Recent national health initiatives emphasized the need for community-based strategies to address oral health disparities. Consequentially, the national attention has caused a significant interest in the nation’s oral health. Oral health conversations at the national, regional, and local sectors have increased and have led to extensive research, comprehensive publications, numerous conferences, and targeted programs focused on treatment and health promotion. The entire dental community has become involved in advancing the public’s interest. The increasing national momentum has served to advance “dental” concerns to authentic public health issues and has presented an opportunity for dental hygiene education programs to contribute to the improvement of the oral health of the nation starting right in our neighborhoods.1-7
The oral health recommendations found in Healthy People 2020 (see Chapter 4) and Oral Health in America: A Report of the Surgeon General (OHARSG) are a road map for change to the current method of teaching community dental health by dental hygiene education programs. If integrated into the dental hygiene curriculum, the recommendations will positively influence community dental hygiene instruction for students and community outreach dental hygienists. Preparing students for the public health workforce is arguably one of the most important outcomes for today’s dental hygiene programs. Use of dental hygienists in community health programming requires that students acquire the knowledge and skills of the public health worker as this will contribute to advancing students’ career options. These public health initiatives have made it clear that the dental community must respond to broader community issues, and the community dental health curriculum must be positioned to prepare students to work in this changing public health environment.2,3,6–8,9
This chapter focuses on a learning technique through which the existing community-based dental hygiene curriculum can be enhanced to better meet the oral public health needs of the community. In addition, it provides guidance and suggestions designed to prepare dental hygiene students to address oral health disparities in their communities. It challenges students to use their dental hygiene education as the foundation for future public health career opportunities. Integrating the objectives of the nation’s health agenda, as outlined in national public health initiatives, into the dental hygiene curriculum positions the dental hygiene profession into the public health arena more decisively and affects the public’s oral health positively.
Historically, dental hygiene students have provided community dental health outreach for diverse populations. Educational methods used to prepare dental hygiene students to instruct these populations include health education lectures with a focus on lesson plan development and implementation. The benefits of these methods are excellent in preparing dental hygiene students to deliver effective oral health messages but fall short of preparing students to anticipate or meet the needs of the public’s oral health challenges.10-13 Further assessment reveals that the primary benefit of traditional outreach instruction and methodology is the acquisition of technical skills in a short time frame.14–17 Though these methods provide practical experience in organizing a presentation, and they assist dental hygiene students in perfecting their presentation techniques, they are prone to be one-shot, short-term projects, rendering the aim to favorably affect oral health behavior as insufficient.
Long-term strategies are needed to improve the oral health behavior of populations for lifelong benefits. Behavioral change is an integral component of effective oral health promotion strategies (see Chapter 8). Students often complain that their patients do not follow their oral health instructions. Practicing dental hygienists are all too familiar with this sentiment. However, once the experienced hygienist realizes that oral health “instructions,” delivered in one appointment, do not translate into better oral health behaviors, they eventually start treating their patients as individuals.
They design oral health education messages that are spread out over time, and they ensure that the messages are individually tailored to the language, reading level, and cultural perspective. They stop assuming that everyone values oral health as much as they do; instead, they ask the patients what is important to them. Experienced hygienists begin to incorporate the assistance of the patients’ significant others for support, and they integrate cultural specific information so that the patients can perceive benefits for themselves (see Chapter 10). In effect, they use theories of health education to motivate, educate, and empower their patients. To positively affect health behavior, dental hygiene students must acquire knowledge of health education theories and the basic principles of health promotion and they must design and implement ongoing projects using them.8,15,16
Dental hygiene students can contribute to the national oral health agenda. Imagine the oral health benefits if the dental hygiene programs in the United States adopted a standard approach of instructing students in community dental health outreach efforts. What would be the impact if all the programs used Healthy People 2020 Objectives in developing durable community dental health projects? Likewise, envision the possibilities of comparing oral health outcomes across the country.
