Class of 2020 dental hygiene (DH) students faced a disruption of clinical educational experiences due to the COVID-19 pandemic. Fear for the loss of structural education through guided patient care experiences created doubt in both the integrity and value of the remaining weeks for graduating students' education. Programs considered delaying graduation due to decreased learning experiences and an inability to complete remaining competency assessments. Final weeks were considered pivotal in preparation for clinical licensure and transition to independent practitioners. The opportunity emerged to reimagine what constitutes clinical education and develop alternative clinical education to meet Commission on Dental Accreditation (CODA) Standards 1 without direct patient care.
The DH program at the University of North Carolina at Chapel Hill Adams School of Dentistry responded quickly, forming a task force to evaluate need for and completion of a revised clinical education model for the remainder of the semester. The task force created alternative curricular modifications in compliance with CODA Standards 1 for clinical education and evaluation of competency to determine graduation eligibility for the graduating class. Task force actions included critical analysis and evaluation of current literature and available resources, creation of a process for completing meaningful clinical learning experiences without patient contact, and development of alternative competency assessments and evaluations.
The alternative educational delivery and assessment plan provided in-depth cognitive and critical thinking applications of patient care while evaluating competency through interactive online activities and assignments. Activities included synchronous and asynchronous sessions, independent assignments, peer collaboration, and one-one-one instructional engagement (Table 1 and 2). To enhance clinical thinking and evidenced-based decision-making, students engaged with in-depth case study assignments, reflection essays, and peer discussion posts. Alternative assessments included utilization of live Zoom meetings for simulation and observation with clinical instructors, Learning Management System (LMS) quizzes, treatment plan development, and synopses of instructional videos and clinical review articles. Practice management skills to engage learners in practice readiness were supported by use of live Zoom mock interviews between senior DH students and fourth-year dental students. Feedback from the peer interviews revealed DH student emphasis on process of prevention and tailored care for patients. Evaluation of competency with adherence to maintaining quality and integrity of the accreditation standards was essential. This was completed through task-specific rubrics with a framework based on objectives and criteria marking task milestones. The rubrics maintained calibration and provided intentional faculty observation based on focused criteria.
Students gained unique and intensive clinical learning experiences through completion of the alternative educational delivery and assessment plan. This included assessment and evaluation to determine successful attainment of overall program objectives, course and program requirements, and program competencies comparable to direct patient care. Students continued to enhance their skills in developing appropriate judgment, analyzing assessment findings, establishing a tailored treatment plan, and using problemsolving strategies related to comprehensive patient care. Clear communication, explicit expectations, and maintaining flexibility during this time was critical. Students and clinical instructors commented that additional faculty calibration could be incorporated to strengthen clarity of expectations and enhance consistency of feedback. 