An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

PURPOSE/OBJECTIVE: To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. METHODS: The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. RESULTS: The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t = 2.181; p < 0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. CONCLUSION: The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.

Pilot test of an emerging leaders program for dental school faculty.

PURPOSE/OBJECTIVES: The School of Dentistry at The University of Texas Health Science Center at San Antonio (UTHSA-SoD) implemented an SoD Emerging Leaders Program (SoDELP) in 2020-2021. This case report describes the leadership training needs of junior faculty that stimulated SoDELP development, the inter-institutional collaboration that facilitated program implementation, SoDELP curriculum content, and outcomes of formative assessment for two pilot cohorts of the SoDELP. METHODS: The 32-h curriculum was comprised of readings, reflection exercises, seminars by the Center for Professional Excellence at the University of Texas at San Antonio, case discussion, analysis of leadership dilemmas, and self-assessments. For a capstone project, participants created a case depicting a challenging leadership situation they experienced as a team leader or member. The SoDELP commenced in a face-to-face format but was completed online due to COVID 19. Formative evaluation included participants' pre- and post-training perceptions elicited by the Leadership Attitudes, Confidence and Concerns Inventory (LACCI) and qualitative appraisal of program components obtained by surveys and focus groups. RESULTS: All 18 participants completed SoDELP and provided positive evaluations of program content, organization, teaching quality, and value. Analysis of pre- and post-assessments indicated that participants' confidence in performing an array of leadership tasks was significantly enhanced, and participants' concerns about assuming leadership roles, such as not being ready for the job, impact on friendships, or concerns about ethical challenges, were significantly reduced. The LACCI displayed promising reliability in assessing participants' confidence, attitudes and concerns, demonstrating the potential to serve as a measurement tool to appraise outcomes of leadership training in the health professions. CONCLUSION: Outcomes suggest that SoDELP enhances faculty members' sense of readiness for leadership roles, and the LACCI may be a useful assessment tool for leadership training.

Case Report of a Program to Enhance Dental Students' Interest in Academic Dentistry.

This case report describes a Teaching Honors Program (THP) at the UT Health San Antonio School of Dentistry and presents findings from an outcomes assessment covering the initial 11 years of the program. The program goals are to enhance dental students' awareness of academic career options, promote student and faculty collaboration on educational development projects, and provide students with training in teacher toolkit skills to increase their readiness for peer teaching during dental school and faculty roles early in their careers. The THP curriculum consists of six core courses and nine electives extending across the four years of dental school. THP graduates receive the academic designation "Distinction in Dental Education" at commencement. Outcomes data are organized by Kirkpatrick's Hierarchy of Educational Outcomes: reaction (participants' satisfaction with THP), indicators (students' attitudes and intentions pertinent to teaching and academic careers), learning (changes in knowledge and skills relevant to teachers' tasks), behavior (students' ability to apply teaching skills in classrooms, labs, and clinics), and results (changes in the infrastructure and capacity of the school as a consequence of the THP). Positive outcomes were found in multiple layers of the assessment hierarchy. In 2016, 51% of students participated in the THP, and 31 graduated with Distinction in Dental Education; in 2017, 50% participated, and 44 graduated with that honor. THP students provide approximately 1,400 hours of supervised peer teaching annually in the predoctoral curriculum and pre-matriculation programs, and 21% of the initial 106 THP graduates entered academic dentistry soon after graduation.

Online Case-Sharing to Enhance Dental Students' Clinical Education: A Pilot Study.

