiene.

Research has shown that we often go through school with minimal opportunities to gain competency in self-assessment. As we transition into practice, we obtain initial licensure and are deemed to have met minimal entry-level competency standards. State regulatory boards operate with the purpose of protecting the health, safety and welfare of the public. A challenge these boards face is to assure that practitioners remain competent to practice throughout their careers. Simply attending continuing education courses without periodic reexaminations or documented self-assessment by which the practitioner identifies gaps in knowledge followed by strategic continuing education efforts aimed at filling those gaps does not lend itself to confidence in continuing competency. This course will discuss how self-assessment is a critical aspect of becoming a professional and maintaining competency throughout the lifetime of one's career.

Objectives

1. Analyze ways in which self-assessment is at the heart of self-regulation.

2. Identify instances where you have engaged in self-assessment, whether in an educational setting or a practice setting and consider whether it has resulted in positive outcomes for you and/or your patients.

3. Assess strategies outlined in this paper for promoting self-assessment in the profession of dental hygiene, and consider whether the ones mentioned or additional strategies you can think of would serve to enhance your skills at self-assessment.

There is no doubt that as we enter into our professional careers in dental hygiene, we realize very quickly the need to question ourselves, to assess our practice of dental hygiene and continually strive to provide the most up-to-date services. However, entering the work world can be an eye-opener, because new practitioners no longer have the luxury of leaning on faculty to provide guidance. It is within this context that many events in dental education have led us to this point where self-assessment is no longer an option in our educational programs -it has become a mandate.

In 1995, the Institute of Medicine published a report on dental education, Dental Education at the Crossroads: Challenges and Change, calling for change in the way we deliver our curriculum. (1) Among many recommendations was for dental education to promote self-assessment. In 2006, the American Dental Education Association Commission on Change and Innovation (ADEA-CCI) issued a white paper that articulated the role of educators in fostering skills in self-assessment, critical thinking and problem-solving for the development of lifelong learners capable of providing evidence-based oral health care. (2) In 2000, the Commission on Dental Accreditation (CODA) transitioned dental hygiene educational programs to competency-based education models. It is in this environment, at the start of their education programs, that students are introduced to their program competencies. As stated in Standard 2-6 of the newly revised accreditation standards, (3)

   The dental hygiene program must define and list
   the competencies needed for graduation. The
   dental hygiene program must employ student evaluation
   methods that measure all defined program
   competencies. These competencies and evaluation
   methods must be written and communicated to
   enrolled students.


In regard to this paper's topic, self-assessment, Standard 2-21 reads:

   Graduates must be competent in the application
   of self-assessment skills to prepare them for lifelong
   learning.


In other words, if a program hopes to become accredited or maintain accreditation, self-assessment is going to be one of their competencies and, as stated in Standard 2-6, educational programs will need to be able to demonstrate evaluation methods for measuring the competency of self-assessment. It is for this reason that self-assessment is no longer a nice component to have in our educational programs, it is a mandate. Further, state licensing boards, for the most part, require that applicants graduate from accredited dental hygiene programs--so this is not an option for schools, it is a must.

Sounds simple--right? Well, actually, a study conducted and subsequently published in 2011 (11 years following CODA's transition to competency-based education) examined the experience of second-year dental hygiene students with self-assessment in an associate of applied science degree program. (4) What the researchers found was that students reported having little to no exposure or educational preparation in self-assessment prior to entry into dental hygiene. Another finding was a lack of ownership on the part of students, or a general attitude of not wanting to accept responsibility for their education, but rather acquiesce to the feedback and assessment of faculty. This attitude is in direct contrast to becoming the kind of self-directed learner required for professional practice. Not surprisingly, the students indicated a need for an orientation to self-assessment at the time of entering the program, including the purpose and process of self-assessment. An additional theme that emerged in this study was that of awareness. The students indicated making a shift from unaware to aware as it related to the intent and benefits of utilizing self-assessment in their educational process. This study is highlighted because it so clearly demonstrates the need for developing skills in self-assessment, preferably before beginning one's career in dental hygiene. And dental hygiene is not alone, as illustrated by a recently published study where dental students were required to self-assess on a oral periodontal exam. Results found faculty examiner reliability to be high when using the grading rubric designed for the exam, while student-faculty reliability using the same rubric was weak to moderate. (5)

The above describes how dental education continues to grapple with bringing a stronger emphasis on self-assessment into the educational environment. If you graduated from dental hygiene school longer than a decade ago, it is doubtful that self-assessment was part of your learning experience in any structured way. Then how does self-assessment factor into our work lives and throughout our professional careers? The ability to make well-informed decisions on our own and then take ownership for our decision making is a critical component of competency. Competency is defined by CODA as: the levels of knowledge, skills and values required of new graduates to begin the practice of dental hygiene (unsupervised and independent). (3) And the ability to self-assess has been identified as one of the hallmarks of a competent practitioner. (6) Entering our professional careers with experience and familiarity with self-assessment can only help us as we continue our journeys in the work place where we employ critical thinking and problem-solving skills each day to deliver quality dental hygiene care to our patients. A study in 2001 examining dental hygienists' perceptions of self-assessment found that while dental hygienists reported consistently performing self-assessment, study participants who worked fewer hours per week were less likely than their peers who worked more than 20 hours a week to self-assess when providing dental hygiene care. (7) This study, conducted over 15 years ago, concluded that there was a need for well-developed self-assessment strategies in both educational and practice settings that would benefit dental hygienists and the public.

