MEDEV

School of Medical Sciences Education Development

Introduction

The Progress File Learning System (PFLS) has been developed by Barts and The London Queen Mary’s School of Medicine and Dentistry and other partners for use by dental undergraduates and their teachers.The PFLS comprises a Progress File / Logbook, Record of Achievement and Personal Development Planer (PDP) and Tutor Resource File and Record book.

We have encouraged the use of Progress Files (PF) as a means to promote reflection and self evaluative learning to underpin life long learning and continuing professional development. The PF was designed to encompass the expectations of the HE sector and Dearing1 and reduce the ‘front loading’ of training and learning. Pee and colleagues2 recognise the need to facilitate reflection, networking and communication and open discourse but at the same time acknowledged that systems such as these take time to become embedded. If the PF is placed at the centre of student learning reflection, communication and open discourse results with the aim of promoting excellence in teaching and learning.

Two hundred and fifty six clinical dental undergraduate students in years 2, 3, 4 and 5 were invited to complete a structured questionnaire as part of the general curriculum evaluation process. The questionnaire was given out at the end of scheduled lectures in the autumn of 2003, twelve months after the implementation of the PF in the Institute of Dentistry. It was developed to investigate the use, usefulness and requirements of the PF, its design and format, the interaction between students with personal tutors, module and thread convenors and patients, their use of action plans and the impact of PF in learning in a clinical setting. A 50% response rate was achieved, where 127 responded from the four clinical years, and this was variable across the years mainly related to non attendance at lectures and failure to hand in questionnaires. Approximately half the responders were female, and aged between 22 and 25 years of age.

The undergraduates found the PF easy to use. The junior students (2nd and 3rd years) found it helped with their organisational skills. Despite this less than 50% used it to help them with identifying their strengths and weaknesses. However, the 3rd and 4th year students whilst finding their feet on the clinic were more positive but final year students felt it did not provide a means to identify areas for concern. Once the PF was established in the clinic, the students were better at recording all interactions with their patients. More than 60% of the students reported factual data, diagnosis and treatment plans for their patients as an ‘aide memoir’. The fourth years demonstrated the most consistent approach to recording data.

Feedback

The perceived impact on the management of the student’s patients is also shown in Table 1. Fourth year undergraduate students were better able to see what they were doing by using the PF, but on the whole the value was unclear. The junior students felt that the PF helped them to try harder whereas only a quarter of the 4th year was sure it helped.Feedback was generally given at the end of a session and most appreciated when given in relation to a clinical procedure especially advice on how to improve as well as being praised on things well done. Typical feedback encompassed having errors pointed out. Negative feedback was thought to influence their interaction with patients and was felt to be detrimental to their progress. It also made them nervous about the next appointment/encounter as did poor grades from the module/speciality tutors. In order for the undergraduate to get the most out of their PF they agreed time was needed to complete it and that it was useful in improving organisational skills. Time constraints have been a long standing complaint from staff and undergraduates alike.

Aid to reflection

Overall the PF has proved to be a useful tool as it provides a means to record interactions and progress whether in the clinic, seminar or clinical skills laboratory. It helps reflection about the treatment provided and achievements. It is believed to help to plan for the next clinical encounter. We believe that the undergraduates are better able to understand what they are doing and can develop coping strategies to fulfil their goals in the short, medium and long term. However, we need to continue to break down barriers to the PF’s use to facilitate innovative practice and promoting self assessment, life long learning and action planning as required for professional dental practice.

Next steps

Having evaluated the PF for two years now and in general have found it to be a successful tool for recording undergraduate practice experience and in promoting reflection we have moved on to develop an electronic Progress File (ePF) in partnership with six other dental schools and one Vocational Dental Practitioner Scheme.

Conclusions

• The PF therefore helps the majority of undergraduates to record and log their progress
• The PF encourages the undergraduate to think about what they are doing in order to manage their patients practice better
• Negative feedback and low grades many be detrimental to good patient undergraduate interaction