2015 American College of Rheumatology Workforce Study and Demand Projections of Pediatric Rheumatology Workforce, 2015-2030.

OBJECTIVE: To describe the character and composition of the 2015 pediatric rheumatology workforce in the US, evaluate current workforce trends, and project future supply and demand of the pediatric rheumatology workforce through 2030. METHODS: The American College of Rheumatology created the workforce study group to study the rheumatology workforce. The workforce study group used primary and secondary data to create a representative workforce model. Pediatric rheumatology supply and demand was projected through 2030 using an integrated data-driven framework to capture a more realistic clinical full-time equivalent (FTE) and produce a better picture of access to care issues in pediatric rheumatology. RESULTS: The 2015 pediatric rheumatology workforce was estimated at 287 FTEs (300 providers), while the estimated excess demand was 95 (33%). The projected demand will continue to increase to almost 100% (n = 230) by 2030 if no changes occur in succession planning, new graduate entrants into the profession, and other factors associated with the workforce. CONCLUSION: This study projects that the pediatric rheumatology workforce gap will continue to worsen significantly from the 2015 baseline, and by 2030 the demand for pediatric rheumatologists will be twice the supply. Innovative strategies are needed to increase the workforce supply and to improve access to care.

Reflections of psychomotor skill development in preclinical simulation: A qualitative analysis.

INTRODUCTION: Reflection on competency helps students become more proficient in performing skills, with the ultimate goal of better retention of knowledge and skill. Competency progression involves a complex interplay of factors, and not having the insight of such multiple perspectives of the same experience, we will not be able to understand students as learners fully and consequently may rely on assumption and may not be able to provide the necessary interventions for growth and progress towards competency. This study aims to investigate students' insight of their own progression during psychomotor skill development. MATERIALS AND METHODS: Data were obtained from scanned reflective dialogue log document portfolios from the preclinical fixed dental prosthodontics section, which is part of a comprehensive dental care course during the second year. Data were coded using NVivo software version 12 plus (QSR International Pty Ltd, Vic, Australia), and subsequent thematic analyses identified emerging themes. RESULTS: Three themes emerged and these were (a) challenges to overcome, (b) feed-back and self-appraisal, and (c) progress and growth. The qualitative data generated did not reveal considerable variation in the students' reflections, and the three themes seem to interrelate. CONCLUSIONS: The main challenge was the concept of the single path of insertion and the perception that it was a source of frustration during this course. Self-appraisal identified time management issues and the transformation from preconceived or learned concepts. As the semester progressed, students reflected progress and growth.

Modeling the Hepatology Workforce in the United States: A Predicted Critical Shortage.

BACKGROUND AND AIMS: Liver disease is prevalent in the United States, and as the population ages, an increasing number of patients are anticipated to present for care. The state of the current hepatology workforce and future demand for hepatology providers is not known. The aim of this study was to model future projections for hepatology workforce demand. APPROACH AND RESULTS: A workforce study of hepatology providers in the United States was completed using primary and secondary data sources. An integrated workforce framework model was used that combined socioeconomic factors that drive economic demand, epidemiological factors that drive need, and utilization rates of health care services. Supply and demand projections were calculated for adult and pediatric hepatology professionals. Sensitivity analyses were conducted to cover the feasible range of these assumptions. An electronic survey of American Association for the Study of Liver Diseases (AASLD) members whose practice included 50% or more hepatology was conducted. In 2018, the adult and pediatric workforce included 7,296 and 824 hepatology providers, respectively, composed of hepatologists, gastroenterologists, and advanced practice providers whose practice was ≥50% hepatology. The modeling analysis projects that in 2023, 2028, and 2033, there will be shortages of 10%, 23%, and 35% adult hepatology providers, respectively, and 19%, 20%, and 16% pediatric hepatology providers, respectively. In sensitivity analyses, a shortage of hepatology providers is predicted even under optimistic assumptions. Among the respondents to the survey, the median age was higher among gastroenterologists and general hepatologists compared with transplant hepatologists. The most common category treated by transplant hepatologists was general hepatology. CONCLUSIONS: There is an impending critical shortage of adult and pediatric hepatology providers. Strategies are needed to encourage clinicians to pursue hepatology, especially in areas outside of transplant centers.

Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S.

This study was designed to examine national trends and evaluate social determinants of health that were associated with the provision of dental services in emergency rooms in the United States between 2007 and 2014. A pooled cross-sectional database of emergency department (ED) visits combined the 2007-2014 waves of the Nationwide Emergency Department Sample. A total of 3,761,958 ED visits with dental conditions were extracted and the principal diagnosis was identified. A series of modified Poisson regression models were used to assess the relationship between patient sociodemographic factors and hospital characteristics, and the likelihood of visiting the ED for a nontraumatic dental reason. Unadjusted descriptive results indicated that there was no apparent increase in the percentage of patients who visited an ED with nontraumatic dental conditions (NTDCs) between 2007 and 2014. The greatest users of EDs for NTDCs were among those who were uninsured and Medicaid beneficiaries relative to persons privately insured. ED visitors were more likely to reside in lower socioeconomic areas (when compared with visitors in the top quartile of the income distribution). Patients in all other age groups were more likely to seek care in an ED for NTDCs relative to those 65 years of age or older. Multiple strategies are required to reduce the use of EDs for routine dental care. This approach will require an interprofessional dialogue and solutions that reduce barriers to receiving dental care.

2015 American College of Rheumatology Workforce Study: The Role of Graduate Medical Education in Adult Rheumatology.

OBJECTIVE: Graduate medical education (GME), through fellowship training, plays a critical role in preparing new rheumatologists for our workforce and is an essential component when addressing the gap of excess demand for adult rheumatology care. This study was undertaken to assess the demographic characteristics and employment trends of new entrants entering the rheumatology workforce and the impact this will have on the supply of rheumatologits over the next 15 years. METHODS: Primary and secondary data sources were used to develop an integrated workforce model. Factors specific to new graduates entering the workforce included available and filled fellowship positions, gender shifts, planned work schedules (part-time or full-time), practice settings (academic or non-academic, private practice), and number of international medical graduates (IMGs) anticipating US practice. RESULTS: In 2015, there were 113 adult rheumatology programs, with 431 of 468 available positions filled. Using the 215 actual positions available annually in fellowship programs as a starting point, after all factors were applied, the projected clinical full-time equivalent number entering the workforce each year was 107; this number was affected significantly by gender and generational trends. In addition, 17% of IMGs self-identified their plan to practice outside the US. Confounding predictions included a large proportion of current rheumatologists planning retirement with substantially reduced patient loads by 2030. CONCLUSION: The current US adult rheumatology workforce is in jeopardy of accelerated decline at a time when demands on the workforce face tremendous growth. The current GME training structure cannot support the increased demand. Potential strategies to address this gap include innovative mechanisms for GME funding to increase fellowship training positions, incentives for pursuing rheumatology training (e.g., loan repayment programs), and novel means for recruitment of care to underserved areas of the US.

2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030.

OBJECTIVE: To describe the character and composition of the 2015 US adult rheumatology workforce, evaluate workforce trends, and project supply and demand for clinical rheumatology care for 2015-2030. METHODS: The 2015 Workforce Study of Rheumatology Specialists in the US used primary and secondary data sources to estimate the baseline adult rheumatology workforce and determine demographic and geographic factors relevant to workforce modeling. Supply and demand was projected through 2030, utilizing data-driven estimations regarding the proportion and clinical full-time equivalent (FTE) of academic versus nonacademic practitioners. RESULTS: The 2015 adult workforce (physicians, nurse practitioners, and physician assistants) was estimated to be 6,013 providers (5,415 clinical FTE). At baseline, the estimated demand exceeded the supply of clinical FTE by 700 (12.9%). By 2030, the supply of rheumatology clinical providers is projected to fall to 4,882 providers, or 4,051 clinical FTE (a 25.2% decrease in supply from 2015 baseline levels). Demand in 2030 is projected to exceed supply by 4,133 clinical FTE (102%). CONCLUSION: The adult rheumatology workforce projections reflect a major demographic and geographic shift that will significantly impact the supply of the future workforce by 2030. These shifts include baby-boomer retirements, a millennial predominance, and an increase of female and part-time providers, in parallel with an increased demand for adult rheumatology care due to the growing and aging US population. Regional and innovative strategies will be necessary to manage access to care and reduce barriers to care for rheumatology patients.

