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Undergraduate and postgraduate dental students’
‘reflection on learning’: a qualitative study
F. A. Ashley, B. Gibson, B. Daly, S. Lygo Baker and J. T. NewtonUnit of Oral Health Services Research and Dental Public Health, GKT Dental Institute, Kings Campus, Caldecot Road, Denmark Hill SE5 9RW, UK
Abstract The aim of this study was to explore undergraduateand postgraduate dental students’ understanding of a good
learning experience by using ‘reflection on learning’ as describedby Schon. Four groups of Year 4 BDS students and one group of
postgraduate students in dental public health took part in a seriesof focus group discussions. The responses were grouped into
four broad themes (a) active, practical and positive learning; (b)interactive/together learning; (c) personal learning; (d) theory into
practice. Six educational models of good learning proposed bythe students are described.
Key words: active learning; focus groups; pedagogy; qualitativemethods.
ª Blackwell Munksgaard, 2006
Accepted for publication, 13 September 2005
Background
R eflective practice is a recognised pedagogical
method which encourages active learning as it
allows experiences to be considered not only by
thought and feeling but also by action (1). Although
Schon (2) is credited with the reinvigoration of the
notion of reflection the tradition had previously been
supported by Dewey, Lewin and Piaget, each of
whom argued that learning occurs when we integrate
experience with reflection and theory with practice.
Although all believed that experience is the basis for
learning, they also argued that learning could only
occur with reflection. It is, however, the work of Schon
(2) that has most recently been applied to learning and
development in higher education especially in the
fields of medicine, nursing and education (3–8). The
key assumptions and methods of reflective practice
correspond closely to the underlying approach to the
teaching of dental students outlined in the General
Dental Council (GDC) document The First Five Years
(9). In designing a core curriculum for all dental
students in the UK, the GDC state as a key principle
inter alia.
‘That learning opportunities and experiences should
be designed to encourage a questioning, scientific
and self-critical approach to dental practice and to
foster the intellectual skills required for future
personal and professional development’. (9, p. 6)
Within this principle and the curricula itself, learn-
ing through a critical link between theory and practice
is acknowledged. Indeed, it regularly arises as a key
issue in evaluations both by students as well as
teaching staff. There is less work on the application of
reflection within the undergraduate and postgraduate
dental curricula and how this impacts upon learning.
One such study looks at the role of reflective practice
and experiential learning, and how they can contrib-
ute to the continuing professional development of
dentists and the dental team (10). By setting realistic
goals, the dental practitioners can improve their skills
and reduce stress. The aim of this study is to explore
undergraduate and postgraduate dental students’
understanding of a good learning experience by using
‘reflection on learning’ as described by Schon (2), the
intention being to develop ‘personal confidence and a
feeling of competence in learning’ (11). Is Schon
correct to suggest that reflection is not constant and
that reflection on action enables us to spend more time
exploring why we act as we do, what has happened to
us within a learning group and so on? Can developing
students’ understanding of a good learning experience
supplement the research literature by adding some-
thing new?
This is important to question if we are to respond to
the crucial dilemma that faces us. On the one hand,
theory suggests that university education is about
developing creative, independent thinkers (12) and yet
at the same time we need to ensure that a set of
professional standards and competencies are met at
some threshold level. Understanding how students
interpret a good learning experience may help us
10
Eur J Dent Educ 2006; 10: 10–19All rights reserved
CopyrightªBlackwell Munksgaard 2006
european journal of
Dental Education
adapt and develop curricula to ensure that these two
issues are compatible rather than potentially in con-
flict. This is of particular importance as the notion of
reflection becomes more closely related to professional
practice. As Driscoll and Teh (13) point out ‘what
passes for reflection is often not reflection’ (p. 96).
Reflecting effectively is a skilled activity requiring an
ability to analyse practice actions and beliefs and to
make judgements about their effectiveness. Reflective
practice is, however, crucial to dentists because they
are dealing with people who as Jarvis (5) points out
are all individual and require us to be responsive and
reflective rather than simply carrying out a routine
task or ritual.
