Cultural topics with clinical implications needed in the dental curriculum to develop intercultural competence: A systematic review

OBJECTIVE

To identify cultural topics with clinical implications to be incorporated into the dentistry curriculum to develop Intercultural Competence.

METHODS

Systematic review with PRISMA criteria that exported 216 articles from the Web of Science, Scopus, and SciELO databases from 2012 to 2022, of which 40 were selected. The inclusion criteria were theoretical and empirical scientific articles, of quantitative, qualitative, or mixed methods nature, on cultural topics.

RESULTS

The data analysis allowed the organization of information into four cultural topics: Development of professional intercultural self-awareness, Individual, family, and cultural implications, Construction of intercultural therapeutic relationships, and Specific clinical aspects, each with particular contents to be developed in the dentistry curriculum. However, some clinical issues have yet to be explored in-depth, leaving research possibilities open to all disciplines in dentistry. Additionally, it is necessary to analyze the cultural bias in the discussion and conclusion of some reviewed articles, as they were conducted from an ethnocentric perspective. Thus, peer reviewers of scientific journals and researchers in these topics must have appropriate training in Intercultural Competence.

CONCLUSIONS

This review provides a guide and pedagogical sequence of the cultural topics that should be incorporated into the dentistry curriculum to achieve Intercultural Competence, it also highlights a wide range of relevant aspects to consider in establishing an adequate therapeutic relationship. Explicit accreditation criteria contribute to the establishment of Intercultural Competence in the curricula; however, in countries that lack regulations, there is a moral and ethical duty to incorporate the subject so that the future professional can manage and establish inclusive healthcare.

Mechanisms Driving Postgraduate Health and Social Science Students' Cultural Competence: An Integrated Systematic Review

PURPOSE

The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals.

METHOD

The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC.

RESULTS

Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity.

CONCLUSIONS

CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.

Dentistry in a multicultural society: the impact of animal-based products on person-centred care

Cultural competence of healthcare professionals requires a combination of awareness, knowledge and skills to provide healthcare services to culturally and lingually diverse populations. The aim of this paper is to raise awareness regarding animal-based constituents in dental products which may not be acceptable to patients from different cultural, spiritual, or religious backgrounds. Animal-based products are used widely in medicine and dentistry. However, patients and sometimes even dental professionals may not be aware of this. This paper identifies some common products used in clinical dentistry which are derived from animal-based sources and discusses the implications of their use in a multicultural society.

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.

Teaching Cultural Competence and Cultural Humility in Dental Medicine

Dental students need to be equipped as clinicians to treat diverse communities and to recognize oral health disparities that are rooted in the social determinants of health. Library instruction is frequently focused on information literacy topics. Within the health sciences this might include critical appraisal or evidence synthesis, and instruction centered on locating and using library resources. This paper details the unique experiences of two liaison librarians to the School of Dental Medicine who taught the topics of cultural competence and cultural humility to first-year dental medicine students. While the authors do not discuss typical information literacy instruction in this paper, they share strategies used to design the instruction sessions, reflections on teaching these themes, lessons learned, and suggestions for other liaison librarians who might have an interest in teaching about cultural competence or cultural humility.

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.

Building Collaboration: A Scoping Review of Cultural Competency and Safety Education and Training for Healthcare Students and Professionals in Canada

Phenomenon: This scoping literature review summarizes current Canadian health science education and training aimed to lessen health gaps between Aboriginal and non-Aboriginal peoples.

APPROACH

Keyword searches of peer-reviewed and gray literature databases, websites, and resources recommended by local Aboriginal community members identified 1,754 resources. Using specific inclusion and exclusion criteria, 26 resources relevant to education and training of healthcare professionals and students in Canada were selected. Information included self-assessment for cultural competency/safety skills, advocacy within Canadian healthcare, and descriptions of current programs and training approaches.

FINDINGS

In spite of increasing awareness and use of cultural competency and safety concepts, few programs have been successfully implemented. Insights: A concerted effort among health science education and training bodies to develop integrated and effective programs could result in comprehensive processes that hasten the Canadian culturally safe healthcare provision, thus reducing the gaps among populations.