Entrustable Professional Activities in Oral Health for Primary Care Providers Based on a Scoping Review

Oral Health Nursing Education and Practice Program: Ten-Year Outcomes

The Oral Health Nursing Education and Practice Program (OHNEP), a core partner of the National Interprofessional Initiative on Oral Health, is a national initiative focused on implementing an interprofessional oral health workforce innovation to influence change in clinical education, practice, and policy. OHNEP aims to address oral health disparities by enhancing the nursing profession's role in integrating oral health and its links to overall health in both academic and clinical settings. Leveraging the opportunity to cultivate faculty, preceptors, and clinicians as oral health champions, OHNEP aims to integrate interprofessional oral health clinical content and competencies in undergraduate and graduate nursing programs through faculty and preceptor development, curriculum integration, and establishing oral health as a standard of care in clinical settings. Outcomes include widespread dissemination of OHNEP virtual products and resources used by a significant number of undergraduate and graduate programs nationwide. OHNEP has a notable impact on policy related to integrating oral health and its links to overall health in undergraduate and graduate nursing programs, thereby increasing interprofessional oral health workforce capacity and aiming to improve oral health equity.

Evaluation of a virtual interprofessional oral-systemic health simulation experience in nursing, dentistry, medicine, and pharmacy education

PURPOSE

The annual teaching oral-systemic health (TOSH) virtual clinical simulation and case study activity exposes interprofessional teams of nurse practitioner, nurse midwifery, dental, medical, and pharmacy students to a virtual clinical simulation experience that uses oral-systemic health as a clinical exemplar for promoting interprofessional core competencies. The present study examines changes in participating students' self-reported interprofessional competencies following participation in virtual TOSH from 2020 to 2022. These findings are also compared to those from in-person TOSH (2019) to examine the equivalence of student outcomes of both the in-person and virtual programs.

METHODS

A pre- and post-test evaluation design was used to examine the effectiveness of exposure to the TOSH program on self-reported attainment of interprofessional competencies for participating students using the interprofessional collaborative competency attainment scale.

RESULTS

Analysis of pre- and post-surveys demonstrated statistically significant improvement in students' self-rated interprofessional experience competencies following the virtual TOSH program, which aligns with results from the in-person cohorts. Similar findings between the in-person and virtual cohorts indicated no statistically significant difference between the two formats.

CONCLUSION

These findings demonstrate the success of TOSH in promoting attainment of interprofessional competencies among future health professionals. We encourage administrators and faculty who lead health professional programs to take advantage of using virtual simulations as an integral component of interprofessional oral health clinical experiences where students from different health professions learn from and about each other in assessing and treating patients across the lifespan.

Awareness, Knowledge and Practice Patterns of Oral Health and Hygiene among Speech-Language Pathologists in India

Individuals with communication and swallowing disorders often exhibit poor oral health and hygiene (OHH), that can lead to further complications. OHH assessment and management is a part of scope of practice of Speech-Language Pathologists (SLPs). The study aims to determine the level of awareness, knowledge and practice patterns of OHH amongst the SLPs in India. A questionnaire with 20-item and three sections was developed to assess the awareness and knowledge regarding OHH among SLPs. A total of 162 participants responded to the survey. 93.2% participants were aware of the importance of OHH, however 42.6% participants did not feel confident enough to assess the same. A majority (82.7%) agreed that poor OHH can lead to different health complications. 38.8% of the participants responded that they assessed oral health only sometimes and 54.3% reported that they never used any standard screening/assessment tools to assess oral health. Only a very small percentage of participants (28.65%) counselled the patients for maintenance of oral hygiene and more than 40% never recommended appropriate OHH practices during management. Though a vast majority were aware of the importance of OHH and consequences of poor OHH, they did not feel confident and consequently did not incorporate OHH during clinical practice. Though the scope of SLP includes oral care assessment and management, Indian SLPs were not practicing this. Hence, the clinical and academic curriculum should focus on topics pertaining to oral health assessment and management, which will improve the quality-of-service delivery of the SLPs.

Entrustable professional activities in undergraduate dental education: A practical model for development and validation

OBJECTIVE

Entrustable professional activities (EPAs) are tasks that a person who is qualified or is in the process to be credentialed are allowed to engage. There are several levels of entrustment based on degrees of supervision assigned to each EPA. This paper aims to describe the process and outcome of creating EPAs; validate EPAs relevant to undergraduate dental training.

METHODS

A draft set of EPA statements was developed based on the consensus of an expert panel. These were then mapped to the nationally determined minimum experience thresholds (clinical and procedural experiences/competencies) and aligned to task-based instructional strategy. The EPAs were validated to improve the relevance by using a criterion-based rubric.

RESULTS

An end-to-end process workflow led to the development of an EPA-based educational framework to bridge the gaps in the curriculum. The process identified a total of 41 EPAs and out of which, 10 EPAs were notated as core EPAs and will be subjected to structured workplace-based assessment complying to the national standards. The validation exercise rated core EPAs with an overall score matching close to the cut-off of 4.07 (Equal rubric).

CONCLUSION

The end-to-end process workflow provided the opportunity to elaborate a structured process for the development of EPAs for undergraduate dental education. As validation is a continuous process, feedback from implementation will inform the next steps.

Integrating Oral Health into Health Professions School Curricula

Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.