In this way, the study is not merely intended to be a
passive process. Rather as Reid (14) suggests, the
intention is to review learning in order to ‘describe,
analyse, evaluate and so inform learning about prac-
tice’. Reflection on action was seen to be important in
order to enable those engaged in the research to
explore their experiences together and lead to ‘new
understanding and appreciation’ (13). It is recognised
that reflection not only comprises of thinking about
what one has been engaged with but also about how
one learns and this key element is an essential element
in the learning cycle proposed by Kolb (15). Whilst
inevitably the outcomes of the study were aimed at
providing information that may assist practitioners
adapt curricula, many of the issues raised may appear
to be common and inevitable, already available in the
literature and previously researched. The common
refrain being that ‘nothing can be done’ and ‘we know
that already’. The intention of this study was not only
to re-examine these but also to engage the students in
reflective practice, to develop their understanding of it
as a process in order for them to be able to use
reflection as part of their learning. As Dewey (16)
stated ‘We do not learn by doing… we learn by doing
and realising what came of what we did’. But do the
students think like this when they consider their own
learning?
Method
The study is clearly focused on the second of Schon’s
two types of reflection: reflection on action. The
methodology focused on getting the students to reflect
back on action and their learning in order for them to
discover how their ‘knowing in action may have
contributed to an unexpected outcome’ (2, p. 26). The
study was conducted at the Guy’s, King’s and St
Thomas’ Dental Institute, London, UK. The Institute is
the largest dental school in the UK and is based across
three sites in London. The Institute has an intake of
around 145 students per year.
The methodology used Kottkamp’s (17) view of
working ‘offline’ – by using reflection on action when
full attention can be given to the analysis without the
need to take any immediate action and to enable
others to assist with the analysis – in this case, peers.
Studies with five focus groups were carried out over a
2 week period. Four dental undergraduate groups and
one postgraduate group were chosen for the study. All
undergraduate students were in year 4 of their BDS
course. The undergraduate groups were chosen ran-
domly from lists provided by the Department of
Dental Public Health. The postgraduate group consis-
ted of the current intake of students on the MSc course
in Dental Public Health at GKT. In total, 25 students
participated; 20, undergraduate dental students and
five postgraduate MSc students of which 15 were
females and 10 males. Each session lasted approxi-
mately 3 h.
Studies with the focus groups were carried out in
teaching rooms which were familiar to the students.
The undergraduate interviews took place at the Guy’s
campus in London Bridge and the postgraduates at
Denmark Hill in the Department of Dental Public
Health and Oral Health Services Research.
An information sheet was provided to each student
explaining the purpose of the study, students were
told that the study was completely confidential and
that names would not be used in the report. They were
given the opportunity to ask questions if they were
unsure about anything. All students signed a consent
form which was required by the ethics committee.
Students were given a pad of sticky notes and a pen
and asked to write a response to the following
questions; What is a good learning experience?; What
is a bad learning experience?; What do you think you
could do in order to enhance your learning experience
at GKT? The intention was to spend time exploring
why the students acted as they did, to consider how
they learned and what situation the teaching put them
into and to enable them to do this together to consider
what was happening within the learning groups that
they helped to populate.
The first student was asked to talk about what they
had written and then each student in turn was asked
to respond to the specific remarks of the first student.
Two note takers were assigned to record anything
relevant; however, all students were encouraged to
make as many notes on each point as they felt
necessary. The second student would then talk about
their answer and everybody would respond in turn to
Dental students’ ‘reflection on learning’
11
their specific comments and so on. Each new response
was written on a separate note. Many notes were
generated over the course of each session.
At the end of each set of questions, the ‘memos’
were fixed to a wall and grouped by each student’s
responses. Additional memos were added underneath
the sections by the other members of the group.
Students were then asked to sum up each section with
a statement which would form the concepts for each
section.
This methodology was selected because a number of
different models of learning through reflection have
suggested that group discussion assists with the
development of reflective activity (6–8). As the aim
of the study was to examine the learning experiences
of the students by reflection on action, it was hoped
that discussion would facilitate the reflections further
and mirror the essence of the very study itself. Indeed
discussion groups have been described as places
where students interact and relate theory to practice
thus developing ‘insight both into the students them-
selves and their practical experience’ (18, p. 690).
Reflective groups can also increase the ability to
understand the viewpoints of others and to empathise
and as a result challenge the status quo. It was felt
important within this study that as the intention was
students’ own personal experience, it was important
to enable them to work in a supportive environment
and not merely repeat back what they felt the
researchers wanted to hear. Eraut (19) has suggested
that getting people to reflect together and to share
ideas develops more self-regulation, and a group
that is able to effectively translate knowledge and
descriptions, and consider key values. As such it
seemed important to incorporate this within the
methodology.
