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Integrative Approaches Essay

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
Melissa Del Real
Eastern Oregon University


The definition of interdisciplinary studies is a process in which people draw on
disciplinary perspectives and integrate their insights and modes of thinking to advance their
understanding of a complex problem with the goal of applying the understanding to a real-world
problem (Repko, Szostak, & Buchberger, 2014, pg 28). In this introductory course to Integrative
Studies I have learned to begin thinking in this manner. While I have been integrating theories
and modes of thinking throughout my entire academic career, it was not until I began this course
that I realized there is a defined and organized way to go about this process; this course has
guided me to explicitly outline my manner of thinking in a way that allows me to more
efficiently solve problems. The following essay is a reflection of what I have learned during
these past nine weeks. It will consist of two major parts. The first part will be a process of selfexamination as I evaluate my methods of thinking in accordance with the Theories of
Interdisciplinary Studies found in our principle textbook. The second part of this essay will
combine aspects of my first two essays to answer the complex question that I posed at the
beginning of this term.

Evaluation of Learning
In terms of the complex questions that I have identified, I know that the Complexity
Theory has proven to be true. At the core of the theory is the fact that the problem must be
complex enough to involve multiple disciplines. If the problem were able to be answered
proficiently through the ideals of a singular discipline, it would be a simple problemnot a
complex one. By selecting my complex problem at the beginning of this term, I had to
understand and accept the complexity theory to choose properly. The problem that I chose is a


health sciences based problem that can draw on the disciplines of psychology and physiology to
understand the behavior as a whole (Repko, Szostak, & Buchberger, 2014, pg 127) by
integrating the insights from [these] relevant disciplines.
When it comes to the Perspective Taking Theory, I have considered the complex problem
at hand from two different disciplines. By viewing the problem through the insights of
psychology and physiology, this means that I have had to remain unbiased. My first instinct is to
view problems from my preferred discipline of health studies; however, in my attempts to apply
this theory, I have had to ignore these preferences and perceive the problem from the other
disciplines perspectives. While viewing these two disciplines I have been able to develop a
better understanding of the causes of academic underperformance due to stress. One thing that I
have yet to see in regards to this theory is how disciplines may conflict. In the case of my
complex problem, the disciplines of psychology and physiology were so closely related that
sometimes it was hard to remember which discipline I was researching. To understand this theory
better, I would have to examine a complex problem in which the disciplinary perspectives
conflicted and still be able to make a creative connection to devise a solution (Repko, Szostak,
& Buchberger, 2014, pg 128).
By understanding and applying both of the above mentioned theories, the third theory
has, in essence, already taken place. When I viewed the situation from multiple perspectives, the
Common Ground was present because many of the psychological factors cause physiological
effects. According to the textbook, finding common ground is necessary when disciplines are
conflicting (Repko, Szostak, & Buchberger, 2014, pg 131); I did not find this to be the case in
my particular complex problem. Again, I feel like this would be an aspect I would need to learn


more about in the future because I did not get to experience finding common ground with
conflicting disciplines in my current scenario.

The Integration Theory

The fourth theory found in the textbookthe integration theorymost appropriately fit
my complex problem. Although this theory can be viewed as controversial, I feel that it is the
very essence of the concept of integrative studies. From what I learned through this process and
this class, viewing a complex problem through different disciplines is not done with the intent of
choosing the solutions of a single discipline. Exploring multiple disciplines is done to produce a
more complete understanding of the problem by integrating the best elements of competing
concepts (Repko, Szostak, & Buchberger, 2014, pg 131). It is through this blending of concepts
that I was able to find a solution to the problem. This is not a process that solely took place this
term in IS 301. According to Blooms Taxonomy, this has been a process starting back from my
general studies. Early on, I took classes where I learned the basics about health sciences,
psychology, and anatomy; these classes fulfilled the lower levels of intellectual behavior, such as
remembering, understanding and applying. Through this class and other upper division courses, I
have now been analyzing and evaluating the information by piecing parts of my classes and
research together to form an interdisciplinary viewpoint. The remainder of this essay will
demonstrate how my analysis and evaluation of two disciplines has led me to find an integrative
approach in solving a complex problem.


