Dental Students’ Beliefs About Culture in Patient Care: Self-Reported Knowledge and Importance

Cultural Competence in the nursing, dentistry, and medicine professional curricula: a qualitative review

BACKGROUND

Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs.

METHOD

A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula.

RESULTS

Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses. Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline.

CONCLUSION

Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching-learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients' cultural characteristics and needs.

Oral Health Literacy in Migrant and Ethnic Minority Populations: A Systematic Review

Cultural background influences how migrants and ethnic minority populations view and assess health. Poor oral health literacy (OHL) may be a hindrance in achieving good oral health. This systematic review summarizes the current quantitative evidence regarding OHL of migrants and ethnic minority populations. The PubMed database was searched for original quantitative studies that explore OHL as a holistic multidimensional construct or at least one of its subdimensions in migrants and ethnic minority populations. 34 publications were selected. Only 2 studies specifically addressed OHL in migrant populations. Generally, participants without migration background had higher OHL than migrant and ethnic minority populations. The latter showed lower dental service utilization, negative oral health beliefs, negative oral health behavior, and low levels of oral health knowledge. Due to its potential influence on OHL, oral health promoting behavior, attitudes, capabilities, and beliefs as well as the cultural and ethnic background of persons should be considered in medical education and oral health prevention programs.

Cultural competence of Australian dental students

BACKGROUND

Australia possesses a highly multicultural demographic, and thus dental practitioners are likely to regularly encounter culturally and linguistically diverse individuals. It is important for dental practitioners to be culturally competent, however, cultural competency education is highly variable in the curricula of dentistry and oral health courses in Australia, and research is largely limited to dentistry students. This study aims to investigate and compare perceived attitudes, beliefs and practices of cultural competence amongst first and final year Doctor of Dental Surgery (DDS) and Bachelor of Oral Health (BOH) students at the University of Melbourne Dental School.

METHODS

Following ethics approval, anonymous questionnaires were completed by 213 participants. The questionnaire was adapted from Schwarz's Healthcare Provider Cultural Competence Instrument and consisted of five scales. Data was analysed using SPSS V 24.0 software.

RESULTS

A total of 213 students participated in this study (response rate = 88%) The majority of participants were female (n = 114, 53.5%) and the mean age of 23.5 years (range 18-40). The majority of participants were Australian born (n = 110) with 74.6% (n = 159) first generation Australians. Participants who identified as Australian represented 35.7% (n = 76) with 66.1% (n = 141) identified as partly Australian. Multivariate analysis indicated that, after controlling for other independent variables in the model, those who had the highest cultural competence score were female, who self-identify as "Australian", who were in the final year. Furthermore, those who were in the final BOH year scored significatively higher than final year DDS students.

CONCLUSION

The findings of this study suggest that there is a significant difference in students self-reported cultural competence at different stages of their education. This may be attributed to differences in cultural competence education, scope of practice and the type of patient encounters and role modelling that students may experience. Future research should involve follow up to create longitudinal data, as well as research at other dental schools in Australia and overseas.

A scoping review on social justice education in current undergraduate dental curricula

BACKGROUND

A recent shift in educational components within healthcare has pushed dentistry toward a greater understanding of the role of social components on oral health. There has also been an increased awareness of inappropriate conduct among dental students.

STUDY DESIGN AND METHODS

A scoping review was conducted to determine if, how, and when social-justice-oriented education has been incorporated into dental curricula worldwide. A systematic and reiterative search of articles was performed on February 22, 2018, and combined quantitative and qualitative synthesis of data. An updated search was done on September 26, 2019.

PRIMARY RESULTS

Seventy-three studies were evaluated: 46 quantitative (63%), 24 qualitative (33%), 3 multimethods (4%). The majority used self-reported surveys and questionnaires (66%), while the remaining used interviews (9.5%), student reflections (16%) and focus groups (5.5%). Studies included dental students only (78%); dental students with dental hygiene students (5.5%) or faculty/staff (4.1%); dental students in year 1 (17%), year 2 (1.6%), year 3 (1.6%), year 4 (14.2%); first- and second-year students (3%); third- and fourth-year students (1.6%); all years of study (20%); and academic year not specified (41%). The study areas included "learning in dental school," "experiencing dental school," "focusing on cultural competency," and "addressing dental ethics and social responsibility."

PRINCIPAL CONCLUSIONS

Three major research gaps were identified: no discussion of a social contract between dentists and society, no explicit social justice-oriented topics within undergraduate dental curricula, and no standardized tool to measure these topics. Further research is necessary to understand how such topics can be included in dental curricula to form socially competent dentists.

