Evaluation of Social Interaction, Task Management, and Trust Among ...

Evaluation of Social Interaction, Task Management, and Trust Among Dental Hygiene Students in a Collaborative Learning Environment Catherine D. Saylor, B.S.D.H., M.S.; Nancy T. Keselyak, B.S.D.H., M.A.; Melanie Simmer-Beck, B.S.D.H., M.S.; Daniel Tira, Ph.D. Abstract: The purpose of this study was to evaluate the impact of collaborative learning on the development of social interaction, task management, and trust in dental hygiene students. These three traits were assessed with the Teamwork Assessment Scale in two different learning environments (traditional lecture/lab and collaborative learning environment). A convenience sample of fifty-six entry-level dental hygiene students taking an introductory/preclinic course at two metropolitan area dental hygiene programs provided comparable experimental and control groups. Factor scores were computed for the three traits, and comparisons were conducted using the Ryan-Einot-Gabriel-Welsh multiple comparison procedure among specific cell comparisons generated from a two-factor repeated measures ANOVA. The results indicate that the collaborative learning environment influenced dental hygiene students positively regarding the traits of social interaction, task management, and trust. However, comparing dental hygiene students to undergraduate students overall indicates that dental hygiene students already possess somewhat higher levels of these traits. Future studies on active learning strategies should examine factors such as student achievement and explore other possible active learning methodologies. Prof. Saylor is Clinical Assistant Professor, Division of Periodontics; Prof. Keselyak is Associate Professor, Division of Dental Hygiene; Prof. Simmer-Beck is Assistant Professor, Division of Dental Hygiene; and Dr. Tira is Professor Emeritus—all at the School of Dentistry, University of Missouri–Kansas City. Direct correspondence and request for reprints to Prof. Catherine D. Saylor, Division of Periodontics, School of Dentistry, University of Missouri–Kansas City, 650 E. 25th Street, Kansas City, MO 64108-2784; 816-235-6226 phone; [email protected]. Keywords: collaborative learning, social interaction, task management, trust, dental hygiene, Teamwork Assessment Scale (TAS) Submitted for publication 12/3/09; accepted 9/1/10

T

he National Science Foundation, the National Research Council, and the Boyer Commission are among the many national groups advocating instructional innovation in education to promote higher levels of learning such as analysis and evaluation while emphasizing the development of communication, teamwork, and lifelong learning.1-5 A national assessment of college graduates examined student learning and identified essential skills that graduates should possess.2 This report, published by the U.S. Department of Education’s National Center for Education Statistics, focused on writing, speech and listening, and critical thinking skills—concluding, “It is essential for college graduates to communicate effectively in our society where daily operations and success of business organizations are contingent upon managing, making decisions, documenting, and reporting large amounts of complex information.” “When working in teams,” the report added, “communication skills need to be developed in ways that

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allow flexibility and openness to changes necessary for expanding fields of knowledge.”2 Over the last ten years, there has been considerable discussion regarding the need for dental educators to initiate changes for more effective student outcomes by adjusting curricula.6 Findings from the Institute of Medicine report Dental Education at the Crossroads: Challenges and Change had earlier expressed these concerns, pointing out that traditional dental curricula are crowded with redundant or marginally useful material that students do not have time to fully consolidate or utilize in critical thinking.7 This report noted that the science base of oral health is not effectively related to clinical practice and recommended decreasing the number of lecture hours and increasing time spent in more active learning or alternative learning environments such as working in small groups.6,7 Thus, it is reasonable that faculty members begin actively looking at alternative ways to engage