Preventable Emergency Department Visits for Nontraumatic Dental Conditions: Trends and Disparities in Nevada, 2009-2015.

OBJECTIVES: To examine trends and socioeconomic disparities for preventable dental-related emergency department (ED) visits in Nevada. METHODS: We pooled retrospective data containing 66 267 ED visits involving dental conditions from Nevada hospital ED databases from 2009 to 2015. The dependent variable was nontraumatic dental conditions identified by International Classification of Diseases, Ninth Revision, codes; 3 independent variables included treatment year, health insurance status, and race/ethnicity. RESULTS: Odds of ED visits for nontraumatic dental conditions increased 16% annually from 2009 to 2015 (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 1.13, 1.19). Medicaid (OR = 2.16; 95% CI = 1.96, 2.39) and uninsured patients (OR = 2.75; 95% CI = 2.52, 3.00) presenting with nontraumatic dental conditions were 1 to 2 times more likely than those with private dental insurance to seek ED treatment. Black patients were more likely than White patients to seek ED treatment (OR = 1.13; 95% CI = 1.02, 1.24). CONCLUSIONS: Socioeconomic and demographic factors were significantly associated with ED visits for nontraumatic dental conditions, with a steady increase in trends and a widening of socioeconomic disparities in recent years.

Leadership Development in Dental Education: Report on the ADEA Leadership Institute, 2000-14.

The American Dental Education Association's Leadership Institute (ADEA LI) is the association's flagship development program for those aspiring to leadership in dental and higher education. As with previous studies of the ADEA LI, ADEA will use information from the survey described in this report to improve the ADEA LI curriculum and to guide other leadership development efforts. In 2014-15, ADEA distributed a 50-item online survey via email to all ADEA LI alumni from the classes of 2000 through 2014. The survey included selected-response questions, closed-ended questions, and open-response questions. The survey had an overall response rate of 47% (133/285); response rates to individual items varied. The mean age of the respondents when they participated in the Institute was 48.5 years. Men and women were almost equally represented among the respondents. Nearly half reported their ultimate career goal as department chair, associate dean, or assistant dean, while 20 (15.8%) indicated a goal of becoming dean and 15 (11.8%) aspired to administrative roles higher than dean. Areas the respondents recommended for improvement included more programming in budgeting and financial management, fundraising, and personnel management. Almost 100% of the respondents indicated they would recommend the ADEA LI to others. Overall, the survey respondents confirmed the value of the ADEA LI in their assessment of their fellowship and its subsequent application to their careers. Comparison of elements from this study to previous studies of ADEA LI alumni demonstrates the effectiveness of past changes made to the Institute and the creation of additional ADEA leadership initiatives.

Defining the Meaning of Spirituality Through a Qualitative Case Study of Sheltered Homeless Women.

The primary purpose of this case study was to assess the meaning of spirituality in a convenience sample of women located in an urban city in the southwest United States. The secondary purpose was to describe their lived experiences associated with spirituality. From these interviews five themes emerged: Belief in God or a Higher Power, Distinction Between Religion and Spirituality, Belief That There Is a Plan for Their Lives, Spirituality Providing Guidance for What Is Right/Wrong, and Belief That Their Lives Will Improve. These findings support the perceived fundamental importance of spirituality in the lives of homeless women. Nurses and other clinicians can use this information to develop interventions to help support women using spirituality practices and to help improve the outlook of homelessness for these women.

Use of High-Definition Audiovisual Technology in a Gross Anatomy Laboratory: Effect on Dental Students' Learning Outcomes and Satisfaction.

