Establishing an antiracism framework for dental education through critical assessment of accreditation standards.

PURPOSE: The purpose of this manuscript is to establish an antiracism framework for dental education. Since the accreditation process is an influential driver of institutional culture and policy in dental education, the focus of the framework is the Commission on Dental Accreditation (CODA) standards for predoctoral education. METHODS: The authors of this manuscript reviewed each CODA predoctoral standard for opportunities to incorporate antiracism strategies. Eight standards were identified under themes of diversity (Standards 1-3, 1-4, 4-4), curriculum development (Standards 2-17, 2-26), and faculty recruitment and promotion (Standards 3-1, 3-4, 3-5). Guided primarily by National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, a logic model approach was used to critically assess those standards for opportunities to establish antiracism strategies, with anticipated outcomes and impacts. RESULTS: Strategies highlighted a need to improve recruitment, admissions, and accountability among dental schools to address the low numbers of historically underrepresented racial and ethnic (HURE) students and faculty. They emphasized the inclusion of racism in curricula geared toward training dental students to provide care to HURE populations. Finally, there are opportunities to improve accountability that dental schools are providing equitable opportunities for career advancement among HURE faculty, with consideration of conflicting demands for scholarship with HURE student mentoring, role modeling, teaching, and/or service. CONCLUSIONS: The framework identifies gaps in CODA standards where racism may be allowed to fester, provides specific antiracism strategies to strengthen antiracism through the accreditation process, and offers dental education programs, a process for evaluating and establishing their own antiracism strategies.

Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study.

BACKGROUND: Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. METHODS: A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. RESULTS: Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). CONCLUSIONS: These findings can be used in the generation of a clinical guideline for this group of patients.

Clinical and Community-Based Education in U.S. Dental Schools.

This review of U.S. dental schools' clinical curricula suggests that the basic structure of clinical education has not changed significantly in the past 60 years, although important developments include the introduction of competency-based education and community-based clinical education. Most dental schools still have a two-year preclinical curriculum and a two-year clinical curriculum, and most schools still operate a large clinical facility where students receive the bulk of their clinical education and assessment for graduation. In those clinics, dental students are the main providers of patient treatment, with faculty serving in supervisory roles. In addition, a major portion of the entire dental curriculum continues to be dedicated to student education on the restoration of a single tooth or replacement of teeth. This article was written as part of the project "Advancing Dental Education in the 21st Century."

A difficult case of recurrent hypoglycaemia: role of insulin assays in establishing the diagnosis.

BACKGROUND: Insulin assays are designed to detect endogenous insulin, however, insulin assays produced by different manufacturers may detect exogenous recombinant insulin, with varying degrees of cross-reactivity between different assays. We report a fascinating and difficult case of recurrent hypoglycaemia, where the final diagnosis was established with the help of insulin assays using different platforms. CASE REPORT: A 24-year-old female presented with recurrent hypoglycaemic episodes on a background of Type 1 diabetes mellitus and a completely resected synovial sarcoma of the right hip several years previously. She reported significant physical, sexual and emotional abuse leading to reduced appetite and weight loss. Despite withdrawing insulin therapy, she experienced profound hypoglycaemic episodes with detectable C-peptide and inappropriately elevated insulin levels, suggesting endogenous hyperinsulinaemic hypoglycaemia; however, localization studies were negative and finally she was found to have exogenous hyperinsulinaemia after discordant insulin levels were detected using two different insulin assays. The C-peptide level was elevated as a result of stimulation by parenteral dextrose and was suppressed after dextrose was ceased. Her Type 1 diabetes mellitus was fabricated and she had factitious hypoglycaemia. CONCLUSIONS: Factitious hypoglycemia is difficult to diagnose and treat. A low blood glucose level, suppressed C-peptide level and an inappropriately elevated insulin level is the classic finding. We were able to make a diagnosis in the present case after discordant insulin levels were detected on the two different insulin assays, signifying cross-reactivities of the recombinant insulin with the assays. A multidisciplinary team approach with psychiatric input is needed to treat such cases.

Impulsivity as a Multifaceted Construct Related to Excessive Drinking Among UK Students.

AIMS: A substantial number of university students exceed alcohol guidelines. Impulsivity has been repeatedly implicated in heavy alcohol use, yet despite knowledge that impulsivity is multifaceted, there have previously been few studies applying multiple measures of self-report and behavioural impulsivity to examine the relationship with excessive student drinking. This results in a limited understanding of the relationship of various facets of impulsivity to student drinking. METHODS: Participants completed a comprehensive battery of impulsivity measures: the Barratt Impulsiveness Scale as a self-report index and the Stop Signal Task, Information Sampling Task and Monetary Choice Questionnaire as behavioural measures of three facets of impulsivity. Participants who exceeded UK drinking guidelines were compared to those who did not on measures of impulsivity. Hierarchical linear regression was then employed to test whether indices of impulsivity were associated with the average units consumed per week. RESULTS: Participants who exceeded UK guidelines reported increased impulsivity in facets of self-report impulsivity. They also displayed performance deficits in normal adjustment of Go responses on the Stop Signal Task. In the regression model, nonplanning impulsivity on the Barratt Impulsiveness Scale was seen to predict quantity of alcohol consumed per month. CONCLUSIONS: The study applies a comprehensive selection of behavioural and self-report measures of impulsivity and indicates that excessive drinkers are more impulsive in some but not all aspects. The results indicate that the wide range of deficits apparent in alcohol-dependent individuals are not evident in this younger, heavy drinking population, but that specific performance and self-identified deficits are already apparent.

Recommended standards for dental therapy education programs in the United States: a summary of critical issues.

