title: Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence.
abstract: BACKGROUND
  This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the four-component instructional design model for complex learning.
  
  
  METHODS
  Progress test scores of third- to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth- and fifth-year cohorts. These fourth- and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions.
  
  
  RESULTS
  Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions.
  
  
  CONCLUSIONS
  The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.
authors.affiliation: Department of Dental Management Sciences, University of Pretoria, Pretoria, South Africa.
authors.forename: T C
authors.initials: TC
authors.lastname: Postma
authors.affiliation: Department of Dental Management Sciences, University of Pretoria, Pretoria, South Africa.
authors.forename: J G
authors.initials: JG
authors.lastname: White
mesh_terms: D002983:Clinical Competence; D003151:Community Health Centers; D003479:Curriculum; D004497:Education, Dental / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D019359:Knowledge; D007858:Learning; D017145:Models, Educational; D005791:Patient Care; D018794:Problem-Based Learning; D015397:Program Evaluation; D012575:Schools, Dental; D013019:South Africa; D013335:Students, Dental / Q000523:psychology* / Q000706:statistics & numerical data; D013663:Teaching; D013850:Thinking
keywords: 4C/ID-Model of Complex Learning; authenticity; case-based learning; integrated clinical reasoning; part-whole-task simulation; scaffolding