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The purpose of this study was to examine the effect of case segmentation schemes in problem-based learning (PBL) on the development of problem-solving skill, self-directedness and technical knowledge. Seventy-four dental education students were randomly assigned to 12 PBL groups. Six groups experienced PBL cases that were formatted in short segments and six groups experienced PBL cases that were formatted in long segments. Pretest measures of problem-solving skill, self-directedness and technical knowledge were administered at the beginning of the Fall 1998 semester. Students studied three PBL cases in their assigned groups in the ensuing semester. Posttest measures were administered at the conclusion of the semester. Analysis of the data found that students who experienced PBL with a short case segmentation scheme were better able to solve problems highly similar to the problems in the teaching cases than students who experienced PBL with a long case segmentation scheme. No significant differences were found for selfdirectedness, technical knowledge, or ability to solve problems distinctly different from the teaching cases. Explanations of these findings and their implications for research and practice in PBL are discussed.

Patient-centered care involves an inseparable set of knowledge, abilities, and professional traits on the part of the health care provider. For practical reasons, health professions education is segmented into disciplines or domains like knowledge, technical skills, and critical thinking, and the culture of dental education is weighted toward knowledge and technical skills. Critical thinking, however, has become a growing presence in dental curricula. To guide student learning and assess performance in critical thinking, guidelines have been developed over the past several decades in the educational literature. Prominent among these guidelines are the following: engage the student in multiple situations/exercises relecting critical thinking; for each exercise, emulate the intended activity for validity; gain agreement of faculty members across disciplines and curriculum years on the learning construct, application, and performance assessment protocol for reliability; and use the same instrument to guide learning and assess performance. The purposes of this article are 1) to offer a set of concepts from the education literature potentially helpful to guide program design or corroborate existing programs in dental education; 2) to offer an implementation model consolidating these concepts as a guide for program design and execution; 3) to cite speciic examples of exercises and programs in critical thinking in the dental education literature analyzed against these concepts; and 4) to discuss opportunities and challenges in guiding student learning and assessing performance in critical thinking for dentistry.

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The educational application of critical thinking has increased in the last twenty years with programs like problem-based learning. Performance measurement related to the dental student's capacity for critical thinking remains elusive, however. This article offers a model now in use to measure critical thinking applied to patient assessment and treatment planning across the four years of the dental school curriculum and across clinical disciplines. Two elements of the model are described: 1) a critical thinking measurement "cell," and 2) a list of minimally essential steps in critical thinking for patient assessment and treatment planning. Issues pertaining to this model are discussed: adaptations on the path from novice to expert, the role of subjective measurement, variations supportive of the model, and the correlation of individual and institutional assessment. The critical thinking measurement cell consists of interacting performance tasks and measures. The student identifies the step in the process (for example, chief complaint) with objective measurement; the student then applies the step to a patient or case with subjective measurement; the faculty member then combines the objective and subjective measurements into an evaluation on progress toward competence. The activities in the cell are then repeated until all the steps in the process have been addressed. A next task is to determine consistency across the four years and across clinical disciplines.