Journal of Dental Education ■ Volume 75, Number 2

students in a learning process that better stimulates knowledge acquisition, individual critical thinking skills, teamwork, and other traits/skills needed for the study and practice of both dentistry and dental hygiene. These needs are congruent with competencies fundamental to the successful practice of dentistry and dental hygiene stipulated by the Commission on Dental Accreditation (CODA) and the American Dental Education Association (ADEA) and comply with the Standards for Clinical Dental Hygiene Practice of the American Dental Hygienists’ Association (ADHA).8-11 Five domains (Core Competencies, Health Promotion/Disease Prevention, Community, Patient/Client Care, and Professional Growth and Development) with specific competencies regarding dental hygiene have been established for which all dental hygienists should exhibit competence.10,11 Dental hygienists facilitate the implementation of collaborative, patient-centered, oral health care in multidisciplinary teams of health professionals.9 The ADHA recognizes multiple roles for the practicing dental hygienist: these include clinician, educator, researcher, advocate, and administrator/manager, with public health being an integral component of each role.9 It is reasonable to assume that trust is an important attribute for developing the substantial relationships needed in these areas of professional practice. Trust is defined as interpersonal and communication skills that lead to getting to know and understand others, interacting, and managing conflict.12 It is also reasonable to assume that social interaction and task management are necessary competencies for one to function appropriately within each of these defined roles. Social interaction is defined as the interpersonal behaviors that communicate respect, acceptance, and willingness to work together—a requirement for positive group interaction.12 Dental hygienists are responsible for communicating effectively and articulating their roles with patients, interdisciplinary team members, and referring providers. A recent document from the ADHA featuring the Standards for Clinical Dental Hygiene Practice describes the dental hygienist’s professional responsibility to “interact with peers and colleagues to create an environment that supports collegiality and teamwork.”9 Task management is also considered to include the functioning skills and actions of leading, encouraging, sharing, and helping others that result in the successful completion of team tasks.12 Dental hygienists entering the profession are expected to provide oral health care

February 2011 ■ Journal of Dental Education

and assume responsibility for their actions while meeting the expectations of the core competencies. These are examples of the task management abilities required to be a dental hygienist. Social interaction, task management, and trust are three factors fundamental to the five domains and competencies necessary for the successful practice of dental hygiene as established by CODA and supported by ADEA and the ADHA. 8,10,11 Additional abilities under the core competencies include communicating effectively (social interaction and trust) with groups both verbally and in writing, as well as providing care (task management) in an “individualized approach that is humane, empathetic, and caring” (trust).11 The remaining four domains also include specific guidelines/standards incorporating social interaction, task management, and trust. Standards are required for all accredited dental hygiene institutions regardless of the degree being awarded (baccalaureate, associate, or certificate). Program directors must develop curricula that emphasize the standards for the practice of dental hygiene. Because traits of social interaction, task management, and trust are integral to the achievement of these competencies, these traits should also be incorporated into curricula. Critics of the traditional lecture method suggest there is a difference between passive learning, in which students remember approximately 10 percent of the content, and active learning strategies, in which students understand and retain up to 50 percent of the content.13,14 Alternative teaching methodologies such as problem-based learning, cooperative learning, and collaborative learning are examples of interactive teaching methodologies that encourage student engagement through active learning.15,16 Each of these teaching methodologies incorporates tasks that increase opportunities for students to develop higher cognitive abilities by utilizing group work.14 Educational researchers in the sciences and humanities at the college level have endorsed collaborative teaching modalities.17-21 Active learning has been successfully implemented in statistics courses and engineering, medical, and nursing programs.14,22-24 In the field of dentistry and dental hygiene, however, limited research has been published regarding active learning strategies.6,25 The purpose of this study was therefore to evaluate collaborative learning as an instructional modality among dental hygiene students regarding the further development of the traits of social interaction, task management, and trust.

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Methodology This study was approved by the Social Science Institutional Review Board at the University of Missouri–Kansas City and the director of the Office of Institutional Research at Johnson County Community College.

Subjects A convenience sample of fifty-six entry-level dental hygiene students entering one of two local area metropolitan dental hygiene programs in 2007 were recruited for the study. The control group consisted of twenty-six dental hygiene students who participated in a traditional lecture/lab setting (TLL) in an associate degree program. The experimental group consisted of thirty dental hygiene students who participated in a collaborative learning environment (CLE) in a baccalaureate degree program. These samples represented the entire entering classes of both institutions. Participation in the study was completely optional and voluntary. Demographics for both institutions were gathered for baseline comparison (Table 1), and all fifty-six students chose to participate. Coursework taught under the two settings was comparable in both content and contact hours. All courses at both institutions were taught using the traditional lecture/ lab format with the exception of “Introduction to the Preventive Practice of Dental Hygiene” taught at the experimental site. These introductory courses

