Measuring transfer of biological knowledge to clinical problem solving in the education of dentists

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Measuring transfer of biological knowledge to clinical problem solving in the education of dentists
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viii, 102 leaves : ; 28 cm.
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English
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Martin, Robert Edwin, 1937-
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Subjects / Keywords:
Dentistry -- Study and teaching   ( lcsh )
Transfer of training   ( lcsh )
Problem solving   ( lcsh )
Educational tests and measurements   ( lcsh )
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bibliography   ( marcgt )
theses   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1989.
Bibliography:
Includes bibliographical references (leaves 93-101).
Statement of Responsibility:
by Robert Edwin Martin.
General Note:
Typescript.
General Note:
Vita.

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University of Florida
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All applicable rights reserved by the source institution and holding location.
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aleph - 001482507
notis - AGZ4521
oclc - 21018769
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Full Text



















MEASURING TRANSFER OF
PROBLEM SOLVING


BIOLOGICAL KNOWLEDGE TO CLINICAL
IN THE EDUCATION OF DENTISTS


ROBERT


EDWIN


MARTIN


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY


OF FLORIDA






























Copyright


1989


Robert


Edwin


Martin















ACKNOWLEDGEMENTS


wish


express


appreciation


to the


members


graduate


advisory


committee


Jame s


. Hensel,


chairman,


Dr. R

their


ichard


Mackenzie,


encouragement


and


support


Dr. James

t during


Wattenbarger


my graduate


studies.


particularly


wish


to thank


mentor,


. Richard


Mackenzie,


providing


opportunities


to participate


many


experien


ces


in dental


education


research,


guidance


in applying


my training


to the


practice


dental


education


clinical


res


earch.


Special


thanks


are


extended


immediate


family,


Donna


Lou,


Laura,


Amy'


my parents,


Harold


Helen


Mart in;


extended


Wilkins,


interest,


family,


support,


especially


Joan


encouragement


they


have


given


throughout


my profes


sional


education.


















TABLE OF CONTENTS

Page


ACKNOWLEDGEMENTS. .. .. . .. .. .. ... iii

ABSTRACT. ........ .... ... .......... .. vi

CHAPTERS


INTRODUCTION TO THE PROBLEM.......................


Statement of the Problem...........
Research Questions and Hypotheses..
Delimitations .. . . .
Limitations.. .. ......... ... .....
Significance. .. .. ... . . .
Assumptions. ... . . . .
Definition of Terms................
Summary. ... ......... ...


*. aasa a
*.. a. aa.. .. .. *......a
....*..ta a.... a a.


REVIEW OF LITERATURE. .. .. ...... .. .... ... . 18


Introduction.... ........ .... ... ..
Theoretical Foundations............
Teaching Problem Solving.........
General Problem-Solving Models...
Transfer. .. . .. . ..
Medical Clinical Problem Solving.
Dental Clinical Problem Solving..
Summary .............................


a a a. .
. a a a a a .

* S *5 S
a a a a a ..
. .a a.a a. .. .a a. .
. .a . ..a a .a.a .a
*..a. a. a. .a .a .a .
a.............


METHODOLOGY........ ...... .. .... .. .... 47

Development of the Test Instrument............... 47
Problem Recognition. .. .. .. . .. .. 48
Data Gathering and Hypothesis Formation........ 48
Testing Hypotheses and Evaluating the


Outcomes. .... .. ... .
Content Validity..............
Validation of the Test Instrument


Validating Instrumentation.
Test Scorina. .. .... .


... .........
..0 ....00.*. 0...
. .a .a .. a .* ..a .a


.......a.....a a0 ...









Data Collection and Analysis.................J. 62
Sample Description.......... ...................... 63

IV RESULTS............... ................... ....... 64

Introduction................... ..... .. ........ . 64
Scoring Consistency............................... 65
Tests of Research Hypotheses...................... 65
Criterion-Related Construct Validity..... ...... 65
Predictive Criterion-Related Validity.......... 67
Stability 67
Experimental Sensitivity and Construct
Validity.................................... 68
Summary...... . . . . . . . . ..... 70

V DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS...... 71

Discussion ........................................ 71
Criterion-Related Construct Validity........... 71
Concurrent Criterion-Related Validity.......... 73
Predictive Criterion-Related Validity.......... 74
Stabili ty ... .... ... .. .. ... ........ 75
Experimental Construct Validity and
Sensitivity................................. 76
Conclusions and Recommendations................... 77

APPENDICES

A TEST OF TRANSFER OF BIOLOGICAL KNOWLEDGE.......... 80

B DECISION RULES FOR COUNTING BIOLOGICAL CONCEPTS... 86

C VALIDATION INSTRUMENTS................ ........... 90

D NORMALIZING PROCEDURES FOR BIOTRANS TEST SCORES... 92

REFERENCES.... . . . . . . . . .......... 93

BIOGRAPHICAL SKETCH... ................................... 102
















Abstract


of Dissertation


Presented


Graduate


School


the University
Requirements f


of Florida


Degree


in Partial


of Doctor


Fulfillment


of Philosophy


MEASURING


TRANSFER


PROBLEM


SOLVING


OF BIOLOGICAL


IN THE


KNOWLEDGE


EDUCATION


TO CLINICAL


OF DENTISTS


ROBERT


EDWIN


MARTIN


1989


Chairman:


James


. Hensel


Major


Department


Educational


Leadership


purpose


of this


study


was


to describe


development,


validation,


experimental


application


measure


of transfer


of biological


knowledge


(the


BioTrans


test)


to clinical


reliability


of the


problem


BioTrans


solving


test


in dentistry.


were


Validity


evaluated


investigating


relationships


between


scores


BioTrans


Knowledge


test


Test


instrument


(FJKT),


scores


a context-sensitive


Functional


measure


cognitive


structure;


Word


Association


Test


(WAT),


context-free


measure


of cognitive


structure;


final


class


rank


of examinees;


a separate


administration










Test


data


senior


dental


students


University


of Florida


College


Dentistry


were


collected


analy


analy


zed,


:1-s


utilizing


of variance


correlational


ANOVA)


repe


designs.


ated


Evidence


measures


criterion-


related


construct


validity


was


provided


a significant


positive


correlation


.05)


between


BioTrans


test


scores


FJKT


scores


. Evidence


stability


type


reliability


was


furni


shed


a positive


significant


correlation


.05)


between


successive


administrations


BioTrans


problems.


test


Analysis


using


different


of the


effects


patient


management


of experimental


treatment,


repeated measures


ANOVA,


furni


hed


support


construct


validity


of the


BioTrans


instrument


and


sensitivity


in detecting


such


effects.


Meaningful


overlearning

biological c


was


found


oncepts


to produce


.05)


greater


to the


process


transfer


of clinical


problem


solving


than


either


simple


overlearning


experiential


learning.


Simple


overlearning


experiential


learning


concepts.


concurrent


did


differ


No evidence


validity


degree


was


using


found


WAT,


of transfer


criterion


nor


of biological


-related


validity


predicting


final


class


rank.


Findings


suggest


that


BioTrans


test


instrument


can


be used


with


appropriate


patient


management


problem


Ir rr










a detailed evaluation


dental


student


performance and in


evaluation of teaching program effectiveness.















CHAPTER


INTRODUCTION TO THE PROBLEM


"Many people would sooner


die than


think.


In fact


they


-- Bertrand Russell


In recent


years,


instruction


in thinking and problem


solving has


received a considerable amount


of attention


the educational


literature and in


public press.


least


two phenomena appear to be at


work prompting this


recent


attention.


First,


rapid changes occurring


in today's


culture


require


skills


in thinking and problem solving to cope


with


the accelerating appearances of


new problems and new


technology


(Nickerson,


1984;


Simon,


1980;


Tuma


Reif,


1980).


Policy decisions made by public and corporate officials


such affairs as


example,


strategic defense or nuclear


have been subjected to the cold


energy safety,


scrutiny of the


press.


that


Often,


skills


conclusions drawn by


critical


journalists


thinking and problem


suggest


solving are not


common attributes of


these public and corporate officials


(Young,


1980) .


These


journalistic observations


sometimes


imply that


public and higher education have


failed to provide


their graduates with adequate development


of critical


-A-. U.- t -


LLI I










effective

product o


thinking


and problem-solving


f our educational


programs


abilities


(Association


American


Colleges


[AAC],


1985;


Halpern,


1984;


National Assessment


Educational Progress


[NAEP],


1983;


Norris,


1985;


Simon


1980) .


Much of


recent


research


in problem solving has


been directed toward understanding and resolving this


perplexing


situation.


s introductory section provides an overview of


recent


research


in problem solving


understanding of


and its


related issues,


contribution


which


to the


leads to the


focal


problem for this


knowledge


study,


in the process


measuring the

of clinical


use of biological


problem solving


dentistry.


The overview of problem-solving


issues


will


have


following


organization:


Historical


and present


concerns


for developing


problem-solving


skills


in higher education.


The controversy over transfer of problem-solving


skills


among


content-specific domains.


Medical and dental


clinical


problem solving


Transfer of biological


knowledge


in dental


clinical


problem


solving.


Measuring


clinical


performance and


transfer of


training


clinical


problem solving.


Some


investigators equate


terms critical


thinking,


W I V










Sprafka,


Young,


1978;


1980) .


Halpern,


1984;


ensuing


Paul,


discu


1987;


sslon


Swartz,


uses


1987;


terms


critical


thinking,


reasoning,


deci


sion


making,


problem


solving


interchangeably.


Historically,


search


effective


teaching


general


problem


solving


had


an extended,


if inglorious,


past.


ancient


Greeks


relied


upon


mathematics


to make


person


"quick


to learn,


retentive,


shrewd"


(Mann,


1979,


. 13) .


Similarly,


as Europe


emerged


from


dark


ages


into


of enlightenment,


philosophers


and


scientists,


such


as Sir


Francis


Bacon


and


John


Locke,


advocated


mental


discipline

develop ab


provided


ilities


study


thinking


of mathematics


learning.


or Latin

the


nineteenth


need


century,


a liberal


American


arts


higher


education


education


based


had


on the


accepted


trivium


quadrivium


ancient


Roman s


(Levine,


1978


Such


curriculum


thinking


was


and


thought


judgment,


to instill


deemed


competency


essential


in critical


educated


elite


nation.


curriculum


philosophies


of the


early


American


institutions


of higher


education


were


epitomized


Yale


Report


1828,


which


stated


that


purpose


of a college


curriculum


was


to provide


scipline


and


furniture


of the


mind"


(Levine,


1978,


foregoing


excerpts


serve


to illustrate


w -


w


v v v










In the


Yale


Report


of 1828,


"discipline"


was


a reference


to the


abilities;


chotomy


development


"furniture"


expressed


mental


indicated


phrase,


faculties


acquired


or thinking


knowledge.


discipline


furniture


of the


mind,


suggests


another


dichotomy


in the


realm


general


problem


process


solving;


content.


frequently


In cognitive


expressed


science,


process


terms


iS a


term


used


to describe


thinking


activities


cognition)


which


are


directed


toward


some


end,


such


as solving


a problem


or making


a judgment


or de


sion.


Content


knowledge


information


base from


which


appropriate


concepts


are


drawn


carry


a thinking


activity,


example,


ciding


on a


course


of action


Sanchez


, 1987;


Mann,


1979)


Researchers


have


long


held


theory


that


both


process


content


are


requirements


effective,


purposive


use


knowledge.


This


theory


came


under


severe


attack


Thorndike


in the


early


twentieth


century,


when


conc


luded


from


work


that


transfer


minimal


to touch


training


wars


of thinking


Glaser,


what


wars"


occasionally


1984) .


Mann


skills


(process)


effect


(1979


371).

surface


Some


between


Thorndike


described


related


current


disciplines


s work


"tran


skirmishes


literature


was


was


sfer-of-


these


(e.g


Harasym


et al.,


1979)


There is no


full


agreement


among


problem-solving










Resnick,


1983) .


In a recent


critical


review


of the


teaching


thinking


problem


solving,


Bransford


colleagues


concluded


that


problem-solving


kill


requires


use


general


problem-solving


strategies


combined


with


access


to a broad


knowledge


base


in the


domain


of interest


(Brans ford,


Sherwood,


Vye,


Rieser,


1986) .


This


theory


became


prominent


in recent


years


as cognitive


scientists


began


to recognize


importance


intelligence


cific


applications


knowledge


(Waldrop,


artifi


1984),


cial


as well


education


(Glaser,


1984).


Many


of the


studies


which


support


this


conclusion


involved


comparisons


of expert


and


novice


performance


in problem


solving


within


specific


disciplines,


such


as engineering,


phy


sics,


mathematics,


social


sciences


clinical


medicine.


These


studies


also


lend


credence


duality


Learning


theory


a skill


process


requires


content)


teaching


in another


components


sense.


of the


skill


providing


guided


practice


in their


use


(Mackenzie,


1986)


Components


considered


to involve


skill

process


of problem s

s dimension,


;olving


can


whereas


guided


practice


takes


place


making


use


body


of knowledge


within


a content-specific


domain.


Ther

critical


debate


thinking.


about

Halpern


what

(198


skills


are


involved


provided


a useful


definition


of critical


thi nin n


rtrflM i -


nl ~1rvn rar roro


-


N \I ~










. 75).


