Preparing learners to ACT as change agents: Early implementation of leadership curricula in dental education.

OBJECTIVE: Graduates of dental schools are expected to become leaders in their practices, communities, and profession. Yet, formal leadership training is underutilized in U.S. dental school curricula to help learners develop these skills. The objective of this study was to understand third- and fourth-year dental students' perceptions of their initial semester of Bell Leadership Institute training as part of the novel Advocate, Clinician, Thinker curriculum at the UNC Adams School of Dentistry. METHODS: Focus groups of 52 third- and fourth-year dental students were conducted after the completion of the first semester of leadership seminars. Session notes were transcribed, and qualitative analysis was performed to help elucidate student perceptions of the value and pertinence of the leadership seminars. RESULTS: Participants valued the opportunities to self-reflect, develop listening skills, and learn strategies to address and mitigate conflict through the leadership seminars. Perceptions of seminar length, frequency, and structure were varied. Participants also noted that explicit connections and applications of leadership topics to the field of dentistry would improve the quality of the programing. Feedback from 52 focus group participants suggests a general appreciation for curriculum-integrated leadership training. CONCLUSION: Early implementation of seminar-style leadership training in dental school curricula appears to be a productive avenue for developing critical leadership skills in dental school graduates.

Pre-doctoral dental faculty perceptions toward value-based care: An exploratory study.

OBJECTIVES: To explore pre-doctoral faculty perceptions toward implementation of value-based care (VBC) in didactic and clinical teaching. METHODS: This project was a collaborative effort between CareQuest and the University of North Carolina at Chapel Hill, Adams School of Dentistry introducing VBC to pre-doctoral dental faculty as part of a new curriculum. Following a faculty development session on VBC in June 2021, faculty and subject matter experts were invited to participate in qualitative interviews. Subject matter experts were interviewed to establish a baseline for VBC knowledge and understanding. Interviews were recorded and transcribed verbatim. Analysis was conducted by two analysts using ATLAS.ti and a thematic analysis approach. RESULTS: Six faculty and two subject matter experts participated in interviews. Although dental faculty demonstrated some understanding of VBC, they recognized that more training is required to build in-depth knowledge and implementation strategies for teaching dental students. Faculty discussed value-based concepts such as prevention-focused teaching, person-centered care, and disease management over invasive restoration of teeth, and how VBC is bringing about a paradigm shift in dentistry that needs to be reflected in dental education. They acknowledged a disconnect between VBC in didactic teaching versus clinical instruction. Those interviewed believed it would take time to shift faculty mindset and readiness to teach VBC, and continued efforts are needed at the leadership and faculty level for acceptance and implementation. CONCLUSIONS: Although dental faculty recognize that VBC can bring a shift in dental practice, more training and guidance to implement it in didactic and clinical teaching is needed.

Assessing students' mental health in two American dental hygiene programs.

OBJECTIVES: Dental hygiene students adapt to new environments while learning technical skills and providing clinical care during their education. Understanding how stress affects students in their professional healthcare program warrants exploration. This study assessed stress among dental hygiene students in two educational settings in the Southeastern United States. METHODS: First and second-year dental hygiene students (N = 136) from a community college setting (n = 67) and a university setting (n = 69) were invited to complete an anonymous online survey on mental health in fall 2019. Validated surveys on depression, anxiety, social support, and burnout were included. Data analysis included chi-squared and Mantel-Haenszel statistics, depending on the scale of measurement, with the level of significance set at 0.05 for all analyses. RESULTS: Participants included 54 dental hygiene students from a community college (Response rate = 80.6%) and 69 dental hygiene students from a university (RR = 100%). There was a statistically significant difference in the proportion of students reporting moderately severe or severe anxiety (p = 0.007), with 56% (n = 30) of the community college respondents and 36% (n = 24) of the university reporting these anxiety levels. Students attending a community college were also more likely to express feelings of worry (n = 34) compared to students in a university setting (p = 0.005). There was no statistically significant difference in depression (p = 0.07) or suicidal thoughts (p = 0.41). CONCLUSION: Dental hygiene students enrolled in these two programs reported high levels of self-reported stress, mental and emotional concerns that may increase suicidal tendencies.