from both institutions covered the beginning and essential aspects of dental hygiene, including infection control, ergonomics, instrumentation, assessment procedures, medical history, therapeutic procedures, and documentation. In the collaborative environment, the course content was divided into five separate units as recommended by Fink.26 Each of the units incorporated both individual and group projects designed to promote learning and understanding of the materials. Students were randomly assigned to a five- or six-member team for the semester and were responsible for assigned readings to prepare for each unit. Students’ level of preparedness for the CLE coursework per unit was evaluated by administering the Readiness Assessment Test (RAT) at the beginning of each new unit as recommended by Michaelson et al.27 A RAT is a series of questions completed independently to test students’ understanding of the reading materials before they work in a group environment. By taking the tests individually first, students are able to identify their own level of preparedness for each unit. The same RAT is taken again as a team, in which students can discuss their understanding and reach group consensus for each item response. The RAT fosters individual accountability, which is necessary for meaningful collaborative learning, as well as identifies a foundation of understanding upon which to support higher level group activities.27 RATs were created by the course instructor based on the assigned reading materials

Table 1. Demographics for the two institutions in study Characteristics Female/males per class Previous degrees Previous institutions attended Ethnicity Age of students

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Institutions Collaborative Learning Environment

Traditional Lecture/Lab

29:1

24:1

9 Associate Degrees 3 Bachelor Degrees 1 Advanced Degree

3 Associate Degrees 8 Bachelor Degrees

18 Two-Year Institutions 12 Four-Year Institutions

13 Two-Year Institutions 12 Four-Year Institutions

27 Caucasian 2 Hispanic 1 African American

24 Caucasian 1 Asian

23 and under: 21 students 24 to 29: 8 students 30 to 34: 1 student 35 to 39: 0 students 40 and over: 0 students

23 and under: 15 students 24 to 29: 8 students 30 to 34: 0 students 35 to 39: 1 student 40 and over: 1 student


for each unit. To ensure that each student achieved a level of competence in the course content, midterm and final examinations were taken individually. By comparison, students in the traditional lecture/laboratory setting were exposed to a traditional lecture two times per week. Each student was responsible for preparing for classroom sessions, and assignments were given to each student to complete individually. Lecture grades were determined by completion of the lab observation assignments and examinations (exams I and II, midterm, and final). Students received a laboratory grade as well based on completion of critical skills, professionalism, and summative instrumentation exams (midterm and final). The lecture and lab portions of all assignments and examinations were calculated independently.

Instrument and Data Analysis The focus of this research study was to assess the traits of social interaction, task management, and trust among dental hygiene students. The Teamwork Assessment Scale (TAS), created by Maria Lourdes del Consuelo De Hoyos Guevara, is an instrument that assesses task management, social interaction, and trust contributions.12 The assessment instrument is comprised of twenty-eight items, each of which describes characteristics representing successful social interaction, trust behaviors, and task management activities12 (Figure 1). Response for each of the twenty-eight items is based on a five-point scale as follows: 1=never, 2=seldom, 3=sometimes, 4=frequently, and 5=always. Guevara previously used the TAS instrument with students in an undergraduate course to examine face-to-face collaborative learning teams. After confirmatory factor analyses in our study, only twelve of the twenty-eight original items were included for dental hygiene students. Data from Guevara’s study were compared with the twelve items used in our study and showed that undergraduate students scored lower overall than the dental hygiene students for all three traits. For the purpose of this study, a series of factor analyses were conducted in attempt to confirm the factor structure of the TAS among the specific groups of undergraduate dental hygiene students recruited. As was done in the development of the TAS, maximum likelihood factor extraction methodology with Promax rotation (Kappa=3) was applied to the data on the twenty-eight items collected during the first class sessions of the two samples of hygiene students. After the series of factor analyses were conducted,


