Orthodontists' use of remote monitoring platforms pre-, amid, and post-COVID-19: a survey study.

BACKGROUND: Did the COVID-19 pandemic affect orthodontists' use of remote monitoring platforms? The goal of this research was to examine orthodontists' experiences implementing remote monitoring platforms before, during, and after the initial COVID-19 lockdown. METHODS: In this descriptive cross-sectional survey study, an electronic, anonymous questionnaire consisting of a series of 31 short-answer and multiple-choice questions was administered to an international sampling of practicing orthodontists. The target population in the study included currently practicing orthodontists who were graduates of an accredited orthodontic residency program. Participants were recruited in 2021 through collaboration with the American Association of Orthodontists (AAO) Partners in Research Program and the Harvard School of Dental Medicine Orthodontic Alumni Association. Descriptive analysis was conducted, reporting frequency (N and %) distributions for each question. The questionnaire aimed to describe whether orthodontists incorporated remote monitoring platforms into their practices, their experiences doing so, and if the COVID-19 pandemic influenced their use of these resources. RESULTS: Orthodontists' use of remote monitoring platforms was negligible prior to the pandemic; however, a quarter of surveyed orthodontists began using a remote monitoring platform during COVID-19 and nearly all respondents plan to continue using remote monitoring for the foreseeable future. Approximately half of orthodontists believe most patients' treatment progress can be monitored to the standard of care between in-person orthodontic appointments using remote monitoring platforms. Half of the orthodontists who do not currently use a remote monitoring platform in their practice are interested in learning more about how to implement one. CONCLUSIONS: The COVID-19 pandemic led to an increase in the interest and adoption of remote monitoring platforms in orthodontic practices. Most orthodontists had not incorporated remote monitoring platforms into their practices prior to the COVID-19 pandemic. However, this study revealed that a subset of orthodontists utilized the pandemic as motivation to incorporate remote monitoring into their practices and an additional group of orthodontists were interested in incorporating one in the future. Remote monitoring platforms garnered interest and importance with the arrival of the COVID-19 pandemic and may only have an increasing role in the field in years to come.

A Three Delays theoretical framework to describe social determinants as barriers to dental care.

OBJECTIVES: The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1-Deciding to seek care, (2) Delay #2-Reaching an appropriate facility and (3) Delay #3-Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework. METHODS: This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework. RESULTS: Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma. CONCLUSION: The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

A 2-arm randomized controlled study to improve the oral health of children living with HIV in Nigeria: Protocol and study design.

Background: Good oral health is an integral part of overall child health. However, immune-deficient states like the presence of Human Immunodeficiency Virus (HIV) will compromise oral health and salivary bacterial composition, leading to adverse oral conditions. Nigeria has 1.9 million HIV-positive residents, and 0.2% of incident HIV infections occur among children below 15 years. Aim: This study aims to determine through a randomized control study, the effect of an educational intervention on the oral health status and oral health-related quality of life (OHRQoL) of HIV-positive children presenting to five pediatric HIV clinics in Kano, Nigeria. Methods/Design: This 2-arm randomized control study will be conducted in five pediatric HIV outpatient clinics in Kano State, Nigeria over a period of 6 months. Eligible participants will include 172 HIV-infected frequency matched children aged 8-16 years (they can self-implement the oral health intervention with minimal supervision from the caregivers) who will be randomized and allocated into control and intervention groups. The evaluation and oral health assessment will be carried out by five examiners who will be trained and calibrated. Discussion: Our findings will help inform policies to improve the oral health and OHRQoL of HIV-positive Nigerian children and inform the need to integrate oral health care services into HIV programs in similar settings. Trial registration: ClinicalTrails.gov ID: National Clinical Trial (NCT) NCT05540171. Registered on 12th September 2022.

Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams.

PURPOSE: The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. METHODS: A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. RESULTS: On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. CONCLUSIONS: The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.

