Dental hygiene students are required to work in a clinical setting during their two years of school. Instructors give grades based on student's performance on their patients. Instructors spend time calibrating to attempt to ensure that each student is graded similar but this system left room for instructor's personal judgment. After reviewing other dental hygiene schools, it became clear that is a program that could alleviate this subjective grading format.

TalEval was originated by Cynthia Biron Leiseca in 1990. Leiseca was a clinic coordinator at New Hampshire Technical Institute. The original grading system was in paper format. The grade form was called the Dental Hygiene Process of Care Evaluation. Grades were done by hand until 2006 when the form was then computerized by America's Software and renamed "TalEval". After two years of beta testing, TalEval was eventually sold to other schools in 2008. (Leiseca 2014)

All dental hygiene school programs are responsible for maintaining school accreditation by following a set of national guidelines. The criteria for these standards comes from CODA - Commission on Dental Accreditation. Two of these components "On-going Outcomes Assessment Plan" and "Quality Assurance in Patient Care Assessment Plan" are met with the TalEval program. TalEval is an online, rubric based program for clinical grading in dental hygiene programs.

The intentions of TalEval include: (Leiseca 2014)

• Keep faculty on task with focusing on individual student clinical skills without having the subjective opportunity to fail or pass students based on their subjective opinion.
• To provide students with a genuine assessment of their clinical strengths and areas in need of improvement.
• To track faculty performance and calibration
• —To use the results to make changes to the curriculum to improve the clinical learning experience for students.

TalEval is a formative assessment program. Formative assessments are "a process used by teachers and students during instruction that provides feedback to teachers to adjust learning to improve student achievement of intended outcomes." (Coffey 2014) TalEval uses its 140 objects for assessment to try to provide a more detailed feedback picture for the student. "Formative assessments help teachers identify concepts that students are struggling to understand, skills they are having difficulty acquiring, or learning targets they have not yet achieved so that adjustments can be made to lessons, instructional techniques, and academic support. They also help identify which students need to be challenged. The general goal of formative assessment is to collect detailed information that can be used to improve instruction and student learning while it’s happening." (Amodei 2014)

TalEval is an online technology assessment program based on an elaborate rubric. Instructors have an itemized list of 140 competencies that are preset at "+" for meets competency. Based on student performance throughout the patient's appointment, instructors can go in and move the radial dial to "√" for a single minor error, "x" for multiple or major errors or "N" for not performed/observed at this appointment.

The grade form's 140 competencies are segmented into 4 major categories: Assessment, Planning, Implementation and Evaluation. Each category has various sub headings. The 140 individual assessment items are listed under each sub heading. The number of individual assessments for each are in parenthesis.

• Assessment:

1. Risk Assessment Medical/Dental Histories (9)
2. Extra/Intra Oral Assessment (3)
3. Occlusal Assessment (7)
4. Periodontal Assessment (9)
5. Radiographic Process and Assessment (6)
6. Hard Tissue Exam (5)
7. Deposit Assessment (5)

• Planning:

1. Treatment Planning (9)

• Implementation

1. Preventive and Supportive Treatment (18)
2. Pain Control (8)
3. Instrumentation - Ultrasconics (24)
4. Calculus Removal (5)

• Evaluation:

1. Evaluation and Quality Assurance (13)
2. Ethics and Professionalism (19)

TalEval Grade Form

Symbols are defaulted to the "+" bubble to note that student has met competency. Teachers enter the appropriate changes during and after each appointment. The teacher does not provide any letter grade or numeric value to the student for their work on a patient that day in clinic. The TalEval software does its mathematical computations after all data is collected for the semester. Scores are based on the number of difficult patients that students complete. At the end of the semester, "the total number of errors are calculated using mean of individual and total class performances". (TalEval 2008)

Critical errors are noted by the items shown in red. Critical errors can be assessed in two ways. Critical errors can be set up prior to the semester with a predetermined number of points deducted for every student who receives a "√" in that category. Each category can have a different deduction.The second method is teachers can assign specific deductions to each student in a Critical Error box located on the grade header. (TalEval 2008).

TalEval Critical Error Box

Students can access TalEval at anytime from any computer with internet access. They have immediate feedback from instructors availble to them in the comment box. Students can bring up a Patient Care Report that allows them to view comments from all patients at one time.

TalEval Progression of Skill Development

Students can also view the progression of their skill development. The key on the right of the image (I, II, III) indicates which semester the student achieved that score. "A" is to note a time period from the beginning of the semester to midterm. "B" is used to note a time period from midterm to the end of the semester. The graph shows number of errors throughout the student's clinical experience. If the bar graphs decline for each grading period, it denotes the student is making fewer errors in progression and mastering the content.

