The Development of Problem-Based Learning Module for Clinical Dentistry in Dental Hygiene

REVIEW ARTICLE

Received: February 14, 2017, Revised: May 25, 2017, Accepted: September 7, 2017 ISSN 1598-4478 (Print) / ISSN 2233-7679 (Online)

†

Correspondence to: Soo-Myoung Bae

Department of Dental Hygiene, College of Dentistry, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea Tel: +82-33-640-2756, Fax: +82-33-642-6410, E-mail: edelweiss@gwnu.ac.kr

Copyright © 2017 by Journal of Dental Hygiene Science

The Development of Problem-Based Learning Module for Clinical Dentistry in Dental Hygiene

A-Yeon Jeong ¹ , Sun-Jung Shin ^1,2 , Bo-Mi Shin ^1,2 , and Soo-Myoung Bae ^1,2,†

1

Department of Dental Hygiene, College of Dentistry and

Research Institute of Oral Science, Gangneung-Wonju National University, Gangneung 25457, Korea

We attempted to develop a problem-based learning (PBL) module for integrated education in dental hygiene with the aim of helping students gain clinical competencies necessary for dental hygienist work. To develop the PBL Module for Clinical Dentistry in Dental Hygiene course, the researchers identified literature related to not only educational technology, but also medical science, nursing, dentistry, and dental hygiene. During the design phase of the PBL module, problem scenarios and a plan for the teaching and learning process were developed. Developing problem scenarios involved describing a problematic situation and three questions related with that situation. To cultivate competencies required in dental clinics, each question was related to the diagnosis of a dental disease, dental treatment, and dental hygiene procedures for care. Teaching-learning process plan included the designs of operating environment, operational strategies, learning resources, facilitation of problem-solving process, and evaluation. It is necessary to evaluate the PBL module for integrated education in dental hygiene to confirm its effectiveness.

Key Words: Clinical dentistry, Education, Problem-based learning

Introduction

Dental hygiene education in Korea began with the introduction of a 2-year curriculum in 1965 by the Severance Hospital affiliated with College of Medicine at Yonsei University, which was based on dental hygienist training program from Fones School of Dental Hygiene in the United States. Contrary to the goal of dental hygienist training that focuses on preventive duties, dental hygiene education at the time consisted of theoretical and practical education on assistance for care ¹⁾ . In 1994, dental hygiene education throughout Korea was converted to a 3-year curriculum, and the development of a 4-year curriculum in 2002 has led to an extension of the schooling, along with an increase in the number of well-qualified dental hygi- enists to date ¹⁾ .

Existing dental hygiene education has several problems, such as the content being excessively segmented into too

many courses, the courses not being focused on dental

hygiene, courses being dentistry-based, focusing on the

duties of dental care assistance, without any consideration

for the various roles that dental hygienists play ^2,3) .

Course-based education may lead to content overlapping

with other courses or certain lessons not being taught

based on the belief that these would be taught in other

courses ⁴⁾ . Moreover, because the curriculum progresses in

no logical order, blended learning between courses

becomes difficult, which limits the students’ ability to

build interdisciplinary integrative thinking ⁴⁾ . Additionally,

dentistry-based education has the goal of disease treat-

ment, and its focus on dental care assistance duties differ

from the duties of dental hygienists, whose goal is health

promotion. This presents difficulties for the dental hygiene

students in gaining comprehensive understanding and in

applying what they learn to actual work situations. This

ultimately leads to dental hygienists losing their profe-

Table 1. Design of the Research

Step The process of research in this study Step 1 Development of scenarios for PBL 1-1 Curriculum analysis

1-2 Create scenarios

1-3 Expert validity evaluation

Step 2 Development of teaching and learning process 2-1 Design of operating environment

2-2 Design of operational strategies 2-3 Design of learning resources

2-4 Design of facilitating problem-solving process 2-5 Design of studying evaluation

ssionalism and identity ^5,6) .

Numerous studies on dental hygiene education have emphasized the need for the type of education that can improve students’ problem-solving abilities by mutually linking theory and reality, and as a teaching-learning method, problem-based learning (PBL) was suggested ^7,8) . PBL refers to a teaching-learning method of having the learner learn on his or her own through the process of solving given problems. The learner solves problems that may actually occur in real life through self-directed learning (SDL) and collaborative learning ⁹⁾ . In this process, the learner thinks by connecting theory with reality, which develops comprehension, application, critical thinking, and the ability of task performance for the problematic situation, while also having an effect on learning-related motivation, interest, self-concept for- mation, cooperation, bonding, communication, and res- ponsibility ^10,11) .

PBL was first used in medical schools, and it is currently being used in a variety of fields, including healthcare, mathematics, law, education, economics, management, sociology, and engineering ¹²⁾ . In the field of dental hygiene, various abilities, such as interdisciplinary integrative thinking, critical thinking, and communication skills, are needed for dental hygienists to perform their professional duties in clinical settings, and PBL has been presented as a teaching-learning method for achieving such a goal ^7,8) . There have been studies that developed problem scenarios or packages of PBL for some dental hygiene courses; however, studies that have analyzed the clinical duties of dental hygienists and course contents of available PBL modules are still lacking ¹³⁾ . Accordingly, the present study aimed to present modules based on development of PBL problems and teaching-learning process plan to provide basic data needed for opera- tionalizing PBL.

Materials and Methods

In this study, we developed a PBL module, to be used as a part of dental hygiene and clinical dentistry courses, instead of the existing educational methods. The PBL module developed in this study included the development

of problem scenarios and a plan for teaching-learning process that are covered during one semester of the clinical dentistry courses. Problems for PBL development was based on practical understanding ⁹⁾ , while the teaching-learning process plan was based on PBL design model development for college courses ¹⁴⁾ . The overall procedures used in the study are shown in Table 1.