100 Million Mouths Campaign: Creating a Pilot Program to Advance Oral Health Equity.

PURPOSE: More individuals access primary care compared with oral health services. Enhancing primary care training to include oral health content can therefore improve access to care for millions of individuals and improve health equity. We developed the 100 Million Mouths Campaign (100MMC), which aims to create 50 state oral health education champions (OHECs) who will work with primary care training programs to integrate oral health into their curricula. METHODS: In 2020-2021, we recruited and trained OHECs from 6 pilot states (Alabama, Delaware, Iowa, Hawaii, Missouri, and Tennessee) with representation from varied disciplines and specialties. The training program consisted of 4-hour workshops over 2 days followed by monthly meetings. We conducted internal and external evaluations to assess the program's implementation through postworkshop surveys, identifying process and outcome measures for engagement of primary care programs, and through focus groups and key informant interviews with the OHECs. RESULTS: The results of the postworkshop survey indicated that all 6 OHECs found the sessions helpful in planning next steps as a statewide OHEC. Each OHEC was also successful in engaging 3 primary care training programs within their state and incorporating oral health curricular content through various modalities, including lectures, clinical practice, and case presentations. During the year-end interviews, the OHECs reported that they would overwhelmingly recommend this program to future state OHECs. CONCLUSIONS: The 100MMC pilot program was implemented successfully, and the newly trained OHECs have the potential to improve access to oral health within their communities. Future program expansion needs to prioritize diversity within the OHEC community and focus on program sustainability.

Behavioral Health Within Primary Care Postgraduate Dental Curricula: A Mixed Methods Study.

PURPOSE: This study evaluated the integration of behavioral health topics (anxiety disorder, depressive disorder, eating disorders, opioid use disorder, and intimate partner violence) into primary care postgraduate dental curricula. METHODS: We used a sequential mixed methods approach. We sent a 46-item online questionnaire to directors of 265 Advanced Education in Graduate Dentistry programs and General Practice Residency programs asking about inclusion of behavioral health content in their curriculum. Multivariate logistic regression analysis was used to identify factors associated with inclusion of this content. We also interviewed 13 of the program directors, conducted content analysis, and identified themes pertaining to inclusion. RESULTS: A total of 111 program directors completed the survey (42% response rate). Less than 50% of programs taught their residents to identify anxiety disorder, depressive disorder, eating disorders, and intimate partner violence (86% taught identification of opioid use disorder). From the interviews, we identified 8 main themes: influences on the inclusion of behavioral health in the curriculum; training strategies; reasons for incorporating the training strategies; training outcomes (ie, ways in which residents were evaluated); training outputs (ie, ways in which a program's success was quantified); barriers to inclusion; solutions to barriers; and reflections on how the current program can be made better. Programs housed in settings with no to minimal integration were 91% less likely (odds ratio = 0.09; 95% CI, 0.02-0.47) to include identifying depressive disorder in their curriculum compared with programs in settings with close to full integration. Other influences for including behavioral health content were organizational/government standards and patient populations. Barriers to including behavioral health training included organizational culture and lack of time. CONCLUSIONS: Advanced Education in General Dentistry and General Practice Residency programs need to make greater efforts to include in their curricula training on behavioral health conditions, particularly anxiety disorder, depressive disorder, eating disorders, and intimate partner violence.

Evaluation of the Oral Health Knowledge Network's Impact on Pediatric Clinicians and Patient Care.