Dental students' clinical learning is dictated by patients' needs. Thus, not all students have identical educational experiences. Even routine treatment can require different approaches depending on concurrent dental problems, patients' health status, or unexpected complications. No curriculum can expose students to all treatment alternatives when issues arise. Consequently, mechanisms to facilitate students' learning from the collective experiences of their classmates can augment their clinical acumen. The aim of this pilot study was to investigate a blended learning experience consisting of a website on which third- and fourth-year students posted and discussed PowerPoint presentations depicting patient treatment and weekly seminars in which students and faculty discussed posted cases to retrospectively assess treatment decisions. All 49 students in two of the school's general practice groups (23 fourth-year and 26 third-year students) in academic year 2011-12 participated, using a PowerPoint template to create cases to share with their peers. The students completed the Clinical Education Instructional Quality Inventory (Clin-EdIQ) before and after the case-sharing experience. The results showed statistically significant pre- to posttest increases on the four ClinEdIQ dimensions: overall clinical learning experience, specific learning opportunities, interaction among students and instructors, and collaborative learning. These students also reported that the online case-sharing and follow-up seminars were a valuable educational experience. However, students not involved in case-sharing had similar pre to post ClinEdIQ score changes. The results suggest that online case-sharing supported by case analysis seminars facilitated exchange of clinical insight among students and instructors, but may not have altered students' perceptions of the clinical learning environment.

Critical Thinking in Dental Students and Experienced Practitioners Assessed by the Health Sciences Reasoning Test.

To date, there has been a lack of published studies examining the validity of the Health Sciences Reasoning Test (HSRT) to assess critical thinking among dental students. The aim of this study was to examine the construct validity of the HSRT using a novice-expert model consisting of first-year dental students as novices and experienced general dentists as experts. Novice cohort subjects were recruited from all 105 students in the first-year dental school class at the University of Texas Health Science Center at San Antonio during a regularly scheduled course in August 2015. A total of 83 students participated, for a 79% response rate. Thirty individuals personally recruited from the same school's faculty and from private practitioners made up the expert cohort. The results showed that the adjusted mean overall score for the expert cohort (25.31) was significantly higher than that of the novice cohort (22.64) (p=0.04). The expert cohort achieved higher adjusted mean scores in all scales (Induction, Deduction, Analysis, Inference, and Evaluation), with the difference in the Analysis scale being significant (p=0.02). In this study, experienced general dentists achieved significantly better overall scores on the HSRT as compared to first-year dental students, suggesting the instrument was able to measure differences between novice and expert. Further efforts to validate the instrument in a dental education setting and to understand its correlation with strategies and practices aimed at developing critical thinking in dental students are warranted.

Is Dental Students' Clinical Productivity Associated with Their Personality Profile?

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.

Expansion of a Predoctoral Surgical Implant Selective for Dental Students.

Historically, predoctoral dental education programs have focused on the restoration of implants in the clinical environment; however, given the increase in dental implant therapy being performed by general dentists, the need to incorporate surgical implant training is becoming evident. This article describes a predoctoral surgical implant selective at the University of Texas Health Science Center at San Antonio and its evolution across five years to include emerging techniques and technology to enhance students' understanding of dental implant therapy, both surgical and restorative. From virtual implant planning and guided surgery to intra-oral scanning of implants for custom abutments and restorations, students obtained first-hand experiences with a wide spectrum of aspects of implant therapy. The results of anonymous surveys completed by 2014-15 students before and after the year-long selective regarding their impression of the program are also discussed.

Fostering dental student self-assessment of knowledge by confidence scoring of multiple-choice examinations.

Creating a learning environment that fosters student acquisition of self-assessment behaviors and skills is critically important in the education and training of health professionals. Self-assessment is a vital component of competent practice and lifelong learning. This article proposes applying a version of confidence scoring of multiple-choice questions as one avenue to address this crucial educational objective for students to be able to recognize and admit what they do not know. The confidence scoring algorithm assigns one point for a correct answer, deducts fractional points for an incorrect answer, but rewards students fractional points for leaving the question unanswered in admission that they are unsure of the correct answer. The magnitude of the reward relative to the deduction is selected such that the expected gain due to random guessing, even after elimination of all but one distractor, is never greater than the reward. Curricular implementation of this confidence scoring algorithm should motivate health professions students to develop self-assessment behaviors and enable them to acquire the skills necessary to critically evaluate the extent of their current knowledge throughout their professional careers. This is a professional development competency that is emphasized in the educational standards of the Commission on Dental Accreditation (CODA).

Improving multiple-choice questions to better assess dental student knowledge: distractor utilization in oral and maxillofacial pathology course examinations.