1. Development of problems for PBL

1) Content analysis for problem development

The present study selected “dental disease” as the

problem idea, after which, it conducted content analysis as

a method of confirming learning content, learning goals,

and clinical duties related to this idea. For the learning

content, we used main topics from a total of 9 courses in

oral medicine, oral and maxillofacial radiology, oral and

maxillofacial surgery, pediatric dentistry, preventive den-

tistry, orthodontics, conservative dentistry, prosthodontics,

and periodontology. These were taken from 1st and 2nd

semester lecture plans posted on the intranet of

Gangneung-Wonju National University, as of the end of

September 2015. As for the learning goals, dental hygiene

and learning goals ¹⁵⁾ based on national examination items

were used. As for the clinical duties, the 2nd dental

hygienist job analysis report from the National Health

Personnel Licensing Examination Board of Korea was

used ¹⁶⁾ . In addition to content analysis, we also referenced

actual clinical data and various literature pertaining to

PBL problems already developed, clinical dentistry,

dental administration, dental insurance, diagnosis, and

clinical cases.

2) Construction of problems for PBL

The problems for PBL determined the role of the learner so that SDL could be encouraged when the student recognizes he or she has the main role in problem solving.

Problematic situations related to the idea (disease) that may occur in clinical hospitals and clinics were cons- tructed based on the content analysis. After completing the construction of problems, problem-related learning goals and core competency and sub-competencies that can be gained after problem solving were presented through the development of competency-based dental hygiene educa- tion evaluation system ⁸⁾ .

3) Expert validity assessment

For the assessment of problems developed for PBL, 3 active professors from dental hygiene colleges in Korea and 1 outside expert who majored in education technology were invited and commissioned to perform the assessment. The expert assessment tool was comprised of 27 questions compiled from PBL problems validity asse- ssment questions ^17,18) . The expert assessment tool was distributed to the 4 invited experts, and the tool was constructed in a self-reporting questionnaire form with each question graded on a 5-point scale (strongly agree, agree, average, disagree, and strongly disagree). Expert validity assessment results showed an average score of 4.6 points. Highest scores were found in the order of practicality, ill-structured, and role of the problem. The problem development process was completed when all questions received a score of 4 points or higher.

2. Development of a teaching-learning process plan for PBL

1) Operating environment design

For designing the operating environment, the operating environment was determined by performing environ- mental analysis on temporal limitations of the teacher and learner and securing learning space among face-to-face, online, and blended methods. Subsequently, based on the operating environment, learning space was presented with

consideration for physical space, such as classroom, laboratory, and lecture rooms, and online space, such as clubs, cafes, and blogs.

2) Operational strategy design

To design the operational strategy, the total learning period required for operating PBL was established;

weekly activities were constructed; and time plan for activity contents was constructed. Weekly activities were divided into individual and team activities involving the teacher, tutor, and the learner. Theoretical learning issues that should be taught by the teacher during the course of the activities were presented together.

3) Learning resources design

Learning resources design presented learning resources related to the learning issues and confirmed the data used in content analysis, as well as other learning resources, including professional literature, actual objects, models, experimental tools, multimedia data, internet sites, professor lectures, and expert invitation.

4) Facilitation of problem solving process design To facilitate the problem-solving process, the point of sharing the intra-group content, the point of verifying the inter-group output, the point of sharing need among all students, the point of providing feedback, and the process of task performance plan were properly structured.

Moreover, usage data, such as group activities log, task performance plan, problem analysis log, and reflection journal that are needed at different time points were presented.

5) Assessment design

As for the assessment design, a decision was made to

perform multi-source assessment by teachers and learners

with assessment divided into process assessment that

assessed the entire learning process and outcome

assessment that took place at the end of learning. The

assessment tool comprised of the assessment sheet based

on content from literature related to existing PBL asse-

ssments.

Table 2. Analysis of Learning Contents, Learning Objectives, Clinical Job Content

Classification Learning contents and objectives Clinical task Subjects

1. Examine and diagnosis

Examine and diagnosis process History taking/vital sign measurement/

observe body/extra-oral assessment/

intra-oral assessment/dental hygiene diagnosis/dental hygiene plan

Oral medicine Conservative

dentistry Dental radiology 2. Dental

treatment

Conservative treatment procedure/cavity preparation & root canal treatment/restorative materials/prosthetic treatment/repair and removal of prosthetic devices

Conservation treatment/pediatric treat- ment/prosthetic treatment/impression and bite taking

Conservative dentistry Prosthodontics

3. Dental hygiene process

Dental hygiene diagnosis/tooth

brushing/dentifrice/oral hygiene products/

professional plaque control/fluoride tropical application/sealant/caries activity

test/smoking cessation/endocrine diseases/dry mouth/halitosis/diet and oral condition

Dental hygiene assess, diagnosis, planning, evaluation/preventive dental treatment/

oral medicine treatment/periodontal treatment

Oral medicine Preventive dentistry Periodontology

Results

1. Development of problems for PBL

1) Analysis of learning content, learning goals, and clinical duties

As for the designer idea for PBL, dental decay was chosen among extracted keywords, because of its high-prevalence among outpatient cases commonly enco- untered in the clinical institutions in Korea. The results of content analysis were divided into examination and diagnosis, disease treatment, and dental hygiene care to organize the learning content, learning goals, and clinical duties. Among the 9 clinical dentistry courses selected for content analysis, 6 courses had content related to dental decay (Table 2).

