Evaluation of a student telehealth rotation at the Columbia University College of Dental Medicine.

OBJECTIVES: This study aimed to assess the impact of a telehealth rotation on the perceived benefits and challenges of telehealth use among third-year dental students at the Columbia University College of Dental Medicine (CDM). METHODS: A newly implemented weeklong telehealth rotation at CDM engaged all 95 third-year dental students from the 2022 graduating class through assigned readings and virtual interaction with patients. The telehealth rotation involves virtual visits with patients for screening and triage. An ongoing retrospective assessment of the students' post-rotation evaluation was analyzed qualitatively to identify emerging themes and was coded to describe students' attitudes and beliefs about telehealth. RESULTS: Students reported that the greatest benefit of telehealth is logistical convenience, while the greatest challenge to telehealth is related to the use of technology. After the telehealth rotation, students reported improvement in their clinically relevant skills and knowledge, including patient education, facilitating access to care, and communication skills. CONCLUSIONS: The skills reported by students as the most important learning takeaway from the telehealth rotation are applicable to many aspects of care delivery, beyond the scope of telehealth. The incorporation of telehealth education into dental curricula allows students to improve essential clinically relevant skills and knowledge beyond the procedural skills emphasized during in-person patient appointments.

Relationship of the Esophageal Microbiome and Tissue Gene Expression and Links to the Oral Microbiome: A Randomized Clinical Trial.

INTRODUCTION: Although the microbiome is altered in various esophageal diseases, there is no direct evidence for a link between the oral or esophageal microbiome and underlying esophageal tissue. Here, we aimed to address these gaps through use of an antimicrobial mouth rinse to modify the esophageal microbiome and tissue gene expression. METHODS: In this randomized controlled trial, patients scheduled to undergo endoscopy for clinical indications used chlorhexidine mouth rinse or no treatment for 2 weeks before endoscopy. Oral swabs and saliva were collected at baseline and at follow-up, and the esophagus was sampled on the day of endoscopy. The microbiome was analyzed by 16S rRNA gene sequencing, and esophageal tissue gene expression was ascertained by RNA-Seq. RESULTS: Twenty subjects were enrolled and included in the analyses. Within individuals, the oral and esophageal microbiome composition was significantly correlated. Chlorhexidine treatment associated with significant alterations to the relative abundance of several esophageal bacterial taxa, and to expression of genes in the esophagus including reductions in periostin, claudin-18, chemokines CXCL1 and CXCL13, and several members of the tumor necrosis factor receptor superfamily. A taxon in genus Haemophilus in the esophagus also associated with significant changes in tissue gene expression. DISCUSSION: The oral and esophageal microbiomes are closely related within individuals, and esophageal microbiome alterations correlate with tissue gene expression changes. The esophageal microbiome may act as an important cofactor that influences pathogenesis and outcomes of diseases such as eosinophilic esophagitis, gastroesophageal reflux, and Barrett's esophagus.

Using Big Data to Uncover Patient Determinants of Care Utilization Compliance in a Student Dental Clinic.

This study aims at assessing the relationship between social determinants of health (SDH) and dental care utilization compliance in a student dental clinic. Electronic dental records (EDR) were queried based on visit codes and evaluated using descriptive and inferential statistics, and binary logistic regression. Overall, characteristics of 16,474 visits were analyzed to identify potential predictors of appointment compliance. Factors affecting compliance with treatment plans prescribed at comprehensive care visits were identified in a cohort of 6,105 patients. Determinants of compliance with a comprehensive care visit following triage visits were analyzed in a cohort of 5491 patients. Results indicated that certain patient characteristics were associated with either increased or decreased compliance with dental care utilization. We concluded that EDR can be instrumental in identifying patterns of care utilization and determinants of patient compliance based on SDH.

Evaluation of a Local Anesthesia Simulation Model with Dental Students as Novice Clinicians.

