Rita Ann Classe, RDH, BS EDHP 500: Teaching and Learning Theory August 12, 2013 Topic: Paralleling technique for taking maxillary and mandibular anterior periapical radiographs Audience: 1st year Dental Hygiene Students Learning Objectives: Upon completion of this lesson the student will be able to: 1. Demonstrate the correct film and tubehead placement for maxillary and mandibular anterior periapical radiographs using the paralleling technique on Dexter 2. Develop radiographs using the processor 3. Mount maxillary and mandibular periapicals in the correct placement on a FMX mount 4. Critique exposures of mounted anterior radiographs Learning Theory The social learning theory fits best for delivering instruction to first year dental hygiene students on the paralleling technique to take anterior periapical radiographs and properly mount them. Social learning theory involves learning through observation, usually followed by imitation and modeling of a specific behavior (Rutherford-Hemming, 2012). Bandura initially described observational learning as including the processes of attention, retention, motor reproduction, and motivation (Rutherford-Hemming, 2012). He later relabeled this the social cognitive theory to include the significance of thought process on motivation and action (Rutherford-Hemming, 2012) A lecture accompanied by the included handout will accompany will provide the details of film and tubehead placement, key interproximal spaces, and a description of acceptable radiographic appearance. After this material has been taught in the lecture, the instructor will model the task of taking radiographs from start to finish using Dexter, the dental mannequin with a full set of real teeth. The instructor will demonstrate each anterior maxillary and mandibular film and tubehead position and model the tasks of developing the film using a processor, mounting the radiographs in the proper position on an FMX mount, and critiquing them. Demonstration of the radiographic procedures allows novice dental hygiene students to observe necessary techniques and procedure. Initial practice of radiographic exposures on Dexter is recommended to prevent inexperienced clinicians, such as first year dental hygiene students, from causing patient discomfort and damage to oral soft tissues, while still providing these students with a life-like clinical atmosphere (Jenson, 1978). Studies have also shown that simulator supported training is an important tool for students interpreting spatial relationships in radiographs (Nilsson, Hedman, & Ahlqvist, 2011). Assessment of Outcomes Since the social learning theory involves motor reproduction and motivation, student learning will be assessed by both the instructor and student. Using a checklist, the instructor will observe the student’s motor reproduction of taking the radiographs. The checklist will include observation on proper film placement, tubehead alignment, and focus on the key interproximal space. The students will model the observed tasks of taking, developing, mounting and critiquing the 6 anterior radiographs. The assessment of modeled behavior is influenced by Bandura’s initial concept of social learning theory. The aim of this assessment is to ensure the student can perform the task after observational learning. The self-critique mode of assessments utilizes Bandura’s further encompassing social cognitive theory. Self-critique of radiographic appearances will allow students to identify discrepancies and explain their technique error that caused distortion of the image, if any. The student will submit their critiqued mount to be re-assessed by the instructor, who will provide feedback on their critique of radiographic appearance. The aim of the self-assessment is to promote motivation from within the student to enhance their learning. Self-assessment is considered an essential part of clinical competence and is an important tool to prepare dental hygienists for autonomous clinical practice and lifelong learning (Mould, Bray, Gadbury_Amyot, 2011). The self-assessment method used in this radiology lesson will mimic other self-assessments that dental hygiene students will be responsible for throughout their education to guarantee that they graduate with sound critical-thinking and problem-solving skills necessary for clinical practice (Mould et al., 2011). Evidence Based Medicine- Reference List Jenson, T.W. (1978). Beam-guiding instruments for simplified dental radiography, with a training device. Oral Surgery, Oral Medicine, Oral Pathology, 46(1): 146-155. Dental Radiography: Principles and Techniques. n.d. Lesson 4, radiographic exposures technique. Retrieved from http://www.dentalradiographyprinciplesandtechniques.com/ Mould, M.R., Bray, K.K., Gadbury-Amyot, C.C. (2011). Student self-assessment in dental hygiene education: a cornerstone of critical thinking and problem-solving. Journal of Dental Education, 75(8):1061-1072. Nilsson, T.A., Hedman, L.R., Ahlqvist, J.B.. (2011). Dental student skill retention eight months after simulator-supported training in oral radiology. Journal of Dental Education, 75(5): 679-684. Rutherford-Hemming, T. (2012). Simulation methodology in nursing education and adult learning theory. Adult Learning,23(3): 129-137. The Paralleling Technique for Taking Anterior Periapical Radiographs Maxillary Central Incisors Film placement: film centered directly between the two maxillary central incisors Tubehead alignment: beam perpendicular to the long axis of the tooth and film (vertical angulation) Interproximal space: central ray directed between the central incisors (horizontal angulation) Radiographic appearance: Central incisors will be centered with lateral incisors on either side Maxillary Right and Left Cuspids Film placement: film centered directly behind the cuspid Tubehead alignment: beam perpendicular to long axis of the tooth and film (vertical angulation) Interproximal space: central ray directed at the center of the cuspid (horizontal angulation) Radiographic appearance: cuspid centered on the film with lateral and 1st premaolar on either side Mandibular Central Incisors Film placement: film centered directly between the two central incisors Tubehead alignment: beam perpendicular to long axis of the tooth and film (vertical angulation) Interproximal space: central ray directed between the two central incisors (horizontal angulation) Radiographic appearance: central incisors centered on the film with lateral incisors on either side Mandibular Right and Left Cuspids Film placement: film centered directly behind the cuspid Tubehead alignment: beam perpendicular to long axis of the tooth and film (vertical angulation) Interproximal space: central ray directed perpendicular to the cuspid with mesial and distal contacts open (horizontal angulation) Radiographic appearance: cuspid centered with lateral incisor and 1stpremolar on either side Images from: http://www.dentalradiographyprinciplesandtechniques.com/ Handout Connections The handout “The Paralleling Technique for Taking Anterior Periapical Radiographs” describes the essential principles of taking an anterior periapical radiograph using the paralleling technique including film placement, tubehead alignment, interproximal space, and radiographic appearance. A photo is provided for each region illustrating anatomical placement of the film, equipment placement (tubehead alignment) in regards to the patient, and a radiographic example of the region. The photo allows students to make sure they are producing a diagnostic radiograph by placing the film and tubehead in the proper position. The handout provides novice dental hygienists with a step-by-step explanation of how to place the film and tubehead when taking radiographs on a patient. It also highlights the key interproximal space to focus on and describes the appearance of an acceptable, diagnostic radiograph. As previously stated, social learning theory includes student learning through observation of a task or behavior modeled by an instructor. The principles found on the handout act as a “script” for the instructor modeling the task of taking an anterior periapical. The handout serves as a written model in the absence of instructor modeling. Students will be able to use this handout as a reference during the assessment portion of the class activity of critiquing the radiographs they took on Dexter.