2) Construction of problems for PBL

The role of a learner was defined as 1st year dental hygienist working in a dental hospital, while the problematic situation was presented as the visit to a clinical dental hospital or clinic by a patient with tooth ache. In total 3 problems were developed based on the content related to examination and diagnosis, disease treatment, and dental hygiene care as a result of the content analysis. The first problem presented content about consultation on the examination results after completion of diagnostic testing. The second problem

presented content about patient education and dental care assistance duties during the disease treatment process. The third problem involved performing dental hygiene care according to oral care needs of the subject (patient) after examination. Learning goals and competencies were presented as problems that took into account the learning outcomes based on problem solving (Table 3).

2. Development of a teaching-learning process plan for PBL

Teaching-learning plan employed through the operating

environment design, It was decided by mixing face-to-face

classes and online use environment for assuming that there

are no temporal or spatial limitations between the teacher

and learner. The learning issues were presented after

constructing the weekly activity and time plans based on

the operational strategy design that would allow PBL to be

operated 3 hours per week during a single semester (total

of 15 weeks), and the learning resources design present the

material used in the content analysis as the learning

resources. As the design for facilitation of problem solving

process, weekly planned content was combined and

divided into activities. After checking that the points of

sharing the intra-group content, verifying the inter-group

output, need for sharing among all students, and providing

feedback were adequately included in the curriculum,

activity categories were divided into implementation,

development, and completion. Subsequently, guidelines

Tab le 3. C lin ica l D en tistr y P ro bl em -Base d L ear n in g P ro ble m S ubject C linical d entist ry (integrated course) Year 3/ sem ester 2 Pr ob lem top ic T reatmen t and man agem ent of d ental caries Cor e com petencies D ental hy gienists w ho g ra du ate fr om the D epar tment o f Dent al H ygiene shoul d hav e knowledge and skill s related to th e cl in ic al w or k re qu ir ed f or th eir d ut ie s. Lear ni ng object ives & D et ailed compet ency Problem 1 1. Describe the s ubjecti ve diagnosti c process 2. Explain the objecti ve diagnosti c process 3. Cl assify dental caries and de ntal disease and expl ain t he ca use, r isk f actor s, and cli ni cal sympt oms of the di sease. 4. Describe the t reatment of de nt al caries and dent al di sease

1) Be able t o util ize basic m edi cal and dent al cl inical knowled ge in patien t man agem ent pr ocess. Problem 2 1. Dent al car e support services can be per fo rm ed dur in g t he treatm ent of dental caries and dent al di seases. 2. Patient m anagem ent and pat ien t educati on relat ed to dental c are can be performed.

2) B e able to perform tasks for effect ive dental care (i m pressi on tak in g, temp or ary attach men t a nd rem ov al, tem por ar y fi lling and rem ov al, o rtho don tic w ir e ligatur e and r emo val). 3) B e ab le to per fo rm patien t m anagem ent and or al health edu cat ion related to dental care. P ro blem 3 1. Based on the inf or mation gather ed, it shou ld b e ab le to identi fy the oral h ealth needs of the p atient an d p erf or m den tal h ygienist judg men t. 2. I t is possible to estab lish the necessary denta l hy giene int er vention based on th e judg men t of den tal h ygienist. 3. The p lan ned dental hy giene intervention can be performed and evaluated.

4) B ased on the inform at ion gath ered, the pati en t shou ld b e ab le to ident ify the oral healt h needs and to m ake dental hygienist judg men t. 5) I t sh ould be ab le to establish dent al hygiene plan by classi fy in g into professi onal treatm ent and self- pr actice based on dental hygiene ju dgm ent. Probl em scenario Dental hygi eni st △△△ : It is the first year den ta l hy gi en is t w ork in g a t ○○ ho sp ita l. A m an w it h a gr ay h air a nd a f le sh y s to m ac h c om es in the hospital you work in w ith frow n face. D ental hy gienist △△△ : (w it h a sm il e) H el lo ? Gil -dong Hong: Hi (frown). I cam e because of the t ooth pai n … . D ental hy gienist △△△ : H ave you ever b een tr eated at ou r hosp ital? G il- do ng H on g: ( in a tr emb ling vo ice) N o, this is the f irst tim e. My ri gh t lo wer back w as so si ck that I coul d not sl eep yeste rd ay … . D ental hy gienist △△△ : (w ith anxiou s exp ression ) When did you get sick? G il- do ng H on g: I f elt u ncom fo rt ab le fr om the last w eek, bu t I w as n ot com ing to den tal h ospital. I am reall y afraid of getti ng dental t reatment … . W ha t do I do … . I am s o sick a nd painf ul … . I su dd enl y feel pain an d it' s get tin g wor se … . D o I have to b e cured? H ow is the treatm ent going … ? I'm so nervous because I do n’ t kno w an ything abou t. I am w ond ering if th ere is anythin g I can do at hom e for oral heal th wit hout treat m ent. C linical chart /oral hygiene chart

