Service-learning's impact on dental students' attitude towards community service

Training Socially-Conscious Dentists: Development and Integration of Community Service-Learning in Dental Curricula in Ontario, Canada

INTRODUCTION AND AIMS

Commuity-centred education models of care are needed to address the high dental treatment needs of equity-deserving populations with a focus on person-centred care and learner-centred education. The Community Service-Learning (CSL) programme was developed and integrated into the undergraduate dental curriculum at the Schulich School of Medicine and Dentistry in Canada to train undergraduate dental learners with a curriculum reflective of the complex and evolving oral health needs of local equity-deserving communities and global populations.

METHODS

The CSL programme was developed utilizing Yoder's framework for service-learning and Lave and Wenger's framework for situated learning. Community consultations were held with partner organizations and their service users in Ontario and East Africa to engage them in the development and implimentation of the CSL programme. Learners' feedback was sought through an anonymous self-reported survey to gauge their overall experiences and perceptions about the newly implemented CSL programme.

RESULTS

Seven community sites were selected in London, Ontario for the third-year mandatory placements. Eight learners rotated through each site. All fourth-year learners rotated through one community site in Woodstock, Ontario. Overall, the CSL programme received positive feedback from all the learners who participated in the survey with an emphasized desire for the CSL program to continue. Three major strengths emerged from the learners' perceptions of the programme: 'the importance of community outreach and access to care', 'educational and professional development', and 'strengthening of community relationships'. Perceived areas for improvement included: 'patient accessibility and communication' and, 'enhanced exposure and opportunities for the CSL programme'.

CONCLUSION

The CSL programme provided positive experiential learning opportunities for learners while addressing the oral health needs of equity-deserving community members in local and global contexts.

CLINICAL RELEVANCE

This case study provides a practical and evidence-based approach in developing an experiential learning programme that trains dental learners to overcome challenges associated with oral health access and to address the unmet oral health needs of equity-deserving communities.

Five-Year Evaluation of Students' Profiles and Professional Perspectives in an Innovative Dental Education Modality: A Mixed-Methods Approach

INTRODUCTION

This study explored the effects of a novel dental education modality (evening enrolment) on the graduating dental students' profiles within a public university setting, encompassing both their curricular experiences and professional perspectives.

MATERIALS AND METHODS

This cross-sectional observational study was conducted with dental students (daytime and evening enrolment modalities) who graduated between 2018 and 2022. It employed a semi-structured, non-identified, pretested research instrument examining sociodemographic-family profiles, experiences in teaching-community-research activities and professional perspectives. A mixed-method approach was employed, adopting the phenomenology of Maurice Merleau-Ponty as its theoretical framework and employing multivariable logistic regression for quantitative analysis.

RESULTS

A total of 205 students participated. Overall, the majority were females, single, childless and state natives. Daytime students were younger (47.7% aged 21-24 years) than evening peers (84.8% aged ≥ 25 years) (p = 0.00). Daytime students had higher parental education and workforce engagement, whereas evening students were more likely to have mothers with lower education levels (OR = 4.72; 95% CI: 1.33-16.74) and not in the workforce (OR = 3.78; 95% CI: 1.46-9.76). Daytime students participated more in elective service-learning activities (p = 0.00). Qualitative analysis revealed challenges in the high mandatory curricular workload, limited promotion of teaching-community-research activities, slot availability and difficulty balancing work and study. Students from both modalities expressed intentions for diverse professional affiliations and postgraduate career advancement.

CONCLUSION

This study underscores the alignment in sociodemographic profiles and professional perspectives between daytime and evening education modalities. However, disparities in age, parental workforce engagement, family income and elective service-learning activities necessitate tailored strategies for optimised educational training. These insights contribute to enhancing access and retention of dental students in low- and middle-income countries.

