Professional Documents
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An Integrative Approach in the Discovery of Why Some Students Perform Well in a Classroom
Setting but Not a Clinical Setting and How to Help Them Succeed
Introduction
This essay is the culmination of my past work in IS 301 for my capstone project to earn
and discussed its importance, relevance, multidisciplinary facets and possible approaches for
solutions. In the next series of essays, I will go into more detail regarding this complex problem,
the absolute need for a multidisciplinary approach and, in the later essays, the strengths and
The complex problem that I am going to be discussing is, why do students who perform
well in a classroom setting have trouble performing well in a clinical (mock real-life clinic)
Medical programs are rigorous and demanding programs that students often struggle
through. This is something of no surprise because the medical field is a very difficult,
meticulous, and technique sensitive area of study. A simple mistake could be the difference
between life and death for a patient; for this reason, the training of medical professionals is one
that is strict, exact and seemingly unforgiving. Unfortunately for many situations in medicine,
there is no gray; it is black or it is white. Likewise, with many medical programs, they require
their students to pass their classes with a 75% or higher to continue on. If they cannot earn that
grade, then they simply cannot continue in the program. The reason for this is not to be cruel and
unforgiving, on the contrary, the faculty are preparing the students for the future. In the case of
most medical boards and exams, the student has to pass with a 75% proficiency or higher, if they
cannot do so, then they will not earn their license or certifications (Chemeketa Dental Assisting
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Program Handbook, 2016, p.8). Yes, they can be granted the opportunity to retake, but this will
cost the student time and money. However, even with the opportunity to retake, the simple fact
remains, if the student does not know the information, they may fail again. This is the reason for
why educators set the 75% standard for their programs, so that the students can begin to prepare
The complex problem that I have chosen to investigate looks into why some students,
who do well in the lecture (written) portions of medical programs have trouble in the clinical
(mock real-life clinic) portions of the program. Medical programs are composed of two parts; the
lecture portion, or didactic, is where students listen to lectures, take notes, participate in in-class
activities and ask questions in order to supplement their textbook readings. They are also
expected to take tests and quizzes and write essays. The other part found in medical programs is
what is called the clinical portion. This is where the students will perform what they have
learned in lecture. Often times they will do this in a mock-clinic that is designed to simulate a
real-life medical setting. The clinical portion involves using motor skills in the application of
cognitive learning rather than simple study skills. I have explained the two portions of a medical
program to clarify the fact that I will be limiting the scope of this study to why students who do
As instructors, we want to see our students succeed. Any good instructor wants the best
for their students. The medical field is booming and we need more trained professionals every
day. Unfortunately, the pool of qualified medical professionals is lacking. To give one example,
in the Willamette Valley Area, there is a shortage of dental assistants. So much so that for the
first time in over 20 years, major companies like Kaiser Permanente and Willamette Dental are
offering sign-on bonuses of $1,000 dollars in addition to very competitive hourly wages and
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benefit packages for any dental assistant who is willing to come to work at their company
(Chemeketa Dental Advisory Meeting, 2017). If medical programs are losing students due to
incompetency clinic, then they are not able to satisfy the needs of the community, which is what
the program is there for in the first place. Not only this, but also, in the case of the student,
failing a program means that they have spent time, money and resources that they will not get
back. Many times, failing a program can be a blow to their confidence and set them back so
much financially that they must join the work force and postpone returning to school
sometimes indefinitely. Therefore, failing out of a medical program is not something that is
desirable for the student, for the college, or for the medical community. While some students
perform poorly in all aspects of their studies, there are other students who seem to only be failing
in one aspect. Unfortunately, in a medical program, this one aspect is enough for them to fail out
completely. This is why when a student who would otherwise be considered a good student
(because they are passing their lecture portions) fails in clinic, it is both sad and puzzling to their
instructors.
The answer to this question is one that involves insights from many different
perspectives. In fact, the intricacy of this topic embodies the very essence of a complex problem.
