My Thoughts About Differentiated Instruction in Clinical Teaching

I Learn Poster

Recently I started working as an adjunct clinical instructor. In this setting I will work with dental students as they provide dental hygiene treatment to patients. I believe good teachers have an excellent understanding of the content they teach, experience with using that knowledge effectively, and that they take time to really get to know their students. Tomlinson and Moon (2013) stated that teachers should get to know their students and their leaning preferences because each student is different and has unique needs for learning. I feel it is important for teachers to be flexible in their approach to adapt to the needs of their students. Applying this concept to clinical teaching may mean that I spend extra time re-teaching previous instruction, but altering my presentation to accommodate the learning style of the student (Tomlinson & Moon, 2013). Building trust from my adult students as a new teacher and simply being new to the environment in which I am currently teaching is essential. I want them to be receptive to my instruction and trust that I know what I am talking about (Tomlinson, 2013).

coffee:tobacco stain

In class this week we discussed various ways in which differentiated instruction empowers students to make choices about their learning readiness, the process for learning and the product, which demonstrates their learning. One of the strategies that I keep thinking about in regards to the clinical teaching environment is student-teacher goal setting and learning contracts. By starting with an informal assessment of student understanding I can determine what a student knows about the learning target and then differentiate my instruction based on what I know of their learning preferences and their knowledge thus far. Student-teacher goal setting and learning contracts provide an opportunity for students, with guidance of the instructor to set a reasonable learning goal to demonstrate their understanding (Tomlinson, 2001). While teaching in the clinical setting, a student may have a patient with very heavy tobacco and coffee stain in which they are responsible for removing. An example of a student-teacher goal might be a discussion in which the student discusses plausible ways in which the stain can be removed. After they decide upon a course of action, the student carries out the process. In this same discussion, if I have gained the trust of the student they will be more likely to use my suggested approach based on my dental hygiene experience.


Tomlinson, C. A. (2001). How to differentiate instruction in mixed-ability classrooms. Alexandria, Va: Association for Supervision and Curriculum Development

Tomlinson, C. A. (2013, July 30). Differentiation and the brain: A discussion with carol-ann tomlinson [Video file]. Retrieved September 13, 2015 from

Tomlinson, C. A., & Moon, T. R. (2013). Assessment and student success in a differentiated classroom. Alexandria, Va: Association for Supervision and Curriculum.


Differentiated Instruction: Does it Really Have to be Different for Remedial Training in Dental Hygiene Education?

Concept Map for Differentiated Instruction (Tomlinson & Allan, 2000).

Concept Map for Differentiated Instruction (Tomlinson & Allan, 2000).

Great teachers routinely differentiate the content, process and product of their instruction based on student readiness, interests and learning preferences (Tomlinson & Allan, 2000). Consistent with a Constructivist approach, dental hygiene education requires students to continuously build their clinical skills on previously learned competencies. Therefore it is imperative that educators identify struggling students early in the program so that they can support them through remedial training to gain the necessary skills to successfully continue their progression through this type of competency-based education (Wood, Villalpando Mitchell, Holt & Branson, 2014).   Differentiating instruction is not only an essential task of any type of teaching, but is especially important when remedial training is indicated (Wood et al., 2014). Albers (2014) stated that when students are asked to make connections about course content material or topics with their existing knowledge they are better equipped to apply what they have learned to a greater context. Because so many skills in dental hygiene build upon previously learned information, if students do not grasp a concept early on they will likely fall behind. In a study by Wood et al. (2014) researchers found that often these students are not identified until they fail a competency exam or if and when the instructor observes their performance deficit. Unfortunately, even when a student has been recognized as having difficulty achieving a certain level of competency, these students when addressed by their instructors are often re-taught using the same teaching strategy as the first time the skill was introduced.