Challenges in implementing community-based dental education programs in Australia: The lived experiences of program coordinators

PURPOSE

The benefits of community-based dental education (CBDE) are well documented and reach far beyond students' educational growth, encompassing advantages for both dental schools and their community partners. Nonetheless, barriers associated with administering CBDE programs can have a significant impact on program outcomes. This study aims to explore the challenges faced by dental school CBDE coordinators in implementing and managing their programs.

METHODS

This Interpretive Phenomenological study employed in-depth semi-structured interviews with CBDE program coordinators from Australian dental schools (n = 6). Interviews, conducted between February and May 2023, via Microsoft Teams, were audio and video recorded and lasted an average of one hour each. Interviews were analyzed using NVivo 13. Questions explored administrative challenges, required resources, student management issues, and development goals for CBDE programs.

RESULTS

Data analysis included deductive and inductive coding through a seven-step iterative process, organizing information into codes and sub-codes, forming emerging themes. Four major themes with subthemes emerged: 1) Program administration, encompassing challenges in scheduling, coordinating, and adapting to changes; 2) Funding, crucial for establishing and maintaining remote educational sites; 3) Student experience management, highlighting student supervision, student behavior, and exposure; and 4) Partner site relationships, particularly in clinical supervisor recruitment and training.

CONCLUSION

The successful implementation requires meticulous planning, effective coordination, and recognition of CBDE as an educational activity that should be grounded in evidence-based pedagogy. Dental institutions are therefore encouraged to establish collaborative partnerships with local community organizations, allocate resources for outreach initiatives, and facilitate appropriate guidance to coordinators, students, and external clinical supervisors.

Factors associated with the perception of university social responsibility among dental students from two universities in the Peruvian capital: a multivariable regression analysis

Students play a key role in university social responsibility (USR), as they are the protagonists of change and the fundamental axis in the teaching-learning process. This study aims to assess the factors associated with the perception of university social responsibility among dental students from two universities in the Peruvian capital. This analytical cross-sectional study assessed 754 students from two Peruvian universities between May and July 2023. The study utilized a validated 51-item questionnaire to assess sociodemographic factors and dental students' perception of USR. A Poisson regression model with robust variance and prevalence ratio (PR) was used to assess the influence of variables such as age, sex, marital status, type of university, academic year, and awareness of taking subjects related to USR. The significance was set at p < 0.05. The perception of USR was rated as poor, fair, and good by 16%, 67%, and 17% of the participants, respectively. According to the study, dental students from public universities were 68% more likely to perceive their USR education as poor than those from private universities (APR = 1.68, 95% CI: 1.06-2.66), and those who were aware of taking MSR-related courses were 37% less likely to perceive their USR education as poor (APR = 0.63, 95% CI: 0.40-0.98). Similarly, dental students attending public universities were 2.28 times more likely to perceive poor organizational management in USR compared to their counterparts at private universities (APR = 2.28, 95% CI: 1.51-3.44). Additionally, students in their first and second academic years were 62% and 57% less likely to perceive poor organizational management in USR compared to those in their sixth year (APR = 0.38, 95% CI: 0.19-0.79 and APR = 0.43, 95% CI: 0.20-0.95; respectively). Furthermore, students from public universities were 2.31 times more likely to perceive social participation in USR poorly compared to their counterparts from private universities (APR = 2.31, 95% CI: 1.63-3.26). Lastly, it was observed that students from public universities were 2.51 times more likely to have a poor overall perception of USR compared to students from private universities (APR = 2.51, 95% CI: 1.67-3.78). Acknowledging the diverse contexts and challenges inherent in public and private institutions, it can be concluded that more than half of the dental students had a fair perception of USR. Additionally, attending a public university was found to be a risk factor for having a poor perception of USR. However, taking a course related to USR and being in the early years of the program were identified as protective factors against a poor perception of organizational training and management in USR. It is recommended that students be involved in USR activities, including the Sustainable Development Goals, from the first years of their university education, especially in public universities.