How many incorrect response options (known as distractors) to use in multiple-choice questions has been the source of considerable debate in the assessment literature, especially relative to influence on the likelihood of students' guessing the correct answer. This study compared distractor use by second-year dental students in three successive oral and maxillofacial pathology classes that had three different examination question formats and scoring resulting in different levels of academic performance. One class was given all multiple-choice questions; the two other were given half multiple-choice questions, with and without formula scoring, and half un-cued short-answer questions. Use by at least 1 percent of the students was found to better identify functioning distractors than higher cutoffs. The average number of functioning distractors differed among the three classes and did not always correspond to differences in class scores. Increased numbers of functioning distractors were associated with higher question discrimination and greater question difficulty. Fewer functioning distractors fostered more effective student guessing and overestimation of academic achievement. Appropriate identification of functioning distractors is essential for improving examination quality and better estimating actual student knowledge through retrospective use of formula scoring, where the amount subtracted for incorrect answers is based on the harmonic mean number of functioning distractors.

Faculty development for underrepresented minority dental faculty and residents.

This report describes the implementation and evaluation of the Bronx-Lebanon Hospital Center Dental Faculty Development Program (DFDP) for fifteen participants: five advanced dental education faculty members and ten residents. The 100-hour DFDP, designed in the longitudinal immersion model for faculty development, was conducted in four phases at the Bronx-Lebanon Department of Dentistry in the Bronx, New York, in 2010-11. The DFDP was implemented to help underrepresented minority (URM) dental residents and clinical faculty members develop skills necessary for academic careers and enhanced teaching effectiveness. The program's curriculum had four themes: teaching and learning, scholarship, academic leadership, and career planning. For each phase, the participants completed pre- and post-training assessments of their knowledge, attitudes, and confidence, as well as qualitative evaluation of DFDP organization, content, activities, and value. The participants' pre-instruction mean knowledge score for all phases combined was 48.3 percent, and the post-test score was 81.1 percent (p=0.01). The participants showed minimal change in their attitudes about educational issues, but they reported enhanced confidence for twenty-five skills addressed in the DFDP. The total confidence score was 77.5 (25 skills × 3.1 group mean) on all pre-tests combined and 100.2 (25 × 4.0 group mean) on the post-tests (p=0.01). The participant ratings for overall DFDP implementation and for twenty-four topical sessions were uniformly positive. The faculty and resident participants in this year-long faculty development initiative at an advanced dental education program with a high URM representation demonstrated enhanced knowledge and confidence and provided positive program evaluations. This report also describes curricular and assessment enhancements for subsequent years of the DFDP based on the first-year outcomes.

Career transition and dental school faculty development program.

Academic dentistry, as a career track, is not attracting sufficient numbers of new recruits to maintain a corps of skilled dental educators. The Faculty Development Program (FDP) at the University of Texas Health Science Center at San Antonio Dental School received federal funds to institute a 7-component program to enhance faculty recruitment and retention and provide training in skills associated with success in academics including:(1) a Teaching Excellence and Academic Skills (TExAS)Fellowship, (2) training in research methodology,evidence-based practice research, and information management, (3) an annual dental hygiene faculty development workshop for dental hygiene faculty, (4) a Teaching Honors Program and Academic Dental Careers Fellowship to cultivate students' interest in educational careers, (5) an Interprofessional Primary Care Rotation,(6) advanced education support toward a master's degree in public health, and (7) a key focus of the entire FDP, an annual Career Transition Workshop to facilitate movement from the practice arena to the educational arm of the profession.The Career Transition Workshop is a cap stone for the FDP; its goal is to build a bridge from practice to academic environment. It will provide guidance for private practice, public health, and military dentists and hygienists considering a career transition into academic dentistry. Topics will be addressed including: academic culture, preparation for the academic environment,academic responsibilities, terms of employment,compensation and benefits, career planning, and job search / interviewing. Instructors for the workshop will include dental school faculty who have transitioned from the practice, military, and public health sectors into dental education.Objectives of the Overall Faculty Development Program:• Provide training in teaching and research skills,career planning, and leadership in order to address faculty shortages in dental schools and under representation of minority faculty.• Provide resident and faculty training in cultural and linguistic competency.• Develop and conduct a collaborative inter professional education project with a Pediatric Medicine department, a nursing school, and other health professions' education programs.• Provide faculty and residents with financial support to pursue a master's degree in public health; and • Provide support and assistance for dental practitioners desiring to explore a transition into the educational environment.

