Table 1 Common patterns identified in clinical notes from 24 dental students
From: Early steps towards professional clinical note-taking in a Swedish study programme in dentistry
Content in clinical notes | Forms of notes | |||
|---|---|---|---|---|
Categorizational clinical notes | Degree of familiarity | Descriptive clinical notes | Degree of familiarity | |
Oral mucosa | ✓ (n = 19) | Familiar content | - (n = 12) | Familiar content |
Pharynx | ✓ (n = 16) | Familiar content | - (n = 9) | Familiar content New context |
Teeth | ||||
Present/absent | ✓ (n = 24) | Familiar content | na | na |
Caries | ✓ (n = 24) | Familiar content | na | na |
Periodontal status | ✓ (n = 24) | Familiar content | na | na |
Oral hygiene | na | na | ✓ (n = 24) | Familiar content |
Tooth wear | ✓ (n = 24) | Familiar content | na | na |
Restaurations | ✓ (n = 24) | Familiar content | ✓ (n = 24) | Familiar content |
Dental relations | - (n = 8) | New content | na | na |
Occlusion | ||||
Static | ✓ (n = 17) | Familiar content | - (n = 2) | Familiar content New context |
Dynamic | - (n = 5) | Familiar content New context | - (n = 2) | Familiar content New context |
DC/TMD protocol | ✓ (n = 23) | New content | na | na |
History taking | na | na | - (n = 8) | Familiar content New context |
Evaluation of treatment | na | na | - (n = 5) | Familiar content New context |