PURPOSE: Oral disease has a major impact on the overall health of US children, with dental caries being the most prevalent chronic disease in this age group. Given nationwide shortages of dental professionals, interprofessional clinicians and staff with proper training can influence oral health access. The American Academy of Pediatrics created the Oral Health Knowledge Network (OHKN) in 2018 to bring together pediatric clinicians via monthly virtual sessions to learn from experts, share resources, and network. METHODS: The Center for Integration of Primary Care and Oral Health partnered with the American Academy of Pediatrics to evaluate the OHKN in 2021. The mixed method evaluation included an online survey and qualitative interviews among program participants. They were asked to provide information on their professional role and prior commitment to medical-dental integration as well as feedback on the OHKN learning sessions. RESULTS: Of the 72 program participants invited, 41 (57%) completed the survey questionnaire and 11 took part in the qualitative interviews. Analysis showed that OHKN participation supported both clinicians and nonclinicians in integrating oral health into primary care. The greatest clinical impact was incorporating oral health training for medical professionals (cited by 82% of respondents), while the greatest nonclinical impact was learning new information (cited by 85% of respondents). The qualitative interviews highlighted the participants' prior commitment to medical-dental integration as well as drivers for their current medical-dental integration work. CONCLUSIONS: Overall, the OHKN had a positive impact on pediatric clinicians and nonclinicians and, as a learning collaborative, successfully educated and motivated health care professionals to improve their patients' access to oral health through rapid resource sharing as well as clinical practice change.

The Current State of Antiracism Curricula in Undergraduate and Graduate Medical Education: A Qualitative Study of US Academic Health Centers.

PURPOSE: We undertook a study to evaluate the current state of pedagogy on antiracism, including barriers to implementation and strengths of existing curricula, in undergraduate medical education (UME) and graduate medical education (GME) programs in US academic health centers. METHODS: We conducted a cross-sectional study with an exploratory qualitative approach using semistructured interviews. Participants were leaders of UME and GME programs at 5 institutions participating in the Academic Units for Primary Care Training and Enhancement program and 6 affiliated sites from November 2021 to April 2022. RESULTS: A total of 29 program leaders from the 11 academic health centers participated in this study. Three participants from 2 institutions reported the implementation of robust, intentional, and longitudinal antiracism curricula. Nine participants from 7 institutions described race and antiracism-related topics integrated into health equity curricula. Only 9 participants reported having "adequately trained" faculty. Participants mentioned individual, systemic, and structural barriers to implementing antiracism-related training in medical education such as institutional inertia and insufficient resources. Fear related to introducing an antiracism curriculum and undervaluing of this curriculum relative to other content were identified. Through learners and faculty feedback, antiracism content was evaluated and included in UME and GME curricula. Most participants identified learners as a stronger voice for transformation than faculty; antiracism content was mainly included in health equity curricula. CONCLUSIONS: Inclusion of antiracism in medical education requires intentional training, focused institutional policies, enhanced foundational awareness of the impact of racism on patients and communities, and changes at the level of institutions and accreditation bodies.

Training and educational programs that support geriatric dental care in rural settings: A scoping review.

PURPOSE/OBJECTIVES: Access to dental care for older adults is challenging, especially for those living in rural areas. People living in rural areas are less likely to visit the dentist, have greater oral health needs, and face significant oral health disparities. Given the projected increase in the older adult population, the aim of this study was to conduct a scoping review (SR) to identify the current landscape of geriatric dental training in rural healthcare settings. METHODS: Four guiding concepts (i.e., dental workforce, education/training, rural setting, and older adult population) were searched in PubMed, Embase (Elsevier), Dental and Oral Sciences Source (EBSCO), and ERIC (EBSCO) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EndNote and Covidence were used for de-duplication algorithms and title/abstract screening. RESULTS: Seventy-nine citations were identified for the final full-text review based on inclusion and exclusion criteria, and ten articles were eligible for data extraction as applicable to the research question. Three themes emerged from the review: geriatric dentistry inclusion within dental school curricula, clinical training at rural/remote locations, and improving geriatric oral health knowledge through interprofessional training. CONCLUSION: This SR highlights the limited number of currently trained geriatric dentists, as well as, the paucity of dental programs/curricula offered to produce competent dental geriatricians with an advanced skill set for practicing in rural settings. Our review indicates the need to expand the dental workforce, curricula, and training to better position dentists to serve the older and underserved population in rural and remote areas.

Oral health outcomes among adults with diabetes served at HRSA-funded health centers.