Pr ob lem 1 G il- do ng H on g f inished pati ent exam in at ion and cli ni ca l ex amination and came back to the w aiting ro om . G il- do ng H on g, why is hi s bo tto m ri gh t s ick and what is his condi tion? Is th ere any other oral probl em ? What tr eatm ent should I receive in the future? I asked dental h ygienis t △ △△ to expl ain w it h anxi ous face. S el ect a role th at can appear in the dent al cli ni c for ea ch team , an d pr od uce and subm it ab out 5 m inutes of video w ith th e content of the pr ob lem s olving . Pr ob le m 2 T he d en ti st □□□ who di agn osed hi m by G il -d ong Ho ng re quest ed to pr ep ar e th e tr eat ment o f toot h #4 5 on t he day. Th e dent al hy gien ist △ △△ thou ght t hat there w as a lack of capacit y to suppor t m edi cal care w hil e prep ar ing eq uip m ent an d mater ials fo r #45 toot h. W hile I w as w ond er ing how to solve it , I thought that it w oul d be helpf ul to cr eat e a m anual rel ated to dental hygi en ist 's w or k and educat ional m edia necessar y for pat ient e ducat io n. If y ou a re a d en ta l hy gi en is t △△ △ , please pr epare th e m anual of the w ork w hich can be made in H angu l/Wor d and su bmi t th e educat ion al med ium w hich can be pr esen ted to the patient du ring the ex am in atio n period in free f orm. P ro bl em 3 G il- don g Ho ng, w ho h as fin ished hi s car e, w ant s to hav e hi s own or al cav ity a nd h op es that he w ill not h av e any mo re problem s, but he is w orr ied about th e si tuat ion th at he is not w ell man aged and cont inu es to h av e pr obl ems wi th his or al heal th. He al so re quest s hel p fr om den tal hyg ieni st △△ △ . I f y ou a re a d en ta l h yg ie ni st △△ △ , w hat kinds of dent al hygi ene in ter venti ons can yo u su ggest f or the recovery or enhancement of d ental heal th of Gi l- dong H ong a nd h ow c an y ou e xp la in them to hi m ? P lease w ri te th e content s of each st ep of d ental hygi ene management p ro cess and l astly sub mit bot h t he con tent s o f dent al h ygi ene in ter venti on and explanat ion you have w ritt en. Final p ro duct B ased on the r esults of the abov e-m entioned pr ob le m sol vi ng, organi ze t he cont en ts i n accordance w ith the flow of the medi cal care pro cess and the dental hy giene m anag emen t pr ocess an d su bm it them in th e f or m of Po w er P oi nt ( PP T) .

Clin ical cha rt/o ra l hy gien e ch art is us ed for th e ev alu ation of o ra l he alth sta tus by a d en tis t or de ntal hyg ienist in a den ta l h ospital, w hich inc lude s extra and intra oral exam in ation as w ell as vita l s ig n, ov erall he alth, th e be hav ior of oral he alth, e tc.

Tab le 4. P ro ble m -Ba sed Le ar ni ng ( PBL ) T ea chin g Lea rn in g Pro c es s Cla ssi fic ati on Ac tiv iti es Time Check list Le arn ing is sue s Tea che r St ude nt 1 w eek Orie nta tio n & pe rf orma nce pl an pre par a- ti on Intr odu cti on O ri ent ati on for PBL The in str uct or pre par es and pr ep ar es a P BL O ri ent ati on P P T be for e pr ob lem P B L i s im pl em en te d. Desc rib e t he rol e o f s tud ent s a nd tea che rs, gu ide lear ner ro le and us e o f t he lea rni ng spa ce, gu ide th e teac hin g p roc ess an d me tho d, and so lve pr eli mina ry ques tio ns.

30 min □○ Unde rst and th e d efi nit ion of PBL ○ Unde rst and th e d iff ere nce be twee n Ex ist ing Lec tur e Lea rni ng and PBL ○ Unde rst and th e P BL ○ Unde rst and th e P BL ’s eff ect Gui de to org ani ze gro up and dis tri but ion of gr oup act ivi tie s

Guid es for gr oup ing of le ss tha n 6 te ams of 4 t o 8 peop le con sid eri ng fre e r ide an d p rof ess or' s feed bac k a cti vit ies . E ven if th e c our se is a l arg e grou p, the gr oup sh oul d b e l ess th an ten . Dist rib ute gr oup ac tiv iti es and gu ide gr oup ac tiv iti es.

10 min □ Do gro up act ivi tie s T he le arn er org ani zes gr oup s f or tea m ac tiv iti es. Defi ne you r t eam name , t eam rul es, ro les , e tc. , a lon g wi th a b rie f i ntr odu cti on of eac h t eam, an d t hen crea te a g rou p a cti vit y s hee t.

10 min □ Pr ese nt sce nar ios Tea che rs pre sen t p rob lems to le arn ers in a var iet y o f wa ys (vi deo s, pho tos , r ole pl ays , v oic e r eco rdi ngs , et c. ).

5 m in □ Gu ide to pr epa re th e per for manc e p lan For in div idu al stu den ts, di str ibu te an ind ivi dua l t ask pe rf orma nce pl an for m to ea ch tea m , a nd ass ign a team tas k p erf orma nce pl an to eac h t eam to cre ate lear nin g o bje cti ves , c ore co mpet enc ies , p rob lem situ ati ons , p rob lem sol vin g, pro ble m so lvi ng appr oac h, and fi nal pr odu ct for m.

5 m in □ De vel opme nt D raf t p rob lem in the sce nar ios and pre par ing the per for manc e pl an

Stu den ts ide nti fy pro ble m si tua tio ns tha t n eed to re ad and res olv e p rob lem sce nar ios . Pre par e a pe rfo rman ce pla n f or the pr obl em s itu ati on deri ved fr om t he pro ble m sc ena rio , t he lea rni ng obje cti ves to be le arn ed aft er sol vin g t he pro ble m , the cor e c ompe ten cy, th e p rob lem sol vin g me tho d, the pro ble m so lvi ng con ten ts, an d t he fin al pro duc t form tha t t he ind ivi dua l t hin ks.

20 min □

Tab le 4. C o n ti n u e d Cla ssificatio n A ctiv ities Tim e Check lis t Learn ing i ss ues Teac her Student 1 wee k Deve lop m ent M ake up th e pe r- form ance plan In the p ro cess of sh ar ing th e co nten ts o f th e ind ividu al task cr ea tion, w e sh ar e op inion s o n ho w to solve the p ro blem tha t can be solv ed b y ad dition , and the fee dba ck g athe re d in th e tea m is o ne ta sk Creat e a pe rform ance plan form , an d f inally dete rm in e the type of fin al pr od uct to be presented by your team .