Also,


models


of the


general


problem-solving


process


have


been


formulated


several


investigator


(Brans ford


Stein,


1984;


sse


Mayhew,


1954;


Polya,


1971;


Rubinstein,


1975


Many


Simon,


of them


1979;


have


Whimbey


common


Lochhead,


features


Woods,


ch describe


1987).


generic


strategies


employed


in problem


solving,


and


which


can


summarized


the following


categories


of activity


Recognizing


or identifying


a problem.


Gathering


data


about


problem


restating


formal


terminology


of the


domain.


Forming


solving


causal


hypotheses


applying


chosen


planning


prin


problem


ciples.


Testing


hypotheses


carrying


out


plan.


Evaluating


outcome


plan


Here


again,


much


of the


current


knowledge


of the


process


problem


solving


been


gained


studies


expert


problem


solving


various


disciplines.


Discovery


of the


methods


(process


which


expert


use


their


broad


knowledge


base


content)


strengthens


argument


that


general


problem-


solving


skills


are


teachable


can


be transferred


from


one


domain


to another


Adler,


1987;


Perkins


Salomon,


1987;


Swartz


, 1987;


Yinger,


1980).


problem


of transfer


skill


training


also


was


addressed


Bransford


colleagues


(1986)


context


access


to concepts


procedural









knowledge.


that


Lack


relatively


Whitehead


29) .


of appropriate


"inert"


Thus,


cues


results


, as described


skill-oriented


knowledge


Alfred


knowledge


North


as well


information-oriented


knowledge


must


be made


accessible


effective


use


in new


situations


through


proper


teaching


learning


strategies


which


include


cues


about


applications


know


edge.


field


which


a great


deal


of attention


paid


problem

In this


solving

field,


clinical


discussion


practice


will


in the


be limited


health


to medical


sciences.

1 and


dental


clinical


practice.


Problem


solving


essence


of clinical


practice


dentistry


medicine


(Boring


Nutter,


1984;


Ettinger,


1984;


chman,


1986;


Neidle,


1986) .


an extensive


review


of medical


Colleges


education


[AAMC],


(Association


1984),


of American


necessity


Medical


of problem-solving


training


in clinical


medic


was


underscored.


This


report


stimulated


much


discussion


about


medical


education.


question


arising


from


discussion


was,


"Can


clinical


problem


solving


be taught?"


answer


provided


a review


of the


recent


research


was


yes,


with


some


qualifications,


example,


faculty


model


desired


behavior


carefully


(Whitman


Schwenk,


1986).


The e


effectiveness


of predoctoral


medical


and


Dental


and










Boring


Nutter,


1984;


Culliton,


1984;


DePaola,


1986;


Ettinger,


1984;


Fischman,


1986;


Neidle,


1986;


Roth,


1986;


Small,


White,


1986;


Whitman


Schwenk,


1986).


to correct


this


deficiency


some


programs


are


being


revise


d to


clude


problem-based


curricula,


development


analytical


skills,


training


developing


problem-solving


strategy


ies


Abraham


son


, 1987;


Boring


Nutter,


1984;


Evangelauf,


1987;


McFarland,


1987) .


Such


approaches


stem


from


common


reco


ignition


that


dental


medical


students


have


difficulty


applying


basic


biological


science


concepts


when


confronted


with


a clinical


problem


(AAMC,


1984;


Roth,


1986) .


access


ability


to basic


to solve


biological


clinical


knowledge


problems


rests


clinical


science


knowledge


stored


long


term


memory


(the


content


aspect),


use


of cognitive


skills


(the


ocess


aspe


to bring


that


knowledge


to bear


on a problem


(Brans ford,


1979;


Ettinger,


1984;


Glaser,


1984;


Mayer,


1977) .


, the


phenomenon


of transfer


training


involves


both


process


content


knowledge.


a transferable


skill,


Ef it i

then,


.s accepted


order


that


problem


to improve


tha


solving

t skill,


much


guided


practice


needed.


One does


practice


process


skills


absence


a knowledge


base,


must


use


knowledge


base


during


practi


ce.


Review


of the


dental


education


literature


reveals


that










(Mackenzie,


1965;


Mackenzie


Bennett,


1967;


Mackenzie,


Hollway,


Kilpatrick,


Secola-Ocanto,


1976


Marynuik,


ch investigate


1986;


Mackenzie


utilization


biological


information


groups


examinees


, measured


Func


tional


Knowl


edge


Test


(FJKT) .


This


strument


elicits


examinee


s free


recall


of clinical


incidents,


and


measures


incidents.


memory


organization


Because


in the


examinees


context


are


of clinical


confronted


with


same


clinical


problem


or incident,


results


are


usually


analyzed


with


a group


of examinees


as the


unit


analy


sis.


In view


renewed


interest


teaching


clini


problem-solving


skills,


there


needs


to be


an accompanying


development of evaluation

problem-solving theories,


measures


can


which

utilize


reflect


simulate


current

clinical


problems,


place


examine


as the


unit


of analysis,


have


been


tested


validity


reliability.


Very


recently,


Norman


(1987)


written


about


current


state


of clinical


performance


evaluation


instruments


Certainly,


that
term


a review


field


recall


stimuli, o
Rarely are
yardsticks


unclear


how


as evaluation


recent


is dominated


of clinical
"thinking a


measures


of reliability


these


methods


instruments


data,
loud"


basic
y metho
rapid
around


subjected


and v
could
. (p.


studies
ds such
percepti
clinical


to the


alidity,


find


suggests
as short


sual


problems


conventional


there fore


useful


application


Statement


of the


Problem










measures o

biological


f clinical

knowledge


performance,

to clinical


including

problem so


transfer


living,


developed.


Few


validated


instruments


have


been


reported


which


directly


measure


effect


individuals.


The

instrument

biological


dental


primary

t for a

1 know


students


purpose


ssessing


edge


of this

access


to solving


(designated


the


study w

to and t

clinical


BioTrans


ras


to develop


transfer


problems


test),


basic


senior


to test


instrument


construct


predictive


validity


reliability.


second


purpose


of this


study


was


to collect


data


using


BioTrans


instrument


to determine


whether


will


detect


effects


of differential


treatment


experimental


study


of teaching


learning


interventions


University


of Florida


College


of Dentistry.


interventions

abilities to


were


transf


undertaken

er basic b


improve


biological


dental


science


students

knowledge


clinical


practice.


Research


Questions


Hypotheses


research


questions


and


their


related


hypotheses


addressed


this


study


were


following:


scores


on the


BioTrans


assessment


instrument


related


scores


on an existing


context-s


sensitive


measure


cognitive


structure,


the


FJKT?


This


relationship


was


tested


examininacr


resetarc'h


hvn1nt1hT .


thai-


Psa rsnn


nrndriinl-


1. 1 l:_


I I |%m


AJ











FJKT


is greater


than


zero


.00)


at alpha


.05,


as evidence


construct


validity.


Are


scores


on the


BioTrans


instrument


related


scores


on an existing


context-free


measure


of cognitive


structure,


Word


Association


Test


(WAT)


This


relationship


that


was


Pearson


tested


examining


product-moment


research


correlation


between


hypothesis


scores


BioTrans


test


greater


than


zero


.00)


at alpha


.05,


as evidence


of concurrent,


criterion-related


validity.


scores


on the


BioTrans


instrument


related


to the


final


ass


rank


examinees?


This


relationship


was


tested


rank-order


examining


correlation


research


between


hypothesis


scores


that


BioTrans


Spearman


test


final


class


rank


of examinees


greater


than


zero


.00)


alpha


.05,


as evidence


of predictive


criterion-related


validity.


scores


on the


BioTrans


instrument


stable


when


examinee s


are


tested


on separate


problems


This


question


was


tested


examining


product-moment


test


research


correlation


separate


between


problems


hypothesis


scores


greater


that


on the


than


Pearson


BioTrans


zero


j -- S t *m


II


r r I t


1 r











construct


tested


validity


test


examining


null


sensitivity?


hypothesis


This


that


question


there


was


are


different


ces


in the


mean


number


of reported


biological


concepts,


learned


one


of three


different


methods


during


examinees


' freshman


year,


* mul


= mu2


-= mu3


evaluated


alpha


.05.


summary,


to determine


correlational


first


construct


three


validity


methods.


hypotheses


of the


fourth


were


BioTrans


hypothesis


was


formulated


instrument


posed


test


stability


correlational


type


method.


of reliability


fifth


of the


hypothesis


instrument


was


formulated


determine


construct


validity


well


as test


sensitivity


examining


treatment


effects


expected


application


theory.


Delimitations


study


was


constrained


in several


ways.


First,


examinees


were


a single


senior


class


of 65 dental


students


University


of Florida


College


of Dentistry.


Second,


throughout


four


year


dental


school


curriculum,


examinees


experienced


nearly


identical


training.


They


differed


total


only


program


in elective


effort)


course


in the


work


(representing


assignment


4% of the


of learning


sets


of biological


concepts


during


shman


year.


Third,


.I


m










ability


are


unique


to this


college


of dentistry,


although


similar

testing


in general


other


format


dental


to patient


schools.


problems


These


used


problems


are


sometimes


called


"Patient


Management


Problems"


"Simulated


Patient


blems


The proportion


of North


American


dental


schools


using


similar


patient


problems


been


reported.


Limitations


With


respect


internal


validity,


this


study


was


partially


limited


controlling


confounding


variables


because


no random


selection


senior


students


was


utilized.


This


limitation


assignment


attenuated


sets


of biological


random n

concepts


ature


to be learned


three


methods.


In addition,


this


portion


study


was


made


statistically


more


powerful


having


each


student


as his/her


own


control.


Each


student


learned


one


concepts


first


control


experimental


method,


method,


another


a third


of concepts


of concepts


a second


experimental


method.


Another


potential


limitation


that


dental


student


classes


are


quite


homogeneous


in pre-


professional


preparation,


experience,


abiliti


es.


This


homogeneity


of performance


result


scores,


restriction


potentially


range


reducing


of variability


validity


reliability


coeffi


clients


(Crocker


Algina,


1986,


226)


Si2nificance


S


r


- ---- --










reliable


measures


Furthermore,


such


to evaluate


measures


outcomes


should


be based


new


programs.


on current


theories


of problem


solving


transfer


of knowledge.


foundation


of dental


practice


clinical


problem


solving.


This


professional


attribute


requires


a well


-developed


understanding


biological


phenomena


skill


to apply


that


understanding.


knowledge


transfer


A valid

in problem


reliable


solving


will


measure


valuable


dental


educators


evaluating


programs


student


performance.


Assumptions


is assumed


that


senior


dental


students


were


motivated


to produce


a test


result


that


an accurate


representation


in clinical


of their


problem


ability


solving.


use


This


biological


assumption


knowledge


strengthened


inclusion


of the


BioTrans


test


final


test


sequence


a required


module.


passing


evaluation


module


is a necessary


condition


graduation.


Definition


of Terms


Some


of the


terminology


used


this


study


require


definition


the


reader


to have


a clear


understanding


information


presented.


BioTrans


test


instrument


developed


in this


study


measure


transfer


of biological


knowledge


to clinical


T w


-- w










degree


of interconnection


of ideas,


concepts,


facts,


principles


a measure


of how


well


they


are


understood


Context


refers


to the


background


or setting


which


learning


takes


place.


Broadly


inte


rpreted,


cludes


stimuli


both


external


internal


to the


learner,


such


under


standing


a future


use


information


to be learned


as well


Critic


affective

;al Thinkin


sensations


experienced


process


of rationally


learner.

deciding


what


to think


or do


Attributes


of this


thinking


process


include


systematically


applying


criteria,


evaluating


information,


utilizing


reasoning


judgment.


skill


which


can


improved


with


practice


(Mackenzie,


1986;


Norris,


1985;


Swartz,


1987).


Judgment


thinking


process


involved


deciding


between


or more


alternatives.


util


izes


judgment


when


determining


an event


falls


into


a certain


category


or not.


Metacoanition


literally


means


thinking


about


thinking.


It refers


to the


active


statements


questions


used


during


thinking,

statements


judging,


guide


one


reasoning.


thinking


These


questions


learning


activities


A problem


an existing


situation


which


differs


from


desired


situation


or goal.


Problem


solving


process


which


a person


changes


a problem


to a dsli red


fO~r]


Theref


R rS


Qsvrspiy 1


rarnrnni 7eci


W










outcome


broadest


of the


sense,


plan


problem


relative


solving


desired


involves


use


goal


In its


judgment,


reasoning,


critical


thinking,


decision


making.


Re a sonin


intellectual


activity


of using


previous


knowledge


new


information


or observations


to formulate


conclusion


or inference.


Judgment


part


of the


reasoning


process.


term


transfer


indicates


application


previously


learned


knowledge


or skills


a new


situation.


Thus,


example,


transfer


of biological


knowledge


clinical


one


problem


situation


solving


(learning


involves


from


use


a biological


of knowledge


science


gained


course)


to understand


or solve


a problem


in another


situation


clinical


problem


presented


a patient).


Siimmairv


Acqui


ideal


sition


which


of problem


recently


solving


received


skills


increased


an educational


attention


administrators


higher


education,


including


those


concerned


with


education


Presently,


controversy


clinical


exists


health


among


profes


sionals.


researchers


concerning


existence


of independent


problem


solving


process


skills,


whether


these


skills


can


applied


variety


disciplines,


role


played


specific


knowledge


*n-r 1- *k 1 an I I m~


n rr 1










planned


curriculum


changes


which


are


designed


improve


clinical


problem-solving


abilities


their


graduates.


Reliable,


valid


measures


are


needed


to evaluate


both


program


effectiveness


individual


competence


in problem


solving,


to understand


how


how


well


biological


information


utilized


clinical


practice.