Each exercise was tape-recorded and transcribed.
Each set of answers (post-it’s) were collated and put
into an envelope. There were over 55 sets of responses
to the three questions. This paper will address the
‘good learning experience’ section. The notes were
categorised into four broad learning areas:
1 active, practical, and positive learning;
2 interactive/together learning;
3 personal learning;
4 theory into practice.
Results and discussion
Active, practical and positive learningFigure 1 gives an overview of ‘active, practical and
positive learning’ which provoked the most discussion
in the ‘good learning experience’ section. Whilst it is
acknowledged that students’ approach to their learn-
ing depends partly on their previous experience and
their interest in the particular task (20), there were a
number of qualifications that were highlighted. Stu-
dents believed that learning took place through a
number of dimensions and these are discussed below.
Students stated that it was important to have a
‘gradual build up’ to topics and felt they needed an
understanding of how the course was structured
which would enable them to see the fit between the
topics. It is interesting to note that this concern over
‘structure’ may actually be partially a reflection of
students coming to grips with a more loosely defined
learning environment than they have previously
experienced. McInnis and James (21) discovered that
students became ‘disillusioned’ by the lack of clarity
over expectations and guidelines in higher education.
So whilst it may be understandable that the curricu-
lum needs to be logical and consistent, the responses
may also reflect a desire for a structure to be imposed
and provided to the learning environment. The cur-
riculum at GKT is highly structured, more so than
would be usual for many university subjects, but
students are expected to draw links between topics
and link their learning across different disciplines.
Here we see the potential dilemma again between
developing creative, independent critical thinkers
expected to reach the highest level of Bloom’s (22)
cognitive taxonomy and the desire for a rigid, easily
defined structure.
The students described active learning in practical
terms (Fig. 1). They expressed the importance of being
able to both talk about and see a subject. Basing a
discussion around a phantom head was given as an
example of how this worked effectively. Undertaking
practical work was seen as important for learning. Too
much theory was seen as inhibiting the ability to retain
information.
Active/practical and positive learning
Talk Look Write
Group discussions Tutorials
Good things about current experience
Grasp of subject Understanding Summarising
Fig. 1. Active/practical and positive learning.
Ashley et al.
12
Figure 2 looks at student participation and one-to-
one learning. Students felt that group sizes were too
big, both on the clinics and in the tutorials. They felt
that one-to-one learning was valuable where they
could gain access to either a tutor or a demonstrator
on the clinics or in the class room setting. Staff:student
ratios of 1:9 are typical of GKT Dental Institute and
common in dental schools throughout the UK and
Europe.
Lecturers who were interactive or who taught with
practical examples were thought to be helpful rather
than being abstract. Moreover, good clear handouts
which allowed students to listen and concentrate on
lectures rather than require students to write furiously
were perceived as beneficial.
Repetition (Fig. 3) was also felt to help in the
learning process as it reinforced ideas. Many students
expressed this as a learning technique which they
used and one that worked for them. It was acknow-
ledged that it was not suitable for everyone as it was
time consuming and would depend on the topic being
learnt. Applying the information would be better for
some rather than just repeating it. This reflects the
desire of students to have material that is pitched
effectively, is well paced and clear (23). It also
demonstrates that through reflecting upon their
experiences and those of their peers that they acknow-
ledge the need for differentiation in learning and that
they learn differently.
Ramsden (20, p. 155) believes that after a year in
higher education ‘students expect teaching to be a
passive experience where something is done to them,
and they object to having to be active’. Whilst the
focus groups responses suggest they acknowledged
the importance of active learning they also expressed a
desire to be guided through the course and told why
they were learning certain topics and how these
gradually develop over the curriculum (Fig. 4). For
example, students were not guided on how to hold
instruments and did not feel that there was any
standardisation in their knowledge. The move from
phantom head to ‘real’ patients was also sudden and
did not take into account the problems that occur with
patients. Student’s felt that it would be helpful if they
could be given easier patients first to build up their
confidence rather than being thrown in at the deep
end.
