Oral health educators' reflections on teaching 2022 and beyond.

INTRODUCTION: The global pandemic prompted changes in health science education affecting both teaching and learning. This multi-institutional study assesses the near-term implications of these changes on faculty and faculty development. The project goals were to: (1) describe faculty experiences of teaching during the pandemic; (2) identify ways to sustain new pedagogical approaches, (3) describe the types of support faculty members need, and (4) offer recommendations to enhance oral health professions education. METHODS: A mixed-method approach using exploratory sequential design was conducted in two phases collecting qualitative and quantitative data. Focus group participants included didactic, pre-clinical, and clinical faculty in dental school (DMD/DDS), dental hygiene and dental therapy programs, and also faculty members serving in administrative roles in these programs (N = 37). One hundred forty-four faculty participated in the multi-institutional follow-up survey. RESULTS: Focus group and survey results led to 14 recommendations (nine structural and five individual) for oral health profession institutions and educators. CONCLUSION: Oral health profession education faculty were dramatically impacted by the pandemic and new faculty development needs were identified. Traditional faculty development topics and practices may be no longer applicable in the post-COVID-19 environment. Additionally, the pandemic stimulated creative approaches for curriculum design, teaching, and assessment in oral health profession education. Strategies need to be implemented to sustain these innovations.

Dental education 2026: A scenario exploration.

PURPOSE: The purpose of the following papers is to explore plausible alternative futures for dental education. The COVID-19 pandemic, challenges emerging from racism in the US, and social unrest were the precipitating factors leading to this consideration of academic dentistry in approximately 5 years. METHODS: In 2020-2021, five teams of six individual followed a seven-step process to develop five different scenarios of dental education in 2026. Four of these scenarios are constructed by considering a range of uncertainties associated with economic sustainability and educational innovation. A fifth scenario describes the optimal case for dental education's role should another pandemic occur. RESULTS: Each scenario is presented as a narrative in three parts: scenario highlights (summary), life in the scenario (fictional case), and scenario details (a description of significant factors within the envisioned future of the scenario). As a strategic tool, these scenarios will assist leaders, institutions, and stakeholders to anticipate and prepare for different futures, identify key indicators that a particular future is emerging, and guide decision-making to create the most desirable future in a changing environment. CONCLUSION: Institutions are encouraged to incorporate these scenarios into their strategic and contingency planning efforts and to use them to generate dialogue during faculty development initiatives. This study provides institutions with a process and model they can follow to create scenarios at the institutional level. The final paper in this collection is a guide that provides ideas and instructions for using the scenarios in curricular and extracurricular activities with faculty members and students.

Collaborating and teaching a synchronous, multi-university, virtual course: Health policy and access to dental care.

PURPOSE: In response to COVID-19, dental educators have been tasked with maintaining the quality of education while reducing cost, increasing efficiency, and leveraging technology. METHODS: This collaborative, multisite virtual health policy course used the Staged Self-Directed Learning Model (SSDL) to lead a diverse group of students studying health policy. Twelve Core sessions were offered with three additional sessions in August or December for a total of 15 total synchronous Zoom sessions that covered policy issues on supply, demand, and need for dental care. RESULTS: Twenty-eight students, seven lead instructors, and two course directors from six schools reported positive feedback on the course format, use of technology and the SSDL model, and breadth of topics presented. Participation by universities in four states with differing health policies stimulated virtual classroom discussions. CONCLUSION: In conclusion, collaborative interinstitutional virtual teaching and learning is cost effective, efficient, and engaging for students. This model has the potential to continue even when institutions are no longer affected by COVID-19.

Working With Interpreters as a Team in Health Care (WITH Care) Curriculum Tool Kit for Oral Health Professions.

Introduction: Limited English proficiency (LEP) patients face multiple care barriers and disproportionate risks for communication errors. Working with trained interpreters as a health care team can improve communication and drive high-quality care for LEP patients. Simulation and interprofessional education provide key strategies to address the critical training gap that exists at the intersection of patient safety, interprofessional practice, and cultural competence. Methods: Using action research principles across 16 months, we created a 3.5-hour simulation-based training for oral health and interpreting learners. The curriculum included profession-specific orientations with didactic and experiential content, three immersive simulations using start-stop-rewind methodology, virtual scenarios, and summary reflection discussions. A comprehensive tool kit facilitated curriculum implementation and standardization. Results: Forty-nine students from dentistry (first- through third-year predoctoral), dental hygiene, and dental therapy participated in this elective training during the 2017-2018 academic year; as required training, 126 third-year dental students participated in fall 2018. Students' familiarity with provider and interpreter best practices, appreciation of challenges faced by LEP patients, and confidence in skills working with spoken language interpreters increased. For all evaluation parameters, pre- and postsurvey ratings were statistically significant (chi-square tests, p < .001). Discussion: The curriculum efficiently and effectively develops oral health and interpreting learners' abilities to work as a team with LEP patients. Curriculum design and resources address key barriers to feasibility and sustainability. The curriculum informs communication across all patient populations, revealing that getting by with partial understanding can be insufficient for any patient and any health care team.