A research


study


was


proposed


to design


evaluate


one


type


measure,


namely,


a test


transfer


of biological


knowledge


to clinical


problem


solving


dentists.














CHAPTER


REVIEW


OF LITERATURE


Introduction


purposes


of this


study


were


twofold.


first


was


construction


measuring


transfer


validation


of basic


biological


instrument

knowledge


for

to specific


clinical


problem-solving


exercises


dental


students.


sec
<3of


was


to determine


whether


instrument


sufficiently


sensitive


to detect


differential


treatment


effects


among


senior


dental


students


on acquis


ition


of basic


biological


concepts


occurring


during


their


freshman


year.


order


review


to construct


of the


test


literature


such


an instrument,


necessary


in several


a cogent


subject


areas


to illuminate


the theoretical


underpinnings


project.


To sati


that


need,


this


review


chapter


will


organized


as follows.


First,


a discussion


of research


teaching


modeling


general


problem


solving


presented,


followed

findings


an examination


to transfer


of the


of knowledge.


relationship


A discussion


these

of medical


clinical


problem


solving


ensues,


commonalities


differences


between


medical


dental


clinical


problem










Theoretical


Foundations


Teaching


Problem


Solvina


A small


portion


anecdotal


history


concern


teaching


critical


thinking


problem-solving


skills


was


presented


in Chapter


For


many


years,


cators


theorized


that


some


sort


"mental


muscle"


existed


which


could


exercised

ability (


with


Mann,


appropriate


1979;


academic


Nickerson,


work


1984) .


to develop


was


reasoning


later


acknowl


edged


that,


instance,


Latin


or mathematics


scholars,


had


labored


long


at exercising


that


presumptive


muscle,


rarely


demonstrated


problem-solving


abilities


outside


their


own


areas


of expertise.


This


recognition


spurred


search


those


elus


ive,


teachable


skills


which


could


enhance


learner


s ability


to solve


problems


nature


(Bran


sford


et al.,


1985;


Mann,


1979).


There


been


agreement


among


problem-solving


researchers


about


existence


teachable


process


skills


critical


thinking


which


are


transferable


any


number


subject


domains.


Halpern


(1987


argues


that


there


are


number


of recognizable


critical


thinking


skills


which


are


teachable


applicable


more


than


one


domain


list


these


skills


includes


understanding


cause-effect


relationships,


recognizing


assumptions,


analyzing


means-goals


relationships,


reducing


omolex


problems


to simpler


ones,


c










teaching


use


analogies


comprehension


recall


of scientific


information


helps


students


to generate


their


own


analog


spontaneously


an aid


future


recall


transfer.


A possible


explanation


this


instance


of lack


evidence


transfer


a theory


of training


learning


abilities,


explained


Derry


Murphy


(1986).


theory


distinguishes


between


learning


strategies


learning


tactics.


Whereas


learning


strategies


are


conceived


as broad,


general


plans


one


uses


exercise


control


over


thinking


processes


in learning


situations,


learning


tactics


are

that


more

may


specific


kills


be easily


(perhaps


transferred


subj


specific


outs


that


skills


domain.


be that


Halpern


list


skills


represents


tactics


rather


than


strategic


therefore,


they


would


be expected


to be transferable.


Other


investigators


would


agree


with


Halpern


s assertion


that


there


exist


process


skills


critical


thinking


problem

content.


names


solving


which


A partial


of Dewey


are


list


(1933),


independent


of these


Bloom


of discipline


investigators


(1950


would


Dressel


-specific

d contain


Mayhew


(1954),


Polya


(1971),


Rubinstein


(1975


, Feuerstein,


Rand,


Hoffman,


and


Miller


(1980),


Yinger


(1980),


Whimbey


Lochhead


(1982),


Nickerson


(1984),


Brans ford


and


Stein


(1984),


and


Sternberg


(1985),


with


reservations.










In a recent


article


reviewing


findings


on the


interaction


of developing


problem-solving


skills


acquisition


of domain


-specific


knowledge,


Glaser


(1984)


maintained


that


thinking


skills


are


learned


primarily


through


acquisition


application


of a particular


know


edge


base.


He did


allude


to the


possibility


that


mature


learners


can


benefit


from


instruction


in the


use


of self-regulating


procedures


or metacognitive


skills


which


monitor


progress


one


s thinking


or problem


solving.


However,


Glaser


s primary


thesis


was


that


role


specific


knowledge


central


developing


thinking


abilities.


joined


that


position


other


researchers


such


as Gagne


(1977),


Resnick


(1983),


Greeno


(1985),


and


Mayer


(1987).


other


researchers


field


differences


domains


have


concentrated


between


(see,


experts


example,


their


and


investigations


novices


Bhaskar


Simon,


on the


content-specific


1977,


engineering;


McDermott,


Glaser,

Norman,


Chi,


Simon,


Wang,


Tugwell,


Feltovich,


Simon,


1981,


Glaser,


1980,


radiology;


Feightner,


1981,


physics;


Mayer,


Muzzin,


1987,


oby,


phys


gold,


Larkin,


Feltovich,


mathemati


1985,


clinical


medicine;


sciences).


Voss


While


, Greene,


many


Post,


of these


Penner,


authors


1983,


have


social


addressed


issue


of transfer


of problem-solving


skills,


they










literature


cited


this


section


leaves


this


researcher


with


impression


that


some


problem-solving


theorists


are


inclined


to adopt


an either/or


attitude


formulating


theoreti


concepts.


illustrative


example


assertion


either


there


are


or are


teachable


skills


in problem


solving


exclusive


subject


content.


surprls


that


difficulty


encountered


confirming


section


developed


such


describes


models


polarized


work


problem


theories


of other


solving


research.


researchers


have


next


have


elucidated


necessity


of knowledge


in teaching


problem-solving


skills.


General


Problem


Solvina


Models


Modeling


process


of problem


solving


involves


categorization


of discrete


cognitive


activity


into


several


groups


ease


of understanding,


learning,


discussion.


Many


researchers


have


presented


models


organized


easy


characterization.


A few


these


models


will


presented


provide


a basi


discu


ssion


consolidation.


Dressel


Mayhew


1954,


179-180)


identify


ed five


type


mental


activity


which


were


presented


as skills


critical


thinking:


ability


to define


a problem.


. The


ability


to select


pertinent


information


a aI -....--A-1 -1


ILL










. The


ability


to formulate


select


relevant


promising


hypotheses.


. The


ability


to draw


conclusions


validly


to judge


validity


of inferences.


Another


descriptive


categories


was


provided


Polya


(1971)


which


included


questions


to ask


oneself


during


problem


solving:


Understand


problem


Ask


yourself


what


known


unknown;


what


conditions


exist


. Devise


a plan.


Look


a related


problem


that


been


solved


before.


Could


use


. Carry


plan.


your


solution


plan,


checking


each


step.


. Look


back.


What


res


argument s


can


check


which


indicate


a sati


factory


solution


In a presentation


which


outlines


a plan


teaching


problem


solving


a subject


context,


Woods


(1987)


offers


holistic


approach:


Learn

Define


occurrence


given


of a problem.


problem.


. Define


"real"


problem


create


a representation


of it.


Plan


a solution.










components


of thinking


they


believe


are


applicable


to a wide


variety


situations:


= Identification


of problems.


Paying


attention


cues


that


do not


make


sense


or that


do not


with


current


knowledge.


= Definition


a problem


of problems.


perceived


Defining


worked


affects


out.


= Exploration


strategies.


Creating

Examining


manageable

special c


subproblems


ases


Working


backward


Identifying


assumptions


inconsistencies


4. A


= Acting


on ideas,


based


on strategies.


= Looking


effects.


As part


a program


recently


designed


training


arithmetic


problem-solving


skill


, Derry


Murphy


(1986)


have


outlined


specific


skills


that


they


stress


in their


program:


Clarify


problem.


Categorization,


goal


identification,


and


evaluation


of information


are


involved.


. Choose


a solution


procedure


Apply


problem


heuristics


(rules


thumb)


____ A *1 S


*


t 1


I r










their


book


entitled


Concepts


in Problem


Solving,


Rubinstein


Pfeiffer


(1980)


provided


another


problem-


solving


model


Perceive


analyze


problem


components.


. Formulate


hypothe


ses


about


possible


solution


paths.


. Select


among


hypotheses.


. Test


most


likely


hypothesis.


tests


fail,


rethink


first


two


steps.


Other,


quite


similar


models


have


been


reported


(see,


example,


Belmont,


Butterfield,


Ferretti,


1982;


Holyoak,


1984;


Lochhead


Whimbey,


1987) .


Only


more


recently


been


pointed


standing


problem


alone,


solving.


that


are


general


problem-solving


effective


Derry


Murphy


teaching


(1986,


strategies,


learning


have


referred


to these


most


general


problem-solving


steps


"weak


solution


methods


more


general


model,


more


fuzzy


imprecise


are


ways


of responding


particular


problem.


aspect


of problem


solving


been


avoided


or only


hinted


most


recent


literature


. That


skill


nature


of problem


solving.


If problem


solving


indeed


a skill,


as many


have


assumed,


then


should


recognized


that


improving


skill


requires


practice.


. If










necessary


use


skills


within


a domain


of knowledge,


such

have


as science,


researcher


thinking


math,


or clinical


recognized


problem


solving


that


can


dentistry.


programs


Only


structured


improved


recently

to teach


focusing


more


on domain


knowledge


role


earning


to solve


relevant


problems


(Bransford


et al.,


1986)


This


leads


next


topic


review,


transfer


of knowledge


problem


solving.


Transfer


question


of how


teach


transfer


of knowledge


an intriguing


at least


thrust


one


a decade.


of current


which


occupied


Weaver


efforts


(1987,


trans


cognitive


583)


researchers


stated


of training


when


recognized


"the


environment,


need


one


that


to teach


within


emphasizes


'metacognitive


only


training


practice


skills


taught


also


self regulation


awareness


of the


utility


trained


skill


Following


this


line


reasoning,


Perkins


Salomon


(1987,


1988)


have


formulated


a theory


of transfer


that


distingui


shes


between


mechanisms,


which


they


term


"low


road


transfer"


and


"high


road


transfer.


According


to this


theory,


road


transfer


occurs


automatically


as the


result


of practicing


variations


a skill.


To demonstrate


this


mechanism


they


offer


example


having


practiced


driving


a car


a variety










High


road


transfer,


on the


other


hand


does


happen


automatically,


recognize


a princip


requires

le and f


mental


orm


effort


an internal


repres


learner

entation


that


abstract


allows


generalizing


representation


a range


thought


to act


situations.


as a bridge


This


between


learning


facilitating


context


high


and


road


a new


transfer


application.


should


An example


be familiar


graduate


students:


How


can


multiple


regression


models


applied


one


s domain


of interest


, such


as evaluation


information


gathered


a clinical


problem?


Asking


such


metacognitive


domain


questions


of statistical


begins


bridge-building


theory


application


between


to the


domain


of the


learner.


In medical


a difficult


dental


problem.


education


Traditionally,


inert


these


knowledge


students


been


memorize


list


upon


list


facts


about


basic


medical


science,


sciplines


such


as phy


siology


or anatomy,


without


exposure


to the


future


diagnostic


applications


they


will


need


to make.


This


prompted


at least


one


medical


school


adopt


a problem-based


learning


approach


to basic


medical


science

students


(Barrows

acquire


Tamblyn,


technical


1980).

knowledge


In this

of the


setting


human


medical


body


working


through


problem


cases


which


require


diagnosis.











importance

facilitates


in developing


access


cognitive


to knowledge


structure


(Mackenzie,


which

1986).


Understanding


paraose


learning


new


information


can


help


a person


process


later


access,


as can


intrinsic


motivation


learning


material


Also,


directing


attention


to important


concepts


their


relationships,


forming


images


associated


with


concrete


concepts,


increasing


meaningfulness


through


association


with


several


other


concepts,


using


contexts


appropriate


desired


transfer


when


giving


examples


are


important


factors


affecting


recall.


Perhaps


most


influential


variable


transfer-appropriate


processing


information


extends


varied


practice


recalling


information


beyond


that


needed


adequate


performance.


Finally,


active


use


of metacognitive


strategies


during


learning


can


improve


access.


Such


mental


activities


elaboration,


forming


associations


images,


and


fitting


new


information


to that


already


known


exemplify


metacognitive


strategies


1986).


known


It has


to aid


been


recall


recognized,


(Brans ford,


however,


1979;


that


Mackenzie,


such


metac


ognitive


strategies


are


difficult


to teach;


they


must


gradually


developed


over


an extended


period


with


copious


amount s


of guided


practice


desired


range


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detect


effects


of the


treatment.


study


design


described


Medical


detail


Clinical


Chapter


Problem


III.


Solvina


There


been


a great


deal


of research


medical


problem


solving


last


two


decades


of the


earlier,


influential


studies


was


conducted


Elstein,


Shulman,


Sprafka (1978)

physicians and

problems, they


From a

medical s

developed


detailed

students


study

solving


conclusions


a small


a few


which


group


clinical


guided


direction


study


further


described


research


a general


some


information


years.


processing


First,


model


medical


inquiry


which


four


important


stages


cue


acqui


sition,


hypothesis


generation,


cue


interpretation,


hypothe


collection


evaluation


. Cue


of pertinent


acqui


data,


sition


involves


which


the

is immediately


available


at the


start


patient


encounter.