If we think in terms of self-assessment serving as a form of quality assurance, then we can make the connection that health care providers unable to accurately self-assess could be at risk of providing less than optimal care for their patients. (8) A term synonymous with quality assurance is continued competency, a topic that is receiving a lot of attention in the health sciences. Stakeholders including employers, regulators, certifying agencies, insurance companies and professional associations are grappling with how to best assure continuing competency. (9) Whittaker points out that in many states, a practitioner is deemed competent when initially licensed and remains so unless proven otherwise. This practice is being called into question, particularly in today's environment where technology and science are continually changing, new health care systems are evolving and consumers are demanding to know that providers are competent. In the context of continued competency, we find ourselves back to the topic of self-assessment.

Self-assessment has been described as a means to identify one's strengths and weaknesses. (10) It is posited that realistic assessment of strengths and weaknesses assists in setting appropriate learning goals and thus challenges us to find ways to fill gaps in knowledge, skills or values. The next step would be for the dental hygienist to use the outcomes of self-assessment to guide continuing education activities to assist in overcoming gaps in our knowledge, skills or values as opposed to merely choosing professional development courses and activities that confirm what we already know and simply meet the requirements for relicensure. Rather than thinking of self-assessment as an ability, Eva and Regehr challenge us to think about self-assessment in terms of a process and have used the term "self-directed assessment seeking" to describe a process where the individual seeks feedback from external sources. The thesis of their thinking is derived from research in the areas including self-efficacy and self-concept, cognitive and metacognitive theory, among others. (10) These areas of research would say that accurate self-assessment is difficult at best, as it is human nature to protect one's self-concept. Therefore, it is critical to seek valid and reliable external feedback to guide us in our quest for self-assessment that will assist in our growth as professionals and ultimately lead to better care for our patients. At the end of the day, that is why we all chose health care as a profession.

Going forward as a profession, it will be important to consider strategies for promoting self-assessment. In the educational environment, a review of the literature on self-assessment combined with strategies for its promotion in dental and dental hygiene education was recently published. (11) One of the findings in the self-assessment literature is that students tend to give their peers a more balanced assessment than they give themselves. This is not surprising, since self-assessment gets tied up with self-efficacy and self-concept. What we can take away from this is a strategy in which self-assessment is combined with peer-assessment in our educational programs, where we embrace an atmosphere where mistakes and need for further learning can be openly shared, discussed and accepted as part of the learning experience. Beyond the student experience, Boud describes a workshop format where self-assessment and peer feedback are used to promote professional development. (11) Specific to professional development in dental hygiene, we find in Ontario, Canada, that dental hygienists are required to maintain a professional portfolio for relicensure where self-assessment guides professional development activities.

Ending where we started, self-regulation is a privilege that the public bestows upon health care practitioners. Self-assessment is integral to our ability to self-regulate, to make well-informed decisions on our own and then take ownership for our decision making. The public is counting on us to live up to these standards!

By Cynthia C. Gadbury-Amyot, MSDH, EdD

References

(1.) Field MJ. Dentai education at the crossroads: challenges and changes. Washington D.C.: National Academic Press, 1995.

(2.) Haden NK, Andrieu SC, Chadwick DG, et al. The dental education environment. J Dent Educ. 2006; 70(12): 1265-70.

(3.) Commission on Dental Accreditation. Accredittion standards for dental hygiene education programs. Chicago: American Dental Association, 2016.

(4.) Mould MR, Bray KK, Gadbury-Amyot CC. Student self-assessment in dental hygiene education: a cornerstone of critical thinking and problem-solving. J Dent Educ. 2011:75(8): 1061-72.

(5.) Satheesh KM, Brockmann LB, Liu V, Gadbury-Amyot CC. Use of an analytical grading rubric for self-assessment: a pilot study for a periodontal oral competency examination in predoctoral dental education. J Dent Educ. 2015:79(12): 1429-36.

(6.) Chambers DW. Some issues in problem-based learning. J Dent Educ. 1995: 59: 567-72.

(7.) Fried JL, DeVore L, Dailey J. A study of Maryland dental hygienists' perceptions regarding self-assessment. J Dent Hyg. 2001: 75(2): 121-9.

