Using chair side practice and video recording to improve English communication skills of dental hygiene students

Transcription

1 J Osaka Dent Univ 2017 (October) ; 51 (2) : Using chair side practice and video recording to improve English communication skills of dental hygiene students Junichi Fujita 1,KieranGreen 1, Tomoharu Okamura 2, Takako Tohyama 3, Masako Terashima 3, Mutsuaki Kobayashi 4, Tatsuro Miyake 4 and Akio Tanaka 3 1 Department of English, 2 Department of Oral Pathology, 3 School of Dental Hygiene, and 4 Department of Preventive and Community Dentistry, Osaka Dental University, 8-1 Kuzuhahanazono-cho, Hirakata-shi, Osaka , Japan On completion of the English curriculum of Osaka Dental University School of Dental Hygiene, the students participated in a questionnaire. Results revealed that the second and third year students have very little confidence in conducting basic hygienist procedures in English with foreign patients. Based on the results and feedback from the questionnaire, the authors revised the English curriculum to feature chair side role playing and video recording as opposed to conventional classroom instruction by listening and speaking. After the first year students completed this new curriculum, questionnaire results revealed a marked improvement in their confidence with English communication skills. (J Osaka Dent Univ 2017 ; 51 : ) Key words : Dental Hygienist ; English ; Foreign patient ; Communication INTRODUCTION With the projected increase in foreign visitors to Japan, the number who seek medical attention will also rise. In dental clinics, the role of the hygienist will become important for the foreign patient in making the visit a satisfying experience. In assisting the treatment, the hygienist needs to guide the patient to the chair, check if they are comfortably seated, place the dental bib, and preferably engage in some small talk until the dentist is ready. Along with the main hygiene procedures such as calculus removal, fluoride application, and brushing instructions, the initial patient interview may also be their responsibility. Being able to conduct these procedures smoothly in English is crucial in establishing rapport with the patient. Various books on dental English are available for classroom use. The authors used these resources in the English curriculum at Osaka Dental University School of Dental Hygiene (2014 and 2015) to prepare students to help foreign patients. Despite the good quality of some of these teaching materials, we have felt a gap between what is taught in the classroom and what is actually required in the clinics. A questionnaire conducted with students confirmed this problem. Therefore, it became necessary to create a revised curriculum that more effectively prepares the students for speaking English in clinical situations. Based on feedback from the questionnaire, the authors decided to use practice rooms equipped with dental chairs to enhance the clinical atmosphere of the lessons. Visualized texts (video files) and in class video recording was also included in the new curriculum. The use of videos in English language education has been proven effective. By taking videos of the student s performance, the teachers as well as the students can make evaluations 1 and conduct critical reflection. 2 By viewing the video footage, the students can reflect on their ability, which eventually leads to autonomous learning. 3 METHODS English Curriculum (2014 and 2015) English classes at the hygienist school are taught to first year students. The length of each class is

2 146 J. Fujita et al. Journal of Osaka Dental University, October minutes, with a total of 30 classes in one year. The curriculum focuses on the three basic skills of reading, writing, and speaking. A listening comprehension and conversation workbook themed on dental English was chosen as the textbook. Native English instructors were hired to team teach with the Japanese instructor. Classes were conducted in lecture halls using various speaking drills to improve communication skills. For example, the students were drilled on correct pronunciation and intonation of the dental vocabulary and phrases. Quick response, often used for training interpreters, was also conducted. In this drill, dental terms and phrases were read out in Japanese by a student. In reply, the counterpart student must instantly respond by saying the English translation. Through these exercises, the curriculum aimed at forming a substantial vocabulary of basic dental terminology and providing the student with a stock of key phrases necessary in communicating with foreign patients. In a questionnaire taken at the end of the school year, the students were asked to rate themselves on a scale of 1 (not confident) to 5 (confident) on their ability to conduct the following procedures in English : 1) Guiding and seating the patient, placing the bib and offering a blanket ; 2) Conducting a patient interview ; 3) Explaining scaling procedures and cautions after the procedures ; 4) Explaining fluoride application and cautions after the application ; and 5) Tooth brushing instructions. Participants in this questionnaire were 38 third year students who studied English in the 2014 school year, and 36 second year students from the 2015 school year class. The results are shown in Fig. 1 for the third year students and in Fig. 2 for the second year students. As indicated in the figures, very few of the students had confidence in conducting basic hygiene tasks in English. Guiding the patient was an exception with slightly better results among both second and third year students. When asked how they would respond when a foreign patient visited their clinic, more than 70% said they would try to make up for their lack of Fig. 1 Fig. 2 Results of questionnaire for the third year students. Results of questionnaire for the second year students. communication ability by using pictures, drawings, dental models and references. Some even said that they would use voice to voice smartphone translation applications. The remaining students replied that if time allowed, they would review their textbooks and prepare in advance. These results show that students are far from being prepared for an unexpected visit from a patient who uses English to communicate. Revised English curriculum (2016) Preparation of teaching materials In the questionnaire, more than 70% of the second and third year students wished to practice the dental phrases in an actual clinical setting. They commented that this would better prepare them when called upon to assist in dental hygiene procedures for English speaking patients. The reformed curriculum starting from 2016 places more emphasis on practical use by conducting role play sessions using actual dental chairs. Also, along with paper

