FINDINGS AND FUTURE DIRECTIONS FROM A SMOKING CESSATION TRIAL UTILIZING A CLINICAL DECISION SUPPORT TOOL.

BACKGROUND: Tobacco smoking is the leading cause of disease, death, and disability in the United States. Dental practitioners are advised to provide evidence-based smoking cessation interventions to their patients, yet dental practitioners frequently fail to deliver brief smoking cessation advice. OBJECTIVES: To test whether giving dental practitioners a clinical decisions support (CDS) system embedded in their electronic dental record would increase the rate at which patients who smoke (1) report receiving a brief intervention or referral to treatment during a recent dental visit, (2) taking action related to smoking cessation within 7 days of visit, and (3) stop smoking for 1 day or more or reduce the amount smoked by 50% within 6 months. METHODS: Two-group, parallel arm, cluster-randomized trial. From March through December 2019, 15 nonacademic primary care dental clinics were randomized via covariate adaptive randomization to either a usual care arm or the CDS arm. Adult smokers completed an initial telephone survey within 7 days of their visit and another survey after 6 months. RESULTS: Forty-three patients from 5 CDS and 13 patients from 2 usual care clinics completed the 7-day survey. While the proportion of patients who reported receipt of a brief intervention or referral to treatment was significantly greater in the CDS arm than the usual care arm (84.3% vs 58.6%; P = .005), the differences in percentage of patients who took any action related to smoking cessation within 7 days (44.4% vs 22.3%; P = .077), or stopped smoking for one day or more and/or reduced amount smoked by 50% within 6 months (63.1% vs 46.2%; P = .405) were large but not statistically significant. CONCLUSIONS: Despite interruption by COVID-19, these results demonstrate a promising approach to assist dental practitioners in providing their patients with smoking cessation screening, brief intervention and referral to treatment.

Validation of an instructional module to help dental students learn to avoid plagiarism.

OBJECTIVE: This study aimed to validate the learning effectiveness of an instructional module in helping first-year dental students and international graduate advanced standing students learn to avoid plagiarism in their scientific writing. METHOD: The module was administered to a total of 226 first year dental students (157 at the University of Pittsburgh, in 2018 and 2019; 69 at the University of Illinois at Chicago, in 2019), and a total of 102 international graduate advanced standing students at the University of Illinois at Chicago, in 2019 and 2020. Psychometric analysis of the module's test items confirmed reliability and validity. RESULTS: An independent sample t-test performed on the module pretest scores determined that the first -year dental students entered their programs with more knowledge about plagiarism than the international graduate advanced standing students. Mean differences were calculated between pretest and posttest scores for each group and indicated that the module was equally effective at helping both groups learn to avoid plagiarism. An independent sample t-test compared the posttest mean scores of the 2 groups and determined that the first -year students achieved a greater learning outcome from the module. An independent sample t-test for Equality of Means with Levene's Test for Equality of Variances were performed to compare the mean differences between posttest and pretest scores for the 2 groups. These tests indicated that the 2 groups learned to avoid plagiarism at the same rate. CONCLUSIONS: The instructional module proved to be valid, reliable, effective, and time-efficient in improving student knowledge about avoiding plagiarism.

Leadership development for early-career educators: Association report on the ADEA summer program for emerging academic leaders.

There is a continuous challenge in academic health education to retain early career faculty members and staff. Attrition rates in the field can be as high as 42% in the first five years of an individual's career and are principally due to a sense that academic careers do not progress at a satisfactory rate. In response to this ongoing issue, the American Dental Education Association launched the Summer Program for Emerging Academic Leaders (ADEA EL) in 2012. The program has supported 301 participants from over 74 academic programs and private practice institutions. This current study describes data collected from program participants in an effort to conduct a thorough review of the program. In all, pre- and post-program data were assessed from faculty members and staff who have participated in the program over its eight-year history. The outcomes of this mixed-methods study describe an assessment of the curriculum (including changes that have occurred over the tenure of the program), the fit of the intended learning outcomes, reasons why a program such as the ADEA EL is needed, and what can be done to provide additional leadership resources and support for faculty members in dental education. This study represents the first time a longitudinal report of a professional development program designed exclusively for early-career faculty and staff has been described in the literature. Its outcomes are intended to be supportive of institutions and other programs focused on support and retention of early faculty and staff.