Adopting a standard teaching method for implementing community dental health outreach would prepare the dental and dental hygiene programs to answer such questions as asked by Indiana University School of Dentistry professor, Dr. Karen Yoder: “Do dental graduates internalize an appropriate vision of their role as a health professional in the context of community?”17 Programs would be able to consistently evaluate and measure the impact of their collective public health efforts. The oral health promotional efforts and results of dental hygiene students could then move beyond the anecdotal; their efforts could have a lasting impact on the nation’s oral health.
Short-term community outreach provides little opportunity for community members to become empowered with the skills and knowledge they need to sustain the intended goals of the program. Likewise, short-term community dental health outreach provides inadequate opportunity for dental hygiene students to become proficient in applying theoretic concepts and for investigating public health career options in depth. Finally, short-term community dental health outreach efforts inhibit the development of a collective national oral health agenda for the dental hygiene programs in the country.3,4,8,18–19
Experiential learning, commonly referred to as “practical learning” or “real-world learning,” originated from the grassroots research of such theorists as John Dewey, Kurt Lewin, Jean Piaget, and Carl Rogers. Experiential learning is an umbrella term that references various models of learning in which experience governs the learning process.
A specific example of experiential learning is first-year dental hygiene students who enrolled in a didactic dental radiology course are learning how to interpret radiographic findings. Thus far, the instructor and the dental hygiene students are not pleased with the retention and comprehension of the content. The dental radiology course instructor and a secondary education teacher decide to collaborate for mutual benefit by providing an environment in which experience is dominant in the learning process. The dental hygiene students can connect their didactic learning with the real need of the high school teacher’s objectives for his or her students through experiential learning. The dental hygiene students have to design age-appropriate activities and present on radiographic findings to the group of high school students. The traditional methods of lectures, textbook reading, and even radiographic interpretation exercises are enhanced because of the practical application of those methods. Active learning becomes experienced learning just as experience learning becomes active learning.
Experiential learning changes the focus of learning, shifting it from the confines of the classroom to the community. Classroom learning is supplemented with purposeful work-based learning opportunities within the community, and to ensure that the course objectives are being met, the students apply their program planning skills with guidance from their faculty and from the community partner. Experiential outreach efforts should place emphasis on tasks that contribute to the students’ knowledge base (Figure 11-1).
In the cognitive approach, theorists see learning as primarily a mental process in which the learner is able to recall acquired facts and figures. Unlike cognitive learning, experiential learning incorporates personal experiences (a known concept) with the application of new skills. For example, here is a case in which personal experience is incorporated in the learning. A service-learning team of dental hygiene students meets to plan oral health activities for a youth group. Only one of the dental hygiene students has previous experience working with this population and quickly mobilizes the dental hygiene team into action. Experiential learning benefits students through growth opportunities resulting from civic participation.
Cognitive knowledge is very important in experiential learning, but it should be used in conjunction with experiential methods for increased proficiency in interpreting situations and acting appropriately. If, for example, a dental hygiene student finds that the caregivers in a long-term facility are reluctant to provide frequent oral health care to the patients, the student’s efforts may be better spent by having the group of caregivers brainstorm for a decision regarding what is reasonable in their circumstances. In this example, although the student is fully aware of what the literature says regarding the removal of prostheses during the night, they are also able to interpret the fact that the habits of the staff are not going to be changed quickly but gradually.
Experiential learning takes place in authentic situations. A Women, Infant, and Children’s (WIC) facility is a good example of a service-learning setting in which a broader understanding of oral health is necessary to effect change for a lifetime. In the community health course, students are learning about the social determinants of oral health. They are shown an image of a woman standing in line at a local WIC facility. They are asked to document their thoughts about this woman, and this is followed by small group discussions that explore the social determinants of oral health. Without actually interacting with the woman, how can they really know what her visits to the WIC facility signify? Perhaps she is seeking nutritional provisions for her child, but is that all? In assisting this woman, the students will have to use their learned skills to “see” beyond the obvious. The dental hygiene students need to apply cognitive skills, such as the recall of facts regarding the mission of the public health facility, but they will also need to construe other oral health needs that the mother and her family may have; the reality is bigger than the image. In this case, the dental hygiene students will learn more because they construct the strategies that they will use to assist this family. They are brainstorming, sharing, and reminding each other to be thoughtful and use evidence-based discussions rather than anecdotal opinionated fragments of thought. In essence, they are learning through experience. Experiential learning links genuine learning opportunities to the classroom and the textbook material.20-22
The spectrum of experiential learning methods in health professions education is broad, and the decision regarding which method to use should be determined by the intended goal. As such, care must be taken in choosing methods that are reflective of the goal. It is not unusual for multiple experiential methods to be used in health professions education. Box 11-1 is a list of common experiential methods and their unique purposes.