30 m in □ Sub m is sion of team wor k p erfo rman ce pl an

U ploa d tea m w ork pla n to th e ho m epa ge o f th e de partm en t of de ntal h ygie ne. 10 m in □ Presenta tion o f te am wor k p erfo rman ce pl an Pro vide a brief presen tation of team perform an ce plan by tea m s o that th ey c an sha re their op inion s. 30 m in □ Pr ovid e f eed bac k on te am pe rform ance pl an

A fte r c hec king that th e pr ob lem situatio n an d pr ob lem - solvin g ap pr oac h de riv ed b y th e learne r a re appropriate, ex plain th e lea rn ing ob jectiv es and a ttainm ent ca pab ilities relate d to th e prob lem .

20 m in □ Closing O rg an ize y our lessons and e xpla in the nex t cour se

D escr ibe th e co ur se of pr oble m 1, ex plain ing th e pr ob lem situatio n an d the ro le of the learne r. Expla in the nex t PBL pr oc ess to stu den ts.

10 m in □

Tab le 4. C o n ti n u e d Cla ssificatio n A ctiv ities Tim e C hec k list Lea rning issues Tea che r Student 2 ∼ 3 we ek s Solv ing p ro blem s an d pr od ucin g results In tr od uctio n In tro duc e lea rn ing goals and course D escr ibe the le ar ning ob jec tives an d instruc- tio nal p ro cess re lated to pr ob le m 1

15 m in □ [Pro bl em 1 ] ○ The diagnostic proc ess - Patie nt's c ond ition (history e xam in ation ) - Clin ical e xam in ation ○ The ora l diseases - Cla ss ificatio n of de ntal c aries and den tal disea se s - Ca uses of illness, risk fac tors , c linica l s ym ptom s - Treatm ent for diseases [Pro bl em 2 ] ○ Tre atm en t flo w ○ The nece ssary proced ur e fo r tr eatment ○ Lega l sc ope of den tal hy gien ist ○ Clinic al du ties of den tal hy gien is t - D en tal ca re s uppo rt: rela ted to the trea tm ent proc edu re , activ ities re quired fo r th e treatm ent pr oc ess, m ater ials and equ ipm en t - Co unselin g an d ed uca tion-relate d: co nsultatio n ab out c linica l sy m ptom s, tr eatm ent pr oc ess, prec autions after tre atm ent , oral he alth care ha bits [Pro bl em 3 ] ○ U nde rstan ding and app lying the d enta l hyg iene m ana gem ent pr oc ess - Co rrela tion b etw ee n system ic d is eases and oral he alth - Self-hyg iene m ana gem en t m eth od a nd pr of essiona l m ana gem ent m eth od o f p ro sth etic pa tients w ith h igh r isk of de ntal c ar ies - Ca uses and tre atm en t or m ana gem en t of ba d br ea th - Ca uses of dry m ou th an d treatm ent or m an age m ent m et hod - Re lation sh ip be tw een diet a nd o ra l hea lth, die t co unselin g an d die t pr escr iption - D rinkin g an d sm okin g ce ssatio n m eth ods

Tab le 4. C o n ti n u e d Cla ssificatio n A ctivitie s Tim e C hec k list Learn ing i ss ues Te acher Student 2 ∼ 3 we ek s Solv ing p ro blem s an d pr od ucin g results D evelopm ent S eeking te am problem solvin g an d pr od ucin g ou tput

To sh ar e the inf or m ation and opin ions tha t are searched by the individua l w ithin the team , a nd to organize the results of the pr oble m so lving in the pr oble m ana lysis pa per an d to p ro du ce th e int ermed iat e re su lt. If ne cessary du rin g tea m proble m so lving , the c onte nts of the te am task per fo rm anc e pla n ca n be re vised a nd su pple m ente d.

2 h □ Q uestion and answ er on prob lem -s olving Th e instructo r w ill a sk all lea rn er que stio ns re lated to prob lem 1 a nd p ro vide the answ ers including nec ess ar y learning contents.

30 m in □□ Clos ing O rganiz e your less ons and explain the next cours e

Explain the c om pe tenc ies that need to be ach ieve d thr ou gh p ro blem solv ing, a nd guid e the pr esenta tion o f r esults.

15 m in □ 4 w ee ks Presentin g the results (in terim presen tation )

In tr odu ction In tro duc e PBL p ro cess on interm ediate presen tation

Ex plain PBL pr oc ess o n inte rm ediate pr esenta tion a bou t pr oble m 1. 15 m in □ D eterm ine the o rd er of inte rm ed iate presen tation Th e or de r o f p re se ntatio n is dete rm in ed in a ra ndom w ay s uc h as l ot d ra w in g, l ad de r rid ing, e tc.

10 m in □ D ev elop m ent P re se nt the re su lts a bou t solvin g pr ob lem 1 Th e r esult ab out solv ing p ro blem 1 got pr esente d to s har e and a rr ang e th e conte nts to other team s.

60 m in □ Ev al uat e an d pr ov id e feed bac k on presen tation

Th e instr ucto r c ond ucts the pr oce ss eva luatio n on the p roble m s olvin g attitu de, pa rt ic ip at io n atti tude and presentati on af te r the p re se ntatio n of all th e tea m s a nd pr ovid es fe edb ack b ased on the result. Provide the ne cessary lea rning resourc es if the le arners hav e difficultie s.

30 m in □

Tab le 4. C o n ti n u e d Classific ation A ctiv ities Tim e C hec k list Learn ing i ss ues Tea che r Student 4 w ee ks Presentin g the results (in terim presen tation ) D eve lopm en t D ev is e s olution s T he learne r c hec ks the a ctivitie s i n the te am by re fe rr ing to the c onte nts of the f ee dba ck a nd th e pr es en ta ti on o f th e ot her t ea m, and c or re ct s an d co m ple m ents the pr oble m app ro ach , pr oble m solu tion m ethod s.