What dental educators need to understand about emerging technologies to incorporate them effectively into the educational process.

Many dental schools are currently struggling with the adoption of emerging technologies and the incorporation of these technologies into the educational process. Dental students exhibit an increasing degree of digital comfort when using social networking, mobile devices, search engines, or e-textbooks. Although the majority of students might consider themselves to be very skilled at using information technology, many faculty members would claim the opposite when evaluating their own knowledge and skills in the use of technology. As the use of technology, both formally and informally, continues to increase, dental educators are faced with many questions, such as: Does students' digital comfort disguise a lack of information literacy? What is the appropriate path of implementing technology into teaching and learning, and how can institutions support such an implementation? This article surveys a series of myths that exist about the use of technology in education and raises questions about their validity and how dental educators can avoid being misled by them.

Use of lecture recordings in dental education: assessment of status quo and recommendations.

This research project was part of a planned initiative at the University of Pittsburgh School of Dental Medicine to incorporate lecture recordings as standard educational support technologies. The goal of an institutional survey was 1) to gather current data about how dental educators across the United States and Canada use lecture recordings; 2) determine dental educators' perceived value and outcomes of using lecture recordings; and 3) develop recommendations based on #1 and #2 for the dental education community. Of the sixty-six North American dental schools at the time of the study, forty-five schools responded to the survey, for a 68 percent response rate. Of the respondents, twenty-eight schools were found to currently conduct lecture recording; these comprised the study sample. This study focused on the dental schools' past experiences with lecture recording; thus, those not currently engaged in lecture recording were excluded from further analysis. The survey questions covered a wide range of topics, such as the scope of the lecture recording, logistics, instructional design considerations, outcomes related to student learning, evaluation and reception, barriers to lecture recording, and issues related to copyright and intellectual property. The literature review and results from the survey showed that no common guidelines for best practice were available regarding lecture recordings in dental education. The article concludes with some preliminary recommendations based on this study.

Are dentists interested in the oral-systemic disease connection? A qualitative study of an online community of 450 practitioners.

BACKGROUND: Dentists in the US see an increasing number of patients with systemic conditions. These patients are challenging to care for when the relationship between oral and systemic disease is not well understood. The prevalence of professional isolation exacerbates the problem due to the difficulty in finding expert advice or peer support. This study aims to identify whether dentists discuss the oral-systemic connection and what aspects they discuss; to understand their perceptions of and attitudes toward the connection; and to determine what information they need to treat patients with systemic conditions. METHODS: We retrieved 14,576 messages posted to the Internet Dental Forum from April 2008 to May 2009. Using natural language processing and human classification, we identified substantive phrases and keywords and used them to retrieve 141messages on the oral-systemic connection. We then conducted coding and thematic analysis to identify recurring themes on the topic. RESULTS: Dentists discuss a variety of topics on oral diseases and systemic health, with the association between periodontal and systemic diseases, the effect of dental materials or procedures on general health, and the impact of oral-systemic connection on practice behaviors as the leading topics. They also disseminate and share research findings on oral and systemic health with colleagues online. However, dentists are very cautious about the nature of the oral-systemic linkage that may not be causal. Nonetheless, they embrace the positive association as a motivating point for patients in practice. When treating patients with systemic conditions, dentists enquire about the cause of less common dental diseases potentially in relation to medical conditions in one-third of the cases and in half of the cases seek clinical guidelines and evidence-based interventions on treating dental diseases with established association with systemic conditions. CONCLUSIONS: Dentists' unmet information needs call for more research into the association between less studied dental conditions and systemic diseases, and more actionable clinical guidelines for well-researched disease connections. To improve dissemination and foster behavioral change, it is imperative to understand what information clinicians need and in which situations. Leveraging peer influence via social media could be a useful strategy to achieve the goal.