(8.) Fitzgerald JT, White CB, Gruppen LD. A longitudinal study of self-assessment accuracy. Med Educ. 2003: 37: 645-49.

(9.) Whittaker S, Carson W, Smolenski M. Assuring continued competence--policy questions and approaches: how should the profession respond? Online J Issues Nuts. 2000: 5(3).

(10.) Eva KW, Regehr G. Self-assessment in the health professions: a reformulation and research agenda. Acad Med. 2005: 80(10 Suppl): S46-54.

(11.) Gadbury-Amyot CC, Woldt JL, Siruta-Austin KJ. Self assessment: a review of the literature and pedagogical strategies for its promotion in dental education. J Dent Hyg. 2015: 98(6): 357-64.

(12.) Boud D. Enhancing learning through self-assessment: New York: RoudedgeFiamer, 2003.

Post-Test

1. Self-assessment is a teaching strategy that has been used extensively in dental hygiene education for decades.

a. True

b. False

2. Self-assessment has been described as a means for identifying one's preferences. It is posited that realistic assessment of strengths and weaknesses assists in setting appropriate learning goals and thus challenges us to find ways to fill gaps in knowledge, skills or values

a. The first statement is true, the second statement is false.

b. The first statement is false, the second statement is true.

c. Both statements are true.

d. Both statements are false.

3. Research has shown that dental hygiene students:

1) Report having both exposure and educational preparation in self-assessment prior to entry into dental hygiene.

2) Take ownership of their education and exhibit the self-directed learning required for professional practice.

3) Desire an orientation to self-assessment at the time of entering the program, including the purpose and process of self-assessment.

4) Over time were able to make the shift from unaware to aware as it related to the intention and benefits of utilizing self-assessment in their educational process.

a. 1 and 2

b. 2 and 3

c. 3 and 4

d. 1 and 4

4. Each of the following contributed to a greater awareness of the need for educational experiences with self-assessment in dental hygiene programs EXCEPT:

a. The 1995 Institute of Medicine (IOM) report, Dental Education at the Crossroads: Challenges and Change.

b. The 2000 Commission on Dental Accreditation (CODA) adoption of competency-based education for dental hygiene educational programs.

c. State licensure boards across the United States.

d. The American Dental Education Commission of Change and Innovation (ADEA CCI).

5. Competency is defined by the Commission on Dental Accreditation as:

1) The level of knowledge required of new graduates to begin the practice of dental hygiene unsupervised and independent.

2) The level of skills required of new graduates to begin the practice of dental hygiene unsupervised and independent.

3) The level of values required of new graduates to begin the practice of dental hygiene unsupervised and independent.

a. 1 and 2

b. 1 and 3

c. 2 and 3

d. All of the above

6. Standard 2-21 of the Commission on Dental Accreditation 2016 dental hygiene accreditation standards leaves it up to dental hygiene programs to determine whether or not their graduates are to be competent in the self-assessment skills in order to prepare them for life-long learning.

a. True

b. False

7. Rapid changes in -- and -- are bringing attention to the need for better strategies for ensuring continued competency for health care providers, including dental hygiene.

a. Accreditation and education

b. Science and technology

c. Statutes and laws

8. When engaging in "self-directed assessment seeking" Eva and Regehr state that we need to seek valid and reliable external feedback to guide us in our quest for self-assessment. The primary reason for this strategy is that accurate self-assessment is difficult at best, as it is human nature to protect one's self-concept.

a. The first statement is true, the second statement is false.

b. The first statement is false, the second statement is true.

c. Both statements are true.

d. Both statements are false.

9. The self-regulated practicing professional would ideally use the outcomes of self-assessment to guide continuing education activities to assist in overcoming gaps in our knowledge, skills or values.

a. True

b. False

10. Strategies for promoting self-assessment for the practicing professional including the following EXCEPT:

a. Require a professional portfolio where the practitioner is required to show self-assessment; identifies gaps in knowledge, skills and values; and then actively seeks out continuing education aimed at addressing self-identified deficiencies.

b. Participate in workshops aimed at developing skills in self-assessment where peer feedback is employed.

c. Seek out the most convenient and cheapest continuing education activities to satisfy relicensure requirements.

Cynthia C. Gadbury-Amyot, MSDH, EdD, is associate dean and professor of Instructional Technology and Faculty Development, the University of Missouri-Kansas City (UMKC), School of Dentistry. She has been a full-time faculty member at UMKC since 1993 and teaches at all levels of the curriculum. Her service to the university, her profession and professional organizations is extensive, and she has received numerous distinguished awards.
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Title Annotation:CE COURSE
Author:Gadbury-Amyot, Cynthia C.
Publication:Access
Date:Feb 1, 2016
Words:2752
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