3 Vol. 51, No. 2 Chair side practice and video recording to improve English communication skills 147 Fig. 4 Still shot from a model video clip. based texts, video clips were used to enhance the learning experience. The 15 lessons were equally divided into the five units of Guiding the Patient, Basic Oral Care Interview, Scaling, Stain Removal and Fluoride Application, and Brushing Instructions. The dialogs for each unit were simplified to include only the basic terms and phrases. Based on the 5 dialogs, model video clips were filmed in advance using an ipad at an actual private clinic in downtown Osaka. A group of English speaking dentists participated by playing the roles of the foreign patient, hygienist, dentist, and receptionist in the videos. To make the practice drills appropriate for beginner to intermediate levels, the length of the video clips were kept to less than 90 seconds each. Fig. 3 Dialog for oral care interview. Lessons In the first lesson, the model video clips were distributed to the students for viewing with their smartphones. Since over 90 percent of the students were iphone users, the instructor was able to use the airdrop function of the ipad, making the transfer of files quick and easy. The non iphone users received the video clips via Line and other SNS applications. The students were told to view these clips and write out the dialogs in preparation for the next lesson. In the second lesson of the unit, the pronunciation, intonation, and delivery of the dialogs were practiced in the classroom through role playing. Making eye contact and using appropriate gestures, which are very important in communication, were also practiced. For the third lesson of the unit, the students used a clinical practice room equipped with 24 dental chairs. Groups of three students were assigned to each chair. One student played the role of dental hygienist while another was the foreign patient. The third student recorded her classmates performance with a smartphone. The roles were rotated so that each student had a chance to experience each of the three tasks. The

4 148 J. Fujita et al. Journal of Osaka Dental University, October 2017 main objective of this chair side practice was to reproduce and record exactly what the students had seen in the model video clips that were downloaded onto their smartphones. At the end of the class, each group submitted their best video takes, and files were transferred to the instructor s ipad via airdrop. The clips are then viewed by the instructors. Evaluation sheets were prepared for providing feedback to the students for the subsequent lesson. The performances on the video clips are evaluated on a scale of 1 (poor) to 5 (excellent) for each of the following five categories : pronunciation, intonation, eye contact, camera work, and creativity. Comments on the performance are presented below. Fig. 5 Filming session during class. RESULTS Questionnaire concerning the revised English curriculum (2016) To assess the effectiveness of implementing chairside practice and video recording in the new English curriculum, the same questionnaire (used with the second and third year students) was conducted with the first year students. A total of 39 students participated in the questionnaire. The improvement in confidence was marked in all five procedures when compared with the results of the second and third year students. To verify this, we performed Chi squared tests on the Likert scale data. For first year students, who had done the chair side practice sessions, there were significantly (p 0.001, DF 1) fewer students who were not confident in all functions except showing patients to their seats (p 0.008, DF 1). Furthermore, the number of students who had carried out chair side sessions who Fig. 6 Evaluation sheet for feedback to the students. Fig. 7 Results of questionnaire for the first year students.