Differences in Dental Students' Intercultural Competence Across a Four-Year Program

Cultural competence is a combination of knowledge, awareness, and skills that dentists must acquire during their training in order to work with diverse populations. The aim of this study was to measure the perceived cultural competence of dental students in all four years at the University of Alberta in Canada. In 2018, a validated 17-item questionnaire-the Knowledge, Efficacy, and Practices Instrument for Oral Health Providers-was used to assess the students' perceived level of cultural competence on a scale from 1=lowest to 4=highest. Students were grouped into four cohorts (C1, C2, C3, C4) based on their level in the program. Newly admitted students (C1) were surveyed before they took any classes; first-year students were designated C2; second-year students were designated C3; and third- and fourth-year students were combined into C4. Of 160 students, 72% responded, and 102 eligible students (64%) were included in the analysis. The average age of participants was 24.6 years (SD=3.23), 56% were men, and 75% were born in Canada. White and East Asian were the most (48%) and second most (23%) prevalent race/ethnicity. The analysis showed a significant relationship between cohort groupings and determinant components for student classification. The overall mean scores by cohort were C1 2.50 (SD=0.81), C2 2.60 (SD=0.79), C3 2.81 (SD=0.69), and C4 3.04 (SD=0.80). The mean scores of C4 were significantly higher than the mean scores of the other cohorts (p=0.001). This study found that clinical-level students at the University of Alberta had significantly higher perceived cultural competence than those in the preclinical years, though the results also pointed to the need for increased training in this area.

Cultural competence skills in a dental curriculum: A review

This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne.

METHODS

The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses.

RESULTS

Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours).

CONCLUSION

The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.

Cultural competency and communication skills of dental students: clinical supervisors' perceptions

OBJECTIVES

This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught.

METHODS

Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software.

RESULTS

A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience.

CONCLUSIONS

For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well.

Self-reported cultural skills from dental students and graduates from Melbourne, Australia

OBJECTIVE

To explore Melbourne Dental School students and graduates' self-assessed levels of competence and skill regarding cultural issues which emerge in dental treatment, and their perceptions of the dental curriculum in addressing socio-cultural issues.

METHODS

Information was derived from a 59-item questionnaire consisting of three parts: socio-demographic; self-assessed level of culture competency within the clinical encounter; and cultural aspects in the dental curriculum. Data was collected from undergraduate dental students enrolled in the fourth year of 2006 and 2007 and fifth year of 2006 and from dentists who graduated in 2002 and 2003.

RESULTS

A total of 133 students and 37 dentists took part in the survey. Response rates were 68.9% among students and 92.6% among dentists. The majority (students: 90.2%; graduates: 62.1%) indicated 'Very often'/'Always' treating patients from different cultural backgrounds. Distribution of competencies showed that participants felt fairly competent in communicating and establishing rapport, but less competent in dealing with patients' cultural practices, and patients' family involvement. The majority (students: 72.1%; graduates: 59.7%) perceived the coverage of socio-cultural aspects in the course as not adequate. Around 40% of participants indicated that inclusion of socio-cultural awareness in the dental curriculum was important or very important.

CONCLUSION

Although there were some significant differences in participants' reports, they generally self-reported having good competency and skill in providing care to patients from different cultural backgrounds. Further exploration of these issues would enhance the future dental workforce's quality of care, professionalism and capacity for cultural competence.

Oral health disparities and the workforce: a framework to guide innovation

INTRODUCTION

Oral health disparities currently exist in the United States, and workforce innovations have been proposed as one strategy to address these disparities. A framework is needed to logically assess the possible role of workforce as a contributor to and to analyze workforce strategies addressing the issue of oral health disparities.

METHODS

Using an existing framework, A Strategic Framework for Improving Racial/Ethnic Minority Health and Eliminating Racial/Ethnic Health Disparities, workforce was sequentially applied across individual, environmental/community, and system levels to identify long-term problems, contributing factors, strategies/innovation, measurable outcomes/impacts, and long-term goals. Examples of current workforce innovations were applied to the framework.

RESULTS

Contributing factors to oral health disparities included lack of racial/ethnic diversity of the workforce, lack of appropriate training, provider distribution, and a nonuser-centered system. The framework was applied to selected workforce innovation models delineating the potential impact on contributing factors across the individual, environmental/community, and system levels. The framework helps to define expected outcomes from workforce models that would contribute to the goal of reducing oral health disparities and examine impacts across multiple levels. However, the contributing factors to oral health disparities cannot be addressed by workforce innovation alone.

CONCLUSION

The Strategic Framework is a logical approach to guide workforce innovation, solutions, and identification of other aspects of the oral healthcare delivery system that need innovation in order to reduce oral health disparities.