The students enjoyed learning in practical demon-
strations, anatomy tutorials were given as an example
(Fig. 5). It was felt that this was ‘real’ life rather than
theoretical and, therefore, it was easier to absorb the
information. These responses suggest that the students
enjoyed and responded to being actively engaged in
reflecting upon the subject matter and as a result were
able to create personal meaning (24). It was described
as a ‘fun way of learning’, although it was noted that
not all topics can be explained in practical terms and
some subjects are theoretical, the example of Dental
Public Health was given. It was felt that practical
demonstrations should be held as close to lectures as
possible so that the information given can be tied into
a practical demonstration and, therefore, would be
remembered. Evidence from medical education (25)
supports the need for this. Where the practical and
theory are not taught together or linked effectively
students often perceive the two to be unrelated and
have difficulty applying information and knowledge
in a clinical situation. All too often in the practical
environment, it is taken for granted that once a
student has done something they understand and
can replicate it. The key, as students within the focus
groups alluded too, is to enable the students to engage
with the content so they understand it (20). Students
noted that having consistency between staff in terms
of information given was key to enabling this process
to occur.
‘…everybody should have the same kind of teaching
and interaction with the tutor… different tutors have
different styles of teaching, and the styles practiced.
And you find, on more than one occasion, that one
Participation/one to one
Personal Guidance Discussion
Encourage interactive lectures
Produce handouts so we can sit and listen
Stick to specifics
Consistency
Things to think about
Encourage questions
Fig. 2. Participation/one to one.
Dental students’ ‘reflection on learning’
13
tutor says one thing and one tutor says another
thing, and you’re just confused, you can’t remember
what to do or what’s right or wrong. And that just
kind of makes matters worse’. (Undergraduate
student, female, year 4 focus group 3; 20/05/03)
The qualities of a good demonstrator (Fig. 6) were
discussed. The responses reflect Ramsden’s (20) view
that students appreciate teaching and learning strat-
egies that enable them to relate to the subject matter
that they are studying in a meaningful way. The
students also felt that being approachable, competent
and a good communicator who was supportive, rather
than intimidating, were essential. They wanted to be
able to ask questions freely to the demonstrators and
not feel intimidated and humiliated if they were
wrong. These skills and attributes reflect the views
outlined by a range of writers in higher education (20,
26). They liked the mix of teachers who came in from
practice as this added to their learning experience.
Demonstrators and students work closely in patient
care and the relationship is close to that of apprentice
and master.
‘Yeah, I think, well I felt that… my best learning
experience has been with teachers who, or
Repetition
Highlight and condense
Writing out info
Bite sized revision
Lectures
Tutorials
Handouts
Own notes
Tutor on clinic?
Memorising
Reflection
Application
Quick repetition - talking
Methods of repetition
Working with friends
Laziness
Time consuming
Applying is better than repeating
Time factor
Information reinforcement
Problems with repetition
Fig. 3. Repetition.
Gradual build-up
Taking easy steps
Not too big jump from phantom head to patient
Guidance through everything at start
Screen patients – easy patients first?
Don’t get taught about individual problems usually too ideal
From Phantom head to clinic
Standardisation
Calibration
Instrument holding
Sitting
Treatment planning
Whole patient
Issues to consider about build-up
Fig. 4. Gradual build-up.
Ashley et al.
14
demonstrators who I felt comfortable and I felt
confident in and I think that’s where you’re
pointing, because they, hopefully they know what
they’re talking about, they’re moulding us to be
the dentists we’re going to be later on.…’.
(Undergraduate student, male, year 4 focus group
1; 14/05/03)
Reflection was only seen by a few as a way of
retaining information. Long term, it was felt that there
was not enough time in the timetable to allow for this.
Group discussions and tutorials were felt to be a good
practical way of learning but these needed to be
organised and not include conflicting information
with other tutorials and lecturers.
Interactive/together learningAccording to the students, interactive together learn-
ing was about learning through interaction, informal
chats, getting together or in clinical and non-clinical
small group teaching. Together learning had an
important dimension concerning the degree to which
it was either formal or informal.
‘I think that getting together with my friends and
them teaching me things that they’ve been taught
and are being demonstrated. Because you don’t
always get all the things that you’re told in the
class. The important bits of information, getting
together with them, you’re exchanging informa-
tion. That was really good. Specially with these
classes’. (Undergraduate student, female, year 4
focus group 3; 20/05/03)
Fun way of learning
Interactive
Questionsanswered
Guidance
Real life
Rather than theory
Learningtechniques
Able to touch
See, touch, do
With friends, learning
Patient experience
Learning from mistakes
Showing, seeing, drawing, explaining, touch
How it was described
Efficient demonstrators teach more students
Demonstrators who stick to point
Differences lead to confused teaching
Guidance better than showing
The Good demonstrator
Slides for practicals?
