Growing Into a Professional: Tracing Clinical Reasoning Across a Problem-Based Dental Curriculum in Hong Kong

Abstract

Objectives: Problem-based learning (PBL) has been effective as a pedagogical approach and curriculum design in higher education. Despite the growing research interests in exploring the lived experiences of PBL process, clinical tutorials in situ remain under explored. This study, therefore, traces how the clinical learning contexts support and constrain a student’s clinical reasoning (S32) development by examining the interactions within dental clinical tutorials over time. The findings contribute to deeper understanding of the “inside” of PBL and provide insights into healthcare students’ learning processes to inform future directions in the design of appropriate pedagogical and curriculum approaches for inquiry-based learning environment. Perspectives: This study employs Interactional Ethnography that examines the local theories, cultural practices, and situated processes that members of a sustaining social system (co)construct through their discursive and social interactions (Heap, 1991). Central to IE is Bakhtin’s philosophy that any utterance is a link in a very complexly organized chain of other utterances (utterances (Bakhtin, 1979/1986.) Therefore, this study through multiple levels of analysis traces intertextual and inter-contextual links between and among the past, present and future texts that shaped the development of clinical reasoning of S32 over time. Methods: A telling case (Mitchell, 1984) is undertaken to trace the clinical reasoning of S32 across contexts over a three-year period. Therefore, the paper provides particular accounts of specific configurations of events, in some particular points in time, by presenting two levels of analysis exploring how and in what ways a clinical learning environment shaped S32’s development of clinical reasoning over time. The first level is a contrastive analysis of S32’s discourse of his first, (Year 3 (Y3)), and last video recorded clinical presentation (Year 5 (Y5)). The second analysis traces the intertextual references that indicate evidence of growth in S32’s clinical reasoning over a three-year period (Bloome & Egan-Robertson, 1993). Data sources: This study is part of a longitudinal (2014-2047), nationally-funded study of PBL across three programmes, dental medical, and hearing and speech education. Drawn from archived records (Table 1), analyses were undertaken from 6 video records of dental clinical tutorials across three years (Y3-Y5), consisting of briefing and debriefing sessions. Results: Tracing the communicative processes in each clinical tutorial revealed that the interactive and collaborative dialogues among the participants across contexts supported the development of the clinical reasoning of S32 over a three-year period. The student’s discourse from earlier years showed that clinical knowledge discussed was consequential to building clinical reasoning in later years, leading to providing appropriate justification for diagnosis and recommendations for patient care in his fifth year of the program. Scholarly significance: Fostering authentic learning experiences in clinical contexts requires participants to actively engage in inquiring, hypothesizing, and theorizing, providing opportunities for immediate feedback leading to growth in development. A robust archive of multiple sources of records from a longitudinal study is central to explore the affordances of complex learning environments. This study calls for further exploration for innovative ways to understand ‘how’ student learn and ‘what’ students learn across learning environments and overtime.