The Knowledge, Efficacy, and Practices Instrument for Oral Health Providers: A Validity Study with Dental Students

Final year dental students' perception and practice of professionalism and ethical attitude in ten Sudanese dental schools: A cross-sectional survey

Introduction:

Professionalism and ethics are essential components of all dental schools. Therefore, this study aimed to assess the level of professionalism among Sudanese undergraduate dental students.

Materials and Methods:

This descriptive cross-sectional study was conducted among 307 students in the final year undergraduate Dental Surgery Bachelor program with 155 public and 152 private university students. We collected data through a self-administrated, semistructured questionnaire.

Results:

Although most of the students enrolled in dental schools due to their performance at higher school (P value 0.00), this has no significant effect on their attendance and academic performance afterward (P value 0.25). The perception of the students toward ethics teaching was generally positive in both public (77.34%) and private schools (78.77%). Ethics was represented in the curriculum of both private (51.7%) and public (48.3%) dental schools as perceived by their students. 95.43% and 94.00% of public and private students, respectively, would always or sometimes work in teams, and 98.02% and 94.04% of public and private students, respectively, would always or sometimes respect patients' preference (P value 0.01). A total of 95.33% of the dental students would consult or refer patients with unexpected situations. Only 26% of all students would treat infectious diseases themselves.

Conclusion:

About three-quarters of Sudanese dental students showed a satisfactory level of perception toward the importance of teaching dental ethics and professionalism. It was reflected in an excellent attitude for teamwork and respecting patients' choices. The demand for teaching professionalism course in every dental school will increase gradually, and family physicians with interest in medical education may play a pivotal role in teaching professionalism to dental students.

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.

Determining the Associations between Dietetic-Related Activities and Undergraduate Dietetic Students’ General Cultural Knowledge, Attitudes, and Beliefs

Background: As required by the Accreditation Council for Education in Nutrition and Dietetics, undergraduate dietetic programs need to include classroom learning activities to support cultural competence among dietetic students. Though these activities vary in terms of type, length, and engagement, it is not known the impact these activities have on students’ general knowledge, attitudes, and beliefs (KAB) towards cultural aspects. Therefore, the study’s purpose was two-fold: (1) validate a general cultural KAB instrument for dietetic students, and (2) determine associations among dietetic-related cultural activities and students’ KAB. Methods: A general KAB instrument was developed based on a literature review and dietetic curriculum. The original instrument (34 items) consisted of two dimensions (i.e., knowledge and attitudes/beliefs) that was reviewed by content matter experts (n = 4) and a focus group with dietetic graduate students (n = 6), resulting in a 41-item tool. This instrument was further piloted in a diverse population of undergraduate dietetic students across the United States. Exploratory Factor Analysis (EFA) and Cronbach alpha (α) for internal consistency were conducted. Multiple linear regressions and Spearman correlation analyses determined associations between demographics, activities, and KAB scores. Statistical significance was determined at p < 0.05. Results: Students (n = 187) completed the questionnaire. From the EFA, the Knowledge dimension included 12 items and the Attitudes/Beliefs dimension included 10 items. Internal consistency for the overall instrument (α = 0.86), Knowledge (α = 0.93), and Attitudes/Beliefs (α = 0.74) was high. Students’ cultural knowledge was associated (r = 0.30; p < 0.05) with cultural-related activities. Similarly, students who had lived or studied abroad had better attitudes and beliefs towards cultural aspects. Conclusions: The KAB had good validity. Cultural learning activities enhanced cultural knowledge, however to a lesser extent influenced the attitudes and beliefs of dietetic students.

Assessment of Psychometric Properties of an Oral Health Care Measure of Cultural Competence Among Dental Students Using Rasch Partial Credit Model

Reliability, validity, and feasibility of the only validated oral health care measure of cultural competence, the Knowledge, Efficacy, and Practices Instrument (KEPI), have been confirmed. However, the instrument's psychometric properties including item and person reliability, category response functioning, and scale targeting, as well as differential scale functioning for subgroups, have not yet been examined. The aim of this study was to test the psychometric properties of KEPI among dental students using Rasch Partial Credit Model to determine if this model provided broader valid information that cannot be demonstrated according to Classical Test Theory. A total 1,290 dental students in the first or final semester at four U.S. dental schools were invited to participate in the study in 2016. Of those, 1,231 individuals completed the survey, for a 95.4% response rate. The participants were 613 males and 618 females and 889 non-underrepresented minority (URM) and 342 URM students. The Rasch Partial Credit Model assessed the psychometric properties of KEPI's 20 items/three subscales. Differential scale functioning was found in the Culture-Centered Practice and Efficacy of Assessment subscales. Four items were endorsed differentially by gender; four items were endorsed differentially by URM/non-URM students. This study examined the psychometric properties of the KEPI using Rasch analysis to assess differential item functioning by dental student gender and race. The results provided valid evidence for the high internal reliability, measurement properties, and unidimensionality for the KEPI domains, ideal targeting, and well response category functioning, showing that the KEPI is a reliable instrument for measuring the subscales Knowledge of Diversity, Culture-Centered Practice skills, and Efficacy of Assessment for health care providers.

Addressing Oral Health Disparities Via Educational Foci on Cultural Competence

An ever-present challenge for the oral health profession is to reduce the extent of oral disease among racial and ethnic minority populations. Adding to this complex dilemma is the linkage between oral health and systemic health. We describe enhanced cultural competency, in the context of individual cultural beliefs, values, language, practice, and health behaviors, among dental professionals, as one approach to meeting the dental care needs of the underserved. An overview and examples of teaching methods used by University of Florida dental educators to enhance student cultural competency is provided. Evidence-based evaluation results provide evidence of methodology efficacy. We conclude by describing actions that can be implemented by academic dental institutions to facilitate development of culturally competent practitioners.