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 dental education in Iranian dental schools

BACKGROUND

Community-based dental education (CBDE) has been an essential advancement in dental education in recent decades, enhancing it in many aspects. This study aimed to determine the characteristics and improvements of CBDE in dental schools in Iran.

METHODS

In the present descriptive study, an electronic questionnaire, including 18 "yes/no", "multiple choice", and "short answer" questions about the nature and extent of CBDE and students' experience in CBDE, was used. In early 2021, the questionnaires were mailed to the deans of all 43 dental schools in Iran under the supervision of the Council for Dental Education of the Iranian Ministry of Health and Medical Education. Reminder calls were made after 6 and 12 weeks. Dental schools that did not follow the CBDE program were excluded. The responses were analyzed descriptively.

RESULTS

Thirty-six dental schools completed the questionnaire (response rate: 84%). Seventeen schools (47%) reported having CBDE in their dental program. Sites lacking a well-equipped dental setting were the most used out of all extramural sites. The number of weeks dedicated to CBDE ranged between 1 and 20 (median: 4). The most common dental procedures practiced in extramural sites were pediatric dentistry (100%), restorative dentistry (71%), and dental examination (59%). The student-to-supervisor ratio in CBDE ranged between 3 and 15 (median: 5). In most schools (65%), the staff involved in directing CBDE were Community Oral Health PhDs.

CONCLUSIONS

An increasing number of Iranian dental schools have integrated CBDE into their undergraduate dental curriculum. The characteristics and extent of this educational strategy vary widely among dental schools. CBDE can be more effective by making positive changes in dental programs.

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.

'The dental nurse played a vital role in helping to manage the patient': a thematic analysis of undergraduate dental students' reflective journals from outreach placements

Introduction Community-based dental education, or 'outreach', forms a key part of dental courses in some high-income countries. Its educational benefits are well-established and once graduated, participants feel better prepared for their early career. Yet, it is less clear what students actually learn while on placements.Materials and method Qualitative document and thematic analysis of a convenience sample of anonymised dental student reflective journals (n = 51).Results The reflective journals described varied and broadly positive learning experiences. Analysis identified a number of themes of learning. Most related to the process and outcomes of care, but two key themes - dental anxiety and teamworking - were interrelated with both. Within teamworking, dental nurses appeared important in students' learning. Three process interrelated themes of learning were identified in the data. These were: tailoring your approach; communication and time; and evidence-based dentistry and minimising risk. Two broad interrelated themes relating to outcomes for patients and students were also identified: trust and confidence; and professionalism and personal development.Conclusion This research identified important and potentially transformative learning from outreach placements. This included how dental anxiety impacts patients and the dental team, the importance of teamworking, and the role of dental nurses in students' experiential learning.

Foreign-trained dentists' reflections on access to care after participating in a community-based dental education curriculum

Many people suffer poor oral health due to dentists not providing care to them. The number of foreign-trained dentists in the US is increasing, yet little is known about their involvement in providing care to underserved populations. Dental education programs use community-based dental education (CBDE) to expose dental students to access to care issues, and encourage them to provide care to underserved populations upon graduation. The aim of this study was to assess foreign-trained dentists' attitudes about access to care issues after completing a CBDE course at a dental school in the Midwest. Fifty-two dentists participated in the CBDE program from 2018 to 2019, as part of an advanced standing curriculum, and completed guided, reflective essays. Forty-seven dentists agreed to have their essays anonymously coded for research. Four researchers reviewed the essays independently, developed a coding scheme, and recoded to agreement. The main themes dentists mentioned were the affect of the CBDE program on enhancing their clinical skills, fostering an awareness of healthcare system inadequacies, as well as an awareness of how specific social determinants limit access to care, and helping to encourage a sense of personal and professional responsibility to address access to care issues. This study highlights the value of CBDE on helping future dental providers learn about and reflect on access to care issues. It also provides insight into foreign-trained dentists' attitudes about access to care issues, and supports their participation in CBDE programs to foster their contributions in addressing access to care issues in the US.

Establishing an antiracism framework for dental education through critical assessment of accreditation standards

PURPOSE

The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education.

METHODS

The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts.

RESULTS

Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service.

CONCLUSIONS

The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Designing Oral Health Curriculum That Facilitates Greater Integration of Oral Health Into Overall Health

For several decades, health professions education has been transforming; pedagogical constructs such as active learning, recorded lectures, electronic assessment, asynchronous content delivery, and interprofessional education and practice. However, the typical oral health curriculum has need for further transformation to ensure graduates' ability to function in an integrated health system. There is significant literature outlining associations between oral health and overall health, therefore, it is paramount that oral health learners develop skills to collaborate in an integrated model. Satcher, in 2000, outlined the gravity of oral health inequities and the importance of oral health. He said, “Too little time is devoted to oral health and disease topics in the education of non-dental health professional.” However, on the contrary typical oral health curriculum provide knowledge acquisition of topics related to overall health but isn't specifically designed to guide integrated care. In order to increase integrated care, groups like the Interprofessional Education Collaborative (IPEC) have developed competencies for interprofessional education and collaborative practice that guides the training of health professionals. One way to improve integration is accreditation standards that guide transformation as well incorporate IPEC competencies. Having competencies is important to prepare learners to function in clinics like Kaiser Permanente's medical-dental integration model that rely upon teams and teamwork and clarity of roles and responsibilities. This manuscript outlines principle of oral health curriculum that facilitate graduates ability to work in an integrated health system and how that contributes to the improvement overall health of patients.

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.