Shaping tomorrow's dentists: a multi-institutional survey of undergraduate dental students' perceptions towards interprofessional education

BACKGROUND

Interprofessional education (IPE) is essential to foster collaboration among healthcare professionals for holistic patient care. However, Malaysian dental education remains discipline-centric, hindering multidisciplinary learning approaches. Hence, this study aimed to explore Malaysian undergraduate dental students' perceptions of IPE.

METHODS

The present cross-sectional study employed convenience sampling to survey undergraduate dental students from four Malaysian institutions using a modified questionnaire with 20 close-ended and 2 open-ended questions. The questionnaire covered three domains (effectiveness, preference, importance) to assess students' perceptions using a five-point Likert scale. Psychometric validation was performed to assure validity and reliability of the modified questionnaire. Quantitative analysis (descriptive and inferential statistics), and qualitative analysis (content analysis) were subsequently performed.

RESULTS

397 students responded, and positive perceptions were generally noted with mean scores ranging from 4.13 to 4.35 across all domains. Questions 2 and 3, assessing the improvement in understanding the roles and responsibilities, and communication among healthcare professionals, received the highest mean scores. Meanwhile, Question 15 concerning the incorporation of IPE into educational goals received the lowest mean score. Regression analysis identified gender and clinical phase as significant factors, with females and preclinical students exhibiting more favourable perceptions. Motivators for IPE included a keen interest in diverse perspectives and recognising the importance of teamwork, while barriers encompassed tightly packed schedules, lack of understanding about IPE, misconceptions regarding dental education, and students' nervousness and fear of participation.

CONCLUSION

This study produced a valid and reliable instrument to measure undergraduate dental students' perceptions towards IPE. Strategic planning, such as overcoming logistical challenges, improving awareness, and creating a supportive learning environment are crucial for successful IPE integration into existing curricula, especially in resource-constrained developing countries like Malaysia.

Challenges and opportunities in preparing dentists for primary care

With the growing understanding of the relationship between oral and systemic diseases there is an increasing interest in integrating dental providers more completely into the health care delivery system. Technology advancements in traditional dental disease diagnosis and management as well as in salivary diagnostics for systemic disease provide great opportunities for the profession but numerous challenges for dental educators who are impacted by the intersection of numerous, sometimes competing interests. While economic factors play a significant role in curricular innovation and change, in the United States the accrediting process for dental education programs can be an equally vexing challenge. Movement away from primarily a competency-based assessment model to a model focusing on the establishment of Entrustable Professional Activities (EPAs) may provide a needed catalyst to enhance dental education to graduate dentists who embrace an expanded role as primary care providers.

Screening, brief intervention, and referral to treatment in oral health settings: A scoping review

OBJECTIVES

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an effective evidence-based model to provide early intervention and treatment to people with substance use disorders across diverse health settings. Yet, how SBIRT has been implemented within oral health settings and its associated outcomes has not been explored. This scoping review assessed how SBIRT has been implemented in oral health settings in the U.S. and discusses the implications for SBIRT integration in dentistry and oral health research, education and practice.

METHODS

Five scholarly databases were searched using a scoping review methodology for relevant literature, yielding seven articles that met inclusion criteria.

RESULTS

Findings from seven U.S. studies show that SBIRT has been implemented into oral health settings in three distinct ways: through education/training, as an intervention and in one national survey. Findings of this scoping review support the inclusion of SBIRT education for oral health professionals in both practice and clinical environments and offer examples of existing models for future implementation and study.

CONCLUSIONS

The scant literature on SBIRT intervention effects in dental settings-both within and outside of the U.S.-underscores the need for more empirical work to better understand how SBIRT impacts dental providers' knowledge, practices, referrals and ultimately, patient outcomes.

Proposing a communication module to enhance dental students' attitudes towards people with dementia: Phase 1 of a curriculum revision study

INTRODUCTION

The number of mentally altered patients a dentist meets in practice is increasing and interaction with them can be very challenging. As a baseline for an interventional study, we want to assess the attitude of dental students and identify areas of improvement in patient communication. This work compares the attitude of dental students towards people suffering from dementia to the attitudes of trained medical caregivers and the general population. Our aim is to use the results to assess the need for training in communicating with mentally altered patients.