Laboratory cadaver dissection is essential for three-dimensional understanding of anatomical structures and variability, but there are many challenges to teaching gross anatomy in medical and dental schools, including a lack of available space and qualified anatomy faculty. The aim of this study was to determine the efficacy of high-definition audiovisual educational technology in the gross anatomy laboratory in improving dental students' learning outcomes and satisfaction. Exam scores were compared for two classes of first-year students at one U.S. dental school: 2012-13 (no audiovisual technology) and 2013-14 (audiovisual technology), and section exams were used to compare differences between semesters. Additionally, an online survey was used to assess the satisfaction of students who used the technology. All 284 first-year students in the two years (2012-13 N=144; 2013-14 N=140) participated in the exams. Of the 140 students in the 2013-14 class, 63 completed the survey (45% response rate). The results showed that those students who used the technology had higher scores on the laboratory exams than those who did not use it, and students in the winter semester scored higher (90.17±0.56) than in the fall semester (82.10±0.68). More than 87% of those surveyed strongly agreed or agreed that the audiovisual devices represented anatomical structures clearly in the gross anatomy laboratory. These students reported an improved experience in learning and understanding anatomical structures, found the laboratory to be less overwhelming, and said they were better able to follow dissection instructions and understand details of anatomical structures with the new technology. Based on these results, the study concluded that the ability to provide the students a clear view of anatomical structures and high-quality imaging had improved their learning experience.

A Profile of Dental School Deans, 2014.

To develop a profile of current U.S. dental school deans and report their perceptions, challenges, and opportunities that should be addressed in the leadership development programs of the American Dental Education Association (ADEA), data were gathered using a web-based survey organized into seven content areas. In 2014, the deans of all accredited dental schools in the U.S. including Puerto Rico were invited to participate in the survey. The response rate was 86% (56/65). A majority of the deans were male (N=44; 79%) and white/non-Hispanic (N=49; 88%); all reporting degrees held a DDS/DMD (N=54; 100%). Just over half were between the ages of 46 and 55 (N=31; 55%) when they first became a dean. The mean age of these deans was 61.4 years, with a range of 48-72. The respondents reported that school administration/management, fundraising, students, the academic environment, leadership development, and faculty had a high level of influence on their job satisfaction. Communication, conflict resolution, and finance were reported as the most important knowledge areas. A majority reported being better prepared for clinical education and student relations than fundraising and research when they took their positions. They responded that finances and faculty recruitment and retention were their greatest challenges as a dean. Among these respondents, 98% (N=55) reported being satisfied to very satisfied with their job overall. The survey results will inform ADEA's leadership development programs for the next five to seven years.

Evaluation of an integrative model for professional development and research in a dental curriculum.

The purpose of this project was to evaluate a Research, Professional Development, and Critical Thinking Integrative Model developed for use in a dental curriculum. This article outlines strategies used in developing a competency-based pedagogical model designed to provide a tailored student learning environment with objective, measurable, and calibrated assessment outcomes. The theoretical model integrated elements of critical thinking, professionalism, and evidence-based dentistry across dental school disciplines; implementation was based on consensus of dental faculty and student representatives about course content, faculty allocation, and curriculum alignment. Changes introduced included the following: 1) conversion and integration of previously siloed course content taught in Years 1 and 2 to sequential two-year combined courses; 2) reduction of course and content redundancies; 3) delivery of courses by teams of faculty members in biomedical, behavioral, and clinical sciences; and 4) reduction of total curriculum credit/contact hours from 13.5 (201 contact hours) to 5.0 (60 contact hours), allowing the Curriculum Committee to accommodate additional courses. These changes resulted in improvement in student satisfaction.

Interprofessional faculty development: integration of oral health into the geriatric diabetes curriculum, from theory to practice.