What are the public health benefits of community-based education in dentistry? A scoping review

Aim To examine what is known about the public health benefits of community-based education in dentistry.Method A scoping review was conducted using a modified Arksey and O'Malley framework. Database searches were undertaken on PubMed, Medline via Ovid, CINAHL via EBSCO and ERIC, and a grey literature search was undertaken on OpenGrey, Medlar, BASE and the British Library. Reference lists of included studies were also searched. Although no formal quality assessment was undertaken, observations on methodological rigour were recorded.Results In total, 31 studies from nine countries met the inclusion criteria. Most were from high-income countries. Methodologies of included studies varied: quantitative (n = 17); qualitative (n = 5); mixed methods (n = 6); and reviews (n = 3). Several potential public health benefits were reported: increased access to dental services (including improvements in their availability, affordability, acceptability, accessibility, and accommodation); improved awareness/health literacy of students and communities; and improved clinical outcomes. The overall quality of the evidence was low and had little community engagement.Conclusion Notwithstanding the methodological limitations of the included studies, several potential public health benefits have been associated with community-based education in dentistry. Rigorously designed, methodologically appropriate research is needed, which should include engagement with communities.

"A life-changing experience and the beginning of a lifelong commitment": experiences and impact of Global Health Community Service-Learning in undergraduate dental curriculum in Canada

BACKGROUND

Global Health Community Service-Learning (GHCSL) can have a profound professional and personal impact on learners. This pedagogy provides understanding of unfamiliar environments and challenges learners to step out of their comfort zones, adapt to new cultures, and navigate unique situations. Yet, there are relatively few studies exploring the experiences of learners participating in community service-learning placements in global regions as part of undergraduate dental curriculum. This study aimed to explore the experiences and impact of the GHCSL program in East Africa among undergraduate dental learners at the Schulich School of Dentistry.

METHODS

Eight undergraduate dental learners were enrolled in GHCSL pilot placements. Placement agreements were established with Makerere University in Kampala, Uganda, and the University of Rwanda in Kigali, Rwanda for the summer of 2022. Stakeholders from both institutions were engaged in the development and implementation of these placements. Learners were required to engage in weekly reflection through a 'storytelling and incident-based narrative' while carrying out their placement. A qualitative study design was employed, and an inductive interpretive approach was utilized to thematically analyze the learners' reflective essays.

RESULTS

Five major themes emerged from the learners' reflective essays: (1) experiential clinical learning; (2) cultural humility and social awareness; (3) awareness of contrasting healthcare systems; (4) commitment to service; and (5) personal and professional growth. Most learners reflected on their engagement with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments. These experiences presented the learners with an opportunity to develop cultural humility and gain a newfound motivation to mitigate global oral health disparities in populations beyond that of their local communities. Learners also reflected on enhanced social awareness experiences and the awareness of contrasting healthcare systems in Canada and their placements, which encouraged the development of empathy, communication, and compassion skills, as well as an understanding of the disproportionate burden of conditions in low-resource settings.

CONCLUSION

The reflective essays concluded that the GHCSL placements had a positive impact on the learners, encouraging many to develop a heightened desire for lifelong learning to address oral health disparities within a global context.

Community-Based Dental Education (CBDE): A Survey of Current Program Implementation at Australian Dental Schools

Purpose

Community-based dental education (CBDE) diverges from traditional dental school training methods by integrating dental students into primary care community settings. This immersive approach enables students to refine their clinical and hands-on skills while serving the oral health needs of underserved populations. This study aimed to identify ways in which Australian dental schools are currently implementing CBDE and compared to current evidence.

Materials and Methods

This study utilized a 24-item, self-completion survey, adapted from existing questionnaires, which was sent to the CBDE coordinators in the nine eligible dental programs in Australia between mid-January 2023 and mid-April 2023. The survey consisted of multiple-choice, binary, and open-ended questions, including information on the level of student involvement, types of external clinics used, length of rotations, student supervision and assessment, pre-rotation preparation, and post-rotation evaluation, as well as challenges faced in implementing programs.