MATERIALS AND METHODS

Fourth-year dental students attended two lectures on dementia given by a psychiatrist as part of the geriatric dentistry lecture and were questioned afterwards using the Dementia Attitude Scale. In 2016 and 2017, 73 students at the University of Greifswald were interviewed. The response rate was 84%. Using a factor analysis, the Dementia Attitude Scale's validated questions were interpreted and compared with data from nursing staff from Switzerland and the USA.

RESULTS

The factor analysis of the data showed the same two-factor loadings as the comparative groups, and that dental students' attitude is more comparable to the general population than to medically trained nursing staff.

CONCLUSION

Given the results, we conclude that the implementation of a communication module can serve in improving the attitude of dental students towards patients with dementia.

Infant Oral Health Education Curriculum for Medical, Nursing, and Social Work Trainees

Tooth decay is the most common chronic disease in children, and children often see their primary care practitioners more frequently than dentists (Adjaye-Gbewonyo and Black 2019-2020; National Center for Health Statistics 2019-2020). This Infant Oral Health Education Program included two online training sessions for trainees in social work, nursing, medicine, and dentistry. Trainees were assessed on anticipated changes to their practice related to children's oral health. During the first training session, trainees received a lecture on infant oral health, and then discussed a case study in interprofessional groups to reinforce the content. Trainees in medicine and nursing completed training to receive Medicaid reimbursement for performing preventive oral health services. The second training session was profession specific with tailored instructions in the form of videos, as well as a demonstration on fluoride varnish application. Of the 78 trainees (22 social work, 4 pediatric nurse practitioner, 38 pediatric medicine residents, and 14 pediatric dentistry residents), 91% (n=70) reported that they were introduced to at least one new health information resource or tool. Four-fifths of the eligible trainees (n=16/20, 80%) who completed the evaluation had fulfilled the State's requirements to receive Medicaid reimbursement for performing preventive oral health services. Three-fourths of trainees (n=22/29, 75%) reported that they are likely to promote children's oral health in future clinical practice. Trainees from all four professions provided positive feedback about the content.

Large-group simulation as a learning method to promote interprofessional collaboration and older adults' patient centered-care

AIMS

This study described the influence of a large-group simulation on social and health care students´ working life competence concerning interprofessional collaboration (IPC) and patient centered-care.

METHODS AND RESULTS

The target group (n = 319) was social and health care students from several different degree programs taking part in a large-group simulation concerning older people´s oral health as a part of his comprehensive well-being and health. Data were collected with a questionnaire containing background questions, statements about interprofessional practice and open-ended questions about learning experiences. The number of respondents was 257, including 51 oral health care students (OHCS). The data were analyzed using descriptive and statistical methods and content analysis. Working life competencies covers the overall social and collaborative skills which health-care professionals need in their work. They were reported to be improved in IPC and patient-centered care (PCC). The main described learning experiences in open responses included appreciating different professionals' competencies and the importance of interprofessional decision-making, interpersonal communication competence and patient-centered attitudes in care provision.

CONCLUSION

The large-group simulation is a good model for educating larger student groups simultaneously and it functioned well in improving understanding of IPC and PCC among older adults.

Trends in Scope of Practice for Oral Health Care: Future Transformative Effects

KNOWLEDGE TRANSFER STATEMENT

The results of this study can help key stakeholders, such as health care facilities, educational and research institutions, insurance companies, and governmental bodies, plan future activities and policies on dental practice and education.

Interprofessional education in the Dentistry curriculum: Analysis of a teaching-service-community integration experience

INTRODUCTION

Interprofessional education (IPE) offers relevant theoretical, conceptual and methodological approaches to the development of effective teamwork competencies.

OBJECTIVE

To analyse an interprofessional experience of teaching-service-community integration carried out at a public university in the South of Brazil.

METHODS

A case study with a qualitative approach was carried out. The study's participants were thirty-eight undergraduate dental students who attended the IPE activity between 2012 and 2019. Data collection was developed in two sequential steps that included the application of an online instrument and semi-structured interviews. The textual material was interpreted by content analysis, considering Kirkpatrick's evaluation levels (reaction, learning and behaviour).