Differentiating instruction is important always, but especially when students present deficiencies. Dental hygiene instructors should strive to identify students that are struggling as early as possible. Once these students are identified scaffolding techniques may be applied to support student learning (Alber, 2014). When learners share their insight and experience related to concepts being taught they also provide the instructor with an informal pre-assessment, which may be used to guide their instruction (Tomlinson, 2001).   Dental hygiene educators responsible for remedial instruction should consider alternative strategies to guide student learning. Differentiating instruction could utilize peer tutoring, video, observation, and instructors acting as patients for these students (Wood et al., 2014). Other methods of differentiated instruction include learning contracts, tiered lessons, jigsaw activities, and varied questioning strategies (Tomlinson & Allan, 2000). Although the standard approaches to remedial training may be effective further research is needed to substantiate the familiar strategies consisting of one-on-one instruction with a dental hygiene instructor, Typodonts, and clinic time one-on-one with student and instructor (Wood et al., 2014). Nevertheless differentiated instruction is apparent for any struggling student.

If you are a dental hygiene educator, how do you differentiate instruction in remedial training situations? Have you utilized an “out-of-the-box” strategy that was effective?


Alber, R. (2014). Scaffolding strategies to use with your students [Web log]. Retrieved September 1, 2015 from

Tomlinson, C. A., & Allan, S. D. (2000). Leadership for differentiating schools & classrooms. Alexandria, VA: Association for Supervision and Curriculum Development.

Tomlinson, C. A. (2001). How to Differentiate Instruction in Mixed-ability Classrooms. Alexandria, VA: Association for Supervision and Curriculum Development.

Wood, D. F., Villalpando Mitchell, T., Holt, L. A., & Branson, B. G. (2014). Factors associated with clinical skill remediation in dental hygiene education programs. Journal Of Dental Hygiene, 88(1), 13-19.

Learning Style and Preferred Ways of Thinking


This is the first week of my class, differentiated instruction. Similar to other classes I was asked to create a mind map of my initial thoughts prior to reviewing the course material for the week and then again after. Here you can see my initial thoughts (very limited!) of what I believed to be differentiated instruction in green. Thoughts and connections I have concluded after viewing the unit readings and videos are visible in purple. Working on this mind map has helped me understand how my instruction, evaluation and assessment of students can be adversely affected by my learning strengths and weaknesses. I have also realized that differentiated instruction is much more than simply adapting a learning activity from one type of media to another.

The assignment this week was to complete a learner sketch activity (“Your Learner Sketch,” 2015) in which these factors were described at the end in a report. In my work as a dental hygienist, I can see how I use my strengths to benefit the care I provide to my patients. In this same way, I could also identify with ways in which I can build on my weaknesses to further benefit patients in my care. For example, one of my strengths is to express my thoughts verbally.   So often I have only provided instructions to my patients in this way. I am humbled to realize that I have always done it this way, with little regard for putting these instructions in writing. This is not to say that I have not been aware that some individuals learn better with written information versus verbal, but to some capacity I have often thought that because I am so good at providing verbal instruction, perhaps they will not need anything more. However, there are some that I have taken another step to provide this to them, but more often than not I have not. So really, what I recognize to be most important is that regardless of how clear I feel I have spoken, for those who learn best from written information it is best to vary my instruction to meet those patients’ need.

To my colleagues I would suggest that you become familiar with your learning strengths and weaknesses.  It is important to know these because they will influence your preference for instructing and assessments, including your general evaluation of student work (Sternberg & Zhang, 2005). Recognize that your students are very likely to have different strengths and weakness that yours.   Within any class you teach some students will not need nearly as much support as others (Tomlinson, 2012). It cannot be overstated that varied instruction is a must (Gardner, 2009). Although some methods of teaching will feel more comfortable than others, a varied approach ensures that all students will be addressed in the way they prefer at least some of the time (Sternberg & Zhang, 2005). Instead of looking at the classroom as a whole, try to observe the differences between students and visualize both the classroom and you as their teacher, from each of your student’s perspective (Tomlinson, 2001).

We are all learners whether in a formal or informal way does not matter. What matters is that you identify what your strengths and weaknesses are and try to find ways in which to improve them. In the education environment try to find ways to modify what you are learning to utilize your strengths so learning is not so difficult.


Your learner sketch. (2015). Retrieved from

Gardner, H. (2009, November 7). Howard gardner of the multiple intelligence theory [Video file]. Retrieved from

Sternberg, R. J., Zhang, L. (2005). Styles of thinking as a basis of differentiated instruction. Theory Into Practice, 44(3), 245-253.

