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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 healthcare.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 life-long 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 after 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 an 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 workplace 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 healthcare 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 healthcare 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 re-licensure. 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 healthcare 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, because 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 the 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 re-licensure where self-assessment guides professional development activities.
Ending where we started, self-regulation is a privilege that the public bestows upon healthcare 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.
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2. Haden NK, Andrieu SC, Chadwick DG, et al. The dental education environment. J Dent Educ. 2006;70(12):1265-1270.
3. Commission on Dental Accreditation. Accreditation 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):1061-1072.
5. Satheesh KM, Brockmann LB, Liu Y, 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):1429-1436.
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7. Fried JL, DeVore L, Dailey J. A study of Maryland dental hygienists’ perceptions regarding self-assessment. J Dent Hyg. 2001;75(2):121-129.
8. Fitzgerald JT, White CB, Gruppen LD. A longitudinal study of self-assessment accuracy. Med Educ. 2003;37:645-649.
9. Whittaker S, Carson W, Smolenski M. Assuring continued competence—policy questions and approaches: how should the profession respond? Online J Issues Nurs. 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-S54.
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):357-364.
12. Boud D. Enhancing learning through self-assessment: New York: RoutledgeFlamer, 2003.
ABOUT THE AUTHOR
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.