RESULTS

In the reaction level, students highlighted the contents provided by the National Curricular Guidelines regarding public health system and teamwork, as well as the pedagogical teaching proposal by tutoring groups, which stimulated students' autonomy. It was observed that the learning was geared towards the development of collaborative teamwork competencies and cultural competencies. In the behaviour level, students perceived positive changes in their attitudes and behaviours towards patients, focused on needs related to life conditions, realising that dentists may work within a team. The elective/optional nature of the experience allied with the absence of other IPE activities in the curricular grid showed to be challenging.

CONCLUSION

IPE in undergraduate education presented positive results related to the reaction, learning and behaviour of dental students. We recommend the inclusion of interprofessional activities of teaching-service-community integration in Dentistry curricular structure to complement uniprofessional education.

Input From Practice: Reshaping Dental Education for Integrated Patient Care

Among the primary challenges in advancing the practice of integrated primary dental and medical health care is the appropriate educational and clinical preparation of a dental workforce that can function and flourish within integrated care environments. Most dental schools teach to traditional concepts and standards of dental care delivery which may be inconsistent with those of integrated care and could deter the entry and retention of graduates in contemporary, non-traditional practice models. To better understand how the dental school curriculum should be modified to accommodate integrative care models, a number of patient care organizations actively engaged in dental-medical integration were site visited to gain insight into the readiness of newer graduates, with emphasis on the US DMD/DDS graduate, to function in integrated practice. Leaders, practicing clinicians and staff were interviewed and common observations and themes were documented. This manuscript will focus on those educational components that integrated care organizations identify as absent or inadequate in current dentist education which must be addressed to meet the unique expectations and requirements of integrated patient care. These changes appear pivotal in the preparation of a dental clinician workforce that is respectful and receptive to new practice concepts, adaptative to new practice models, and competent in new care delivery systems.

Dentists as Primary Care Providers: Expert Opinion on Predoctoral Competencies

Dentistry and medicine traditionally practice as separate professions despite sharing goals for optimal patient health. Many US residents experience both poor oral and general health, with difficulty accessing care. More efficient collaboration between these professions could enhance health. The COVID-19 pandemic disclosed further disparities while underscoring concerns that physician supply is inadequate for population needs. Hence, enhancing healthcare provider education to better meet the public's health needs is critical. The proposed titles “Oral Physician” or “Oral Health Primary Care Provider” (OP-PCP) acknowledge dentist's capacity to diagnose and manage diseases of the orofacial complex and provide some basic primary healthcare. The US Surgeon General's National Prevention Council and others recommend such models. Medical and dental education already overlap considerably, thus it is plausible that dental graduates could be trained as OP-PCPs to provide primary healthcare such as basic screening and preventive services within existing dental education standards. In 2018, 23 dental and medical educators participated in an expert-opinion elicitation process to review educational competencies for this model. They demonstrated consensus on educational expansion and agreed that the proposed OP-PCP model could work within existing US Commission on Dental Accreditation (CODA) standards for predoctoral education. However, there were broader opinions on scope of practice details. Existing CODA standards could allow interested dental programs to educate OP-PCPs as a highly-skilled workforce assisting with care of medically-complex patients and to helping to reduce health disparities. Next steps include broader stakeholder discussion of OC-PCP competencies and applied studies including patient outcome assessments.

Assessing dental student perceptions after engaging in a longitudinal interprofessional education curriculum: A preliminary study

PURPOSE/OBJECTIVES

Baseline IPE perceptions for dental students were gathered prior to the implementation of a 2-year formalised IPE curriculum at a US institution. The goal was to establish a baseline of student perceptions and, in the future, continue to track student IPE perception data with IPE engagement as one measure of outcomes. The purpose of this paper is to analyse two dental student cohort perceptions of IPE after engaging in a 2-year longitudinal curriculum.

METHODS

First- and second-year students were required to participate in a 2-year IPE curriculum. As a requirement of the curriculum, students were asked to complete a validated IPE assessment, the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). Students completed the SPICE-R2 survey, using a retrospective pretest/post-test design, after engaging in the 2-year curriculum.