Tomlinson, C. A. (2001). How to Differentiate Instruction in Mixed-ability Classrooms. Alexandria, Va: Association for Supervision and Curriculum Development.

Tomlinson, C. A. (2012, July 10). What is differentiated instructions [Video file]. Retrieved from

Get to the Point…Because You’ve Lost Me!

Do you see what I see? - Blog pic

It’s becoming clearer to me why it is so important for educators to understand where their students are coming from, meaning what is their social background? What is their perception of what I am teaching? Do they understand? Am I challenging them enough? Or too little?  Over the past few weeks I have found a few things particularly insightful. This past week I finished reading one of the supplemental reading materials for the class,  Making Learning Whole: Seven Principles of Teaching Can Transform Education by David Perkins.  The author’s ideas are thoughtful, intelligent, clever and adaptable.  Although I found all seven principles to be constructive, I’d like to focus on the fifth and sixth principles: Uncover the Hidden Game and Learn From the Team…and Other Teams. The most recent discussion in class was interesting too, that of cognitive illusions.  I’ve titled this blog post “Get to the Point…Because You’ve Lost Me!” because I feel it summarizes my personal feelings about experiences I’ve had as a student when the information that was being taught, just didn’t “click” to me.  What I’ve learned in the past few weeks has enlightened me as to how I can teach students in a manner they can relate.

“Uncover the Hidden Game”

You can think of this as discovering the strategy behind what makes the “doing” part of what is learned possible.  What is it that makes someone really good at what they do?  It’s the details, the step-by-step approach that is sometimes intuitive, something we just know because it is.  This is what we need to help students to discover.  When students learn the skills or necessary steps (even if they seem obvious) to really excel at doing something, only then are they equipped to understand the complexity of learned material and how it relates to the “big picture.”  To give you an idea of the hidden game within the field of dental hygiene, there is the “game” of time management.  There are a number of things that need to be addressed within a dental hygiene appointment and having the skills to do so are not necessarily something you explicitly learn how to do in school.  Interpersonal skills are an essential skill for dental hygienists because they work to build constructive, professional relationships with their patients, dentists, assistants and other dental hygienists. Just because a hygienist knows how to scale teeth, does not make them good at their job.  Teaching students the essential skills while also helping them to discover the hidden games will assist them in better understanding and job performance (Perkins, 2009).

Thinking cap - blog pic













“Learn From the Team…and Other Teams”

Perkins’ sixth principle discusses how participation structures can engage learners in a social interaction that fosters learning from others, learning together and learning how to apply concepts in other contexts (Perkins, 2009).  In my work as a hygienist we may recognize this as a community of practice – like a Facebook group for dental hygienists.  The community offers support and guidance to find and/or offer solutions to practice-related issues.  It is a place for learning and sharing experience, so that those with greater experience can share to those with little.  In a similar manner, “newbies” contribute fresh perspectives of which those with experience may not have considered.

Some of the teaching strategies Perkins (2009) suggested are: Pair Problem Solving, Cross-age Tutoring, Studio-Learning, Debate, Jigsaw Methods and Problem-based Learning.  All of these I think can be adapted for dental hygiene education.  One of the things I’ve always thought would’ve been nice as part of my education is the idea of Studio-Learning (Perkins, 2009) for learning about the process of a dental hygiene services in a real “appointment” setting.  It would give students the opportunity to watch how a dental hygienist works “in the real world,” but in school where students can ask questions, critique the process and reflect on their own practice.  This strategy would enable students to “Learn from the Team” and to “Uncover the Hidden Game.”

Cognitive Illusions

Cognitive “illusions” are pieces of information that has been conceptualized incorrectly, basically bad information that is regarded as true by an individual (Cognitive Illusions, 2011).  Sometimes these illusions can be controlled to some degree by the individual, but more often than not it is a misperception that cannot be interpreted by the person in any other way.  Every so often this may mean that students will need to unlearn or rectify their illusions first in order to create an appropriate new connection of the information in their mind.  This is easier for students and teachers to accomplish if the illusions are known, but unfortunately this is often not the case.  For this reason, it’s important for us as educators to think outside of the “box” to present information not only from our perspective but from others’ as well.  In my early experience as a dental hygiene student I recall an illusion I held about exploratory (examining) strokes with curettes.  I thought that it was necessary to apply pressure to the tooth surface as I explored and because I thought this was the right way I had trouble adapting any related information the teacher provided.  The illusion I held about exploring limited my ability to perform the skill effectively.  It took a few attempts from different instructors on separate occasions to “get through” to me where I was finally able to let go of the illusion and truly perform.