Implementing Environmental Sustainability Educational Intervention in Dental Hygiene Instruction.

Purpose: The planet faces a climate crisis threatening public health. Dentistry contributes to a large portion of the waste output in the United States. The purpose of this study was to assess dental hygiene (DH) students' perceptions and knowledge on environmentally sustainable dentistry (ESD) prior to and following an educational intervention.Methods: A convenience sample of second-year DH students (n=34) at the University of North Carolina at Chapel Hill (UNC-CH) was recruited for this pilot study consisting of a pre-survey, an online educational module and immediate post-survey, and a final assignment followed by another post-survey. The educational module followed a funnel approach to educate learners on the topic of sustainability before narrowing down to how sustainability can be applied to dentistry. Paired t-tests compared pre- and post-module survey scores on changes in knowledge and attitudes. Univariate and qualitative analyses were conducted on the post-assignment component.Results: Twenty-five participants had qualifying responses for the pre- and post-module survey (71.4% response rate); 22 participants completed the post-assignment survey (62.7% response rate). There was a statistically significant increase from pre- to post-module knowledge scores (p < 0.0005). Most respondents (>90%) indicated that the follow-up assignment strengthened their learning experience. Qualitative analysis revealed that the assignment helped participants apply module concepts in the real world and adopt less wasteful behaviors in clinic.Conclusion: Instructional interventions on ESD in DH education may improve students' knowledge of environmentally sustainable habits and encourage behavioral changes. Study findings can help introduce an environmental sustainability component to the DH educational curriculum.

Preparing for implementation of an entrustable professional activity assessment framework.

Following the adoption of competency-based education in dentistry in the 1990s, entrustable professional activities (EPAs) were introduced in the field of medicine in the mid-2000s to help educators better determine the competence of trainees. More recently, the field of dental education has begun exploring EPAs as a framework for assessing competence while ensuring compliance with accreditation standards. This paper explores one dental school's process of preparing for implementation of a major curriculum change using an EPA assessment framework, shifting away from the use of singular assessments for competency determination to a global and longitudinal approach using a constellation of data to determine practice readiness. This paper describes how the EPA framework was developed, including the complementary capacities, assessment tool development and programming, and data reporting to follow learner progression and determine practice readiness. We discuss lessons learned leading up to implementation, and we position this perspective as a space to describe opportunities and complexities to consider when using a longitudinal assessment system. We attend to the tension between the current language of Commission of Dental Accreditation Standards as "competencies" and the evolving conversation of operationalizing EPAs while addressing accreditation Standards. To do this, we describe the process of finalizing our EPA framework and preparing for initial implementation in a new curriculum.

Safe to speak: Fostering psychological safety among incoming predoctoral dental students.

PURPOSE: To describe the implementation and impact of an introductory session on psychological safety for incoming first-year Doctor of Dental Surgery (DDS) learners. METHODS: In August 2020, first-year DDS students participated in a 2-h online instructional session focused on defining psychological safety, the behaviors that promote and disrupt it, and setting expectations for learner and faculty behavior to foster it. Learners worked in small groups to discuss the various components of psychological safety and document their discussion in a collaborative workspace before a large group debriefs. Participants were requested to complete an electronic survey before and after the session to evaluate their change in knowledge, confidence in performing tasks to foster psychological safety, and perceptions about their level of control. Six months after the session, learners were requested to participate in a focus group for additional feedback and reflections. RESULTS: Seventy-four participants completed the before and after experience survey. There was a statistically significant increase in knowledge of the components of psychological safety and perceptions of control. In addition, self-reported measures of confidence to perform the tasks increased from an average rating of 36% confident before the session to 86% confident afterward. In the experience, learners were active in their discussion and generated many ideas about behaviors that promote and disrupt psychological safety, which informed the creation of learner and faculty classroom expectations. CONCLUSION: Engaging learners in discussions about psychological safety can be a useful activity to establish expectations and create group norms that may support collaborative learning environments.