In the book Introduction to Interdisciplinary Studies, the definition of a complex problem is one
that has multiple parts and that each part is studied by a different discipline (Repko, Szostak, &
Buchberger, 2017). The complex problem that is the topic of my studies cannot simply be
addressed from the technical medical program vantage point; if this were to be the case, both the
explanation and solution would be limited. The simple answer for why a student performed
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poorly on a test could be that they did not study. However, in clinic, performance is not merely a
reflection of how well a student can retain information. It involves much more. This aspect of
why a studious student seems to blank in the clinical setting. To name just a few, it could be due
to outside pressures such as family, finances, and personal conflict. These issues could call upon
the discipline of psychology to investigate further into their effect on a students ability to
perform. Another possible explanation could be the students own bodys stresses and internal
struggles physically inhibit their abilities in clinic. This issue would be more related to the
discipline of physiology. The point is that it is not just a matter of the students ability to study
well, like the medical career technical discipline might expect and has expected up until now.
the above section, when students fail, they lose money, time, confidence, and the prospect of
working in a field that contributes to society. Therefore, it is important to find the reasons
causing students to underperform in a clinical setting so that they may succeed in all aspects of
The complex problem of why a student performs well in the lecture, or classroom setting,
but not the clinic, or hands on, setting is one that could involve a number of different disciplines.
The first and most obvious discipline is that of Health Sciences, a career technical field, because
they clinic they are in is based in a Health Sciences medical program. Aside from that, other
communications. A few, but not all, potential interdisciplinary fields could include cognitive
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neuroscience, and biological psychology. In regard to the education field, it could be that the
student is not understanding the way the clinic instructions are given versus how instructions are
given in the lecture classes. Scholars from the education field may look to different teaching
strategies to suit different learning styles and not only learning styles, but they also strive to
teach in ways that help promote retention. Psychology, physiology and biology would probably
approach the problem from the bodys reactions. Is the student too stressed? Is the stress of their
body causing them to perform poorly? Are there outside sources in their family or personal life
that have caused the student to lose focus in clinic? In the communication field, scholars might
presume that the student knows exactly what they need to do on the clinical check-off but they
cannot communicate effectively enough in order to pass. This list of potential disciplines is not
exhaustive and this complex problem could likely apply to many other disciplines, however,
there are certain disciplines that I have found to be most relevant to this problem.
The disciplines of psychology and physiology are two that I have focused my studies on
for this complex problem. The first will be discussed in more detail in the following section of
this essay. These two disciplines had extensive research that could apply to this problem. Other
disciplines had some research but not as much, and not as high of quality as these two that I have
chosen. The second reason that I chose these two disciplines is that they are congruent with
student feedback. Because I work in a medical program where I see students fail clinical check-
offs, I get to talk to students after theyve failed and they usually have an explanation for why
they think theyve failed. Many times, the reason they give are similar to those that apply to the
psychology and physiology disciplines. Their intentions were good, they studied, but when it
came time for the clinical check-off, they were overcome by emotions or stress and they could
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not do what they had practiced. This is why I felt that these two disciplines were the best to focus
Further research into different disciplines has reinforced the fact that this complex
problem is truly an interdisciplinary one. For example, a peer reviewed journal article from the
education discipline discusses middle school student difficulties with retention in certain virtual
science laboratories versus physical laboratories (Chiu, DeJaegher, & Chao, 2015). In fact, this
study confirms that combining virtual and physical labs has the potential to promote science
learning (Chiu et al., 2015). This article can be beneficial to the complex problem that I am
researching because the classroom experiences that the article discusses could be likened to the
lecture portion of medical programs and the physical lab could be likened to the clinical
portion of medical programs. This research study found that physical labs that are supplemented
with virtual labs can promote better learning; this, then, poses the question, could virtual labs be
implemented into medical programs? If virtual labs were to be implemented, maybe they could
help students who were struggling in the physical clinic. This is one example of an insight that
While many of the disciplines mentioned in the STEP above could apply to the complex
problem, in reality the most relevant disciplines are psychology and physiology, and their
insights speak for themselves. For example, psychological effects such as family problems can
be a contributor to a students failure. They may be dealing with problems at home but the
emotional baggage that goes along with these problems does not stay at home, they may
unintentionally bring their worries with them to class. An online stress management website
states that, emotional stress can make you seem scattered and unable to focus (Brinser,
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2007). A student who is unable to focus would not perform well in a check-off, even if they were
doing well prior to their home problems. By looking at the problem through a psychological
Another aspect to the psychological approach to this problem is the ability to recall
information. A check-off requires memorization of steps in sequence and the ability to imitate an
action that was previously seen performed by the instructors in their demo. In medicine, the
order in which materials or instruments are utilized is crucial to the end result; therefore, if a
student cannot remember the steps of a check-off (which are designed to emulate real life
medical procedures), they will not be able to pass the class. In the book, Handbook of Stress
Neuropsychological Effects on the Brain, Cheryl Conrad states intrinsic stress [...] at extremely
high levels can have adverse effects on memory-related processes (2011). A student who is
severely stressed will not be able to recall the order of which a check-off is to be performed.
