Unleashing the Power of Reflective Treatment Planning

By Laura Ramsey

Self-reflection can be one of the most meaningful components of continuous improvement as a dentist, and it starts in school.

The American Dental Association (ADA) states in the accreditation standards for predoctoral dental education programs that becoming a competent professional involves “reflection in daily practice for the benefit of the individuals and communities served.”

Students in their final year at the University of Colorado School of Dental Medicine (CU SDM) are learning its importance through a newly reimagined course called Treatment Planning and Case Presentation (TPCP). Cofacilitators Kunjan Kakar, DDS, MS, BDS, assistant professor and assistant director of the Advanced Standing International Student Program, and Amisha Singh, DDS, assistant professor and director of diversity programming, encourage interactive sessions where students present their cases for group discussion and collective learning.

Dr. Kakar said, “Self-reflection helps students improve not only their clinical skills, but it also helps them become better providers. They become more conscientious, they think more critically through the problems they encounter, and then they can use that information to improve their overall practice.”

THE ROLE OF REFLECTION IN DENTAL EDUCATION

In each TPCP class, one student presents a recent or current case using a formal presentation template to include de-identified information like dental, medical and social history, chief complaint, periodontal chart, oral pathology, relevant findings, consults (if applicable), and a timeline of dental treatment. The class engages in dynamic discussions, asking questions and providing critiques about the treatment plan. Faculty members contribute questions, enriching the discussion with diverse perspectives.

The final slide of every presentation poses two questions:

1. What did I learn?

2. What would I do differently?

“It’s more of an education in self-reflection and critical thinking than anything else,” Dr. Kakar explained. “It’s about taking everything you have learned in school and then integrating it into this class. And when students share what they learned, now the rest of their classmates benefit from that reflection too.” This teaching approach offers a holistic learning experience, departing from the typical lecture-based model to open students' minds and embrace critical thinking. It also helps students understand the importance of continuous improvement and collaborative learning in a professional environment. Dr. Singh said she learns something new in every TPCP class. “We designed this course so we can engage our students and make sure they are truly benefiting from it. We want students to walk out every single day and say, ‘This was valuable. I learned something that I can use this afternoon in clinic, or next week on my ACTS rotation, or in six months after I graduate.’ And I think we’ve really done that.”

FROM THE CLASSROOM TO THE CLINIC

When CU SDM alum Cody DelReal, DDS, presented his case to the TPCP class, he emphasized the need for continuous analysis and flexibility in planning. “I had worked with this patient since my second year of dental school. They had a disease that attacked the salivary and lacrimal glands, which caused constant dry mouth and made them highly susceptible to caries. We had to go through extensive treatment planning, and we had to re-think our treatment plan as we saw lots of new cavities at every appointment.”

“This patient made me think outside the box,” he said. One of the most important things he learned from this case was how to set realistic expectations with the patient, even if the expectation is that the plan may change.

Now a full-time general dentist in Loveland, Colorado, Dr. DelReal said he is constantly re-evaluating his treatment plans based on any number of factors. “It’s important to consider things like how well a patient can keep up their oral hygiene and to remember that there are sometimes systemic issues that can limit the treatment plan you originally presented.”

He credits the TPCP course for instilling the importance of daily reflection into his practice.

RESEARCHING THE IMPACT OF REFLECTION

To better understand how reflection in the TPCP course prepares students to be well-rounded providers, Dr. Kakar and Dr. Singh teamed up with CU SDM Faculty Development Program Director Jennipher Murphy, MS Ed, to pilot a research study.

The study aims to identify and analyze themes in students’ responses to the selfreflection questions, “What did I learn?” and, “What would I do differently?” Over three years, 120 responses were collected. Now the research trio is conducting a thematic analysis, looking at the key takeaways from each response and categorizing them based on a series of topics that were developed prior to examining the data, including:

• the importance of medical history,

• the importance of patient communication,

• better clinical diagnosis and treatment planning,

• better integration with specialists,

• active listening to the patient’s chief complaint, and more.

“We want to see if we need to make any changes to the way we teach students in their first three years,” said Dr. Kakar. “If 90 percent of them come back and say communication was something they could have worked on, then is there something in our curriculum that we could adjust to improve communication skills and techniques? What if a considerable number of students say they could have done data gathering better? Then maybe we need to change the way we teach that.”

Dr. Kakar also emphasized the rapidly changing way in which students learn and communicate, on top of the ever-evolving landscape of dental technology and patient care. Each new cohort of students will bring new challenges and new opportunities for improvement.

The themes uncovered from this data can reveal endless insights. Dr. Kakar said, “It’s two-fold: We learn how students can improve as providers and we also learn how the school can modify curriculum and/or teaching methods to support that.”

The results of the research study will be presented in poster format at the American Dental Education Association (ADEA) Annual Meeting this year.

HOW TO INCORPORATE REFLECTION IN YOUR PRACTICE

Self-reflection can be an important part of professional development beyond the classroom as well. Dr. Singh shared, “Intentional reflective practice throughout our careers can help increase clinical excellence and fulfillment and engagement in our professional lives.”

Whether you are new to reflection or simply want to brush up on your skills, here are four ways you can begin to use reflection as a tool for continuous improvement in practice.

1. Case review sessions: Set aside dedicated time to review recent or challenging cases. By asking yourself what worked well and what could be improved, you will engage in constructive self-reflection on a regular basis. This method can be used individually or in a group or study club setting.

2. Peer discussions and study clubs: Creating or joining study clubs and engaging in constructive discussions with colleagues allows you to share experiences, seek advice and reflect on alternative approaches to various cases.

3. Patient feedback integration: How do you collect feedback from your patients? Listening to comments and critiques directly from the source not only enhances patient satisfaction but also provides valuable insights for professional growth. Intentional collection of this data and timely reflection may show themes or areas for improvement.

4. Continuing education courses: Actively participating in workshops, conferences and courses enables you to reflect on current practices, learn about advancements in your field and consider how to integrate new knowledge into your approach.

ABOUT THE AUTHOR

Laura Ramsey is the Communications and Content Manager at the University of Colorado School of Dental Medicine. Her professional experience has spanned many industries, but finding her place in the dental community has been especially rewarding as her dad and granddaddy were dentists.