Tutorials can be as good?
Not everything can be put into practice
Needs good access to resources, i.e. chairs
Should be close to lectures
All staff should say the same thing
Quandaries
Learning in practicals
Fig. 5. Learning in practicals.
The Good demonstrator
Supportive
Good communication Relaxed
Sympathetic Competent teachers
Helping
Empathy Approachable
RespectPersonalised
Qualities
Constructive, positive and immediate feedback
Good to learn from different teachers
Need time to ask questions
Makes you think
Actions
Can ask silly questions
Fig. 6. The good demonstrator.
Dental students’ ‘reflection on learning’
15
Not all students saw this as a useful method of
learning and for some it could lead to confusion. For
example to the statement above another student
replied:
‘Yes. I think that’s very true, but when we come to
the practical exam I think it’s not true with every-
thing. For me, the practical side of things really
helps to sort of memorise them and for example,
I’ve done it once and I wouldn’t need so much help
of the demonstrator to do it again. That means I get
hold of what I can remember of it once, and then I
never do it again… becoming more confident every
time’. (Undergraduate student, female, year 4 focus
group 3; 20/05/03)
In the main, however, the students did discuss this
as an important aspect of undergraduate life. The chief
method of together learning was described in terms of
small group clinical and non-clinical teaching. This
was described as a better way to learn, more relevant,
not intimidating, enjoyable, humorous and interactive.
Such sessions were considered ‘good’ because they
gave the students a chance to understand what was
being taught. They could deviate from the formal
structure and, therefore, gain more personalised
learning. In addition, the students felt that they could
ask silly questions and have a discussion in a stress
free environment.
‘In a small place it’s less intimidating to ask
questions but I would ask them, I also wouldn’t
ask them if there’s a lot of people around. Because
[unclear] and also it’s a bit embarrassing talking
about things in groups where you have, you know
each other and it’s easier to discuss the questions’.
(Undergraduate student, male, year 4 focus group 1;
14/05/03)
Although the students did suggest that tutorials
using different media were more interesting, this also
raised a concern for some students over consistency.
As raised in the previous section, the concern was that
they were not all being taught in a standardised way.
Such variation in small group teaching experience was
seen as undesirable and ought to be controlled.
The results indicated that learning through interac-
tion involved being able to learn through ones own
and others mistakes, taking action and being person-
ally engaged. It also involved discussions with other
students, for which there is an increasing body of
evidence that suggests this method is effective in
enabling learning to occur (27–30). The students felt
that this form of learning was much more patient
related and about getting the basic principles into
proper order.
‘I find it, when you have to learn something, then
you get together and [unclear] you pull that topic
together and that’s the way to get a topic into your
head. I’ve only done it for a couple of months, but I
still remember what I learned… I don’t do enough
active learning at all but…’.
‘Yeah… It obviously depends on different people,
whether they like that kind of structure. And then
the topics get into your head as well’. (Undergra-
duate Students, male and female respectively, year 4
focus group 2; 19/05/03)
Students also talked about being involved in reality
situations although they perceived this to have a
gradient from underlying theory to practice. They
were concerned about being forced to ‘jump in at the
deep end’ and favoured teaching which had a gradual
build-up. In all of this, seeing the demonstrator on the
dental clinic was of help as was having both good and
bad patient related experiences.
‘One of the worst things is being put under
pressure. There’ve been situations where the num-
ber of tutors, or lack of tutors, because there are,
normally there 18 of us, there are only 2 tutors’.
‘Yeah. That does happen quite a lot. I think it’s
because the, everyone knows there aren’t enough
staff to students, especially clinically. There’s too
many students, there’s too few demonstrators… The
patients are sitting there and that’s for them, and
they kind of not have a go, but obviously they’re not
pleased. You’re not pleased because you get
stressed and you have no time to finish what you’re
doing, your next patient’s already here, it can be
really stressful. And at the end, you don’t really
learn anything, you just get a lot of hassle from your
patient and yourself’. (Undergraduate students,
both females, year 4 focus group 3; 20/05/03)
Other methods of together learning involved the
formation of informal study groups for the exchange
of information. This was found to be particularly
useful for theory examinations when they might
have to get through large amounts of information. It
was also considered a useful form of peer-to-peer
teaching. The students were able to explore how
concepts relate to each other and to their own prior
knowledge. These collaborations help students ‘dis-
cuss and assimilate new ideas and to learn at a
deeper level’ (31). The development of small informal
study groups were noted as beneficial by the
students because they were with their friends and
this helped to remove the often confusing aspects of
large group teaching.