50 m in □ Closing O rg an ize y our lessons and e xpla in the nex t cour se

The instru ctor ex plain s th e lea rn ing c onte nts and attainm ent ab ility tha t s hould be le arned throug h pr ob lem solv ing in re lation to prob lem 1, a nd expla ins the c our se of pr ob lem 2.

15 m in □ Pro blem 2 pr ogr essed f or 5 to 7 w ee ks and pr oble m 3 pr og re ssed fo r 8 ∼ 10 w eeks .

[A pply the sam e pr oce dur e to pr oble m 2 an d pr ob lem : Solv ing p ro blem s an d pr od ucin g r esults → Presentin g the re su lts (Interim Presenta tion)] 11 ∼ 13 w ee ks Synth esizing the pr oble m s ol ution In tr od uc ti on Introduce learning goals and cours e D escribe learnin g ob jectiv es and instru ction al pr ocesses re la te d to p ro bl em 1, 2, an d 3 15 m in □ D eve lopm en t C om plete the f ina l results Prepa re the fina l re su lts b y sum m arizin g the conte nts of pr oble m 1, 2, a nd 3 . 2 h □ Qu es ti on a nd a ns wer on p ro bl em-s ol vi ng The instru ctor w ill ask a ll learne r q uestion s rela ted to Q uestion 1 an d pr ov ide th e an sw er s inc ludin g nece ssar y le ar ning con tents.

30 m in □□ Closing O rg an ize y our lessons and e xpla in the nex t cour se

Exp lain th e lea rn ing c onte nts and attain m ent skills th at yo u ne ed to kno w thr oug h pr ob lem solvin g, and g uide you thr oug h the nex t class. G uid e the presenta tion o f th e final result (PPT) on the hom ep ag e.

15 m in □ 14 w eeks Presentin g the resu lts ( fin al presen tation )

In tr od uc ti on Introduce learning goals and cours e D escr ibe the f ina l ann oun cem en t pr oc ess f or pr ob le m 1, 2, and 3 . 10 m in □

Tab le 4. C o n ti n u e d Classific ation A ctivitie s Tim e C hec k list Learn ing i ss ues Teac her Stude nt 14 w eeks Presentin g the resu lts ( fin al presen tation ) In tro duc tion D eter m ine the o rd er of final p re se ntatio n The or der of pr esen tation is d eter m ine d in a ra ndo m w ay such as lot draw in g, lad der riding , etc. 10 m in □ D eve lopm en t P re se nt f inal r esults T he lear ne r h as a pr esen tation tim e to sha re and ar range the contents of the corresponding state di sc ri mi nat io n re su lt s amo ng t he t eams.

60 m in □ Closing M ak e a n ev alua tion A s w ell as the instru ctor (tutor), the le arner pa rticipa tes in the eva luatio n pr oc ess a nd e valu ates th e ou tcom e of the r esult a nd e valu ates the cou rse of t he lear ni ng pr ocess.

30 m in □□ Provide fe edback on evalua tion A fter all tea m s h ave fin is hed th eir presenta tions, the cour se ev alua tion is co ndu cted in r elatio n to pr ob lem solv ing, a ttitude s a nd p articipa tion in le arning, and fe edback i s pr ov id ed b as ed o n th e results.

50 m in □ Create a reflection log an d gu ide th e presen tation

Crea te an indiv idua l re fle ction log a nd u ploa d it to th e ho m epa ge o f th e du e da te so tha t it can be sub m itted. Stud ents w ho hav e dif ficulty in m ak ing jo ur nals f or th e first tim e b y w riting a re fle ction log w ill b e pr es en ted w ith ex em pla ry exa m ples prep ared b y other stude nts.

10 m in □ Closing O rg aniz e yo ur lesso ns and explain the next cours e

The instru ctor w ill ex plain the le arning con tents an d attainm ent ab ility tha t nee d to b e lea rn ed th ro ugh pr ob lem solv ing in re lation to prob lem 1, 2 , and 3, and w ill p ro vide guid anc e on fin al ex am s.

10 m in □ 15 w eeks PBL finishin g In tro duc tion G uide the fina l exa m A lloc ate a fi na l ex am ina tion te st she et an d ex plain pr ecau tions f or the te st. 20 m in □ D eve lopm en t F inal e xam T ak e the fin al ex am by sy nthe siz ing th e co nten ts le arned in the m ean tim e. 60 m in □ [O ptiona l] le cture pr ov ided If th e lea rn ers h ave diffic ulties in le arning , the in str uc tor pr ovid es lectu re s. 60 m in □ Closing P ro vide fin al f eed bac k Pr ovid e f inal f ee dba ck o n lea rn ing c onte nt an d ac hie vem en t ca pab ilities based on e valu ation and re flec tion lo gs.

40 m in □ Eva luatio n pla n (① + ② + ③ ) ① A tte nda nce 10% ② Professor/tutor ev alua tion 2 0% ③ Le arner ev alua tion (=self-ass es sm en t+in-grou p ev alua tion+ interg ro up e val uat io n) 50% ④ Final exam 20%

were established by including activities log, task per- formance plan, problem analysis log, and reflection journal needed for activities, and then categories for performing each activity were presented separately for teachers and learners. Finally, assessment design was used to present attendance, teacher evaluation, learner evalua- tion, and written final exam as the assessment items, and the percentages for each assessment item were established (Table 4). Moreover, the assessment tool was presented to allow the teacher and learner to perform multi-source assessment (Table 5).

