Does Use of an Electronic Health Record with Dental Diagnostic System Terminology Promote Dental Students’ Critical Thinking?

Abstract

The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to reine study protocols. The study design was a natural experiment with crosssectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was signiicantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary indings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.Dr. Reed is Associate Professor,

The use of Electronic Health Records to Support Population Health: A Systematic Review of the Literature

“… No standards - None identified - Data collection Data management - Interoperability No standards - Improved efficiency Productivity/ efficiency - Inconsistent documentation Missing data / data error - Data quality Decreased quality Chang, et al [ 55 ] - None identified None identified - Missing data Missing data / data error - External validity limited: While the computed algorithm satisfactorily predicted one behavior, it is uncertain if such models can be developed for all. Reed, et al [ 56 ] - Increased/positive impact on critical thinking skills Decision support - None identified None identified - Response bias decreased the number of participants. Inokuchi, et al [ 57 ] - Productivity (reduced time) Productivity/ efficiency - No patient outcomes - Need larger sample size - Increased physician satisfaction Satisfaction Decreased quality - The Hawthorne effect may have increased bias toward the new EMR.…”

“…Articles that mentioned both facilitators are marked in the tables with an asterisk. Facilitators identified are productivity/efficiency [19,21,22,24,25,27,28,30*,32,33–36*,38,43,45–47*,51,53-56,59*,60,63,64,70,72,73] ,quality [19*,20,22,24-27,33,34,45,46,49,53,54,56,62,69,72] ,data management [ 7 , 18 – 21 , 26 , 30 , 33 , 37 – 39 , 41 , 48 , 54 , 64 – 66 , 68 , 71 ] , surveillance [19,20,23,25,26,28,31,41,54,55,62,63,66,67,69*,70] , preventative care [19*,23,26,28,30,36,37,39,52,62,63,65,68,69] , communication [ 30 , 36 , 47 , 50 , 58 , 62 , 64 , 70 ] , interoperability [ 7 , 19 , 23 , 31 , 41 , 43 , 47 , 49 ] , decision support [ 7 , 19 , 34 , 56 – 58 , 61 ] , health outcomes [ 25 , 26 , 44 , 53 , 58 , 61 ] , satisfaction [ 32 , 33 , 43 , 57 , 70 ] , financial assistance [ 23 , 47 , 48 , 58 , 66 ] , ease of use [ 20 , 51 , 63 ] , and current technology [ 30 , 47 ] , B...…”

Association Between Critical Thinking and Academic Performance in Dental Hygiene Students

“…Whitney et al found that dental hygiene faculty members had difficulty defining critical thinking and implementing teaching strategies that supported the development of critical thinking skills 6 . In Reed et al's study, having dental terminology embedded into the electronic health record resulted in increased critical thinking scores 23 . Allaire found that, although the use of virtual patient simulations did not result in improved critical thinking scores, students reported the experiences enhanced their critical thinking skills 24 .…”

Critical Thinking in Dental Students and Experienced Practitioners Assessed by the Health Sciences Reasoning Test

“…If the HSRT is a valid instrument to assess critical thinking skills, what are the appropriate uses for such an instrument in health professions education? Most obviously, the HSRT could be used as an outcome measure for educational practices aimed at increasing critical thinking skills, as was done in the Pardamean and Reed et al studies 9 , 10 . Pardamean examined the problem‐based learning dental school curriculum at the University of Southern California, by administering the HSRT to a cross section of 98 students from the first‐, second‐, and third‐year classes and found mean overall HSRT scores of 22.31 (SD 4.503), 23.47 (SD 3.979), and 20.86 (SD 5.254), respectively 9 .…”

“…Differences in overall mean scores among the three class years were not statistically significant based on a one‐way AVONA and ANCOVA considering the covariates of age, gender, race, and English as a first language. Reed et al's multi‐site pilot study with 361 dental students at three dental schools used the HSRT to measure critical thinking skills in students exposed to an electronic health record (EHR) with a diagnostic terminology meant to facilitate research and diagnostic acumen among users 10 . Students who experienced the experimental EHR had higher overall scores on the HSRT than students using the traditional EHR when significant covariates were considered.…”