Hypothesis


generation


relies


on retrieval


of likely


diagno


ses


from


memory


an associative


process.


interpretation


was


thought


to be


a form


of pattern


matching


with


known


disease


processes


which


would


either


confirm


or disconfirm


hypothesized


describe


diagnosis.


procedure


Hypothesis


of choosing


evaluation


among


was


likely


meant


diagnoses


generated.


process


been


termed


"hypothetico-


S.. -1a


II


II










transfer


of clinical


problem-solving


skills


from


one


problem


domain


to another.


Several


other


studies


appeared


to confirm


this


interpretation


using


varied


methods


of performance


scoring

Donnely,


Grosso,


and patient

Fleisher,


Webster,


formats (

Schvenker,


1983;


(Berner,


Chen,


Norman


Bligh,


1982


Tugwell,


Guerin,


Norcini,


1982;


1977;

Swanson,


Skakun


al.,


1979


More


education


recently,


literature


disagreement


about


prevailed


existence


medical


functioning


general


clinical


problem-solving


problems.


skill


Norman


solving


(1985b)


different


reviewed


types


medical


problem-solving


psychology


literature,


expert


introduced


reasoning,


a theory


contrasted


from


this


the


approach


with


hypothet ico-deduct ive


theory


medical


problem


solving.


He concluded


that


experienced


clini


cian


better


innate


at solving


or learned


clinical


skill,


problems,


a gradual


virtue


accumulation


experience


which


allows


better


perception,


organization,


recall


of patient


information


relevant


knowledge.


Yet,


in another


article


published


the


same


year,


Norman


other


colleagues


(Norman,


Tugwell,


Feightner,


Muzz


Jacoby,


1985)


appeared


to relent


somewhat


such


stringent


interpretations


about


lack


of transfer


problem-solving


skills.


They


concluded:









a better


choice


measures


improve


generalizability.


. 354)


In other


words,


method


of measuring


performance


did


anticipate


range


variability


in each


clinician


problem-solving


applications.


conclusions


about


generalization


ability


from


one


type


of problem


to another


may


have


resulted.


Similarly,


same


year


McGuire


(1985


criticized


narrowness


medical


problem-solving


studies


validity


of their


conclusions.


review


characterized


hypothet ico-deductive


method


as a five-step


process


in which


clinician


begins


with


initial


impression


or concept,


. formulates


a limited


number


hypotheses


(diagnostic


impressions),


. uses


these


hypotheses


to direct


search


additional


data,


interprets


data


collected,


and


refines,


verifies,


revises,


rejects,


or re-ranks


hypotheses,


leading


to a working


diagnosis.


McGuire


s criticisms


centered


around


methodology


most


of the


studies.


Nearly


of them


used


microscopic


analyses


data


from


small


numbers


of clini


cians


with


real


simulated


patients.


pointed


that


these


studies


are


'i wt l-oA


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it must


concluded


methodology


many t
large
physic
finally


roublesome


portion


ia


ns engage
resolving


that


employed


questions an
the universe


between


that


studies
n those
leave


initial


patient


reported
studies


to date
raise


unilluminated


activities
ly seeing


s problem.


in which
a patient
p. 592)


an attempt


to clarify


contradictory


sometimes


puzzling


res


ults


of two


decades


studies,


Barrows


Feltovich


(1987)


presented


a model


of the


clinical


reasoning


proc


ess


which


they


believe


cons


istent


with


past


research


process,


novice-expert


diff


erences,


clinical


experience,

reasoning.


and

They


artificial

emphasized


intelligence


that


modeling

essential


of clinical

to recognize


that


in most


patient


encounters,


needed


information


available


outset,


gradually


unfolds


through


investigation.


Furthermore,


problem-solver


may


never


assured


that


a solution


been


reached,


because


many


problems


authors


are


claim


clear


that


cut,


use


are


ill-structured.


of well-structured


simulated


patient


problems


measure


performance


will


indicative


of performance


actual


practice.


model


Barrows


of the


Feltovich


clinical


(1987


reasoning


contains


process


following


presented


elements


Initial


patient


presentation.


Several


initial


hypotheses


as to the


cause


of the


patient


complaints


are


generated.


hypotheses


may


be of










. Hypothesis-oriented


inquiry.


guides


further


questions,


examination,


tests


result


from


combination


of problem-driven


questions


menu-


driven


questions


(such


as a standardized


review


systems


inquiry).


Internal


representation


problem


data


acquired


concerning


problem


is synthesized


into


an understandable


model


of the


patient


s medical


condition,


which


can


compared


to that


expected


under


working


hypotheses.


Underlying


pathophys


biological


mechanisms


are


considered


which


further


shape


representation


direct


additional


until


inquiry.


clini


This


cian


type


proceeded


process


from


continues


an initially


ambiguous


diagnostic


situation


to the


point


where


diagnostic


each


deci


clinician


sion


will


can


vary


be made.


approach


as information


obtained


problem


represent action


continues


to be


shaped.


Diagnostic


decision.


now


most


clinicians


would


agree


on the


at work,


with


underlying


perhaps


greater


pathophysiologi c


on the


experience


diagnosis.


variability


mechanisms


expert,


of disease










results


of tests


are


reached,


and


a working


diagnosis


been


established


as treatment


begins.


Most


studi


clinical


reasoning


deal


primarily


with


formulating


a definitive


diagnosis


deal


with


treatment


or management


problem-solving


models


of the

do not


patient.

go beyond


Thus,


most


diagnose


medical


s stage


This


true


because


once


a diagnosis


been


made,


usually


leads


to a specified


course


of treatment


(Ettinger,


1984


scusse


d later


, this


repre


sents


a major


point


departure


between


clinical


medi


cine


and


clinical


dentistry.


Barrows


issues


and


clinical


'eltovich

problem


(1987)

solving


address


other


as well.


Somi


controversial

e researchers


have


claimed


that


reasoning


process


used


medical


clini


cians


resemble


more


pattern


matching


process


than


hypothetico-deductive


process


(see,


example,


McGuire,


1985;


Norman,


1988


Also,


been


claimed


that


multiple


hypothesis


formation


deductive


reasoning


are


used


novice


authors


whereas


refute


expert


these


uses


claims


a different


asserting


process.


(but


demonstrating)


that


such


diff


erences


only


appear


to be


present


because


experienced


clinicians


have


automatized


many


steps


do not


express


them


when


asked


to think


aloud


while


problem


solving.


Finally,


the


authors


underscore










integrated


knowledge


bases


as well


as the


reasoning


process


outlined


above.


Missing


these


discussions


medical


problem-


solving


literature


is any


evidence


of attempts


to teach


use


well


-defined


princ


iples


medi


problem


solving


and


guided


practice


in the


use


these


principles


in many


different


medical


sciplines.


If this


type


teaching


were


implemented


evaluated,


then


one


might


expect


to be able


measure


transfer


general


skills


across


problem


domains.


Such


research


could


resolve


some


controversies


criticism


associated


with


narrow


methodologies


Dental


Clinical


broad


Problem


interpretation.

Solvina


Reports


of studies


of the


clinical


problem-solving


process


or of


transfer


of training


to clinical


problem


solving

1980) .


dentistry


Until


are


recently,


sparse

studies


(Ettinger,

about deci


1984;


.sion


Kress,


making


dentistry


have


been


confined


prac


tice


management


aspects


of dental


practice,


such


as s


students


' choice


of occupation,


practice


of clinical


location,


appointment


treatment,


cost


book


control,


control


quality


of dental


care


control


(see


Ettinger,


1984


a list


citations).


Mendel


Scheetz


(1982)


presented


a study


on the


effects


of seminars


and


S S S


I


i


I










1987)


described


issues


in transfer


of training


from


clinical


laboratory


to clinical


application,


article


was


primarily


confined


to transfer


of psychomotor


skill


training.


Milgrom


Weinstein,


treatment


could


colleagues


Ratener,


planning


account


1981


over


this


(Milgrom,

reported


general


variation


Kiyak,

great v


Conrad,


variability


dentists.


attitude,


authors


training,


or experience


of the


dentists.


They


suggested


that


little


known


about


dentists


' clinical


deci


sion-making


proce


sses


that


training


in data


reduction


integration


should


part


of the


dental


student


s experience.


Mackenzie


(1975)


provided


guidelines


developing


tests


of clinical


judgment,


particularly


written


patient


simulation


problems,


with


objective


of increa


sing


dental


educators


' abilities


assess


systematically


clinical


judgment


of dental


students.


volume


dealt


primarily


with


measurement


issues,


rather


than


with


modeling


process


of problem


solving.


An evaluation


of written


patient


management


problems


use


assessing


clinical


judgment


was


reported


Adams,


Wills,

study


Shannon,


was


Hadac,


concerned


Weinstein


with


testing


(1979).


However,


accept ance


feasibility


of usin


such


problems,


with


clinical


,


w -


r -v


w


~rr rr


-


J










testing


clinical


performance


simultaneously


large


groups


students,


or to provide


students


with


a wider


variety


experience


with


clinical


problems


than


dental


school


can


provide


patient


A descriptive


discussion


need


including


formal


instruction


underlying


principles


problem


solving


was


provided


Taintor,


Taintor,


Biesterfeld


(1980).


These


author


argued


that


even


though


diagnostic


treatment


planning


principles


each


dental


cipline


are


thoroughly


associate


taught


ed with


dental


identifying


schools,


applying


formal

these


steps

general


principles


future

problem


are


dental p

solving


lost


to the


practice.


applic


student,


They


able


offered


to dental


to the


detriment


a general


clinical


model


use


. Recognize,


limit,


and


define


problem.


. Analyze


evaluate


problem.


. Establish


criteria


which


solution


will


evaluated as

Collect data.


Implement


acceptable.


solution.


Citing


a survey


of diplomats


of the


American


Board


Endodont i


, it


was


pointed


that


percent


those


surveyed


indicated


that


diagnosis


was


most


difficult


area










diagnosis


indicated


a need


that


dental


school


programs


should


sati


sfy.


Mackenzie


(1980


described


event s


in dental


education 1

departments


leading


to the


in dental


establishment


schools


a movement


of oral


biology


designed


to promote


better


correlation


between


basic


and


clinical


sciences


dentistry.


He then


presented


detail


finding


cognitive


science


research


and


instructional


principles


derived


therefrom


that


are


related


improving


transfer


biological


knowledge


to clinical


practice.


resulting


curriculum


suggestions


were


into


practice


in the


University


Florida


College


of Dentistry


1981,


and


formed


basis


differential


treatment,


which


subject


of investigation


differential


treatment


present


described


study


in detail


methodology


section.


In a recent


article,


Ettinger


(1984)


discussed


general


prin


ciples


of problem


solving


decision


making


their


applications


to dental


diagno


treatment


planning.


pointed


lack


of research


dental


deci


sion


making


proposed


a model


of the


ocess


Patient


seeks


treatment


. Diagnosis


(problem


solving)


proceeds


either


-A-- '- -. 6 -. S -. -, -I--- -A --.


-i


-r


_ I


_ A


*. L -










and


environment,


disease


lesion,


host-


disease


interaction)


. Treatment


planning


(dec


vision


making


purposes


prevention,


cure,


palliation,


or reconstruction


. Treatment


. Observation

. Maintenance


of outcomes

procedures.


model


appears


to present


an either/or


scenario;


that


represent s


dentist


as using


either


anatomical


model


models


or the


are


medical


used


model


together.


diagnosis.


However,


In practice,


model


both


and


description


point


a fundamental


difference


between


medical


dental


clinical


problem


solving.


Traditionally,


medi


problem


solving


been


concerned


primarily


with


identifying


disease


processes.


Once


diagnosis


been


made,


course


of treatment


is generally


clear


specific.


solving


Until


been


recently,


emphasis


on determining


course


dental


problem


of treatment


from


among


many


alternatives,


once


rather


straight forward


diagnosis


been


made.


diagnosis


was


usually


concerned


with


dental


caries


(decay),


periodontal


disease


(disease


bone


soft


tissue


supporting


teeth),


their


sequelae.


Lately,


changes


epidemiology


of these


4.r~~ tA4*4nnn


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dentistry.


These


additions


to the


lexicon


of dental


practice


require


more


effort


diagnosis


aspect


problem


solving.


While


Ettinger


s article


is directed


toward


deci


sion


conclu


making


sions


apply


dental

to all


treatment

aspects of


of the


dental


elderly

care.


He has


concluded,


example,


that


research


is needed


dental


clinical


deci


sion


making


measuring


outcomes


treatment,


which


will,


in turn,


affect


future


clinical


problem


solving.


He also


suggested


that


the


groundwork


laid


use


of written


medical


patient


management


problems


or simulations


can


be productively


utilized


extending


this


needed


research


base.


summary


of the


problem-solving


models


presented,


indicating


their


similarities


di f ferences,


is provided


Table


Each


element


of the


table


derived


from


general


each


problem-so


models


lying


can


scheme


presented


readily


partitioned


Chapter


into


categories


shown.


Inspection


table


indicates


that


models


have


steps


category zed


as data


gathering,


hypothes


formation


hypothesis


testing.


models


(Polya,


1971;


Derry


Murphy,


1986)


do not


specify


a problem


recognition


step,


because


these


models


assume


that


a problem


already


been


presented.


three


medical


problem-solving


models


(Rarronws


(V


FP et nvi nh.


1987:


Wlstsin


el- all


1978:t


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primarily with


diagnosis;


follow-up evaluation


concerned with the outcomes of treatment.


1986,


an entire


issue of the


Journal of Dental


Education


was


devoted


topic of basic


sciences


and the


dental


curriculum.