twelve total items out of the original twenty-eight were determined to relate specifically to the two groups of undergraduate dental hygiene students recruited for the study (Table 2). A total of 112 copies of the TAS were made for distribution to a total of fifty-six students. The investigator coded each TAS to form pre-exposure/ post-exposure paired sets. The pre-exposure surveys were completed on the first day of the course, and the post-exposure surveys were completed on the last day of the course for both the CLE and TLL groups. The simple, unweighted rating for each item was entered into an SPSS data worksheet for analysis. Factor scores based on the revised factor structure of this study were computed as the average of the respective item ratings for social interaction, task management, and trust. Because each student received the survey pre and post exposure, observation time was considered a repeated measures variable. A second independent variable of the study was the instructional method (CLE and TLL). To compare the differences between the learning environment and the change in factor scores from the beginning to the end of the semester, the Ryan-Einot-GabrielWelsh multiple comparison procedure (REGWQ) was used with appropriate error terms for specific cell comparisons generated from a two-factor repeated measures ANOVA.

Results The purpose of this study was to evaluate the impact of collaborative learning in the development of social interaction, task management, and trust among dental hygiene students. A total of fifty-six surveys were completed by students in both settings at the beginning of the semester (pre-exposure). A total of fifty-five surveys were completed post-exposure due to one student in the TLL group voluntarily withdrawing from the program. This individual was not included in any analysis, thus giving a total of 110 TAS surveys for analysis. Frequency distributions were developed for each learning environment for all three factors both pre-exposure and post-exposure. Students in both learning environments considered themselves high on each of the traits upon entry to their programs. In both learning environments, more than half of the students recorded scores of 4 or above on the Likert scale for social interaction and task management at pre-exposure (see Tables 3 and 4). Trust was

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Please select one answer, and with your pencil fill out the circle that corresponds to your answer in the scantron sheet. The items below inquire about your present teamwork experience. Each item consists of a phrase that describes a different aspect of the experience of working in a team. For each question, identify the statement that best describes your perception of how you participate in your team. The letters A, B, C, D, and E represent a 5-point scale (A=1, B=2, C=3, D=4, E=5) between the two extremes of Never (A) to Always (E ). Y ou are to choose the letter that describes where you fall on the scale. For each item, select the option you believe best reflects your personal efforts and contributions to your team. Select A for Never, B for Seldom, C for Sometimes, D for Frequently, and E for Always. 1. I take an active role on initiating ideas or actions. 2. I am willing to take on task responsibilities. 3. I am willing to frequently share ideas. 4. I am willing to frequently share resources. 5. I accept responsibilities for tasks determined by my group. 6. I help to promote a team sense of community. 7. I respect differences of opinions. 8. I respect differences of backgrounds. 9. I am willing to negotiate and make compromises. 10. I provide leadership whenever necessary. 11. I provide support whenever necessary. 12. I acknowledge other members’ good work. 13. I provide positive feedback. 14. I am willing to work with others for our group success. 15. I communicate in friendly tone. 16. I keep in close contact with the rest of the team so that everyone knows how things are going. 17. I produce high-quality work. 18. I meet the team’s deadlines. 19. I am sensitive to the needs of team members. 20. I am sensitive to the feelings of team members. 21. I understand the problems of team members. 22. I contribute possible solutions to problems of team members. 23. I openly share my needs with team members. 24. I openly share my feelings with team members. 25. I promote a positive team environment. 26. I establish positive dialog to resolve team conflicts. 27. I monitor team progress toward task deadlines. 28. I am flexible to adapt to team needs.

A A A A A A A A A A A A A A A

B B B B B B B B B B B B B B B

C C C C C C C C C C C C C C C

D D D D D D D D D D D D D D D

E E E E E E E E E E E E E E E

A A A A A A A A A A A A A

B B B B B B B B B B B B B

C C C C C C C C C C C C C

D D D D D D D D D D D D D

E E E E E E E E E E E E E

Figure 1. Teamwork Assessment Scale (TAS)

different between learning environments as only 46 percent of the students in the CLE group recorded a score of 4 or higher compared to 60 percent in the TLL group (Table 5). Post-exposure distributions (Tables 3, 4, and 5) indicate both groups had more than half of the students score 4 or higher for all three traits. The CLE group demonstrated a slight increase in the percentage of scores 4 or higher for

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both social interaction and task management, while the TLL group demonstrated essentially no change in the percentage of scores for either trait. The greatest change in percentage of factor scores at or above 4 occurred among students in the CLE group for trust. A 26.7 percentage point difference was demonstrated between pre-exposure and post-exposure.


