This paper addresses literacy practices within a Swedish study programme in dentistry, in which we refer to reading and writing as cultural and social practices. Within the framework of New Literacy Studies (NLS). Within such theoretical frameworks, literacy practices are considered as context-specific, historically and socially established, and developed and changed over time. When it comes to literacy practices in professional contexts, the development of new technologies, materials as well as professional and societal demands contribute to changing literacy practices (Barton 2007). 

Becoming a student in higher education assumes participating in an activity that to a large extent is literacy based. Many students accepted for studies in higher education have little experience of the literacy demands required. The transition from upper secondary school to higher education is challenging for them (Ask, 2007; Baker, 2018). To have the literacy competences and strategies needed for educational activities are crucial resources for students, since these are the means for coping with literacy demands in varying but relevant situations, depending on the purpose of reading and or writing (Berthén et al. 2008; Street, 2003; Street & May 2017). Students need to master different genres (a breadth), but also a progression, in terms of complexity, to become successful within a study programme or a discipline (Blåsjö 2004).

Our interest relates to dentistry as an example of professional higher education programmes. Within dentistry, literacy practices are on the one hand academic, researched within the field of academic literacy (Lea 2017). But on the other they prepare for literacy practices within specific professions. Thus, students within the study programme in dentistry are faced with double literacy challenges: to appropriate the academic literacy practices of this particular programme and, as part of and within the programme, to appropriate sufficient aspects of the literacy practices characteristic for the dential profession. 

While clinical learning has been studied in medical and nursing programmes, the focus has been on interaction and students’ learning of professional thinking (c.f. Theobald & Ramsbotham 2019) or behavior (de Swardt 2019). Studies that specifically focus on medical clinical notes were found to focus on the communication between patients and clinicians with the help of computerized language processing techniques (Weng, Chung & Szolovits 2019). Collaboration between researchers in informatics and various medical and health care fields work with the development and use of diagnostic codes in clinical contexts for diagnosis, treatment planning and communication (for an example within dentistry, cf. Shimpi et al. 2018). However, we found no studies on clinical note-taking as part of the learning within professional higher education.

In previous work within this project, we have addressed issues of academic literacy related to teaching-learning within a Swedish study programme in dentistry (Lindberg et al. 2020, 2021)  Taken together, the aim of this paper is to explore differences in the clinical notes of dental students, , in the middle of their education, in order to discern what knowing and experience teaching needs to address for an acceptable result. In this respect this study includes an interventionist interest.

Data for this paper consists of students’ notes in the form of twelve clinical protocols (in total 120 pages), produced by 24 students working in pairs. These students were in their third year of the study programme in dentistry, and participated in the module “Orofacial Pain and Jaw Function 2”, part of the course “Clinical Odontology 2”. These notes were based on students’ written completion of: 1) a teacher constructed protocol regarding oral mucosa, the dental apparatus including pathology on tooth level, oral hygiene as well as analysis of the occlusion and jaw-relations; and 2) an international clinical examination protocol of the temporomandibular region. Preceding this clinical task, the students were object of two three-hour lectures as well as a clinical demonstration by two teachers regarding the protocols concerning 1) oral examination of the mucosa and teeth and analysis of the occlusion and jaw-relations, and 2) the examination of the temporomandibular region, which was module specific. To complete these protocols, the students were expected to draw on knowledge from both previous courses and preceding modules of this particular course, their previous clinical experiences of relevance for the task, as well as knowledge and experiences related to the actual module of the course. Initially, a thematic analysis (Boyatzis 1998; Braun & Clarke 2006) was used based on whether students’ notes were professionally acceptable or not and what characterized the patterns of acceptable vs. unacceptable notes.

Preliminary findings: Preliminary themes related to professionally not acceptable notes were 1) students’ abilities to distinguish between normal and deviating dental relationships; 2) their assessment of mucosal status after visual inspection; 3) difficulties to distinguish between anamnesis, with information from the patient, and status, with information retrieved from the examination; 4) the use of everyday terminology instead of professional terminology‚ and 5) overuse of abbreviations without supplementary comments. Preliminary conclusions: These are partly related to unsatisfactory knowledge of new content but also to lack of experience. When content instead related to previously familiar subject matter, this resulted in structured and when relevant in rich descriptions, fulfilling professional demands. Furthermore, when relating these findings to the syllabus of the study programme, we found that the order of courses for students accepted before 2019 was not satisfactory in terms of what had been available for them to learn.

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