Creating and Evaluating Skills-Based Training in Working with Spoken-Language Interpreters for Oral Health Professions Students.

In a multicultural society, the ability to work effectively with spoken-language interpreters is a critical skill for oral health professionals. The aims of this study were to design and evaluate training for oral health professions students to work effectively with interpreters as a health care team. A total of 89 University of Minnesota dental, dental hygiene, and dental therapy students and 41 Century College translating and interpreting students participated in the elective three-hour training from 2016 to 2018. The 89 oral health professions participants were invited to respond to a seven-item survey about working with interpreters and patients who are limited English proficient (LEP), along with a comparison group of an additional 462 oral health professions students who did not participate in the program. Of the oral health professions participants, 49 responded to the survey, for a 55% response rate; and 245 of the comparison group responded, for a 53% response rate. A qualitative focus group with 11 program participants and inductive analysis provided further insights. The differences between participants' pre and post self-ratings were statistically significant (p<0.001) for each of the seven survey questions. After training, students were more familiar with provider and interpreter best practices and the context for patients who are LEP, as well as more confident in their skills to work effectively with interpreters. Student focus groups identified training relevance and necessity and learning format as the most significant success factors. This project highlights the process and value of creating these experiences for and with students and the value of simulation to develop knowledge, skills, and confidence.

Using Situated Learning Theory to Build an Interactive Learning Environment to Foster Dental Students' Professionalism: An Ignite Project.

Recognition that professionalism is at the heart of dentistry's contract with society has led to an emphasis on educational strategies designed to improve cultivation of professional behaviors. The aim of this study was to investigate the effectiveness of a project based on situated learning theory and using an Ignite format to support dental students' learning and promote professionalism. Learning activities were evaluated in terms of new thinking, changing perspectives, and professional relationships. Professional relationship development and professional self-identity were explored. First-year dental students (n=108) enrolled in a two-semester professional development course at one U.S. dental school in fall 2017 comprised the study sample; all participated in the study. The mixed-methods study design used simultaneous triangulation with the qualitative component adding insight to the evaluation results. A 25-question evaluation form was used to collect quantitative data, and student self-assessment essays provided qualitative information. On the survey, the students' responses were generally agree/strongly agree and ranged from 60% (creating the presentation, changed perspective on academic integrity) to 98% (interaction and discussion with facilitators, appreciate professional relationships beyond dental school). Four themes emerged from content analysis of the essays: Behavior and Consequences: Academic Integrity and Professionalism, Patient Trust: Conflicts of Interest, Professional Interactions, and Professional Standards and Reputation. Overall, this Ignite project was found to advance the desired learning goals with respect to initial professional development. The social interactions with peers and outside practitioners facilitated introspection and learning. Students saw themselves as part of a profession, they started to appreciate and develop professional relationships, and many left the event with a deeper understanding of issues related to academic integrity, professional behavior, and conflicts of interests in dental practice.

Identifying Needs to Ensure a Humanistic Academic Dental Environment: A Multi-Site Survey of Dental Students' Perspectives.

Dental school academic environments, whether the overall environment or the smaller environments of the classroom, lab, clinic, or community, are critical to student learning and professional development. The aims of this study were to assess dental students' experiences in the overall academic environment related to discrimination, destructive communication, belittlement, and isolation and to explore the relationships between students' emotional health and such experiences. Dental students in all four years at five U.S. dental schools were invited to participate in an electronic survey in April 2017. A total of 358 students responded for a 19.4% response rate. These students reported a total of five cases of discrimination that had been formally reported to their schools. Among these respondents, 24% had experienced destructive communication, 33% had experienced belittlement, and 33% reported feeling a sense of isolation. Non-males and students with disabilities were more likely to experience belittlement and isolation. Both destructive communication and feeling belittled increased with program year (relative to year 1)-spiking in year 3. Destructive communication and isolation were associated with behavior changes such as weight change, increased alcohol or over-the-counter medication use, and consultation with a health professional. To improve overall academic environments, dental educators should create learning environments to foster development of professional relationships, and schools should continue to provide student support services. Identifying and acknowledging shared issues across dental education might stimulate a national discussion that could lead to concerted approaches to address these issues. Identifying the proportions of students with feelings of isolation or loneliness along with experiences of belittlement and destructive communication could provide schools with a useful picture of their academic environment.