BACKGROUND: Health care workforce shortages and an increase demand for health care services by an older demographic challenged by oral-systemic conditions are being recognized across health care systems. Demands are placed on health care professionals to render coordinated delivery of services. Management of oral-systemic conditions requires a trained health care workforce to render interprofessional patient-centered and coordinated delivery of health care services. The purpose of this investigation was to evaluate the effectiveness of an interprofessional health care faculty training program. METHODS: A statewide comprehensive type 2 diabetes training program was developed and offered to multidisciplinary health care faculty using innovative educational methods. Video-recorded clinically simulated patient encounters concentrated on the oral-systemic interactions between type 2 diabetes and comorbidities. Post-encounter instructors facilitated debriefing focused on preconceptions, self-assessment, and peer discussions, to develop a joint interprofessional care plan. Furthermore, the health care faculty explored nonhierarchical opportunities to bridge common health care themes and concepts, as well as opportunities to translate information into classroom instruction and patient care. RESULTS: Thirty-six health care faculty from six disciplines completed the pre-research and post-research assessment survey to evaluate attitudes, knowledge, and perceptions following the interprofessional health care faculty training program. Post-training interprofessional team building knowledge improved significantly. The health care faculty post-training attitude scores improved significantly, with heightened awareness of the unique oral-systemic care needs of older adults with type 2 diabetes, supporting an interprofessional team approach to care management. In addition, the health care faculty viewed communication across disciplines as being essential and interprofessional training as being vital to the core curriculum of each discipline. Significant improvement occurred in the perception survey items for team accountability and use of uniform terminology to bridge communication gaps. CONCLUSION: Attitude, knowledge, and perceptions of health care faculty regarding interprofessional team building and the team approach to management of the oral-systemic manifestations of chronic disease in older adults was improved. Uniform language to promote communication across health professionals, care settings, and caregivers/patients, was noted. Interprofessional team building/care planning should be integrated in core curricula.

The effect of tobacco and marijuana use on dental health status in Nevada adolescents: a trend analysis.

PURPOSE: Tobacco use is the leading cause of preventable death worldwide. If current trends persist, tobacco will kill more than 8 million people worldwide by 2030 and 1 billion by the end of the century. The purpose of this study was to determine trends in tobacco/marijuana use in Nevada adolescents and their effect on dental health status. Relative comparative data were compared with nationally reported data. METHODS: Retrospective data in this cohort study was from an ongoing statewide, school-based, dental health screening initiative that was conducted across 8 years (2002-2010) in public/private middle/high schools in Nevada. A total of 66,941 dental health screenings of adolescents between ages 13-18 were conducted. Self-reported data were collected on tobacco/marijuana use. Descriptive statistics and trends were reported. Means (SE) were computed for caries prevalence and severity. Effect size was reported on dental caries and use of tobacco/marijuana. RESULTS: Overall, percentage prevalence of tobacco use was approximately the same as the national average; however, there were significantly higher rates of marijuana use (12.0% vs. 3.3%). Prevalence and severity of dental caries was significantly higher in those who used tobacco/marijuana than those who did not across all variables and across all 8 years controlling for gender, race/ethnicity, where they lived, and exposure to secondhand smoke. CONCLUSIONS: Tobacco use negatively affected dental health status with marijuana having the largest negative effect. The findings from this study identified the need for tobacco/marijuana prevention services targeting adolescents residing in the geographic areas most at risk.

Distance from source and fluoride concentrations in municipal water supply.

AIM: The purpose of this study was to evaluate the concentrations of fluoride in community water at the point of source, compared to the concentration delivered to various locations within the Las Vegas Valley, to determine if the levels of fluoride change over distance. METHODS: Ten samples per week over an 8-week period were taken from four locations, totaling 320 samples. The first location included the water treatment facility where fluoride is added to the municipal water to bring the concentrations to the desired amount. The other locations included three residences at an increasing distance from the source of fluoridation. The 320 samples were submitted for fluoride analysis. Repeated-measure anova was used to compare the means between the four data points. RESULTS: The fluoride concentration data for the four test locations ranged from 0.73 to 0.89 mg/L. Mauchly's test of sphericity revealed no significant difference in the fluoride concentrations in Las Vegas from the point of source to distant locations. CONCLUSIONS: The analysis of the collected data revealed that there was no statistical difference in the fluoride concentration in the Las Vegas municipal water supply from the source to the remote locations, and that distance does not affect fluoride concentration in the Las Vegas Valley municipal water supply.

Evaluation of the spatter-reduction effectiveness of two dry-field isolation techniques.