Presentation of Complex Problem

The complex problem I have chosen to answer is why do some students perform well in a
classroom setting but not a clinical setting and how to help them succeed.

Background Information
To begin the discussion of the complex problem I am attempting to investigate, I will
start by explaining what the dental assisting program is and what it means to be a student in the
program. Similar to most medical programs, the dental assisting program is intensive and
accelerated. It is a nine-month program that requires the students to be enrolled in at least 16
credit hours per term. Subjects vary from Anatomy to Dental Sciences to Office Management.
There are lecture classes in which the student is given chapters to read before arriving and
expected to participate in class to reflect that they have understood the reading and comprehend
basic concepts. There are weekly quizzes and a number of tests throughout the term culminating
with the final exam. In addition to lecture courses, there is also the clinical portion of the
program. This clinical portion is tied to the lecture class: Introduction to Clinical Skills in which
the student is expected to apply what they have learned from the classroom in the real life dental
clinic. This is when they get to interact with patients by completing check offs, which are
performance tests of typical duties that dental assistants are expected to be proficient in by their
employers. Examples include: seating and greeting patients, instrument identification and
transfer, oral evacuation and air water syringe use.


The Problem
In the Chemeketa Dental Assisting Program, there are some very studious students who
do well in the lecture portion but struggle in the clinic portion. This is a problem because if a
student cannot pass his or her classes with at least a 75% C, then he or she will be dropped from
the program (Chemeketa, 2016). As a clinic instructor in the program, I see that there are always
students who struggle in lecture classes and consequently struggle in clinic. However, there are
some cases when a student who has a very high grade in lecture cannot perform in the clinic. If
they cannot perform well enough on their check-offs to receive at least a 75% C in clinic, they
cannot continue in the program, regardless of how well they perform in the classroom. The
problem once again is that disciplined and studious people have been dropped from the program
due to their lack of proficiency in clinic. On average about 1 in every 10 students is dropped from
the program due to this reason (Interview with Program Chair, 2016). Failure to perform the
hands-on activities that are required in clinic does not just depend on their knowledge of the
discipline of health sciences, it is a problem that requires the insights of multiple disciplines. If
the problem only pertained to the discipline of health sciences, then the students would also be
struggling in the lecture portion, but this is not the case, the students that I am referring to are
struggling in the clinical portion only. This is an issue that encompasses more than just the
discipline of health.
When students are struggling in clinic, we aim to find out why they are having trouble.
Over the years I have heard students say that they were feeling under the weather, that they were
having interpersonal relationship problems outside of school, and many have said that they
simply blanked out. They say that they knew what to do before walking into clinic, but once
they started their check off, they could not remember what to do. In the online article I Know


the Material, But When I Take the Test I Go Blank! David Danskin explains that this type of
reaction is called test anxiety (para. 1). This sort of test anxiety is a form of stress. A curriculum
designed by the Health Quest Institute in Longmont, Colorado to help teens deal with stress
affirms that stress is such a big topic that it crosses over many disciplines: physiology,
sociology, psychology, theology, anthropology, and perhaps many, many more (Seaward &
Bartlett, 2002). In this essay, I will focus on the two disciplines most relevant to the students
struggling in the dental assisting clinic: psychology and physiology.
Discipline 1: Psychology
Approaching this problem in a psychological sense, a student who is stressed come
check-off time in clinic can be hindered in many ways. One example of how psychological
effects can be a contributor to the problem is if a student were having family problems at home.
They may be dealing with the problems at home but the emotional baggage does not stay at
home, they may unintentionally bring their worries with them to class. A stress management
website online states that, emotional stress can make you seem scattered and unable to focus
(Brinser, 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 standpoint, it is evident that stress impacts students mentally.
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 dentistry, 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 dental
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.

Discipline 2: Physiology
The second disciplinary approach to this problem is physiology. 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 normal dental assistant is responsible of on a daily basis. If a student is affected
physically, this may hinder their ability to perform well on a check-off. For example, 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, 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 causing students to underperform in clinic.