The Role of Self- and Peer Assessment in Dental Students' Reflective Practice Using Standardized Patient Encounters.

The aim of this study was to gain insight into the nature of the role played by self- and peer assessment in the development of dental students' reflective practice skills and the value gained through structured encounters with standardized patients. Four standardized patient encounters in an objective structured clinical exam (OSCE) format served as a learning experience for students to demonstrate decision making and communication skills in complex scenarios regarding issues of ethics. Self- and peer assessment and peer-to-peer discourse were used to enhance student reflection. A sample of 16 peer pairs was randomly selected from the population of 108 fourth-year students who participated in the 2014 Clinical Dental Ethics OSCE. Data were collected from self- and peer assessment forms. Five overall performance themes (personal affect, verbal communication, professional demeanor, relationship-building, and patient management) and three student learning themes (application and knowledge, ways to change, and impressed with peer/increased confidence in self) were identified. The results showed that peer assessment ratings were consistently higher than those in the self-assessments, but overall the students deemed both their peers' and their own decision making and communication skills to be quite good. These students rated their experience with the OSCE and self- and peer assessments as positive, appreciating the importance of reflection and learning from their peers. These results provide support for the continued formative use of standardized patient OSCEs and self- and peer assessment to help students develop skills in decision making, communication, professionalism, and reflection.

Conversation Salons: A Flexible Format for Open Discourse in Dental Education.

A series of conversation salons was created at the University of Minnesota School of Dentistry as an innovative format with the objective of engaging students, faculty, staff, and practitioners in discussion to promote reflection. The aim of this study was to explore the nature of students' abilities in the salons to connect experiences through reflection and apply what they learned to practice. Reflective essays (written during the summer and fall semesters of 2014) from 108 fourth-year dental students (all members of the Class of 2015) were read and assessed for the nature of reflection, number of connections, references to the past, applications to the future, and use of examples. For analysis, the theoretical works of Schön and Mezirow provided a useful framework. Overall, the results showed that the participants found the salon experience to be positive, and student participation was strong. When asked about learning, the most frequent responses were topic-related. At this stage of dental education, the students were largely focused on their future practice and found it easier to connect to an imagined future than a past experience. In terms of student abilities to reflect, the majority were skilled at simple reflection, based on these essays since only 18% were non-reflective and 15% showed strong critical reflection skills. The open and respectful environment of the salons enabled discussion and promoted reflection. These results suggest that more opportunities for collegial conversations and instruction in reflective practice earlier in the dental curriculum may be beneficial.

NEW ACCREDITTATION STANDARD FOR DENTAL EDUCATION PROGRAMS ON HUMANISTIC ENVIRONMENT.

Dental techniques and materials have changed dramatically in the past few decades, as have the expectations of patients, and the relationships among oral healthcare professionals and those they serve. The most current accreditation standards for dental education require that programs demonstrate success in preparing graduates for these relation- ships. The core approach emerging is that this part of dentistry should be built around humanism or respect for the dignity of all. This paper describes the new accreditation requirement, some of the historic need for change, the evolving environment of oral health care, and some programs that schools are developing to address these needs.

A humanistic environment for dental schools: what are dental students experiencing?

A Commission on Dental Accreditation (CODA) standard now requires that dental schools commit to establishing a "humanistic culture and learning environment" for all members of the academic environment. The aim of this study was to identify students' perceptions of factors that affect the dental school environment and to test differences in their experiences in terms of gender and year. This picture of the existing environment was meant to serve as a first step toward creating and supporting a more humanistic academic environment. A mixed-methods approach was used for data collection during the 2009-10 and 2010-11 academic years at one U.S. dental school. Four focus groups were first conducted to explore challenges and conflicts faced by students during their dental education. A written survey informed by the focus group results was then used to obtain quantitative data. The survey response rate was 47 percent (N=188). Faculty inconsistency, cheating, and belittlement/disrespect were experienced by many of the responding dental students during their education, similar to what has been documented in medicine. These students also reported experiencing both constructive communication (90 percent) and destructive communication (up to 32 percent). The female students reported more gender discrimination and sexual harassment than their male peers, and the clinical students reported more experience with belittlement and destructive communication than the preclinical students. The results suggest that greater effort should be directed toward creating a more humanistic environment in dental schools. Based on the issues identified, steps academic institutions can take to improve these environments and student skills are outlined.