Table 2. Limited items that loaded appropriately after analysis for undergraduate dental hygiene students

Factors

Trust

Task Management

Social Interaction

Questions Pre1 Pre2 Pre7 Pre8 Pre11 Pre16 Pre18 Pre22 Pre23 Pre24 Pre25 Pre26

.239 .372 .183 .343 .442 .449 .252 .672 .777 .833 .702 .723

.554 .705 .153 .269 .561 .706 .654 .404 .497 .284 .670 .362

.083 .292 .993 .636 .339 .130 .072 .252 .260 .162 .262 .215

Note: Italicized scores represent adequate loadings for questions represented by the trait in the respective columns.

Table 6 displays the mean factor scores (standard deviation) with the minimum and maximum factor scores for both schools at pre-exposure and post-exposure. The mean factor scores for social interaction and trust at pre-exposure were slightly higher for the TLL group than the CLE group. The differences in these mean scores were minimal; however, the greatest difference in the mean factor scores was demonstrated for the factor of trust at 0.312 of a scale point. The difference in these scores could be due to one or two students having extreme scores relative to the vast majority. As implied by the factor score distributions, very little variability was found in either group both pre- and post-exposure. For comparison of mean score differences between learning environments (pre- and postexposure) and pre- and post-exposure changes per learning environment, the critical mean difference (CMD) was computed for each trait (see Tables

7 and 8) according to the REGWQ methodology. Error-rate was maintained at an alpha level of 0.05 for the school and time comparisons using a Bonferroni adjustment over the four sets. Mean differences higher than the CMD indicate statistical significance. The difference between the mean scores for both learning environments was not significant at pre-

Table 3. Percentages of scores for social interaction

Table 5. Percentages of scores for trust

Scores 5 4 3 2 1

CLE

TLL

Pre

Post

Pre

Post

43.3% 43.3% 13.4% 0 0

56.7% 40.0% 3.3% 0 0

48.0% 52.0% 0 0 0

68.0% 32.0% 0 0 0


Table 4. Percentages of scores for task management Scores 5 4 3 2 1

Scores 5 4 3 2 1

CLE

TLL

Pre

Post

Pre

Post

6.7% 66.6% 26.7% 0 0

26.7% 70.0% 3.3% 0 0

4.0% 84.0% 12.0% 0 0

12.0% 76.0% 8.0% 4.0% 0

CLE

TLL

Pre

Post

Pre

Post

3.3% 43.4% 53.3% 0

30.0% 43.3% 26.7% 0

28.0% 32.0% 40.0% 0

28.0% 44.0% 20.0% 8.0%

0

0

0

0

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Table 6. Descriptive statistics of factor scores

Minimum

Maximum

Std. Deviation

CLE (N=30)

Pre

Post

Pre

Post

Pre

Post

Pre

Post

Social Interaction Task Management Trust TLL (N=25)

3.0 3.4 3.0 Pre

3.5 3.0 3.2 Post

5.0 5.0 5.0 Pre

5.0 5.0 5.0

4.4 4.3 3.9

4.6 4.6 4.4

.64 .42 .49

.43 .40 .59

Post

Pre

Post

Pre

Post

Social Interaction Task Management Trust

4.0 3.4 2.6

4.0 2.4 2.0

5.0 5.0 5.0

5.0 5.0 5.0

4.7 4.3 4.2

4.7 4.4 4.2

.37 .42 .68

.43 .58 .76

Table 7. Differences in mean scores of schools (CLE compared to TLL)

CMD


0.34 0.32 0.44

Difference Difference in Pre in Post Mean Mean Scores Scores 0.28 0.01 0.31

0.04 0.23 0.18

Table 8. Change in mean scores over time (pre-exposure to post-exposure)

CLE

CMD

Change in Mean Score


0.282 0.215 0.306

0.300* 0.330* 0.490*

CMD*

Change in Mean Score


0.301 0.236 0.335

0.060 0.096 0.000

TLL

*p