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In dental hygiene clinical courses, students develop clinical dental hygiene skills and learn to think critically to make ethical, evidence-based patient care decisions. Clinical instructors play vital roles in shaping these learning experiences. They provide individualized instruction and guidance while students develop and demonstrate their skills on live patients. Instructors are also responsible for assessing student performance in various skills, including instrumentation, radiographic imaging, and professionalism. A southeastern United States dental hygiene program reported clinical grading efficiency and calibration challenges. In previous surveys, the program’s students reported discrepancies in clinical grading among the instructors. Additionally, the clinical instructors reported the need to streamline grading procedures to allocate more time for individualized student instruction. Thus, the clinical grading problem in the dental hygiene program was twofold. There was a need to improve the efficiency of the grading process and to enhance grading standardization and consistency. Improvements were urgent for these stakeholders to support their clinical education effectiveness.
The purpose of this study was to identify interventions to address the root cause of the clinical grading challenges faced by the dental hygiene program. An action research approach, guided by specific research questions, was implemented to investigate and resolve the program’s performance problem. The human performance technology model served as the framework for the study. The decisions made throughout the study were based on data and supported by the literature. Performance improvement theories, models, and tools, including the organizational elements model, the updated behavior engineering model, and the 5 Whys technique, facilitated the HPT model’s phases. Qualitative research methods were employed for data collection and analysis, alongside a review of the current literature on similar challenges faced by other United States dental hygiene programs. Leadership, change management, and project management strategies were applied to collaborate with the stakeholders.
Following the human performance technology model, a performance analysis was conducted to identify the root causes of performance gaps in clinical grading efficiency and calibration. An organizational analysis established the program’s desired performance, while an environmental analysis determined its actual performance. Qualitative data were collected from organizational documents, faculty, and students using protocols for reviewing existing documents, focus groups, interviews, questionnaires, and field observations. Four key themes in desired and actual performance emerged from the coding procedures: quality education, student satisfaction, continuous improvement, and program resources. Conflicts between the desired and actual performance indicated performance gaps in grading guidelines, grading technology, and instructor accessibility. A meeting with leadership and faculty was held to prioritize, confirm, and identify the root causes of the performance gaps. The three prioritized gaps were caused by: a lack of instructor access to student textbooks and materials; grading technology not designed for dental hygiene clinical education; and inadequate adaptation of teaching methods to meet diverse student needs. The gap and cause analyses informed the intervention selection, design, development, and implementation.
The key stakeholders reviewed proposed interventions and selected an intervention set based on feasibility. The set comprised knowledge management, expert systems, and continuous improvement interventions. The knowledge management intervention involved providing the instructors with access to current textbooks used by the students and creating a digital knowledge repository, addressing the performance gap in objective and standardized grading guidelines. A software program for managing dental hygiene clinical education was selected to replace the existing grading system. A continuous improvement program was introduced to gather and address student-instructor interactions regularly. These interventions function synergistically to improve clinical grading efficiency and calibration.
Formative evaluations were conducted for quality control of the inputs and processes during the design and development phases. The formative evaluations examined the stakeholders’ immediate reactions, acceptance, and adoption of the intervention set. Summative evaluations were conducted six weeks after the interventions were implemented to determine their effectiveness in addressing the priority performance gaps. Adjustments and modifications were made based on the formative and summative evaluations to enhance the interventions’ adoption and effectiveness. A confirmative evaluation will be conducted one year after implementation to determine the intervention set’s long-term impact.
This study has implications for using an action research approach and human performance technology frameworks to explore and address this dental hygiene program’s current and future performance problems. The dental hygiene program and its stakeholders are encouraged to adopt, replicate, and adapt the HPT model, leadership, and change management methods used in this study for continuous improvements. Additionally, this study illustrated that the root causes of performance problems may not always be apparent, reinforcing the HPT model’s value in facilitating comprehensive organizational performance analyses.
This dissertation-in-practice project helped me grow as a writer, thinker, researcher, performance improvement practitioner, and educator. I have learned to adapt to change myself and be confident in my leadership abilities to manage it. Working with these stakeholders to further refine the dental hygiene program’s excellence was a tremendous privilege.