BACKGROUND: The authors conducted a study to compare the effectiveness of two dry-field isolation techniques with that of a control technique (no isolation) in reducing spatter from a dental operative site. METHODS: The authors designed a benchtop experiment to evaluate spatter patterns after performing simulated occlusal surface preparations on three typodont teeth in a dental manikin. Fluorescein dye served as the marker to enable visualization of the spatter distribution. The authors compared the effectiveness of a nonisolated control consisting of high-volume evacuation (HVE) alone with that of two dry-field isolation techniques: a dental dam with HVE and the Isolite system (Isolite Systems, Santa Barbara, Calif). RESULTS: The authors performed a two-way analysis of variance. Both the Isolite device and the dental dam with HVE exhibited a significant decrease in the number of contaminated squares (P < .001) compared with that for the nonisolated control. In addition, overall, the results showed no statistically significant difference between the Isolite system and the dental dam with HVE (P = .126). CONCLUSIONS: The study results showed that use of a dental dam with HVE or the Isolite system significantly reduced spatter overall compared with use of HVE alone. CLINICAL IMPLICATIONS: Isolation with a dental dam and HVE or with the Isolite system appears to aid in the reduction of spatter during operative dental procedures, potentially reducing exposure to oral pathogens.

Electronic vs. traditional textbook use: dental students' perceptions and study habits.

This descriptive study assessed dental students' attitudes about computer use as it relates to study habits and use of e-textbook technology. Academic deans and student leaders at all accredited dental education programs in the United States, Puerto Rico, and Canada were asked to forward an e-mail to students explaining the purpose of the study and asking them to participate. The e-mail included an embedded URL link to the survey. A total of 703 complete responses from twenty-four dental schools were received and used in the final analysis. Because the number of students contacted could not be determined, the overall response rate cannot be calculated. Over 65 percent of the respondents reported spending >11 hours per week studying although over 75 percent said they spent little time studying from their textbooks. Over 55 percent were from schools that use e-textbooks exclusively, with 25 percent from schools that exclusively use print textbooks. One-fourth indicated they purchased a traditional printed textbook even when an e-textbook was provided; more than one-third printed information from the e-textbooks rather than reading on the computer. A majority (59 percent) preferred traditional textbook resources over e-textbooks, with over 50 percent reporting not using the required e-textbooks at all. E-textbooks were used by students in this study less frequently than materials/notes provided by dental school faculty. The majority preferred to use traditional resources as references and for augmenting lecture material.

Southern Nevada assisted living residents' perception of their oral health status and access to dental care.

OBJECTIVE: Oral health is an integral component of general health, and quality of life. The purpose of this study was to determine the perceptions of oral health status and acces\s to dental care by Southern Nevada Assisted Living Facilities Residents. METHODS: A cross-sectional questionnaire study design was used to survey residents between 34 and 99 years old residing in Assisted Living Facilities. Seventy respondents (42 males and 28 females) completed a survey that included personal oral hygiene, access to care, and demographic information. Data analyses included descriptive statistics and chi-square. RESULTS: Mean age was 75.78 years, and the majority had a college education (n = 41). Four currently smoked cigarettes. Twenty-nine (males = 14; females = 15) reported having dental insurance. Eleven respondents had seen a dentist twice a year, while 33 reported a visit less than 6 months. Forty-one reported the facility did not provide oral health care with majority (n = 64) indicating that accessing oral health care was difficult. Self-rated response to oral hygiene, a majority (n = 64) reported their oral hygiene as fair and five reported their oral hygiene as poor. CONCLUSIONS: Assisted living residents in Southern Nevada reported difficulty accessing dental services within and outside of the facility. Oral care models to address this unique population should be explored.

Ninth-grade students' perceived attitudes and behaviors in a tobacco cessation program delivered by dental educators.

This study measured whether a tobacco cessation program in Nevada's Clark County School District (CCSD) delivered by dental educators affected ninth-grade students' short-term perceived knowledge, attitudes, behaviors, and intentions (KABI) toward tobacco use and whether the CCSD's immersion approach led to positive changes in students' KABI. A quantitative research methodology with a descriptive research design was used. Data were collected from 617 students using pre- and post-program surveys self-administered by the participants. The surveys were based on those used previously in national and other large-scale epidemiologic studies assessing tobacco intervention program effectiveness. The survey data revealed that, after the program, more students had an increased awareness of tobacco use dangers to their health and significantly increased awareness of the negative consequences of tobacco use. The number of students who did or did not use tobacco changed very little as a result of the program, but the tobacco users on the post-program survey did report statistically significant decreases in overall use. Significant reduction in tobacco usage by the tobacco users indicates some desire on the part of smoking students to quit or reduce their tobacco usage. Little evidence of major changes in student attitudes was found.