The topics I’ve discussed here, in addition to the others I’ve mentioned in the previous two posts will help me to find ways that make learning meaningful, interesting for me personally, and applicable in other areas of my life.  As a future educator these connections are worthwhile and I’m taking them with me!


Perkins, D. (2009). Making learning whole: How seven principles of teaching can change education. San Francisco: Jossey-Bass

Cognitive Illusions. (2011). World-Mysteries. Retrieved February 19, 2015 from:

Additional Sources

Pair Problem Solving, also known as Think Aloud Pair Problem Solving (TAPPS).

A research article – The dark side of cognitive illusions: When an illusory belief interferes with the acquisition of evidence-based knowledge.

Yarritu, I., Matute, H. and Luque, D. (2015), The dark side of cognitive illusions: When an illusory belief interferes with the acquisition of evidence-based knowledge. British Journal of Psychology. doi: 10.1111/bjop.12119

What can we learn from cognitive illusions, art, and children? Drawing the Light by Black Elephant Blog

How Can I Say This Differently? Are You Listening To Me?


In the past two weeks I’ve been learning about motivation, emotion and attention.  I wanted to write a little about this because of how closely they relate to dental hygiene and  how they influence each other.  Recently I was talking with a friend (non-dental related) who shared her thoughts about going to the dentist.  She said “I always get anxious about being scolded.” My first thought was: She’s not flossing.  Maybe it’s true, maybe it’s not. Regardless, as a dental hygienist and future educator I know I shouldn’t start a conversation by telling her what I think she needs to do.  I’ve learned that negative emotions can be a distraction, dividing a person’s attention away from me, and limiting their ability to process incoming information (Gazzaley, 2011).  Furthermore, emotions effect our drive for action, but if a person feels as though they have no choice, they may rebel against what has been suggested simply because it was not their decision (Thagard, 1996).  As dental hygienists and educators it’s important to be able to interpret the emotional state of our patients or students.  It’s our nature to want to help people, but we need to have a clear understanding of our students (or patients) so we can create a supportive environment that inspires curiosity and makes learning worth it.

Are you Listening to me???

When I think about teaching I conjure up a picture of a group of students or a patient looking me in the eyes with their full attention.  This may not always be the reality, but I know that in order for someone to learn, they need to be present, in the moment; I need their attention.  Thagard (1996) stated that emotions shouldn’t be viewed as this annoying, random characteristic of being human, but rather something that is closely related to a person’s appraisal of what’s going on, not only in their mind but of what’s going on around them. Emotions have a big impact on a person’s ability to pay attention.  If we can’t have their undivided attention, communication can be misinterpreted or completely dismissed.

Using the example of my friend who feels anxious about going to the dentist, her anxiety will undoubtedly have an effect on her desire to pay attention and be open and receptive to what her dental hygienist has to say.  Emotions impact a learner’s motivation in both good and bad ways.  Thagard (1996) described emotions as the result of neuron firing patterns in the brain that are connected to and defined as images, mental representations, and analogs (their feelings related to the situation). The emotional connection will either increase or decrease the learner’s motivation depending on how the mental representation is interpreted.  Perkins (2009) stated that intrinsic motivation was a better predictor of academic success than extrinsic motivation, which is especially true for adults.

Miller and Rollnick (2009) discuss motivational interviewing as a model of conversation to “increase the client’s strength of expressed motivation for a target behavior change, and to diminish defenses of the status quo” (p. 135).  Patients are likely quite accustomed to the typical approach in dental settings of Show-Tell-Do, where we show them what’s going on, tell them what to do and hope that they will decide then that what we’ve  told them is what they want to do, but usually this isn’t the case.  Bray, Catley, Voelker, Liston, & Williams (2013) stated that motivational interviewing “is characterized by an underlying philosophy or “spirit” that encompasses partnership, acceptance, compassion and evocation (of patient motivation and strengths) as well as specific processes…and skills” (p. 1662).  The point is that patients and students alike have both extrinsic and intrinsic motivations.  Their emotional state and motivation influences their perception and drives their attention (Gazzaley, 2011).