Discussion

A dental hygienist refers to a professional who works to promote oral health, and the role of a dental hygienist has become more important in changing from a treat- ment-centric to a preventive care-centric role to keep up with the changing trend over time ¹⁶⁾ . However, current dental hygiene curriculum has educational content that is divided based on dentistry courses, which makes interdisciplinary connection difficult. Because it involves top-down method of delivering fragmentary knowledge and skills for license acquisition, the opportunities to gain integrative understanding about the actual work situations and the application of such knowledge and skills are limited. Consequently, there are difficulties in gaining the necessary competencies to perform the basic duties of a dental hygienist ¹⁹⁾ . Therefore, with this study, we present the development of a PBL module that included problem scenarios and teaching-learning process plans to be incorporated into clinical dentistry courses, PBL module provides the basic information for an integrative dental hygiene education that would allow learners to gain the competencies needed in the clinic.

Dental decay, a high-prevalence disease among outpa- tient cases in Korea, was selected as the problem scenario for the PBL module that was developed. Then, contents of the curriculum and clinical duties were verified. Learning content, learning goals, and clinical duties related to dental decay were analyzed, and the findings were taken into account when developing the 3 problems based on the flow of examination and the dental hygiene care pro-

cesses, while presenting the learning goals and compe- tencies at the same time. The significance of the present study is that by developing PBL problems that took into account the curriculum and clinical duties, it was designed to allow acquisition of theoretical concepts about disease and treatment process, along with gaining comprehensive understanding of the disease and treatment process through problem solving, then applying the theoretical concept during actual duties. The learner should be able to obtain new knowledge via PBL by connecting concepts that are handled in various different clinical dentistry courses. Ultimately, the learner, as a future dental hygienist, must also gain comprehensive and professional job competencies and knowledge to apply when needed in clinical setting during their actual duties. It is expected that during the process of problem solving, the learner would not only integrate the various concepts that he or she understood through SDL and collaborative learning to create knowledge, but also would develop various job competencies, such as comprehension, application, critical thinking, task performance abilities, cooperation, bonding, communication, and responsibility ^20-22) . The problems developed in the present study took into account the clinical duties of dental hygienists and dental hygiene and clinical dentistry curricula of Korea in recent years.

However, those problems cannot cover all of the learning contents of clinical dentistry courses and clinical duties of dental hygienists; thus, development of additional problems is needed, as well as additional examinations to determine whether such problems developed are being reflected in actual clinical situations.

The present study is also significant because it provided

actual help for operating PBL by constructing a tea-

ching-learning process plan. The teaching-learning process

plan included the entire class schedule, location, and

learning resources. Moreover, operating PBL was made

easier by the present guideline based on dividing the

weekly activities by time, dividing the activities by who is

performing them, and including usage data. Furthermore,

assessment plan was established based on various asse-

ssment subjects and the necessary tools were presented to

allow multi-source assessment. However, prior to ope-

rating PBL, operational decisions need to be made based

Table 5. Problem-Based Learning Assessment Tool

Subject Evaluation contents

Professor/tutor evaluation 1. Did all members of the team faithfully attend the class?

2. Did you understand your role in the problem solving process?

3. Did you organize the contents of problem solving to achieve the learning objectives and competencies?

4. Was there a variety of problem-solving approaches to problem situations you had found?

5. Did you use appropriate evidence to derive valid problem solving?

6. Did you collect the necessary data for problem solving, analyze it, and create various knowledge through the process?

7. Was the outcome of the problem based learning unique and practical in clinical practice?

8. Was the results of your work faithfully written with the team's diverse opinions?

9. Was the presenter well aware of what were the problems in each scenario and how to solve it?

10. Were the presenter ready for presentation (presentation, dress, posture, voice, accent, etc.)?

Learner evaluation (self-assessment) 1. Did you attend the class with exactly knowing problem based learning process and evaluation methods?

2. Were you interested in the problem based learning process and sincerely involved in the class?

3. Had you identified problems with the problem and sought various solutions?

4. Did you collect, analyze, and organize your own data for individual tasks?

5. Did the problem based learning process develop the competencies needed to solve problems such as problem analysis, logic, judgment, and critical thinking?

6. Could you deal with similar real-world situations by learning the knowledge, skills, and attitudes necessary to solve the problems during the problem based learning process?

7. Did you take responsibility for your role and did not you interfere with your team?

8. Did you participate in the problem-solving process while respecting and collaborating with team members?

9. Did you make a lot of contributions to the problem-solving process and results?

10. Did the problem based learning achieve the competencies required for the clinic?

Learner evaluation (in-group) 1. Did you offer a variety of ideas to solve your problem?

2. Did you carry out individual assignments faithfully and share within the team?

3. Did you perform responsibly and faithfully in your role in the team's activities?

4. Did you contribute much in the problem-solving process?

5. Did you make a lot of contributions in producing intermediate and final products?

6. Did you keep the time well in your team activities?

7. Did you follow all of your team-defined rules?

8. Did not you interfere with team activities?

9. Did you respect other people's opinions and encourage team atmosphere?

10. Did you participate and actively participate in team activities?

Learner evaluation (intergroup) 1. Did you identify the core content of the problem and solve the problem?

2. Did you find various solutions in the problem-solving process?

3. Did you use the various resources in the problem-solving process?

4. Was the information and materials you used clear and reliable?

5. Did the information and materials you used persuasively explain the problem solving?

6. Was the content of the problem solving creative?

7. Was the content of the problem solving useful in a real situation?

Learner evaluation (intergroup) 8. Did the problem seem to be solved faithfully?