Transition to a Competency-informed Dental Hygiene Clinical Evaluation System.

Purpose: Competency-informed clinical education includes rigorous and specific performance outcomes with an emphasis on demonstrated outcomes. The purpose of this study was to assess faculty and dental hygiene (DH) student perceptions and elicit feedback regarding the transition to a competency-informed clinical evaluation model in the DH program at the University of North Carolina Adams School of Dentistry for the purpose of continuous quality improvement.Methods: A mixed-methods approach was utilized to survey senior DH student (n = 36) and clinical DH faculty (n = 15) during the 2018 -19 academic year. Cohort-specific surveys included demographics, Likert-scale questions, and open-ended questions to gauge perceptions of the new system. Two debriefing sessions were held, one for faculty and one for students, to provide open feedback and expand discussions. Survey responses were compared using descriptive statistics. Open-ended responses and debriefing comments were reviewed to identify common themes.Results: All senior DH students (n=36) and two-thirds of the faculty (67%, n=10) completed the survey. Findings revealed an overall preference to the new evaluation system and indicated that it was a more accurate reflection of clinical performance. Open-ended and debriefing comments revealed an increased quantity and quality of faculty feedback with an emphasis on patient-centered care, rather than a grade-based focus. Students reported decreased stress levels regarding asking clinical care questions and grade outcomes. While improvement in faculty calibration was reported, students also noted a need for continued calibration.Conclusion: Surveys and debriefing sessions revealed areas of strengths and challenges in a competency-informed clinical evaluation system. Transitioning to a competency-based system provided an environment that is conducive to learning and patient-centered care rather than focused on grades.

Piloting a first-year resident-as-teacher workshop to foster evidence-based teaching.

PURPOSE: Residents function as important educators of dental students; however, they often have limited training in educational best-practices. Resident-as-teacher programs have been designed and implemented in other health professions to prepare residents to teach in clinic and classroom settings. In this research, we describe the design, implementation, and evaluation of a 2-day workshop for first-year advanced dental residents. METHODS: The program engaged residents in techniques to: (1) foster psychological safety, (2) use the cognitive apprenticeship framework, (3) deliver quality feedback, and (4) conduct effective didactic instruction. Nineteen first-year residents attended 2 four-hour workshops in July 2019. The impact of the program was evaluated using Kirkpatrick's model, which included participant reactions, learning, and self-reported behaviors. RESULTS: Most residents (at least 83.3%) reported the value and quality of the workshop was high or very high. With regard to knowledge, residents had statistically significant higher scores after the workshop on knowledge questions about cognitive apprenticeship (P < 0.01), feedback strategies (P < 0.05), and classroom instruction techniques (P < 0.05). Resident reported self-efficacy had a statistically significantly increase (P < 0.05) after the workshop in psychological safety, cognitive apprenticeship, and most items related to providing feedback; there were few changes in self-efficacy on classroom instruction strategies. CONCLUSION: Overall, a workshop to prepare residents as teachers can improve knowledge and self-efficacy in evidence-based educational practices.

"I don't think the problem's the student I think it's us": Engaging faculty in curriculum innovation.

PURPOSE: The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation. METHODS: Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants. RESULTS: Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school. CONCLUSION: When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Call for ACTion: Transforming Dental Education at the University of North Carolina at Chapel Hill.

The University of North Carolina at Chapel Hill Adams School of Dentistry is developing a transformative curriculum that prepares students to enter contemporary practice. The Advocate, Clinician, and Thinker (ACT) framework will provide the basis for developing a resilient workforce capable of meeting emerging health care needs over the next 40 years.