The aim of this study was to evaluate the use of a local anesthesia (LA) simulation model in a facilitated small group setting before dental students administered an inferior alveolar nerve block (IANB) for the first time. For this pilot study, 60 dental students transitioning from preclinical to clinical education were randomly assigned to either an experimental group (N=30) that participated in a small group session using the simulation model or a control group (N=30). After administering local anesthesia for the first time, students in both groups were given questionnaires regarding levels of preparedness and confidence when administering an IANB and level of anesthesia effectiveness and pain when receiving an IANB. Students in the experimental group exhibited a positive difference on all six questions regarding preparedness and confidence when administering LA to another student. One of these six questions ("I was prepared in administering local anesthesia for the first time") showed a statistically significant difference (p<0.05). Students who received LA from students who practiced on the simulation model also experienced fewer post-injection complications one day after receiving the IANB, including a statistically significant reduction in trismus. No statistically significant difference was found in level of effectiveness of the IANB or perceived levels of pain between the two groups. The results of this pilot study suggest that using a local anesthesia simulation model may be beneficial in increasing a dental student's level of comfort prior to administering local anesthesia for the first time.

Dental student perceptions of the educational value of a comprehensive, multidisciplinary OSCE.

The aim of this study was to examine student perceptions of the educational value of a comprehensive, multidisciplinary objective structured clinical examination (OSCE). The examination is administered after the second year of the curriculum, prior to the beginning of clinical training at the Columbia University College of Dental Medicine. The quantitative component of the study consisted of a survey administered to students who had taken the OSCE (N=78). Due to the ordinal level of data produced by the Likert-scale survey, statistical analysis was performed through calculation of the median and interquartile range (IQR). Overall, student perceptions of the educational value of the OSCE, as measured using a five-point scale (1=strongly disagree to 5=strongly agree) were positive, demonstrating students' agreement that the exam required the ability to think critically and problem-solve (median=4, IQR=1), assessed clinically relevant skills (median=5, IQR=1), and was a learning experience (median=5, IQR=1). A statistically significant chi-square value (p<0.001) was found for all questions. The qualitative component consisted of phenomenological examination of student focus group interviews (N=15). Four main themes were identified including that the OSCE was an authentic assessment that required integration and application of knowledge.

Reliability and predictive validity of a comprehensive preclinical OSCE in dental education.

This study examined the reliability and predictive validity of a comprehensive, multidisciplinary objective structured clinical examination (OSCE) used to assess the transition from preclinical to clinical education in a dental school. The examination is administered prior to clinical training at the Columbia University College of Dental Medicine to assess student preparedness for patient care activity. The study population consisted of seventy-five students in the Class of 2010 and seventy students in the Class of 2011. The total reliability of the exam was assessed by Cronbach's coefficient alpha. Using polynomial regression, the predictive validity of the examination was evaluated by correlating student scores on the OSCE with clinical performance as measured by successfully completed clinical procedures during the first year of clinical training. Findings indicate a highly reliable exam (α=0.86 and α=0.80) with a moderately high correlation predicting future clinical performance (r=0.614, p<0.0001; r=0.540, p<0.0001) for the Classes of 2010 and 2011, respectively. The findings suggest that an OSCE can serve as a reliable and predictive assessment during the transition from preclinical to clinical education in the predoctoral dental curriculum.

Advancing the educational training of dental educators: review of a model program.

Very few dental educators have formal pedagogical training, and the availability of degree-granting programs for dental educators is very limited. A joint D.D.S.-M.A. program for predoctoral students and a Ph.D. program for faculty members have been established at Columbia University's College of Dental Medicine in conjunction with the Graduate School of Education, Teachers College. Six students have completed the joint degree program, five are currently enrolled, and an additional three have taken courses at Teachers College without pursuing a degree. One faculty member has completed the Ph.D. program, and one is enrolled. This article describes the details of both programs and discusses preliminary outcomes. The model described here may serve as an example for other dental schools that may choose to implement degree programs in education for dental educators.