TalEval is a lengthy rubric established to create a method of grading that is beneficial for the student in creating mastery over clinical work. Clinical treatment of patients is very involved in steps, policies and procedures. TalEval's rubric keeps the grad in an organized form and lets students see very specific items missed and areas of proficiency that need more work. The 140 criteria uses the symbols (+,√, x,N) instead of a number guide.

This article describes the intentions of a rubric based assessment as follows: (Crane 2014)

Rubric-based assessment is a form of student evaluation that is integrated with the learning process because learning occurs as assessment takes place. Rubric-based assessment is based on standards, focused on the learner, and provides feedback during the process. These features make the assessment experience more authentic and effective. Technology provides teachers and students with support necessary to make rubric-based assessment an integral part of the educational process

TalEval is able to accomplish more than a percentage grade would in the same scenario. TalEval focuses on what areas and skills the student is efficient and deficient in learning. A letter grade cannot provide the specific feedback that a student needs in order to improve skills and pass the proficiency Dental Hygiene Board exam. Instructors can see at a glance on graphs where a student is struggling and correct the area before it becomes an issue.

Bloom's Taxonomy Key Words

Retrieved from http://www.learning-theories.com/blooms-taxonomy-bloom.html

Bloom's Taxonomy is a learning theory consisting of six levels. The theory classifies the learning into three categories of basic learning followed by the achievement of three higher levels of thinking. The three basic levels include knowledge, comprehension and application followed by the three higher levels including analysis, synthesis and evaluation. These levels have been renamed to apply to 21st century needs. The basic levels are remembering, understanding and applying. The higher levels include analyzing, evaluating and creating. (Learning-Theories 2014)

Students in clinic will move along these levels of thinking as they improve their knowledge base for clinical treatment. Certain skills students can learn to apply to patient treatment quickly. Other skills take many appointments to develop. The "Progression of Skill Development" Chart best shows the improvement of students' level of thinking in clinic. This chart can be printed at anytime and learning needs can be addressed quickly. In Clinic I, students are able to quote their instructors during oral hygiene instructions. By Clinic IV, students know how to apply the initial assessments of soft and hard tissues to design their own oral hygiene instruction for the patient based on patient need.

The TalEval criteria collectively apply to the student's knowledge, application to the patients, evaluation of their performance and creating new approaches within their scope of practice to improve performance. The 140 items use the descriptor words shown in the photo above as part of their explanation of each criteria. The TalEval then produces reports showing improvement by the student on each item through the clinical assessment period.

TalEval provides two methods of grading: The Objective Method and the Grade by Appointment Method. The Objective Method takes the mean of the class performance and uses a mathematical formula to calculate a student's grade. The critical errors are preweighted and students receive individual grades based on performance. The Objective Method requires no math by the instructor during the grading process. Instructors utilize the symbols (+, √, x, N) and the predetermined weights are applied after all data is gathered at the end of the course. The program uses the mean, total class performance, points lost from errors, plus points gained for performance on more difficult patients to determine a final grade. The Objective Method better identifies students under certain needs as requiring more learning (√,x) vs. more (+) symbols indicating mastery of certain areas. Points lost are offset by the more difficult levels of patients. (TalEval 2008)

TalEval Point Values

The Point Value above shows how a student's grade is calculated based on which clinic. The "easy" patients are a Calculus Class "0" and a Periodontal Skill Level "0". In clinic IA they would receive credit of .25 + .0 for this patient. In Clinic IIIB they would receive .05 + .0 for this same patient. This gives more credit to students who are seeing the more difficult patients (Classification IV.IV). 

Critical errors are a red flag in patient care and safety. Examples include item #124: Infection control and patient safety assured or item # 89: Instrument selection - correct end/edge - sharpness. Every program can choose which items they intend to note as critical errors. You can also base it on clinic. If you choose, Clinic I could have 10 critical errors and Clinic IIIB could have 40+ critical errors (out of the 140 items). For each "√" the student loses -.25 points. For all non critical "√" errors, students lose -.05 points. For each "x" the student loses -.50 points. For all non critical "x" errors, students lose -.10. Instructors are also give the option to impose addition lose of critical error points for more serious infractions or same error occurring multiple appointments.

When the instructor is ready to view grades, they type in the median score and the computer prints a grade form. This median performance level is imputed by the lead instructor and can change easily. The grades can be viewed as often as the instructor wants. For example, based on the median performance level (80) students could receive points for more patients (from Point Value chart above) + 6.25 and would lose any critical error points received - 2.25. The grade is then calculated 80 + 6.25 - 2.25 = 84. This student is at a passing level (above the 80 median performance level).