Results

Six of the nine invited coordinators responded, resulting in a 66.7% response rate. All participants confirmed that their schools had a community-based teaching program. All six respondents reported that participation in external clinics is required for graduation. Implementation of CBDE appears to be influenced by (1) level of student involvement, (2) the types of clinics utilised, (3) allocation and length of rotation, (4) student supervision and assessment, (5) pre-rotation preparation, and (6) post-rotation evaluation. Six (n = 6) institutions reported requiring a post-rotation reflection from students and all respondents reported seeking feedback from clinical supervisors at external sites. Emerging themes from open-ended questions highlight challenges in coordinating external rosters, securing funding, supervising students at external sites, and ensuring diverse types of student exposure during external rotations.

Conclusion

This study provided insights into the implementation of CBDE in Australian dental schools. Results outlined in this research offer valuable insights for dental schools aiming to enhance their programs and improve student learning outcomes.

Community-based education programmes in the context of dental education: A scoping review

BACKGROUND

Community education programmes are vital tools for teaching skills, such as understanding the larger cultural, economic and social determinants of health and how these factors impact people's health. It is currently unclear whether community education programmes in the field of dentistry deliver adequate value. This review aims to scope, collate and analyse globally published evidence concerning community education programmes in dentistry from inception, to gain an understanding of the intentions for these programmes and establish whether outcomes have shifted over time from the original intentions.

METHODS

Arksey and O'Malley's framework for scoping reviews was employed to guide the reviewers. A systematic search of electronic databases and the reference lists in key papers was conducted.

RESULTS

A systematic search concerning community education in dentistry identified a total of 140 papers for full-text evaluations. After further exclusions, 115 articles were selected for data charting. There was a lack of clarity in the literature concerning programmes' definitions and strategies for achieving intentions. Origins, intentions and motivations of the programmes were identified. The literature largely focused on assessing students' clinical treatment skills, contradicting the programme's original idea and intentions. Only a few studies incorporated patient and community perspectives, and the majority of assessments were self-reported, primarily by students.

CONCLUSIONS

There is broad interest in integrating community education into dental curricula to teach complex concepts, dental public health principles and to ensure professional skills development. We identified issues in the literature around programme definitions, strategies, measurement approaches and programme success requiring additional research.

Oral Health Strategies: Surveying the Present to Plan the Future of Community-Based Learning

Introduction: Oral health literacy relates to the capacity of individuals to acquire, understand and to act upon oral health information to make appropriate health decisions. This scientific review's main goal is to analyze the strategies that improve oral health literacy within the community, specifically oriented to a community-based learning model focused on the most vulnerable risk groups in society. Materials and Methods: The current review is based on the literature on oral health literacy within community-based learning strategies. The present review selected scientific studies by searching MEDLINE and related databases, such as Web of Science and PUBMED, and by consulting existing bibliographies. Results: Based on the application of the inclusion criteria to the abstracts, 45 publications were retrieved which explicitly dealt with the definitions of oral health literacy, community-based learning, and service learning. Several studies have demonstrated that health consumers with low health literacy fail to understand the available health information. Therefore, innovative oral health literacy strategies should be undertaken. Service learning is an example of an educational approach where the student learns specific soft skills in the classroom and collaborates directly with an agency or institution and engages in reflection activities to deepen their understanding of what is being taught. Conclusions: One of the main strategies used to incorporate the oral health professional in social responsibility and direct contact in the community is through experiencing community-based learning projects. The future graduate must be an educator capable of educating patients in order to themselves acquire high-level skills in oral health literacy.

Service-learning's impact on dental students' attitude to community service

BACKGROUND

This study aimed to observe the impact of service learning on the attitude of senior dental students toward community service.

METHODS

A cross-sectional survey-based was conducted and recruited a total of 120 senior students of Dentistry Taibah University that were enrolled in a clinical service-learning course using convenience sampling. The attitude of dental college students toward community service based on the model of helping behavior by Schwartz was evaluated through Community Service Attitude Scale (CSAS). The data was collected using the same questionnaires for the pre-test and post-test. Data were analyzed by using SPSS 25. A repeated-measures mixed-model ANOVA was used to test the changes across pre-and post-test.

