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Journal: Journal of dental education

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Concerns about health care quality have affected much of the health care delivery system including dentistry and dental education. Believing measurement is the key element in improving quality, the Dental Quality Alliance brought together major stakeholders in oral health care to lead the development of oral health performance measures that can be used to evaluate the performance of dental programs and practices. These measures complement the quality assurance measures dental schools use to ensure compliance with accreditation standards on patient care delivery. This article describes the rationale for and process of developing these performance measures and argues that dental schools should implement quality measurement processes in their clinical programs to improve the clinical practices of the present and better prepare their graduates for their practices of the future.

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The aims of this study were to evaluate the feasibility of an interprofessional education and collaborative practice model (IECPM) developed by the School of Dentistry (SOD) and College of Pharmacy (COP) for the University of Minnesota dental clinics and to report results of the needs assessment using specific primary care metrics and medication histories gathered through use of the model in 2015-16. Planning focused on establishing a workflow to implement the IECPM by the SOD and COP. The interprofessional team that provided patient care for the study consisted of 50 dental students, ten dental therapy students, one pharmacy student, one pharmacy resident, one faculty pharmacist, one dental assistant, one faculty dental hygienist, and two dentists. The team selected 190 patients in the SOD clinic for the study based on the inclusion criteria: patients with two or more chronic medical conditions who were taking medications. The 190 patients received a comprehensive dental exam, review of social and medical history, and medication therapy management assessment by the interprofessional team. Specific core primary care metrics (blood pressure, pulse, tobacco use, and diabetes status) and identification of drug therapy problems (DTPs) were monitored and/or screened for during the dental visit. The results showed that the IECPM helped identify that this cohort of patients presented with chronic conditions: 64% had hypertension, 34% had diabetes, and 10.5% reported smoking cigarettes. Several DTPs were identified, of which “needs additional drug therapy” was the most common. This cohort was taking multiple medications (2-34 per patient) to address a variety of medical conditions. The study concluded that the IECPM with the SOD and COP helped address a primary care need that often goes unmet in dental clinics.

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Integration of oral-systemic science into clinical care holds promise for improving patient outcomes and presenting opportunities for individuals in various health care professions to learn with, from, and about each other. The aim of this study was to examine whether an interprofessional continuing education program dedicated to oral-systemic health improved participants' attitudes toward interprofessional education and collaboration between dental and non-dental health care professionals and whether it influenced the physicians' practice of screening for debilitating oral diseases. The study took place in 2014 and used a mixed-methods approach, consisting of Readiness for Interprofessional Learning Scale (RIPLS) surveys conducted before, immediately after, and six months after the intervention, as well as surveys of self-reported practice behaviors and semi-structured interviews. A total of 231 health care professionals participated in the lectures and roundtable discussions. Of those, 134 responded to the pre-program survey (58% response rate), 110 responded to the post-program survey (48% response rate), and 58 responded to the survey six months after the program (25% response rate). The participants' median total RIPLS score at baseline was 76.5, which increased significantly immediately following the program (81.0) but returned to baseline six months later (76.5). Participants' RIPLS domain scores also increased significantly by profession from before to after the event, with effects returning to baseline after six months. Significantly more physicians reported screening for caries and periodontal disease after the intervention. An overall theme of “learning with, from, and about each other” was drawn from the interviews with 15 participants. The physicians took away a message of “just look in the mouth,” while the dental professionals reported feeling valued as members of the health care team. Although reported improvements in oral-systemic health practice immediately after the intervention were encouraging, further research is necessary to understand why collaborative behaviors were not sustained.

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In recognition of the importance for dental education programs to take a student-centered approach in which students are encouraged to take responsibility for their learning, a pediatric dentistry course redesign aimed at promoting greater active and self-directed learning was implemented at one U.S. dental school. The aim of this study was to examine the association between the students' self-reported study habits and active learning practices necessary for meaningful learning in the flipped/blended classroom. A convenience sample of two classes of second-year dental students in spring 2014 (SP14, n=106) and spring 2015 (SP15, n=106) was invited to participate in the study. Of the SP14 students, 84 participated, for a response rate of 79%; of the SP15 students, 94 participated, for a response rate of 87%. Students' self-reported responses to questions about study strategies with the prerecorded lecture materials and assigned reading materials were examined. Non-parametric analyses resulted in a cohort effect, so data are reported by class. In the SP15 class, 72% reported watching all/more than half of the prerecorded lectures versus 62% of the SP14 class, with a majority watching more than one lecture per week. In the SP15 cohort, 68% used active learning strategies when watching the lectures versus 58.3% of the SP14 cohort. The time of day preferred by the majority of both cohorts for interacting with course materials was 7-11 pm. Both SP14 and SP15 students reported being unlikely to read assigned materials prior to coming to class. Overall, the course redesign appeared to engage students in self-directed active learning. However, the degree to which active learning practices were taking place to achieve meaningful learning was questionable given students' self-reported study strategies. More work is needed to examine strategies for promoting study practices that will lead to meaningful learning.

