Development and Implementation of a New Course Regarding Patients with Special Health Care Needs

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Development and Implementation of a New Course
Regarding Patients with Special Health Care Needs
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• Stephanie M Munz,
• MR Inglehart RK Niemer
• University of Michigan
• SCDA Meeting 2014

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BACKGROUND
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• Focused Pre-doctoral Education in Special Care
  Dentistry
• Is this a new phenomenon?
• How many schools teach this in the didactic
  curriculum?
• How many schools have a clinical component?
• How many schools have a dedicated clinic space?
• How many dental schools have collaborative
  efforts with other health care professional
  schools and programs?

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CODA Standard
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• Standard 2-24 Graduates must be competent in
  assessing the treatment needs of patients with
  special needs.

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Development of a New Course
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• Introduced as one course of three in a module
  for third year dental students
• Many topics were previously addressed in
  separation as aspects of other courses.
• Includes a subsequent clinical rotation component
  at the adjacent University of Michigan Health
  System in the Oral and Maxillofacial
  Surgery/Hospital Dentistry Clinic
• Patients with special health care needs (SHCNs)
  are often referred to the University of Michigan
  Hospital Dentistry Clinic for comprehensive care
  when it is not appropriate in a pre-doctoral
  clinic environment.

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Patients with disabilitiesWhy do we talk about
it?
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• 1st Reason We all share some common stereotypes
  that might work against providing the best
  professional care for persons with disabilities.
• most positive Ulcer, Arthritis, Asthma,
  Diabetes, Heart disease
• most negative Mental illness, Alcoholism,
  Mental impairment, Ex-convict, Tuberculosis

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Why?
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• 2nd Reason These patients are likely to have
  access to dental care issues. If you dont learn
  about these issues, you will be less comfortable
  and less likely to treat patients with SHCNs.
• Dao, Zwetchkenbaum Inglehart. General Dentists
  and Special Needs Patients Does Dental
  Education Matter?

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Education and .
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Why?
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• 3rd Reason Patients with disabilities are likely
  to have
• More dental disease
• More missing teeth
• More problems finding dental care.
• Prevention is key!!!

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OBJECTIVES
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• To assess attendance of classes, use of podcasts
  and aspects of the new course that are evaluated
  as helpful at the midterm time of the class.
• To assess how well the students evaluate their
  educational experiences in classroom, clinic and
  community settings,
• which topics are seen as interesting vs. not
  interesting and how interested the students are
  in the topics presented, and
• which attitudes they hold concerning these
  issues.

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METHODS
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• Respondents Data were collected from two
  separate classes of third year dental students.
• Midterm data were collected from 40 students in
  the Winter term and from 55 students in the
  Spring/Summer term course.
• End of term data were collected from 84 students
  in the Winter Term and from 31 students in the
  Spring/Summer term course.
• Procedure Data were collected with anonymous
  web-based surveys at the midterm and end of the
  two semesters.
• Educational intervention
• The class consisted of 14 sessions.
• The lectures focused on specific patient groups
  and their management.
• Cases and guest speakers in their respective
  disciplines and a guest patient speaker were
  included.

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MATERIALS
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• The midterm survey consisted of 2 closed and 4
  open ended questions concerning attendance, use
  of podcasts, and aspects of the course that were
  useful/ not useful.
• The end survey consisted of 20 closed ended
  questions concerning
• interest in the course overall as well as in
  learning about specific patient groups,
• evaluation of how well their education had
  prepared them to treat patients with SHCNs and
  medical complexity,
• attitudes towards providing care for these
  patients,
• confidence when doing so, and
• challenges they perceive.
• In addition, 4 open ended questions inquired
  about aspects of the class that were useful / not
  useful.

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Results - Objective 1
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• Objective 1 was to assess attendance of classes,
  use of podcasts and aspects of the course that
  are evaluated as helpful at the time of the
  midterm.
• Only 15 of the students in class 1 and 42 in
  class 2 attended all lectures until the midterm.
• Of those students who did not attend, only 13 in
  class 1 and 13 in class 2 listened to the
  podcasts of all classes they missed.
• When asked what were helpful aspects of the class
• 26 indicated attending lectures
• 23 chose powerpoint slides and cases / examples
  and
• 11 named podcasts.