Make “The Game” Worth Playing

Perkins (2009) talks about making “the game” worth playing by finding topics that our students (or patients) can relate.  Find something that sparks curiosity makes them want to learn.  Support learners by providing small, approachable step-by-step skills or goals that will help to build their confidence in pursing something new. “The game” is the big picture. It’s what we are trying to help our students (or patients) to learn.  Perkins (2009) stated “one fine way of stoking enthusiasm is choice…when learners feel that they have a choice about just where they focus their attention and just how they proceed, they are more likely to show intrinsic motivation and, along with, this broader deeper learning” (p.71).

Finally, with regard to my anxious friend, if her dental hygienist was receptive to her emotional state and considered ways in which to make “the game” worth playing my friend might one day feel differently about her future dental visits.  Using the approach I’ve discussed here she could be supported in a way that positively influences her emotions, fuels her intrinsic motivation, and directs her attention toward learning.

Homer Simpson - Have you been flossing?


Bray, K. K., Catley, D., Voelker, M. A., Liston, R., Williams, K. B. (2013). Motivational interviewing in dental hygiene education: Curriculum modification and evaluation. Journal of Dental Education. 77(12)/1662-9. Retrieved February 8, 2015 from:

Gazzaley, A. (2011, April 17). TEDxSanJoseCA – Adam Gazzaley, MD, PhD – Brain: Memory and multitasking. Retrieved February 6, 2015 from:

Miller, W. R., Rollnick, S. (2009). Ten things that motivational interview is not. Behavioural and Cognitive Psychotherapy, 37, 129-140. Retrieved on February 8, 2015 from:

Perkins, D. (2009). Making learning whole: How seven principles of teaching can change education. San Francisco: Jossey-Bass

Thagard, P. (1996). Mind: Introduction to Cognitive Science. Cambridge, Mass: MIT Press.

Additional Resources

Motivational Interviewing in Dental Hygiene Education: Curriculum Modification and Evaluation – An article from the Journal of Dental Education, December 2013.

Motivational Interviewing: Helping People Change (Applications of Motivational Interviewing) – A book for clinicians to help guide people and foster their intrinsic motivation to create change.  Available on

Consciousness vs. Subconscious Thinking – A video by Sentis

Three Implications for Teaching with a Cognitive Approach

The brain - neurons firingTomorrow is the beginning of week 4 and the subject matter is both fascinating and thought provoking. Here, I’d like to provide “Honorable Mention” to three implications I’ve concluded thus far.

Implication #1

 Artificial Intelligence is on the rise, and so are we (as educators).

Artificial intelligence (AI) is becoming more prominent in our day-to-day lives – like Siri on your iphone, or on a more basic level, those blasted recordings we refer to as phone-trees when you call the bank. AI is getting “smarter” every year and has the potential to make learning personalized and fun! It may be a little intimidating that AI technology is advancing so quickly, but there are still things that remain difficult to achieve such as the human quality of free will and the sense to know that which they do not understand. Bostrom (2012) stated, “an agent [AI] might not value knowledge and understanding for their own sakes” (p. 79).   It is this type of statement that is both reassuring, because AI is not human, but it’s also a little disconcerting that the value of AI as being anything is being considered. The good part is that AI is getting better and better and will have positive effects on education, without replacing teachers.

Implication #2

Everyone has their own logic, but as educators we help students learn by creating and altering the rules that define their existing concepts.

Thagard (1996) states, “rules can be learned by inductive generalization, in which examples are summarized by means of a rule… with experience you can use a higher­-level rule” (p.49). Although it may not be possible for students to learn everything, understanding that we, as educators have the capability to make even a small computational changes to existing representations in the students’ minds, will have an effect on learning. True learning may not occur at the moment in time we desire, but given enough exposure to specific examples and scenarios, a student’s logic will change because their rules will have changed. In the video How We Learn – Synapses and Neural Pathways Rogers (2010) explains how learning new information is like crossing a ravine for the first time. A first it is difficult and slow, but with repeated experience (repetition) the “bridge” to new knowledge becomes easier and quicker.