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The aim of this study was to assess the relationship between personality preferences of incoming fourth-year dental students at the University of Texas Health Science Center at San Antonio as measured by the Keirsey Temperament Sorter II and their third-year clinical productivity and percentage of broken appointments. All 105 incoming fourth-year dental students in 2016 were invited to participate in the study, and 92 students completed the temperament questionnaire, for a response rate of 87.5%. Those students' clinical activity during their third year was measured by production points and percentage of broken appointments extracted from the electronic health record. The results showed that the majority of the respondents were extroverts rather than introverts and that the extroverts had significantly higher production points and significantly fewer broken appointments than the introverts. The most common personality preferences were sensing and judging. More than two-thirds of the respondents represented the Guardian temperament, one of four categories on the temperament measure. These findings help highlight the traits that may contribute to success in clinical training during dental school and support the notion that clinical success may be influenced by certain personality characteristics as well as the technical and specialized skills of dentistry.

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Dental students are assessed using a range of methods in their final-year examinations. The aim of this study was to explore the correlations and predictive value of final-year dental students' performance on knowledge-based and clinical assessments. Examination data related to applied dental knowledge (ADK), exit case presentation (CP), and integrated structured clinical examination (ISCE) assessments for five consecutive cohorts of final-year students at one U.K. dental school from 2011-12 to 2015-16 were collated. The relationships between the scores produced by each assessment were investigated to explore the relative contributions of each to the understanding of students' abilities across the domains. The study utilized data from all 304 students: 147 (48.4%) females and 157 (51.6%) males. Significant positive correlations were found between ISCE and ADK performance (r(391)=0.42, p<0.001) as well as between ISCE and CP (r(391)=0.44, p<0.001). In addition, both ADK performance and CP performance were significant predictors (at p<0.001) of ISCE performance. This study provides important information about the relationship between these students' performance across knowledge (ADK) and clinical (ISCE and CP) domains and highlights their predictive value. Further research is required to establish if these findings can be generalized and to explore the correlations between performance of dental students before and after graduation.

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The aim of this study was to determine the validity of peer evaluation for team-based learning (TBL) classes in dental education in comparison with the term-end examination records and TBL class scores. Examination and TBL class records of 256 third- and fourth-year dental students in six fixed prosthodontics courses from 2013 to 2015 in one dental school in Japan were investigated. Results of the term-end examination during those courses, individual readiness assurance test (IRAT), group readiness assurance test (GRAT), group assignment projects (GAP), and peer evaluation of group members in TBL classes were collected. Significant positive correlations were found between all combinations of peer evaluation, IRAT, and term-end examination. Individual scores also showed a positive correlation with group score (total of GRAT and GAP). From the investigation of the correlations in the six courses, significant positive correlations between peer evaluation and individual score were found in four of the six courses. In this study, peer evaluation seemed to be a valid index for learning performance in TBL classes. To verify the effectiveness of peer evaluation, all students have to realize the significance of scoring the team member’s performance. Clear criteria and detailed instruction for appropriate evaluation are also required.

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The aim of this study was to compare the effectiveness of a novel assessment software system with the traditional grading protocol used in the University of Texas School of Dentistry at Houston operative dentistry preclinical curriculum. In the study, conducted in 2016, 98 Class I preparations were evaluated both traditionally and digitally by two teams of calibrated preclinical faculty members (two evaluators for each team). Scores from each faculty pair were averaged for the traditional and the digital grading systems, and the scores for the two grading systems were compared. The analysis found no significant difference between the two grading systems with respect to isthmus width (p=0.073) and remaining marginal ridge (p=0.5841), but there was a significant difference with respect to pulpal floor depth assessment (p<0.0001). The data suggested that both grading techniques can be used with repeatable confidence for two out of three grading criteria: isthmus width and remaining marginal ridge. In addition, the software offers a self-assessment tool for students to perfect their psychomotor skills while promoting independence and immediate feedback.

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Evidence suggests that involving patients in health care decisions has a positive impact on health care outcomes and patients' perception of quality. However, the extent to which dental students are trained in communication and shared decision making (SDM) differs, and studies have identified a need for intensified learning and assessment of this competence. A need to more clearly define and operationalize what it means to be proficient in this area has been identified. The aim of this study was to operationalize communicative and relational skills in a comprehensive assessment instrument for SDM. Relevant skills in information exchange, negotiation, communication, and relationship-building were identified through an extensive review of previous research and instruments for assessing communication competence. Indicators for assessing these skills were formulated. The instrument was submitted to a pilot test in 2016 and evaluated on test content, internal structure, and response processes. The Assessment of Shared Decision Making (ASDM) instrument consists of 18 items addressing various aspects of the construct and three types of skills. Findings suggest that the ASDM represents a valid measure of SDM with three major components. The importance of developing the ASDM lies both in the summative assessment of students' communication with patients and for formative assessment purposes. Once identified, the components essential for SDM can be woven into the curriculum and shared with students. Thus, the ASDM provides a structure that can meet the need for intensified learning and assessment of dental students' competence in communication and SDM.

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Many readers may be familiar with patient-centered care, but they may not be familiar with the concept of person-centered care. Person-centered care implies knowing the patient as a person, not as just another patient or as a clinical requirement in dental school. Person-centered care gains the trust of the patient and is meaningful to the person because it respects his or her values, preferences, needs, and beliefs, emphasizing the individual’s freedom of choice while promoting emotional and physical comfort. This article describes the concept of person-centered care, compares person-centered care with patient- and student-centered care, presents a vision of person-centered care in a clinic setting, discusses its opportunities and challenges in general, and outlines future topics of interest for the academic, research, and practicing dental communities, including opportunities for in-depth reviews and guidelines.

Concepts: Sociology