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Impact of the virtual patient introduction on the clinical reasoning process in dental education

Zary N, Johnson G., Fors U. G. H.

Bio-Algorithms and Med-Systems

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2012

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Vol. 8, no. 2

173--184

EN

In the Virtual patient (VP) system Web-SP, the case authoring is entirely delegated to faculty. An analysis of the virtual patients (VPs)VPs authored by faculty showed that the most common practice chosen by the case authors was to provide an introductory clinical vignette including rich anamnestic data. To evaluate the influence of the vignette, a controlled trial was conducted to determine if the absence of vignette would influence the students’ therapeutic decisions and their clinical reasoning. This double blind controlled trial randomized 57 fourth year dentistry students into two groups. Two virtual patient cases were created with the same content in both groups, but the VPs encountered by the intervention group lacked the introductory vignette. The therapy decisions and the history taking activity were scored and analysed by the course director. A stratified analysis was undertaken, stratifying by day. There were no statistically significant differences between the two groups with respect to their therapeutic decision scores (p=.16). Participants in both groups were equivalent with respect to the number of relevant medical history questions asked (p=.33) and the number of irrelevant questions asked (p=.20). This study indicates that vignettes did not have an impact on students' problem solvingclinical reasoning process. The use of detailed vignettes or case introductions might not be needed. A possible reason includes students’ prior exposure for a full semester to other VPs for course work and problem solvingclinical reasoning. Perhaps the intervention was too subtle to impact on learners at this stage of development. Clinical vignettes might have more impact at earlier stages of student learning such as early in the semester but not as preparation for final exam. The limited number of participants may have concealed differences between the groups. We also need to investigate if the one-hour limit given the students might influence the therapeutic decisions.

2

Ctenacanthiform Cladodont Teeth from the Lower PermianWichita Group, Texas, U.S.A.

Johnson G.

Acta Geologica Polonica

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2008

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Vol. 58, no. 2

205-209

EN

Isolated teeth of Glikmanius occidentalis occur in ten vertebrate faunas in the Waggoner Ranch Formation and in one fauna in the underlying Petrolia Formation. They range in size (anteromedial-posterolateral base length) from 1.28 mm to 10.15 mm (n = 12). In addition to the typical teeth, one with an asymmetrical base and one possible posterior tooth (both G. ?occidentalis), and a questionable symphyseal tooth (Glikmanius?), occur in the collection.

3

Denitions of Late Palaeozoic Orthacanthus species and new species of ?Xenacanthus (Chondrichthyes: Xenacanthiformes) from North America

Johnson G.

Acta Geologica Polonica

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1999

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Vol. 49, no. 3

215-266

EN

Orthacanthus lateral teeth have paired, variably divergent, smooth, usually carinated labio-lingually compressed principal cusps separated by a central foramen; one or more intermediate cusps; and an apical button on the base isolated from the cusps. Several thousand isolated teeth from Texas Artinskian bulk samples are used to define the heterodont dentitions of O.texensis and O. platypternus. The O. texensis tooth base has a labio-lingual width greater than the anteromedial-posterolateral length, the basal tubercle is restricted to the thick labial margin, the principal cusps are serrated to varying degrees, and the posterior cusp is larger. The O.platypternus tooth base is longer than wide, its basal tubercle extends to the center, the labial margin is thin, serrations are absent on the principal cusps, the anterior cusp is larger, and a single intermediate cusp is present. More than two hundred isolated teeth from Nebrasca (Gzhelian) and Pennsylvania (Asselian) provide apreliminary description of the heterodont dentition of O. compressus. The principal cusps are similar to O. texensis but usually(?) are not serrated, and the base is usually wider than long but has a thin or sometimes thick labial margin beneath a single intermediate cusp. A few dozen very small isolated teeth define two ?Xenacanthus dentitions. ?X. ossiani sp. nov. (Gzhelian, Nebrasca) teeth have a thin, longer than wide base with a flange at one end, an isolated apical button, a centrally extended basal tubercle, and a central foramen; the principal and intermediate cusps are recumbent, divergent, highly compressed, smooth and lack serrations. ?X. slaughteri sp. nov. (Artinskian, Texas) teeth have nearly parallel, smooth, carinated, nonserrated, compressed principal cusps and intermediate cusp; the base is thin, longer than wide, with the apical button often in contact with the principal cusps, present or absent central foramen, and basal tubercle restricted to the labial margin. The new species of ?Xenacanthus, as well as O. platypternus and other xenacanth species, appear to be endemic to North America. Other upper Palaeozoic species are endemic to Europe. However, O. compressus and possibly O. texensis are similar to some European species. Despite the Appalachian-Hercynian barrier, dispersal may have occurred in coastal marine waters during a migration phase of the reproductive cycle of some Orthacanthus species.