Teaching dental undergraduates behaviour change skills

Healthcare professional students' perceptions of supporting patient self-management: A mixed method study

OBJECTIVES

Individuals self-manage chronic illnesses daily with episodic support provided by healthcare professionals. Learning about supporting self-management should be part of healthcare professional student programme curricular and training. However, little is known about the perceptions and attitudes students hold about supporting patient self-management and whether support for self-management is implemented on clinical placement.

METHODS

A mixed method approach explored students' perceptions and attitudes to supporting patient self-management via e-survey and semi-structured interviews.

RESULTS

Survey data (n = 96; 11 programmes) were analysed descriptively and interviews thematically (n = 10; F = 9; aged 19-34 years; 8 programmes). Survey data suggested participants had a positive attitude towards, and were confident in providing support for self-management, but did not implement it frequently in clinical environments. One main theme "Self-management support is puzzling" identified the uncertainty around what students thought their role was or how to enact support within the patient interaction. A smaller theme "Self-management support is valuable" showed participants were open to learning more about how to support patient self-management.

DISCUSSION

We suggest more explicit and frequent learning opportunities need to be provided for healthcare professional students to learn how to support patient self-management, with particular emphasis on involving family and incorporating self-management tools within the patient encounter.

Behavioural change as a theme that integrates behavioural sciences in dental education

The behavioural sciences curriculum in dental education is often fragmented and its clinical relevance is not always apparent to learners. Curriculum integration is vital to understand behavioural subjects that are interrelated but frequently delivered as separate issues in dental programmes. In this commentary, we discuss behavioural change as a curricular theme that can integrate behavioural sciences in dental programmes. Specifically, we discuss behavioural change in the context of dental education guidelines and describe four general phases of behavioural change (defining the target behaviour, identifying the behavioural determinants, applying appropriate behavioural change techniques and evaluating the behavioural intervention) to make the case for content that can be covered within this curricular theme, including its sequencing. This commentary is part of ongoing efforts to improve the behavioural sciences curriculum in dental education in order to ensure that dental students develop the behavioural competencies required for entry-level general dentists.

The behavioural and social sciences as hidden curriculum in UK dental education: A qualitative study

INTRODUCTION

The behavioural and social sciences (BeSS) are an integral part of dental curricula, helping students become holistic, patient-centred practitioners. Nevertheless, UK studies document that dental undergraduates struggle to see the relevance of BeSS to their training. Using the concept of hidden curriculum, this study explored dental students’ perceptions of and attitudes towards BeSS in one dental school in the UK.

MATERIAL AND METHODS

Six focus groups were conducted with 37 dental students from years 1 to 5. Thematic analysis was conducted revealing five themes: student attitudes towards BeSS, teaching culture, learning culture, curricular issues and student culture.

RESULTS

Many students recognised how BeSS contributed to their communication and patient management skills. Nevertheless, the study revealed a dental student cohort who have a strained relationship with BeSS. This negative attitude became more apparent from year 3 onwards, when the clinical phase of studies begins. It was perpetuated and legitimated by the existence of a strong student culture that openly critiqued BeSS among and between student year groups.

DISCUSSION AND CONCLUSION(S)

In UK dental education there is a hidden curriculum related to BeSS. By underestimating the utility of BeSS, students are failing to recognise the biopsychosocial dimensions relevant to oral health and dental practice. All UK dental schools should review their relationship with BeSS and assess whether they are perpetuating a hidden curriculum about BeSS within their curricula.

Why UK dental education should take a greater interest in the behavioural and social sciences

Recent moves by public health academics and social scientists for increased recognition of the behavioural and social sciences (BeSS) in medical education in the UK have put the role and place of the BeSS in dental education back on the curricular agenda. Behavioural and social sciences have been a component of the UK dental curriculum since 1990 but, to our knowledge, have only been reviewed once, in 1999. The aim of this article is to reignite a discussion about the role and place of BeSS in dental education in the UK. It reiterates the benefits of BeSS to dental education and dentistry in general, while remaining cognisant of the implicit and explicit barriers that can conspire to side-line their contribution to dental education. This paper concludes by making renewed calls for more integration of BeSS into the dental undergraduate curriculum as well as sectoral recognition for its contribution to the advancement of dental education and the professional development of dentists.

Effectiveness of Motivational Interviewing Training for Primary Care Dentists and Dental Health Technicians: Results from a Community Clinical Trial

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.

The Structured Clinical Operative Test (SCOT) in dental competency assessment

INTRODUCTION

This paper describes a method of assessment of invasive clinical procedures which are currently being devised, and which are perceived to be a method that may be used to complement OSCEs in overall clinical skills assessment.

OBJECTIVE

The objective of the Structured Clinical Operative Tests (SCOT) is to introduce a greater level of objectivity to the assessment of operative clinical skills. Invasive or irreversible clinical operative procedures from a large part of dental undergraduate training and are by their very nature precluded from OSCE scenarios. It is also important to test intraoperative skills, communication skills and contingency management, and performance of these with awareness of the psychosocial context and ethical framework. The paper describes the use of checklists in the monitoring of clinical operative skills in a more authentic clinical situation using the SCOT. FORMATIVE ASSESSMENT: Continuous assessment should a) record achievement of competency in as objective a manner as possible and b) should encourage continuous self-evaluation. In the SCOT the students reflect on their clinical performance and in consultation with their supervisors record their plans to improve their competence in that skill or procedure in the future. This is done immediately on completion of a clinical task while the experience is still fresh in the mind. This encourages deep reflective learning as opposed to superficial factual learning which is characteristic of the more traditional curriculum, and is described as supervisor validated self-assessment.

DISCUSSION

The discussion outlines how SCOTs can be practically implemented and integrated into the undergraduate curriculum and an example of a SCOT is appended to the paper. The scope for using SCOTs in postgraduate assessment such as in VT/GPT is also described.