Regulative, normative and cultural-cognitive elements that shape clinical pedagogy: Case studies of dental school clinics in Ontario

Abstract

The clinical dental education model is an apprenticeship-type format where the students perform procedures on live patients under the supervision of licensed dentists. This model is the most common format among all dental schools in North America despite the lack of empirical evidence of its effectiveness. I had explored the following research questions: 1. How have institutional elements influenced the development of clinical dental education? 2. What are the factors that the dental school senior leaders consider when developing the clinical dental education model? 3. What are clinical instructors teaching approaches and how were they developed? Multiple case studies of University of Toronto and Western University were used to explore the perceptions and motivations of the senior education leaders and clinical instructors. Data collection consisted of semi-structured interviews and examination of school documents. Using institutional theory as a framework, data analysis was performed by coding to determine certain themes. The findings reveal that despite differences between the schools, both have adopted a patient-centered, multidisciplinary approach. The development of this model was mainly influenced by normative and cultural-cognitive elements. Guided by the values and norms of the dental education community, the dental schools experienced internal collegial control that eventually shaped this particular model. The school that resisted was eventually made to conform through the coercive power of accreditation. There is an assumption that the clinical instructors will know how to teach the students. The clinical instructors' teaching style is reflective of their past learning experience. The style is focused on fostering a positive and collaborative relationship between the instructor, student and patient. Many instructors also employ a Socratic approach where they formulate questions to guide the dental students to attain the needed clinical knowledge. The instructors' professional values and obligations to the patients also dictated how they taught the students.