Several


of the articles


underscored the


need for


revising the dental


schools programs


to achieve a


much greater transfer


of basic


science


knowledge


to the


judgment,


reasoning,


and decision-making tasks of


clinical


practice


(DePaola,


1986;


Fischman,


1986;


Neidle,


1986;


Roth,


1986;


White,


1986) .


Neidle


(1986


stated her perception


the problem as


a basic scientist


and administrator:


What's the problem?


In a


word,


everything.


percent
sciences


our


students


are taught


42 schools,


in medical


schools


the basic
or health science


centers and their


relevance to a


dentist's present


future needs


tenuous


inconsistent.


.The


remaining
sciences


35 percent
from dental


of students


school


take


their


departments that


basic


are


increasingly under


fire as being financially burdensome


to the


school and probably eminently expendable.


p.455)


Roth


(1986)


presented the problem from the viewpoint


clinician and administrator


A climate


of student


disaffection


[with basic science]


results


in those


an appreciation


same


students entering practice


for the biologic basis


for the scientific method and its


without


of dentistry,


importance.


Students


graduate without
skepticism, and
critically. (p.


the spirit
without the


inquiry,


without healthy


ability to evaluate


462)


The Association


of American Medical


Colleges


had come to


rc 4 m 1i 1 r r nrrl,,14ano o ral / h f r n m r 1


1 QA\


rcslra r~ ~ nn mp~ i


lan Mr











are


required


asse


ssing


new


programs


designed


increase


transfer


of biological


science


knowledge


to clinical


practice


dentistry


Summary


Recent


research


shown


that


there


more


to problem


solving


than


ssess


of a set


general


strategies,


appli


cable


situation.


foundation


of problem-


solving


abilities


domain


of the


a strong


problem.


knowledge


capstone


base


appropriate


to that


foundation


that


problem


solver


have


effective


access


to the


appropriate


knowledge


base.


Access


improved


when


learning


occurs


under


certain


conditions,


such


as when


specific


teaching,


learning,


recall


strategies


are


utilized


which


are


known


improve


understanding


retrievability


information.


Thus,


effective


problem


solving


depends


a great


deal


upon


quality


quantity


knowledge


available


a person


when


attempting


to solve


a problem.


Educators


in medicine


and


dentistry


have


expressed


concern


graduate


about


apparent


practitioners


with


failure


excellent


of their


clinical


programs


problem-


solving

appears


science


abiliti


es.


to be


training


A major


lack


contributor


of transfer


to clinical


to this


of basi


practice.


This


dilemma


biological


recognition


fi'l Iron 4-f' ~~~n r on n rnrma f '4f l%* n


tn rain


rio


a


o" an


~h ; nnf~~~a


nrhk l~m,


hl'lfCln


m A


--Ah--AmA










an accompanying


need


valid,


reliable


instruments


evaluate


the


effectiveness


revised


programs.


A tabular


display


elements


of problem-solving


models


were


was


presented


integrated


into


to indicate


a structural


how


problem-solving


framework


upon


theories


which


BioTrans


instrument


was


constructed.


elements


of this


instrument


are


described


Chapter


III.

















CHAPTER


METHODOLOGY


Development


of the


Test


Instrument


first


objective


this


study


was


to develop


validate


a test


instrument


measuring


transfer


biological


problems


knowledge

dental


to the


students.


activity

Review


of solving


of the


clinical


literature


provided


a theoretical


basis


general


model


clinical


problem


solving


which


became


structural


framework


instrument.


general


model


five


element s


derived


from


common


features


of general


clinical


problem-solving


models


Recognizing


identifying


a problem.


Gathering


data


about


problem


restating


formal


terminology


domain.


. Forming


causal


hypotheses


planning


problem


solving


. Testing


. Evaluating


applying


chosen


hypotheses


outcome


principles.


carrying


of the


plan.


plan.


A set


of questions


was


adapted


to these


structural


elements


a -


- a S


,, ,


i


..


..










Senior


dental


students


University


of Florida


College


of Denti


story


(UFCD)


must


complete


a module


eva


luation


of clinical


judgment


as a requirement


graduation.


Part


of the


requirements


success


sful


completion


of Module


(Evaluation


of Clinical


Judgment)


are


manage


problems


with


properly


written


several


responses


comprehensive


of diagnosis


patient-oriented


patient


management

materials,

radiographs


laboratory


decisions.


such


as patient


mounted


reports,


dental


and


student

history,

models,


asked


provided


examination

photographs


to describe


clinical

findings,

, and


justify


sequence


of steps


managing


patient


problem.


Problem


Recognition


test


we re


instrument


developed


questions


use


(BioTrans


Module


test,


test


Appendix


setting.


Questions


l.A.


. ask


identification


cues


utilized


in problem


recognition


identification.


Questions

biological


.B. and

concepts


query


to the


students'


problem


cues


application


identified.


Data


Gathering


Hypothesis


Formation


An active


review


of the


data


encouraged


in question


II.A.


followed


formation


of diagnoses


(hypotheses)


Parts


B and


C of


question


II ask


student


to connect


biological


concepts


with


chosen


diagnoses,


with


consequences










Testing


Hypotheses


Evaluatina


Outcomes


Question


III.A.


asks


that


therapy


management


patient


patient


tested


problem


management


carrying


summarized.


problem,


treatment.


to the


hypotheses


Thus,


nature


cannot


a plan


of the


actually


carrying


treatment


is substituted


this


situation.


Planning


treatment


could


also


require


includes

alteration


cons


idering


of the


plan


potential

This s


events


tep


which


encourages


thinking


about


such


eventualities,


estion


III.B.


intended


to stimulate


responses


linking


biological


concepts


to such


events.


Question


III.C.


substitutes


actual


monitoring


of treatment


outcomes


requiring


responses


associating


biological


concepts


with


cues


to be monitored


during

Content


follow-up.

Validity


A draft


submitted


instructions


seven


dental


clinical


test


quest


faculty,


ons was

chairman


dental


dentistry


education


review


department,


graduate


recommendations


revi


students


sion.


Action


was


taken


on suggestions


to include


a cue-directed


approach


to elicit


more


easily


connections


with


biological


concepts,


to clarify


question


terminology,


to clarify


test


instructions.


a -


- a


v


v


t


- 1











randomly


examinee


chosen


was


volunteer


asked


from


to recall


among


a clinical


first


case


ten.


from


Each


or her


own


experience


which


involved


some


degree


of comprehensive


care.


This


substitution


avoided


disclosing


content


patient


management


problems


used


this


study


or to be


used


during


sequent


Module


test


program.


Employing


responded


recall


to the


case


instructions


as a problem


test


case,


questions


examinees


writing.


Upon


completion


each


test


administration,


researcher


briefly


interviewed


examinee


to determine


whether


difficulties


were


encountered


completing


test.


was


found


that


wording


test


questions


required


clarification.


In addition,


several


changes


became


necessary


wording


of the


instructions


to cl


early


define


meaning


of the


term


"biological


concept


Also,


was


necessary


to provide


some


example


responses


in the


instructions


to indicate


type


range


responses


desired


test.


example


respon


ses


we re


drawn


from


discipline


of orthodontics,


a field


which


would


included


in the


patient


management


problems


to be


used


this


study.


After


each


revised


interview,


next


trial,


test


and


repeating


instructions


this


process


were


until


.. S.' -a-------------- '---1 -- *3 A- ~ - a Ta L.t~ a a a a fl -


n rr ~k


t, ~L!





1


l__r


,L--l


r


L1 L


I r%










Validation


of the


Test


Instrument


Validating


Instrumentation


Functional


Knowledae


Test


(FJKT).


This


test


uses


critical


incident


technique


measure


use


of biological


knowledge.


questions,


responding


respondent


to a short


asked


to recall


open


ended


a clinical


episode


which


biological


knowledge


made


a difference


patient


care.


Thus,


is a context-sensitive


instrument


nature


use


of clinical


episodes


. Validation


studies


(Mackenzie,


1965)


showed


that


content


analysis


responses


detected


differences


between


students


from


different


dental


schools


< 0.0001).


In contrast,


analysis


responses


juniors


compared


seniors


in the


same


schools


showed


significant


differences.


A system


categorizing


thought


ocesses


has been


developed


using


FJKT


responses


zie,


et al.,


1986)


Validity


system


was


tested


comparing

clinical


dat a


collect


thinking


ed from

judgment


a grou

with


having


a group


more

having


training

less.


Using


very


specific


criteria,


five


judge


could


category


data


reliably


percent


agreement


level.


FJKT


tests


were


administered


to senior


dental


students


earlier


senior


year


than


Module


tests,


under


nearly


identical


test


conditions


testing


center.


A sample


the FJKT


s found in


Appendix


-- T











transfer


learning


a new


setting.


A probe


task


concept


printed


on the


test


sheet,


respondent


to write


down


as many


words


or ideas


related


to the


probe


as p


oss


ible,


in a one


minute


time


period.


responses


are


categorized


content


analy


sis.


Shavelson


(1974,


the

tion


241)


interpretation

of cognitive


presented


of word-a.

structure


ample


validation


association

(memory or


data


ganizatio


evidence


a representa-

n). This


researcher


used


another


validation


study


(Mackenzie,


was


Martin,


administered


Gale,


to the


1988).


senior


In the


student


present


during


study


Module


testing.


A sample


of the


found


Appendix


Test


corona


responses


three


types


of tests


(WAT,


FJKT,


BioTrans)


were


content


analyzed


a blind


fashion


placing


response


concepts


into


one


of four


categories


biological


concept s,


applied


biological


concepts,


clinical


tasks,


or other


concepts.


Decision


rules


category


zing


concepts


were


as follows.


Basic


biolocrical


concepts


are


those


concepts


which


pertain

human o


or describe


rganism.


endochondral


Examples


bone,


bony


structure


basic


sutures


and/or


biological


, osteoblasts,


function of the

1 concepts are


bone













. Applied


biological


concerts


are


those


biologically


oriented


concepts


which


are


particular


importance


describe


gnathi


dentist.


:ructure


the st

system,


Examples


and/or


system


are


function

primary


orthodontic


of the

concern


treatment


human


forces,


stomato-


skeletal


malocclusion,


saliva,


calculus,


or dental


pulp.


Clinical


tasks


are


specific


activities


that


dentist


care,


performs


that


while


diagnosis,


carrying


treatment


duties


planning,


of patient


treatment,


follow-up


care.


Examples


cavity


preparation,


tooth


restoration,


occlusal


equilibration,


gingival


surgery,


radiographic


examination,


and


clinical


discipline


phrases


such


as endodontic


treatment


or periodontal


surgery.


Other


concepts


are


those


responses


that


do not


first


three


categories.


They


include


tools


and


materials


used


in denti


stry,


such


as impres


sion


materials,


resins,


matrix


materials,


explorers,


forceps,


film


developer


Rules


counting


biological


concept s


were


those


specified


a classification


system


developed


Mackenzie


et al.


(1986);


pertinent


excerpts


are


provided


Appendix


Placement


of concepts


into


four


categories


was


done


to facilitate


data


analysis


future


studies.


purposes


of the


present


study


a single


test


score


each


t 1- -I-~ A A tf -


r


*I ^ *


r


I I


C.I~ ~1 ~1e~lll~l










least


weeks


after


first


scoring


Scoring


consistency


was


determined


percent


agreement


between


initial


sec


ratings.


Validation


Data


Analysis


Construct


validation


involves


making


a series


predictions,


results


based


on theory,


on instruments


which


about

measure


the

the


relationship


same


between


or similar


constructs


(Crocker


& Algina,


1986;


Thorndike


Hagen,


1969).


predictions


or hypotheses


are


made


about


correlations


between


measures


differences


between


groups,


and


responses


to experimental


interventions,


are


tested


obtaining


experimental


dat a


utilizing


the


instruments.


In the


present


study,


hypotheses


about


correlations


and


about


responses


experimental


interventions


were


made.


review


basis


ses


this


of the


relationships


, cognitive


theoretical


literature


between


structure,


basi


discussed

problem


trans


investigator


theoretical


solving,


of training.


formulated


knowledge


Upon


hypotheses


about


correlations


between


BioTrans


test


and


measures


of cognitive


structure,


WAT


FJKT.


was


reasoned


that


instruments


measuring


organization


biological


information


memory


would


correlate


positively


with


a measure


transfer


of biological


information


to the


nrrhl sm-sn vi no


nrnxss-


RsnanssSF


Irz 'I -I


n a~ss


rank


I 1V


S-1










ranks.


Experimental


interventions


conducted


while


students


learned


biological


concepts


were


expected


to produce


differences


in cognitive


structure,


therefore,


differences


in access


transfer


of the


concepts


clinical


problem


solving.


reasoning


was


that


these


differences


would


cognitive


expressed


structure


difference


of biological


frequency


information


recall


concepts


applied


to solving


clinical


problems.


Thus,


was


hypothesized


that


concepts


learned


under


each


three


learning


conditions


would


have


differential


frequencies


appearance


in test


responses.


three


learning


conditions


are


described


later


section


concerning


learning


interventions.


predictions


Experimental


provide


evidence


results


which


construct


support


validity


these


of the


BioTrans


instrument.


first


research


question


of this


study


was,


are


scores


on the


BioTrans


assessment


instrument


related


scores


on an existing


structure,


question


FJKT?


was


stated


context-sensitive


hypothesis

direction


measure


associated


form:


of cognitive


with


Pearson


product-moment


correlation


coefficient


between


scores


on the


BioTrans


test


and


scores


on the


FJKT


greater


than


zero


alpha


.05,


as evidence


of construct


validity.


rrnrrlati n


rnp ffi


ni nt


Was


a1 ] nl ated


flhi.2 il


teroreted.