RESULTS

A total of 96 students completed the first survey, making a response rate of 80%, and 78 among them completed the second survey as well, making a response rate of 81%. Significant change (P < 0.0001) in ANOVA indicated that there was an overall change in attitude.  CONCLUSIONS: It can be concluded that community-based service-learning positively impacts the attitude of last year's dental students toward understanding needs at the community level and the attitude to help in providing dental care at the community level.

Dental trainees' mental health and intention to leave their programs during the COVID-19 pandemic

BACKGROUND

Dental trainees (dental students, graduate students, and postdoctoral residents) are at increased risk of experiencing poor mental health, which can lead to intentions to leave their program, especially during the COVID-19 pandemic.

METHODS

The authors invited 355 dental trainees at the University of Washington School of Dentistry to complete an 83-item questionnaire in August and September 2020. The outcome analyzed was intention to leave their programs. There were 4 self-reported predictors: anxiety, burnout, depression, and COVID-19 impact on overall mental health. The authors ran multiple variable logistic regression models to evaluate relationships between each predictor and outcome (α = .05) and reported odds ratios (ORs) and 95% CIs.

RESULTS

The survey response rate was 35.5%. Overall, 12.7% of participants reported any intention to leave. In total, 22.2% and 16.7% of participants endorsed clinically significant anxiety or depression symptomatology, respectively; 28.6% reported 1 or more burnout symptoms; and 69.0% reported that COVID-19 affected their overall mental health. Participants reporting anxiety (OR, 8.87; 95% CI, 1.80 to 43.57; P = .007), depression (OR, 11.18; 95% CI, 1.84 to 67.74; P = .009), or burnout (OR, 8.14; 95% CI, 1.73 to 38.23; P = .008) were significantly more likely to report intention to leave than those not reporting mental health problems. All participants reporting that the COVID-19 pandemic impacted their mental health expressed intention to leave.

CONCLUSIONS

Poor mental health is common among dental trainees and is associated with intention to leave their program.

PRACTICAL IMPLICATIONS

COVID-19 has exacerbated the prevalence and consequences of poor mental health among dental students, highlighting the importance of providing wellness resources.

How are the social determinants of health being taught in dental education?

INTRODUCTION

The social determinants of health that influence how wellness and illness are experienced within society must be a core component of dental curricula where aspiring dental professionals are taught about the aetiology and social history of dental diseases. Through this scoping review, we examine the current approaches that have been employed to incorporate the social determinants of health within dental curricula.

METHODS

Using a scoping review methodology, we searched the databases Scopus, PubMed, and Embase using keywords relevant to the social determinants of health and dental education.

RESULTS

Following screening and sorting, 36 articles were included within this review. The majority of the articles described research that evaluated outcomes of educational interventions with relevance to the social determinants of health. The remainder of the included studies discussed attitudes and readiness relative to the social determinants of health and how this core competency could be taught effectively.

CONCLUSION

The included literature revealed that the social determinants of health frequently are not the focus of educational activities in dental curricula, with students frequently having little active guidance on how they might make sense of their educational experiences in this domain. The socioeconomic, cultural, political, geographic, and structural barriers that contribute to patients being impacted by the social determinants of health should be explicitly addressed and discussed with students as a foundation element of the dental curriculum.

The impact of outreach programs on academics development, personal development and civic responsibilities of dental students in Bhubaneswar city

INTRODUCTION

Inequalities persists in distribution, accessibility, and utilization of oral health services between urban and rural population. One approach to lessen this inequality is by incorporating rural outreach programs in the academic curriculum of health-care professionals.

OBJECTIVES

The objective of the study was to evaluate the effectiveness of outreach programs on academic development, personal development, and civic responsibilities of dental students and also to assess the changes in the domain scores within and between genders postintervention.