RESULTS

Sixty-four students in cohort 2017 and 70 students in cohort 2018 completed the entire SPICE-R2. Statistically significant positive changes (p < .05) were found in both dental student cohorts after engagement in the 2-year longitudinal IPE curriculum.

CONCLUSION(S)

A longitudinal IPE curriculum has the potential to impact student IPE perceptions. Additional longitudinal multi-institutional research is needed to determine best practices in delivery and learning.

Interprofessional education between dentistry and pharmacy students: delivery, barriers and facilitating implementation

Interprofessional education (IPE) between dentistry and pharmacy students is an approach to teach effective collaborative practice between a team of future health care providers. It relies on the support and motivation of students, staff and professionals to implement a variety of educational strategies and might involve evaluating student progression before and after delivery. Many barriers exist towards the implementation of IPE between dentistry and pharmacy health disciplines and outlining experiences across educational/clinical practice settings and possible solutions would assist in reducing those walls to realization. Implementation of IPE between pharmacy and dentistry undergraduate programs might lead to improved workplace collaborations and reduce medication errors, adverse events and increase in cross-referrals. Interprofessional education within undergraduate training forms the first steps towards reducing the burden on health care systems by enabling effective collaboration to improve patient outcomes. This narrative review describes IPE strategies used between pharmacy and dentistry undergraduate disciplines to enable collaboration, discusses the barriers and facilitators towards implementing IPE, and future directions for IPE education between these two disciplines.

Understanding oral health disparities in children as a global public health issue: how dental health professionals can make a difference

Oral disease in children is an urgent public health issue worldwide. Early childhood caries (ECC) affects 600 million children globally, yet it is entirely preventable. Dental health professionals around the world need to act to improve use of measures to prevent ECC and of quality dental health care to improve oral health worldwide. The University of California/Los Angeles (UCLA) Center for Children's Oral Health hosted an interprofessional innovation forum to discuss and recommend options. We present the policy, educational, and public health-related suggestions for improving outcomes and professional collaboration and five key areas for action: (1) increase advocacy efforts, (2) support interprofessional education and practice, (3) promote oral health education and increase health literacy, (4) increase collaboration with community and school-based oral health care workers, and (5) use of technology to increase access to dental care and health information.

Working collaboratively across schools to promote oral health education through interprofessional education

PURPOSE

The Association of American Medical Colleges and American Dental Education Association have identified oral health knowledge, skills, and attitudes shared by both medical and dental professionals. Although oral health was deemed an essential competency for medical practitioners, our state struggled to ensure learners received proper training. This training deficit resulted in conducting a needs assessment and implementing an oral health interprofessional module at our schools.

METHODS

First-year medical students and clinical faculty were emailed surveys in 2016 to obtain baseline information. A team of faculty and students from the Schools of Medicine and Dentistry reviewed the curriculum to determine where to augment oral health content. An oral health module to teach a basic head, neck, and oral examination to first-year medical students during their patient-centered care small-group sessions was implemented and evaluated.

RESULTS

Only 13.6% of faculty respondents were aware of national oral health competency recommendations, and <50% rated oral health important for primary care physicians (PCPs) to include in history, physical exam, or oral health counseling. On baseline, ≤25% of PCP respondents reported integrating the listed skills in their practice, and most indicated lacking expertise to teach oral health. Teaching sessions were rated helpful by students and faculty. After the teaching sessions, ratings on the importance of including oral health significantly increased from baseline.

CONCLUSION

Collaboration between Schools of Dentistry and Medicine successfully integrated oral health into medical school curriculum and improved the tutors' attitudes of its importance.

