title: 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 refine study protocols. The study design was a natural experiment with cross-sectional 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 significantly 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 findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry.
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine. reedsg@musc.edu.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Reed
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Adibi
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Mullen
authors.initials: M
authors.lastname: Coover
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gellin
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wahlquist
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Anitha
authors.initials: A
authors.lastname: AbdulRahiman
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Lindsey H
authors.initials: LH
authors.lastname: Hamil
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Muhammad F
authors.initials: MF
authors.lastname: Walji
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Paula
authors.initials: P
authors.lastname: O'Neill
authors.affiliation: Dr. Reed is Associate Professor, Department of Pediatrics-Neonatology, College of Medicine, and Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Adibi is Associate Professor, Department of General Practice and Dental Public Health, The University of Texas School of Dentistry at Houston; Dr. Coover is Assistant Professor, Department of Oral Rehabilitation, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Gellin is Professor and Chair, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Ms. Wahlquist is Research Instructor, Department of Public Health Sciences, Medical University of South Carolina; Dr. AbdulRahiman was Research Assistant, Department of Oral Health Policy and Epidemiology and student, Harvard School of Dental Medicine at the time of this study; Dr. Hamil is Assistant Professor, Department of Stomatology, James B. Edwards College of Dental Medicine, Medical University of South Carolina; Dr. Walji is Associate Professor and Associate Dean for Technology Services and Informatics, The University of Texas School of Dentistry at Houston; Dr. O'Neill is Professor Emerita, The University of Texas School of Dentistry at Houston; and Dr. Kalenderian is Chair and Associate Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Kalenderian
mesh_terms: D000328:Adult; D059019:Clinical Coding; D003430:Cross-Sectional Studies; D003792:Dental Records; D003937:Diagnosis, Differential; D003945:Diagnosis, Oral / Q000145:classification*; D004497:Education, Dental; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D010347:Patient Care Planning; D010808:Physical Examination; D010865:Pilot Projects; D015397:Program Evaluation; D013335:Students, Dental / Q000523:psychology*; D039061:Systematized Nomenclature of Medicine; D009626:Terminology as Topic; D013850:Thinking; D055815:Young Adult
keywords: clinical education; critical thinking; dental education; diagnostic terminology; electronic health record