OBJECTIVES: To examine the association of diabetes with tooth loss and oral manifestations among adult health center patients (HCPs). METHODS: This cross-sectional study utilized the nationally representative 2014 HCPs-Survey. Descriptive and logistic regression analyses limited to adults (n = 5524) were used to compare self-reported responses of tooth loss and oral manifestations (i.e., loose teeth, bleeding gums, mouth sores, and dry mouth) among HCPs with and without diabetes. RESULTS: Almost a quarter of the HCPs reported having diabetes. Among patients with diabetes, more than half were 45-64 years old, had low-income status, and attended rural health centers. Analyses revealed that diabetes was significantly associated with permanent tooth loss and presence of at least one oral manifestation after controlling for confounders. Among adults with diabetes, probability of "missing at least one tooth." were two times higher compared to not missing any teeth [AOR = 2.10, (95%CI 1.40-3.16); P ≤0.001]. Adults with diabetes had higher odds of having one or more "oral manifestations" compared to adults without diabetes [AOR = 1.60, (95%CI 1.22-2.11); P = 0.001]. CONCLUSION: Diabetes disproportionately affects HCP adults (23%) compared to the general U.S. adult population (10%). In HCPs having diabetes was associated with a higher prevalence of oral manifestations (i.e., loose teeth, bleeding gums) and losing "At least one" of their permanent teeth. These findings suggest that adults with diabetes had higher prevalence of oral manifestations and tooth loss, highlighting the need for innovative interprofessional models for early screening and identification.

Context matters: Integration of social determinants of health in AEGD and GPR curricula.

PURPOSE: To examine the integration of social determinants of health (SDH) in the US Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS: This study used an explanatory sequential mixed-methods approach. A 46-question survey was sent to all 265 AEGD and GPR programs in February 2019. Descriptive statistics and multivariate analyses were conducted to identify factors influencing SDH curricular inclusion. A convenience sample of program directors (PDs) was interviewed between June and December 2019. Through content analysis, themes and subthemes were identified. RESULTS: Of the 265 AEGD and GPR PDs, 111 completed the survey (42% response rate). Almost three-quarters of PDs (72%) agreed that it was important for residents to understand basic SDH concepts. However, programs lacked eight of the 10 surveyed SDH subtopics. The odds of teaching five or more SDH subtopics were 0.09 (95% CI: 0.02-0.41) for programs with none-to-minimal levels of SDH integration in their clinical settings compared to close-to-fully integrated ones. Coding of PD interviews (N = 13) identified five major themes: 1. influences to integrate SDH, 2. training strategies, outcomes, and outputs, 3. reasons for training strategies, 4. barriers and solutions, and 5. future integration goals. Most PDs cited delivering SDH content during patient care and reported time and organizational culture being barriers to more curricular inclusion. CONCLUSIONS: AEGD and GPR curricula are deficient in SDH content and risk underpreparing residents for caring for the underserved. PDs and organizational leaders must prioritize SDH inclusion in order to train dentists for integrated person-centered care.

Burnout, Engagement, and Dental Errors Among U.S. Dentists.

BACKGROUND: Errors can happen during patient care, and some result in harm to the patient. Work place stress has been well established in dentistry, but its relation with errors in the delivery of patient care is less understood. The authors evaluated the relationship between burnout, work engagement, and self-reported dental errors among American dentists. METHODS: From May to August 2016, a national sample of American Dental Association member dentists were sent a validated, electronic survey assessing their levels of burnout, work engagement, and dental errors. RESULTS: Of the 391 responding dentists, 46.1% reported concern that they had made a dental error in the last 6 months, 12.1% of the dentists were informed by dental staff that they may have committed an error in the last 6 months, 16% were concerned that a malpractice lawsuit would be filed against them, and 3.6% were actively involved in a malpractice lawsuit. In the adjusted analysis, multivariate logistic regression showed that dentists with either high burnout risk were more likely to report concern over a perceived error within the last 6 months. CONCLUSIONS: The results suggest that dental provider burnout is potentially a key predictor of reporting perceived dental errors. It is imperative that the dental profession continue to study the effects of work-related stress, develop professional practices that decrease burnout, and reduce errors. PRACTICAL IMPLICATIONS: Efforts that minimize the potential for burnout may help reduce the occurrence of errors and improve the quality of care provided to dental patients.

