Can a virtual learning module foster empathy in dental undergraduate students?

BACKGROUND: Empathy is an essential part of patient-centred health care, which positively benefits both patients and clinicians. There is little agreement regarding how best to design and deliver training for healthcare trainees to impart the skills and behaviours of clinical empathy. The study aimed to inform the field by sharing an educational intervention where we aimed to improve empathy amongst dental undergraduate students in Trinity College Dublin using a virtual learning module. METHODS: Adopting pre-post-repeat pre-experimental design, dental professional students completed the Jefferson Scale of Empathy (JSE) for Health Professional Students immediately prior to and after a three-week virtual programme designed to increase clinical empathy. Using a three-factor model described for the JSE in the literature, scores were evaluated for internal consistency and paired tests were performed on scores appropriate to their distributions. Seven-point Likert scales were scored to record student experience of training and technology, which are reported descriptively. RESULTS: Most of the 37 participants were female (76%) and represented dental science (N = 27) and dental hygiene roles (N = 7). Results revealed a mean JSE-HPS scale score rise from 110.0 (SD = 10.4) to 116.4 (SD = 11.1), which represented a rise of 5.8% (t (36) = 3.6, p = 0.001). The three factors associated with cognitive empathy, namely perspective-taking (T(36) = 3.931, p < 0.001; walking in the patient's shoes T(36) = 2.093, p = 0.043); and compassionate care (Z = 2.469, p = 0.014) were all found to have increased after the intervention. Students reported a positive experience of discipline-specific and generic videos as part of the module. CONCLUSION: The study demonstrated that a virtual educational module was associated with an increase in empathy amongst dental undergraduate students. The design of a blended module incorporating the Massive Open Online Course (MOOC) and virtual learning are beneficial and have a promising future.

What is it about carer-led oral hygiene interventions for people with intellectual disabilities that work and why? A realist review.

OBJECTIVES: To undertake a realist review of carer-led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. METHODS: Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context-mechanism-outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. RESULTS: Of the 697 potential sources, 112 studies progressed to full-text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer-led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer-led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system-level approach; involving carers in design and implementation; tailoring of training to suit carers' needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well-being of carers; and repeating training. CONCLUSIONS: The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how.

Using the International Classification of Functioning, Disability and Health (ICF) to describe children referred to special care or paediatric dental services.

Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child's capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child's real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ± 3.6 yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were 'Intellectual functions', 'High-level cognitive functions', and 'Attention functions'. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including 'Handling stress', 'Caring for body parts', 'Looking after one's health' and 'Speaking'. In the Environment domain, facilitating items included 'Support of friends', 'Attitude of friends' and 'Support of immediate family'. One item was reported as an environmental barrier - 'Societal attitudes'. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use.