Should dentistry be a specialty of medicine? Two viewpoints

Dentistry and dental education are well-established domains with deep-rooted institutions, educational programs, organizational structures, and advanced specialty fields. Almost 100 years ago, Dr. William Gies, founder of the Columbia University College of Dental Medicine, stated that to best serve the oral health needs of the population, dentistry should be considered a specialty of medicine, and dental students should have the same solid foundation in the basic and clinical sciences as medical students. More recently, the report on "Advancing Dental Education in the 21st Century" recommends an increase in the integration of dental and medical education as a means to address 2 of its key challenges: "shrinking demand for dental services" and "shifting practice environment." However, it has also been argued that making dentistry and dental education a subspecialty of medicine and medical education will create logistical, structural, regulatory, and financial dilemmas. Instead of a drastic change to current dental educational, organizational, and institutional models, some argue a contemporary approach to dental education is required to ensure dentists are well prepared to address the healthcare needs of the population and future healthcare delivery systems and practice models. Recognizing the need for change in dental education to keep pace with changes in patient demographics and healthcare systems, the dental profession has the responsibility and opportunity to develop new models and paradigms that improve educational and clinical outcomes in our educational programs and future practice.

Development, implementation, and early results of a 4-year interprofessional education curriculum

This article seeks to outline the implementation of a longitudinal interprofessional education (IPE) program in the predoctoral curriculum at a U.S. dental school. The challenges of implementing the curriculum in a complex environment are reviewed, and an overview of the 4-year curriculum is offered, including exposure, immersion, and clinical readiness components. Results of developmental evaluations are reviewed. Respondents to surveys regarding the capstone case conference experiences overwhelmingly suggest the conferences were educationally rewarding as well as enriching for each of the health professions represented. While response was limited, alumni surveys also indicate satisfaction with the IPE experience. A discussion of challenges and suggestions regarding successful implementation and expansion of IPE programs from didactic to clinical settings are also included.

Clinical dental technicians in the United Kingdom: A qualitative understanding of the experiences, of practices and challenges of communication for dental professionals

AIM

To investigate the roles and relationships of registered Clinical Dental Technicians (CDTs) in the dental team and healthcare systems, and their perspective as a professional group in the United Kingdom (UK).

METHODS

This qualitative study was conducted following a national questionnaire survey of CDTs, 18 of whom participated in semi-structured interviews; they were purposively sampled to represent the diversity and demography of CDTs. A topic guide, informed by the literature and survey findings, guided discussions which were recorded and transcribed verbatim. Drawing upon phenomenological and cultural relativistic theories, thematic analysis was conducted, thus enabling an "analytic story" of the lived experience to emerge.

RESULTS

Clinical dental technicians expressed pride, passion and satisfaction in their work yet feel misunderstood in their role. Experiences of being accepted and incorporated into the wider dental profession are strained. Ultimately, there is a complex web of inter-dependence between all actors-a triadic relationship-bounded by policymakers and regulators which directly impacts on best practice and the balance between collaboration and autonomy. Looking to the future, Ideal practice may involve different models of care, with examples of good practice emerging.

CONCLUSION

This paper provides a unique examination of the lived experience, feelings and relationships of CDTs. The perceptions of their role, their inter-professional relations and the progression as a professional group must be addressed, and their potential to work collaboratively actively engaged to serve our ageing population.

Collaboration of Dental Hygiene and Nursing Students on Hospital Units: An Interprofessional Education Experience

The aims of this study were to implement and evaluate an innovative collaborative event with hospitalized patients to help develop dental hygiene and nursing students' interprofessional competence. The Interprofessional Collaborative Competency Attainment Survey (ICCAS) was used to assess the students' perceptions of interprofessional skill acquisition. Participants were 24 dental hygiene and 25 nursing students at the University of Southern Indiana in spring 2016. The results showed that all students had statistically significant improvement on the ICCAS items from pretest to posttest. There were no significant differences in improvement between the two groups on any single posttest item as the impact of the responses was similar. These results suggest that incorporating collaborative experiences in hospital settings can be an effective means to develop students' skills in interprofessional competence.

Comparison of Dental Students' Self-Evaluation and Faculty Evaluation of Communication Skills During a Standardized Patient Exercise

The aims of this retrospective study, conducted in 2017, were to explore dental students' perceptions of their first standardized patient encounters and to assess the relationship between students' self-evaluation and faculty members' evaluation of students' communication skills in those encounters. Data from a simulation training laboratory at one U.S. dental school were obtained for all 46 second-year students, who had a standardized patient communication learning session. The students had completed self-evaluations before and after a debriefing with a clinical psychology and/or social work faculty member and three or four student peers. The faculty members had also completed evaluations of the students' communications skills. The results showed that the students found the standardized patient encounter helpful. The students rated "making an introduction" most positively. Students had a weighted Kappa agreement of 0.22 (p=0.024) with the faculty evaluations on their post-debriefing evaluation of overall communication skills, which was within the 0.21-0.40 range of fair agreement. This study found that, during their first standardized patient simulation exercise, the second-year students rated their overall communication skills in fair agreement with the faculty member after debriefing.

