Swedish dental students’ clinical notes and reflections as part of a case-based examination – challenges for undergraduate education

Main Article Content

Nikolaos Christidis Viveca Lindberg Helen Helo Sandra Koj Maria Christidis


Clinical records are the basis for clinical reasoning, diagnostics, treatment planning, and management as well as for management of the patient and the outcome of the treatment, and therefore an important aspect of health professionals’ work. Several articles emphasize the importance of adequate and correct content in these records. Previous research shows that even health professionals need to improve the content and structure of their clinical records, for them to give the information needed for various needs. The focus of this article are the clinical records of undergraduate dental students. The aim of the study was to explore patterns of adequate and inadequate content in clinical notes of undergraduate dental students in their final year of education. Secondly, whether these results could provide insights for development of health professions education.

Data comprised of 33 cased-based examinations collected during January 2020 at the University Dental Clinic, Department of Dental Medicine, Karolinska Institutet, in Huddinge Sweden. Also, data included teachers’ assessment of these examinations. The texts were analyzed with thematic analysis.

Analytical results showed three themes. The first theme, (i) Professional content knowledge, concerned information in patient history, status, diagnostics and treatment plan, and an information ambiguity. The theme also included the students' use of professional terminology and the choice of articles to support reflections. The second theme (ii) incomplete method of investigation involved the actual patient interview, but also students’ various misunderstandings of the template. The third theme was (iii) Academic formalities. This theme concerned students' understanding of the purpose of referencing and its function, but also a non-use of references, the use of irrelevant references, errors in the given citation style, and an incorrect structure of the text according to the template. 

In conclusion, results showed the need for continuous training in clinical note-taking and reflections during dental students' professional education. In this training, teachers’ assessment is important for students' development of professional literacy and professional judgment. Also, a continuous reminder of science and proven experience as the basis for the profession which is also made visible through academic formalities.

Keywords: clinical notes, patient records, professional literacy, professional judgement, health professions education, patient safety.

Article Details

How to Cite
CHRISTIDIS, Nikolaos et al. Swedish dental students’ clinical notes and reflections as part of a case-based examination – challenges for undergraduate education. Medical Research Archives, [S.l.], v. 11, n. 10, oct. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4539>. Date accessed: 21 july 2024. doi: https://doi.org/10.18103/mra.v11i10.4539.
Case Reports


1. Bjerkan J, Valderaune V, Olsen RM. Patient Safety Through Nursing Documentation: Barriers Identified by Healthcare Professionals and Students. Original Research. Frontiers in Computer Science. 2021-June-01 2021;3 doi:10.3389/fcomp.2021.624555

2. Charangowda BK. Dental records: An overview. J Forensic Dent Sci. Jan 2010;2(1):5-10. doi:10.4103/0974-2948.71050

3. Barton D. Literacy: An Introduction to the Ecology of Written Language. Wiley; 2007.

4. Lea MR. Academic Literacies in Theory and Practice. In: Street BV, May S, eds. Literacies and Language Education. Springer International Publishing; 2016:1-12.

5. Lindberg V. Yrkesutbildning i omvandling: En studie av lärandepraktiker och kunskapstransformationer. HLS Förlag; 2003.

6. Tusting K, McCulloch S, Hamilton M. Academics' experiences of networked professional learning. In: Cranmer SJ, Bonderup-Dohn N, De Laat M, Ryberg T, Sime JA, eds. Proceedings of the Tenth International Conference on Networked Learning 2016: Looking back – moving forward. Lancaster University; 2016:422-425.

7. Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Periodontol. Jun 2018;89 Suppl 1:S1-s8. doi:10.1002/jper.18-0157

8. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. Article. J Oral Facial Pain Headache. 2014;28(1):6-27. doi:10.11607/jop.1151

9. Bozbiyik O, Makay O, Ozdemir M, Goktepe B, Ersin S. Improving the quality of operation notes: Effect of using proforma, audit and education sessions. Asian J Surg. Jul 2020;43
(7):755-758. doi:10.1016/j.asjsur.2019.10.002

10. Christidis N, Lindberg V, Jounger SL, Christidis M. Early steps towards professional clinical note-taking in a Swedish study programme in dentistry. BMC Med Educ. Sep 14 2022;22(1):676. doi:10.1186/s12909-022-03727-7

11. Mathioudakis A, Rousalova I, Gagnat AA, Saad N, Hardavella G. How to keep good clinical records. Breathe (Sheff). Dec 2016;12(4):369-373. doi:10.1183/20734735.018016

12. Gunningberg L, Lindholm C, Carlsson M, Sjödén PO. The development of pressure ulcers in patients with hip fractures: inadequate nursing documentation is still a problem. J Adv Nurs. May 2000;31(5):1155-64.