I I











measure


instrument


of a related


can


construct


be interpreted


designated


as a measure


test


of validity.


second


research


question


was,


are


scores


on the


BioTrans


instrument


related


scores


on an existing


context-


free


measure


hypothesis


was


cognitive


stated


structure,


directional


WAT?

form:


The

The


associated

Pearson


product-moment


correlation


coefficient


between


scores


on the


BioTrans


test


WAT


greater


than


zero,


at alpha


.05.


correlation


coeffi


cient


was


calculated


interpreted.


Crocker


Algina


(1986,


p.224)


identified


concurrent


validity


as the


relationship


between


test


scores


those


on a criterion


measure,


both


measures


obtained


same


test


time.


A suffi


ciently


high


positive


correlation


between


the


scores


can


be considered


as evidence


concurrent


construct


validity


third


research


question


was


are


scores


on the


BioTrans


instrument


related


to the


final


class


rank


of the


examinees

Spearman


associated


rank-order


directional


correlation


coeffi


hypothe


cient


was


between


scores


BioTrans


test


final


class


rank


examinees


greater


than


zero,


at alpha


.05,


as evidence


predictive


criterion-related


validity.


Crocker


Algina


(1986,


224)


described


predictive


validity


as the


degree


to which


4- -A


- -


r La ~ L' F % raa L ,-2flnrarl4 t- Inf 1 1100 trr4 ta4n mna


iol,4 nh


nra~; ~t


111~Q


/^ar


mb~ 011rb


r f~ c r c! ~n ro c











rank


rank


was


score


thought


to be


which


meaningful,


heavily


weighted


because


represents


clinical


evaluations,


reflecting


an emphasis


on clinical


performance.


Thus,


final


class


rank


thought


to be


an overall


rating


clinical


competence


admini


strators,


therefore


can


construed


as a measure


of clinical


problem-solving


competence.


used


Spearman


to determine


rank


order


correlations


correlation


between


scores,


coefficient


both


which


are


measured


on an ordinal


or higher


scale


measurement.


Spearman


value


was


calculated


interpreted.


fourth


research


question


was,


are


scores


on the


BioTrans


instrument


stable


when


examinees


are


tested


separate


was


problems


Pearson


corresponding


product-moment


directional


correlation


hypothesis


coefficient


between


scores


on the


BioTrans


test


separate


patient


management


problems


greater


than


zero,


at alpha


.05.


definition


of reliability


degree


stability


scores


between


equivalent


forms


a test


admini


stered


to the


same

p. 1


1


examinees

7). While


same


testing


patient


(Crocker


management


Algina,


problems


1986,


used


study


are


equivalent,


they


can


considered


parallel


forms


purpose


of stimulating


recall


of biological


--- ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ L, -- -i --- e ..- iI 3


ml-


'1, L


,, L1


L-Y~


,, L


A










fifth


research


question


was,


results


BioTrans


when


test


learning


reflect


biological


effects


concepts


of differential


related


treatment


null


hypothesis


was:


There


are


no differences


mean


number


of reported


biological


concepts


learned


each


of three


different


methods,


at alpha


Rejection


null


hypothesis


provides


evidence


construct


validity


of the


instrument


occurring


demonstrating


as a result


predictions


experimental


of changes


interventions


(Thorndike


& Hagen,


1969,


176-177).


data


were


analyzed


repeated


measures


analysis


of variance.


Experimental


Methods


Experimental


Design


second


objective


of this


study


was


to determine


whether


detect


the


long


BioTrans


term


instrument


effects


sufficiently


of differential


sensitive


treatment


teaching


learning


interventions


carried


during


students


' freshman


year


measured


during


senior


year


dental


school.


experimental


design


portion


of the


study


was


a repeated


measures


design,


which


each


subject


acts


as as his/her


own


control.


Such


a design


provides


increased


statistical


power


over


designs


of equal


sample


size


with


a separate


control


group.


Learning


a


Interventions










courses.


purpose


of the


module


is to aid


future


clinical


judgment


presenting


learning


experiences


which


help


connect


biological


information


with


certain


clinical


procedures.


In order


to test


effects


of overlearning


elaboration


ultimately


on development


on trans


of cognitive


of biological


structure


training),


(and


clinical


tasks


their


related


biological


principles


were


taught


tested


three


different


methods


as follows.


Forty


commonly


used


dental


task


were


selected,


four


from


each


of ten


clinical


disciplines,


to provide


a core


of clinical


tasks


associated


biological


concepts


module.


student s


were


provided


a syllabus


containing


procedural


tasks


descriptive


narrative


about


biological-clinical


connections.


students


were


asked


read


about


each


task


and


associated


connections,


and


view


a clinical


photograph


depicting


procedure.


addition,


they


were


required


to observe


examples


tasks


being


performed


during


a one


hour


clinical


observation


period


every


other


week.


They


were


asked


to recall


biological


concepts


associated


with


task


decisions


while


clinically


observing


task.


Also


, the


student


were


asked


to think


about


dental


task


each


time


an ass


ociated


biological


concept


was


mentioned


a biological


science


lecture.


This


tvpe


of learning


was


labeled


"experiential


-- T










clinical


discipline.


1984


freshman


class


of 76


student


was


arranged


alphabetical


order


and


ass


signed


alternatively


one


of two


groups


of ten


task


was


then


randomly


assigned


to each


group


This


method


been


replicated


previous


year


with


remaining


tasks


tasks


assigned


were


risk


testing


once


each


month


eight


months.


testing,


lide


were


selected


at random


from


those


at risk


and


students


were


asked


to recall


name


task


and


four


biological


concepts


that


were


part


information


used


in deci


sion


made


during


performance


of the


percent


task.


students


of these


responses


recalled


each


between


month,


and


demonstrating


overlearning


of the


tasks


concepts


beyond


the


usual


performance


requirements.


This


learning


condition


was


labeled


"simple


overlearning


Five


of the


assigned


tasks


were


randomly


selected


ass


signed


an additional


learning


testing


requirement.


students


were


required


to write


a short


essay


about


one


five


task


randomly


selected


each


month.


essays


required


a desc


ription


of four


decisions


that


might


occur


during


performance


task


an indication


roles


played


biological


concept s


those


deci


sions


Also


a second


paragraph


was


required


describing


/-rnfl,-


ont a


ii act-I


,qor4~


ac an


'a Irf r


van ra


r u\l


Ir iur I ilu


&


rio


i n Tn










labeled


"meaningful


overlearning.


summary,


each


group


students


overlearned


five


tasks


with


simple


associations,


five


task


with


meaningful


associations,


experientially


learned


other


tasks


associated


concepts


contained


Module

Testing


500.

Procedures


Testing


Module


took


place


April,


1988


this


time,


class


size


was


with


changes


attrition


transfers.


testing


took


place


College


of Dentistry


testing


center


under


equivalent


conditions,


with


no more


than


students


being


tested


one


time.


depending


testing


on the


period


working


took


speed


from


of the


three


to five


student.


hours,


Each


student


read


instructions


test


procedures,


then


began


with


timed


testing,


followed


five


separate


patient


management


problems


(PMPs).


Work


on each


was


completed


handed


before


proceeding


to the


next.


Sequencing


five


PHI's


was


randomized


to avoid


a sequencing


bias


test


results.


BioTrans


test


questions


are


general


nature,


are


applicable


PMP.


each


student,


BioTrans


tests


were


randomly


assigned


to two


PMPs


each


such


PMP,


student


was


instructed


to complete


first,


then


proceed


to the


BioTrans


test


usina


'-'I r "Ar I- tI -U L.-I I-


same


test


i .-


s. .-2










Data


Collection


and


Analysis


Each


of test


answer


sheets


was


identified


test


number


only,


order


that


test


res


ults


could


scored


blind f

blindly


fashion.


Respon


rese


ses


archer,


on the


BioTrans


identifying


only


test


were


group


as


scored

signment


test


number


each


answer


sheet


Each


biological


concept s


reported


were


classified


into


category


of meaningfully


overlearned,


simply


overlearned,


experientially


learned


These


categories


were


determined


listing


the


biological


concepts


unique


to each


group


of task


assigned


to the


student


Scores


both


BioTrans


tests


were


summed,


then


normalized


to adjust


di fferences


number


concepts


at risk


each


learning


treatment


(meaningful


learning).


overlearning,


Normalizing


imple


procedures


overlearning,


are


experiential


described


Appendix


. The


data


record


each


student


was


thus


established,


comprised


of the


number


biological


concept


reported


each


three


learning


category


, plus


test


identification


number.


Each


three


data


point


record


represents


correlated


or repeated


measure


each


student


appropriate


statistical


analysis


to detect


different


ces


in the


three


learning


methods


these


data


was


a repeated


measures










biological


concepts,


reported


on the


BioTrans


tests,


categorized


as meaningfully


or experientially


learned,


overlearned,


evaluated


simply


at alpha


overlearned,

.05.


Sample


Description


Subjects


this


study


were


65 senior


students


entering


class of


1984


University


of Florida


College


Dentistry


(UFCD)


There


were


female


students


male


representative


students.


of the


entering


population


class


of public


was


generally


university


dental


school


entering


classes


with


respect


to abilities


assessed


entrance


examinations


pre-professional


academic


preparation.


not,


however,


a random


sample


from


that


population.


senior


class


was


representative


of recent


near-future


senior


asses


at UFCD.


Generalization


results


of the


experimental


validation


portions


of this


study


are


rest ricted


senior


dental


students


undergo


similar


training


programs


dentistry.
















CHAPTER


RESULTS




Introduction


will be


recalled that


the purposes


of this study were


to present


evidence


several


types of


reliability and


validity for the BioTrans


test,


and to determine


sensitivity to


the effects


of differential


teaching


treatments on transfer of biological


information


to clinical


problem solving.


types of


reliability and validity


investigated were stability,

criterion-related forms of c


construct


:oncurrent,


validity, and

predictive, and


construct


validity.


The purpose of presenting


evidence of validity


is to


help this


researcher


and others


decide


if the BioTrans test


is a


useful,


meaningful measure


for making inferences or


decisions based on test


scores.


As Borg and Gall


(1983)


have


stated,


"The prospective test


user should ask not


this


test


valid?'


this test


valid for the


purposes to


which I


wish


to put


it?'"


275)


findings of


this


study will be presented in











headings


indicating


type


validity


investigated.


Following


will


be the


results


of hypothesis


tests


concerning


ects


of experimental


treatment.


Finally,


a summary


findings


will


conclude


chapter.


Scorina


Consistency


consistency


of the


researcher


in scoring


tests


was


estimated


blindly


re-sc


oring


sets


tests


seven


percent)


randomly


selected


examinees


three


weeks


after


first


scoring.


An index


of consistency


was


determined


calculating


percent


agreement


between


scores


on the


first


second


scoring.


Ninety


percent


agreement


was


obtained.


Tests


of Research


Hypotheses


Distributions


of the


data


used


to test


research


hypotheses


were


examined


normality


utili


zing


stem-leaf


plots,


box


plots,


normal


probability


plots.


variables


of interest


were


determined


to be approximately


normally


distributed


in the


sample.


Five


research


hypotheses


were


tested


to provide


evidence


construct


validity,


stability,


and


sensitivity


to the


results


of experimental


treatment.


first


hypothesis


tests


will


be considered


together


Criterion-Related


Construct


Validity


Evidence


of construct


validity


was


sought


testing


nra 1 + 1 n ei nnohno


ha ir ra 1 a t : nn a 1


k ~ rnnC k a a a a


ak hl~C


a rrh *a a


r-


Fnn










Table


Pearson
Scores


Product-Moment


Correlations


Criterion


Test


Test BioTrans FJKT WAT


BioTrans .36* .16

FJKT .21

WAT -


.005,


= 61


three


test


scores.


A significant


moderate


correlation


was


found


.05)


between


context-sensitive


measures


of transfer


of biological


knowledge


(BioTrans)


and


cognitive


structure


BioTrans


(FJKT),


test


no association


WAT,


was


a context-free


found


test


between


of cognitive


structure.


first


research


hypothesis


was


that


Pearson


product-moment


correlation


coefficient


between


scores


on the


BioTrans


test


and


FJKT


greater


than


zero,


evaluated


a significance


level


.05.


results


study


supported


moderate


Table


this


relation


research


ship


furnishing


some


hypothesis,


indicated


between


evidence


that


measures


construct


see


validity


,n1 -'--a--, -e .e a .5 C- S.


Among


--


,,-,-.,


,,


I ~,


CI


I


T


I


mL


*










second


research


hypothesis


was


that


Pearson


product-moment


correlation


coefficient


between


scores


on the


BioTrans


test


greater


than


zero,


evaluated


a significance


level


.05.


correlation


coefficient


between


these


variables


(see


Table


was


statistically


support


different


second


tests


from


research


share


an ass


zero.


hypothesis,


ociation


data


failed


indicating


in measuring


that


transfer


or potential


transfer


biological


knowledge.


Predictive


Criterion-Related


Validity


Predictive


criterion-related


validity


was


evaluated


testing


third


research


hypothesis:


Spearman


rank-


order


correlation


between


scores


on the


BioTrans


test


final


class


rank


examinees


is greater


than


zero,


evaluated


at a significance


level


.05.


resulting


Spearman


correlation


was


rLo


-.30


.05,


= 63),


indicating


that


a relationship


However,


between


relationship


sets


was


of ranks


inverse


does


there fore


exist.


failed


support


research


hypothesis.