9. Was the presenter aware of the problem and the way how to solve it?

10. Are you ready for presentation (materials, dress, posture, voice accent, etc.)?

on determination of suitability and demand analysis for PBL. Additionally, it is also necessary to secure the necessary basic data for actual operation through the

analysis of operating environment and learners to ensure

smooth operation within educational institutions once a

decision is made on using PBL ¹⁴⁾ . Environmental analysis

should be performed to investigate time constraints, securing learning space, size of lectures, whether tutors should be used, and budgetary support to determine whether there are environmental factors that would place restrictions in using PBL. The alternative methods would be using online space ²¹⁾ . Moreover, the level of the learner should be identified to adjust the difficulty level of the problems, and various learning methods, such as prac- ticum, lectures, and videos should be used systematically to find ways to encourage class participation and increase the interest level for the lessons ²²⁾ . When multiple teachers or tutors are involved in the use of PBL, those teachers and tutors need to be trained in consistent and systematic manner prior to class. Furthermore, it should be kept in mind that when forming a team for collaborative learning, responsibility and collaborative learning may be easier with fewer team members than with a crowded team ²³⁾ . Lastly, further examination into when PBL should be applied is needed because having limited knowledge, rather than detailed knowledge, can maximize learning by triggering motivation for learning, stimulating curiosity for problem solving and that early education is ideal for achieving the goal of creative reasoning ²⁴⁾ .

As for the recognition of dental hygienists’ profe- ssionalism, competencies for professional knowledge and skills needed in actual field of work must be achieved systematically, for which, implementation of PBL has been suggested as one of the methods. However, studies on PBL within the field of dental hygiene are still lacking.

The present study was significant because it analyzed existing dental hygiene curriculum and clinical duties in presenting problems. This may help learners gain the competencies necessary to perform their duties as professionals. The problems developed were used to design a teaching-learning process plan for incorporating PBL into clinical dentistry courses, which was also presented as a module. The limitation of this study is the fact that the problems and teaching-learning process plan for PBL were not developed in actual educational settings, and their effects were not tested. Therefore, in order to present future operation of standardized integrative courses on dental hygiene based on PBL, the demand for PBL should be identified. Additional studies are also

needed in the future to test the usefulness and effecti- veness of PBL by actually incorporating PBL into the dental hygiene curriculum.

References

1. Korea Dental Hygienists Association, Korean dental hygie- nists professor conference: the history of Korean dental hygiene education for the last 50 years. 1st ed. Daehannarae Publishing Inc., Seoul, pp.4-223, 2015.

2. Cho YS: Comparison of curriculums of dental hygiene edu- cation programs for B.S degree. J Dent Hyg Sci 5: 251-258, 2005.

3. Lee HS: Analysis of dental hygiene curriculum of dental hygiene programs in Korea. J Korean Soc Dent Hyg 9: 1-19, 2009.

4. Kim YI: Integrated curriculum: a pedagogical background in medical school. Korean J Med Educ 10: 1-10, 1998.

5. Kim YS, Shin MU: A study on the current state and weight of dental hygienists' works. J Korean Soc Dent Hyg 8: 161-175, 2008.

6. Yoo EM, Han HJ: A study on the work and turnover of clinical dental hygienists. J Korean Soc Dent Hyg 11: 41-46, 2011.

7. Lee SM, Ryu JS, Ahn SY, et al.: Basic research on development of integrated curriculum for dental hygiene in dental clinic. Korean Dental Hygienists Professor Confe- rence, Seoul, pp.43-99, 2014.

8. Bae SM, Shin SJ, Jeong WG, et al.: Development on the evaluation system for dental hygiene based on competency.

Korean Dental Hygienists Professor Conference, Seoul, pp.6-26, 2014.

9. Kang IA, Jung JH, Jeong DN: The practical understanding of PBL. 1st ed. Hakjisa, Seoul, pp.15-408, 2013.

10. Shon M, Ha JM: A meta-analysis on the effects of problem based learning. J Educ Inf Media 14: 225-251, 2008.

11. Kim HJ, Kim SH, Kim HS, Song SM: The case studies about educational effects on problem-based-learning (PBL)-focus on problem solving, self-directed learning and collaborative learning-. J Parent Educ 6: 1-19, 2014.

12. Gasser KW: Five ideas for 21st century math classrooms. Am Second Educ 39: 108-116, 2011.

13. Jung YR, Hwang YS: Development of PBL package-fo-

cusing on dental hygienist roles-. J Korean Soc Dent Hyg 4:

119-132, 2004.

14. Na JY, Chung HM: Development of a PBL instructional design model for higher education. J Yeolin Educ 20:

111-140, 2012.

15. Korea Dental Hygienists Association: The learning objectives on dental hygiene. 4th ed. Komoonsa, Seoul, pp.1-248, 2012.

16. Park JR, Kang KH: The second study on the job imple- mentation of dental hygienist. National Health Personnel Licensing Examination Board, Seoul, pp.1-390, 2012.

17. Chung HM: The development of PBL instructional design model and a checklist to guide the process of designing PBL.

J Educ Inf Media 15: 155-185, 2009.

18. Choi JI: A study on the problem design principle for Problem-Based Learning through the case analysis. J Educ Technol 20: 37-61, 2004.

19. Choi GY, Lee HS: Analysis of the education objectives of the dental hygiene department from core competencies-based

perspective. J Korean Soc Dent Hyg 12: 1049-1058, 2012.

20. Park MJ: An evaluation on the implementation of pro- blem-based learning in medical education. J Curric Stud 28:

225-253, 2010.

21. Kim SH, Lee IS: The effects of academic emotions on motivation in e-Learning. J Educ Technol 30: 749-775, 2014.

22. Kang KS, Park MY, Lee WS: An example of development and implementation of PBL module in fundamentals of nursing. J Korean Acad Fundam Nurs 8: 244-258, 2001.

23. Lim KY: Implementation of problem-based learning to established medical schools with insufficient resources.

Korean J Med Educ 10: 21-28, 1998.

24. Jung YR, Lee WS, Cho DJ: Development of PBL packages

for the improvement of the problem-solving ability, self-di-

rected learning capability and communicative competence of

dental hygiene students. J Korean Soc Dent Hyg 10: 33-49,

2010.