Sealants and dental caries: insight into dentists' behaviors regarding implementation of clinical practice recommendations.

BACKGROUND: The authors conducted a qualitative study of private-practice dentists in their offices by using vignette-based interviews to assess barriers to the use of evidence-based clinical recommendations in the treatment of noncavitated carious lesions. METHODS: The authors recruited 22 dentists as a convenience sample and presented them with two patient vignettes involving noncavitated carious lesions. Interviewers asked participants to articulate their thought processes as they described treatment recommendations. Participants compared their treatment plans with the American Dental Association's recommendations for sealing noncavitated carious lesions, and they described barriers to implementing these recommendations in their practices. The authors recorded and transcribed the sessions for accuracy and themes. RESULTS: Personal clinical experience emerged as the determining factor in dentists' treatment decisions regarding noncavitated carious lesions. Additional factors were lack of reimbursement and mistrust of the recommendations. The authors found that knowledge of the recommendations did not lead to their adoption when the recommendation was incongruent with the dentist's personal experience. CONCLUSIONS: The authors found that ingrained practice behavior based on personal clinical experience that differed substantially from evidence-based recommendations resulted in a rejection of these recommendations. PRACTICAL IMPLICATIONS: Attempts to improve the adoption of evidence-based practice must involve more than simple dissemination of information to achieve a balance between personal clinical experience and scientific evidence.

Using natural language processing to enable in-depth analysis of clinical messages posted to an Internet mailing list: a feasibility study.

BACKGROUND: An Internet mailing list may be characterized as a virtual community of practice that serves as an information hub with easy access to expert advice and opportunities for social networking. We are interested in mining messages posted to a list for dental practitioners to identify clinical topics. Once we understand the topical domain, we can study dentists' real information needs and the nature of their shared expertise, and can avoid delivering useless content at the point of care in future informatics applications. However, a necessary first step involves developing procedures to identify messages that are worth studying given our resources for planned, labor-intensive research. OBJECTIVES: The primary objective of this study was to develop a workflow for finding a manageable number of clinically relevant messages from a much larger corpus of messages posted to an Internet mailing list, and to demonstrate the potential usefulness of our procedures for investigators by retrieving a set of messages tailored to the research question of a qualitative research team. METHODS: We mined 14,576 messages posted to an Internet mailing list from April 2008 to May 2009. The list has about 450 subscribers, mostly dentists from North America interested in clinical practice. After extensive preprocessing, we used the Natural Language Toolkit to identify clinical phrases and keywords in the messages. Two academic dentists classified collocated phrases in an iterative, consensus-based process to describe the topics discussed by dental practitioners who subscribe to the list. We then consulted with qualitative researchers regarding their research question to develop a plan for targeted retrieval. We used selected phrases and keywords as search strings to identify clinically relevant messages and delivered the messages in a reusable database. RESULTS: About half of the subscribers (245/450, 54.4%) posted messages. Natural language processing (NLP) yielded 279,193 clinically relevant tokens or processed words (19% of all tokens). Of these, 2.02% (5634 unique tokens) represent the vocabulary for dental practitioners. Based on pointwise mutual information score and clinical relevance, 325 collocated phrases (eg, fistula filled obturation and herpes zoster) with 108 keywords (eg, mercury) were classified into 13 broad categories with subcategories. In the demonstration, we identified 305 relevant messages (2.1% of all messages) over 10 selected categories with instances of collocated phrases, and 299 messages (2.1%) with instances of phrases or keywords for the category systemic disease. CONCLUSIONS: A workflow with a sequence of machine-based steps and human classification of NLP-discovered phrases can support researchers who need to identify relevant messages in a much larger corpus. Discovered phrases and keywords are useful search strings to aid targeted retrieval. We demonstrate the potential value of our procedures for qualitative researchers by retrieving a manageable set of messages concerning systemic and oral disease.