St ability


degree


stability


scores


on the


BioTrans


instrument


was


investigated


testing


the


fourth


research


hypothe


Pearson


product-moment


correlation


n a! m *-


nhh CC h; ha


k A C I.rA A n


AA CkA


Lr r~


F1 n A un FI










management


problem


testing


was


.0009,


= 63).


result


provided


moderate


support


fourth


research


hypothesis.


Wvnari mnnt-a 1


-- A~JJ ~ ~ L. t. p p


5c~ns e.t jul t


Construct


Validity


fifth


hypothesis


was


tested


to determine


whether


BioTrans


test


res


ults


demonstrated


treatment


effects


predicted


theory.


null


hypothesis


no differences


mean


number


of reported


biological


concepts


learned


one


three


different


methods


was


tested


repeated


measures


analysis


of variance


Frequency


scores


of reported


biological


concept s


from


each


learning


method


were


normalized


to adjust


differences


number


concepts


risk


in each


learning


method


(see


Appendix


normalized


scores


were


used


in the


repeated


measures


ANOVA,


results


are


summarized


Tables


Table


Normaliz
Learning


ed Score
Method


Means


Reported


Biological


Concepts


Learning Method Mean SD


Meaningful Overlearning 73.16 25.69

Simple Overlearning 59.45 25.88

W vnnr4 ant -i Tnnrn 4 nn C 1 7









Table


Dan sa4- a


Mna o i r c


MlavaL


Silmm~ rv--T1P;arninaQ


J.Li p L.U ICP t. SC~t. LA. au t. .5 u 2ruru A p. Vp *.s-.-


Methods


Source df SS F ADJ PR > Fa


Methods 2 5961.45 7.04 .0015*

Error 118 49955.78


Huynh


-Feldt


epsilon


.9660


probability
sphericity


results


adjusted by
assumption


repeated


Huynh-Feldt


measures


method


ANOVA


violation


(Table


rejection


of the


null


hypothesis


no differences


among


means.


Pairwise


post-hoc


comparisons


means


were


performed


using


Tukey


s (HSD)


test,


as recommended


Stevens


(1986,


419-423).


mean


number


of reported


biological


concepts


from


meaningful


overlearning


method


was


greater


than


means


either


simple


overlearning


or experiential


learning


methods


.05);


means


simple


overlearning


experiential


learning


differ


significantly


These


results


support


alternative


hypothesis


that


BioTrans


test


sensitive


detection


of differential


transfer o

treatment


f biological


during 1


concepts


earning.


resulting


Meaningful
- a a S


from


differential


overlearning


appeared
* S -,- _






70


Summary


results


of the


data


analysis


supported


three


five


research


hypotheses


formulated


testing.


significant


posit


correlation


coefficient


was


found


between


BioTrans


instrument


context-sensitive


FJKT


measure,


providing


evidence


of criterion-related


construct


validity.


significant


positive


correlation


coefficient


was


found


between


BioTrans


test


scores


on the


first


second


patient


management


problems


using


BioTrans


instrument.


This


finding


demonstrated


moderate


test


stability

Analysis


between


problems


effects


differing


experimental


clinical

treatment


character.

furnished


support


instrument,


construct


and


validity


sensitivity


of the


BioTrans


in detecting


such


effects.


greater


Meaningful


transfer


overlearning


of biological


was


concept


found


s in


to produce


process


clinical


problem


solving


than


either


simple


overlearning


experiential


learning.


No evidence


was


found


particular


criterion-related


examinations


concurrent


validity


findings,


or predictive


their


validity.


implications,


Discus


ions


suggest ions


further


research


are


presented


Chapter
















CHAPTER


DISCUSSION,


CONCLUSIONS,


RECOMMENDATIONS


Discussion


Review


of the


relevant


literature


indicated


need


development


of valid,


reliable


measures


of clinical


performance

transfer of

present inv


which


reflect


training

estigation


and

was


current

clinical

designed


theories

problem


in the

solving.


to develop


one


areas

The

such


measure,


BioTrans


test.


In addition,


investigation


was


expected


answer


questions


focused


test


reliability,


validity,


sensitivity.


Correlational


hypotheses


were


tested


to determine


whether


test


score


data


provided


evidence


of stability,


concurrent


criterion-related


criterion-related


construct


validity,


validity,


predictive


criterion-related


validity.


effects of differential

determine experimental


A hypothesis


teaching

construct


methods

validity


concerning


was

and


expected


tested

test


sensitivity.


results


Each


one


section


of these


discussion


reliability


will


or validity


center


tests.


Criterion-Related


Construct


Validitv


Results


of the


data


analysis


indicated


that


evidence


v










was


.36,


was


interpreted


as a moderate


correlation


providing


modest


evidence


construct


validity.


Understanding


moderate


correlation


finding


can


aided


reviewing


method of


administration


tests


under


consideration.


BioTrans


test


relies


on a


specific


patient


management


problem


preparation


responding


cues,


to problem-s


which


solving


trigger


questions


access


posed


pathways


test.


to relevant


concepts


student


s memory,


are


specifically


provided


problem.


Thus,


BioTrans


test


measures


cued


recall.


In contrast,


on the


FJKT


student


asked


to recall


a clinical


incident


in which


biological


knowledge


made


difference


in treatment.


In this


situation


student


in effect,


providing


a personal


patient


management


problem,


including


access


cues.


availability


information


stimulated


FJKT


dependent


upon


free


recall


instead


of problem-cued


recall.


In addition,


students


tended


report


incidents


stimulated


fewe r


which

cue p


were


athway


narrow

s than


in scope,


patient


probably


management


problem.


tests


existing


under


commonalities


consideration,


between


the before,


are


res


ults


likely


expression


of similarities


in cognitive


structure


general si


milarit


f context.


S-a -


context


that of


v










BioTrans


test


FJKT


viewed


instrument s


measuring


related


constructs


which


have


a common


basis


of organization


of biological


knowledge.


Thus


would


expected


that


a high


correlation


coefficient


would


result


from


this


data


analy


S1S.


Concurrent


Criterion-Related


Validity


No evidence


was


provided


concurrent


validity,


hypothesized,


relationship


between


WAT


BioTrans


test


results.


This


unexpected


result


may


have


occurred


because


context-free


single


task


or single


concept


cues


used


to stimulate


recall


did


overlap


appreciably


with


those


found


patient


management


problems.


limited


overlap


could


produce


responses


which


represent


different


segments


of cognitive


structure,


leading


to a lack


relationship


between


test


results.


This


finding


may


an expression


of fundamental


differences


information


structures


which


are


recalled


context-


rich


or context-


free


methods


of stimulation.


BioTrans


test


differ


context


provided


cue


recall.


essentially


context-free,


relying


on a single


word


or phrase


problem


as the


rich


cue.


comparison,


clinical


problem


BioTrans


context,


test


generating


wealth


cues


problem


description


These


context


it










size


of the


sample,


or restriction


in range


of variability


allow


detection


of that


relationship.


guidelines


used


category


zing


counting


types


of concepts


may


insuffi


cientl


y precise


to detect


subtle


relationships.


Predictive


Criterion-Related


Validity


An unexpected


finding


occurred


examination


of the


relationship


ranks.


between


significant,


BioTrans


small


score


negative


ranks


rank


final


correlation


class


.30)


was


found,


indicating


that


ranks


are


inversely


related.


This


means


that


high


BioTrans


score


ranks


are


slightly


predictive


final


class


rank.


unanticipated


finding


could


an assumption


made


about


nature


of the


final


class


rank


was


reasoned


that


final


class


rank


emphasized


clinical


performance


because


senior


year


dominated


clinical


course


work


clinical


practice.


may


however,


that


senior


year


evaluations


reflect


performance


in technical


exce


llence


procedural


knowledge


more


than


performance


clinical


problem


solving


or level


biological


knowledge


Stated


differently,


to evaluate


appears


technique


that


attention


clinical i

to detail,


instructorss


rather


tend


than


diagnostic


problem


solving,


treatment


planning,


application


of biological


knowledge.


If this


is true,


then


* -


6- a a a a - -1-* -- ..- 1 - -- a r L, Il l -


,,,L


. ^1


,L1.


LL


C










Stability


The hypothesis concerning stability


of BioTrans


scores


from one


testing to the next


correlational


was evaluated by


relationship between


first


investigating


and second


problem test


scores.


A significant


positive moderate


correlation was


found


.41)


furnishing support


for the


stability hypothesis.


This


finding


is encouraging


in view of


fact


that


first


and second testing


accomplished using


different


patient problems.


was


reasoned that


tests,


though different


in clinical


presentation,


would draw upon


similar cognitive structures


of biological


concepts


problem solution.

substantiates that


The attained stability coefficient

reasoning.


The lack


a high


correlation between different


problems


is similar to


findings


of other studies which


investigated transfer of the medical


problem-solving process


among different


clinical


problems.


For example,


correlations between performance scores on unlike medical


problems were


found by Elstein,


Shulman,


and Sprafka


(1978),


prompting conclusions about


lack of transfer of problem-


solving skills.


Norman and co-workers


(1985)


reviewed


similar reports and inferred that


performance variability on


single problems measured by existing methods was too great


-~- r -* 7. A s S l lA










A finding


of moderate


test


stability


can


result


from


combination


of influences.


First,


likelihood


of wide


variability


a high


on single


stability


problem


coeffici


scores


ent.


lessens


ond,


probability


an opposing


influence,


trans


of biological


knowledge


during


solution of

probability


different


at least


problems,


would


a moderate


increase


coeffi


cient.


the

Few


conclusions


can


be drawn


about


effect veness


of transfer


of problem-solving


skills


on the


basis


of data


derived


from


only


problems.


Experimental


Construct


Validity


Sensitivity


finding


a significant


difference


in the


mean


number


of biological


concepts


reported


from


three


different


learning

construct


part,


methods provides

validity. The


differences


strongest


BioTrans


in recall


test


predicted


evidence for

results demonstrated,


theory.


Meaningfully


most


learned


frequently;


concepts


data


were


supported


expected


this


to be reported


prediction.


Simply


overlearned


concepts


were


expected


to be


reported


more


frequently


than


experientially


learned


concepts.


This


difference


was


demonstrated


data


It is


possible


that


these


methods


produce


striking


differences


availability


of knowledge.


For


example,


much


of the


a~~~ I -


I .I


1 1


i I


A










take


place.


However,


simple


overlearning


have


been,


essentially,


practiced


rote


memorization


only


a few


of the


concepts


risk,


because


students


were


required


only


identify


a procedure


list


four


ass


ociated


ologi


concepts


monthly


izzes.


Context


during


learning


available


understanding


overlearning.


the

was


Therefore,


narrative


description


required,


cognitive


of the


was


structure


syllabus.

meaningful


developed


simple


equivalent


overlearning


when


or by


tested


experiential


BioTrans


learning


may


instrument.


It also


that


instrument


can


detect


small,


true


differences


of this


nature


with


a sample


of 60


examinees.


Conclusions


Recommendations


Based


on the


results


of this


study,


several


conclusions


may


be drawn


about


BioTrans


test


instrument


the


experimental


results


obtained


use.


First,


evidence


construct


validity


has


been


provided


association


shown


with


a context-sensitive


measure


of cognitive


structure,


detection


of effects


of experimental


treatment


predicted


theory.


demonstrated


Second, t

correlation


est


stability


of test


scores


been


using


separate


patient


management


problems.


Third,


BioTrans


test


data


do not


indicate


evidence


of predictive


validity


-~~~~~~~~~~~~~r 1a -- -1.- ---*.I t


,1


m


I


1-











Fourth,


meaningful


overlearning produces greater


transfer of biological

problem solving, using


concepts


to the process of


patient management


problems


clinical

, than


either


simple overlearning


simple overlearning


or experiential


and experiential


learn


learning.

ng do not


Fifth,

appear


to differ


the amount


of transfer of biological


knowledge


produced during patient management


problem solving.


Therefore,


other


investigators


should find the BioTrans


test


useful


as a


valid,


reliable


instrument


for evaluating


student


performance or program effectiveness.


This experience


with


the BioTrans


instrument


draws


attention to some recommended changes


in methodology which


would strengthen the


utility of the test


for understanding


the effects of


learning methods


on transfer


of knowledge.


The patient management


problems


used in


the present


study


were chosen


from among those already


in use


for the


curricular module


for evaluating


clinical


judgment.


These


problems

important


were collected or


formulated to test


diagnosis and treatment


decisions


the most


commonly


encountered in


each dental


discipline.


Presently,


there


inadequate


integration of


disciplines


in these problems.


Therefore

problems


it would be preferable


if patient management


were developed specifically for use with


4-a e4


t. LL~tlhf t~r fl I ir


nPw nrnhlsimn


sbhni rt rsnii i rs


nD a










Once


desired


management


problems


were


developed,


equivalent


forms


could


be prepared.


A better


estimate


stability


of test


scores


under


equivalent


forms


then


would


ssible.


Preparation


of appropriate


management


problems


extremely


time


consuming,


heretofore


been


done


with


these


purposes


mind.


It would


be instructive


rescore


analyze


FJKT


responses


to reflect


frequencies


of concept


learned


each


method.


A repeated


measures


ANOVA


could


then


be performed


demonstrate


to determine


same


effects


either


of these


differential


tests


treatment


learning


shown


BioTrans


data.