Developing and pretesting case studies in dental and dental hygiene education: using the diffusion of innovations model.

Case-based learning offers exposure to clinical situations that health professions students may not encounter in their training. The purposes of this study were to apply the Diffusion of Innovations conceptual framework to 1) identify characteristics of case studies that would increase their adoption among dental and dental hygiene faculty members and 2) develop and pretest interactive web-based case studies on sensitive oral-systemic health issues. The formative study spanned two phases using mixed methods (Phase 1: eight focus groups and four interviews; Phase 2: ten interviews and satisfaction surveys). Triangulation of quantitative and qualitative data revealed the following positive attributes of the developed case studies: relative advantage of active learning and modeling; compatibility with a variety of courses; observability of case-related knowledge and skills; independent learning; and modifiability for use with other oral-systemic health issues. These positive attributes are expected to increase the likelihood that dental and dental hygiene faculty members will adopt the developed case study once it is available for use. The themes identified in this study could be applied to the development of future case studies and may provide broader insight that might prove useful for exploring differences in case study use across dental and dental hygiene curricula.

Changes in educational methodologies in predoctoral dental education: finding the perfect intersection.

This article describes the evolution of thinking, primarily over the past fifteen years, within the academic dentistry community concerning teaching and learning strategies to facilitate students' acquisition of competence. Readers are encouraged to consider four issues. First, looking back to the time of the Institute of Medicine report Dental Education at the Crossroads: Challenges and Change fifteen years ago, in the mid-1990s, where did we think we would be now, in 2011, in regard to the structure of the predoctoral curriculum and use of specific educational methodologies, and to what extent have those predictions come true? The author's own crystal ball predictions from the 1990s are used to kick off a discussion of what connected and what did not among numerous advocated educational reforms, many of them transformative in nature. Second, what is the nature of the evidence supporting our ongoing search for educational best practices, and why are advocacy for educational best practices and prediction of down-the-road outcomes so treacherous? This section distinguishes types of evidence that provide limited guidance for dental educators from evidence that is more helpful for designing educational strategies that might make a difference in student learning, focusing on factors that provide a "perfect intersection" of student, teacher, educational method, and learning environment. Third, readers are asked to revisit four not-so-new teaching/learning methods that are still worthy of consideration in dental education in light of best evidence, upcoming events, and technology that has finally matched its potential. Fourth, a specific rate-limiting factor that hinders the best efforts of both teachers and students in virtually all U.S. dental schools is discussed, concluding with a plea to find a better way so that the good works of dental educators and their students can be more evident.

Introduction of an implant surgical selective into a predoctoral dental curriculum.

This article describes the introduction of an implant surgical selective into a predoctoral dental curriculum. It outlines the various challenges encountered in developing the program and the methods used to overcome those challenges. The article also discusses the outcomes of the first year of the program.

Teaching evidence-based practice at the University of Texas Health Science Center at San Antonio dental school.

The overarching goal of the Evidence-Based Practice Program at San Antonio is to provide our graduates with life-long learning skills that will enable them to keep up-to-date and equip them with the best possible patient care skills during their 30-40 years of practice. Students are taught to (1) ask focused clinical questions, (2) search the biomedical research literature (PubMed) for the most recent and highest level of evidence, (3) critically evaluate the evidence, and (4) make clinical judgments about the applicability of the evidence for their patients. Students must demonstrate competency with these "just-in-time" learning skills through writing concise one-page Critically Appraised Topics (CATs) on focused clinical questions. The school has established an online searchable library of these Critically Appraised Topics. This library provides students and faculty with rapid, up-to-date evidence-based answers to clinical questions. The long-range plan is to make this online library available to practitioners and the public.

Validation of an instrument to assess evidence-based practice knowledge, attitudes, access, and confidence in the dental environment.