The third and arguably most important concept from the physiological standpoint is how
stress can cause difficulty concentrating and trouble learning new information. This is because
stress hormones can decrease the functions of neurons in both the hippocampus and the frontal
lobe area (Mills, Reiss, & Dombeck, 2008). This is particularly troubling in respect to the frontal
lobes because they are responsible for paying attention, filtering out irrelevant information, and
using judgment to solve problems (Mills, Reiss, & Dombeck, 2008, para. 10). If a student is so
stressed that their hormones affect their ability to filter out irrelevant information and their ability
to solve problems, this will be detrimental in clinic. Sometimes on check-offs students make a
mistake, while making a mistake will not cause them to fail, their inability to correct their
mistake properly will. For example, if they make a mistake that could put their patient in danger
and instead of correcting their mistake, they are so nervous that they actually put their patient in
harms way, then they will fail the safety portion of their check-off. If this is something that
continues to happen, they risk failing clinic all together. Clearly, the physical aspects of stress is
an important realm that needs to be considered when answering this complex question.

Integrating the Disciplines

Having analyzed the inputs from both disciplines, it is evident that students can
underperform for psychological or physiological reasons not tied to the discipline of health
sciences. In accordance with the Integration Theory, there may even be some cases when the
student suffers from reasons caused by both disciplines. For example, we can return to the
example of an otherwise good student who suddenly has an unexpected family problem arise
before a check-off. The emotional stress (psychological) that this home problem caused him or
her in addition to the fact that they could not get a good nights rest prior to the check-off



(physiological) made them fail. These are examples of an assumption from each theory that
could be compounding to contribute to the same failure. Without considering the physiological
discipline and only the psychological, one would assume that the problem was only caused by
emotional stress, ignoring the fact that it was this same emotional stress that caused the student
not to sleep at night. The opposite could be said if only the psychological discipline was
considered while ignoring the physiological. Therefore, it is apparent that the integration of the
concepts of both disciplines needs to be considered for this evaluation to be complete.

Now that that stress has been established as the primary factor causing students to fail in
clinic, the next step would be to find a way for students to effectively manage their stress. In one
of my previous classes called Behavior Change Theory, I learned that there are many different
methods available to help people adopt new habits. Using one of these methods, for example, we
could implement a technique for reducing stress levels before entering clinic. A study performed
on Southern California medical students proved that pre-test exercises like deep diaphragmatic
breathing and self-control relaxation helped decrease the number of stressed students from
46.95% to 21.9% (Bughi, Sumcad & Bughu, 2006). We could recommend similar techniques to
students who are struggling. If they felt that this sort of technique proved to be effective for
them, I could implement theories from my behavior change class to help them turn these
techniques into pre-test habits or rituals to ensure their continued success. There are also a few
classes that I plan to take in the future which can help me expand on my solution of this problem.
In Spring 2016, I plan to take Community and Social Skills as well as Cultural Competence in
Health Education. I am sure that these classes, in addition to the Behavior Change Theory class



that I have already taken, can help me learn the important concepts applicable to social
interactions and education. These classes will further assist me in developing methods for
advising and guiding students who suffer from test anxiety.

In this essay, I evaluated my methods of thinking and expanded on areas that I need
improvement. I also posed a complex problem and presented research from two disciplines that
applied to this problem. Modeling the Integration Theory, I connected the assumptions of these
two disciplines to propose a solution. While the problem could have been solved by the input of
only one discipline, the solution would have been limited. It may have been an acceptable
solution but not the best one. By considering and appreciating the visions of the two disciplines,
both separately and together, I have strived to achieve a better, integrated understanding of this
complex problem. As always, my work is never done; as I continue taking classes for my
Integrative Studies degree, I will be looking for more concepts and methods to help these
students succeed.




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Danskin, D. G., PhD. (1997). I Know the Material, But When I Take the Test I Go Blank!
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Mills, H., PhD., Reiss, N., PhD., & Dombeck, M. Ph.D. (2008). Mental And Emotional Impact
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