Mouthguards during orthodontic treatment: Perspectives of orthodontists and a survey of orthodontic patients playing school-sponsored basketball and football.

INTRODUCTION: The objectives of this research were to identify the beliefs and practices of orthodontists about mouthguard use in orthodontic patients and to survey orthodontic patients currently playing school-sponsored basketball and/or football about mouthguards. METHODS: Fifteen orthodontists were interviewed about mouthguard use in their patients. Patients (aged 11-18 years) playing organized school basketball (n = 53) or football (n = 22) from 13 of those 15 orthodontic practices participated in an online survey about mouthguards. RESULTS: Approximately half of the orthodontists interviewed had initiated discussions about mouthguards with their patients. Although boil-and-bite mouthguards were recommended most often by orthodontists with only a single orthodontist recommending a stock type, stock was the most commonly used type (football [59%], basketball [50%]) followed by boil-and-bite (football [27%], basketball [35%]). Only 2 of the 75 patients surveyed (<3%) reported using a custom mouthguard. All football players reported using a mouthguard, as mandated by this sport. Basketball does not mandate mouthguard use, and only 38% of basketball players reported wearing one. Players who used mouthguards cited forgetting as the most frequent reason for not always using one. A greater percentage of football (91%) than basketball (32%) players reported that their coach recommended a mouthguard (P <0.001). CONCLUSIONS: Orthodontists differ in how they approach mouthguard use by their patients, which likely reflects a lack of evidence-based guidelines. The beliefs, recommendations, and practices of orthodontists concerning mouthguard use and the use of mouthguards by orthodontic patients are discussed. Research directions to improve mouthguard use are suggested.

Oral Health is Health: The Future is Now.

Oral disease is strongly affected by social determinants of health, policy, genetics, and other factors. Because of the multifaceted nature of oral health, many members of the health care team can participate in oral care services. Primary care providers (PCPs) are essential team members. Patients often visit PCPs while forgoing dental care. Primary care providers traditionally receive little training in oral health, but that is changing. A thorough, well-organized, systems approach is required to train future providers in oral health. Primary care has 12 disciplines that must be involved in these efforts and coordinated at the highest levels as well as at the grassroots level to affect systems change for didactic and clinical training. Acceptance and sustainability will require new funding mechanisms, innovations in education, patient care, and quality incentives, and evolution in value-based care models and national health organizations. This is achievable with the right champions.

Who, What, and Where: Transforming Primary Care Education to Advance Health Equity.

To transform primary care with the goal of achieving health equity, changes in the way the health care workforce is selected, trained, and ultimately delivers care should be expedited. Research has repeatedly shown the immense impact of the social determinants of health and the gaps related to health equity in the United States. Despite this knowledge, health care education and delivery systems have been slow to evolve. The Health Resources and Services Administration established the Academic Units for Primary Care Training and Enhancement to work towards strengthening the primary care workforce. Through their research, the six individual Academic Units (AU) have identified gaps related to health equity in their areas of focus. This article provides recommendations from the AUs on ways primary care health professions education can be transformed to advance health equity and serves as background for the articles to follow in the remainder of the supplement.

A Framework for Transforming Primary Care Health Care Professions Education and Training to Promote Health Equity.

A diverse and well-trained, distributed and resourced primary care workforce is essential for advancing health equity. However, few standardized models exist to guide health care professions education (HCPE) on core competencies regarding understanding and effectively addressing social determinants of health, social injustice, structural barriers, and the high burden of health needs in marginalized populations. We propose a framework with domains of policies and incentives, enabling institutional climate, educational content and integration, and community-orientation and community engagement. The framework encompasses inter-disciplinary team-based care and immersive community experiences to equip learners with cognitive skills and knowledge needed to understand and address unmet needs and ensure equitable access to the entire continuum of care. Research is needed to understand barriers and promoters of a health equity-guided HCPE, and standards for theory-driven curricular contents and metrics to evaluate and track progress. Multisector collaborations and demonstration projects may help guide standardized training on advancing health equity.