The Dentist's Role in Southern Brazilian Teaching Hospitals: A Grounded Theory Study

The aim of this study was to develop a theoretical model to describe the role that the dentist plays in Brazilian hospital settings. This qualitative study was based on the grounded theory research method. Participants were a total of 27 individuals in three groups: dentists and general practice and oral and maxillofacial surgery residents; faculty; and other health professionals who interacted with dental patients in the hospital setting during the 2012-13 year. Data were collected in three teaching hospitals in the state of Santa Catarina, Brazil, through scripted interviews using open-ended questions. The stages of collection, codification, ordination, and integration of data were guided by constant comparative techniques to formulate a theoretical model. The codes generated were organized into seven categories: identifying the hospital as a working and teaching environment; recalling the dentists' professional pathways; reflecting on the dentist's work in the hospital; considering the political and organizational dimension of the role of the dentist in the hospital; understanding patients' life and health contexts; education and professional practice; and moving on towards interdisciplinary practices in the hospital setting. Integrating the categories led to a theoretical model called "The Dentist's Role in the Hospital Setting: An Interdisciplinary Construction." This theoretical model provides a framework to understand how dentists perform in the hospital setting, with a focus on interdisciplinary practice, which in this study was shown to be incipient and heterogeneous.

Developing Interprofessional Education at One U.S. Dental School: Establishing a Baseline and Moving Forward

Dental schools across the U.S. are in the process of incorporating interprofessional education (IPE) into their curricula. At Louisiana State University Health Sciences Center-New Orleans (LSUHSC), the process of educating competent students fully prepared to maximize patient outcomes through interprofessional care is under way. The aim of this study was to establish baseline data on three years of LSU dental students' perceptions of IPE prior to and as a new two-year IPE curriculum was being introduced. A survey was conducted of dental students in all four years from 2015 to 2017 using the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). In 2015, 120 students participated in the survey for a response rate of 46%, followed by 160 students in 2016 (62%) and 170 in 2017 (67%). The results showed that the first-year students in 2017 had a higher total SPICE-R2 mean score than the first-year students in 2015 and 2016; the difference was statistically significant. Even though the 2017 first-year students had only received an orientation to the curriculum at the time they completed the survey, this change in attitude suggests the new focus on IPE was already having an effect on students. There were no statistically significant differences between mean scores for the three cohorts of second-, third-, and fourth-year students, none of whom had experienced the new IPE curriculum. Data from this study will serve as a baseline from which to evaluate the impact of the new IPE curriculum that is now required of all first- and second-year dental students. Through continued IPE exposure in the curriculum and ongoing faculty development, further improvements in students' attitudes toward IPE can be anticipated.

Looking Back to Move Ahead: Interprofessional Education in Dental Education

Interprofessional education (IPE) is a widely recognized and critical component of dental and health professions education and is included in two of the predoctoral education standards required by the Commission on Dental Accreditation (CODA). Following a review of the literature on the state of IPE education in U.S. dental education programs, this article revisits six institutions identified in previous research as exemplars successfully implementing IPE on their campuses. Interviews were conducted with leaders at the following programs: Columbia University, Medical University of South Carolina, University of Colorado Anschutz Medical Campus, University of Florida, University of Minnesota, and Western University of Health Sciences. Strengths and weakness of IPE in dental education are discussed, along with opportunities for the future including reducing barriers to scheduling, increasing intraprofessional education, and consistent outcomes assessment. The article concludes with lessons learned by administrators and suggestions for improving incorporation of these requirements into predoctoral dental education programs by emphasizing the importance of IPE and dentistry's role in overall health. This article was written as part of the project "Advancing Dental Education in the 21^st Century."