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Results Objective 2aEvaluation of educational
experiences
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• Objective 2a was to assess how these students
  evaluated the quality of their classroom based,
  clinical and community based education concerning
  providing care for patients with SHCNs and for
  medically complex patients at the end of the
  term.

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Results Objective 2aEvaluation of educational
experience
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Results Objective 2bInterest in topics
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Results Objective 2bInterest in topics Open
ended
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Results Objective 2c Attitudes
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LESSONS LEARNED
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• Overall, results showed students were not very
  interested in the topics.
• Of these, patients with developmental
  disabilities and head/neck cancer were most
  interesting.
• Patients with medical complexity and mental
  illnesses were least interesting due to reported
  repetition of this material.

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LESSONS LEARNED
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• Students reported they would appreciate learning
  about these topics in hands-on clinical settings
  rather than in a didactic setting.
• Nevertheless, they reported high satisfaction
  when hearing directly from patients about their
  diagnoses and experiences.

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Emphasize Practice Enhancing Skills
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• Gain referrals from physicians
• Become a consulting source for your local
  hospital/urgent care
• Treat one special patient, treat their entire
  family and all their friends and neighbors

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RECOMMENDATIONS
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• In the future, case discussion and application
  should be further incorporated for preparation
  and competence in the clinical environment.
• While a two-week clinical rotation already exists
  in the pre-doctoral curriculum, improved
  preparation for and integration of this rotation
  is recommended and achievable.
• The addition of the Delta Dental of Michigan
  Integrated Special Care Clinic for the treatment
  of patients with SHCNs will augment this ability
  to apply didactic knowledge to the treatment of
  patients.

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CONCLUSIONS
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1. Lack of student interest in the topics of
   patients with SHCNs and medical complexity is
   likely due to lecture fatigue as well as
   repetition of some material in the curriculum.
2. Active learning models, including case discussion
   and application should be incorporated for
   increased engagement. This can be used to
   emphasize the importance of this aspect of
   dentistry as well as increase students levels of
   competence and confidence.
3. Collaboration with other health care
   professionals in a subsequent, sustained clinical
   experience will also increase clinical competence
   and confidence, making it more likely that
   graduates will pursue treatment opportunities for
   patients with SHCNs.

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REFERENCES
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• 1. Chavez EM, Subar PE, Miles J, Wong A, Labarre
  EE, Glassman P. Perceptions of predoctoral
  dental education and practice patterns in special
  care dentistry. J Dent Educ. 2011
  Jun75(6)726-32.
• 2. Dao LP, Zwetchkenbaum S, Inglehart MR.
  General dentists and special needs patients does
  dental education matter? J Dent Educ. 2005
  Oct69(10)1107-15.
• 3. Greig V, Sweeney P. Special care dentistry
  for general dental practice. Dent Update. 2013
  Jul-Aug40(6)452-4, 456-8, 460.
• 4. Krause M, Vainio L, Zwetchkenbaum S,
  Inglehart MR. Dental education about patients
  with special needs a survey of U.S. and Canadian
  dental schools. J Dent Educ. 2010
  Nov74(11)1179-89.
• 5. Subar PE, Chavez EM, Miles J, Wong A,
  Glassman P, Labarre EE. Pre- and postdoctoral
  dental education compared to practice patterns in
  special care dentistry. J Dent Educ. 2012
  Dec76(12)1623-8.

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ACKNOWLEDGEMENTS
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• This research was initiated as an evaluation of
  a newly designed pre-doctoral didactic course
  aimed at comprehensive clinical management of the
  adult patient with special health care needs and
  medical complexity at the University of Michigan
  School of Dentistry and in conjunction with the
  third authors affiliation with the University of
  Michigan Center for Research on Learning and
  Teaching.

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Questions or comments are welcome
smmunz_at_med.umich.edu
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