This article reports the validation of an assessment instrument designed to measure the outcomes of training in evidence-based practice (EBP) in the context of dentistry. Four EBP dimensions are measured by this instrument: 1) understanding of EBP concepts, 2) attitudes about EBP, 3) evidence-accessing methods, and 4) confidence in critical appraisal. The instrument-the Knowledge, Attitudes, Access, and Confidence Evaluation (KACE)-has four scales, with a total of thirty-five items: EBP knowledge (ten items), EBP attitudes (ten), accessing evidence (nine), and confidence (six). Four elements of validity were assessed: consistency of items within the KACE scales (extent to which items within a scale measure the same dimension), discrimination (capacity to detect differences between individuals with different training or experience), responsiveness (capacity to detect the effects of education on trainees), and test-retest reliability. Internal consistency of scales was assessed by analyzing responses of second-year dental students, dental residents, and dental faculty members using Cronbach coefficient alpha, a statistical measure of reliability. Discriminative validity was assessed by comparing KACE scores for the three groups. Responsiveness was assessed by comparing pre- and post-training responses for dental students and residents. To measure test-retest reliability, the full KACE was completed twice by a class of freshman dental students seventeen days apart, and the knowledge scale was completed twice by sixteen faculty members fourteen days apart. Item-to-scale consistency ranged from 0.21 to 0.78 for knowledge, 0.57 to 0.83 for attitude, 0.70 to 0.84 for accessing evidence, and 0.87 to 0.94 for confidence. For discrimination, ANOVA and post hoc testing by the Tukey-Kramer method revealed significant score differences among students, residents, and faculty members consistent with education and experience levels. For responsiveness to training, dental students and residents demonstrated statistically significant changes, in desired directions, from pre- to post-test. For the student test-retest, Pearson correlations for KACE scales were as follows: knowledge 0.66, attitudes 0.66, accessing evidence 0.74, and confidence 0.76. For the knowledge scale test-retest by faculty members, the Pearson correlation was 0.79. The construct validity of the KACE is equivalent to that of instruments that assess similar EBP dimensions in medicine. Item consistency for the knowledge scale was more variable than for other KACE scales, a finding also reported for medically oriented EBP instruments. We conclude that the KACE has good discriminative validity, responsiveness to training effects, and test-retest reliability.

Development and implementation of an online screening application at the University of Texas Health Science Center at San Antonio Dental School.

This article describes a quality improvement (QI) initiative that is in process at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School and the website that grew out of this effort. The process of screening and assignment of patients was selected for improvement in 2006. QI methods were used to develop a website that improves access to care for patients and assists in the matching of patients and students. The website (www.dentalscreening.com) has received more than 15,000 screening applications in the period from May 2007 to January 2010 and has provided unprecedented insight into the needs of our patients. This article outlines the process by which the website was created, the rationale for the design, and the benefits of establishing a screening website for any dental school. The program was developed entirely at UTHSCSA, but it addresses a problem that may affect many dental schools.

The San Antonio CATs Initiative.

There is evidence from medicine that schools and practitioners are slow to adopt new and proven effective treatments while marketing efforts lead practitioners to too quickly adopt unproven modalities. To address these problems, the dental school at the University of Texas Health Sciences Center at San Antonio, has developed a program designed to teach students, faculty, and practitioners the skills of accessing the literature as an intrinsic part of treatment. The Critically Appraised Topics (CATs) program is described and evidence is presented showing that participants can be taught to prepare high-quality summaries of the literature pertinent to clinical problems.

Chanqes in dental school curricula, 2003-2009.

This 2009 study of dental school curricula follows a similar one conducted in 2002-2003. Through a Web-based survey, the authors gathered information from dental schools about: (a) trends in curricular change over seven years; (b) changes underway in dental school curricula; (c) significant challenges to curricular innovation; and (d) projected trends in curricular change and innovation. In a significant change from the 2002-2003 study, a high proportion (91%) of the responding schools require community-based patient care by all students, with just over one-half ot them requiring five or more weeks of such experience. Respondents reported that priorities for future curriculum modification included: creating interdisciplinary curricula that are organized around themes, blending the basic and clinical sciences, provision of some elements of core curriculum in an online format, developing new techniques for assessing competency, and increasing collaborations with other health professions schools. Respondents identified training for new faculty members in teaching skills, curriculum design, and assessment methods as the most critical need to support future innovation.