Dental therapy is an accepted component of the dental profession in the Alaska Native Tribal Health Consortium and in the state of Minnesota. There are also several states working to enact legislation to permit the practice of dental therapy. However, in the absence of nationally recognized educational standards, concerns have been raised relating to the lack of uniformity in dental therapy education. In 2010, a panel of academicians met and prepared a report on the principles, competencies, and curriculum for educating dental therapists. Still, there remained questions in regard to what the minimal educational standards should be for institutions that wish to sponsor dental therapy programs. A second panel was convened to address education standards. This paper describes the Panel's deliberations on three critical issues in developing the report: the length of the program and degree to be awarded; credentials of the program director; and the nature of supervision.

Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas.

BACKGROUND: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions. TYPES OF STUDIES REVIEWED: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected 5 systematic reviews and 4 clinical studies to use as a basis for developing recommendations. RESULTS: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care. CLINICAL IMPLICATIONS: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

Management of experiences in community-based dental education.

The successful management of community-based service-learning relies on developing and maintaining community partnerships that meet both the educational mission of the dental school and the service mission of the community clinic. The partnership enhances the dental curriculum by introducing students to a wide variety of practice models, patient populations, and perspectives on health care delivery systems. The partnership enhances the service mission of the community sites by providing them with a university affiliation, a window into the state-of-the-art techniques that students bring with them from the dental school, and a pool of future graduates who may choose to practice in that clinic setting. This "win-win" scenario is not automatic, but rather relies on carefully matching, maintaining, and evaluating the service-learning partnerships. This article describes the development and implementation of the community-based service-learning curriculum in the College of Dentistry, University of Illinois at Chicago.

Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas.

BACKGROUND: This article presents evidence-based clinical recommendations developed by a panel convened by the American Dental Association Council on Scientific Affairs. This report addresses the potential benefits and potential risks of screening for oral squamous cell carcinomas and the use of adjunctive screening aids to visualize and detect potentially malignant and malignant oral lesions. TYPES OF STUDIES REVIEWED: The panel members conducted a systematic search of MEDLINE, identifying 332 systematic reviews and 1,499 recent clinical studies. They selected five systematic reviews and four clinical studies to use as a basis for developing recommendations. RESULTS: The panel concluded that screening by means of visual and tactile examination to detect potentially malignant and malignant lesions may result in detection of oral cancers at early stages of development, but that there is insufficient evidence to determine if screening alters disease-specific mortality in asymptomatic people seeking dental care. CLINICAL IMPLICATIONS: The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or who consume alcohol heavily. Additional research regarding oral cancer screening and the use of adjuncts is needed.

A model for selection and assessment of community-based sites for dental students' extramural clinical experiences.

As a recipient of the Robert Wood Johnson's Pipeline, Profession, and Practice: Community-Based Dental Education grant, the Extramural Education Program (EEP) at the University of Illinois at Chicago College of Dentistry was charged with developing partnerships with community-based oral health programs throughout Illinois. These programs are to be used for clinical service-learning rotations for fourth-year dental students, relying on the utilization of the dentists employed at the community site as preceptors for the students. Because the College of Dentistry had essentially no community-based service-learning experiences prior to the Robert Wood Johnson grant, procedures and protocols needed to be developed to standardize a process for site and preceptor selection. An administrative process was developed to engage, recruit, and partner with community-based oral health programs that provided direct clinical services. This article will discuss the development of criteria used to select sites and preceptors for extramural clinical rotations; the development of a set of standardized assessment instruments; and the credentialing process for community-based adjunct faculty that leads to the affiliation agreements. These community-based rotations have been integrated into the College of Dentistry curriculum as a required extramural service-learning course referred to as Extramural Clinical Experience (DADM 325).

The role of dental schools in the issues of access to care.

Some individuals emphasize dentistry as the provision of services; others concentrate on achieving specified levels of oral health. One's vision of dentistry affects how the issue of access is viewed. The University of Illinois at Chicago College of Dentistry has been the recipient of a Profession and Practice: Community-Based Dental Education project (the Pipeline) grant to promote oral health in underserved communities and to train students to function effectively in such settings. The School's Extramural Clinical Experience is described. This involves 60 days of providing care in seventeen sites for students in their fourth year of training. Students must qualify for these rotations based on clinical competency and they must document their experiences. The positive effects observed so far in this program are described.

Eliminating oral health disparities: Ethics workshop reactor comments.

Oral health encompasses dentistry and is broader in concept. Dentistry alone appears insufficient to ensure oral health for the population at large. Troubling disparities in oral health status and access to care have been documented. The segment of the population that has little or no access to care is growing; aging baby-boomers are adding to this problem. As suggested in Oral Health in America: A Report of the Surgeon General, partnerships and collaboration are essential to improving oral health. The ethics of dental practice and the profession are being called into question. Who will provide the necessary leadership to address and resolve these issues, so that oral health is attainable by all?

The need for diversity in the health professions.

The Surgeon General's Report on Oral Health remains a baseline document for addressing the issues of oral health disparities in America. With the problems of access to care and quality of care, cultural differences, history of discrimination, and ongoing severity of poverty, today there are many disturbing disparities in oral health status between people of color and the majority population. While the number of people of color is increasing, the number being prepared to provide quality oral health care is declining. The nation, the dental profession, and dental schools have not made adequate progress in the effort to develop a workforce that can address the disparities in oral health problems based on race and ethnicity. The Office of the Surgeon General is developing a National Oral Health Action Plan to help address these problems, but the role of dental schools is critical. Building a pipeline that will bring diverse people to the dental workforce must be a high priority for all involved. A substantial improvement in the diversity of the oral health student body and eventual workforce is a critical and essential element to achieving the goals of improving oral health and quality of life and eliminating health disparities.

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries.

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.