The literature research found from the physiology discipline fits the complex problem
just as well as insights from the psychology discipline. By dictionary definition physiology is
relating to the way in which a living organism or bodily part functions. To approach the
problem in this sense would be to acknowledge that stress not only affects students mentally (as
in the case of the psychology discipline) but also physically, which pertains to physiology.
Check-offs are tests in which students have to physically show that they can perform tasks that a
this may hinder their ability to perform well on a check-off. According to WebMD, stress can
lead to physical symptoms including headaches, upset stomach, elevated blood pressure, chest
pain (2016). If a student were to be experiencing these types of symptoms during a check-off
this would no doubt affect their physical performance. Feeling nervous before an exam, test, or,
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in this case, check off, is a normal occurrence; however, if the student experiences more than just
the normal pre-test jitters, and it becomes a constant, prolonged feeling of stress, other
physiological problems may arise. A second theory of the physiological discipline can be
illustrated by this quote from The Mayo Clinic, the long-term activation of the stress-response
system and the subsequent overexposure to cortisol and other stress hormones can disrupt
almost all your body's processes (2016). Long term stress, caused by entering the clinic and
having to perform physical tasks on a weekly basis for 10 weeks at a time, could be what is
STEP 5: Critically analyze the disciplinary insights into the problem and locate their
sources of conflict
When looking at multiple perspectives, there are always sources of conflict or varying
opinions. The point of looking at a problem from multiple disciplines is to gain the insights of
various sources from different vantage points. While the pro to this action is to gather more than
one perspective, a con is that at times these perspectives can diverge or even contradict each
other. According to the textbook, it is almost a certainty that when comparing different
disciplinary insights on the same subject, [] they will conflict at one or more points (Repko et
al., 2017, p. 314). However, it is an essential part of integrating multiple disciplines to identify
To begin with, it is important to understand the key elements of the most important
disciplinary insights. The psychology discipline views the problem of a student underperforming
in clinic purely from a mental standpoint. The insights observed focused on stress being the key
principle as to why students do not perform well on tests. For example, according to Cheryl
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Conrad (mentioned in the section above), stress at extremely high levels can have adverse
effects on memory-related processes (2011). The research from the psychology standpoint holds
firm that a students underperformance is due to internal struggles that distract them come test
time. A student who is stressed, no matter how well-prepared, will have difficulty performing on
a clinical check-off. The physiology discipline acknowledges that stress not only affects students
mentally (as in the case of the psychology discipline) but also physically. Feeling nervous before
an exam, test, or, in this case, check off, is a normal occurrence; however, if the student
experiences more than just the normal pre-test jitters, and it becomes a constant, prolonged
feeling of stress, other physiological problems may arise. These problems could be things such as
headaches, upset stomach, elevated blood pressure, chest pain (Goldberg, 2016).
While both disciplines view the reasons for poor performance as something mental, the
physiology discipline sees the mental problems and looks one step further. The physiology
more depth. Both disciplines agree that the problem is something that is internal and out of the
students control, for the most part. However, the discipline with the conflicting insight is the
education discipline. The insights from that discipline mainly focus on the teaching style as the
root of the students problem. The assumptions of the education insight look more to the
instructors as the means of improvement. Referring back to the insights from the education
discipline in the above sections, they implied that students may be more successful if physical
clinical situations could be supplemented by other labs, such as virtual ones (Chiu et al., 2015).