Rubrics 101: a primer for rubric development in dental education.

Identifying and implementing effective methods for assessing dental student performance are ongoing challenges for dental educators. Questions related to grading and assessment are common among faculty and students alike. Faculty members who are well-trained clinicians or scientists often have little formal training in education. In addition, assessment of performance brings with it an element of subjectivity. Questions about assessment and grading are most likely to arise when expectations are unclear or the rationale for the grade awarded is not articulated. The authors propose that one solution to assessment dilemmas can be found in the use of rubrics: scaled tools with levels of achievement and clearly defined criteria placed in a grid. Rubrics establish clear rules for evaluation and define the criteria for performance. Rubrics speak to both teaching and learning expectations and outcomes and can provide faculty members with a tool that can be useful in evaluating dental student performance. Rubrics can also provide students with clear expectations of performance, an opportunity to self-assess, and timely, detailed feedback. The purpose of this article is to define a rubric, apply the steps of rubric development as described in the educational literature to dental student assessment, present two examples of rubric implementation for assessing student progress toward competence, and recommend electronic resources for rubric development.

The rise in prescription drug abuse: raising awareness in the dental community.

Prescription drugs classified as controlled dangerous substances are essential therapeutic modalities in treating a variety of healthcare conditions; however, their pleasurable side effects can appeal to patients for uses other than their intent. As a result, unfortunate consequences of prescription drug use can arise. Misuse or abuse of prescription drugs can contribute to addictive behaviors, serious health risks, and potentially, death. It is imperative that the dental community remains educated and informed of nationwide healthcare trends, and prescription drug abuse is no exception. Ethically, dentists should be able to respond in a manner that addresses the best interests of their patients. To respond appropriately, dentists need to understand the terminology of prescription drug abuse; be able to identify and describe the drugs most often misused or abused; be able to identify individuals who may be at risk for prescription drug abuse; and be prepared to manage patients at risk in the dental setting.

Overcoming barriers to tobacco cessation counselling in dental students.

PURPOSE: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. MATERIALS AND METHODS: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. RESULTS: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. CONCLUSIONS: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Preparing faculty members for significant curricular revisions in a school of dental medicine.

Resistance to change is expected, especially when change involves and impacts many stakeholders. During the past year, the Curriculum Committee at the University of Pittsburgh School of Dental Medicine has been preparing the dental school for a major curricular revision of its predoctoral program. This article describes how a faculty retreat was designed to gain support for and involvement in this reform process. In particular, it examines the results of a faculty survey that was used to shape the retreat and was developed to determine the faculty's perceived knowledge about instructional design, barriers to innovations in teaching, and the influence of student evaluations and evidence-based dentistry principles on faculty teaching. Having identified strengths and weaknesses and areas of concern among faculty members through the survey, the Curriculum Committee was able to prepare a retreat that addressed faculty needs while simultaneously advancing the movement towards curriculum reform.

Is dentistry at risk? A case for interprofessional education.

The goal of interprofessional education (IPE) is to bring various professional groups together in the educational environment to promote collaborative practice and improve the health care of patients. Interest in IPE has been sparked by several factors in the health care system, including the increased awareness of oral-systemic connections, an aging population, the shift of the burden of illness from acute to chronic care, and lack of access to basic oral care. Increasingly, since the publication of the U.S. surgeon general's report in 2000, the dialogue surrounding IPE in dentistry has escalated. But how has dentistry changed regarding IPE since the report was released? This position paper argues that little has changed in the way dental students are taught and prepared to participate in IPE. The authors contend that academic dentistry and organized dentistry must take the lead in initiating and demanding IPE if dental students are to be prepared to work in the health care environment of the twenty-first century. Included are reasons why IPE is necessary and why dentistry must lead the conversation and participate in the solution to the oral health care crisis. It explores existing models and alternate approaches to IPE, barriers to implementation, and proposed strategies for academic institutions.