Ashley et al.
16
‘Well that’s what I think is, you’re not going to get
through everything, there’s so much to learn, you’re
not going to get through everything yourself, so
stuff you don’t know you can pick up from other
people’. (Undergraduate student, female, year 4
focus group 1; 14/05/03)
In addition to the formation of informal study
groups, the students indicated that there was a
considerable economy to be achieved through ‘infor-
mal chats’ with either their peers or with students in
the year above them. They discussed this type of
learning in terms of shared information and experi-
ence. They found this a useful way to reflect on what
they were learning. These forms of collaborative
learning methods are increasingly believed to be
beneficial for student learning (32–34), but it has to
be acknowledged that to be successfully employed
requires considerable effort (35–37).
Although mentioned again within this section, the
notion of reflection was implicitly implied as import-
ant most of the time rather than explicitly noted by
students as a part of their interactive together learning.
Personal learningThere were a series of discussions about learning
which seemed to reflect a concern with important
things which could help the student learn in a
personal manner. These included good feedback
(including learning from mistakes), being able to
access relevant and timely information and finally
for some the use of music to enhance their personal
learning.
The importance of good feedback was highlighted
in general. It was said to be important because it
helped students ‘know their own level of learning’.
Good feedback was said to be positive, intimate and
constructive. In addition, it was stated that where
good feedback was given it would reflect a respect for
the students’ own level of learning. Intimate feedback
in addition implied that the tutor or the lecturer
should know the student.
‘Everyone has different problems, everyone has
different levels of understanding so, it’s important
that you get, you have this basic information but it is
also important that, to a certain degree, try to get
your own like, individual, your own understanding
of the standard as well. Just hope that it’s what
[unclear] do’. (Undergraduate students, male, year 4
focus group 1; 14/05/03)
The importance of being able to learn through
making mistakes was discussed. It reflected the
experiential nature of learning to practice dentistry
and required a good explanation from a sympathetic
demonstrator. It was very important to be shown what
went wrong. In addition to personal mistakes the
students also indicated that it would be better to be
able to learn from other student’s mistakes and indeed
to share their collective learning in this way through
group discussions of what went wrong.
The use of music during personal learning was often
discussed in the focus groups as a way to enhance
ones personal learning environment. In this context, it
was described as leading to a fun environment which
gave the feeling of being more interactive. Views of
the benefits of this nonetheless varied significantly.
Again implicit within the answers provided and
comments made was the importance of reflection on
action. Whilst important to receive timely and con-
structive feedback this was needed to assist reflection.
Learning from peers’ mistakes would also be enhanced
by reflection. However, again reflection was not expli-
citly singled out by the participants.
Theory into practiceThe final broad category of learning discussed by the
students was the challenge of putting theory into
practice and how this could be best achieved. Putting
theory into practice involved a strong connection
between lectures, handouts, and other enabling
resources such as the availability of staff for informal
discussion. This whole process seemed to the students
to be about deciding between various degrees of
relevance.
Students found lectures good for getting a sense
of proportion about the information they were to sift
through. Lectures were, therefore, good for basic
principles and as Bligh (38) found, to teach infor-
mation and provide a framework to orientate the
students to a general outline or overview of the
information relevant to a particular topic. Lectures
were not good for learning as a whole as they did
not stimulate thought or change attitudes (38). Good
lectures involved detailed handouts and were much
better if they were interactive and enabled reflection.
However, the lecture is unlikely to achieve the
sought after level of internalisation through reflec-
tion (27).
‘in a lecture it’s more you’re sitting there passively,
listening, it doesn’t go in as much. Whereas when
you’re involved in a discussion you’re more active
because you are asking questions. And when we’re,
you know, asking questions is like we have a
problem. That’s why you’re asking questions. It’s
different to when you’re just sitting down and
just learning. Because then you, when you ask a
Dental students’ ‘reflection on learning’
17
question you’re obviously more specific about what
you want than in learning…’. (Undergraduate
students, male, year 4 focus group 1; 14/05/03)
The importance of handouts in facilitating the move
from lecture presentation into practice was highligh-
ted in all focus groups. Handouts enabled students to
pay more attention to what was being said in the
lecture, helped them avoid misunderstandings. They
were also good for revision and deemed important
and necessary.