These


results


may


shed


new


light


on the


hypothesi


zed different


ces


in transfer


simply


overlearned


experientially


learned


concepts.


It is


recognized


that


collecting,


training,


scoring,


analyzing


data


with


BioTrans


test


instrument


is quite


time


dental


consuming.


educator


test


needs


will


easily


of 1


ess


scored


utility


data


to the


making


rapid


decisions


student


evaluation.


BioTrans


test


will


of greater


interest


to the


dental


educational


researcher


wishes


gain


understanding


subtle


long-range


consequences


a teaching


program


effects


transfer


of learning.


With


slight


modification,


BioTrans


m



















APPENDIX


TEST


OF TRANSFER


OF BIOLOGICAL


KNOWLEDGE


Please


Read


Thaes


Instructions


Carefully


widely


recognized


in dentistry


that


basic


biological


scien


ces


provide


foundation


understanding


solving


clinical


problems.


In the


early


portion


your


dental training

sciences, which


acquired a

reinforced


knowledge


related


base


biological


to clinical


practice


Module


(Introductory


Clinical


Experiences).


have


extended


that


knowledge


in your


clinical


training


clinical


experience.


Draw


upon


that


knowledge


while


responding


to the


questions


statements


of this


test.


This


test


is designed


measure


your


ability


trans


basic


biological


knowl


edge


to solving


clinical


problems


biological


through


dentistry. You

knowledge related


a clinical


will


be asked


to each


problem-solving


step


format.


to identify


as you


Basi


basic


proceed


biological


knowledge


consists


learned


your


of the


course


concepts


work


relationships


anatomy,


which


embryology,


biochemistry,


microbiology,


histology,


phys


iology,


pathology,


pharmacology,


neurosc


iences.


Many


of th


ese


concepts


were


reinfnrleld


J"2 I 1 tL


s1i~ Rhn rstr sri


in nlinins


rnnt- nti-


rli iri nf


Mnriii 1 n











to each


question.


Biological


concepts


can


be quite


specific


osteoblasts,


synaptic


transmis


sion)


somewhat


broad


skeletal


maloc


clusion)


Examples


clinical


cues


symptoms


, diag


nosis,


some


related


biological


concepts


are


given


below


a particular


orthodontic


case.


example


responses


are


no means


exhaustive,


are


provided


to guide


types


responses


expected.


Clinical


Cues


Patient


appearance,


chief


complaint,


examination


of occlusion,


radiographic


examination


Diagnosis


Mandibular


prognathism


Related


Biological


Applied


-- Orthodontic


treatment


forces,


skeletal


malocclusion,


impaired


mastication


Basic


Growth


centers,


growth


direction,


endochondral


bone,


intramembranous


bone,


sutures,


age,


genetic


determinants,


nutrition,


mineralization,


osteoblast


activity


Your


thoughtful


responses


to this


test


will


provide


measure


your


ability


to apply


biological


principles


your


performance


clinical


thinking


judgment.


following


quest ions


apply


only


to the


patient


care


problem


case


that


have


just


completed.


Please


answer


each


Anl t 4 ntfl -r r 1f


Qnor, f; rr1 1 t


nhfl nnt


Concens:


nlrp e!5 i nn


le vnrr


Sr ir


-










basic


science


relate to


your


disciplines


case,


(listed again below)


the better your score.


that


If necessary,


use


the back


of the answer


sheet


to complete


your answer.


Anatomy

Biochemistry

Histology

Pathology


Embryology

Microbiology

Physiology

Pharmacology


Neurosciences









Examinee


Number


Date


Test
Start
Stop


Number


time
time


State


identify


cues


one


most


(signs


important


nd symptoms
clinical pr


that


oblem


;a you
this


case


What


cues


(signs


are


biologi


symptoms


that


1 concept
relate to


ass


this


ociated
problem


with


patient?


may


in this


case.


to identify


these


have


identified


what


cues


additional


signs


and


clinical
symptoms)


problems


problems


List


cues


(signs


problems


biological


and
the


symptoms)
patient.


tha


concepts
t relate


associate
to these


with


additional









Examinee
Date


Number


Test


Number


II. A. In reviewing the data (history, examination,
laboratory findings, models, radiographs) you formed a pri-
mary diagnosis with possible secondary diagnoses. Write down
your primary and secondary diagnoses.


B. For eac
you believe cha
than those alre
formal diagnosis
yet considered.


h diagnosis
racterize o
ady listed
s, you will
)


it
r
in
b


list the biological concepts that
distinguish the diagnosis, other
section I.B. (By making a
e likely to recall concepts not


C.
patient i
treatment
xplainin
treatment


Upon hearing your explanation of the diagnoses,
indicates lack of interest in continuing with any
. What biological concepts might be used in
g to the patient the consequences of no further
?









Examinee


Number


Test


Number


Date


III.
for
your


Your


final


therapy and
therapeutic


goal


management


management


in the c
t of the


;ase


was


patient.


formulate


Briefly


a plan


summarize


plan.


B.
fracture,
altering


event


During
drug
the tr


in your


therapy,
reaction,


eatment


case,


event
soft


plan.


S


occur


tissue
Identify


indicate


(e.g.


changes)


one


enamel


that


such


biological


require


potential
concepts


related


to this


event


C.
symptoms)


short-term
biological
monitored?


After
would


completion


wish


long-term


concepts


are


treatment,


to monitor


outcomes
associated


what


in order


of treatment?


with


cues


(signs


to evaluate


What
to be


items
















DECISION


RULES


(Adapted


from


APPENDIX
COUNTING
Mackenzi


BIOLOGICAL


CONCEPTS


1986


What


a biological


biological


structure


science


and/or


action


concept?


in this
of the


an idea


case
human


that


usually pe
organism.


basic


retaining


concepts
concept
compound
derived


can


single


modified


concept


from


modifier


this
words


or compound
additional


A single


single
that


concept


concept


form


When


words
t and


are


a new


the meaning of
is considered


a corn


counted


compound


pound concept
independently


concept


are


counted
formed


independently,
idea.


are


cons


idered


part


newly


Ideas


counted


as one


biological


concept


single


compound:


Single


Nouns


inflammation,


heart,
growth,


tooth,
trauma,


diabetes,


infection,


TMJ,


pain.


Compound


concepts


which


are


counted


as only


one


concept


be composed


various


elements:


Adjective (s)


gingival


condition,
different


noun


tiss


harmful


infected


(e.g.


concept


than


lesion,


sue,


exposed p
necrotic


ulp


exposed


debilitating
is counted


pulp,


as a


pulp).


Noun


phrases


are


considered


a compound


concept,


examples
mobility


handle
bone;


prevention


of teeth;


stress;
gingival


sens


ability


heart


itivity


problems;


of ti


to produce


issue;


dentin;


decrea


capacity t
resorption


retraction.


Exception:
biological
separately,


bone


(2);
Note


noun phrases
concepts will
for examples


white


that


cell


inva


gingival


tying
count


together
all those


osteoclastic


sion


sue


of gin


is counted


several


distinct


concepts


activity
gival ti


issue


as one


concept,


whereas


issue


the gingiva


would


be counted










rb--to
xiliar
nnecti
re in
tient
tient)


y
n
a
h


be--(con
verb, a
g noun a
degener
as been


ugat
in
d ad
ted
ermi


ny te
sive
or p
e.g.
11 (e


but not
of anot
iple: t
erated t
terminal


er verb)
issues
issues)
ly ill


Biological
are formed


prepos
prepos
non-bi
adds a
then t
blood
materi
palsy
prepos
the bi
instan
tongue
tongue
Except
come t


When
we pe
nomin
purpo
patie
pain
gingi
rela p
relat


concepts


by t
S.
con
cal
inct
mpou
y to
the
e ri
s co
cal
nest


white


ions:
o stand


we have
reform a
alized c
ses. E.
not's sur
relief;
val tiss


w
A
n
n
i
n


o or
com
ects
oun
vea
d co


lesion

commonly
for one


verb
ansf
cept
, pa
val
ngiv
; th


ent's condi
pronoun, "
entence-phr


pronouns


can


more
pound
one
which
ttrib
ncept
area;
1; kn
ide;
inde


cons


noun
cone
biolo
help
ute t
is c
detr
owled
etc.
pende
re co
epin


on the

used
idea;


that


idered
conne


nt


unte
ephr


palate,


compo


when


they


y
en a
to another
meaning or
ical concept;
E.g.,
alth;
-


natomy; Bell's
r, when
ogical concepts,
independently. For
, growth on the


music


biological
e.a. musci


signifies


led
nte
ed
s;
ced
tha


tran


are


permits


of the


concepts
es of ma


a biol
nomina
for c
he cri
o reli
d ==
patie


e that this
hen allowed
format ions
sible).


e
b


that


have


stication


cal concept,
action. The
sification
= =^^^^^^^


in ==
ion of
sented
has a
meaning


involving


When biological concepts are connected by
(i.e., and, or), they should be counted as
E.g., physical and mental health === physi
mental health.


a conjunction
separate.
cal health an


Rules


counting


biological


concepts.


1. Count t
the same te
However, co


same


concept


only


once,


s or
he s


if r
ingle
e con


repeated


noun
ept


within


s).
as if









If concept's


.,. d
n in
pro
ever
diff
., C


t is
cha
tal
amma
ss w
wo c
ent
IOUS


meaning
unitedd in
d in a d


mpound
meaning,
lesion,


is changed
dependent 1
different w
rampant ca
s, or the
ted as dif
cepts have
unt them a
rious expo


compound


each
wit
es;
solu
rent


ti
hin
the
tio
CO
ame


separate
ure).


me t
the
beg
n of
ncep
roo
e co


then


ts).
t word
ncepts


3.
con
con
per
The
mai
[he
con


When
cepts
cept,
iodont
same
n biol
art va
cepts


irritant
concept.


the
that
coun
al d
rule
ogic
lyve
that


response is
are example
t each examp
disease such
applies whe
al concept i
damage]). H
are not bio


factor


such


as cold


nished
f the
separa
gingiv
dditio
iven (
ver, e
ical a


with
main
tely
itis,
nal i
e.g.,
xampl
re no


Cold


logical
logical
g. .
riodontitis).
rmation to th
eumatic fever
of biological
included, e.g.
a biological



































APPENDIX C
VALIDATION INSTRUMENTS










Functional


Student


Name


Knowledge


Patient


Test

s Name


Date


Approximate


Date


Service


Rendered


Test


of Applied


Knowledge


As directed


clinical
difference


situation


in the


instructions,


in which


providing


biological


a better


service.


think


a spe


knowledge


cific


made


Be specific


What


were


(including


service


circumstances


being


leading


to the


incident


rendered)


What


need


did
use


you notice
biological


(see,


hear,


feel)


that


indicated


information


. What


did


information,
rendered?


that


or say based
contributed t


on the


o the


biological


quality


of the


service


. What


that


was


made


biological


a difference


information


what


(fact


or principle)


or said?


.How


this


information


help


provide


I .-. -t.. aA .~ --- -- a .1 ~ a


better


a-.3I a


service
nS~h 44. 4 traj


i. .












WORD


ASSOCIATION


TEST


This


a test


see how many words


can think


of and


write


down


a short


time.


You will


a task
words


be given


in clinical


which


a key word
dentistry


key word brings


which


represents


a concept


are to write


to mind as


down


"biology"


as many


other


can.


Write
will


as many words


probably not


as you


be able


can which


to fill


key word brings


in all of


spaces


to mind.


on a page,


do the best


can.


sure


to think


the key word


after


eac


word


write


down,


because


the test


is to


see how many


other


words the key


word makes


think


For example,


suppose


relating to electricity


asked an
(his sp


electrician


ecialty)


to write down


as he could


think


as many words


of when


given


the word


"Conductor.


He might


down


following


Conductor


Conductor
Conductor
Conductor


metal
charge


transmit


Conductor
Conductor
Conductor


resistor


will


notice


that


as an electrician,


he did not


"tan"


"cable
concept


car"


or "guide,


of "conductor.


" since


they


In this


same


not relate


way,


to the electrical


should


think


like


dentist based on


what


you have


learned


in dental


school


when


respond


to the


concepts.


You will
and give


have


one minute


the next


on each


page.


will


tell


when


time


sheet


This


test,


in conjunction


with


different


tests


given


to other


students,


is important


for evaluating the


impact


curriculum on


clinical


thought
to help


processes.
us improve


The evaluation


instruction.


This


part
test


our


reply


continuing


aces


a test,


self study


and is


in addition


to the


other


tests


would


ordinarily take.


pass


this


test


need


only make


a valid


attempt


to help


improve.


The examination


proctor will


administer


the test


you.
















APPENDIX


NORMALIZING


PROCEDURES


BIOTRANS


TEST


SCORES


A weight


each


type


learning


score


was


derived


expressing


number


of concepts


risk


in each


learning


category


as a proportion


total


number


of concepts


risk,


then


calculating


inverse


that


proportion


obtain


weight.


product


weight


each


corresponding


example,


raw


if the


score


number


produced


of meaningfully


normalized


score.


overlearned


concepts


at risk


were


total


number


of concept


risk


were


401,


then


proportion


equals


84/401


and


inverse


multiplied


each


.76,


derived


meaningfully


weight.


overlearned


raw


weight


was


score


obtain


a normalized


meaningfully


overlearned


score.


following


weights


were


utilized


this


study.


Odd


group


Meaningfully


Simply


overlearned


overlearned


5.00


Experientially


learned


Even


group


- Meaningfully


Simply


overlearned


overlearned


3.45
5.26


Experientially


learned