Primary Care and Oral Health Integration: Comparing Training Across Disciplines.

BACKGROUND: Primary care (PC) training programs must incorporate oral health (OH) into their curricula to reduce health disparities. The purpose of this study was to evaluate and compare OH education integration across multiple PC disciplines. METHODS: In 2017, the authors surveyed deans and program directors (PDs) across 13 disciplines (2,245 PC programs) and used the Input Process Output framework to evaluate training factors across these disciplines. RESULTS: Nine disciplines represented by 767 respondents were chosen for analysis (disciplines with ³40% response rate were included). Most of the physician assistant (PA) and pediatric nurse practitioner (PNP) programs reported departmental support for OH and covered curriculum content topics on oral health risk assessment and evaluation. Similarly, over-half (>60%) PA and PNP PDs agreed that learners could answer OH-related questions on their board exams. CONCLUSION: Best practices learned from PNP and PA programs can be shared across disciplines to help bolster OH integration.

Entrustable Professional Activities in Oral Health for Primary Care Providers Based on a Scoping Review.

Despite advances in oral health care, inequalities in oral health outcomes persist due to problems in access. With proper training, primary care providers can mitigate this inequality by providing oral health education, screening, and referral to advanced dental treatment. Diverging sets of oral health competencies and guidelines have been released or endorsed by multiple primary care disciplines. The aim of this study was to transform multiple sets of competencies into Entrustable Professional Activities (EPAs) for oral health integration into primary care training. A scoping review of the literature between January 2000 and December 2016 was conducted according to PRISMA methodology to identify all existing sets of competencies. The following primary care disciplines were included in the search: allopathic/osteopathic medical schools and residency programs in family medicine, internal medicine, and pediatrics; physician assistant programs; and nurse practitioner programs. Competencies were compared using the Health Resources and Services Administration Integration of Oral Health and Primary Care Practice competencies as the foundational set and translated into EPAs. The resulting EPAs were tested with a reactor panel. The scoping review produced 1,466 references, of which 114 were selected for full text review. Fourteen competencies were identified as being central to the integration of oral health into primary care. These were converted to seven EPAs for oral health integration into primary care and were mapped onto Accreditation Council for Graduate Medical Education residency competency domains as well to the Association of American Medical Colleges EPAs for graduating medical students. The resulting EPAs delineate the essential, observable work required of primary care providers to ensure that oral health is treated as a critical determinant of overall health.

Residents' Perspectives on and Application of Dental Public Health Competencies Using Case-Based Methods.

The aims of this study were to qualitatively assess dental public health (DPH) residents' perspectives on teaching methods for DPH competencies and to develop and implement a case-based simulation to address those competencies, constructed on the basis of the qualitative assessment. Focus group discussions were conducted with 18 DPH residents enrolled in two university-based DPH programs. Topic areas discussed in the two focus groups were perceived value of DPH competencies, ways to acquire new DPH skills/abilities, and additional skills/abilities needed by DPH residents. The focus groups' responses showed that the residents felt competent in the analytical thinking competencies such as research methodology and critiquing literature. They emphasized the importance of learning leadership skills and reported feeling somewhat uncertain about their mastery of the policy and advocacy and system evaluation competencies. Of the two distinct categories of DPH skills and competencies- analytical/critical thinking and practical competencies-these residents reported that a greater proportion of time needed to be devoted to integrating the practical competencies into their education. Based on the residents' feedback, the authors developed a structured seminar series taking a case-based approach to simulate real-world DPH problems, using real and semi-hypothetical planning projects to meet the residents' perceived needs and covering gaps between didactic learning and practice.