The Grade By Appointment is similar to a more subjective method of grading. The faculty can choose points to be taken off for critical errors at each patient appointment. Instructors can still set weighted grades at beginning of the term in addition to the critical errors. This grade can reflect in percentages with each appointment. The Grade By Appointment Method becomes subjective because the instructor knows exactly what each √ and x cost the student's grade during the appointment. (TalEval 2008)

TalEval changes how instructors assess the student. With 140 items, students can get a better understanding of what skills they need to develop. Instead of focusing on a single grade for just an end performance, students every choice and skill are graded throughout the patient care. And, the more difficult patients are awarding the student with greater point values. Instructors can better explain to students their deficiencies. 

The strengths of the TalEval program are lengthy. This program has given dental hygiene programs a streamlined assessment method for instructors. Other strengths of this program include:

(America's Software 2014)

• Objective Grading Format
• Calculates Individual Student Grades
• Collects and Displays Data for Outcomes Assessments
• Provides Data on Instructor Performance for Calibration
• Component for Quality Assurance
• Customizable to Meet each School’s Needs
• Allows students to login to view progress, complete evaluations
• TalEval is accessible from any computer, no software to download or install

(TalEval 2008)

• Instructors document what happens without knowledge of grades
• Students self assess their clinical performance
• Students can not get an "A" by seeing easier patients, they must become proficient at on difficult patients to receive an "A"
• Paperless

The weaknesses of the TalEval program are minimally noted. Once instructors are comfortable with the system, the benefits are highly visible in student learning. A few to note include:

• Students don't know their grade at evaluation, they have to wait until the end of a grading term for means to be calculated (TalEval 2008)
• Students cannot look up their own grades. They are able to see instructor comments but are not able to view the rubric unless the instructor has made that an option.
• Clinical substitute instructors have a greater learning period when they come for work
• Annual cost of $3,495 one time fee and $995 per year fee (up to 100 students) (America's Software 2014)

If a dental hygiene program can absorb the fee, TalEval can improve the learning and teaching that occurs in the student's clinical performance. One of the best outcomes is the students are receiving a consistent learning environment. Instructors can read comments from the previous clinic to know where the student has had previous problems. Instructors are able to identify student deficiencies immediately. With the paper method, students turned in their grade form, the lead instructor had to grade and then compare to other clinics. The paper grade form had no area for comments. The computer allows for immediate information to be passed among the instructors as it stays attached to the student. Students are getting immediate feedback for their performance.

TalEval has changed the way dental hygiene instructors assess their students in the clinic setting. Instructors can keep the subjectivity out of their grading and focus on exactly what happens at patient appointments. When subjectivity is included, students will get various assessment feedback for the same errors. The objectivity of TalEval provides information on students based on what learning has occurred, what skills are deficient and what skills they have mastered and is consistent with other instructors' feedback. The grading reflects a more consistent and effective grading and an easier method to track each student's progress through the program. The reports provided by TalEval are clear, concise and organized. TalEval has made clinical assessment learning more productive for dental hygiene programs. The program and its assessment items are specifically for dental hygiene. The specificity in assessment is what makes TalEval a great learning tool for students.

America's Software. "TalEval's Features and Benefits". Retrieved October 5, 2014 from http://www.americassoftware.com/images/Dental%20Software_Brochure.pdf

Amodei, Maghan. Scholar.com. "Assessment Theory." September 22, 2014. Retrieved from https://cgscholar.com/community/profiles/amodei2/publications/44480

Coffey, Heather. LearnNC.org. "Formative Assessment." Retrieved on October 17, 2014 from http://www.learnnc.org/lp/pages/5212

Crane, Malgorzata. Scholar.com. "Rubric Based Assessments". September 22, 2014. Retrieved from https://cgscholar.com/community/profiles/malgorzata-crane/publications/45385

Learning-Theories.com. "Bloom's Taxonomy (Bloom's) Retrieved on October 5, 2014 from http://www.learning-theories.com/blooms-taxonomy-bloom.html

Leiseca, Cynthia Biron, RDH, EMT, MA. "TalEval Guide for Students". Retrieved on October 2, 2014. Retrieved from https://taleval.com/signin.aspx

TalEval. "Dental Hygiene Process of Care Ealuation Grading and Outcomes Assessment System." 2008. Pages 6-38. Retrieved on October 2, 2014 from http://www.dhmethed.com/sitebuildercontent/sitebuilderfiles/TalEval%20DH%20grading%20system%202013.pdf