METHODOLOGY

The study population consisted of 100 dental students. The study methodology followed a before and after without control informal experimental study designs. At baseline, the participants were administered pretested structured questionnaire developed by D. Diaz Gallegos. Intervention involved posting participants in various rural outreach activities and academic field visits in various public health installations. A postintervention questionnaire developed by Anu F. Shinnamon et al. was administered to assess the change from the baseline. The change in domain scores was assessed using paired and unpaired t-test appropriately. P ≤ 0.05 was considered as statistically significant.

RESULTS

The baseline scores of academic, personal, and civic domains were 6.05 ± 2.44, 8.04 ± 2.84, and 6.36 ± 2.23 which increased to 6.52 ± 2.10, 13.56 ± 3.44, and 8.55 ± 2.71 postintervention, respectively (P ≤ 0.05). When comparing within genders, there was increase from the baseline, and this change in the scores postintervention was statistically significant (P = 0.001). The mean scores of all three domains between genders were statistically insignificant.

CONCLUSION

The outreach programs developed and enhanced the subject's academic skills, leadership qualities, self-confidence, communication skills, managerial skills, and responsibilities toward the rural community.

Who is the Teacher and Who is the Student? The Dual Service- and Engaged-Learning Pedagogical Model of Anatomy Academy

Anatomy Academy is a simultaneous service-learning experience for preprofessional school undergraduate students and preclinical professional students acting as classroom paraprofessional teachers (Mentors), and engaged-learning experience for fourth to sixth grade elementary school children (Students). Using didactic and kinesthetic active learning teaching strategies in small-group classroom environments, Mentors taught anatomy, physiology, and nutrition concepts to Students. In this study of the program's early years (2012-2014), overall objectives of improving Mentors' pedagogical confidence; and Students' science interest, science knowledge, and exercise self-efficacy were assessed. Mentors showed (89% response of 595 surveyed) improvement in content delivery (P < .001), student engagement (P < .001), classroom management (P < .001), and professionalism (P = .0001). Postprogram Mentor reflections were categorized into 7 major themes that demonstrated personal growth through the service-learning opportunity: (1) realization of an ability to make a difference in the world now; (2) acknowledgment of the importance of listening in teaching; (3) recognition that lives can and will change with "a little love"; (4) insight into the effectiveness of guiding Students through material rather than lecturing; (5) awareness of the value of respect in the learning environment; (6) cognizance of the power of individualized attention to motivate Students; and (7) reflection of one's own personal growth through the open influence of Students. Students showed (88% response of 1259 surveyed) improvement in science knowledge (P = .014) and exercise self-efficacy (P = .038), but not science interest (P = .371). Thus, while Students are learning more science and becoming more aware of their health, we need to be more overt in our presence as scientists in the educational arena.

Are dental students ready for supercomplex dental practice?

Contemporary dental practice requires practitioners who are able to draw upon varying interconnected knowledge and skills, in order to make judgments and take action when faced with multiple, often contradictory, ways of interpreting a situation. However, the curricula that prepare students for dental practice are traditionally based on the theoretical knowledge and technical skills to be gained by students. This is despite evidence in the dental literature of a collective desire for graduates to have more range and depth in their repertoire. Examination of contemporary dental practice through the lens of supercomplexity (Higher Education, 40, 409 and 2000) provides contextual understanding and a platform to explore the types of learning and curriculum approaches that can best prepare students for professional practice. From the insights offered by examples from other professional fields, we, as dental educators, can begin to conceptualise learning dentistry as much more than competency frameworks or descriptions of what students need to know and be able to do. Rather, to equip graduates for contemporary dental practice, the dental curriculum needs to become a vehicle for students to develop personally and professionally as well as teaching the theoretical and technical aspects of dentistry.

A focus group study of chiropractic students following international service learning experiences

OBJECTIVE

One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students.

METHODS

Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes.

RESULTS

The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor-patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning.

CONCLUSION

Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.