Service-Learning (SL) is one of the many techniques of experiential learning. Definitions of SL may vary, but they all imply equality between the service as received by the community partner and the learning for the dental hygiene students. Essentially, SL is a jointly structured learning experience between the community partner and the academic course of instruction. The definition of SL by the Community Campus Partnership for Health (CCPH), a nationally recognized organization whose mission includes the improvement of the health of the public, has remained relevant and consistent in its description. CCPH executive director, Sarena Seifer, MD, has defined SL in the following manner23:
Service-Learning is a structured learning experience that combines community service with preparation and reflection. Students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens.
This definition promotes collaboration between communities and health professions educational institutions, and the planning and implementation of SL clearly illustrates the collaboration. The community partner’s objectives are called service objectives (SO)—a service is desired. The academic course objectives are called learning objectives (LO)—academic course desired learning. Through intentional thoughtfulness, the SO and the LO are combined, forming service-learning objectives (SLO). Box 11-2 summarizes each of the three objectives.
The equal weighing of the SO and the LO is a classic feature of SL. Note that even the configuration of the words “service-learning” illustrates that both the service and the learning are equivalent. The “S” in service and the “L” in learning are always written in identical fashion, either capitalized or in lower-case letters.19,23,24 Also note that, in this chapter, a hyphen is used to emphasize that the service and the learning are “connected.” The service is a community task, and the learning is the academic goal.19,24,25
The end-product of SL is not a one-way directional process. In other words, both the community and the academic institution’s students are learning from the experience. What about the service aspect of SL; do both parties contribute to the service side of SL? If service is thought of as something received, both sides are beneficiaries. The community partner is a recipient of the skills, knowledge, and expertise of the dental hygiene program, and the dental hygiene student is the recipient of the outcomes of the exposure afforded by way of the community partner.25
SL is not a substitute for traditional classroom instruction nor does it assist in the learning pursuit. For example, when students are learning about the socioeconomic status of the population, the textbook may be used to convey background information about the subject. In addition to specific textbook readings, students may also read a journal article and additional details may be gathered from the Internet, other media, and classroom lectures. Each of these assignments may add to the knowledge base; however, all require little active involvement, hence retention and comprehension are compromised.26 An active learning approach requires multiple levels of consideration and can contribute to a deeper understanding of the subject. With SL, students are expected to integrate the SO of the community partner and incorporate previous and concurrent learning into the assignment. In this way, students are assisting in the construction of their own learning and fulfilling the course objectives while fulfilling the desires of a community partner.
The following is an example of how the SO and the LO may be combined. A community organization, which educates children with social learning disabilities such as Asperger syndrome and attention deficit disorder, wants the children to recognize the social context of the smell of breath and its relationship to oral hygiene behaviors. The organization’s SO is for the dental hygiene students to teach the children how and why they should keep their mouths clean. The two most fitting academic course LOs for the dental hygiene students are (1) to discuss the current literature regarding the oral microbial flora and its relationship to halitosis and (2) to deliver educational content in an appropriate approach. Combining the community partner’s objectives and the academic course objects may result in a SL objective such as “the dental hygiene students will use imagery of a pollution overcast caused by the varied automotive fumes as an analogy to relate halitosis as the result of the crowded collection of bacteria on the tongue.”
In this case, as in all SL experiences, the dental hygiene students will have provided a community service in response to community-identified needs. In the process, the dental hygiene students are provided an opportunity to learn about oral bacteria in a different wa/>