What is cognitive integration and why is it important for learning dentistry?

A dentist uses different mental abilities, such as critical thinking, problem-solving, and decision-making, in a holistic approach to solve patients’ problems. The mental abilities are called as cognitive skills. The dentist also uses other skills like being attentive, learning, recalling memory, reasoning etc to understand the patients’ problems. A dentist who is trained in a curriculum that holistically integrates the use of different mental abilities can effectively apply and use it for effective patient care. A holistic safe student-centered environment allows the optimum use of various mental abilities in patient care. In educational terms, this type of learning is called ‘cognitive integrated learning’.

The Bachelor or Dental Surgery (BDS) program is an excellent opportunity to apply the concepts of cognitive integration during the learning (training) of a student. This post is a humble attempt to explain how various learning activities use cognitive integration in learning and assessment.

Early student: The student in the early years learn dentistry in context. An exposure to the working of a dentist, in form of clinic observation or assisting, will put into perspective the future career. When observing a clinic, few areas are highlighted. The dentist (dental student) managing a patient, the dental assistant closely working in tandem as if the dentist has an extra pair of hands, eyes, feet. The sterilization and dispensary units who assist the dental care at a distance. The janitor who invisibly makes sure that the area is clean. It is like a ballet where everyone moves in the same space in harmony. This is reinforced when the early student becomes a part of the dance in the form of an assistant. The assistant now carries more responsibility, he can affect the care of a patient and interact with the support staff. The basic science explanation of all the working in a clinic, like sterilization, selection of a particular restorative material, use of physical barrier are reinforced when there is a discussion on them well supported with self-reading materials. Various basic science knowledge can be assessed in context to clinical care during the early clinical exposure of a student. The various data points collected along the journey of a student allows for reaching a decision on the progression to the next year/level.

Learning medical science: Medical science in many universities is taught by academic staff of medical schools. Some schools have progressed to recruit dental experts specialized in medical sciences as faculty. This allows the learning of medical science concepts in the management of dental patient to be integrated in context. The student understands the concept of circulatory disorders in terms of pre-assessment of a dental patient, contraindications for any dental procedure for a patient with certain underlying medical conditions, interaction of drugs, effect of various medical management on oral tissues, etc. As in above, suitable contextual assessment questions can test the understanding of the medical knowledge in relation to dental care.

Practical skills: Learning and mastery of the practical skills in simulation is a mandatory criteria before real patient management. The mastery of any practical skill can occur by practice and has the danger of the student not understanding when to use it or how to modify it based on need. This requires understanding of the basic concepts. The basic concepts for the successful application of any practical skills should be seamlessly integrated during the learning as well and assessed frequently. High fidelity simulation which allows students to progress to the next steps in a skill training ensures that the student understands the skill well and can use the skill judiciously

Patient care: Real patient care is a loosely structured, non-standardized authentic learning opportunity. This is unique for dentistry where active patient care can be done safely by undergraduate students. The interaction with the patient and clinical supervisor is an excellent opportunity for a student to assess his basic concepts. The explanation provided by the student for obtaining informed consent demonstrates the cognitive integration of the student in that treatment plan. The task of student to convince on the suitability and safety of the proposed treatment plan to the clinical supervisor makes the assessment of cognitive understanding a notch higher. This regular practice with the patient, supervisor and clinic partner allows the student to practice and test his clinical knowledge through its application in real patient care.

Summary: Dental education is an excellent field where students can learn through cognitive integration. Assessments have advanced drastically to keep pace for the improvements and feedback sought by the student. This also allows the university to determine the competence of a student towards being a safe, compassionate, and effective dentist.

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