This key concept conflicts with the physiological and psychological concepts in that they are
directing the problem more towards the teaching method versus the person being taught. If a
disciplinarian from each area were to give their insights regarding this complex problem, it is
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likely that the psychology and physiology disciplinarians would find common ground because
their epistemological bases are similar whereas the disciplinarian from the education field might
disagree.
Disciplinary Tables
Author Disciplinary Thesis Assumptions Theory Key Method Phenomena Authors Bias
Perspective Name Concept(s) Addressed
Conrad Psychology Intrinsic Stress is the Adverse Stress is a Clinical Effects of That stress is the
stress at cause of Effects dynamic testing stress on the only internal
extremely memory of Stress factor in human body factor occurring
high problems memory in the subject;
levels can capacities inadequate
have Stress is the memory
adverse main cause for Stress is not performance
effects on poor just a feeling could be due to
memory- performance but a trigger additional factors
related for more
processes symptoms
Author Disciplinary Thesis Assumptions Theory Key Method Phenomena Authors Bias
Perspective Name Concept(s) Addressed
Mills, Physiology Stress Frontal lobes Stress Frontal Clinic Physical Stress is the
Reiss, & hormones are important Hormones lobes are observation effects of only physical
Dombeck can decrease to judgment Affect integral to stress on the factor
the functions Frontal filter out human body accountable
of neurons in Hippocampus Lobes irrelevant for poor
both the affects information performance
hippocampus decision and to use
and the making judgment to
frontal lobe solve
area Stress is the problems
main
attributable
factor
After researching and analyzing this complex problem over the course of these essay
assignments, I have come to realize that my thoughts and original assumptions were incorrect.
Coming from a career technical, highly specialized medical programs view, when students
failed it was always due to under preparation. Forcing myself to view the problem from multiple
disciplines showed me that there are a number of reasons why students struggle in school. These
reasons can vary from academic abilities to personal problems outside of school to involuntary
body responses. After completing research from the epistemology from each individual
discipline, I have come to see that each discipline has their distinct and very valid assumptions,
There is much merit in the insights of each discipline and those that study and set their
focus solely for their discipline. However, what surpassed my appreciation for the diligence that
contribute to a solution of a complex problem. In the case of the complex problem that is the
subject of this essay, a single discipline would have given a solution by fixing either the student
addressing the problems that the student is experiencing both internally, externally, and possibly
Viewing problems and situations from an interdisciplinary perspective is not just a skill
that proves useful in the classroom. This is a skill that I will take on to my everyday life both
professionally and personally. Viewing anything from a one-sided approach is often frowned
upon. In arguments or discussions, many times you are urged to put yourself in the position of
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the opposing side; interdisciplinary thinking is just that. It is not only viewing things from the
opposing side, but it is viewing things from all sides. If I continue to use this style of problem
solving outside of the classroom, I will be giving myself an advantage of not only being more
open minded, but also finding better, more thorough and comprehensive solutions.
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References
Brinser, L. (2007). Psychological Effects of Stress. Psychological Stress Is Real! Retrieved from
http://www.stressaffect.com/psychological-effects-of=-stress.html
Chemeketa Community College. (2016). Dental Assisting Program Handbook. Salem, OR.
Chemeketa Dental Advisory Meeting. (2017, October). Dental assisting advisory committee
Chiu, J. L., DeJaegher, C. J., & Chao, J. (2015). The effects of augmented virtual science
laboratories on middle school students' understanding of gas properties. Computers &
Education, 85, 59-73. Retrieved from
http://www.sciencedirect.com.access.library.eou.edu/science/article/pii/S0360131515000
512
Goldberg, J., MD. (2016). The Effects of Stress on Your Body. WebMD. Retrieved from
http://www.webmd.com/balance/stress-management/effects-of-stress-on-your-body
Mills, H., PhD., Reiss, N., PhD., & Dombeck, M. Ph.D. (2008). Mental And Emotional Impact
impact-of-stress/
Repko, A. F., Szostak, R., & Buchberger, M. P. (2017). Introduction to interdisciplinary studies