Implication #3

Learning styles are varied, and so shall your teaching approach.

After taking a quick online assessment of my learning style I was able to identify, well actually it was more like a verification of what my learning preferences are and what they are called. Then, using suggestions by Felder and Soloman (n.d), I read about both the benefits and challenges of my learning style. While I found the information helpful from the perspective of a student, as a future educator it stands to say that my learning style is only one of many ways in which individuals prefer to receive information Willmingham (2008) suggests that our memories or representations are stored in one or multiple sensory formats. Which is to say, that although students may have a preference for how they obtain and recall information, the teaching approach can and should be varied. Cummings (2009) suggests that if you want to reach all of your students you need to ask them to write it, say it, do it.

The post-its








Bostrom, N. (2012). The superintelligent will: Motivation and instrumental rationality in advanced artificial agents. Minds & Machines, 22(2), 71-85. doi:10.1007/s11023-012-9281-3

Cummings, K. (2009). Teaching Strategies – LearningStyles [Video file]. Retrieved January 20, 2015 from

Felder, R., & Soloman, B. (n.d.). Learning Styles and Strategies. Retrieved January 20, 2015 from

Rogers, R. (2010). How We Learn – Synapses and Neural Pathways [Video file]. Retrieved January 20, 2015 from

Additional Resources

Here is a link to the online assessment questionnaire I used from Felder & Soloman, North Carolina University. Learning Styles Questionnaire.

How Does the Brain Learn Best? Smart Studying Strategies by Mindshift.







The Good and Bad of Open Educational Resources


Today there are so many ways that technology facilitates learning both in and out of the traditional classroom. Open educational resources (OER) are one type of technological advance that is likely to flourish over the course of many years to come. And why wouldn’t they? Like countless other things in our society that are just a Google search away, education can now be obtained in just a few clicks of your mouse. One of the greatest benefits is accessibility to anyone who has an Internet connection. OER is accessible to any one regardless of social status, past academic success, or income. Students of any kind – young, old, non-traditional or international, have the ability to access a free education. Of course with anything that elicits public interest and demand, there is competition. Where there is opportunity for financial gain, there is commercialization. While some educational institutions are in competition to be the best, biggest, and most well known, for others it has become a personal mission to improve education for all (Bonk, 2009). Although there is controversy in this area of OER, “any technology trend opening the world of learning today will increase its momentum and power” (Bonk, 2009, p. 391).

As with any great and shiny new idea, there are often disadvantages as well. One of the challenges with OERs is copyrights and licensing. Although contributors to OER hold the copyright to their material, they still can still fall victim to someone abusing their material, let alone having it misconstrued or criticized. And, “What if people share knowledge that is confidential, improper, or unauthorized?” (Bonk, 2009, p. 377).   Tracking someone down for unlawfully using your work is no easy task. Obtaining the proper copyrights and licensing can be cumbersome and time consuming for both the contributor and for instructors looking to use someone else’s work. The technologies we have today makes sharing information quick and easy, but just because it’s easy does that make it our civic duty to share? Some people think so. These are valid questions instructors should consider before contributing to OERs.

What are your thoughts? Educators: Would you consider submitting to an OER? Why or why not?


Bonk, C. (2009). The world is open: How web technology is revolutionizing education. San Francisco, CA: Jossey-Bass.

Related information is the leading online Global Directory of Massive Open Online Courses (MOOCs). Here you will also find links for higher education MOOCs and K-12 MOOCs.

Is Dental Education Ready for MOOCs? From

An update for the design of my learning activity…

Seeing as though I have no experience in formal teaching, it has been challenging to design a learning activity for the final project. I’ve decided to go back to my original idea of having the focus be on toothbrushing techniques. I’m planning to have the students create a video to post on YouTube of their experience providing patient education to a friend or family member. Students will post their videos with a private link (unless the student and friend/family member choose otherwise). Then they will post those links to Blackboard for classmates and the instructor to gain access for viewing. The creation of novice videos on smartphones is likely something familiar to most students. Bridging activities in their personal life with school will hopefully be a fun experience for the students and promote metacognitive thought in order to complete the activity.