Dental students' reflections on their experiences with a diverse patient population.

Recent developments, including national reports and new accreditation standards, have emphasized the need for dental students to be prepared to address the needs of a diverse patient population. The purpose of this study was to explore students' descriptions of and reflections on their day-to-day interactions with a diverse patient population in the clinical setting, using a qualitative approach. All dental students (sixty-six) enrolled in the third year of the D.M.D. program at a Midwestern dental school were required to write a paper reflecting on their experiences working with a diverse patient population in the general dental clinic of the school as part of a behavioral sciences course. All third-year dental students were invited to participate in the study. The students' papers were deidentified prior to data analysis. Forty-two students' papers describing a total of 126 patient-student interactions were reviewed. Data analysis resulted in identification of three key themes: 1) development of cultural awareness and recognition of the need to understand each patient as a unique individual, 2) desire to build rapport with all patients, and 3) realization that the development of cultural competence is a lifelong learning process requiring ongoing experiences working with a diverse patient population. Review of student reflection papers is valuable in providing faculty with an understanding of students' degree of development of cultural competence. A greater understanding of students' day-to-day experiences with a diverse patient population can provide insights for dental educators who develop cultural competence curricula.

What is the relationship between emotional intelligence and dental student clinical performance?

Emotional intelligence has emerged as a key factor in differentiating average from outstanding performers in managerial and leadership positions across multiple business settings, but relatively few studies have examined the role of emotional intelligence in the health care professions. The purpose of this study was to examine the relationship between emotional intelligence (EI) and dental student clinical performance. All third- and fourth-year students at a single U.S. dental school were invited to participate. Participation rate was 74 percent (100/136). Dental students' EI was assessed using the Emotional Competence Inventory-University version (ECI-U), a seventy-two-item, 360-degree questionnaire completed by both self and other raters. The ECI-U measured twenty-two EI competencies grouped into four clusters (Self-Awareness, Self-Management, Social Awareness, and Relationship Management). Clinical performance was assessed using the mean grade assigned by clinical preceptors. This grade represents an overall assessment of a student's clinical performance including diagnostic and treatment planning skills, time utilization, preparation and organization, fundamental knowledge, technical skills, self-evaluation, professionalism, and patient management. Additional variables were didactic grade point average (GPA) in Years 1 and 2, preclinical GPA in Years 1 and 2, Dental Admission Test academic average and Perceptual Ability Test scores, year of study, age, and gender. Multiple linear regression analyses were conducted. The Self-Management cluster of competencies (b=0.448, p<0.05) and preclinical GPA (b=0.317, p<0.01) were significantly correlated with mean clinical grade. The Self-Management competencies were emotional self-control, achievement orientation, initiative, trustworthiness, conscientiousness, adaptability, and optimism. In this sample, dental students' EI competencies related to Self-Management were significant predictors of mean clinical grade assigned by preceptors. Emotional intelligence may be an important predictor of clinical performance, which has important implications for students' development during dental school.

Leaders and emotional intelligence: a view from those who follow.

Abstract-Boyatzis and Goleman state that Emotional Intelligence (EI) "is an important predictor of success." In their book Primal Leadership, they refer to "the leadership competencies of emotional intelligence: how leaders handle themselves and their relationships." The leadership exercises reported here examined the practices of effective and ineffective leaders as identified by individuals who have worked under such leaders (ie, followers/subordinates). We sought to ascertain to what extent these practices are related to EI. The 2-year data from these leadership exercises show the strong relationships between perceived leadership effectiveness and emotionally intelligent leadership practices as observed by leaders' followers. For example, whether considering the practices that made effective leaders effective or the practices that ineffective leaders needed to adopt or significantly improve upon (in the eyes of subordinates), these practices were almost exclusively related to EI. These findings are supported in the EI literature, as is the strength of subordinates' assessments in predicting leadership effectiveness.

Concordance of chart and billing data with direct observation in dental practice.

OBJECTIVES: The commonly used methods of chart review, billing data summaries and practitioner self-reporting have not been examined for their ability to validly and reliably represent time use and service delivery in routine dental practice. A more thorough investigation of these data sources would provide insight into the appropriateness of each approach for measuring various clinical behaviors. The aim of this study was to assess the validity of commonly used methods such as dental chart review, billing data, or practitioner self-report compared with a 'gold standard' of information derived from direct observation of routine dental visits. METHODS: A team of trained dental hygienists directly observed 3751 patient visits in 120 dental practices and recorded the behaviors and procedures performed by dentists and hygienists during patient contact time. Following each visit, charts and billing records were reviewed for the performed and billed procedures. Dental providers characterized their frequency of preventive service delivery through self-administered surveys. We standardized the observation and abstraction methods to obtain optimal measures from each of the multiple data sources. Multi-rater kappa coefficients were computed to monitor standardization, while sensitivity, specificity, and kappa coefficients were calculated to compare the various data sources with direct observation. RESULTS: Chart audits were more sensitive than billing data for all observed procedures and demonstrated higher agreement with directly observed data. Chart and billing records were not sensitive for several prevention-related tasks (oral cancer screening and oral hygiene instruction). Provider self-reports of preventive behaviors were always over-estimated compared with direct observation. Inter-method reliability kappa coefficients for 13 procedures ranged from 0.197 to 0.952. CONCLUSIONS: These concordance findings suggest that strengths and weaknesses of data collection sources should be considered when investigating delivery of dental services especially when using practitioner survey data. Future investigations can more fully rely on charted information rather than billing data and provider self-report for most dental procedures, but nonbillable procedures and most counseling interactions will not be captured with routine charting and billing practices.