‘Good handouts are really important. There’s a lot of
lecturers that don’t give out handouts and…’.
‘If you can’t write quickly, or you’re absent that day,
or you really can’t get into the subject, then you’re
left with no notes’. (Undergraduate students, male
and female, year 4 focus group 3; 20/05/03)
The availability of tutors after lectures to discuss
particular topics was said to be another important
enabling resource in the move from formal lectures to
internalised and reflective learning. As Zeegers and
Martin (39) discovered, students respond to tutors
who are ‘supportive’ and ‘motivating’ and the key to
achieving this is an awareness of the individual and
their learning approach. The students in this study
noted the important role tutors have in building their
self-confidence about their knowledge. They could
help give specific advice and through a greater degree
of informal learning on a one to one basis they could
help the student decide on what was relevant.
Conclusion
The reflective approach to learning requires learners to
consider not only the information they have acquired
but also the processes through which knowledge
was acquired. In other words, both content and
process knowledge. The dental students interviewed
here, reflected on their own processes of learning.
Several key themes emerged. In summary, students
seem to prefer an approach to learning which is
graded and cumulative – such that students are
exposed to introductory principles, which are later
built upon. These students placed a great deal of
emphasis on practical applications of their knowledge
and learning through observation of the applications
of their knowledge. This may reflect the topic they are
learning – dentistry. It is possible that individuals with
this very applied learning style are attracted to
dentistry as an area to study, or alternatively that the
demands of the course force students into this learning
style. However, their reflections also noted that they
recognise the differences in approach to learning of
their colleagues. The need for flexible teaching to
respond to these different learning styles may be lost if
we assume that the learning styles of those attracted to
dentistry are similar. We may be requiring the student
to adapt to our teaching style as a result and not
negotiating this with the learners.
Good learning experiences in the move from theory
to practice from the dental students’ perspectives
seemed to involve enabling resources to help them
decide on various degrees of relevance. Information
could be either relevant in an indirect way or directly
relevant to their professional life. Deciding which was
the principal problem and good learning experiences
were explained as those which helped this process in
an efficient manner.
Students also emphasised learning through rehear-
sal, either through repetition or by discussion with
peers or tutors. A desire for consistent approaches was
a common theme. The consistency related both to the
learning and those engaged with the teaching/dem-
onstrating. The main qualities emphasised in a tutor
are interpersonal, including being approachable and
friendly and non-judgemental.
Interestingly, through a process of reflective groups
it can be noted that the process of reflectionwas usually
an underlying, implicit or assumed function. This may
indeed reflect our own pre-occupation with content
knowledge and not the process of the learning. As
Dewey (16) and others suggested, learning occurs
when we integrate theory with practice and this theme
is highlighted in the research. However, they also
argue that learning only occurs when these experiences
are reflected upon. How often do we work with our
students upon reflection in their learning, in discussing
with them the important of the process they are
involved in? Is it any wonder that reflection, whilst
suggested as a powerful learning tool, remains under
utilised and slightly mystical to our students. The
findings suggest that reflection can be used effectively
as Schon (2) advocates to enable the practitioner to:
‘criticise the tacit understandings that have grown
up around the repetitive experiences of a specialised
practice, and can make new sense of the situations
of uncertainty or uniqueness which (they) may
allow (themselves) to experience’. (p. 61)
The findings are of value to curriculum planners
and teaching staff in dental schools. The findings
suggest specific ways in which students feel their
learning can be maximised. There are some limitations
Ashley et al.
18
to the inferences that can be drawn from the data. The
students interviewed were either postgraduates or in
the fourth year of their dental degree and it is possible
that by that point in their studies they have developed
specific learning strategies which are not as common
in earlier years of the course. Furthermore, the
findings are likely to be applicable only to dental
students, given the great emphasis placed on the
learning of practical skills, and the practical applica-
tion of knowledge. It should also be considered that
many arrangements for student learning may be in
place for sound reasons. In particular, staff may feel
that certain basic information must be understood
before students are allowed to apply their knowledge
to real-life patients.
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Address:
Prof. J. T. Newton
Unit of Oral Health Services Research and Dental Public Health
GKT Dental Institute
Kings Campus
Caldecot Road
Denmark Hill SE5 9RW
UK
Tel: 44-0171-346-3481
Fax: 44-0171-346-3409
e-mail: [email protected]
Dental students’ ‘reflection on learning’
19