13. Florin J, Ehrenberg A, Ehnfors M, Björvell C. A comparison between the VIPS model and the ICF for expressing nursing content in the health care record. Int J Med Inform. Feb 2013;82(2):108-17. doi:10.1016/j.ijmedinf.2012.05.016

14. Lindberg V, Jounger SL, Christidis M, Christidis N. Literacy as part of professional knowing in a Swedish dental education. BMC Med Educ. Jul 8 2021;21(1):373. doi:10.1186/s12909-021-02800-x

15. Lindberg V, Jounger SL, Christidis M, Christidis N. Characteristics of dental note taking: a material based themed analysis of Swedish dental students. BMC Med Educ. Dec 16 2020;20(1):511. doi:10.1186/s12909-020-02441-6

16. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006/01/01 2006;3(2):77-101. doi:10.1191/1478088706qp063oa

17. Braun V, Clarke V. Thematic Analysis: A Practical Guide. SAGE Publications; 2021.

18. Hellesø R, Ruland CM. Developing a module for nursing documentation integrated in the electronic patient record. J Clin Nurs. Nov 2001;10(6):799-805. doi:10.1046/j.1365-2702.2001.00557.x

19. Blair W, Smith B. Nursing documentation: frameworks and barriers. Contemp Nurse. Jun 2012;41(2):160-8. doi:10.5172/conu.2012.41.2.160

20. Akhu-Zaheya L, Al-Maaitah R, Bany Hani S. Quality of nursing documentation: Paper-based health records versus electronic-based health records. J Clin Nurs. Feb 2018;27(3-4):e578-e589. doi:10.1111/jocn.14097

21. Meek EL. Learning to see: The role of authoritative guides in knowing. Tradition and Discovery: The Polanyi Society Periodical. 2005;32(2):38-50.

22. Teo K, Yong CW, Chuah JH, Murphy BP, Lai KW. Early detection of readmission risk for decision support based on clinical notes. Journal of Medical Imaging and Health Informatics. 2021;11(2):529-534.

23. Winsor DA. Writing like an engineer: A rhetorical education. Routledge; 2013.

24. Wheeler E, McDonald RL. Writing in Engineering Courses. Journal of Engineering Education. 2000;89(4):481-486. doi:https://doi.org/10.1002/j.2168-9830.2000.tb00555.x

25. Säljö R. Epilogue: From transfer to boundary-crossing. Between school and work: New perspectives on transfer and boundary-crossing. 2003:311-321.

26. Dias P, Freedman A, Medway P, Par A. Worlds apart: Acting and writing in academic and workplace contexts. Routledge; 2013.

27. Grigg G. Plagiarism: Institutional policies and their implications for learning advisers. In: Grigg G, Bond C, eds. Supporting learning in the 21st century: Refereed proceedings of the 2005 Association of Tertiary Learning Advisors of Aotearoa New Zealand Conference. ATLAANZ; 2016:60-74.

28. Patriotta G. Crafting Papers for Publication: Novelty and Convention in Academic Writing. Journal of Management Studies. 2017;54(5):747-759. doi:https://doi.org/10.1111/joms.12280

29. Teo K, Yong CW, Chuah JH, Murphy BP, Lai KW. Discovering the predictive value of clinical notes: machine learning analysis with text representation. Journal of Medical Imaging and Health Informatics. 2020;10(12):2869-2875.

30. Kelly MP, Heath I, Howick J, Greenhalgh T. The importance of values in evidence-based medicine. BMC Medical Ethics. 2015/10/12 2015;16(1):69. doi:10.1186/s12910-015-0063-3

31. Bruner JS. Beyond the information given: Studies in the psychology of knowing. WW Norton; 1973.

32. Lonka K. Helping Doctoral Students to Finish Their Theses. In: Björk L, Bräuer G, Rienecker L, Jörgensen PS, eds. Teaching Academic Writing in European Higher Education. Springer Netherlands; 2003:113-131.