Expectations for PhDs in health professions education: an international EPA-framed, modified Delphi study

Health professions education (HPE) has matured into field of study that employs and produces specialized educational scholars. Many academic institutions employ such scholars to support development and innovation in education. Simultaneously, the possibilities to obtain a PhD degree in HPE are expanding. Clarity in the expectations that such a degree brings along can be useful for scholars, employers and institutions. Anticipating that the views of what a PhD in HPE is or should be can vary between institutions, cultures and countries, we conducted an international Delphi study to identify EPAs for HPE PhDs. We used a framework of 24 EPAs resulted from a national consensus study in Iran as input to seek more generalized validity and a wider consensus of reasonably suitable activities. A three-round modified Delphi study was conducted with participation of 15 international experts. Final framework consisted of 17 relevant EPAs with a justification, specifications and limitations, and risks in case of failure per EPA (all had overall CVI > 0.8 for adequacy of description). Eleven EPAs were considered by the majority to be core to PhD training, 16 to be desirable for HPE PhDs as a capability to carry out without supervision, but the majority would trust current HPE PhDs to carry out only 5 of the 17 without supervision. The EPAs identified in this study arguably reflect the expectations of educators with a PhD degree in HPE. The framework has the potential to advance HPE training across countries and to inform personal development and employment decisions.

An innovative interprofessional dental clinical learning environment using entrustable professional activities

INTRODUCTION

Changes in society, new public demands for dental care and contemporary educational insights have influenced dental education worldwide and demand a renewed perspective. Following this perspective, an innovative interprofessional dental Master curriculum was developed at Radboud University Nijmegen in the Netherlands.

EDUCATIONAL PRINCIPLES

The curriculum is based on five contemporary educational principles and the core of the curriculum consists of a Student Run Dental Clinic that is fully run by students under professional supervision.

THE NEW CURRICULUM

In the Student Run Dental Clinic, Master dental students and Bachelor oral hygiene students are responsible for the care of approximately 750 patients. The students work within the same clinic for 3 years and patients receive oral health care from the same students over a long period. The clinic is a longitudinal cross-disciplinary clinic with different dental subdisciplines. Entrustable professional activities (also known as EPAs), to our knowledge not yet widely used in dental education, were introduced to facilitate learning and assessment. Fourteen EPAs have been developed to stimulate interprofessional education and learning. Of these, five EPAs are identical for the dental and oral hygiene curriculum, leading to extended interprofessional education and learning in the Student Run Dental Clinic.

DISCUSSION

Preliminary results show that EPAs are generally well received by supervisors and students.

CONCLUSION

To monitor and investigate the exact effect of the interventions and underlying mechanisms, a research programme on interprofessional learning, practice-based learning and EPAs and entrustment in dental education was recently set up.

Entrustable professional activities in entry-level health professional education: A scoping review

Entrustable professional activities (EPAs) are a recent enhancement to competency-based health professional education that describe the observable work done by a competent health professional. Through defining education outcomes in a work-based context, EPAs offer potential to identify skill gaps in individual or student cohorts and focus improvements. Entrustable professional activities have been pioneered and gained rapid acceptance in postgraduate medical education; however, less is known about their application and use in undergraduate or entry-level health professional education. The Joanna Briggs Institute scoping review methodology was used to explore how and in what context EPAs are being used in entry-level health professional education. Databases searched include CINAHL, EMBASE, MEDLINE, Web of Science and PsycINFO. A total of 748 abstracts were returned after duplicates removed, and 127 full-text articles were screened with 30 included for data extraction. Publications in this area have recently accelerated with disciplines of professions of medicine, pharmacy, dietetics and physician assistants reporting on EPA development, implementation and evaluation. EPA use has been reported in the United States, Canada, Europe Australia and Central America. Major motivation reported for EPA use is to improve patient safety by aligning performance and expectations and to improve student assessment. Several studies report on the use of EPAs to evaluate different curriculum models or identify curriculum gaps representing potential application in education research.

Attaining interprofessional competencies by connecting oral health to overall health

PURPOSE

The purpose of this study was to evaluate the effectiveness of an annual oral-systemic health interprofessional education (IPE) clinical simulation and case study experience with nurse practitioner/midwifery (NP/MW), dental (DDS), medical (MD), and pharmacy (PharmD) students.

METHODS

The Interprofessional Collaborative Competency Attainment Scale (ICCAS) was used to measure students' self-reported attainment of interprofessional competencies before and after the IPE experience. Pre- and post-test surveys were completed by NP/MW, DDS, MD, and PharmD student cohorts from 2017 to 2019. Students also had the opportunity to provide qualitative feedback about their experience at post-test. Data were collected from IPE faculty facilitators to assess their perception of the value of the Teaching Oral-Systemic Health (TOSH) program.

RESULTS

Student ICCAS results demonstrated statistically significant improvement in self-reported interprofessional competencies among all types of students across all 3 years (P < 0.001); qualitative student comments reflected positive experiences with the TOSH program. Survey data from IPE faculty facilitators supported the value of the IPE experience for all students.

CONCLUSIONS

The findings demonstrate the effectiveness of the TOSH program in using oral-systemic health as a clinical exemplar to develop interprofessional competencies. The 2017-2019 data reinforce the credibility of scaling the TOSH model for developing interprofessional competencies with students from different health professions.

Oral health care in the 21st century: It is time for the integration of dental and medical education

Major issues exist in the provision of oral health care in America, especially to underserved populations. Access to care, health disparities, an aging population with higher chronic disease burden, and rising healthcare costs continue to impact health outcomes for millions. The marginalization of oral health care, like that of behavioral health care, is a contributor. This perspective presents an idea whose time has come: putting the mouth back in the body. Several national reports stress the imperative to better integrate the practice of medicine and dentistry, including the first-ever Surgeon General's Report on Oral Health in 2000. A plan to lead a multifaceted integration of oral health into overall health is proposed. Leaders will come from new educational and practice models stressing teamwork, interprofessional education, innovative residency training programs and even dual degree options.