5 Vol. 51, No. 2 Chair side practice and video recording to improve English communication skills 149 rated their own competence at a medium level in all functions was significantly higher for all functions (p 0.001, DF 1) except for showing patients to their chair (p 0.03, DF 1). Comments In addition to the questionnaire, individual comments were collected from the first year students concerning the following points. When reviewing your performance on video, what points did you focus on? When reviewing their performance, about 40% of the students checked that they were making sufficient eye contact with the patient. Another 40% checked that they had a bright facial expression. When asked why this is important, the students commented the initial impression that the patient gets is very important for building rapport. They want to make sure that the patient feels relaxed. The remaining 20% checked that their pronunciation sounded good. They wanted to know if they really were communicating with the patient. Should this practice be continued in the future (after graduation)? Of the 39 students, 26 felt that what they had practiced in the classroom should be continued after graduation. These students gave the increase of foreign visitors and globalism as the reason. Some ambitious students mentioned the possibility of working abroad in the future. Also, many thought this chair side practice should be a part of their continuing education in the future because they feared that they may not be prepared when the time actually comes. There were also a fair number of students who wished not to continue this practice. Those who made this comment mentioned that they had had enough of English speaking for a while. What was the advantage of the chair-side sessions? The replies were equally divided into the following five comments : It was easier to understand and memorize the English phrases because they were spoken with actual movements ; Compared to a conventional classroom setting, using the dental chairs gave the classes more reality. Also it was more fun ; By taking videos it is possible to review and assess the English performances from an objective viewpoint ; It is clear what to do and how to act when a foreign patient visits the clinic since a mental image of the procedures is already formed ; It is reassuring to know that the video clips are in the smartphone ready for quick reference in the future. What needed improving? Comments for improvement included : It took time to transfer the video clips to the instructor s ipad ; The noise created by the proximity of the neighboring chairs sometimes made it difficult to concentrate on the filming ; Compared to a classroom setting, the proceedings in the practice room appeared to be rushed. Details such as Japanese translation and pronunciation were blurred at times. DISCUSSION AND CONCLUSION As mentioned in the students comments, distributing video files to the students smartphones as well as collecting the video files recorded by the students via airdrop consumed a considerable amount of time from the class. It seems that the transfer speed largely depended on the model of the tablet and phone being used. The old model ipad initially used in the lessons was replaced with the newest model during the last chair side session. The time required to transfer 15 video clips took less than 10 minutes in total which did not seem to be as long as before. Ideally, it would be efficient to have a Wi Fi connection in the classroom. Also, setting up a website for the students to login to for uploading and downloading files would solve time limitation problems. As a result, there would be more time in class to go over translation and pronunciation as requested by some of the students in their comments. The implementation of chair side practice and video taping made possible the improvement in

6 150 J. Fujita et al. Journal of Osaka Dental University, October 2017 confidence among the first year students. Simulations maximize the reality of the experience with limited resources and prepare students as much as possible for real life situations. This would help them relax and have a certain amount of confidence. In addition, synchronizing the English phrases with actual movements helped the students to better understand and memorize the procedures. Along with the use of dental chairs, video taping proved to be very effective. By distributing the model video clips beforehand, the students were able to form a clear mental image of what was expected of them when they take their own videos. Ortiz, et al. noted that Students not only see the skill modeled correctly... but are able to visualize themselves executing the skill without error. 4 This would not have been possible with paper texts or audio recordings alone. Also, rotating the roles between hygienist to foreign patient to cameraman enabled the students to experience the target procedure from different perspectives. It was interesting to see the cameraman take the role of director and give the two other students, who were playing hygienist and patient, tips on eye contact, posture, and voice delivery, which motivated students to maximize their effort. The use of videos also enabled detailed evaluation by the instructors. It was possible to take time after class for reviewing the videos to prepare detailed evaluation sheets. Good performances were selected and shown in class so that the students could share feedback. For the students, the use of videos enabled objective assessment of their own performances. They were able to check their eye contact, expressions, and pronunciation and to see what kind of impression they gave the foreign patient. This proved to be an extremely important factor in increasing their confidence for future encounters with foreign patients. It could be shown without doubt that students who had completed the chair side session had significantly greater confidence in their own abilities to carry out the specific functions, except for showing patients to their chair, which is possibly a generic function that could be done using secondary school English. The authors intend to continue this style of teaching and gather more data and feedback to assess its effectiveness over a longer time span. REFERENCES 1. Shorsbree M. Digital video in the language classroom. The JALT Call Journal 2008 ; 4 : Orlova N. Video recording as a stimulus for reflection in preservice EFL teacher training. ETF 2009 ; 2 : Okada Y. Video eizo wo katsuyo shita syousatsu no jirei kennkyu. Studies in Language Education 2015 ; 7 : (Japanese) 4. Ortiz J, Burlingame C, Onuegbulem C, Yoshikawa K, Rojas E. The use of video self modeling with English language learners : implications for success. Psychol Schools 2012 ; 49 :