Revisiting comfort: strategies observed in the direct observation study.

The Surgeon General's 2000 report on oral health found that one-third of adults in the U.S. had not visited a dentist in the previous year. Fear of treatments received during a dental encounter can create a barrier to patients receiving care. Most studies of dental anxiety have focused on phobic patients; relatively few studies have explored attempts to provide comfort and alleviate anxiety among everyday patients. This study describes comforting strategies that were performed by dentists, dental assistants, and hygienists for their patient population as a whole. As part of the Direct Observation Study, 120 dental practices in Ohio were observed over a four-day period by trained research hygienists. Researchers observed and recorded 3,800 patient interactions with dentists and hygienists at 30-second intervals using 24 behavior-specific codes. In addition, observers composed qualitative notes detailing the patient visits and recorded in their notes specific comforting techniques performed by dentists, hygienists, and dental assistants.

Patient receptivity to tobacco cessation counseling in an academic dental clinic: a patient survey.

OBJECTIVE: This study investigated dental patient attitudes towards tobacco cessation counseling in the dental school setting. METHODS: Patients attending an academic dental clinic during a six-week period were asked to complete a 22-item self-administered survey. Means and frequency distributions were assessed on all variables as appropriate. RESULTS: Response rate was 71%. Twenty-nine percent of respondents reported that they currently used tobacco. Seventy-two percent of tobacco users agreed that the student dentist should ask patients whether or not they use tobacco, 67% agreed that the student dentist should advise tobacco users to quit, and 89% agreed that student dentists should offer quit tobacco information to patients who want to quit. Seventy percent of tobacco users were considering quitting or currently trying to quit. Of these, only 31% were aware of community resources to help them quit. CONCLUSIONS: The majority of tobacco users were positive in their attitudes toward delivery of tobacco cessation counseling and services in the dental setting. Many were considering or trying to quit, but few were aware of community resources to help them.

Students' perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique.

Students' views of their educational experience can be an important source of information for curriculum assessment. Although quantitative methods, particularly surveys, are frequently used to gather such data, fewer studies have employed qualitative methods to examine students' dental education experiences. The purpose of this study is to explore characteristics of effective learning experiences in dental school using a qualitative method. All third-year (seventy) and fourth-year (seventy) dental students enrolled in one midwestern dental school were invited to participate. Fifty-three dental students (thirty-five male and eighteen female; thirty-two third-year and twenty-one fourth-year) were interviewed using a critical incident interview technique. Each student was asked to describe a specific, particularly effective learning incident that he or she had experienced in dental school and a specific, particularly ineffective learning incident, for comparison. Each interview was audiotaped. Students were assured that only the interviewer and one additional researcher would have access to the tapes. Data analysis resulted in identification of key themes in the data describing characteristics of effective learning experiences. The following characteristics of effective learning experiences were identified: 1) instructor characteristics (personal qualities, "checking-in" with students, and an interactive style); 2) characteristics of the learning process (focus on the "big picture," modeling and demonstrations, opportunities to apply new knowledge, high-quality feedback, focus, specificity and relevance, and peer interactions); and 3) learning environment (culture of the learning environment, technology). Common themes emerged across a wide variety of learning incidents. Although additional research is needed, the characteristics of effective learning experiences identified in this study may have implications for individual course design and for the dental school curriculum as a whole.

Early clinical experience for first-year dental students.

Over the past three years we have exposed our first-year dental students at Case Western Reserve University School of Dental Medicine to an early clinical experience. Following a seventy-two-hour didactic and laboratory course, first-year students spend over 100 hours treating school children in twenty-eight elementary and middle schools in the Cleveland Municipal School District. Not only do dental students learn a clinical procedure, but more importantly they experience the need for health care, in particular, dental care among those less fortunate than themselves. The experience strengthens their desire to help the under-served, their understanding of the problems many face in obtaining oral health care, and their commitment to addressing these issues. Themes from student reflection papers are summarized.

Attitudes of incoming dental students toward tobacco cessation promotion in the dental setting.

Dentists can play an important role in helping patients quit using tobacco. The aim of this study was to investigate incoming dental students' attitudes toward tobacco cessation promotion in the dental setting. Such attitudes can impact students' receptivity to training and subsequent involvement in tobacco cessation promotion. A twenty-six-item written survey was administered to freshman students at a midwestern dental school during orientation weeks 2002 and 2003. Questions focused on students' attitudes toward the dental professional's responsibilities and scope of practice in promotion of tobacco cessation. Response rate was 99 percent (139/140). Respondents were 75 percent male, 25 percent female. Mean age was 24.8 +/- 3.0 years. Ninety-nine percent agreed that it is the dental professional's responsibility to educate patients about the oral health risks of tobacco use. Eighty-five percent agreed that it is within the scope of dental practice to advise patients to quit using tobacco, but fewer agreed that it is within the scope of practice to discuss specific strategies for stopping (70 percent) or to prescribe nicotine gum (45 percent). Sixty-nine percent agreed that tobacco cessation counseling in the dental office could impact patients' quitting. Seventy-one percent anticipated that patient resistance could be a barrier to tobacco cessation promotion. Nearly one quarter (23 percent) were only slightly or not interested in receiving tobacco cessation training. Attitudes of incoming dental students appear to be positive regarding the dental professional's responsibility to educate patients about the risks of tobacco use. However, some students may have reservations about the extent to which tobacco cessation services fit within the scope of dental practice, the efficacy of such services, and patient receptiveness. These reservations should be addressed if dental school curricula in tobacco cessation are to be effective.